RESUMO
OBJECTIVES: To analyze the influence of the COVID-19 pandemic on the productivity of general teaching hospitals in Brazil, by region and legal entity, and to propose parameters of care. METHODS: This was an observational study by means of mathematical modeling with data envelopment analysis and Malmquist index, using data on inputs and healthcare output before (2019) and during (2021) the pandemic. RESULTS: A total of 149 general teaching hospitals were analyzed, 32 of which were considered efficient. There was a decrease in productivity across all regions and legal entity. To bring all inefficient hospitals to the efficiency frontier generated by the model, there is a need to increase output by 2,205,856 (96.5%) hospitalizations and 872,264 (107.4%) surgeries. CONCLUSION: The decline in hospital productivity resulted from the social commitment of hospitals during the pandemic, with a change in the care delivery pattern. The mathematical model used allows for the generation of parameters to facilitate the efficient recovery of care services after the end of public health emergency, and can be applied to hospital planning. MAIN RESULTS: The COVID-19 pandemic led to a reduction in productivity of general teaching hospitals in Brazil across all regions and in all legal entity types. In order to recover, these hospitals will need to increase their average hospitalizations by 96.5% and surgeries by 107.4%. IMPLICATIONS FOR SERVICES: The study presents a methodology that can be adapted and replicated in the management of healthcare services in the country, by defining an efficiency score and calculating the parameters, in a scenario of care recovery following the end of the public health emergency. PERSPECTIVES: Additional qualitative analysis and application of DEA- Malmquist in subsequent years will validate dynamic planning, which considers multiple fluctuations and the influence of new factors and contexts that impact productivity (such as the pandemic).
Assuntos
COVID-19 , Eficiência Organizacional , Hospitais de Ensino , Humanos , Brasil/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Modelos Teóricos , Hospitalização/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , PandemiasRESUMO
INTRODUCTION: The aim of the study was to determine the organization of healthcare activity of internal medicine (IM) services in the surgical area of general acute care hospitals in Argentina. METHODS: A cross-sectional descriptive observational study was performed between 03/01/19-05/01/19. A web survey about shared care (SC) and internal medicine consultations (IMC) was implemented. General acute hospitals under public and non-public management were included. RESULTS: The survey was answered by 141 institutions (58% public), 40% have SC in charge of fixed or rotating internists (88% in orthopedic surgery and 72% in general surgery). Response to IMC: only internists (57%), internists accompanied by IM residents (40%) and only residents (3%). The assignment of the IMC is shared with other tasks of the service (96%); the request is mixed (verbal-written) in 62% and only written in 35%. The follow-up is carried out by the same doctor who responds to the MI in 56%. The response to the IMC is written and verbal (94%) and there is some type of record of the activity (71%). DISCUSSION: The activity of the internist in the surgical area is mainly through the MI and in less than half it is through SC. In Argentina, there is no uniform pattern in the organization of activity of the internist in response to the demand for IMC and in the practice of SC. The activities are subordinate to the activities of the internal medicine service, and it is a statistically hidden activity.
Introducción: El objetivo fue determinar la organización de la actividad asistencial del médico internista en el área quirúrgica de los hospitales generales de agudos en Argentina. Métodos: Se realizó un estudio observacional descriptivo transversal entre 01/03/19 y 01/05/19 mediante una encuesta en línea sobre asistencia compartida (AC) e interconsultas (IC). Se incluyeron hospitales generales de agudos de gestión pública y no pública. Resultados: Contestaron la encuesta 141 instituciones (58% públicas), 40% tiene AC a cargo de internistas fijos o rotativos (88% en traumatología y 72% en cirugía general). Respuesta a las IC: solo internistas (57%), internistas acompañados por residentes (40%) y solo residentes (3%). La asignación de la IC es compartida con otras tareas del servicio (96%). La solicitud de IC es mixta (verbal-escrita) en el 62% y solo escrita en el 35%. El seguimiento está a cargo del mismo médico que responde la IC en el 56%. La respuesta a la IC es de forma escrita y verbal (94%) y existe algún tipo de registro de la actividad (71%). Discusión: La actividad del internista en el área quirúrgica es a través de la IC y en menos de la mitad es a través de AC. En Argentina, no hay un patrón uniforme en la organización de la actividad asistencial frente a la demanda de IC a clínica médica y a la práctica de AC. Las actividades están subordinadas a las actividades de los servicios clínicos y es una actividad estadísticamente oculta.
