Clinical impact of sex differences and procedural setting in transcatheter aortic valve implantation.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a well-established treatment for symptomatic patients with aortic stenosis. Yet, the impact of sex differences and public vs. private procedural setting on TAVI outcomes remain uncertain. METHODS: The RIBAC-NT (Brazilian Registry for Evaluation of Transcatheter Aortic Valve Replacement Outcomes) dataset included 3194 TAVI patients from 2009 to 2021. This retrospective analysis explored disparities in baseline characteristics, procedural and in-hospital outcomes stratifying patients by sex and procedural setting. Temporal trends were also investigated. RESULTS: We included 1551 (49 %) female and 1643 (51 %) male patients. Women were older (83 [78-87] vs. 81 [75-85] years; p < 0.01) but had a lower prevalence of diabetes mellitus (30.2 % vs. 36.3 %, p < 0.01) and coronary artery disease (39.0 % vs. 52.2 %, p < 0.01). However, women had a 3-fold higher higher risk of life-threatening bleeding (6.1 % vs. 2.4 %, p < 0.01). Women presented higher procedural and in-hospital mortality rates (4.4 % vs. 2.5 % and 7.7 % vs. 4.5 %, all p < 0.01, respectively). Although public hospitals presented ~2-fold higher procedural mortality rate compared with private settings (5.0 % vs. 2.7 %, p < 0.01), after multivariable analysis procedural setting was not independently associated with in-hospital mortality. CONCLUSIONS: Women had higher procedural and in-hospital mortality rates after TAVI as compared with men, while facing higher life-threatening bleeding and adverse events rates. Although public hospitals exhibited higher mortality rates than private centers, procedural setting was not independently associated with in-hospital mortality.

Health Care Utilization and Perceived Quality of Care in a Colombian Indigenous Health Organization.

Indigenous governance of health care has increasingly been advocated among Indigenous peoples in many countries. However, there is limited research that has empirically examined its benefits. In 2020/21, we conducted a survey of 2113 Indigenous Wayuu individuals in Colombia who received services from the Indigenous Wayuu led health care insurance organization Anas Wayuu and its network of service providers, and Wayuu individuals who received services from non-Indigenous health insurance organizations. We compared their health care utilization and perception of quality of care. A main finding of the study was that Anas Wayuu enrollees were more than twice as likely to access health care than enrollees from non-Indigenous health insurance organizations, even when controlling for the demographic and health characteristics. The study provided compelling evidence suggesting that Anas Wayuu, being an Indigenous led health organization improves access to, and quality of care, among Indigenous health service recipients.

Mandible Position and Chewing Preference Side Do Not Alter Plantar Support in Children Aged 4-11 Years.

Introduction: Mandible positioning can cause global postural adaptations. Physiotherapists and dentists try to relate the mandible position and chewing side to plantar support; however, this indication is uncertain. Objectives: To check the existence of a relationship between mandible position, preferred chewing side, age, and plantar support in children. Materials and methods: This is a cross-sectional study with 93 children, aged between 4 and 11 years. Photogrammetry was used to confirm the mandibular positions (centralized, to the right, and to the left), and baropodometry was used to measure plantar support. The mandibular displacement distance to the right and left was evaluated, and the plantar support in the three mandibular positions was compared as a function of age (4-7 and 8-11 years) and preferred chewing side. Results: There was greater mandibular displacement in left laterality [13 (9-19) cm] compared to right laterality [7 (3.50-12.00) cm] (p < 0.01). Mandibular position did not alter mean pressure, maximum pressure, or plantar support surface (p > 0.05). With the mandible centralized, higher mean pressure, maximum pressure, and surface area were observed in the left foot (p < 0.01). Older children showed greater mandibular displacement to the left (p < 0.01). No differences were observed for the variables of plantar support as a function of age (p > 0.05) and chewing side (p > 0.05). There was a moderate to strong correlation between age, body mass, height, and plantar surface area (0.63 < r < 0.83; p < 0.05) and between mean and maximum pressures of plantar support (0.58 < r < 0.89; p < 0.05). Conclusion: Mandibular position, age, and preferred chewing side do not influence plantar support in children. How to cite this article: Bittar KCB, Zamboti CL, Macedo CSG. Mandible Position and Chewing Preference Side Do Not Alter Plantar Support in Children Aged 4-11 Years. Int J Clin Pediatr Dent 2024;17(6):658-664.

