The New Coronavirus Pandemic and the Trend of Breast Cancer Diagnosis according to Age-Group: Total and Interrupted Time Series Study.

OBJECTIVE: There is a lack of studies evaluating the COVID-19 pandemic effect on breast cancer detection according to age-group. This study aimed to assess the pandemic impact on the trend of mammograms, breast biopsies, and breast cancer stage at diagnosis according to age-group. METHODS: This was an ecological time series study by inflection point regression model. We used data from women aged between 30 and 49, 50 and 69, and 70 years or more available in an open-access dataset of the Brazilian public healthcare system (2017-2021). We analyzed the trend of the variables in the pre-pandemic and the pandemic effect on the total time series. RESULTS: The decreasing or stationary trend of mammograms in the pre-pandemic has changed to a decreasing trend in the total time series in all age-groups. Before the pandemic, the increasing trend of breast biopsies has changed to stationary in the total time series in all age-groups. The increasing trend of tumors at stages 0 to II in the pre-pandemic has changed to decreasing or stationary in the total time series. Finally, the increasing trend of tumors at stage III or IV remained increasing in the total time series in all age-groups. CONCLUSION: The pandemic has changed the stationary or increasing trend to a decreasing or stationary trend of mammograms, breast biopsies, and tumors at stages 0 to II but has not influenced the increasing trend of tumors at stages III and IV in all age-groups.

Terapia nutricional: custos conforme formulações e composições / Nutritional therapy: costs according to formulations and compositions

Objetivo: Avaliar os custos da terapia nutricional de acordo com os diferentes tipos de composi- ções e formulações de dieta enteral e parenteral industrializada. Além disso, comparar os custos da terapia nutricional com a antibioticoterapia. Métodos: Trata-se de um estudo transversal, documental, retrospectivo, com estratégia qualitativa e quantitativa, a partir da análise de contas hospitalares em uma operadora de saúde do sul do Brasil. Resultados: Foram analisadas 301 contas hospitalares referentes à terapia nutricional de 159 indivíduos. Houve 208 contas apenas com dieta enteral, 32 apenas com dieta parenteral e 61 com dieta enteral e parenteral (uso concomitante ou não). O custo total em dieta foi de 34,30% do valor total das contas hospitalares, comparado com 12,62% em antibioticoterapia (p < 0,0001). A média de custo por dia em dieta enteral especializada foi maior que a padrão (R$ 1.166,91 versus R$ 1.006,45; p = 0,0010); a não polimérica foi maior que a polimérica (R$ 1.210,94 versus R$ 1.063,79; p = 0,0014); a normo ou hipercalórica e hiperproteica foi maior que a normocalórica normoproteica (R$ 1.158,84 e R$ 1.133,61 versus R$ 654,21; p = 0,0036). A média do custo por dia da dieta parenteral especializada foi superior à da padrão (R$ 2.525,44 versus R$ 1.211,21; p < 0,0001), principalmente em razão da dieta imunomoduladora (R$ 3.575,62; p = 0,0001). Conclusão: O custo em terapia nutricional foi significativamente maior que o custo em antibioticoterapia. As formulações de dieta especializadas, com maior complexidade, maior densidade calórica e proteica apresentaram custo significativamente maior.

Objective: To evaluate the costs of nutritional therapy according to the different types of compositions and formulations of industrialized enteral and parenteral diet. In addition, to compare the cost of nutritional therapy in relation to antibiotic therapy. Methods: It is a cross-sectional, documental, retrospective study with a qualitative and quantitative design, based on analysis of hospital accounts from a healthcare service in southern Brazil. Results: We analyzed 301 hospital accounts related to nutritional therapy of 159 individuals. There were 208 accounts with enteral diet, 32 accounts with parenteral diet and 61 accounts with enteral and parenteral diet (concomitant use or not). The total diet cost was 34.30% of the total value of hospital bills, compared to 12.62% in antibiotic therapy (p < 0.0001). The average cost per day of the specialized enteral diet was higher than the standard diet (BRL 1,166.91 versus BRL 1,006.45; p = 0.0010); The non-polymer diet was higher than the polymer diet (BRL 1,210.94 versus BRL 1,063.79, p = 0.0014); The normocaloric or hypercaloric and hyperproteic diet was higher than normocaloric and normoproteic diet (BRL 1,158.84 and BRL 1,133.61 versus BRL 654,21, p = 0.0036). The mean cost per day of the specialized parenteral diet was higher than the standard diet (BRL 2,525.44 versus BRL 1,211.21, p < 0.0001), mainly due to the immunomodulatory diet (R $ 3,575.62, p = 0,0001). Conclusion: The cost of nutritional therapy was significantly higher than the cost of antibiotic therapy. The formulations of specialized diet, with greater complexity, higher caloric density and protein presented a significantly higher cost. The cost of nutritional therapy was significantly higher than the cost of antibiotic therapy.

Economic analysis of costs with enteral and parenteral nutritional therapy according to disease and outcome.

