Interrupção dos serviços de saúde durante pandemia de COVID-19 ameaça eliminação das hepatites virais na América Latina e no Caribe

Uma pesquisa recente conduzida pela Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) indica que a pandemia de COVID-19 afetou o diagnóstico e o tratamento das infecções virais por hepatite B e C na América Latina e no Caribe, o que tem freado o avanço na meta de eliminar essas doenças infecciosas até 2030

Desabastecimiento de piperacilina-tazobactam: una oportunidad para mejorar / Shortage of piperacillin-tazobactam: an opportunity to improve

Introducción: En 2017 se iniciaron los problemas de suministro nacional de piperacilina/tazobactam, pero fue en 2018 cuando nuestro centro sufrió problemas graves de escasez. El objetivo es conocer el impacto de la evaluación de indicación de piperacilina-tazobactam en el marco del Programa de Asesoramiento de Antimicrobianos (PASA) durante el periodo de desabastecimiento de 2018.Material y métodos: Se analizaron de manera prospectiva las intervenciones efectuadas por el PASA. Se recogieron variables demográficas, clínicas, antibioterapia previa, antecedentes, recomendación realizada, aceptación, curación, mortalidad atribuible a la infección y mortalidad bruta a 30 días. Asimismo, se evaluó el impacto en consumo y coste de piperacilina-tazobactam y carbapenémicos. Se compararon los casos que evolucionaron a la curación clínica y la mortalidad, entre los pacientes cuyos facultativos aceptaron o rechazaron la recomendación de modificación.Resultados: Se realizaron 181 recomendaciones (126 pacientes), el tratamiento fue adecuado en el 53,6%, 28,2% desescalada, 8,8% suspensión, 5,5% ajuste posológico y 2,2% escalada. Aceptación global 91,6%. Los antibióticos más recomendados fueron cefalosporinas acompañadas o no de anaerobicida (60%).La curación clínica fue del 85%, la mortalidad bruta 21% y la atribuible 8,7%. No se encontraron diferencias en curación clínica (p=0,068) y mortalidad (p=0,68) entre los que aceptaron y rechazaron las recomendaciones. El consumo se redujo un 58,6%, con un ahorro estimado de 204.299 euros. El consumo de carbapenémicos aumentó un 6,1%.Conclusión: La intervención del PASA sobre la prescripción de piperacilina-tazobactam ha sido mayoritariamente aceptada, eficiente, neutra en los resultados clínicos y ha evitado el desplazamiento a carbapenémicos. (AU)

Introduction: The national supply problems of piperacillin/tazobactam began in 2017, but it was in 2018 when our center suffered severe shortage problems. The objective is to know the impact of the evaluation of the indication of piperacillin-tazobactam in the framework of the Antimicrobial Stewardship Program (ASP) during the shortage period of 2018.Methods: The interventions carried out by the ASP were analyzed prospectively. Were collected: demographic and clinical variables, previous antibiotherapy, background, recommendation made, acceptance, cure, mortality attributable to the infection and gross mortality at 30 days. Likewise, the impact on consumption and cost of piperacillin-tazobactam and carbapenems was evaluated. We compared the cases that evolved to clinical cure and mortality, among patients whose physicians accepted or rejected the recommendation for modification.Results: 181 recommendations were made (126 patients), the treatment was adequate in 53.6%, 28.2% de-escalation, 8.8% suspension, 5.5% dose adjustment and 2.2% escalation. Overall acceptance was 91.6%. The most recommended antibiotics were cephalosporins with or without anaerobicide (60%).The clinical cure was 85%, the gross mortality 21% and the attributable 8.7%. No differences were found in clinical cure (p=0.068) and mortality (p=0.68) among those who accepted and rejected the recommendations. The consumption of piperacillin-tazobactam was reduced by 58.6%, with an estimated saving of 204,299 euros. The consumption of carbapenems was increased by 6.1%.Conclusion: ASP intervention on the prescription of piperacillin-tazobactam has been mostly accepted, efficient, neutral in clinical outcomes and has prevented displacement to carbapenems. (AU)

Absenteísmo à consulta odontológica de crianças com até 5 anos: o caso de Belo Horizonte / Non-show to dental appointments of children up tp 5 years: Belo Horizonte's case