"We didn't even have time to worry about our mental health." Long-term impact of the pandemic on nursing professionals' experiences.

Explore the experiences of nursing professionals during the COVID-19 pandemic and the impact these experiences continue to have on their personal and professional lives. This qualitative study utilized interpretative phenomenological analysis with nine nursing professionals from southern Brazil. Two main themes and five subthemes were developed. The first theme, "Ongoing trauma response," had three subthemes: (a) Fear of dying and family dying, (b) Loneliness and isolation, and (c) My emotions don't matter. The second theme highlights the "Continued problems with the larger healthcare system" and is made up of two subthemes: (a) We are humans, not superheroes, and (b) We are still invisible. Symptoms of trauma response continued to be a significant challenge among nursing professionals even after the end of the pandemic. Recommendations for improving working conditions and making mental health services more readily available are discussed.

Point-of-care biochemistry for primary healthcare in low-middle income countries: a qualitative inquiry.

BACKGROUND: Access to essential diagnostics is crucial for primary healthcare (PHC) in low-and-middle income countries (LMICs). Many LMICs have invested in equipping PHC with point-of-care (PoC) diagnostics for infectious diseases, however there has been no similar investment to improve PHC capacities for clinical chemistry. The biochemistry gap is among the deterrents to universal health coverage. METHODS: A social sciences project was conducted with the aim to understand the key PHC stakeholders' insights on the pertinence of PoC biochemistry for PHC in LMICs. Data generation was conducted between July-November 2023 in Mongolia, Nigeria and Peru. Decision-makers in healthcare delivery, healthcare professionals, and patient and community advocates were engaged using a combination of sampling techniques. Unstructured individual and group conversations, and non-participant observation were conducted. Analysis involved an inductive line-by-line coding on printed transcripts, followed by a deductive coding and theme-by-theme analysis on digitized transcripts. RESULTS: Fifteen, 51 and 20 informants from Mongolia, Nigeria and Peru, respectively, participated. Fifty-five of the 94 informants were female. Most informants considered that PoC biochemistry in PHC would be pertinent, from a clinical and a resources-saving perspective. Those households that currently bear the burden of referrals (i.e., the poor, the bedridden, the older adults) would benefit the most from the deployment of PoC biochemistry for essential biochemistry parameters. Improved access to PoC glycated hemoglobin (HbA1c), lipid, liver and kidney profile was perceived as helpful to inform clinicians' decision-taking. The value of PoC biochemistry for the management of noncommunicable diseases (diabetes, hypertension) and infectious conditions (dengue, malaria, tuberculosis), to improve child health outcomes (severe dehydration in children with diarrhea and/or malnutrition) and to reduce preventable causes of death (dengue-related renal failure) was highlighted. CONCLUSIONS: PoC biochemistry holds potential to revert the impact that the biochemistry gap has for patient care in some LMICs' PHC settings. PoC equipment for parameters such as HbA1c, urea, creatinine or electrolytes could enhance community-level management of preventable causes of mortality, improve service delivery for patients affected by locally-prevalent infectious conditions, and improve the psychosocial and economic wellbeing of patients facing the burden of referrals to remote biochemistry-equipped centers. TRIAL REGISTRATION: Not applicable.

Study on the concentration, distribution, and persistence of health spending for the contributory scheme in Colombia.

Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for over 19 million users of Colombia's health system between 2013 and 2021 (contributory scheme). We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied multivariate statistical techniques such as multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until 60 years, accelerating thereafter abruptly. Health conditions with the highest percentage of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in Amazonía-Orinoquía is almost non-existent, and that outpatient care represents a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure from one year to the next (i.e. they can provide relevant information for prediction), especially in areas with a larger supply of health services such as Bogotá-Cundinamarca. To the authors' knowledge, this is the most comprehensive and detailed micro-analysis of health spending that has been developed for a Latin American country to date.

Evidence-based practice in respiratory healthcare professionals in Latin America: a survey of the Latin American Thoracic Association (ALAT).

Background: Evidence-based practice (EBP) is a systematic approach to professional practice using the best available evidence to make informed clinical decisions in healthcare. It is necessary to measure and identify strengths and opportunities for improvement. Objective: To assess the knowledge and application of EBP in respiratory health professionals in Latin America. Methods: A cross-sectional study was conducted. The questionnaire was distributed online to health professionals in Latin American countries. Demographic data, professional characteristics, EBP training, and questionnaire responses were collected. Descriptive and inferential statistical analyses were performed. Results: A total of 448 respiratory health professionals participated in the study. Responses were obtained from 17 countries where the majority were female, with an average age of 42. Participants included physicians, physiotherapists, nurses, respiratory therapists, speech therapists, and occupational therapists. Overall scores indicated moderate to high levels of EBP knowledge and application. However, variations were observed in different dimensions. Factors such as EBP training, reading scientific articles, and professional characteristics were associated with higher scores. Barriers to implementing EBP were identified mostly related to institutional support. Conclusions: This study provides information on the knowledge and implementation of EBP in respiratory health professionals in Latin America. Although the overall levels of knowledge and application of EBP were moderate to high, there are options for improvement, especially in addressing barriers to implementation.

Introducción: La práctica basada en evidencia (PBE) es un enfoque sistemático para la práctica profesional que utiliza la mejor evidencia para tomar decisiones informadas. Es necesario identificar fortalezas y oportunidades de mejora. Objetivo: Evaluar el conocimiento y la aplicación de la EBP en profesionales de la salud respiratoria en Latinoamérica. Métodos: Se desarrolló un estudio transversal. El cuestionario se distribuyó en línea a profesionales de la salud en países latinoamericanos. Se recopilaron datos demográficos, características profesionales, capacitación en EBP y respuestas al cuestionario. Se realizaron análisis estadísticos descriptivos e inferenciales. Resultados: Un total de 448 profesionales de la salud respiratoria participaron en el estudio. Se obtuvieron respuestas de 17 países donde la mayoría eran mujeres, con una edad promedio de 42 años. Los participantes incluyeron médicos, fisioterapeutas, enfermeras, terapeutas respiratorios, fonoaudiólogos y terapeutas ocupacionales. Las puntuaciones generales indicaron niveles moderados a altos de conocimiento y aplicación de la EBP. Sin embargo, se observaron variaciones en diferentes dimensiones. Factores como la capacitación en EBP, la lectura de artículos científicos y las características profesionales se asociaron con puntuaciones más altas. Se identificaron barreras para implementar la EBP, principalmente relacionadas con el apoyo institucional. Conclusiones: Este estudio proporciona información sobre el conocimiento y la implementación de la EBP en profesionales de la salud respiratoria en América Latina. Aunque los niveles generales de conocimiento y aplicación de la EBP fueron moderados a altos, existen opciones de mejora, especialmente en abordar las barreras.

Qualitative analysis of Portuguese-language YouTube videos about autism spectrum disorders.