OBJECTIVE: To conduct an economic analysis of enteral and parenteral diet costs according to the type of disease and outcome (survivors versus deaths). METHODS: It is a cross-sectional, observational, retrospective study with a qualitative and quantitative design, based on analysis of hospital accounts from a healthcare insurance provider in the Southern region of Brazil. RESULTS: We analyzed 301 hospital accounts of individuals who used enteral and parenteral diets. The total cost of the diet was 35.4% of hospital account total costs. The enteral modality accounted for 59.8% of total dietary costs. The major costs with diets were observed in hospitalizations related to infections, cancers and cerebro-cardiovascular diseases. The major costs with parenteral diet were with admissions related by cancers (64.52%) and dementia syndromes (46.17%). The highest ratio between total diet costs with the total of hospital account costs was in dementia syndromes (46.32%) and in cancers (41.2%). The individuals who died spent 51.26% of total of hospital account costs, being 32.81% in diet (47.45% of total diet value and 58.81% in parenteral modality). CONCLUSION: Enteral and parenteral nutritional therapies account for a significant part of the costs with hospitalized individuals, especially in cases of cancers and dementia syndromes. The costs of parenteral diets were higher in the group of patients who died. OBJETIVO: Realizar uma análise econômica de custos da terapia nutricional enteral e parenteral, conforme o tipo de doença e o desfecho (sobreviventes versus óbitos). MÉTODOS: Estudo transversal, observacional, retrospectivo, com estratégia qualitativa e quantitativa, a partir da análise de contas hospitalares de uma operadora de saúde da Região Sul do Brasil. RESULTADOS: Foram analisadas 301 contas hospitalares de usuários que utilizaram dieta enteral e parenteral. O custo total com dieta foi de 35,4% do custo total das contas hospitalares. A modalidade enteral representou 59,8% do custo total em dieta. Os maiores custos com dieta foram observados em internações relacionadas a infecções, cânceres e doenças cérebro-cardiovasculares. Os maiores custos com dieta parenteral foram observados nas internações relacionadas aos cânceres (64,52%) e às síndromes demenciais (46,17%). A maior relação entre o custo total com dieta e o custo total da conta foi na síndrome demencial (46,32%) e no câncer (41,2%). Os usuários que foram a óbito consumiram 51,26% dos custos totais das contas, sendo 32,81% com dieta (47,45% do valor total com dieta e 58,81% do custo na modalidade parenteral). CONCLUSÃO: As terapias nutricionais enteral e parenteral representaram uma parte importante dos custos no tratamento de indivíduos hospitalizados, principalmente nos casos dos cânceres e nas síndromes demenciais. O custo com dieta parenteral foi maior no grupo de usuários que foram a óbito.

A relação entre a ergonomia e as doenças crônicas não transmissíveis e seus fatores de risco / The relationship between ergonomics and chronic noncommunicable diseases and their risk factors

Contexto: O aumento da prevalência das doenças crônicas não transmissíveis e o seu impacto negativo no ambiente de trabalho promovem a necessidade de ações para o cuidado com a saúde integral dos trabalhadores. Objetivos: Avaliar a relação da ergonomia com as doenças crônicas não transmissíveis e seus fatores de risco no cuidado à saúde integral do trabalhador. Métodos: Foi realizada uma revisão integrativa de literatura por meio da busca de artigos indexados nas bases LILACS, SciELO e PubMed, no período de janeiro de 2000 a janeiro de 2016. Resultados: Identificaram-se 1.083 publicações científicas a partir dos descritores utilizados. Vinte e dois artigos estavam em conformidade com o critério de inclusão do estudo. Houve 11 artigos identificados com o descritor "ergonomia" associado com "obesidade", 10 com "sedentarismo", 4 com "doença crônica", 6 com "doença cardiovascular", 2 com "tabagismo" e 1 com "câncer". Os principais assuntos discutidos nos artigos foram o trabalho e os riscos para as doenças cardiovasculares (4 textos), os riscos não ocupacionais e as doenças relacionadas ao trabalho (2), o impacto da obesidade e do sedentarismo na atividade laboral (12), e a importância da ergonomia no cuidado à saúde integral dos trabalhadores (15). Conclusão: As ações ergonômicas são importantes para reduzir o impacto das doenças crônicas não transmissíveis e seus fatores de risco nas empresas, por meio das intervenções nos postos de trabalho, na organização laboral, no cuidado à saúde integral do trabalhador e na promoção do autoconhecimento e autocuidado à saúde.

Background: The increase in the prevalence of chronic non-communicable diseases and their negative impact on the workplace result in the need of actions targeting the integral care of the workers' health. Objectives: To assess the relationship between ergonomics and chronic non-communicable diseases and their risk factors within the context of integral workers' health care. Methods: We performed an integrative review of the literature through a search of articles included in databases LILACS, SciELO and PubMed published from January 2000 to January 2016. Results: Based on the keywords used, 1,083 scientific articles were located, 22 of which met the inclusion criteria. Combination of keywords "ergonomics" and "obesity" allowed locating 11 articles, with "sedentarism" 10 articles, with "chronic disease" 4 articles, with "cardiovascular disease" 6 articles, with "smoking" 2 articles and with "cancer" 1 article. The main topics addressed in the studies were work and risk factors for cardiovascular disease (4 articles), non-occupational risks and work-related diseases (2), impact of obesity and sedentarism on work (12) and relevance of ergonomics in integral workers' health care (15). Conclusion: Ergonomic actions are relevant to reduce the impact of chronic non-communicable diseases and their risk factors in companies through interventions in the workplace, work organization, integral workers' health care and promotion of self-knowledge and self-care in health matters.

A relação entre o suporte organizacional no trabalho e o risco para doenças crônicas não transmissíveis em um serviço de saúde / Relationship between organizational support at work and risk of non-communicable chronic diseases in a health service

Contexto: Conhecer a relação entre o suporte organizacional e as doenças crônicas e seus fatores de risco pode contribuir no planejamento ações de prevenção e promoção à saúde integral dos trabalhadores. Objetivo: Avaliar a relação entre o suporte organizacional percebido (SOP) e os fatores de risco para as doenças crônicas não transmissíveis (DCNT) em um serviço de saúde. Métodos: Estudo transversal, observacional e descritivo, com delineamento correlacional e abordagem quantitativa, através de dados de um questionário de autopreenchimento. Resultados: A taxa de participação da pesquisa foi de 80,24%, com média etária de 36,9 anos, 52,3% com contrato de trabalho por tempo determinado, 38,5% em turno noturno e 69,3% com trabalho exclusivo no serviço. Os riscos mais prevalentes para as DCNT foram hipertensão arterial sistêmica (29,2%), tabagismo (13,8%), sedentarismo (73,8%), dislipidemia (29,2%) e mais de um fator de risco associado (61,6%). O SOP na população estudada foi favorável, principalmente devido ao salário e às relações sociais no trabalho. Não houve relação significativa do SOP, mais de um emprego, turno noturno ou contratação temporária com os riscos para DCNT. Conclusão: O suporte organizacional percebido não aumentou ou reduziu o risco para as DCNT na população estudada.

