Relación entre el perfil epidemiológico y nivel socioeconómico de la población que demanda atención en la Cátedra de Odontología Integral Niños / Relationship between the epidemiological profile and socioeconomic level of the population requiring care at the Children´s Comprehensive Dentistry Chair

Se identificó el perfil epidemiológico y se caracterizó la situación de la población en base al Nivel Socio-Económico (NSE) asociado al estado dentario y se es-tablecieron las zonas geográficas de pacientes que asistieron a la Cátedra Odontología Integral Niños (COIN) de FOUBA durante el año 2019. La muestra total se conformó con 541 niños de 9,2±3,3 años; masculi-nos 51,0%. La segmentación de los estratos sociales dio como resultado que del total de pacientes, el 33,3% perteneció a Clase Baja D2/E, el 39,2% a Clase Baja Superior D1, el 22,4% a Clase Media Baja C3, el 4% a Clase Media Alta C2 y el 1,1% a Clase Alta ABC1. La mayor demanda de atención provino de las dos clases más bajas de la pirámide social, aunque se trata de un servicio arancelado. Los indicadores del estado den-tario ceod, ceos, CPOD y CPOS, indicaron que los niños de menor posición socioeconómica presentaron los índices más altos. La mayor concurrencia provino de la Ciudad Autónoma de Buenos Aires (52%), respecto a los pacientes concurrentes del Gran Buenos Aires (37%), el 80% provino de la zona Oeste y Sur (AU)

The epidemiological profile was identified, and the situation of the population was characterized based on Socio-Economic Status (SES) associated with their dental state. Geographical areas of patients who attended the FOUBA Children's Comprehensive Dentistry Chair during 2019 were established. The total sample consisted of 541 children aged 9.2±3.3 years; males 51.0%. The segmentation of the social strata resulted in 33.3% belonging to Low-Class D2/E, 39.2% to Upper Lower-Class D1, 22.4% to Lower Middle-Class C3, 4% to Upper Middle-Class C2, and 1.1% to Upper-Class ABC1. The largest demand for care came from the two lowest classes of the social pyramid, even though it is a fee-based service. The indicators of dental status dmft, dmfs, DMFT and DMFS, showed that children coming from the lowest socio-economic position presented the highest rate of occurrence. The highest attendance came from the City of Buenos Aires (52%), compared to patients from Buenos Aires suburbs (37%), of which 80% were from the Western and Southern suburbs (AU)

Effect of Quality of Dental Health Services to Patient Satisfaction in Indonesia 2019: Importance-Performance Analysis

ABSTRACT Objective: To determine the effect of the quality of dental health services based on dimensions of empathy and responsiveness to patient satisfaction in urban and rural areas in Bone District, Indonesia. Material and Methods: This survey used an analytical observational method with a pilot pathfinder survey design. The total of participants included in this survey was 442, with 223 in the urban area and 219 in the rural area. This survey was held on 25 February - 1 March 2019. The Mann-Whitney test was applied, adopting a significance level of 5%. Results: Empathy and responsive dimensions in urban (3.58 ± 0.94 and 3.50 ± 0.94) and rural (3.43 ± 0.99 and 3.63 ± 0.86) areas were in the moderate category. The administration staff was able to complete administrative procedures, and the Dental assistant responded promptly to the patient's request and needs. Conclusion: The quality of empathy and responsiveness dimensions in dental treatment fall in the moderate category for urban and rural areas; this means that empathy and responsiveness dimensions in dental service in hospital/public health need to be improved.

Necesidades de atención en salud mental y uso de servicios en población mexicana con trastornos mentales graves / Mental health care needs and use of services in Mexican population with serious mental disorders

Resumen: Objetivo: Analizar las demandas de atención de los trastornos mentales graves (TMG) y factores asociados con la utilización de servicios en México. Material y métodos: Se llevó a cabo un estudio analítico transversal en dos fases: la primera con una base de datos nacional de servicios disponibles y su utilización; la segunda, una muestra de registros médicos de un hospital psiquiátrico. Resultados: La esquizofrenia es el TMG más prevalente; más de 50% de hospitalizados fueron hombres, con edad promedio 37 años. La utilización de servicios estuvo asociada con la edad (β=1.062; p=.000), ingreso familiar (β=1.000, p=.000) y no tener ocupación (β=3.407; p=.000). La población con esquizofrenia tiene cuatro veces más la probabilidad de requerir estar exenta de pago (β=4.158; p=.000). Conclusiones: La población con TMG es más vulnerable por la discapacidad funcional y social asociada; requiere de intervenciones específicas de salud acompañadas de una política de protección financiera adaptada a sus necesidades de atención.