Estudos epidemiológicos têm apontado que as crianças brasileiras na faixa etária de cinco anos apresentam elevada prevalência de cárie e um alto índice de faltas às consultas agendadas na rede pública de saúde. Objetivo: Compreender as razões que levam os pais ou responsáveis de crianças até 5 anos de idade ao não comparecimento ao tratamento odontológico na rede pública de saúde. Metodologia: Seguindo a metodologia qualitativa, foram selecionadas pelo menos duas mães ou cuidadores de pacientes que faltaram à consulta odontológica agendada, em cada uma das regiões administrativas de Belo Horizonte ¿ MG, Brasil, totalizando 18 entrevistados. As entrevistas seguiram um roteiro semiestruturado, sendo gravadas em áudio e posteriormente transcritas na íntegra. Os dados obtidos foram lidos, tematizados e submetidos à análise de conteúdo. Resultados: Os depoimentos evidenciaram que os responsáveis, embora tenham a percepção da necessidade de tratamento odontológico das crianças, enfrentam dificuldades para levá-las às consultas agendadas por não estarem disponíveis para acompanhar a criança (e. g., por falta de tempo livre do trabalho). Alguns narraram o esquecimento devido à demora entre data de marcação e data da consulta, enquanto outros elencaram doença da criança no dia do atendimento. Pode-se observar que houve ruído na comunicação entre os atores sociais envolvidos, confirmado por meio de relatos de desconhecimento do agendamento. Conclusão: É necessário incluir o aconselhamento centrado no empoderamento dos cuidadores durante o planejamento de estratégias para a promoção e atenção à saúde bucal de crianças com 5 anos ou menos. Além disso, a modificação na forma como é realizado o agendamento das crianças (e. g., com lembretes próximos à data da consulta ou horários alternativos de funcionamento das unidades de saúde) poderia beneficiar a utilização do serviço

Epidemiological surveys have revealed a high prevalence of caries among children aged 5 years in Brazil, as well as the population's high no-show rate at dental appointments scheduled in the public health system. Objective: To identify the reasons for nonattendance at dental appointments scheduled in the public health system among children aged up to 5 years. Methodology: Following a qualitative methodology, at least two mothers or caregivers of patients who missed dental appointments from each administrative region of the Belo Horizonte- MG, Brazil...

Auditoria financiera, informe financiero complementario, evaluación del sistema de control interno / En

Se realiza un servicio de auditoria externa que se presenta a la Central de Abastecimiento de Suministros-CEASS, por el año terminado en diciembre 31 del 2000

Liquefaction remediation near existing lifeline structures

Organized and systematic studies on the phenomenom of liquefaction began after the 1964 Niigata earthquake. Great progress has been made through research, much of it conducted by researchers in Japan and U.S., to develop a dfundamental understanding of the mechanism of liquefaction. A number of in-situ ground improvement methods have been developed to reduce the vulnerability of ground susceptible to liquefaction. May of these methods were developed empirically, and some are very costly to implement. This paper examines the critical factors that influence the effectiveness of live ground improvement techniques which are most suitable for remedial work near existing lifeline structures. Expected cost of using these methods are given, even though the cost data from cases examined is scarce. Advantages and constraints of each of these methods are presented. Eight case histories of remedial work near existing lifeline structures are reviewed.(AU)

Experimental study on countermeasures against liquefaction - induced lateral ground movement by in - ground wall

This paper presents the results of experimental study of countermeasures against liquefaction-induced lateral ground movement by in-ground wall. Experiments were carried out using the shaking table under 1G condition, in order to measure external force on a in-ground wall during liquefied ground movement. The conditions of experiment were initial gradients of ground surface, ground water level and effects of unliquefiable layer on ground surface. From the experimental results, it was proved that the external force on in-ground wall depends on the depth in liquedied layer, and the external force indicates the large value when there is unliquefiable layer on ground surface.(AU)

How lifeline service restoration affects emergency management issues

The relationship between lifeline service restoration and societal reactions after the Hanshin-Awaji earthquake disaster of January 17, 1995 is reviewed in terms of the emergency management point of view. We will discuss how formal organizational responses were enacted, issues concerning emergency responses, relief activities, and restoration activities. We introduce a decision making model for disaster management.(AU)

Soil liquefaction, large ground deformation and earthquake resistant design of lifelines

The U.S.-Japan Research Program on soil liquefaction, large ground deformation, and earthquake resistant design of lifeline facilities focuses on the earthquake perfomance of vital systems, such as water supply, transportation, gas and liquid fuel, telecommunications, electric power, and wastewater conveyance and treatment. Emphasis is placed on liquefaction-induced soil movements and their effects on lifelines. There is recognition in the civil and earthquake engineering communities of the importance of large ground deformations, yet our understanding of the mechanisms of movement and our ability to predict magnitude and distribution of displacements are kimited and in need of substantial improvement. Permanent ground movements are known to have been the most troublesome source of subsurface structural damage during previous earthquakes. Both U.S. and Japanese researchers have coordinated their efforts to collect case history data and recommend analytical and design methods on the basis of a careful data review.(AU)

Earthquake perfomance and simulation of San Francisco's auxiliary water supply system