Assuntos
Medicina Interna , Argentina , Medicina Interna/estatística & dados numéricos , Estudos Transversais , Humanos , Cirurgia Geral/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Background: Rare diseases (RD) are those that have a low prevalence in the population; ≈80% have a genetic origin, and to diagnose them it takes from 5 to 10 years, and they require evaluations from ≈10 specialists. There is no international consensus on the definition and number of RDs, which affects the availability of resources for their diagnosis, treatment, and research. Objective: To determine the prevalence of RDs in the Medical Genetics Service of a regional general hospital belonging to the Mexican Institute for Social Security (IMSS), in Puebla, Mexico. Material and methods: The patients' records who were evaluated by the above-mentioned service from January 2019 to June 2022 were reviewed. Those patients with a diagnosis of a RD were identified, and the prevalence was obtained by using the formula: total number of cases of the disease/number of people in the population at that moment in time. Results: A total of 798 medical records were reviewed and a prevalence of RDs of 27% was obtained. Those diseases with a prevalence of 1 case per 2000 inhabitants were considered, being 118 different RD. Considering only the 20 rare diseases registered in Mexico in 2022, 11 of these were detected, distributed in 35 patients, with an estimated prevalence of 4.3%. Conclusion: The prevalence of RDs differs according to the criteria implemented. In Mexico, several diseases that fall within the definition of a RD based on their prevalence were not considered as such until 2022, so the recent recognition of rare diseases included by the World Health Organization will benefit affected patients.
Introducción: son enfermedades raras (ER) aquellas con baja prevalencia en la población; ≈80% tienen un origen genético, y para su diagnóstico pasan de 5 a 10 años y se requieren valoraciones de ≈10 especialistas. No hay un consenso internacional sobre la definición y el número de ER, lo que afecta la disponibilidad de recursos para su diagnóstico, tratamiento e investigación. Objetivo: determinar la prevalencia de las ER en el Servicio de Genética Médica de un hospital general de zona del Instituto Mexicano del Seguro Social (IMSS), en Puebla, México. Material y métodos: se revisaron los expedientes de los pacientes valorados por el servicio mencionado de enero de 2019 a junio de 2022. Se identificaron los pacientes con diagnóstico de alguna ER, y se obtuvo la prevalencia mediante la fórmula: número total de casos de la enfermedad/número de personas en la población en ese momento del tiempo. Resultados: se revisaron un total de 798 expedientes y se obtuvo una prevalencia de ER del 27%. Se consideraron aquellas enfermedades con una prevalencia de un caso por cada 2000 habitantes, con 118 ER diferentes. Considerando solo las 20 ER registradas en México en el 2022, se detectaron 11 de estas, distribuidas en 35 pacientes, con una prevalencia de 4.3%. Conclusión: la prevalencia de ER difiere según los criterios empleados. En México, muchas enfermedades que cumplen con la definición de ER con base en su prevalencia no eran consideradas como tales hasta el 2022, por lo que el reciente reconocimiento de las ER incluidas por la Organización Mundial de la Salud beneficiará a los pacientes afectados.
Assuntos
Doenças Raras , Previdência Social , Humanos , México/epidemiologia , Doenças Raras/epidemiologia , Doenças Raras/diagnóstico , Previdência Social/estatística & dados numéricos , Masculino , Feminino , Adulto , Prevalência , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Criança , Estudos Retrospectivos , Idoso , Pré-Escolar , Genética Médica/estatística & dados numéricos , Lactente , Hospitais Gerais/estatística & dados numéricosRESUMO
Background: The use of blood components seeks to achieve a therapeutic effect to solve transfusion needs. In cases where they are indicated inappropriately, transfusion has not only a negative effect on the patient's life but also an increase in hospital stays. Objective: To evaluate the appropriate use of blood components in the adult population of the services of the General Hospital of Zone No. 20. Material and methods: Descriptive, cross-sectional, prospective study, non-probabilistic consecutive sampling, over 18 years of age, transfused during their hospital stay. Compared with national and international guidelines for the use of blood components, analyzed with descriptive and inferential statistics. Results: 457 transfusions were included during May to October 2022, of which 62 transfusions (14%) presented inappropriate use. Erythrocyte concentrates are the most transfused, of which 50 transfusions were inappropriate. In the case of platelets (120 concentrates and 5 platelet apheresis) they were used appropriately, while fresh frozen plasma demonstrated inappropriate use in 12 transfusions. Conclusions: Due to the significant inappropriate use of blood components in the Hospital, it is necessary to implement improvement strategies in the management of blood components with the purpose of reducing risks and costs in administration.
Assuntos
Transfusão de Componentes Sanguíneos , Humanos , Estudos Transversais , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Transfusão de Componentes Sanguíneos/normas , Estudos Prospectivos , Adulto , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Adulto Jovem , México , Adolescente , Hospitais Gerais , Fidelidade a Diretrizes/estatística & dados numéricos , Guias de Prática Clínica como AssuntoRESUMO
Introducción. La urticaria crónica es una afección inflamatoria de la piel caracterizada por presencia de habones evanescentes y/o angioedema, que ocurren durante un período ≥ 6 semanas. Objetivo. Determinar la prevalencia de esta enfermedad y describir características clínicas en niños y adolescentes menores de 19 años de un hospital general. Población y métodos. Estudio corte transversal, realizado entre el 2015 y el 2020, en una población de niños y adolescentes de un sistema de salud privado. Resultados. Se revisaron 1567 historias clínicas de pacientes con urticaria atendidos durante el período de estudio. Se identificaron 36 pacientes con urticaria crónica; se estableció una prevalencia del 0,16 % (IC95% 0,11-0,22). Conclusión. La prevalencia de urticaria crónica en niños y adolescentes fue del 0,16 %. Se observó mayor frecuencia en el sexo femenino y adolescentes.
