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1.
Medicina (B Aires) ; 80(1): 31-38, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32044739

RESUMO

A stochastic simulation model allows to study and represents in a simplified manner the behavior of complex variables in terms of probability. In this context, the objective of this work is to present, through the use of information and communication technology tools, the applicability of simulation models and methods, in studies of indicators within the health sector. Through the development of a case study, this work demonstrates the potential of the @Risk and Excel technological tools in the construction of stochastic models that allow health professionals to predict, monitor and support decision making in the treatment and monitoring of indicators and indices of a population.


Assuntos
Comunicação em Saúde , Sistemas de Informação em Saúde/estatística & dados numéricos , Tecnologia da Informação/estatística & dados numéricos , Probabilidade , Processos Estocásticos , Fatores Etários , Índice de Massa Corporal , Pré-Escolar , Equador/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Método de Monte Carlo , Obesidade/epidemiologia , Reprodutibilidade dos Testes , Fatores Sexuais
2.
PLoS One ; 15(1): e0227730, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945115

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with poor quality of life, hospitalization and mortality. COPD phenotype includes using pulmonary function tests to determine airflow obstruction from the forced expiratory volume in one second (FEV1):forced vital capacity. FEV1 is a commonly used value for severity but is difficult to identify in structured electronic health record (EHR) data. DATA SOURCE AND METHODS: Using the Microsoft SQL Server's full-text search feature and string functions supporting regular-expression-like operations, we developed an automated tool to extract FEV1 values from progress notes to improve ascertainment of FEV1 in EHR in the Veterans Aging Cohort Study (VACS). RESULTS: The automated tool increased quantifiable FEV1 values from 12,425 to 16,274 (24% increase in numeric FEV1). Using chart review as the reference, positive predictive value of the tool was 99% (95% Confidence interval: 98.2-100.0%) for identifying quantifiable FEV1 values and a recall value of 100%, yielding an F-measure of 0.99. The tool correctly identified FEV1 measurements in 95% of cases. CONCLUSION: A SQL-based full text search of clinical notes for quantifiable FEV1 is efficient and improves the number of values available in VA data. Future work will examine how these methods can improve phenotyping of patients with COPD in the VA.


Assuntos
Mineração de Dados/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Volume Expiratório Forçado/fisiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Capacidade Vital/fisiologia , Estudos de Coortes , Sistemas de Informação em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Pulmão/fisiopatologia , Processamento de Linguagem Natural , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Índice de Gravidade de Doença , Software , Estados Unidos , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos/estatística & dados numéricos
3.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(4): 947-956, Sept.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1057128

RESUMO

Abstract Objectives: to analyze the trend and the associated factors with the presence of cleft lip and/or cleft palate in Brazilian newborns, in order to verify possible associations with maternal care and newborn factors. Methods: a cross-sectional and ecological study, involving all live births in Brazil, recorded in the Information System on Live Births from 2005 to 2016. Maternal and infant information were evaluated using trend analysis and odds ratio, with a 95% confidence interval. The analyses were performed using SPSS software. Results: we analyzed 17,800 live births with presence of cleft lip and/or cleft palate. The Brazilian prevalence rate was 0.51 / 1000 live births, with South and Southeast Regions registering higher rates than the national rate. There was an association with maternal age above 35 years old, with no partner, less than seven prenatal consultations, premature birth and cesarean section. About the factors of the newborn, being male, Apgar less than seven in the 1st and 5th minutes of life, low birth weight and white color were associated. Conclusions: Brazil has an increasing tendency for cleft lip and/or cleft palate (p=0.019), reinforcing the need to strengthen health care networks, providing adequate support for newborn with cleft lip and/or cleft palate and their families.


Resumo Objetivos: analisar a tendência e os fatores associados à presença de fissura labial e/ou fenda palatina em recém-nascidos brasileiros, a fim de verificar possíveis associações da mesma com fatores maternos, assistenciais e do recém-nascido. Métodos: estudo transversal, ecológico, envolvendo todos os nascimentos vivos do Brasil, registrados no Sistema de Informação sobre Nascidos Vivos de 2005 a 2016. Foram avaliadas informações maternas e infantis, utilizando-se análise de tendência e razão de chances, com intervalo de confiança de 95%. As análises foram realizadas através do software SPSS. Resultados: foram analisados 17.800 nascidos vivos com presença de fissura labial e/ou fenda palatina. A taxa de prevalência brasileira foi de 0,51/1000 nascidos vivos, sendo que as Regiões Sul e Sudeste registraram taxas maiores do que a nacional. Houve associação com idade materna superior a 35 anos, sem companheiro, menos de sete consultas de pré-natal, nascimento prematuro e cesariana. Sobre os fatores do recém-nascido, o sexo masculino, Apgar menor que sete no 1º e 5º minutos de vida, baixo peso ao nascer e raça/cor branca apresentaram associação. Conclusões: o Brasil apresenta tendência crescente das taxas de fissura labial e/ou fenda palatina (p=0,019), reforçando a necessidade de fortalecimento das redes de atenção à saúde, prevendo o amparo adequado aos bebês com fissura labial e/ou fenda palatina e suas famílias.