Background: Accurate knowledge on the relationship between organizational support and chronic diseases and their risk factors might contribute to the planning of prevention and promotion actions focusing on the integral health of workers. Objective: To investigate the relationship between perceived organizational support (POS) and risk factors for chronic noncommunicable diseases (NCD) in a health service. Methods: The present was a cross-sectional, observational and descriptive study, with correlational design and quantitative approach that data collected by means of a self-report questionnaire. Results: The participation rate was 80.24%; the average age of the participants was 36.9 years old; 52.3% of the sample had temporary jobs, 38.5% worked the night shift and for 69.3% this was their only job. The most prevalent risks for NCD were systemic hypertension (29.2%), smoking (13.8%), sedentary lifestyle (73.8%), dyslipidemia (29.2%) and more than one associated risk factor (61.6%). The POS score was favorable, mainly due to the salary and social relationships at the workplace. There was no significant relation between risk for NCD and POS score, more than one job, night shift or temporary job. Conclusion: The perceived organizational support did not increase or reduced the risk for chronic noncommunicable diseases in the study sample.

Economic analysis of costs with enteral and parenteral nutritional therapy according to disease and outcome / Análise econômica dos custos com terapia nutricional enteral e parenteral conforme doença e desfecho

ABSTRACT Objective To conduct an economic analysis of enteral and parenteral diet costs according to the type of disease and outcome (survivors versus deaths). Methods It is a cross-sectional, observational, retrospective study with a qualitative and quantitative design, based on analysis of hospital accounts from a healthcare insurance provider in the Southern region of Brazil. Results We analyzed 301 hospital accounts of individuals who used enteral and parenteral diets. The total cost of the diet was 35.4% of hospital account total costs. The enteral modality accounted for 59.8% of total dietary costs. The major costs with diets were observed in hospitalizations related to infections, cancers and cerebro-cardiovascular diseases. The major costs with parenteral diet were with admissions related by cancers (64.52%) and dementia syndromes (46.17%). The highest ratio between total diet costs with the total of hospital account costs was in dementia syndromes (46.32%) and in cancers (41.2%). The individuals who died spent 51.26% of total of hospital account costs, being 32.81% in diet (47.45% of total diet value and 58.81% in parenteral modality). Conclusion Enteral and parenteral nutritional therapies account for a significant part of the costs with hospitalized individuals, especially in cases of cancers and dementia syndromes. The costs of parenteral diets were higher in the group of patients who died.

RESUMO Objetivo Realizar uma análise econômica de custos da terapia nutricional enteral e parenteral, conforme o tipo de doença e o desfecho (sobreviventes versus óbitos). Métodos Estudo transversal, observacional, retrospectivo, com estratégia qualitativa e quantitativa, a partir da análise de contas hospitalares de uma operadora de saúde da Região Sul do Brasil. Resultados Foram analisadas 301 contas hospitalares de usuários que utilizaram dieta enteral e parenteral. O custo total com dieta foi de 35,4% do custo total das contas hospitalares. A modalidade enteral representou 59,8% do custo total em dieta. Os maiores custos com dieta foram observados em internações relacionadas a infecções, cânceres e doenças cérebro-cardiovasculares. Os maiores custos com dieta parenteral foram observados nas internações relacionadas aos cânceres (64,52%) e às síndromes demenciais (46,17%). A maior relação entre o custo total com dieta e o custo total da conta foi na síndrome demencial (46,32%) e no câncer (41,2%). Os usuários que foram a óbito consumiram 51,26% dos custos totais das contas, sendo 32,81% com dieta (47,45% do valor total com dieta e 58,81% do custo na modalidade parenteral). Conclusão As terapias nutricionais enteral e parenteral representaram uma parte importante dos custos no tratamento de indivíduos hospitalizados, principalmente nos casos dos cânceres e nas síndromes demenciais. O custo com dieta parenteral foi maior no grupo de usuários que foram a óbito.

Analysis of the costs and quality of cardiovascular care in oncological monitoring.

OBJECTIVE:: To analyze the health care costs specifically related to cardiovascular diseases, which were spent by patients of a private healthcare provider in southern Brazil, after their diagnosis of cancer. METHOD:: We developed an observational, cross-sectional, retrospective study, with a qualitative-quantitative strategy, through the activity of analytical internal audit of medical accounts. RESULTS:: 860 accounts from 2012 to 2015 were analyzed, 73% referred to female users, with average age of 62.38 years, and a total direct cost of BRL 241,103.72. There was prevalence of 37% of breast cancer, 15% of prostate cancer and 9% of colon cancer. In relation to the cardiovascular care, 44% were consultations, 44% were complementary exams, 10% were emergency care, and 3% were hospitalizations. Regarding the health care costs with cardiovascular services, higher costs were in hospitalizations (51%), followed by complementary exams (37%), consultations (8%) and emergency care (4%). CONCLUSION:: The cancer survivors commonly use health care in other specialties such as cardiology, and the main cost refers to hospitalization. It is recommended to invest in prevention (consultation and complementary exam) as well as in programs of chronic disease management to reduce costs and improve the quality of health care.

