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1.
Rev Soc Bras Med Trop ; 52: e20190149, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800919

RESUMO

INTRODUCTION: This study aimed to analyze cases of complicated varicella and the impact of varicella vaccination in Minas Gerais, Brazil. METHODS: This was a time series study of a territorial basis using data on varicella cases from 2010 to 2016, which was provided by the State Health Department of Minas Gerais on . Descriptive statistics were used for the analysis, and the generalized linear regression model proposed by Prais-Winsten was used for the time tendency, adopting a significance level of 5% and the integrated autoregressive modeling of moving averages. RESULTS: There were 1,635 cases of varicella; out of which cellulitis (44%) was the predominant complication. The home-acquired cases were 38.9% and 464 cases (40.6%) were not previously vaccinated. There was a significant decrease in the incidence coefficient when comparing the pre- and post- immunization periods, from 1.95 cases/100,000 inhabitants in 2010 to 0.24 cases/100.000 inhabitants in 2016 (p<0.05). There was a higher incidence of cases recorded among males, with higher prevalence in the age group of 1-4 years (54.7%). Lethality was higher between 5-9 years of age (44%). Mortality was higher in the age group of 0-4 years and among females (2.58/100,000 inhabitants/year). The overall trend of the incidence coefficient was a decreasing one, with an annual percentage variation. CONCLUSIONS: The number of complicated varicella cases notified decreased, coincidentally, in the post-immunization period. However, the immunization coverage period was restricted for the assessment of the correlation between immunization coverage and incidence.


Assuntos
Varicela/epidemiologia , Hospitalização/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Varicela/prevenção & controle , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Gravidez , Estações do Ano , Fatores Socioeconômicos , Análise Espaço-Temporal , Adulto Jovem
2.
Rev Soc Bras Med Trop ; 53: e20190086, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31859940

RESUMO

INTRODUCTION: Acquired immunodeficiency syndrome (AIDS) remains a major public health issue in Brazil. This ecological study aimed to evaluate the spatiotemporal distribution of notified new AIDS cases in Brazil between 2012 and 2016. METHODS: A Bayesian spatiotemporal model based on the Poisson distribution was used to obtain smoothed incidence estimates of AIDS in each of the 133 Brazilian intermediate regions. RESULTS: Spatial distribution of new AIDS cases is highly heterogeneous. Regions with higher gross domestic product per capita tend to have higher incidence rates of AIDS. CONCLUSIONS: Strategies to prevent and control AIDS should consider regional differences.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Brasil/epidemiologia , Notificação de Doenças , Feminino , Humanos , Incidência , Masculino , Análise Espaço-Temporal
3.
Rev Saude Publica ; 53: 55, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31432912

RESUMO

OBJECTIVE: To examine the effect of seasonality on femoral fracture incidence among people residing in the state of São Paulo, Brazil. METHODS: Ecological study based on a consecutive series of 216,348 reports of hospital admissions caused by femoral fractures. A Bayesian statistical model was used for time series analysis, considering the monthly average number of events of femoral fractures per day as a dependent variable. RESULTS: Among the female population, significant seasonal effects were observed only for older women, aged 60 years or more. Among younger men (aged less than 20 years) there is not a clear seasonal effect, but among the other age groups there seems to exist a higher number of cases of femoral fractures during the coldest months of the year. CONCLUSIONS: In general, more cases of fractures occur during the coldest months of the year; however, men and women have different patterns of incidence according to each age group.


Assuntos
Fraturas do Fêmur/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estações do Ano , Fatores Sexuais , Adulto Jovem
4.
Cien Saude Colet ; 24(8): 2845-2858, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389533

RESUMO

This study aimed to validate of Fall Risk Tracking Tool (FRRISque) in elderly community dwellers. A cross-sectional evaluative screening study was carried out on a sample of 854 elderly. In addition to the pilot version of FRRISque, the QuickScreen® tool was applied as a standard reference in order to validate a concurrent criterion, determining sensitivity and specificity values. Most of the elderly people were female (57.6%) with an average age of 71.87 years. The multivariate logistic regression analyses showed that only 10 FRRISque items contribute to increased elderly fall risk and they refer to the risk factors of previous falls, use of a walking aid device, polypharmacy, use of psychotropic substances, difficulty to ascend and descend a slope, difficulty to walk for a distance of 100 meters, visual and hearing impairment, low physical activity and poorly lit environment. This risk stratification model assumes sensitivity values of 91.3% and specificity values of 73.4%. The FRRISque is defined as a valid, simple, low-cost and of easy and rapid application tool that can be used by all primary health care professionals, including community health workers.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Avaliação Geriátrica/métodos , Vida Independente , Medição de Risco/métodos , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Fatores de Risco , Sensibilidade e Especificidade
5.
Ciênc. Saúde Colet ; 24(8): 2845-2858, ago. 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1011881