Assuntos
Humanos , Recém-Nascido , Brasil/epidemiologia , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Nascimento Vivo/epidemiologia , Sistemas de Informação em Saúde/estatística & dados numéricos , Anormalidades Congênitas , Recém-Nascido de Baixo Peso , Cesárea , Estudos Transversais , Idade Materna , Nascimento Prematuro
4.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(4): 917-924, Sept.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1057129

RESUMO

Abstract Objectives: to describe the prevalence of congenital malformations in live births in Recife, based on the relationship of birth and infant death data. Methods: a cross-sectional study with data from the Live Birth Information System (Sinasc) and Mortality (MIS) of residents in Recife-PE between 2013 and 2015. The deterministic linkage of deaths and live births (LB) with malformation and the prevalence rate were calculated. Results: 545 (95.1%) deaths and live births were matched. According to the Sinasc, the prevalence of congenital malformations was 10.4 per 1,000 LB. After the linkage, the rate was 12.4. Malformations of the musculoskeletal system (42.1%) among live births were high-lighted, as well as malformations of the circulatory system (35.3%) found in infant deaths. Conclusions: linkage increased the prevalence of congenital malformations in the studied cohort. This demonstrates the potential of this strategy for the monitoring of congenital malformations, which can be used to monitor infant death.


Resumo Objetivos: descrever a prevalência das malformações congênitas em nascidos vivos no Recife, com base no relacionamento de dados de nascimentos e óbitos infantis . Métodos: estudo transversal com dados do Sistema de Informações sobre Nascidos Vivos (Sinasc) e Mortalidade (SIM) de residentes no Recife-PE, entre 2013 e 2015. Realizou-se linkage determinístico dos óbitos e nascidos vivos (NV) com malformação e calculou-se a prevalência. Resultados: obteve-se o pareamento de 545 (95,1%) declarações de óbito e de nascidos vivos. Segundo o Sinasc a prevalência de malformações congênitas foi de 10,4 por 1.000 NV; após o linkage a taxa foi de 12,4. Destacaram-se as malformações do aparelho osteomuscular (42,1%) entre os nascidos vivos, e nos óbitos as do aparelho circulatório (35,3%). Conclusões: o linkage aumentou a prevalência de malformações congênitas nas crianças estudadas. Isso indica a potencialidade dessa estratégia para o monitoramento das malformações congênitas, podendo ser empregada na vigilância do óbito infantil.


Assuntos
Humanos , Recém-Nascido , Anormalidades Congênitas/epidemiologia , Mortalidade Infantil , Estatísticas Vitais , Sistemas de Informação em Saúde/estatística & dados numéricos , Atestado de Óbito , Estudos de Coortes , Nascimento Vivo
5.
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(4): 865-872, Sept.-Dec. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1057121

RESUMO

Abstract Objectives: to assess the epidemiological profile of congenital and syphilis during pregnancy in residents of São José do Rio Preto in São Paulo State. Methods: ecological study of the epidemiological profile of patients with congenital and gestational syphilis, based on the Sistema de Informação de Agravos de Notificação (Information System for Notifiable Diseases) from 2007 to 2016. Results: there were 396 cases of syphilis reported in pregnant women and 290 of congenital syphilis. In 2016, the rate of detecting syphilis in pregnant women was 13.2 cases/1,000 live births, while congenital syphilis the incidence rate was 6.5 cases/1,000 live births. For gestational syphilis, 54% of the diagnosis was performed in 2nd or 3rd trimester and 85% were reported at the primary care. Adequate treatment for pregnant women occurred in 96% of the notifications with 52% of partners treated. In congenital syphilis, 82% of the mothers underwent prenatal care. However, 94% of the pregnant women were treated inadequately while 82% of the partners did not receive any treatment. Conclusions: there has been an increase in the number of cases of gestational syphilis in pregnant women and a decrease in the cases of congenital syphilis from 2014. These results showed that the goal of 0.5 case/1,000 live births proposed by World Health Organization is still far from being achieved in this city.


Resumo Objetivos: conhecer o perfil epidemiológico da sífilis congênita e em gestantes nos residentes de São José do Rio Preto/SP. Métodos: estudo ecológico do perfil epidemiológico dos pacientes com sífilis congênita e gestacional, a partir de dados coletados no Sistema de Informação de Agravos de Notificação entre 2007 e 2016. Resultados: foram notificados 396 casos de sífilis em gestantes e 290 de sífilis congênita. Em 2016, a taxa de detecção da sífilis em gestantes foi 13,2 casos/1.000 nascidos vivos, enquanto a sífilis congênita, a taxa de incidência foi 6,5 casos/1.000 nascidos vivos. Para sífilis gestacional, 54% do diagnóstico foram realizados no 2° ou 3° trimestre e 85% notificadas na atenção primária. O tratamento adequado das gestantes ocorreu em 97% das notificações, com 52% dos parceiros tratados. Na sífilis congênita, 82% das mães realizaram o pré-natal, entretanto, 94% das gestantes foram tratadas inadequadamente e 82% dos parceiros não realizaram o tratamento. Conclusões: foi observado o aumento no número de casos de sífilis em gestantes e uma queda dos casos de sífilis congênita a partir de 2014. Com esses resultados, é notório que a meta de 0,5 caso/1.000 nascidos vivos proposta pela Organização Mundial da Saúde ainda está distante de ser alcançada no município.