Abstract: Objective: To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. Materials and methods: A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical records of a psychiatric hospital. Results: Schizophrenia is the most prevalent MDS; more than 50% of those hospitalized were male, with an average age of 37 years. The use of services was associated with age (β=1.062, p=.000), family income (β=1.000, p=.000) and no laboral occupation (β=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (β=4.158, p=.000). Conclusions: The population with SMD as schizophrenia is more vulnerable due to the associated functional and social disability and it requires specific heath interventions and a financial protection policy adapted to their mental health care needs.

Overview of acute diarrheal disease at the dawn of the 21st century: The case of Mexico / Panorama de la enfermedad diarreica aguda en los albores del siglo XXI: el caso de México

Abstract: Objective: To provide an overview of morbidity and mortality due to acute diarrheal disease in Mexico in order to understand its magnitude, distribution, and evolution from 2000 to 2016. Materials and methods: We carried out a longitudinal ecological study with secondary sources of information. We used data from epidemiological surveillance, health services, and vital statistics. We calculated and mapped measures of utilization of health services rates and mortality due to diarrheal diseases. Results: Diarrhea morbidity decreased by 42.1% across the period. However, emergency department attendances increased by 50.7% in the Ministry of Health. The hospitalization rate and mortality among the general population decreased by 37.6 and 39.7%, respectively, and the infant mortality rate decreased by 72.3% among children under five years of age. Chiapas and Oaxaca had the highest mortality among the states of Mexico. Conclusions: Cases of diarrhea, including rotavirus, have decreased in Mexico. However, in 2016, 3.4 per 100 000 people died due to diarrhea, which could have been avoided with health promotion.

Resumen: Objetivo: Ofrecer un panorama de la morbimortalidad por enfermedad diarreica aguda (EDA) entre 2000 y 2016 en México, para entender su magnitud, distribución y evolución. Material y métodos: Estudio ecológico longitudinal, con fuentes de información secundarias. Se analizaron datos de vigilancia epidemiológica, prestación de servicios y estadísticas vitales. Se calcularon tasas de utilización de servicios y mortalidad. Resultados: La morbilidad por EDA disminuyó 42.1% en el periodo, sin embargo, la atención por urgencias aumentó 50.7% en SS. La tasa de hospitalización descendió 37.6% y la mortalidad 39.7% en población general y 72.3% en menores de cinco años. Chiapas y Oaxaca fueron los estados con mayor tasa de mortalidad. Conclusiones: Los casos de diarrea, incluyendo los de rotavirus, han disminuido en el país. Sin embargo, en 2016 se encontró una tasa de 3.4 por 100 000 personas que mueren por EDA, lo cual podría evitarse con promoción de la salud.

Resolution, access, and waiting time for specialties in different models of care

ABSTRACT OBJECTIVE This study aimed to identify the treatment demands coming from primary health care units and, based on that, the demand for referrals to medical specialties in reference services. This study is justified by the scarcity of scientific literature on the subject. METHODS This is a cross-sectional study using secondary data on the treatments and referrals made by the primary health care units, throughout 2014, in a municipality of the State of São Paulo, Brazil. The total population treated in 2014 was considered, resulting in 411,177 treatments. RESULTS Out of all treatments performed, the percentage of referrals was of 4.42%, showing that 95,58% of the problems did not need to be referred to another service. A number of 8,897 referrals were made, to 6,850 users, who were mostly women (60.74%). The mean of referrals per patient was 1.3 (min. 1 and max. 8), and 1,604 patients (23.5%) were referred at least twice. CONCLUSIONS Primary health care services have been responsible for a large number of treatments, whereas the demand for referrals has decreased, suggesting that such services have established themselves as a gateway to the health system and achieved the expected solvability, although the waiting time for some specialties is very long.