RESUMO

Resumo Objetivou validar a Ferramenta de Rastreamento do Risco de Quedas (FRRISque) em pessoas idosas que vivem na comunidade. Realizou-se um estudo transversal, do tipo screening avaliativo. A amostra foi composta por 854 idosos. Além da versão piloto da FRRISque, foi aplicado o instrumento QuickScreen® como referência padrão no intuito de realizar a validade de critério concorrente, determinando os valores de sensibilidade e especificidade. A maioria das pessoas idosas era do sexo feminino (57,6%), com média de idade de 71,87 anos. Nas análises por regressão logística, evidenciou-se que apenas 10 itens da FRRISque contribuem para o aumento do risco de quedas em idosos e referem-se aos fatores de risco queda anterior, uso de dispositivo de auxílio à marcha, polifarmácia, uso de psicotrópicos, dificuldade para subir ou descer uma ladeira, dificuldade para andar 100 metros, déficit visual e auditivo, baixa atividade física e ambiente mal iluminado. Este modelo de estratificação de risco assume valores de sensibilidade de 91,3% e especificidade de 73,4%. A FRRISque se caracteriza como instrumento válido, simples, porém denso, de baixo custo e de fácil e rápida aplicação, podendo ser empregado por todos os profissionais de saúde da atenção básica, inclusive por agentes comunitários de saúde.


Abstract This study aimed to validate of Fall Risk Tracking Tool (FRRISque) in elderly community dwellers. A cross-sectional evaluative screening study was carried out on a sample of 854 elderly. In addition to the pilot version of FRRISque, the QuickScreen® tool was applied as a standard reference in order to validate a concurrent criterion, determining sensitivity and specificity values. Most of the elderly people were female (57.6%) with an average age of 71.87 years. The multivariate logistic regression analyses showed that only 10 FRRISque items contribute to increased elderly fall risk and they refer to the risk factors of previous falls, use of a walking aid device, polypharmacy, use of psychotropic substances, difficulty to ascend and descend a slope, difficulty to walk for a distance of 100 meters, visual and hearing impairment, low physical activity and poorly lit environment. This risk stratification model assumes sensitivity values of 91.3% and specificity values of 73.4%. The FRRISque is defined as a valid, simple, low-cost and of easy and rapid application tool that can be used by all primary health care professionals, including community health workers.

6.
Hum Vaccin Immunother ; : 1-9, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31242082

RESUMO

Objective: We described pertussis epidemiological trends in Brazil between 2010 and 2015. We also assessed tetanus, diphtheria and acellular pertussis (Tdap) vaccine coverage among pregnant women from 2014, the year of the introduction of Tdap maternal immunization recommendation in Brazil, to 2016. Methods: Epidemiological data for incidence, prevalence, hospitalization, mortality, and maternal vaccination coverage were calculated based on the Brazilian public surveillance databases. Results: The epidemiological data analysis results showed that the pertussis average incidence rate (IR) was 2.19/100,000 inhabitants for all ages, with a peak in 2014 (4.03/100,000 inhabitants) and highest incidence in <1-year-old children (IR = 175.20/100,000). 97.6% of pertussis deaths (405/415) were in <1-year-old children. Maternal immunization coverage was 9.2% in 2014, 40.4% in 2015, and 33.8% in 2016. Conclusions: Pertussis incidence and pertussis-related deaths increased in Brazil from 2010 to 2014 and decreased in 2015. In the two years, 2015 and 2016 that followed the NIP recommendation, Tdap vaccination coverage of pregnant women was low and varying from region to region. More efforts and national plans would help increase awareness and maternal immunization coverage.