BACKGROUND: In the digital age, social media platforms such as YouTube have become significant channels for disseminating health information, including content related to autism spectrum disorder (ASD). The quality and reliability of this information, especially when produced by healthcare professionals, are crucial for public health education and promotion. This study aims the content of Portuguese-language videos about the treatment of ASD on YouTube, produced by healthcare providers from 2019 to 2023, assessing their quality and alignment with evidence-based practices. METHODS: A qualitative exploratory descriptive approach was used, with content analysis based on Bardin's method. A total of 41 videos were selected using keywords related to ASD. Transcriptions were analyzed for discussions on treatment approaches, best practices, and professional recommendations according to DSM-V and ICD-10 guidelines. The quality of information was assessed using the DISCERN questionnaire. RESULTS: The analysis revealed significant variability in the quality of the information. Videos were categorized into four quality groups based on DISCERN scores: good (n = 6), moderate (n = 11), poor (n = 20), and very poor (n = 4). Good quality videos had the highest engagement metrics and overall quality scores. Common themes identified included defining and understanding ASD, ABA interventions and strategies, family and social impact, skills development, and challenges and solutions. CONCLUSION: While some videos provided accurate, evidence-based information, a substantial portion did not meet minimum quality criteria. This highlights the need for improved mechanisms to ensure the dissemination of reliable health information on social media platforms.

Waiting for a Liver Transplant in New Mexico; Understanding the State's Multi-layered Adversity.

Contrary to the assumption of consistent medical care for patients with specific illnesses in the United States, research reveals vast inconsistencies and inequalities in healthcare delivery, affecting various aspects such as mental illness diagnosis and management, life expectancy differences, overall mortality rates, and healthcare accessibility due to racial, ethnic, and cultural disparities. Liver transplantation, particularly studied in the context of the state of New Mexico (NM), highlights the multilayered inherent disadvantages faced by its citizens. Despite these challenges, the new liver transplantation allocation system implemented by the Organ Procurement and Transplantation Network (OPTN) in 2020, which focuses on geographic concentric circles rather than donor service areas (DSA), cautiously raises hope for reducing these inequities. The future of decades' worth of adversity remains uncertain, but we are optimistic that New Mexicans' systemic difficulty in getting a new liver would eventually be eased.

Machine Learning Applied to Edge Computing and Wearable Devices for Healthcare: Systematic Mapping of the Literature.

The integration of machine learning (ML) with edge computing and wearable devices is rapidly advancing healthcare applications. This study systematically maps the literature in this emerging field, analyzing 171 studies and focusing on 28 key articles after rigorous selection. The research explores the key concepts, techniques, and architectures used in healthcare applications involving ML, edge computing, and wearable devices. The analysis reveals a significant increase in research over the past six years, particularly in the last three years, covering applications such as fall detection, cardiovascular monitoring, and disease prediction. The findings highlight a strong focus on neural network models, especially Convolutional Neural Networks (CNNs) and Long Short-Term Memory Networks (LSTMs), and diverse edge computing platforms like Raspberry Pi and smartphones. Despite the diversity in approaches, the field is still nascent, indicating considerable opportunities for future research. The study emphasizes the need for standardized architectures and the further exploration of both hardware and software to enhance the effectiveness of ML-driven healthcare solutions. The authors conclude by identifying potential research directions that could contribute to continued innovation in healthcare technologies.

Rescue, Rehabilitation, and Feeding Schedule of a Franciscana Dolphin (Pontoporia blainvillei) Calf Stranded in Argentina.

The franciscana dolphin (Pontoporia blainvillei) is a small cetacean endemic to the coastal waters of the southwestern Atlantic Ocean. Due to its restricted distribution, it is subject to high bycatch mortality in the gillnets used for commercial and artisanal fishing. The rehabilitation of the franciscana is still a major challenge, as most attempts to rehabilitate stranded animals have failed. This study aims to present the case of the rehabilitation of a franciscana dolphin calf, stranded in San Clemente del Tuyú, Argentina, at the beginning of the predation period. The feeding strategy and nutritional profile at different stages during the 88 days of rehabilitation are meticulously detailed. Its diet was prepared by hand based on studies of milk composition, the feeding ecology of franciscana in Argentinean waters, and previous records of the Fundación Mundo Marino Rehabilitation Center. The diets were designed to meet the nutritional needs of franciscana dolphins. In addition, the hematological, cytological, and fecal analyses recorded during the rehabilitation are presented. Although the animal could not be released, due to its death, this report provides baseline information that can improve the ability of veterinarians to care for debilitated, live-stranded dolphins. This information may also be useful in the implementation and development of healthcare protocols for this species.