Assuntos
Humanos , Feminino , Gravidez , Sífilis Congênita/epidemiologia , Perfil de Saúde , Sífilis/epidemiologia , Notificação de Doenças , Atenção Primária à Saúde , Brasil/epidemiologia , Transmissão Vertical de Doença Infecciosa , Gestantes , Estudos Ecológicos , Monitoramento Epidemiológico , Sistemas de Informação em Saúde/estatística & dados numéricos
6.
BMC Health Serv Res ; 19(1): 890, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31771584

RESUMO

BACKGROUND: Taiwan's Diabetes Shared Care Program has been implemented since 2012, and the health information system plays a vital role in supporting most services of this program. However, little is known regarding the effectiveness of this information-based program. Therefore, this study investigated the effects of the participation of the Diabetes Shared Care Program on preventable hospitalizations. METHODS: This longitudinal study examined the data of health-care claims from 2011 to 2014 obtained from the diabetes mellitus health database. Patients with diabetes aged ≥18 years were included. Preventable hospitalizations were identified on the basis of prevention quality indicators developed for administrative data by the US Agency for Healthcare Research and Quality. A multilevel logistic regression was performed to examine the effects of the participation of the Diabetes Shared Care Program on preventable hospitalizations after adjustment for other variables. Analyses were conducted in late 2018. RESULTS: A medium level of participation (p = 0.05), age between 40 and 64 years(p < 0.0001), and absence of a catastrophic illness(p < 0.0001) were associated with a lower probability of having a preventable hospitalization. Male sex(p < 0.0001), age ≥ 65 years(p = 0.0203), low income level(p < 0.0001), living in the Southern division(p = 0.0106), and presence of many comorbidities(p < 0.0001) were associated with a higher probability of having a preventable hospitalization after adjustment for characteristics at the individual and county levels. CONCLUSIONS: The health information system records patients' medical history, monitors quality of care, schedules patient follow-ups, and reminds case managers to provide timely health education. This health-information-based Diabetes Shared Care Program is associated with better quality care of ambulatory, so it should be promoted on a broader scale.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Sistemas de Informação em Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Idoso , Comorbidade , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Renda , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Taiwan/epidemiologia , Estados Unidos , Adulto Jovem
7.
Int J Med Inform ; 132: 103942, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31627031

RESUMO

BACKGROUND: Health Information Systems (HIS), and especially Electronic Health Records (EHR), offer great promise. However, the true benefits of HIS and EHR are more elusive as research shows they have obtained mixed results across countries. To increase the success of these systems while creating value for healthcare professionals, research emphasizes the importance of involving clinical users in the design of HIS. OBJECTIVE: Following calls for interdisciplinary research and increased end-user participation in HIS development, this paper shows how a service design approach can support the successful development and implementation of national EHRs. Service design brings a human-centered, participatory, holistic, creative and visual approach to HIS development, through an iterative process of exploration, ideation, reflection and implementation, fostering stakeholder participation and co-creation of the solution. METHOD: This paper presents an in-depth case study of the Portuguese National EHR development and implementation following a service design approach. The study involved individual and group interviews, as well as participatory design workshops with more than 170 participants along the different stages of exploration, ideation, reflection and implementation. RESULTS: The service design approach, including the visual models and tools used across the different design stages, was instrumental to envision new EHR concepts and design the system to enhance healthcare users experience. A qualitative study performed after implementation showed that the EHR was considered useful and easy to use, and these results are backed by widespread usage of the system. DISCUSSION AND CONCLUSION: This paper shows how a service design approach can address key challenges in EHR development. By adopting a holistic perspective, service design broadens the scope of EHR development to understand its broader service system and position it to enable value creation with users. The human-centered, participatory, creative, visual and holistic approach supports the understanding of user needs and context, and their active involvement in the design and co-creation effort. This service design approach fosters user adoption at the implementation stage. Service design can thus contribute to the successful development and implementation of EHRs.


Assuntos
Assistência à Saúde/normas , Registros Eletrônicos de Saúde/organização & administração , Sistemas de Informação em Saúde/organização & administração , Pessoal de Saúde/normas , Serviços de Saúde/normas , Administração dos Cuidados ao Paciente/organização & administração , Qualidade da Assistência à Saúde/normas , Atitude do Pessoal de Saúde , Registros Eletrônicos de Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Sistemas de Informação em Saúde/normas , Sistemas de Informação em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Humanos , Portugal , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/organização & administração
8.
Int J Med Inform ; 131: 103945, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31561193

RESUMO

BACKGROUND: Electronic health information systems (HIS) are critical components of national health systems, and have been identified as a key element in the development and strengthening of health systems globally. Novel approaches are needed to effectively and efficiently train health care workers on the use of HIS. One such approach is the use of digital eLearning programs, either alone or blended with face-to-face learning activities. METHODS: We developed a novel blended eLearning course based on an in-person HIS training package previously developed by the United States Centers for Disease Control and Prevention. We then conducted a pilot implementation of the eLearning course in Namibia and Tanzania. RESULTS: The blended eLearning pilot program enrolled 131 people, 72 (55%) from Namibia and 59 (45%) from Tanzania. The majority of enrollees were female (n = 88, 67%) and were nurses (n = 66, 50%). Of the 131 people who participated in the in-person orientation, 95 (73%) completed some or all of the eLearning modules. Across all three modules, the mean score on the post-test was significantly greater than on the pre-test (p < 0.001). When comparing results from previous in-person workshops and the blended eLearning course, we found that participants experienced strong learning gains in both, although learning gains were somewhat greater in the in-person course. Blended eLearning course participants reported good to very good satisfaction with the overall content of the course and with the eLearning modules (3.5 and 3.6 out of 5-point Likert scale). We estimate that the total cost per participant is 2.2-3.4 times greater for the in-person course (estimated cost USD $980) than for the blended eLearning course (estimated cost USD $287-$437). CONCLUSION: A blended eLearning course is an effective method with which to train healthcare workers in the basic features of HIS, and the cost is up to 3.4 times less expensive than for an in-person course with similar content.