7.
Rev Gaucha Enferm ; 40(spe): e20180317, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038602

RESUMO

OBJECTIVE: Analyze incident notifications related to the patient's safety. METHOD: Cross-sectional study with quantitative approach, based on data from the risk Management of a hospital complex, located in northwest São Paulo, from August 2015 to July 2016. RESULTS: 4,691 notifications were analyzed. Nurses were the professionals who notified the most (71%), followed by physicians (8%). The most frequent period in which the notifications occurred was the daytime. There was significant difference in the proportion of notifications between the days of the week. The notifications were classified by reason and the most prevalent were those related to medication (17%), followed by skin lesions (15%), and phlebitis (14%). The highest frequency of notifications occurred in the hospitalization units. In relation to severity, 344 events caused damage to the patient, most of which were of mild intensity (65%). CONCLUSION: Spontaneous notifications are an important source of information, and highlight the magnitude of the problem related to health incidents.


Assuntos
Segurança do Paciente , Gestão de Riscos , Acidentes por Quedas/estatística & dados numéricos , Brasil , Estudos Transversais , Unidades Hospitalares , Humanos , Erros de Medicação/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Flebite/epidemiologia , Melhoria de Qualidade , Estudos Retrospectivos , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração , Gestão de Riscos/estatística & dados numéricos , Dermatopatias/epidemiologia , Fatores de Tempo
8.
Rev Soc Bras Med Trop ; 52: e20180020, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30994791

RESUMO

INTRODUCTION: AIDS remains a major public health concern in Brazil. METHODS: This study investigated spatiotemporal patterns of reported AIDS cases among adults in São Paulo between 2000 and 2016, and their associations with human development index. RESULTS: In the early 20th century, the more developed administrative districts (ADs) indicated higher AIDS incidences among men. From the 2010s, ADs with lower development indicate higher rates of the disease among women. CONCLUSIONS: The results are useful to support the planning of actions aimed at controlling the incidence and transmission of AIDS in certain areas, based on diversification by gender and risk populations.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Adulto , Brasil/epidemiologia , Notificação de Doenças , Feminino , Humanos , Incidência , Masculino , Modelos Teóricos , Fatores de Risco , Fatores Socioeconômicos , Análise Espaço-Temporal
9.
Artigo em Inglês | MEDLINE | ID: mdl-30970049

RESUMO

This study aimed to characterize the cases of tuberculosis (TB) co-infected with the human immunodeficiency virus (HIV) in Minas Gerais State, Brazil, after the notification sheet modification, and to verify the association between the new variables and the treatment outcome. It is an analytical cross-sectional study with TB/HIV cases notified in the year 2016 to the Brazilian Information System for Notifiable Diseases (Sistema de Informação de Agravos de Notificação). Descriptive statistics, chi-square test, and multiple correspondence analysis were performed to verify the association between the outcome, ageand associated diseases. Of the 180 cases, most were male (75.6%) between 30 and 49 years old (63.3%), mixed ethnicity (black and white) (49.4%), 94.4% had the Acquired Immunodeficiency Syndrome (AIDS) and 60.6% had pulmonary TB. The molecular test was not performed at the time of diagnosis in 70.5% of the cases. Homeless people (4.4%) and prisoners (3.9%) featured prominently among the special populations. People between 40 and 49 years old without concurrent diseases were cured in 40.0% of the cases; 18.9% abandoned the treatment due to smoking, drug abuse and mental illness in the age group between 20 and 29 years old. The deaths were associated with the age group between 30 and 39 years old and the occurrence of AIDS. The results have shown that the groups considered vulnerable (drug users, smokers and people with mental illness) abandoned the treatment, the notification upon death from AIDS in adults was late and some treatments were inadequate. The epidemiological surveillance, prevention and assistance strategies towards cases of TB/HIV must be improved in order to achieve the goal of the Brazilian National Plan to end Tuberculosis as a Public Health Problem until 2035 in the state.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Coinfecção/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Notificação de Doenças , Escolaridade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
10.
Rev. bras. med. fam. comunidade ; 14(41): 1998, fev. 2019.
Artigo em Espanhol | LILACS-Express | ID: biblio-1049870