Introduction. Chronic urticaria is an inflammatory skin condition characterized by the presence of evanescent wheals or angioedema that last for ≥ 6 weeks. Objective. To determine the prevalence of urticaria and describe its clinical characteristics in children and adolescents under 19 years of age in a general hospital. Population and methods. This was a cross-sectional study carried out between 2015 and 2020 in a population of children and adolescents seen at a private healthcare facility. Results. A total of 1567 medical records of patients with urticaria seen during the study period were reviewed. Thirty-six patients with chronic urticaria were identified; the prevalence was 0.16% (95% CI: 0.110.22). Conclusion. The prevalence of chronic urticaria in children and adolescents was 0.16%. A higher frequency was observed among girls and adolescents.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Urticária Crônica/epidemiologia , Hospitais Gerais , Urticária/epidemiologia , Prevalência , Estudos Transversais , Estudos RetrospectivosRESUMO
Adverse events (AEs), and particularly adverse drug events (ADEs), represent a health problem as they can cause permanent damage or death. Understanding the frequency, location, and causes of ADEs can prevent harm to patients. The Global Trigger Tool, produced by the Institute for Healthcare Improvement (GTT/IHI), is widely used to identify AEs. Recognizing the profile of patients who suffer ADEs can reveal clinical or individual characteristics that predispose to the occurrence of AEs. A cross-sectional study was carried out through a retrospective analysis of 120 medical charts of patients discharged from hospital between October 2020 and April 2021. Patients over 18 years old, with a length of stay of more than 24 h, were included. The list of triggers used was from the medication module of the GTT/IHI, which was adapted for use in the institution. Two primary reviewers and a medical reviewer applied this tool. The primary reviewers independently assessed the randomized charts. A meeting to achieve consensus among the reviewers was held every 2 weeks to validate the identified ADEs; classifications were based on harm severity. Multivariate logistic regression was utilized to assess the variables that predicted the occurrence of ADEs, using the backward stepwise method. A total of 43 ADEs were identified, with a frequency of 36 per 100 admissions (43/120). Of these, five ADEs (12%) were responsible for patients being admitted to hospital. In the case of in-hospital ADEs, there were 42.2 per 1000 patients/day. The clinical manifestation of altered kidney function (16%) and the anatomical drug group of the nervous system (33%) were the most frequent ADEs. The multivariate logistic regression model was significant (×2 = 44.960, P < .001), indicating that factors such as: known drug allergy [odds ratio 5.728; 95% confidence interval (CI): 1.249, 26.274, P = .025]; being clinically hospitalized (odds ratio 7.504; 95% CI: 1.654, 34.037; P = .009); number of medicines used (odds ratio 1.100; 95% CI: 1.054, 1.148; P < .001); and being under the care of internal medicine (odds ratio 3.633; 95% CI: 1.257, 10.511; P = .017) were predictor variables associated with the occurrence of ADEs. A significant percentage of hospitalized patients experienced at least one ADE, with rates surpassing those found in similar studies. The GTT/IHI effectively assessed medication-related harm, emphasizing the need for tailored triggers based on population characteristics. Predictor variables can inform preventive strategies. Overall, the tool facilitated a localized risk assessment of medication use.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hospitais Gerais , Humanos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Estudos Transversais , Masculino , Feminino , Estudos Retrospectivos , Fatores de Risco , Pessoa de Meia-Idade , Idoso , AdultoRESUMO
The benefits of therapeutic play (TP) in pediatrics are widely reported in the literature, however its use by health professionals is still limited. The objective was to understand how professionals belonging to the BrinquEinstein group evaluate the process of systematic implementation of TP in hospital pediatric units. Exploratory study, with a qualitative approach, developed in the pediatric and intensive care units of extra-large general hospital in São Paulo. The sample consisted of 13 professionals from different categories belonging to BrinquEinstein. Data was collected through individual semi-structured and audio-recorded interviews, being analyzed based on the Inductive Thematic Analysis proposed by Braun and Clark. From the analysis of the interviews, five themes emerged: experiencing a transforming process; the benefits that strengthen the path; the facilities that encourage the walk; the barriers that challenge the process; the future prospects. For the interviewed professionals, it is essential that the use of TP becomes a routine practice in different contexts of the child´s healthcare, in which managers and institutions play a fundamental role in its implementation.