Analysis of the costs and quality of cardiovascular care in oncological monitoring / Análise dos custos e da qualidade da assistência cardiovascular no seguimento oncológico

Summary Objective: To analyze the health care costs specifically related to cardiovascular diseases, which were spent by patients of a private healthcare provider in southern Brazil, after their diagnosis of cancer. Method: We developed an observational, cross-sectional, retrospective study, with a qualitative-quantitative strategy, through the activity of analytical internal audit of medical accounts. Results: 860 accounts from 2012 to 2015 were analyzed, 73% referred to female users, with average age of 62.38 years, and a total direct cost of BRL 241,103.72. There was prevalence of 37% of breast cancer, 15% of prostate cancer and 9% of colon cancer. In relation to the cardiovascular care, 44% were consultations, 44% were complementary exams, 10% were emergency care, and 3% were hospitalizations. Regarding the health care costs with cardiovascular services, higher costs were in hospitalizations (51%), followed by complementary exams (37%), consultations (8%) and emergency care (4%). Conclusion: The cancer survivors commonly use health care in other specialties such as cardiology, and the main cost refers to hospitalization. It is recommended to invest in prevention (consultation and complementary exam) as well as in programs of chronic disease management to reduce costs and improve the quality of health care.

Resumo Objetivo: analisar os custos assistenciais com afecções cardiovasculares utilizados por usuários sobreviventes do câncer de uma operadora de saúde suplementar na região Sul do Brasil. Método: foi desenvolvido um estudo observacional, transversal, retrospectivo, com estratégia quali-quantitativa, através de atividade de auditoria interna analítica de contas médico-hospitalares. Resultados: foram analisadas 860 contas, de 2012 a 2015, com 73% de usuários femininos e uma média etária de 62,38 anos, somando um custo total direto de R$ 241.103,72. Houve predomínio de 37% de neoplasias de mamas, 15% de próstata e 9% de cólon. Com relação à assistência cardiovascular, 44% foram consultas, 44% foram exames complementares, 10% foram atendimentos de emergência e 3% foram hospitalizações. Os custos em assistência cardiovascular foram maiores nas hospitalizações (51%), seguidos pelos exames complementares (37%), pelas consultas (8%) e pelos atendimentos emergenciais (4%). Conclusão: os sobreviventes de câncer habitualmente utilizam a assistência à saúde em outras especialidades, como a cardiologia, e o principal custo é em hospitalização. Recomenda-se investir em prevenção (consultas e exames), assim como em programas de gestão de casos crônicos para reduzir os custos e melhorar a qualidade da assistência à saúde.

Chronic case management: Clinical governance with cost reductions.

INTRODUCTION: With increasing global impact of chronic degenerative non-communicable diseases (CDNCD), multidisciplinary chronic disease management care programs (CDMCP) come as a solution to improve the quality of patients care. METHOD: We conducted a cross-sectional epidemiologic prospective cohort study with data comparing a group of patients monitored by a CDMCP with subjects without CDMCP care, from 2010 to 2012. The patients monitored in this program were selected because they presented CDNCD with frequent hospitalization and/or emergency care in the year prior to study selection. Also, the patients could be referred to the program by their physicians and/or other programs such as HomeCare or family medicine. All costs related to the program were included and compared with the costs of users with the same epidemiological profile who opted for not participating in the CDMCP. RESULTS: We analyzed data from 1,256 cases, including 639 (51%) men and 617 (49%) women. The mean age was 56.99 years and 73% were older than 50 years. There was a prevalence of 34% (428) cases with ischemic heart disease (myocardial infarction and stroke) and 17% (210) with neoplasms. The cases studied showed a reduction of 79% in the number of days of hospitalization compared with the cases without CDMCP monitoring. The average reduction of total costs (hospitalizations, emergency room visits and/or disease complications) was 31.94%, with average reduction of 8.36% in monthly costs. CONCLUSION: Multidisciplinary monitoring carried out by CDNCD patient management programs can reduce hospitalizations, emergency room visits and complications, positively impacting the costs with health care.

Chronic case management: Clinical governance with cost reductions / Gerenciamento de casos crônicos: governança clínica com redução de custos

SUMMARY Introduction: With increasing global impact of chronic degenerative non-communicable diseases (CDNCD), multidisciplinary chronic disease management care programs (CDMCP) come as a solution to improve the quality of patients care. Method: We conducted a cross-sectional epidemiologic prospective cohort study with data comparing a group of patients monitored by a CDMCP with subjects without CDMCP care, from 2010 to 2012. The patients monitored in this program were selected because they presented CDNCD with frequent hospitalization and/or emergency care in the year prior to study selection. Also, the patients could be referred to the program by their physicians and/or other programs such as HomeCare or family medicine. All costs related to the program were included and compared with the costs of users with the same epidemiological profile who opted for not participating in the CDMCP. Results: We analyzed data from 1,256 cases, including 639 (51%) men and 617 (49%) women. The mean age was 56.99 years and 73% were older than 50 years. There was a prevalence of 34% (428) cases with ischemic heart disease (myocardial infarction and stroke) and 17% (210) with neoplasms. The cases studied showed a reduction of 79% in the number of days of hospitalization compared with the cases without CDMCP monitoring. The average reduction of total costs (hospitalizations, emergency room visits and/or disease complications) was 31.94%, with average reduction of 8.36% in monthly costs. Conclusion: Multidisciplinary monitoring carried out by CDNCD patient management programs can reduce hospitalizations, emergency room visits and complications, positively impacting the costs with health care.