RESUMO

Los sistemas de salud se enfrentan al reto de decidir cuáles de las nuevas tecnologías disponibles deben ser utilizadas y estar disponibles con carácter prioritario a través de la cobertura estatal. De esta manera la Organización Mundial de la Salud (OMS) ratifica la importancia de la Evaluación de la Tecnologías Sanitarias (ETS), con el objetivo de fortalecer los sistemas de información y la capacidad de investigación en salud. El proceso de la preparación de un informe de ETS, requiere una búsqueda exhaustiva de la evidencia disponible; para su posterior síntesis y presentación a los interesados. Este es un paso crucial para que una tecnología sea considerada para su introducción en un sistema de salud; convirtiéndose en la cuarta y última barrera (Calidad, Seguridad, Eficacia y Costo-Efectividad); para la implementación de nuevas intervenciones en salud. Sin embargo, para determinar mejor el impacto presupuestario de las intervenciones, la ETS se basa en las herramientas proporcionadas por las Evaluaciones Económicas en Salud (EES), que pueden analizar los costos y las consecuencias clínicas del uso de una determinada tecnología particular para un problema de salud particular en un contexto particular. Esta información resulta vital cuando se consideran principios como la equidad o el costo de oportunidad (lo que se gasta en una intervención no se puede utilizar en otra), y, en última instancia, el limitado presupuesto de salud de los sistemas de salud.


Health systems have the challenge of deciding which of the new available technologies should be used and be available as a priority through state coverage. In this way, the World Health Organization (WHO) ratifies the importance of the Health Technology Assessment (HTA), with the aim of strengthening information systems and health research capacity. The process of preparing an HTA report requires an exhaustive search of the available evidence; for its subsequent synthesis and presentation to those interested in it. This is a crucial step for a technology to be considered for its introduction into a health system; becoming the fourth and final barrier (Quality, Safety, Efficiency and Cost-Effectiveness); for the implementation of new health interventions. However, to better determine the budgetary impact of the interventions, the HTA relies on the tools provided by the Economic Health Assessments (EHA); which can analyze both the costs and the clinical consequences of the use of a certain technology for a particular health problem in a particular context. This information is vital, when we consider principles such as equity, or the opportunity cost (what is spent in one intervention, cannot be used in another), and ultimately the limited health budget of health systems.


Os sistemas de saúde enfrentam o desafio de decidir quais das novas tecnologias disponíveis devem ser usadas e estar disponíveis como prioridade através da cobertura do estado. Dessa forma, a Organização Mundial da Saúde (OMS) ratifica a importância da Avaliação de Tecnologias em Saúde (ATS), com o objetivo de fortalecer os sistemas de informação e a capacidade de pesquisa em saúde. O processo de preparação de um relatório de ATS requer uma pesquisa exaustiva das evidências disponíveis; para sua síntese e apresentação seguintes aos interessados. Este é um passo crucial para que uma tecnologia seja considerada para sua introdução em um sistema de saúde; tornando-se a quarta e última barreira (Qualidade, Segurança, Eficiência e Custo-Eficácia); para a implementação de novas intervenções de saúde. No entanto, para melhor determinar do impacto orçamentário das intervenções, a ATS conta com as ferramentas fornecidas pelas Avaliações Econômicas de Saúde (AES); que pode analisar os custos e as consequências clínicas do uso de uma determinada tecnologia para um problema de saúde particular em um contexto particular. Esta informação é vital, quando consideramos princípios como a equidade, ou o custo de oportunidade (o que é gasto em uma intervenção, não pode ser usado em outra) e em última instância, o orçamento limitado em saúde dos sistemas de saúde.

11.
Rev. saúde pública (Online) ; 53: 55, jan. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1014538

RESUMO

ABSTRACT OBJECTIVE To examine the effect of seasonality on femoral fracture incidence among people residing in the state of São Paulo, Brazil. METHODS Ecological study based on a consecutive series of 216,348 reports of hospital admissions caused by femoral fractures. A Bayesian statistical model was used for time series analysis, considering the monthly average number of events of femoral fractures per day as a dependent variable. RESULTS Among the female population, significant seasonal effects were observed only for older women, aged 60 years or more. Among younger men (aged less than 20 years) there is not a clear seasonal effect, but among the other age groups there seems to exist a higher number of cases of femoral fractures during the coldest months of the year. CONCLUSIONS In general, more cases of fractures occur during the coldest months of the year; however, men and women have different patterns of incidence according to each age group.