Os benefícios do brinquedo terapêutico (BT) em pediatria são amplamente divulgados na literatura, entretanto, seu uso pelos profissionais de saúde ainda é limitado. Objetivou-se compreender como os profissionais que pertencem ao grupo BrinquEinstein e avaliam o processo de implementação sistemática do BT em unidades pediátricas hospitalares. Realizou-se estudo exploratório, de abordagem qualitativa, nas unidades pediátrica e de terapia intensiva de um hospital geral de extraporte, na cidade de São Paulo. Participaram 13 profissionais de diferentes categorias pertencentes ao BrinquEinstein. Os dados foram coletados por meio de entrevista semiestruturada individual e audiogravada, sendo analisados a partir da Análise Temática Indutiva proposta por Braun e Clark. Da análise das entrevistas, emergiram cinco temas: vivenciando um processo transformador; os benefícios que fortalecem o caminho; as facilidades que impulsionam a caminhada; as barreiras que desafiam o processo; e as perspectivas futuras. Para os profissionais entrevistados, é imprescindível que o uso do BT se torne uma prática rotineira nos diferentes contextos de atendimento à saúde da criança, sendo que gestores e instituições têm papel fundamental na sua implementação.
Assuntos
Atitude do Pessoal de Saúde , Entrevistas como Assunto , Pediatria , Ludoterapia , Humanos , Pediatria/organização & administração , Criança , Ludoterapia/métodos , Pessoal de Saúde/organização & administração , Brasil , Masculino , Feminino , Hospitais Gerais/organização & administração , Unidades de Terapia Intensiva Pediátrica/organização & administração , AdultoRESUMO
BACKGROUND: Depression represents one of the leading causes of disability due to illness worldwide. Previous studies have demonstrated the significant heterogeneity of the diagnosis of depression, making it necessary to develop new diagnostic approaches. Network analysis is a perspective that considers symptoms as constituents of the psychiatric disorder itself. The objective was to determine the structure of depressive symptoms using the CES-D and ZDS depression scales. METHODS: Cross-sectional study of secondary analysis of 194 patients using the CES-D and ZDS scales. Correlation matrices and regularised partial correlation networks were constructed from the database. Centrality measures were estimated, and a network stability analysis was performed. RESULTS: On the CES-D scale, the most central item was "Sad"; while on the ZDS scale, the most central items were "Sad" and "Live". On the CES-D scale, the connection between "Enjoy" and "Happy" was the strongest. On the ZDS scale, the strongest connection was between the items "Live" with "Useful". The item "Morning" was the least connected on the ZDS. CONCLUSIONS: The most central symptom from the CES-D scale was sadness, while from the ZDS scale, was sadness and anhedonia.
Assuntos
Depressão , Hospitais Gerais , Pacientes Ambulatoriais , Escalas de Graduação Psiquiátrica , Humanos , Peru , Estudos Transversais , Masculino , Feminino , Depressão/epidemiologia , Depressão/diagnóstico , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Idoso , Adolescente , AnedoniaRESUMO
PURPOSE: Surgical patients are routinely subjected to long periods of fasting, a practice that can exacerbate the metabolic response to trauma and impair postoperative recovery. The aim of this study was to evaluate the association between preoperative fasting time and clinical outcomes in surgical patients. METHODS: An observational, prospective study with a non-probabilistic sample that included patients of both sexes, aged over 18, undergoing elective surgeries. Data were extracted from electronic medical records, and a questionnaire was applied in 48 hours after surgery. Variables related to postoperative discomfort were assessed using an 11-point numeric rating scale. RESULTS: The sample consisted of 372 patients, and the duration of the surgical event ranged from 30-680 minutes. The incidence of nausea (26.34%) was twice that of vomiting (13.17%) and showed an association with the surgical procedure's size (p = 0.018). A statistically significant difference was observed only between pain intensity and preoperative fasting times for liquids (p = 0.007) and postoperative fasting time (p = 0.08). The occurrence of postoperative complications showed no association with preoperative fasting time (p = 0.850). CONCLUSIONS: Although no association was observed between preoperative fasting time and surgical complications, it is noteworthy that both recommended and actual fasting time exceeded the proposed on clinical guidelines.