RESUMO Introdução: com o crescente impacto mundial das doenças crônico-degenerativas não transmissíveis (DCDNT), os programas multidisciplinares de gerenciamento de pacientes com doenças crônicas (PGDC) apresentam-se como uma solução para melhorar a qualidade do atendimento prestado. Método: foi realizado um estudo epidemiológico, tipo coorte, prospectivo, com dados comparando um grupo em acompanhamento em um PGDC com um grupo sem esse acompanhamento, no período de 2010 a 2012. Usuários acompanhados pelo programa eram selecionados por serem portadores de DCDNT, com internamentos e/ou consultas em serviços de emergência frequentes no ano anterior à seleção; por indicação do médico assistente e/ou outros programas como HomeCare ou medicina da família. Foram contabilizados todos os custos relacionados com assistência em saúde do programa e comparados com os custos de usuários com mesmo perfil epidemiológico que optaram pelo não acompanhamento no programa. Resultados: foram selecionados dados de 1.256 casos, sendo 639 (51%) do sexo masculino e 617 (49%) mulheres. A média etária foi de 56,99 e 73% dos casos acima dos 50 anos. Predomínio de 34% (428) de casos de doenças cardiovasculares isquêmicas (infarto do miocárdio e acidente vascular cerebral) e 17% (210) de neoplasias. Os casos acompanhados apresentaram redução de 79% dos dias de internamento em comparação com casos não acompanhados. A redução média de custos totais (internamentos, consultas de emergência e/ou complicações) foi de 31,94%, com redução média mensal de custos de 8,36%. Conclusão: acompanhamento multidisciplinar em programa de gerenciamento de pacientes portadores de DCDNT pode reduzir internamentos, consultas de emergência e complicações, impactando positivamente nos custos da assistência à saúde.

A aplicação da arquitetura de informação na gestão dos riscos das doenças crônicas em trabalhadores: uma análise preliminar / The information architecture to manage the risks of chronic diseases in workers: a preliminary analysis

Contexto: O aumento na prevalência dos casos de doenças crônicas não transmissíveis (DCNT) na empresa pode resultar em queda de produtividade, absenteísmo, presenteísmo, invalidez, aposentadoria precoce e aumento nos gastos com o sistema de saúde. A gestão dos fatores de risco para as DCNT é fundamental para garantir a saúde integral dos trabalhadores. Objetivos: Apresentar um modelo de aplicação da arquitetura de informação no gerenciamento dos fatores de risco para as DCNT dentro do programa de controle médico de saúde ocupacional (PCMSO) da empresa, apresentando os resultados preliminares. Métodos: Foi desenvolvido um sistema de gerenciamento de risco para DCNT a partir do questionário da Michigan Heart Association, e aplicado em uma empresa com 6.398 empregados e 317 estabelecimentos, distribuídos em um mesmo estado, no Brasil. Resultados: Houve a participação de 1.660 empregados (26% do total) no período de uma semana. O escore global médio na amostra foi de 13,32 pontos (DP: ±6,57), ou seja, risco abaixo da média. Os três principais fatores de risco identificados foram o sedentarismo (42%), o sobrepeso e obesidade (54%) e a hipercolesterolemia (54%). O estímulo à atividade física e um programa de orientação nutricional deveriam ser priorizados na prevenção da saúde dos trabalhadores avaliados. Conclusão: A aplicação da arquitetura de informação pode contribuir na identificação dos riscos para saúde dos trabalhadores e no planejamento de ações de prevenção contra as DCNT na empresa.

Background: The increased prevalence of chronic non-communicable diseases (NCDs) in one company can result in decreased productivity, absenteeism, presenteeism, disability and increased spending on the health care system. The management of risk factors for NCDs is critical to overall health of workers. Objective: It was developed an application model of information architecture in the management of risk factors for NCDs within the occupational health program of the company and their preliminary results. Methods: It was developed a risk management system based at the questionnaire of Michigan Heart Association, and applied in a company with 6,398 employees and 317 units, distributed in the same state, in Brazil. Results: There was the participation of 1,660 employees (26% of total) in one week. The overall mean score obtained in the questionnaire was 13,32 points (SD: ±6.5), below the average risk. The three main risk factors identified were physical inactivity (42%), overweight and obesity (54%) and hypercholesterolemia (54%). The incentive to physical activity and the implementation of a nutritional counseling program are the priority in the studied company. Conclusions: The use of information architecture can contribute to the identification of workers' health risks and for planning of preventive actions by the company against NCDs.

A preliminary analysis of the reduction of chemotherapy waste in the treatment of cancer with centralization of drug preparation.

INTRODUCTION: chemotherapy is essential to treat most types of cancer. Often, there is chemotherapy waste in the preparation of drugs prescribed to the patient. Leftover doses result in toxic waste production. OBJECTIVE: the aim of the study was to analyze chemotherapy waste reduction at a centralized drug preparation unit. METHODS: the study was cross-sectional, observational and descriptive, conducted between 2010 and 2012. The data were obtained from chemotherapy prescriptions made by oncologists linked to a health insurance plan in Curitiba, capital of the state of Paraná, in southern Brazil. Dose and the cost of chemotherapy waste were calculated in each application, considering the dose prescribed by the doctor and the drug dosages available for sale. The variables were then calculated considering a hypothetical centralized drug preparation unit. RESULTS: there were 176 patients with a cancer diagnosis, 106 of which underwent treatment with intravenous chemotherapy. There were 1,284 applications for intravenous anticancer medications. There was a total of 63,824mg in chemotherapy waste, the cost of which was BRL 448,397.00. The average cost of chemotherapy waste per patient was BRL 4,607.00. In the centralized model, there was 971.80mg of chemotherapy waste, costing BRL 13,991.64. The average cost of chemotherapy waste per patient was BRL 132.00. CONCLUSION: the use of centralized drug preparation units may be a strategy to reduce chemotherapy waste.