Health system collapse 45 days after the detection of COVID-19 in Ceará, Northeast Brazil: a preliminary analysis

Abstract INTRODUCTION: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil. METHODS: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. RESULTS: The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará's municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. CONCLUSIONS: The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed.

Pandemia por COVID-19 no Brasil: análise da demanda e da oferta de leitos hospitalares e equipamentos de ventilação assistida segundo diferentes cenários / Pandemia por COVID-19 en Brasil: análisis de la demanda y oferta de camas hospitalarias, así como equipamientos de ventilación asistida, según diferentes escenarios / The COVID-19 pandemic in Brazil: analysis of supply and demand of hospital and ICU beds and mechanical ventilators under different scenarios

O objetivo deste estudo é analisar a pressão sobre o sistema de saúde no Brasil decorrente da demanda adicional gerada pela COVID-19. Para tanto, foi realizado um conjunto de simulações para estimar a demanda de leitos gerais (microrregiões de saúde), leitos de UTI e equipamentos de ventilação assistida (macrorregiões de saúde) em diferentes cenários, para intensidade (taxas de infecção equivalentes a 0,01, 0,1 e 1 caso por 100 habitantes) e horizontes temporais (1, 3 e 6 meses). Os resultados evidenciam uma situação crítica do sistema para atender essa demanda potencial, uma vez que diversas microrregiões e macrorregiões de saúde operariam além de sua capacidade, comprometendo o atendimento a pacientes principalmente aqueles com sintomas mais severos. O estudo apresenta três mensagens relevantes. Em primeiro lugar, é necessário reduzir a velocidade de propagação da COVID-19 na população brasileira, permitindo um tempo maior para a reorganização da oferta e aliviando a pressão sobre o sistema de saúde. Segundo, é necessário expandir o número de leitos disponíveis. Ainda que o setor privado contribua para amortecer o déficit de demanda, a oferta conjunta dos dois setores não seria suficiente em várias macrorregiões. A construção de hospitais de campanha é importante, tanto em locais onde historicamente há vazios assistenciais como também naqueles onde já se observa uma pressão do lado da demanda. A terceira mensagem diz respeito à organização regionalizada dos serviços de saúde que, apesar de adequada em situações de demanda usual, em momentos de pandemia este desenho implica desafios adicionais, especialmente se a distância que o paciente tiver de percorrer for muito grande.

El objetivo de este estudio es analizar la presión sobre el sistema de salud brasileño, ocasionada por la demanda adicional de camas hospitalarias y equipos de ventilación mecánica, generada por el COVID-19. Para tal fin, se realizó un conjunto de simulaciones, con el fin de estimar la demanda de camas generales (microrregiones de salud), camas de UTI y equipamientos de ventilación asistida (macrorregiones de salud) en diferentes escenarios, según la intensidad (tasas de infección equivalentes a 0,01, 0,1 y 1 caso por 100 habitantes) y horizontes temporales (1, 3 y 6 meses). Los resultados evidencian una situación crítica del sistema para atender esa demanda potencial, ya que diversas microrregiones y macrorregiones de salud operarían más allá de su capacidad, comprometiendo la atención a pacientes principalmente aquellos con los síntomas más graves. El estudio presenta tres mensajes relevantes. En primer lugar, es necesario reducir la velocidad de propagación del COVID-19 en la población brasileña, permitiendo un tiempo mayor para la reorganización de la oferta y aliviando la presión sobre el sistema de salud. En segundo lugar, es necesario expandir el número de camas disponibles. A pesar de que el sector privado contribuya a amortiguar el déficit de demanda, la oferta conjunta de los dos sectores no sería suficiente en varias macrorregiones. La construcción de hospitales de campaña es importante, tanto en lugares donde históricamente existen lagunas asistenciales, como también en aquellos donde ya se observa una presión por parte de la demanda. El tercer mensaje se refiere a la organización por regiones de los servicios de salud que, a pesar de ser adecuada en situaciones de demanda habitual, en momentos de pandemia, este diseño implica desafíos adicionales, especialmente si la distancia que el paciente tuviera que recorrer fuera muy lejana.