Assuntos
Instrução por Computador/métodos , Sistemas de Informação em Saúde/estatística & dados numéricos , Pessoal de Saúde/educação , Aprendizagem , Sistemas On-Line/estatística & dados numéricos , Recursos Humanos/estatística & dados numéricos , Feminino , Humanos , Masculino , Namíbia , Tanzânia
9.
J Psychiatr Ment Health Nurs ; 26(7-8): 199-211, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31206891

RESUMO

WHAT IS KNOWN ABOUT THE SUBJECT?: Planning and implementation of care are based on the selection and application of nursing interventions, which correspond to a key element in the nursing process. No information was found in the literature about which major nursing interventions are documented by nurses working in psychiatric wards. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Despite the criteria applied to the intervention records' analysis may have led to the exclusion of certain important aspects of mental health nursing, this study provides information on some of the most relevant interventions in the field of psychiatric and mental health nursing documented in Portugal, placing them into the different steps of the nursing process. This study revealed the lack of standardized language used by nurses in intervention definitions, which results in the use of varied terminology to describe the same intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study constitutes an important contribution towards the standardization of language used by mental health nurses in intervention definitions, which may lead to the production of health indicators that will show policymakers the importance of nursing care towards population health. This study also contributes to the improvement of nursing informatics systems in use in psychiatric departments, particularly through the differentiation between different types of intervention, placing them into the proper steps of the nursing process. The problems identified in this study regarding nursing documentation may suggest that more training for professional nurses in the field of intervention formulation is needed. ABSTRACT: Introduction The nursing intervention corresponds to a key element in the nursing process. No information was found in the literature about which major interventions are documented by nurses working in psychiatric wards. Aims (a) To identify the interventions documented by nurses in Portugal that respond to nursing needs within the scope of psychiatric nursing; (b) to identify the main problems in identifying these interventions. Method A descriptive study combining: (a) quantitative content analysis of intervention records identified by mental health nurses in Portugal and (b) a focus group meeting with 14 nurses exploring the results of the first study phase. Results The 2,881 initial intervention records were systematized into 198 intervention categories. Some problems in the interventions' documentation by nurses were identified. Discussion Despite certain important aspects of mental health nursing may have been excluded, this study provides information on some of the most relevant interventions in the field of mental health nursing documented in Portugal. Implications for practice This study may offer an important contribution to the improvement of nursing informatics systems and the production of health indicators that reveal the contribution of nursing care towards population health.


Assuntos
Sistemas de Informação em Saúde/estatística & dados numéricos , Transtornos Mentais/enfermagem , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/provisão & distribução , Enfermagem Psiquiátrica/estatística & dados numéricos , Humanos , Portugal
10.
Congenit Heart Dis ; 14(5): 797-802, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31112369

RESUMO

OBJECTIVE: Neurodevelopmental impairment is common after surgery for congenital heart disease (CHD) in infancy. While neurodevelopmental follow-up of high-risk patients has increased, the referral patterns for ancillary services following initial evaluation have not been reported. The aim of this study is to describe the rates and patterns of referral at the initial visit to our outcomes clinic of patients who underwent surgery for CHD during infancy. OUTCOMES MEASURES: The Cardiac Developmental Outcomes Program clinic at Texas Children's Hospital provides routine longitudinal follow-up with developmental pediatricians and child psychologists for children who required surgery for CHD within the first 3 months of life. Demographic, diagnostic, and clinical data, including prior receipt of intervention and referral patterns at initial presentation, were abstracted from our database. RESULTS: Between April 2013 and May 2017, 244 infants under 12 months of age presented for initial evaluation at a mean age of 7 ± 1.3 months. At presentation, 31% (76/244) were referred for either therapeutic intervention (early intervention or private therapies), ancillary medical services, or both. Referral rates for low-risk (STAT 1-3) and high-risk (STAT 4-5) infants were similar (28 vs. 33%, P = .48). Referrals were more common in: Hispanic white infants (P = .012), infants with non-cardiac congenital anomalies (P = .001), history of gastrostomy tube placement (P < .001), and infants with prior therapy (P = .043). Infants of non-English speaking parents were three times more likely to be referred (95% CI = 1.5, 6.4; P = .002). CONCLUSIONS: At the time of presentation, nearly 1 in 3 infants required referral. Referral patterns did not vary by traditional risk stratification. Sociodemographic factors and co-morbid medical conditions increased the likelihood of referral. This supports the need for routine follow-up for all post-surgical infants regardless of level of surgical complexity. Further research into the completion of referrals and long-term referral patterns is needed.