Uma análise preliminar dos custos em quimioterapia ambulatorial no sistema de saúde suplementar / A preliminary analysis of the costs for outpatient chemotherapy in the supplementary health system

Introdução: O câncer é considerado um problema de saúde pública, tanto pela estimativa do crescimento no número de casos novos quanto pelos custos relacionados ao seu tratamento. Objetivo: Demonstrar uma análise de custos do tratamento quimioterápico antineoplásico no sistema de saúde suplementar, no Brasil. Método: Foi realizado um estudo transversal, observacional, retrospectivo, com estratégias qualitativa e quantitativa, a partir da atividade de auditoria interna analítica de contas médicas em uma operadora de saúde. Resultados: No período de dois anos foram incluídas 1.259 contas médicas referentes ao tratamento quimioterápico de 179 usuários. As neoplasias com maior custo total foram as de origem digestiva (32%), mama (20,5%), linfática e hematopoiética (16,8%) e pulmonar (10,4%). Quando comparado com a quimioterapia endovenosa isolada, o custo total médio dos regimes com anticorpo monoclonal foi maior por regime (180%), por ciclo (105%) e por dia (99%). A quimioterapia oral teve custo diário médio 20% inferior à quimioterapia endovenosa. O custo total médio dos regimes paliativos foi superior ao curativo, por regime (102%), por ciclo (92%) e por dia (81%). O custo total médio das terapias de segunda, terceira ou quarta linha foi superior ao de primeira linha, por regime (59%), por ciclo (48%) e por dia (48%). Conclusão: A análise dos indicadores de custo contribuiu para identificar os procedimentos quenecessitam de um monitoramento detalhado, com objetivo de garantir a melhor aplicação dos recursos disponíveis em busca da qualidade da assistência à saúde.

Introduction: Cancer is considered a public health problem due to estimated growth in the number of new cases and the costs associated with their treatment. Objective: The main objective was to demonstrate a cost analysis of chemotherapy treatment in a private health system in Brazil. Methods: It was conducted a cross-sectional, observational, retrospective study, with qualitative and quantitative strategies, with the data of the analytical internal audit activity of medical bills in a supplementary health service. Results: In two years, there were 1,259 medical bills related to chemotherapy of 179 users. The tumors with more total cost were of the gastrointestinal origin(32%), breast (20.5%), lymphatic and hemopoietic (16.8%) and lung (10.4%). The average total cost of therapy with monoclonal antibody was more expensive than venous isolated chemotherapy per scheme (180%), per cycle (105%) per day (99%). Oral chemotherapy had an average cost per day 20% lower than the cost of the intravenous chemotherapy. The average total cost of the palliative regimens were more expensive than the curative regimens cost per scheme (102%) per cycle (92%) and per day (81%). The average total cost of second, third or fourth line therapy were more expensive than first-line therapy by scheme (59%) per cycle (48%) and daily (48%). Conclusion: The analysis of these cost indicators contributed to identify the procedures that require a detailed monitoring to ensure the best use of available resources in quality of health care.

A preliminary analysis of the reduction of chemotherapy waste in the treatment of cancer with centralization of drug preparation / Uma análise preliminar da redução do resíduo de quimioterapia no tratamento do câncer com a centralização no preparo da medicação

SummaryIntroduction:chemotherapy is essential to treat most types of cancer. Often, there is chemotherapy waste in the preparation of drugs prescribed to the patient. Leftover doses result in toxic waste production.Objective:the aim of the study was to analyze chemotherapy waste reduction at a centralized drug preparation unit.Methods:the study was cross-sectional, observational and descriptive, conducted between 2010 and 2012. The data were obtained from chemotherapy prescriptions made by oncologists linked to a health insurance plan in Curitiba, capital of the state of Paraná, in southern Brazil. Dose and the cost of chemotherapy waste were calculated in each application, considering the dose prescribed by the doctor and the drug dosages available for sale. The variables were then calculated considering a hypothetical centralized drug preparation unit.Results:there were 176 patients with a cancer diagnosis, 106 of which underwent treatment with intravenous chemotherapy. There were 1,284 applications for intravenous anticancer medications. There was a total of 63,824mg in chemotherapy waste, the cost of which was BRL 448,397.00. The average cost of chemotherapy waste per patient was BRL 4,607.00. In the centralized model, there was 971.80mg of chemotherapy waste, costing BRL 13,991.64. The average cost of chemotherapy waste per patient was BRL 132.00.Conclusion:the use of centralized drug preparation units may be a strategy to reduce chemotherapy waste.

ResumoIntrodução:a quimioterapia é essencial no tratamento da maioria dos tipos de câncer. No processo de preparo da quimioterapia, com frequência, parte da medicação precisa ser descartada para se atingir a dose prescrita pelo médico. A dose excedente da medicação resulta na produção de resíduo tóxico.Objetivo:analisar a redução do resíduo de quimioterapia obtida por meio da centralização do preparo da medicação.Metodologia:foi realizado um estudo transversal observacional e descritivo entre 2010 e 2012, a partir da análise das prescrições de quimioterapia, pela auditoria médica de um plano de saúde, no estado do Paraná. Foi calculada a dose de quimioterapia desprezada e o seu custo, em cada aplicação, considerando a dose prescrita pelo médico e as apresentações comerciais das drogas. A mesma análise foi realizada em um modelo hipotético centralizado de preparo de quimioterapia.Resultados:foram identificados 176 pacientes, com diagnóstico de câncer, sendo que 106 pacientes realizaram um total de 1.284 aplicações endovenosas. Houve um total de 63.824 mg de resíduo de quimioterapia com custo de R$ 448.397,00. O custo médio de quimioterapia desprezada por paciente foi de R$ 4.607,00. No modelo centralizado de preparo houve 971,80 mg de resíduo com custo de R$ 13.991,64. Nesse modelo, o custo médio de quimioterapia desprezada por paciente seria de R$ 132,00.Conclusão:conclui-se que a centralização no preparo da medicação para o tratamento do câncer pode ser uma estratégia para reduzir os resíduos de quimioterapia.