Healthcare can't stop evolving: innovation as the catalyst for unleashing the managerial potential of value-based healthcare by stimulating intangible assets and enhancing organizational resilience.

Background: With increasing healthcare service utilization and the introduction of costly therapies, healthcare organizations are pressured to deliver cost-effective services within constrained budgets. Rising costs and the need for efficient healthcare delivery are major concerns for governments, insurers, and health plans. Objectives: It aims to understand the impact of these intangible assets on creating value and organizational resilience in healthcare, informing better practices and strategies for VBHC implementation. Methods: An applied research approach using the Work Breakdown Structure (WBS) methodology was adopted. The research was divided into seven interconnected Work Packages (WPs), each designed to investigate different aspects of the integration between VBHC and intangible assets, with a focus on enhancing organizational resilience through innovative health processes. Key methodologies included literature reviews and qualitative analyses, employing Open Innovation and Design Thinking. Results: The study revealed a dynamic interplay between VBHC, organizational resilience, and intangible assets. It showed that managerial effectiveness is influenced by direct patient outcomes and elements like intellectual capital and organizational reputation. Data integration from various Work Packages provided new insights into how intangible assets underpin VBHC strategies, proposing novel management approaches. Findings highlight the essential role of intangible assets in enhancing service delivery and fostering sustainable healthcare practices. Discussion: The study highlights a significant oversight in the integration of intangible assets within healthcare organizations, despite their crucial role in optimizing VBHC. It supports literature emphasizing the importance of intellectual capital and organizational culture in enhancing healthcare management efficiency and resilience. A paradigm shift in VBHC to include these assets is needed for building a more adaptable and sustainable healthcare system. This integration can lead to better clinical outcomes, patient satisfaction, and overall healthcare efficiency, aligning more closely with VBHC goals. Conclusion: Recognizing and effectively managing intangible assets are paramount for the successful implementation of VBHC and enhanced organizational resilience. Strategic integration of these assets into healthcare management practices can significantly improve patient outcomes and create a more sustainable, patient-centered, and resilient healthcare system. Future studies should develop methodologies for robust measurement and integration of these assets to fully realize the potential of VBHC.

Bypassing sources of care by level and coverage: Access to essential services in Peru and Uruguay in the post-pandemic era.

BACKGROUND AND AIMS: Healthcare provision to distinct social groups in Latin America contributes to inequities. Individuals make active choices by bypassing their coverage and intended healthcare source. After the pandemic, we sought to characterize bypassing behaviors and quantify their effects on access to essential services. METHODS: Cross-sectional data from a population-based telephone survey in Peru and Uruguay were analyzed. Participants were selected by random digit dialing. Outcomes were defined as access to preventive screenings and satisfaction of emerging health needs. Bypassing by level was defined as when participants went around primary care for the usual source of care or last preventive visit; bypassing by coverage when care was sought outside of public coverage or social security. Sociodemographic characteristics were included, and the adjusted average treatment effect was calculated. RESULTS: Data from 1,255 participants in Peru and 1,237 participants in Uruguay were analyzed. Bypassing behaviors by level (32% Peru; 60% Uruguay) and coverage (29% Peru; 21% Uruguay) were more prevalent in more privileged groups, especially in Peru. System competence was low overall and varied by bypassing mode, especially in Peru. In the adjusted analysis, statistically significant differences were found in bypassing by coverage in Peru (-8% difference in unmet health needs) and by level in Uruguay (5% more unmet needs). CONCLUSION: Provision of essential preventive services was insufficient in both countries. In Peru, bypassing could serve as a proxy measure of inequities. Reminders of preventive services could be offered to bypassers of primary care. Profound health system reforms are needed to ensure equitable access to essential services.