Assuntos
Desenvolvimento Infantil , Deficiências do Desenvolvimento/etiologia , Sistemas de Informação em Saúde/estatística & dados numéricos , Cardiopatias Congênitas/complicações , Encaminhamento e Consulta/estatística & dados numéricos , Medição de Risco/métodos , Procedimentos Cirúrgicos Cardíacos , Pré-Escolar , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/psicologia , Feminino , Seguimentos , Cardiopatias Congênitas/cirurgia , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Texas/epidemiologia
11.
Rev Bras Epidemiol ; 22: e190033, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038614

RESUMO

OBJECTIVE: To analyze trends in pesticide poisoning incidence rates in Brazilian regions, according to sex and circumstances of poisoning, between 2001 and 2014. METHOD: Ecological time-series study, with data from the national Notifiable Diseases Information System (SINAN). The incidence rates were calculated by dividing the number of confirmed new cases of pesticide poisoning by the total resident population in the same period and location. Both Polynomial regression analysis and Mann-Whitney and Kruskal-Wallis tests were performed. When significant differences were found, these tests were followed by the Bonferroni penalty, in order to identify the difference more precisely. RESULTS: In Brazil, 80,069 notified poisoning cases were recorded from 2001 to 2014. There was a steadily increasing growth of pesticide poisoning in this population, whose growth trend was 0,377 for 100,000 inhabitants per year. The highest incidence of poisoning occurred in the South and Midest Regions. Regarding sex, no significant differences were found (p < 0,347), and attempted suicide was the most significant circumstance of poisoning (p < 0,001). CONCLUSION: The incidence of pesticide poisoning in Brazil has been continuously increasing in the twenty-first century.


Assuntos
Notificação de Doenças/estatística & dados numéricos , Sistemas de Informação em Saúde/estatística & dados numéricos , Praguicidas/envenenamento , Brasil/epidemiologia , Feminino , Humanos , Incidência , Masculino , Análise de Regressão , Distribuição por Sexo , Estatísticas não Paramétricas , Fatores de Tempo
12.
JAMA Netw Open ; 2(4): e191709, 2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-30951160

RESUMO

Importance: Current electronic health record (EHR) user interfaces are suboptimally designed and may be associated with excess cognitive workload and poor performance. Objective: To assess the association between the usability of an EHR system for the management of abnormal test results and physicians' cognitive workload and performance levels. Design, Setting, and Participants: This quality improvement study was conducted in a simulated EHR environment. From April 1, 2016, to December 23, 2016, residents and fellows from a large academic institution were enrolled and allocated to use either a baseline EHR (n = 20) or an enhanced EHR (n = 18). Data analyses were conducted from January 9, 2017, to March 30, 2018. Interventions: The EHR with enhanced usability segregated in a dedicated folder previously identified critical test results for patients who did not appear for a scheduled follow-up evaluation and provided policy-based decision support instructions for next steps. The baseline EHR displayed all patients with abnormal or critical test results in a general folder and provided no decision support instructions for next steps. Main Outcomes and Measures: Cognitive workload was quantified subjectively using NASA-Task Load Index and physiologically using blink rates. Performance was quantified according to the percentage of appropriately managed abnormal test results. Results: Of the 38 participants, 25 (66%) were female. The 20 participants allocated to the baseline EHR compared with the 18 allocated to the enhanced EHR demonstrated statistically significantly higher cognitive workload as quantified by blink rate (mean [SD] blinks per minute, 16 [9] vs 24 [7]; blink rate, -8 [95% CI, -13 to -2]; P = .01). The baseline group showed statistically significantly poorer performance compared with the enhanced group who appropriately managed 16% more abnormal test results (mean [SD] performance, 68% [19%] vs 98% [18%]; performance rate, -30% [95% CI, -40% to -20%]; P < .001). Conclusions and Relevance: Relatively basic usability enhancements to the EHR system appear to be associated with better physician cognitive workload and performance; this finding suggests that next-generation systems should strip away non-value-added EHR interactions, which may help physicians eliminate the need to develop their own suboptimal workflows.


Assuntos
Cognição/fisiologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Médicos/estatística & dados numéricos , Carga de Trabalho/psicologia , Registros Eletrônicos de Saúde/normas , Feminino , Sistemas de Informação em Saúde/estatística & dados numéricos , Humanos , Masculino , Médicos/psicologia , Estudos Prospectivos , Melhoria de Qualidade , Interface Usuário-Computador , Desempenho Profissional/tendências
13.
Cien Saude Colet ; 24(3): 693-704, 2019 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30892492

RESUMO

This study aims to identify information systems having fatal work-related (ATF) data in Brazil, describing their characteristics, flows and barriers to information quality. Using a documental research approach, we found: the Mortality Information System (SIM), the Hospital Admission Register from the Unified Health System (SIH-SUS), the Notifiable Diseases Information System (SINAN) and the Violence and Injuries Surveillance Program (VIVA) from the Health Ministry; the Work-related Injuries Reporting System (SISCAT) of the Ministry of Social Insurance; and the Annual Report of Social Information (RAIS), Ministry of Labour and Employment. A lack of key common variables limits the construction of a single database composed by all ATF recorded cases. From several barriers identified, the most relevant for data quality was the lack of work-relatedness recognition and recording, a task performed by the health team.