12.
Rev. gaúch. enferm ; 40(spe): e20180317, 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1004116

RESUMO

Resumo OBJETIVO Analisar as notificações de incidentes relacionados à segurança do paciente. MÉTODOS Estudo transversal com abordagem quantitativa, baseado nos dados do Gerenciamento de Risco de um complexo hospitalar, localizado no noroeste paulista, de agosto/2015 a julho/2016. RESULTADOS Foram analisadas 4.691 notificações. O enfermeiro foi a categoria profissional que mais notificou (71%), seguido do médico (8%). O período mais frequente em que ocorreram as notificações foi o diurno. Houve diferença significativa da proporção de notificações entre os dias da semana. As notificações foram classificadas por motivo, com destaque para os medicamentos (17%), seguido de lesões de pele (15%) e flebite (14%). A maior frequência de notificações ocorreu nas unidades de Internação. Quanto à gravidade 344 eventos ocasionaram dano ao paciente, sendo a maioria de intensidade leve (65%). CONCLUSÃO As notificações espontâneas são uma importante fonte de informações e evidenciam a magnitude do problema relacionado aos incidentes em saúde.


Resumen OBJETIVO Analizar las notificaciones de incidentes relacionados con la seguridad del paciente. MÉTODOS Estudio transversal con abordaje cuantitativo, basado en los datos del Gestión de Riesgos de un complejo hospitalario, ubicado em el noroeste paulista, de agosto de 2015 a julio de 2016. RESULTADOS Se analizaron 4.691 notificaciones. El enfermero fue la categoría profesional que más notificó (71%), seguido del médico (8%). El período más frecuente en que ocurrieron las notificaciones fue el diurno. Hubo una diferencia significativa de la proporción de notificaciones entre los días de la semana. Las notificaciones se clasificaron por motivo, con destaque para los medicamentos (17%), seguido de lesiones de piel (15%), flebitis (14%). La mayor frecuencia de notificaciones ocurrió en las unidades de Internación. En cuanto a la gravedad 344 eventos ocasionaron daño al paciente, siendo la mayoría de intensidad leve (65%). CONCLUSIÓN Las notificaciones espontáneas son una importante fuente de información, y evidencia la magnitud del problema relacionado con los incidentes en salud.


Abstract OBJECTIVE Analyze incident notifications related to the patient's safety. METHOD Cross-sectional study with quantitative approach, based on data from the risk Management of a hospital complex, located in northwest São Paulo, from August 2015 to July 2016. RESULTS 4,691 notifications were analyzed. Nurses were the professionals who notified the most (71%), followed by physicians (8%). The most frequent period in which the notifications occurred was the daytime. There was significant difference in the proportion of notifications between the days of the week. The notifications were classified by reason and the most prevalent were those related to medication (17%), followed by skin lesions (15%), and phlebitis (14%). The highest frequency of notifications occurred in the hospitalization units. In relation to severity, 344 events caused damage to the patient, most of which were of mild intensity (65%). CONCLUSION Spontaneous notifications are an important source of information, and highlight the magnitude of the problem related to health incidents.

13.
Rev. Soc. Bras. Med. Trop ; 52: e20180020, 2019. graf
Artigo em Inglês | LILACS-Express | ID: biblio-1041577

RESUMO

Abstract INTRODUCTION: AIDS remains a major public health concern in Brazil. METHODS: This study investigated spatiotemporal patterns of reported AIDS cases among adults in São Paulo between 2000 and 2016, and their associations with human development index. RESULTS: In the early 20th century, the more developed administrative districts (ADs) indicated higher AIDS incidences among men. From the 2010s, ADs with lower development indicate higher rates of the disease among women. CONCLUSIONS: The results are useful to support the planning of actions aimed at controlling the incidence and transmission of AIDS in certain areas, based on diversification by gender and risk populations.