Assuntos
Jejum , Hospitais Gerais , Período Pré-Operatório , Humanos , Feminino , Masculino , Estudos Prospectivos , Pessoa de Meia-Idade , Adulto , Fatores de Tempo , Idoso , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Adulto Jovem , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Resultado do Tratamento , Dor Pós-Operatória/etiologia , Inquéritos e Questionários , Náusea e Vômito Pós-Operatórios/epidemiologiaRESUMO
Introducción. La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes en la población pediátrica, afecta la calidad de vida del niño y la familia, tiene impacto económico y es frecuentemente subdiagnosticada y subtratada. Dada la escasez de datos locales, se describe su prevalencia y las características clínicas de la población en estudio. Población y métodos. Estudio observacional de corte transversal de pacientes menores de 19 años. Resultados. Se incluyeron 250 pacientes al azar, con una media de edad de 9 años (DE 5) Presentaron diagnóstico de RA 14 de ellos; se observó una prevalencia de RA del 6 %. Conclusiones. La prevalencia de RA en nuestro medio es del 6 %. Debemos darle la relevancia que amerita para brindar un diagnóstico y tratamiento adecuado.
Introduction. Allergic rhinitis (AR) is one of the most frequent chronic diseases in the pediatric population; it affects the quality of life of children and their families, has economic impact, and is frequently underdiagnosed and undertreated. Given the scarcity of local data, here we describe the prevalence of AR and the clinical characteristics of the study population. Population and methods. Observational, cross-sectional study in patients younger than 19 years. Results. A total of 250 patients were randomly included; their mean age was 9 years (SD: 5). AR was diagnosed in 14 of them. The prevalence of AR was 6%. Conclusions. The prevalence of AR in our setting was 6%. AR should be given the relevance it deserves so as to provide an adequate diagnosis and treatment.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Rinite Alérgica/diagnóstico , Rinite Alérgica/epidemiologia , Hospitais Gerais , Pediatria , Prevalência , Estudos Transversais , Departamentos Hospitalares/estatística & dados numéricosRESUMO
Introduction. Chronic urticaria is an inflammatory skin condition characterized by the presence of evanescent wheals or angioedema that last for ≥ 6 weeks. Objective. To determine the prevalence of urticaria and describe its clinical characteristics in children and adolescents under 19 years of age in a general hospital. Population and methods. This was a cross-sectional study carried out between 2015 and 2020 in a population of children and adolescents seen at a private healthcare facility. Results. A total of 1567 medical records of patients with urticaria seen during the study period were reviewed. Thirty-six patients with chronic urticaria were identified; the prevalence was 0.16% (95% CI: 0.11-0.22). Conclusion. The prevalence of chronic urticaria in children and adolescents was 0.16%. A higher frequency was observed among girls and adolescents.
Introducción. La urticaria crónica es una afección inflamatoria de la piel caracterizada por presencia de habones evanescentes y/o angioedema, que ocurren durante un período ≥ 6 semanas. Objetivo. Determinar la prevalencia de esta enfermedad y describir características clínicas en niños y adolescentes menores de 19 años de un hospital general. Población y métodos. Estudio corte transversal, realizado entre el 2015 y el 2020, en una población de niños y adolescentes de un sistema de salud privado. Resultados. Se revisaron 1567 historias clínicas de pacientes con urticaria atendidos durante el período de estudio. Se identificaron 36 pacientes con urticaria crónica; se estableció una prevalencia del 0,16 % (IC95% 0,11-0,22). Conclusión. La prevalencia de urticaria crónica en niños y adolescentes fue del 0,16 %. Se observó mayor frecuencia en el sexo femenino y adolescentes.
Assuntos
Urticária Crônica , Hospitais Gerais , Humanos , Estudos Transversais , Feminino , Adolescente , Masculino , Criança , Prevalência , Urticária Crônica/epidemiologia , Pré-Escolar , Lactente , Urticária/epidemiologia , Estudos RetrospectivosRESUMO
The aim of this study was to investigate multi-drug-resistant (MDR) Escherichia coli in urine of adult male patients with enlarged prostate. Three hundred and sixty-eight samples of urine and blood were collected. Escherichia coli was isolated, purified, and identified and prostate-specific antigen (PSA) was determined. Multi-drug resistance test and specific drug resistance genes were assessed. Prevalence of Escherichia coli was high (38.5%) in patients with PSA of 60-79 ng ml-1 and 60% were MDR. The isolates showed highest resistance to tetracycline (53.3.0%) and least to cephalosporins (5%). They had intL and gyrA genes, which are integron, and quinolone resistance genes and sul1 and sul2 which are sulphonamide resistance-associated genes. Levofloxacin, ertapenem, and Augmentin (100% susceptibilities) were considered choice drugs for treatment of Escherichia coli infection in patients with elevated PSA.
Assuntos
Infecções por Escherichia coli , Hospitais Gerais , Adulto , Humanos , Masculino , Próstata , Antígeno Prostático Específico , Escherichia coli/genética , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Antibacterianos/farmacologia , Levofloxacino , Testes de Sensibilidade Microbiana , Farmacorresistência Bacteriana Múltipla/genéticaRESUMO
Introduction. Allergic rhinitis (AR) is one of the most frequent chronic diseases in the pediatric population; it affects the quality of life of children and their families, has economic impact, and is frequently underdiagnosed and undertreated. Given the scarcity of local data, here we describe the prevalence of AR and the clinical characteristics of the study population. Population and methods. Observational, cross-sectional study in patients younger than 19 years. Results. A total of 250 patients were randomly included; their mean age was 9 years (SD: 5). AR was diagnosed in 14 of them. The prevalence of AR was 6%. Conclusions. The prevalence of AR in our setting was 6%. AR should be given the relevance it deserves so as to provide an adequate diagnosis and treatment.