This project involved the development, verification, and implementation of aninteractive computer program with color graphics to model the Auxiliary Water Supply System (AWSS) of San Francisco. The AWSS was built as a consequence of the 1906 San Francisco earthquake to provide fire protection in coordination with the Municipal Water Supply System. Composed of approximately 200 km of 250 to 500-mm-diameter pipelines, it is the backbone of San Francisco's fire protection and critically important for emergency response after a major earthquake.(AU)

Systems analysis for Memphis light, gas and water

In this study, a coordinates systems approach was used to examine the overall seismic perfomance of MLGW's lifeline systems. The study examined: seismic hazard and ground motion characteristics of the area; geotechnical features, with a special emphasis on liquefaction and resulting lateral spread; the effect of ground motion and geotechnical features on the seismic perfomance of mechanical and structural components including pipelines, storage tanks, pumping stations, treatment facilities, etc., measured in terms of fragility quantities; reliability and interactive nature of system functionality under severe seismic conditions with the aid of Monte Carlo techniques utilizing component fragility information; and the socioeconomic impact arising from system failure.(AU)

Estimation of indirect losses caused by disruption of lifeline service : A pilot study of the Memphis light, gas and water system

A general methodology for estimating the indirect losses caused by a disruption of lifeline service is presented. This methodology is different from previous approaches in that it attempts to incorporate local data on lifeline usage patterns and detailed information on regional economics into the analysis. Although the analysis is presented using natural gas as the pilot system, the methodology is general enough to have application for other lifeline systems. Since the conduct of this study is part of a large National Center for Earthquake Engineering Research (NCEER) effort that involves multiple investigators, parts of the analysis are still being perfomed. Therefore, what is presented in this paper is a snapshot of the analysis with particular focus on model development. Models for natural gas usage, economic productivity and natural gas outage are presented. In order to provide the reader with some understanding of how the results of the analysis will feed into the overall loss assessment procedure, a general discussion of the methodology is presented along with a discussion of future activities. This study is part of the Urban Seismic Risk Project that is being sponsored in whole by the NCEER.(AU)

Troubles people have to suffer when lifelines fail to function after earthquake

In the rehabilitation stage of lifelines after earthquake, there would be no room for argument that people tend to experience various kinds of incovenience due to the functional failure of lifeline systems. However, we do not know yet the exact nature and degree of such incovenience people may experience during the lifeline functional failure. In order to make it the optimal the rehabilitation processes of lifelines after earthquake, we need to have some empirical data for the quantitative understanding of the incontinences. In this paper, we would like to present a model that describe the inconveniences due to lifeline functional failure based on the experiences by those who lived in Npshiro-city at time of 1983 Nihonkai-chubu earthquake.(AU)

An investigation into the Erzincan (Turkey) earthquake of march 13, 1992

An earthquake of magnitude 6.8 on the Richter occured at 19.19 on local time on March 13, 1992 in Erzincan (Turkey), which was subjected to big earthquakes in the past and situated on the famous NORTH ANATOLIAN FAULT. Following the earthquake on March 13, there were numerous aftershocks of intensive ones. The earthquake caused the loss of lives more than 590 and destroyed or heavily damaged buildings totaling ,ore than 17000 and made 35000 people homeless. Landslides, avalanches and snow-slides occured during or soon after the earthquake shook the city of Erzincan and its environment. This report will outline the invetsigation undertaken by the authors on various aspects of the earthquake (Hamada and Aydan 1992).(AU)

Post - liquefaction consolidation and lifeline damage in the Marina district after the 1989 Loma Prieta earthquake

The relationship between settlements caused by post-liquefaction consolidation and damage to buried lifeline systems is discussed. Settlement strains of submerged fill are used to evaluate the pattern of observed settlements. Vertical strains predicted with existing simplified procedures show good general agreement with observations, provided that the presence of nonliquefiable soils are accounted for properly. It appears that the postliquefaction consolidation of hydraulic fill in the Marina was influenced by layers of fine-grained sediments. The resolution in delineating subsurface conditions with cone penetration test (CPT) measurements is shown to be an important factor in estimating the magnitude and extent of post-liquefaction consolidation in the hydraulic fill.(AU)

A new method to estimate earthquake liquefaction damage to buried lifelines

A new method that relates soil movement to buried lifeline damage state has been developed and applied during a Federal Emergency Management Agency-sponsored study to evaluate the impacts of lifeline proximity during earthquakes. The method considers landslides and liquefaction as a continum of ground displacement; it uses similar analysis methods for estimating the impacts of such motions on buried lifelines. For landslides, a critical acceleration parameter is used to estimate the lifeline damage state, which is also related to a displacement scaling parameter. Similary, a Liquefaction Severity Index (LSI) parameter is used to estimate the lifeline damage state for lateral spread or liquefactions conditions. The LSI can also be related to a displacement scaling parameter. The relationship of the LSI parameter to the earthquake intensity and lifeline damage state is new and is based on empirical data and expert judgement.(AU)