14.
Rev Soc Bras Med Trop ; 51(4): 427-435, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30133624

RESUMO

INTRODUCTION: Over 30 years after the acquired immunodeficiency syndrome epidemic, several strategies have been implemented to verify the trend of the infection, the profile of the affected individuals, and the impact of prevention and control measures, with notification of asymptomatic carriers being the most recent measure. This study aimed to verify the geographic distribution of human immunodeficiency virus/acquired immunodeficiency syndrome and analyze the association between case definition criteria, sociodemographic data, and clinical aspects of the disease in the State of Minas Gerais between 2007 and 2016. METHODS: In this ecological and analytical study, 35,349 cases of human immunodeficiency virus/acquired immunodeficiency syndrome reported in the State of Minas Gerais between 2007 and 2016 were analyzed. The data were analyzed using multiple correspondence factor analysis, time series analysis, descriptive statistics, and spatial distribution of the cases by macro-region. RESULTS: The majority of the patients were brown-skinned individuals, alive, diagnosed with human immunodeficiency virus/acquired immunodeficiency syndrome on the basis of the criteria adapted from the Centers for Disease Control and Prevention, and living in municipalities with more than 50,000 (80.5%) inhabitants. Between 2007 and 2016, there was an increase in the number of criteria used for diagnosing human immunodeficiency virus. By contrast, a consequent decrease was observed in the number of criteria used for defining cases, which were adapted from the Centers for Disease Control and Prevention, Rio de Janeiro/Caracas, and for identifying AIDS-related deaths. Young people aged between 13 and 29 years, individuals whose education level is compatible with the observed age, and homosexual men were associated with the HIV+ criterion. CONCLUSIONS: Out study showed that after the mandatory notification of human immunodeficiency virus-positive cases in 2014, there was a decrease in other criteria for defining human immunodeficiency virus/acquired immunodeficiency syndrome cases and changes in the profile of people living with human immunodeficiency virus/acquired immunodeficiency syndrome.


Assuntos
Infecções por HIV/epidemiologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Notificação de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
15.
Rev. Soc. Bras. Med. Trop ; 51(4): 427-435, July-Aug. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-957437

RESUMO

Abstract INTRODUCTION: Over 30 years after the acquired immunodeficiency syndrome epidemic, several strategies have been implemented to verify the trend of the infection, the profile of the affected individuals, and the impact of prevention and control measures, with notification of asymptomatic carriers being the most recent measure. This study aimed to verify the geographic distribution of human immunodeficiency virus/acquired immunodeficiency syndrome and analyze the association between case definition criteria, sociodemographic data, and clinical aspects of the disease in the State of Minas Gerais between 2007 and 2016. METHODS: In this ecological and analytical study, 35,349 cases of human immunodeficiency virus/acquired immunodeficiency syndrome reported in the State of Minas Gerais between 2007 and 2016 were analyzed. The data were analyzed using multiple correspondence factor analysis, time series analysis, descriptive statistics, and spatial distribution of the cases by macro-region. RESULTS: The majority of the patients were brown-skinned individuals, alive, diagnosed with human immunodeficiency virus/acquired immunodeficiency syndrome on the basis of the criteria adapted from the Centers for Disease Control and Prevention, and living in municipalities with more than 50,000 (80.5%) inhabitants. Between 2007 and 2016, there was an increase in the number of criteria used for diagnosing human immunodeficiency virus. By contrast, a consequent decrease was observed in the number of criteria used for defining cases, which were adapted from the Centers for Disease Control and Prevention, Rio de Janeiro/Caracas, and for identifying AIDS-related deaths. Young people aged between 13 and 29 years, individuals whose education level is compatible with the observed age, and homosexual men were associated with the HIV+ criterion. CONCLUSIONS: Out study showed that after the mandatory notification of human immunodeficiency virus-positive cases in 2014, there was a decrease in other criteria for defining human immunodeficiency virus/acquired immunodeficiency syndrome cases and changes in the profile of people living with human immunodeficiency virus/acquired immunodeficiency syndrome.

16.
Rev. direito sanit ; 19(1): 121-143, 2018.
Artigo em Português | LILACS | ID: biblio-915924

RESUMO

Este artigo tem por objetivo identificar, nas decisões do Superior Tribunal de Justiça (STJ), as principais causas dos danos decorrentes da prática médica obstétrica no momento do parto. O estudo analisou 21 decisões julgadas pela corte entre 2004 e 2014 relacionadas a indenizações judiciais na obstetrícia. O critério de seleção dos casos utilizou como método a busca de decisões no site do STJ, cujos descritores foram: "parto", "erro médico"; "médico"; "paciente"; "profissional da saúde"; "dano moral"; "dano material"; "SUS"; "responsabilidade civil" e "indenização por erro médico". O Rio de Janeiro foi o estado com maior número de ações indenizatórias (28,6%) apreciadas pelo STJ, seguido de São Paulo e Minas Gerais, com 14,3% cada um. No tocante aos réus que figuraram no polo passivo das demandas, 38,1% eram médicos e hospitais. Verificou-se que 71% das supostas falhas médicas que originaram as ações ocorreram durante a realização do parto natural, contra 29% dos casos de cesariana. A principal causa dos danos relatados foi a demora na realização do parto, seguida dos traumatismos. Apesar de pesquisas demonstrarem que a cesariana oferece maiores riscos para a parturiente e o feto, os resultados obtidos das decisões judiciais analisadas pelo STJ evidenciaram que os danos que resultaram sequelas irreversíveis no nascituro foram recorrentes nos casos relacionados ao parto natural, sugerindo que atenção especial deve ser dada à formação médica obstétrica, bem como à compreensão dos aspectos socioculturais envolvendo a indicação e a escolha pelo tipo de parto.