The public health challenges of female migration: the Venezuelan diaspora in Andean countries.

BACKGROUND: Venezuelan migration has experienced an unprecedented increase in the last decade, with approximately 7.7 million Venezuelan-born individuals residing in other countries as of 2024. Our study aims to identify the potential and actual demand for healthcare services (SRH) in the Venezuelan diaspora's four primary destinations within the Andean Countries: Colombia, Ecuador, Peru, and Chile. METHODS: Using official data from administrative records, censuses, and sample surveys reported by the host countries and international agencies, we estimate the annual evolution of Venezuelan-born women of reproductive age (WRA) and their offspring. Additionally, we conduct two case studies focusing on Colombia and Chile to analyse the groups most vulnerable to unmet health needs. RESULTS: The population of WRA has increased to between 5 and 6.8%, and births have risen to approximately 3-8% in host countries due to Venezuelan migration. Yet, we found a general decrease in health coverage for certain age groups of Venezuelan female migrants in host countries for the period 2017-2022, particularly in Chile. By 2022, an estimated 20% of healthcare needs remained unmet among children, girls, and younger Venezuelan women, contributing to greater health inequalities between Venezuelan-born adolescents and those from other countries of birth. CONCLUSIONS: Our findings highlight the escalating demand for and limited access to healthcare services among Venezuelan WRA in their destinations. Unmet healthcare needs are particularly prevalent among younger women by 2022, underscoring the urgency for health system to incorporate gender-responsive, equitable interventions and ensuring health rights for high-risk migrant groups such as infants, children, adolescents, and younger women. Addressing these challenges remains a critical task for the regional public health agenda in Latin America.

Waning immune response to CoronaVac in health care workers from different age groups.

Introduction: The waning of serum antibodies against severe acute respiratory syndrome coronavirus 2 observed in several studies raises questions about long-term immunity. Lower antibody levels are associated with new cases of COVID-19 even postvaccination, leading to the administration of booster doses. Objectives: To evaluate the postvaccination immune humoral response and the relationship between postvaccination seropositivity rates and demographic data among health care workers 6 months after CoronaVac vaccination. Methods: This was a cross-sectional study including health care workers vaccinated with two doses of CoronaVac after 6 months or more. The present study was conducted with the analysis of postvaccination serology test to assess the level of humoral response (anti-receptor binding domain IgG) after vaccination. Results: A total of 325 participants were enrolled, of whom 76% were female, with a median age of 42 years (20-85; interquartile range 31-53). Overall, 18.8% (61) of the participants results were seropositive for anti-receptor binding domain IgG; 81.2% did not have sufficient quantitative titers. The IgG titers obtained from female health care workers did not differ from those obtained from seropositive male health care workers, regardless of age. Conclusions: A group of positive quantitative titers was identified in the serology test for IgG antibodies against severe acute respiratory syndrome coronavirus 2. Further studies are needed to determine the durability of postvaccination antibodies and how serology testing can be used to determine the ideal timing for booster doses of the vaccine.

Introdução: O declínio dos anticorpos séricos contra a síndrome respiratória aguda grave do coronavirus 2 observado em vários estudos levanta questões sobre a imunidade a longo prazo. Níveis mais baixos de anticorpos estão associados a novos casos de covid-19 mesmo após a vacinação, levando à administração de doses de reforço. Objetivos: Avaliar a resposta imunitária humoral após a vacinação e a relação entre as taxas de soropositividade após a vacinação e dados demográficos em trabalhadores da saúde por mais de 6 meses após a imunização com CoronaVac. Métodos: Estudo transversal incluindo profissionais de saúde vacinados com duas doses de CoronaVac após 6 meses ou mais. O estudo foi realizado com a análise do teste sorológico após a vacinação para avaliar os níveis de resposta humoral (anti-domínio de ligação ao receptor IgG) após a vacinação. Resultados: Neste estudo foram incluídos 325 participantes, 76% do sexo feminino e a idade mediana foi de 42 anos (20-85; intervalo interquartil 31-53). No geral, 18,8% (61) dos resultados dos participantes foram soropositivos para IgG anti-domínio de ligação ao receptor; 81,2% não apresentaram títulos quantitativos suficientes. Os títulos de IgG obtidos para os profissionais de saúde do sexo feminino não foram diferentes daqueles obtidos para os participantes do sexo masculino com soropositividade, independentemente da idade. Conclusões: Foi possível identificar um grupo com títulos quantitativos positivos no teste sorológico para anticorpo IgG contra a síndrome respiratória aguda grave do coronavírus 2. Mais investigações são necessárias para determinar a durabilidade dos anticorpos após a vacinação e como os testes sorológicos podem determinar o momento ideal das doses de reforço da vacina.