Características clínicas e demográficas de pacientes submetidos ao transplante cardíaco ortotópico em um serviço de saúde brasileiro / Demographic and clinical characteristics of patients submitted orthotopic cardiac transplant in Brazilian health services

INTRODUÇÃO E OBJETIVO: Com o crescente aumento mun dial no número de pacientes submetidos ao transplante cardíaco, faz-se necessário conhecer melhor essa população. Este estudo visou descrever as características clínico-demográficas dos receptores, suas complicações e comorbidades, e comparar esses dados com a literatura internacional. MÉTODOS: Foi realizado um estudo descritivo observacional retrospectivo com uma população submetida ao transplante cardíaco ortotópico, no período de 2000 a 2009. Foram analisados os registros em prontuários médicos, suas histórias clínicas, comorbidades, diagnóstico de insuficiência cardíaca, doenças pregressas e terapêuticas em uso. RESULTADOS: Dos 77 registros de pacientes analisados, 63,63% eram do sexo masculino, com média etária de 49,35 anos (±10,11 anos). A comorbidade mais frequentemente registrada foi a hipertensão arterial sistêmica (58,46%), seguida pelo diabetes (22,07%) e por dislipidemia (16,08%). A cardiopatia responsável pela maioria das indicações ao transplante foi a cardiomiopatia dilatada idiopática (41,55%). A maioria dos pacientes (61,62%) apresentava fração de ejeção ventricular esquerda >55%. Todos os sujeitos estavam em uso de drogas antiproliferativas, 80,52% usavam inibidores da calcineurina, 66,23% corticosteroides e 19,48% com inibidores do sinal de proliferação. CONCLUSÃO: Os registros analisados mostraram uma população semelhante a de relatos internacionais, tanto na prevalência das comorbidades, quanto no tempo de sobrevida pós-transplante, utilizando a terapêutica imunossupressora padrão...

BACKGROUND AND OBJECTIVE: With the increasing number of patients undergoing heart transplantation, it is necessary to know this population. The objectives of this study were to describe the receptors clinical profile, theirs clinical complications and theirs comorbidities, and compare then with the international literature. METHODS: We conducted a retrospective epidemiological observation description study with patients undergoing heart transplantation, in the period 2000 to 2009. We analyzed the medical records of these patients, their history, their previous diseases, the heart failure diagnostics and therapeutics used. RESULTS: Of 77 patients medical records studied, 63.63% was males, with an average of 49.35 (±10.11) mean years-old. The most frequent comorbidity was hypertension (58.46%), diabetes (22.07%) and dyslipidemia (16.08%). The most common etiology as indication for transplantation was idiopathic dilated cardiomyopathy (41.55%). The most of these patients (61.62%) had ejection fraction above 55%. All of them used antiproliferative drugs, 80.52% used calcineurin inhibitors, 66.23% used corticosteroids and 19.48% used sign of proliferation inhibitors. CONCLUSION: These records analyzed showed a similar population to the international reports, both at the prevalence of comorbidities, as at the time of post-transplant survival, using the standard immunosuppressive therapy...

Avaliação da doença vascular do enxerto no transplante cardíaco: experiência de um centro brasileiro / Assessment of cardiac allograft vasculopathy in cardiac transplantation: experience of a Brazilian center

FUNDAMENTO: O transplante cardíaco continua sendo o tratamento de escolha para a insuficiência cardíaca refratária ao tratamento otimizado. Dois métodos diagnósticos apresentam elevada sensibilidade no diagnóstico de episódios de rejeição ao enxerto e Doença Vascular do Enxerto (DVE), causas importantes de mortalidade no pós-transplante. OBJETIVO: Avaliar a relação entre os resultados do ultrassom intracoronariano (USIV) e os laudos das biópsias endomiocárdicas (BX) no seguimento de pacientes submetidos a transplante cardíaco em um serviço de referência brasileiro. MÉTODOS: Foi realizado um ensaio epidemiológico retrospectivo observacional, com pacientes submetidos a transplante cardíaco ortotópico, no período de 2000 a 2009. Foram analisados os prontuários desses pacientes e os resultados dos USIV e BX realizados rotineiramente no seguimento clínico pós-transplante e terapêutica em uso. RESULTADOS: Dos 77 pacientes analisados, 63,63% são do sexo masculino, nas faixas etárias de 22 a 69 anos. Quanto aos resultados dos USIV, 33,96% foram classificados em Stanford classe I, e 32,08%, como Stanford IV. Dos 143 laudos das biópsias, 51,08% tiveram resultado 1R, 3R em 0,69% dos laudos, e 14,48% apresentaram a descrição de efeito Quilty. Todos usaram antiproliferativos, 80,51% usaram inibidores da calcineurina e 19,48% usaram inibidores do sinal de proliferação (ISP). CONCLUSÃO: A avaliação dos pacientes pós-transplante cardíaco por meio do USIV incorpora informações detalhadas para o diagnóstico precoce e sensível da DVE, que são complementadas pelas informações histológicas fornecidas pelas BX, estabelecendo uma possível relação causal entre a DVE e os episódios de rejeição humoral.