This article intends to identify the main reasons of damage caused by obstetric medical practice during childbirth, on the decisions of the Supreme Court of Justice of Brazil. The study analyzed 21 decisions judged between 2004 and 2014 related to legal compensations concerning obstetrics. The criteria for the selection of cases was to search the Supreme Court's website, for decisions containing descriptors such as: "birth", "medical error"; "doctor"; "patient"; "health professional"; "moral damage"; "property damage"; "SUS"; "Liability" and "compensation for medical error". Rio de Janeiro was the state with the largest number of compensation claims (28.6%) appreciated by the court, followed by São Paulo and Minas Gerais with 14.3%. Among the defendants listed on the demands, 38.1% were doctors and hospitals. It was found that 71% of the alleged malpractices that led to these actions occurred during vaginal delivery and 29% of cases correspond to caesarean section. The main cause of damages reported was the delays in performing delivery, followed by trauma. Although research has shown that the cesarean section poses greater risks to the woman and the fetus, the results obtained from the decisions analyzed by the court showed that damages resulting in irreversible sequelae in unborn children were recurrent in natural birth related cases, suggesting that special attention should be given to obstetric medical training as well as to the understanding of the sociocultural aspects that surround medical indication and choice of the type of childbirth method


Assuntos
Humanos , Masculino , Feminino , Cesárea , Compensação e Reparação , Conhecimentos, Atitudes e Prática em Saúde , Judicialização da Saúde , Erros Médicos , Parto Normal , Obstetrícia/legislação & jurisprudência
17.
BMC Cancer ; 17(1): 691, 2017 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-29041915

RESUMO

BACKGROUND: Metastatic colorectal cancer imposes a substantial burden on patients and society. Over the last years, progresses in the treatment have been made especially due to the introduction of monoclonal antibodies, such as bevacizumab which, on the other hand, has considerably increased the costs of treatment. We performed a cost-effectiveness analysis of bevacizumab plus XELOX in comparison with XELOX alone in metastatic colorectal cancer in first-line therapy, from the perspective of a public hospital school in Brazil. METHODS: This was a cost-effectiveness analysis performed by a decision tree and Markov models. Costs were expressed in local currency and outcomes were expressed in months of life gained. The model was constructed using the TreeAge Pro 2013® software. RESULTS: The incremental difference in years of life gained was 2.25 months, with an extra cost of 47,833.57 BRL, resulting in an incremental cost-effectiveness of 21,231.43 BRL per month of life gained. CONCLUSIONS: Although the XELOX plus bevacizumab regimen is a more expensive and more effective treatment than XELOX, it does not fit the reimbursement values fixed by the public healthcare system in Brazil.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/economia , Bevacizumab/economia , Neoplasias do Colo/tratamento farmacológico , Análise Custo-Benefício , Desoxicitidina/análogos & derivados , Fluoruracila/análogos & derivados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/uso terapêutico , Brasil , Neoplasias do Colo/patologia , Desoxicitidina/economia , Desoxicitidina/uso terapêutico , Fluoruracila/economia , Fluoruracila/uso terapêutico , Hospitais Públicos , Humanos , Modelos Teóricos , Metástase Neoplásica , Resultado do Tratamento
18.
Clinics (Sao Paulo) ; 72(8): 485-490, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28954008