Introducción. La rinitis alérgica (RA) es una de las enfermedades crónicas más frecuentes en la población pediátrica, afecta la calidad de vida del niño y la familia, tiene impacto económico y es frecuentemente subdiagnosticada y subtratada. Dada la escasez de datos locales, se describe su prevalencia y las características clínicas de la población en estudio. Población y métodos. Estudio observacional de corte transversal de pacientes menores de 19 años. Resultados. Se incluyeron 250 pacientes al azar, con una media de edad de 9 años (DE 5) Presentaron diagnóstico de RA 14 de ellos; se observó una prevalencia de RA del 6 %. Conclusiones. La prevalencia de RA en nuestro medio es del 6 %. Debemos darle la relevancia que amerita para brindar un diagnóstico y tratamiento adecuado.
Assuntos
Hospitais Gerais , Rinite Alérgica , Humanos , Estudos Transversais , Criança , Rinite Alérgica/epidemiologia , Rinite Alérgica/diagnóstico , Masculino , Feminino , Prevalência , Pré-Escolar , Adolescente , Departamentos Hospitalares/estatística & dados numéricos , PediatriaRESUMO
It is necessary to know the resistance profile of Staphylococcus aureus to better control diabetic foot ulcer infections, to establish rational antibiotic therapy, and to avoid the development of resistant strains. This cross-sectional study evaluated the clinical parameters, virulence, and antimicrobial resistance profiles of S aureus in patients with diabetic foot disease admitted to a public hospital. S aureus strains were identified in patients with diabetes with amputation indication. Infected tissue samples were collected, microbes were isolated and identified. The microbial resistance profile was determined. Samples were also analyzed for biofilm formation and other virulence markers. The 34 individuals examined were mostly men, black, aged 60 years on average, and generally had a low income and education level. Most individuals had type 2 diabetes, and the mean time since diagnosis was 13.9 years. On an SF-36 (the Medical Outcomes Study 36-item short-form health survey) quality-of-life questionnaire, 75% of individuals obtained a score equal to 0 for physical impairment. S aureus specimens from 17 patients were isolated, corresponding to 50% of samples. Five isolates were classified as methicillin-resistant S aureus (MRSA). Molecular typing revealed that 20% of MRSA strains were SCCmec type V and 80% were type I. All isolates were sensitive to doxycycline; 61.5% were resistant to erythromycin, 38.5% to cefoxitin, 30.7% to clindamycin and ciprofloxacin, 23% to meropenem, 15.3% to gentamicin, 38.5% to oxacillin, and 7.7% (one strain) to vancomycin. Regarding biofilm production, 53% of samples were able to produce biofilms, and 84.6% had icaA and/or icaD genes. Additionally, the following enterotoxin genes were identified in the isolates: seb, sec, seg, and sei (5.9%, 5.9%, 11.8%, and 23.9%, respectively) and agr types 1 (5.9%) and 2 (11.8%). Genotypic evaluation made it possible to understand the pathogenicity of S aureus strains isolated from the diabetic foot; laboratory tests can assist in the monitoring of patients with systemic involvement.
Assuntos
Antibacterianos , Pé Diabético , Infecções Estafilocócicas , Humanos , Pé Diabético/microbiologia , Pé Diabético/diagnóstico , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Transversais , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/diagnóstico , Brasil/epidemiologia , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Hospitais Gerais , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Idoso , Testes de Sensibilidade Microbiana , Biofilmes , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/genéticaRESUMO
BACKGROUND: In 1944, the call for the construction of "La Raza" Hospital in Mexico City was launched. The project included the proposal to create two murals, and the artists who were invited to participate were Diego Rivera and David Alfaro Siqueiros, who, with their work, bore testimony to the advent of modern medicine and the construction of the social security model in force in Mexico. OBJECTIVE: To determine how mural art is historically linked to medicine in Mexico and how they complement each other, considering two works carried out at the same time and in the same hospital. MATERIAL AND METHODS: Analysis of the historical context and iconographic and iconological analysis of "La Raza" Hospital murals. RESULTS: It was possible to clarify the relationship of the artists with medicine and the role murals play within the modern vision of medicine. CONCLUSIONS: Mural art is intertwined with medicine because it bears witness to the advent of the construction of the social security model currently in force in Mexico, since hospitals became social achievements of the State and were to be known as symbols of welfare and modernity in Mexico.