BACKGROUND: Cardiac transplantation continues to be the treatment of choice for heart failure refractory to optimized treatment. Two methods have high sensitivity for diagnosing allograft rejection episodes and cardiac allograft vasculopathy (CAV), important causes of mortality after transplantation. OBJECTIVE: To assess the relationship between intravascular ultrasound (IVUS) results and endomyocardial biopsy (BX) reports in the follow-up of patients undergoing cardiac transplantation in a Brazilian reference service. METHODS: A retrospective epidemiological observational study was carried out with patients undergoing orthotopic cardiac transplantation from 2000 to 2009. The study assessed the medical records of those patients and the results of the IVUS and BX routinely performed in the clinical post-transplant follow-up, as well as the therapy used. RESULTS: Of the 77 patients assessed, 63.63% were males, their ages ranging from 22 to 69 years. Regarding the IVUS results, 33.96% of the patients were classified as Stanford class I, and 32.08%, as Stanford class IV. Of the 143 BX reports, 51.08% were 1R, and 0.69%, 3R. The Quilty effect was described in 14.48% of the BX reports. All patients used antiproliferative agents, 80.51% used calcineurin inhibitors, and 19.48% used proliferation signal inhibitors. CONCLUSION: The assessment of cardiac transplant patients by use of IVUS provides detailed information for the early and sensitive diagnosis of CAV, which is complemented by histological data derived from BX, establishing a possible causal relationship between CAV and humoral rejection episodes.

Assessment of cardiac allograft vasculopathy in cardiac transplantation: experience of a Brazilian center.

BACKGROUND: Cardiac transplantation continues to be the treatment of choice for heart failure refractory to optimized treatment. Two methods have high sensitivity for diagnosing allograft rejection episodes and cardiac allograft vasculopathy (CAV), important causes of mortality after transplantation. OBJECTIVE: To assess the relationship between intravascular ultrasound (IVUS) results and endomyocardial biopsy (BX) reports in the follow-up of patients undergoing cardiac transplantation in a Brazilian reference service. METHODS: A retrospective epidemiological observational study was carried out with patients undergoing orthotopic cardiac transplantation from 2000 to 2009. The study assessed the medical records of those patients and the results of the IVUS and BX routinely performed in the clinical post-transplant follow-up, as well as the therapy used. RESULTS: Of the 77 patients assessed, 63.63% were males, their ages ranging from 22 to 69 years. Regarding the IVUS results, 33.96% of the patients were classified as Stanford class I, and 32.08%, as Stanford class IV. Of the 143 BX reports, 51.08% were 1R, and 0.69%, 3R. The Quilty effect was described in 14.48% of the BX reports. All patients used antiproliferative agents, 80.51% used calcineurin inhibitors, and 19.48% used proliferation signal inhibitors. CONCLUSION: The assessment of cardiac transplant patients by use of IVUS provides detailed information for the early and sensitive diagnosis of CAV, which is complemented by histological data derived from BX, establishing a possible causal relationship between CAV and humoral rejection episodes.

Infarto agudo do miocárdio de parede inferior sem lesão obstrutiva coronária / Inferior acute myocardial infarction without coronary lesions

Descrevemos um caso de paciente com 70 anos, admitida com quadro compatível de infarto agudo do miocárdio, com sinais clínicos compatíveis, bem como alterações eletrocardiográficas, enzimáticas e de contratilidade. à angiografia coronária não foram evidenciadas lesões obstrutivas, o que foi confirmado pela avaliação com ultrassonografia intracoronária. Os autores discutem as hipóteses levantadas para explicar o infarto do miocárdio com artérias coronárias normais.

We describe the case of a 70-year-old patient admitted with acute myocardial infarction, with clinical, electrocardiographic, enzymatic and left ventricular regional wall motion abnormalities. Coronary angiography showed no obstructive lesions, which was confirmed by intravascular ultrasound (IVUS). Different hypothesis are raised to explain myocardial infarction with normal coronary arteries in this patient.

Citologia do derrame papilar / Cytology of nipple discharge

INTRODUÇÃO: A avaliação citológica do derrame papilar é um método bem estabelecido para o diagnóstico rápido de carcinoma mamário em mulheres. OBJETIVOS: Estabelecer a freqüência das diferentes categorias diagnósticas, as características citomorfológicas das descargas papilares e, ainda, a relação entre o aspecto macroscópico dessas secreções e o citodiagnóstico. MATERIAL E MÉTODO: O presente estudo analisou o resultado obtido do derrame papilar de 423 pacientes no período de janeiro de 1997 a abril de 2002. Os derrames foram classificados em positivo, negativo ou suspeito para células neoplásicas. RESULTADOS: Dos 423 casos analisados, os derrames papilares foram positivos em quatro casos, suspeitos em 11 e negativos em 408. O aspecto macroscópico hemorrágico esteve presente em dois casos positivos, sete suspeitos e 62 negativos. Os achados citológicos mais freqüentes, nos casos positivos ou suspeitos, foram de grupamentos papilares de células epiteliais com hemácias ou células ductais com atipias. DISCUSSÃO E CONCLUSÕES: Com base nessa experiência, conclui-se que os esfregaços catalogados como hemorrágicos, macroscópica ou microscopicamente, devem ser cuidadosa e sistematicamente analisados, pois neles há uma maior possibilidade de serem detectadas lesões significativas.

BACKGROUND: The cytological evaluation of nipple discharge is a well-known method for the fast diagnosis of breast carcinoma in females. OBJECTIVES: To establish the frequency of different diagnosis categories, the cytomorphologic features of nipple discharge and, in addition, the relationship between the macroscopic aspect of those secretions and cytodiagnosis. MATERIAL AND METHOD: This study examined the results obtained from 423 patients with nipple discharge during the period from January 1997 to April 2002. The discharges were classified in positive, negative or suspicious for neoplastic cells. RESULTS: Of the 423 examined cases, nipple discharges were positive in four cases, suspicious in 11 and negative in 408. The bloody macroscopic appearance was present in two positive cases, suspicious in seven and negative in 62. The most frequent cytological features, in the positive or suspicious cases, were papillary clusters of epithelial cells with erythrocytes or ductal cells with atypical findings. DISCUSSION AND CONCLUSIONS: Based on this experience, we concluded that the smears classified as bloody, macroscopic or microscopically, should be careful and systematically analyzed because there is a larger possibility of detecting significant lesions in them.