RESUMO

OBJECTIVE:: Underfunding of the surgical treatment of complex spinal deformities has been an important reason for the steadily growing waiting lists in publicly funded healthcare systems. The aim of this study is to characterize the management of the treatment of spinal deformities in the public healthcare system. METHODS:: A cross-sectional study of 60 patients with complex pediatric spinal deformities waiting for treatment in December 2013 was performed. The evaluated parameters were place of origin, waiting time until first assessment at a specialized spine care center, waiting time for the surgical treatment, and need for implants not reimbursed by the healthcare system. RESULTS:: Ninety-one percent of the patients lived in São Paulo State (33% from Ribeirão Preto - DRS XIII). Patients waited for 0.5 to 48.0 months for referral, and the waiting times for surgery ranged from 2 to 117 months. Forty-five percent of the patients required implants for the surgical procedure that were not available. CONCLUSION:: The current management of patients with spinal deformities in the public healthcare system does not provide adequate treatment for these patients in our region. They experience long waiting periods for referral and prolonged waiting times to receive surgical treatment; additionally, many of the necessary procedures are not reimbursed by the public healthcare system.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/anormalidades , Coluna Vertebral/cirurgia , Adolescente , Análise de Variância , Brasil , Criança , Pré-Escolar , Estudos Transversais , Feminino , Mapeamento Geográfico , Humanos , Masculino , Doenças da Coluna Vertebral/etiologia , Estatísticas não Paramétricas , Fatores de Tempo , Listas de Espera , Adulto Jovem
19.
Clinics ; 72(8): 485-490, Aug. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-890724

RESUMO

OBJECTIVE: Underfunding of the surgical treatment of complex spinal deformities has been an important reason for the steadily growing waiting lists in publicly funded healthcare systems. The aim of this study is to characterize the management of the treatment of spinal deformities in the public healthcare system. METHODS: A cross-sectional study of 60 patients with complex pediatric spinal deformities waiting for treatment in December 2013 was performed. The evaluated parameters were place of origin, waiting time until first assessment at a specialized spine care center, waiting time for the surgical treatment, and need for implants not reimbursed by the healthcare system. RESULTS: Ninety-one percent of the patients lived in São Paulo State (33% from Ribeirão Preto - DRS XIII). Patients waited for 0.5 to 48.0 months for referral, and the waiting times for surgery ranged from 2 to 117 months. Forty-five percent of the patients required implants for the surgical procedure that were not available. CONCLUSION: The current management of patients with spinal deformities in the public healthcare system does not provide adequate treatment for these patients in our region. They experience long waiting periods for referral and prolonged waiting times to receive surgical treatment; additionally, many of the necessary procedures are not reimbursed by the public healthcare system.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/anormalidades , Coluna Vertebral/cirurgia , Acesso aos Serviços de Saúde/estatística & dados numéricos , National Health Insurance, United States/estatística & dados numéricos , Doenças da Coluna Vertebral/etiologia , Fatores de Tempo , Brasil , Estudos Transversais , Análise de Variância , Listas de Espera , Estatísticas não Paramétricas , Mapeamento Geográfico
20.
Braz. J. Pharm. Sci. (Online) ; 53(3): e00217, 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-889393

RESUMO

ABSTRACT In Brazil, 80% of hypertensive patients have no blood pressure controlled, this fact has caused severe financial consequences for the public health system (PHS) and the Pharmaceutical Care (PC) has emerged as an effective alternative. The aim of this study was to analyze the costs and outcomes of systemic arterial hypertension (SAH) for conventional assistance compared to assistance with PC in the PHS. This is a pharmacoeconomic study with cost-consequence analysis nested to clinical trial. Hypertensives patients were followed-up from 2006 to 2012. During 2009 they were assisted by the PC program in Ribeirão Preto-SP, Brazil. Clinical indicators, systolic and diastolic blood pressure (SBP and DBP), triglycerides, total cholesterol (TC) and its fractions and healthcare indicators, consumption of antihypertensive medication and consultations were analyzed. Costs were listed as direct medical and direct non-medical. The average cost of conventional care for 104 patients followed-up was US$ 198.97, in the PC period and after discharge was US$ 407.91 and US$ 214.96 patient/year. After discharge of patients from PC there was reduction of SBP, DBP, TC and cardiovascular risk, 9.4 mmHg, 4.6 mmHg, 12.0 mg/dL, and 23% [p<0.005], respectively. The PC program optimized clinical and healthcare indicators and impacted in the SAH costs for the PHS.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Gastos em Saúde , Custos e Análise de Custo/métodos , Hipertensão/patologia , Assistência Farmacêutica/estatística & dados numéricos , Farmacoeconomia/normas , Monitorização Ambulatorial da Pressão Arterial/classificação
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