ANTECEDENTES: En 1944 se lanzó la convocatoria para la construcción del Hospital de Zona Número 1 "La Raza" en el Distrito Federal, México. El proyecto incluyó la propuesta de realizar dos murales y los artistas invitados a participar fueron Diego Rivera y David Alfaro Siqueiros, quienes con su obra dieron testimonio del advenimiento de la medicina moderna y de la construcción del modelo de seguridad social vigente en México. OBJETIVO: Determinar cómo se enlaza históricamente el arte mural con la medicina en México y cómo se complementan entre sí, considerando dos trabajos realizados en la misma época y en el mismo hospital. MATERIAL Y MÉTODOS: Análisis del contexto histórico y análisis iconográfico e iconológico de los murales del Hospital "La Raza". RESULTADOS: Se logró esclarecer cuál fue la relación de los artistas con la medicina y qué papel desempeñan los murales dentro de la visión moderna de la medicina. CONCLUSIONES: El arte mural se entrelaza con la medicina porque da testimonio del advenimiento de la construcción del modelo de seguridad social vigente en México, ya que los hospitales se convirtieron en logros sociales del Estado y se dieron a conocer como símbolos de bienestar y modernidad en México.
Assuntos
Arte , Hospitais Gerais , Medicina , MéxicoRESUMO
OBJECTIVE: This study aimed to describe the clinical characteristics of the pediatric population with COVID-19 in an Emergency Department (ED) of a Brazilian general hospital. METHODS: Epidemiological and clinical data of patients younger than 20 years old were collected from patients' medical records from February 2020 to July 2021. Most of the epidemiological data described pertains to hospitalized patients. We also reviewed coinfections, treatment, and outcomes and compared the first and second waves of COVID-19. RESULTS: We identified a total of 1303 episodes of SARS-CoV-2 infection. The median time from symptom onset to diagnosis was three days. Symptoms were present in 92.3% of the patients. The most common symptoms were fever (45.2%), nasal congestion/discharge (44.2%), and cough (39.4%). Chest radiography and tomography were performed in 7.7 and 3.3% of cases, with abnormal findings in 29.7 and 53.4%, respectively. Hospital admissions occurred in 3.5% of patients, mainly in the presence of comorbidities, in children under five years old and in those who presented to the ED during the first wave of COVID-19. Coinfection with a viral agent was identified in 20% of the 71 cases tested in this study, and a positive rapid test for Streptococcus pyogenes was found in 8% of the 174 cases tested, with no impact of these coinfections on hospitalization. CONCLUSIONS: We found that COVID-19 was a mild disease in most children in our study population, with most hospitalizations and readmissions occurring during the first wave of COVID-19.
Assuntos
COVID-19 , Coinfecção , Criança , Humanos , Pré-Escolar , Adulto Jovem , Adulto , Brasil/epidemiologia , SARS-CoV-2 , Coinfecção/epidemiologia , Hospitais GeraisRESUMO
OBJECTIVE: To learn about the experience of families of children and adolescents in psychological distress facing hospitalization in a psychiatric inpatient unit of a general university hospital. METHOD: This is a qualitative phenomenological-social study, with data collection carried out from February to March 2022 through open interviews, analyzed using Alfred Schutz's framework with the construction of categories of meaning. RESULTS: Based on the analysis of eight interviews, it was possible to understand changes in the families' way of life, impacts on their routine, work, and social relationships. Their expectations were about the recovery of mental health and autonomy. CONCLUSION: This study allowed us to understand the experience of families faced with the hospitalization of children and adolescents in psychological distress and understand their members' needs. The need for implementation of care spaces that incorporate the relationship between the multidisciplinary team and the family is highlighted.
Assuntos
Hospitalização , Angústia Psicológica , Humanos , Adolescente , Criança , Hospitais Gerais , Hospitais Universitários , Pacientes InternadosRESUMO
Background: In recent years, cesarean section (CS) rates have increased alarmingly. The World Health Organization (WHO) proposes to use the Robson classification system as a global standard, which contributes to a better analysis of CS indications, making it possible to establish strategies to reduce them. Objective: To analyze the classification of CS by Robson groups from July to September 2020 at the Hospital General de Zona No. 4 (District General Hospital [DGH] No. 4), in Celaya, Guanajuato. Material and methods: Retrospective study which included 160 records of women undergoing CS. Robson's group classification was used, and descriptive statistics and cluster analysis were performed to better understand the classification groups. Results: The average age was 27.6 ± 5.6 years. 53.1% had secondary school; 46.9% was a housewife; 46.3% was laborer; 42.8% were cohabitating; 50% had 1 or more births; 42.5% previous CS; 96.9% 1 fetus; 91.9% cephalic presentation; 78.8% 37 weeks of gestational age or more. Robson's group 5 (previous CS) had the highest percentage (42.5%), followed by group 2 (primiparous) with 20.6%, and group 10 (premature) 13.1%. Cluster analysis formed 3 groups, where cluster 1 and 3 contained group 5 of Robson's classification. Conclusions: DGH No. 4 must carry out the necessary strategies so that women with a previous cesarean section can have a vaginal delivery, without compromising the well-being of the mother-child pair, in addition to interventions to avoid primary CS, because women in group 1 and 2 will potentially belong to group 5, in the next obstetric event.