Assuntos
Bases de Dados Factuais/estatística & dados numéricos , Sistemas de Informação em Saúde/estatística & dados numéricos , Programas Nacionais de Saúde , Traumatismos Ocupacionais/epidemiologia , Brasil/epidemiologia , Bases de Dados Factuais/normas , Sistemas de Informação em Saúde/normas , Humanos , Traumatismos Ocupacionais/mortalidade
14.
Cancer Invest ; 37(3): 127-133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30821518

RESUMO

Many Americans use smartphone-based mobile applications to acquire health information. Our study evaluated the readability of mobile application-based patient educational materials (PEMs) about five prevalent cancers in the United States. The Apple and Google mobile application marketplaces were queried for breast, colon, lung, prostate, and stomach cancer-related applications, which were subsequently screened for PEMs and assessed with 10 validated readability assessments. Twenty-one pertinent applications yielded 249 articles that were written at an 11.8 ± 2.3 grade level; only 12 (4.8%) articles were written below an eighth grade level. The majority of cancer-related PEMs were written at too difficult reading levels for American patients.


Assuntos
Compreensão , Redes de Comunicação de Computadores/estatística & dados numéricos , Sistemas de Informação em Saúde/estatística & dados numéricos , Aplicativos Móveis/estatística & dados numéricos , Neoplasias/terapia , Smartphone/estatística & dados numéricos , Humanos , Disseminação de Informação/métodos , Neoplasias/diagnóstico , Educação de Pacientes como Assunto/métodos , Estados Unidos
15.
Cad Saude Publica ; 35(1): e00049718, 2019.
Artigo em Português | MEDLINE | ID: mdl-30652825

RESUMO

The Brazilian Ministry of Health recommends biennial mammographic screening for women aged between 50 and 69 years. Since screening is opportunistic in the country, the actual periodicity varies. This study sought to test a methodology for estimating over-screening due to excessive periodicity, defined as a smaller than recommended interval between exams, and its association with socio-demographic characteristics. A cohort of women who underwent mammography in 2010, and whose result was normal, was assembled through probabilistic linkage SISMAMA records based on a set of personal identifiers. We used data from women living in the micro health region of Juiz de Fora/Lima Duarte/Bom Jardim, Minas Gerais State, Brazil, who were followed in the System until the end of 2012. The rate of over-screening was 150/1,000 women/year (95%CI: 144.9-155.9), affecting 21% of women. Over-screening increased by 24% during Pink October campaigns (adjusted HR = 1.24; 95%CI: 1.15-1.35). The shorter the time passed since the last mammogram, the greater the odds of over-screening. Compared with women who had never had a mammogram prior to 2010, women who had had one in the previous 2 years were two times more likely to be over-screened (adjusted HR = 2.01; 95%CI: 1.74-2.31) whilst those who had had a mammogram ≤ 1 year previously were three times more likely to be over-screened (adjusted HR = 3.27; 95%CI: 2.87-3.73). Over-screening was substantial in this population, excessively exposing women to the risks of screening with no additional benefits and overestimating mammogram coverage. The methodology proved to be successful and should be applied to representative populations in order to guide breast cancer control policies.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Sistemas de Informação em Saúde/estatística & dados numéricos , Mamografia/métodos , Programas de Rastreamento/métodos , Idoso , Brasil/epidemiologia , Bases de Dados Factuais , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Projetos Piloto , Fatores de Risco
16.
Int J Med Inform ; 122: 1-6, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30623778

RESUMO

INTRODUCTION: Timely, complete and accurate patient data is needed in care decisions along the continuum of care. To access patient data from other organizations, there are three types of regional health information exchange systems (RHIS) in use In Finland. Some regions use multiple RHISs while others do not have a RHIS available. The recently introduced National Patient Data Repository (Kanta) is increasingly used for health information exchange (HIE). OBJECTIVES: The purpose of this study was to assess usage of paper, RHISs and Kanta by context in 2017; evolution of paper use over the years; and predictors of paper use in 2017 among Finnish physicians for HIE system development. METHODS: Data from national electronic health record (EHR) usage and user experience surveys were taken from 2010 (prior to ePrescription system implementation), 2014 (prior to implementation of Kanta) and 2017 (Kanta was in full use in the public sector and in large private organizations). The web-based surveys were targeted to all physicians engaged in clinical work in Finland. RESULTS: Kanta was the most frequently used means of HIE in 2017. Paper use had reduced significantly from 2010 to 2014. The trend continued in 2017. Still, up to half of the physicians reported using paper daily or weekly in 2017. There were great variations in paper use by healthcare sector, available RHIS type and EHR system used. In multivariable analysis (with all other variables constant), predictors of more frequent use of paper than electronic means for HIE were: private sector or hospital, access to Master Patient Index RHIS (type 1), multiple RHIS (type 4) or no RHIS (type 5), two particular EHR systems, older age, less experience, operative, psychiatric or diagnostic specialties, and male gender. CONCLUSIONS: Usability of HIE systems including EHRs as access points to HIE need to be improved to facilitate usage of electronic HIE. Usage ensures more timely and complete patient data for safe, coordinated care. Specialty-specific needs and requirements call for more user participation in HIE design. Especially older professionals need training to better exploit HIS for HIE.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Sistemas de Informação em Saúde/estatística & dados numéricos , Papel/normas , Médicos/psicologia , Adulto , Idoso , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
17.
Plast Reconstr Surg ; 143(2): 533-539, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30688897