A real-world study of hereditary angioedema patients due to C1 inhibitor deficiency treated with danazol in the Brazilian Public Health System.

Introduction: Hereditary angioedema (HAE) due to C1 inhibitor (C1-INH) deficiency is an ultra-rare autosomal dominant inherited disease that affects 1 in 67,000 people in the world. The attacks are based on subcutaneous and submucosal edema that can lead to death if not properly managed. Considering the lack of information on the clinical management of Brazilian patients with HAE, this study aimed to identify and characterize patients with HAE-C1-INH that used danazol prophylactic treatment in the Brazilian Public Health System (SUS) and the healthcare resource utilization (HCRU). Methods: This was an observational retrospective database study with patients treated with danazol from January 2011 until December 2021 within the SUS. The HAE cohort included patients with 12 years or older with at least one record for ICD-10 D84.1, one claim for danazol record, and at least 6 months of available history in the database. Results: Our study included 799 patients treated in the SUS, with a mean (SD) age at danazol initiation of 40 years (16). The number of patients with HAE showed a similar distribution over this 10-year period analyzed with the highest number of patients in 2015 (n = 509) and 2016 (n = 480). A total of 253 (32%) patients had a record of at least one attack. Of those, 45 (17.8%) had at least one procedure HAE-related hospital admission, and 128 (50.6%) had at least one HAE-related hospital admission. The mean (SD) hospitalization length of stay was 5 (8) days. Over 14% (n = 36) of HAE patients with attack (n = 253) had at least one HAE-related ICU admission. Conclusion: This database study is the strategy used to allow us to find and describe the characteristics of patients with HAE who use danazol for long-term prophylaxis in the SUS and identify HCRU outcomes of interest such as hospitalizations, inpatient, and outpatient settings. The high rate of attacks, hospitalizations, and general resource uses highlights the necessity to increase awareness of new strategies and accurate approaches to treat HAE patients. Therefore, our findings are important indicators that our health system and guidelines need to be revised and improved to properly diagnose, treat, and assist patients with HAE.

Relationship between antimicrobial use and the highest number of multidrug-resistant-Pseudomonas aeruginosa: a 10-year study.

INTRODUCTION: Multi-drug-resistant (MDR) Pseudomonas aeruginosa is a dangerous pathogen causing nosocomial infection, particularly in low- and middle-income countries like Brazil. This retrospective study at a Brazilian university hospital examined the relationship between antimicrobial use and MDR-P. aeruginosa. METHODOLOGY: Data was collected from 358 patients with non-repetitive P. aeruginosa infections from 2009 to 2019. Antibiotic use was measured in grams and expressed as defined daily dose (DDD) per 1000 patient-days for meropenem, imipenem, polymyxin, and tigecycline. RESULTS: Extensively drug-resistant (XDR) P. aeruginosa occurred in 36.1%, and MDR in 32.6% of cases. Risk factors for XDR infection were hospitalization prior to infection (OR = 0.9901), intensive care unit (ICU) admission (OR = 0.4766), previous antibiotic use (OR = 1.4417), and use of cefepime (OR = 0.3883). Over the ten-year period, utilization of the monitored antibiotics increased, and there was a positive correlation between the rise in MDR-P. aeruginosa and the consumption of ceftriaxone, imipenem, meropenem, and polymyxin B. The 30-day mortality rate was 40.0% for all patients and 41.0% for those infected with XDR-P. aeruginosa. CONCLUSIONS: This study highlights the negative impact of the indiscriminate use of antimicrobials, which has led to a significant increase in multidrug-resistant P. aeruginosa strains in hospitals.