Introducción: recientemente las tasas de cesárea han aumentado de manera alarmante. La Organización Mundial de la Salud (OMS) propone utilizar el sistema de clasificación Robson como estándar global, lo cual contribuye a un mejor análisis de las indicaciones de cesárea y posibilita el establecimiento de estrategias para reducirlas. Objetivo: analizar la clasificación de cesáreas por grupos de Robson de julio a septiembre de 2020 en el Hospital General de Zona (HGZ) No. 4, en Celaya, Guanajuato. Material y métodos: estudio retrospectivo que incluyó 160 expedientes de mujeres sometidas a cesárea. Se utilizó la clasificación por grupo de Robson y se usó estadística descriptiva y análisis de clúster para entender mejor los grupos de clasificación. Resultados: la edad promedio fue 27.6 ± 5.6 años; 53.1% tenía secundaria; 46.9% era ama de casa; 46.3% obrera; 42.8% vivía en unión libre; 50% tuvo 1 o más partos; 42.5% cesárea previa; 96.9% un feto; 91.9% presentación cefálica, y 78.8% 37 semanas de gestación o más. El grupo 5 de Robson (cesárea previa) tuvo el mayor porcentaje (42.5%); el grupo 2 (primigestas) tuvo 20.6%, y el grupo 10 (prematuros) 13.1%. El análisis de clúster creó 3 agrupaciones, donde el clúster 1 y 3 contuvieron el grupo 5 de la clasificación de Robson. Conclusiones: el HGZ No. 4 debe establecer estrategias necesarias para que las mujeres con cesárea previa puedan tener un parto vaginal sin comprometer el bienestar del binomio madre-hijo, además de intervenciones para evitar la cesárea primaria, dado que las mujeres del grupo 1 y 2 potencialmente formarán parte del grupo 5 en el próximo evento obstétrico.
Assuntos
Cesárea , Nascimento Prematuro , Gravidez , Feminino , Humanos , Adulto Jovem , Adulto , Estudos Retrospectivos , Idade Gestacional , Hospitais GeraisRESUMO
OBJECTIVES: to identify the correlation of nurses' knowledge with the application of nurses' therapeutic communication in hospitals. METHODS: a descriptive quantitative, correlational design with a total sampling method was used in the study. Respondents were 68 nurses working in an inpatient room in one of the general hospitals in western Indonesia. Modified questionnaires were used in data collection. Analysis of the Pearson chi-square test was used in data analysis. RESULTS: nurses with sufficient and poor knowledge have a good application of therapeutic communication. There was no correlation between knowledge and the application of nurses' therapeutic communication. CONCLUSIONS: therapeutic communication is influenced by many factors, but nurses' knowledge should be maintained and improved to provide holistic care and increase patient satisfaction.
Assuntos
Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem Hospitalar , Humanos , Competência Clínica , Atitude do Pessoal de Saúde , Estudos Transversais , Hospitais Gerais , Inquéritos e Questionários , ComunicaçãoRESUMO
BACKGROUND: Pharmacological treatment with lipid-lowering and antihypertensive drugs has been proposed as a strategy to improve excess cardiovascular (CV) risk among obese individuals. The present study aimed to assess whether the CV polypill (Sincronium®) could be an effective strategy to help improve CV risk factor control in obese/overweight individuals requiring secondary prevention. METHODS: This was an observational, retrospective study reviewing the hospital medical records of 479 patients with established CV disease who initiated treatment with the CV polypill between 2013 and 2019 at a general hospital in Mexico. Patients were grouped as normal weight, overweight or obese according to their initial body mass index (BMI). We collected blood pressure (BP), lipid profile, and vascular age at the last visit recorded during the period following treatment. RESULTS: At the end of the study, all assessed lipid parameters improved compared to baseline regardless of the initial BMI category (all p<0.001). There was an increase from baseline regarding the proportion of patients with at target low-density lipoprotein cholesterol after treatment (2.3% vs. 30.1%; p<0.001), more than 80% of patients achieved triglyceride levels <200 mg/dL (p<0.001), and more than 80% achieved target BP levels in all BMI subgroups (p<0.001). The subanalyses in the elderly population yielded similar results, with a significant overall improvement in lipid and BP control after initiating the CV polypill strategy. CONCLUSIONS: The use of the CV polypill as baseline therapy for secondary prevention seems to be a reasonable strategy that enhances CV risk factor control regardless of the patient's BMI.