RESUMO

BACKGROUND: Previous attempts at reporting oronasal fistula development and secondary speech surgery following cleft palate surgery have been limited to single-center case series. This limitation can be overcome by querying large databases created by health care governing bodies or health care alliances. The authors examined the effect of cleft type and demographic variables on the clinical outcomes. METHODS: Data from the Pediatric Health Information System database were queried for patients, aged 6 to 18 months, who had undergone primary palatoplasty between 2004 and 2009. Subsequent repair of an oronasal fistula and/or secondary speech surgery between 2004 and 2015 was identified by procedure codes. Logistic regression models were used to assess the associations between cleft type with oronasal fistula and with secondary speech surgery. RESULTS: Seven thousand three hundred twenty-five patients were identified, and 6.4 percent (n = 468) had a subsequent repair of an oronasal fistula and 18.5 percent (n = 1355) had a secondary speech operation. Adjusted for age, sex, and race, patients with cleft lip and palate have increased odds of oronasal fistula (OR, 5.60; 95 percent CI, 4.44 to 7.07) and secondary speech surgery (OR, 2.32; 95 percent CI, 2.05 to 2.63). CONCLUSIONS: Using a large, multi-institution billing database, the authors were able to estimate the prevalence of oronasal fistula and surgically treated velopharyngeal insufficiency following primary palatoplasty in the United States. In addition, the authors demonstrated that patients with isolated cleft palate develop fewer oronasal fistulas and require less secondary speech surgery than patients with cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Bucais/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Feminino , Sistemas de Informação em Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Doenças Nasais/epidemiologia , Doenças Nasais/etiologia , Doenças Nasais/cirurgia , Fístula Bucal/epidemiologia , Fístula Bucal/etiologia , Fístula Bucal/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Complicações Pós-Operatórias/etiologia , Prevalência , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Estados Unidos/epidemiologia , Insuficiência Velofaríngea/epidemiologia , Insuficiência Velofaríngea/etiologia , Insuficiência Velofaríngea/cirurgia
18.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 90-96, Jan.-Mar. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-985139

RESUMO

ABSTRACT Objective: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. Methods: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. Results: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as "good", "excellent" or "better than imaginable". The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. Conclusion: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.


RESUMO Objetivo: Mensurar o grau de satisfação de profissionais de saúde quanto à usabilidade de um sistema de informação em saúde neonatal e identificar os fatores que podem influenciar na satisfação do usuário frente à usabilidade. Métodos: Estudo transversal e exploratório realizado com 50 profissionais de saúde integrantes dos centros da Rede Brasileira de Pesquisas Neonatais. Para avaliação da usabilidade foi utilizado o instrumento System Usability Scale entre fevereiro e março de 2017. Realizou-se a análise estatística descritiva e inferencial das variáveis coletadas, com a finalidade de descrever a amostra, quantificar o grau de satisfação dos usuários e identificar as variáveis associadas ao grau de satisfação do usuário em relação à usabilidade. Resultados: Da população avaliada, 75% era do sexo feminino, com idade média 52,8 anos, 58% com pós-graduação (doutorado); tempo médio da última formação de 17 anos; área de atuação em medicina (neonatologia), grau intermediário de conhecimento em informática e tempo de utilização média do sistema de 52 meses. Quanto à usabilidade, 94% avaliaram o sistema como "bom", "excelente" ou "melhor impossível". A usabilidade do sistema não foi associada a idade, sexo, escolaridade, profissão, área de atuação, nível de conhecimento em informática e tempo de uso do sistema. Conclusões: O grau de satisfação do usuário do sistema informatizado de saúde foi considerado bom. Não foram identificados fatores demográficos que influenciassem sua avaliação.


Assuntos
Atitude do Pessoal de Saúde , Saúde do Lactente/normas , Alfabetização Digital/estatística & dados numéricos , Brasil , Estudos Transversais , Inquéritos e Questionários , Sistemas de Informação em Saúde/normas , Sistemas de Informação em Saúde/estatística & dados numéricos , /estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Pessoa de Meia-Idade , Neonatologia/métodos , Neonatologia/normas
19.
Rev Paul Pediatr ; 37(1): 90-96, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30569950

RESUMO

OBJECTIVE: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. METHODS: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. RESULTS: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as "good", "excellent" or "better than imaginable". The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. CONCLUSION: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.