COVID-19 inpatient care performance in the unified health system, São Paulo state, Brazil: an application of standardized mortality ratio for hospitals' comparisons : COVID-19 inpatient care performance in SUS, Brazil.

OBJECTIVE: To evaluate the variation in COVID-19 inpatient care mortality among hospitals reimbursed by the Unified Health System (SUS) in the first two years of the pandemic in São Paulo state and make performance comparisons within periods and over time. METHODS: Observational study based on secondary data from the Hospital Information System. The study universe consisted of 289,005 adult hospitalizations whose primary diagnosis was COVID-19 in five periods from 2020 to 2022. A multilevel regression model was applied, and the death predictive variables were sex, age, Charlson Index, obesity, type of admission, Brazilian Deprivation Index (BrazDep), the month of admission, and hospital size. Then, the total observed deaths and total deaths predicted by the model's fixed effect component were aggregated by each hospital, estimating the Standardized Mortality Ratio (SMR) in each period. Funnel plots with limits of two standard deviations were employed to classify hospitals by performance (higher-than-expected, as expected, and lower-than-expected) and determine whether there was a change in category over the periods. RESULTS: A positive association was observed between hospital mortality and size (number of beds). There was greater variation in the percentage of hospitals with as-expected performance (39.5 to 76.1%) and those with lower-than-expected performance (6.6 to 32.3%). The hospitals with higher-than-expected performance remained at around 30% of the total, except in the fifth period. In the first period, 64 hospitals (18.3%) had lower-than-expected performance, with standardized mortality ratios ranging from 1.2 to 4.4, while in the last period, only 23 (6.6%) hospitals were similarly classified, with ratios ranging from 1.3 to 2.8. A trend of homogenization and adjustment to expected performance was observed over time. CONCLUSION: Despite the study's limitations, the results suggest an improvement in the COVID-19 inpatient care performance of hospitals reimbursed by the SUS in São Paulo over the period studied, measured by the standardized mortality ratio for hospitalizations due to COVID-19. Moreover, the methodological approach adapted to the Brazilian context provides an applicable tool to follow-up hospital's performance in caring all or specific-cause hospitalizations, in regular or exceptional emergency situations.

Intention to Use Primary Healthcare Services among South-South Migrants.

(1) Background: To evaluate a model based on the right-to-health approach, considering the impact of associated factors on the future utilization of primary healthcare services among international migrants in Chile. (2) Methods: A cross-sectional design was employed to survey 499 South American migrants residing in Chile. Ad-hoc questionnaires were used to assess their experiences related to the right to health, perceived discrimination, income, education, length of residence, age, marital status, gender, migration status, among others. Correlation analyses were conducted, followed by path analysis with significant variables to assess the fit of two models. (3) Results: Ten variables were identified as significant for path analysis. Among the two evaluated models, the final model identified six variables with significant direct and indirect effects. Among them, the availability, accessibility, acceptability, and quality of healthcare services were positively associated with the future intention to use them. Additionally, perceived racial and ethnic discrimination also had a positive effect on the intention to use healthcare services, suggesting a possible adaptive response to adversity, exhibiting acceptable goodness-of-fit indices (χ2 =241,492; p < 0.001; CFI = 0.913; TLI = 0.82; RMSEA = 0.062; SRMR = 0.05). (4) Conclusions: While the initial model provides valuable insights, it is essential to broaden the analysis to include other factors influencing the specific context of international migrants.