Assuntos
Atitude do Pessoal de Saúde , Sistemas de Informação em Saúde , Saúde do Lactente/normas , Neonatologia , Brasil , Alfabetização Digital/estatística & dados numéricos , Estudos Transversais , Feminino , Sistemas de Informação em Saúde/normas , Sistemas de Informação em Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Neonatologia/métodos , Neonatologia/normas , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Inquéritos e Questionários
20.
Cad. Saúde Pública (Online) ; 35(1): e00049718, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1039377

RESUMO

Resumo: No Brasil, o Ministério da Saúde recomenda o rastreamento mamográfico bienal para mulheres entre 50-69 anos. Como o rastreamento é oportunístico no país, a periodicidade efetiva varia. Esse estudo visou a testar metodologia para a estimação do sobrerrastreio por periodicidade excessiva, definido como intervalo entre exames menores que o preconizado e sua associação com variáveis sociodemográficas. Trata-se de uma coorte de mulheres com mamografia de rastreamento de resultado normal em 2010, obtida por relacionamento probabilístico valendo-se das bases identificadas do SISMAMA. Foram utilizados dados referentes a mulheres residentes na microrregião de saúde de Juiz de Fora/Lima Duarte/Bom Jardim, Minas Gerais, Brasil, acompanhadas no Sistema até o fim de 2012. A taxa de sobrerrastreio foi de 150/mil mulheres/ano (IC95%: 144,9-155,9), atingindo 21% das mulheres. O sobrerrastreio aumentou 24% durante as campanhas Outubro Rosa (HR ajustada = 1,24; IC95%: 1,15-1,35). Quanto menor o tempo desde a última mamografia, maior foi a chance de sobrerrastreio. Em relação a mulheres que nunca tinham feito mamografia anterior a 2010, as que fizeram há 2 anos foram 2 vezes mais sobrerrastreadas (HR ajustada = 2,01; IC95%: 1,74-2,31) e há ≤ 1 ano 3 vezes mais (HR ajustada: 3,27; IC95%: 2,87-3,73). Nessa população, o sobrerrastreio foi substancial, expondo excessivamente as mulheres aos riscos do rastreamento sem benefício adicional e superestimando a cobertura mamográfica. A metodologia mostrou-se efetiva e deve ser aplicada em populações representativas para orientar políticas de controle de câncer de mama.


Abstract: The Brazilian Ministry of Health recommends biennial mammographic screening for women aged between 50 and 69 years. Since screening is opportunistic in the country, the actual periodicity varies. This study sought to test a methodology for estimating over-screening due to excessive periodicity, defined as a smaller than recommended interval between exams, and its association with socio-demographic characteristics. A cohort of women who underwent mammography in 2010, and whose result was normal, was assembled through probabilistic linkage SISMAMA records based on a set of personal identifiers. We used data from women living in the micro health region of Juiz de Fora/Lima Duarte/Bom Jardim, Minas Gerais State, Brazil, who were followed in the System until the end of 2012. The rate of over-screening was 150/1,000 women/year (95%CI: 144.9-155.9), affecting 21% of women. Over-screening increased by 24% during Pink October campaigns (adjusted HR = 1.24; 95%CI: 1.15-1.35). The shorter the time passed since the last mammogram, the greater the odds of over-screening. Compared with women who had never had a mammogram prior to 2010, women who had had one in the previous 2 years were two times more likely to be over-screened (adjusted HR = 2.01; 95%CI: 1.74-2.31) whilst those who had had a mammogram ≤ 1 year previously were three times more likely to be over-screened (adjusted HR = 3.27; 95%CI: 2.87-3.73). Over-screening was substantial in this population, excessively exposing women to the risks of screening with no additional benefits and overestimating mammogram coverage. The methodology proved to be successful and should be applied to representative populations in order to guide breast cancer control policies.


Resumen: En Brasil, el Ministerio de Salud recomienda pruebas mamográficas bienales para mujeres entre 50-69 años. Como las pruebas se realizan ocasionalmente en el país, la periodicidad efectiva varía. El objetivo de este estudio fue probar la metodología para la estimación del exceso de pruebas por periodicidad excesiva, definido como un intervalo menor entre exámenes que el preconizado, y su asociación con variables sociodemográficas. Se trata de una cohorte de mujeres con mamografías para la detección de cáncer con un resultado normal en 2010, obtenida mediante relación probabilística, haciendo uso de las bases identificadas del SISMAMA. Se utilizaron datos referentes a mujeres, residentes en la microrregión de salud de Juiz de Fora/Lima Duarte/Bom Jardim, Estado de Minas Gerais, Brasil, a quienes se les realizó un seguimiento en el sistema hasta finales de 2012. La tasa de exceso pruebas fue de 150/1.000 mujeres/año (IC95%: 144,9-155,9), alcanzando un 21% de las mujeres. El exceso de pruebas aumento un 24% durante las campañas Octubre Rosa (HR ajustada = 1,24; IC95%: 1,15-1,35). Cuanto menor era el tiempo desde la última mamografía, mayor fue la oportunidad de exceso de pruebas. En relación con mujeres que nunca se habían hecho una mamografía anterior a 2010, en quienes se la hicieron hace 2 años hubo 2 veces más exceso de pruebas (HR ajustada = 2,01; IC95%: 1,74-2,31) y hace ≤ 1 año 3 veces más (HR ajustada = 3,27; IC95%: 2,87-3,73). En esta población, el exceso de pruebas fue sustancial, exponiendo excesivamente a las mujeres a los riesgos de la detección sin beneficio adicional y sobrevalorando la cobertura mamográfica. La metodología se mostró efectiva y se debe aplicar en poblaciones representativas para orientar políticas de control de cáncer de mama.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Programas de Rastreamento/métodos , Sistemas de Informação em Saúde/estatística & dados numéricos , Brasil/epidemiologia , Mamografia/estatística & dados numéricos , Projetos Piloto , Programas de Rastreamento/estatística & dados numéricos , Fatores de Risco , Bases de Dados Factuais , Detecção Precoce de Câncer
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