This study aims to analyze the pressure on the Brazilian health system from the additional demand created by COVID-19. The authors performed a series of simulations to estimate the demand for hospital beds (health micro-regions) as well as to ICU beds, and mechanical ventilators (health macro-regions) under different scenarios of intensity (infection rates equivalent to 0.01, 0.1, and 1 case por 100 inhabitants) and time horizons (1, 3, and 6 months). The results reveal a critical situation in the system for meeting this potential demand, with numerous health micro-regions and macro-regions operating beyond their capacity, compromising the care for patients, especially those with more severe symptoms. The study presents three relevant messages. First, it is necessary to slow the spread of COVID-19 in the Brazilian population, allowing more time for the reorganization of the supply and relieve the pressure on the health system. Second, the expansion of the number of available beds will be the key. Even if the private sector helps offset the deficit, the combined supply from the two sectors (public and private) would be insufficient in various macro-regions. The construction of field hospitals is important, both in places with a history of "hospital deserts" and in those already pressured by demand. The third message involves the regionalized organization of health services, whose design may be adequate in situations of routine demand, but which suffer additional challenges during pandemics, especially if patients have to travel long distances to receive care.

Inequities in access to mammographic screening in Brazil / Inequidades no acesso ao rastreamento por mamografia no Brasil / Inequidades en el acceso a las pruebas de cribado mamográfico en Brasil

Abstract: Our objectives with this study were to describe the spatial distribution of mammographic screening coverage across small geographical areas (micro-regions) in Brazil, and to analyze whether the observed differences were associated with spatial inequities in socioeconomic conditions, provision of health care, and healthcare services utilization. We performed an area-based ecological study on mammographic screening coverage in the period of 2010-2011 regarding socioeconomic and healthcare variables. The units of analysis were the 438 health micro-regions in Brazil. Spatial regression models were used to study these relationships. There was marked variability in mammographic coverage across micro-regions (median = 21.6%; interquartile range: 8.1%-37.9%). Multivariable analyses identified high household income inequality, low number of radiologists/100,000 inhabitants, low number of mammography machines/10,000 inhabitants, and low number of mammograms performed by each machine as independent correlates of poor mammographic coverage at the micro-region level. There was evidence of strong spatial dependence of these associations, with changes in one micro-region affecting neighboring micro-regions, and also of geographical heterogeneities. There were substantial inequities in access to mammographic screening across micro-regions in Brazil, in 2010-2011, with coverage being higher in those with smaller wealth inequities and better access to health care.

Resumo: O estudo teve como objetivos descrever a distribuição espacial do rastreamento por mamografia entre áreas geográficas pequenas (microrregiões) no Brasil, além de investigar se as diferenças observadas estavam associadas a inequidades espaciais nas condições socioeconômicas, na prestação de assistência à saúde e no uso de serviços de saúde. Este foi um estudo ecológico de base territorial, comparando a cobertura do rastreamento por mamografia em 2010-2011 com fatores socioeconômicos e de cuidados de saúde. O estudo usou 438 microrregiões sanitárias brasileiras como as unidades analíticas. Foram utilizados modelos de regressão espacial para estudar as associações. Houve uma importante variabilidade na cobertura por mamografia entre microrregiões (mediana = 21,6%; variação interquartil: 8,1%-37,9%). A análise multivariada identificou: forte desigualdade na renda familiar, número baixo de radiologistas/100 mil habitantes, número baixo de aparelhos de mamografia/10 mil habitantes e número baixo de mamografias realizadas com cada aparelho enquanto correlatos independentes da baixa cobertura mamográfica no nível microrregional. Houve evidência de forte dependência espacial nessas associações, em que as mudanças em uma microrregião afetavam as microrregiões vizinhas, além de heterogeneidade geográfica. O estudo revelou importantes inequidades no acesso ao exame de mamografia entre microrregiões brasileiras em 2010-2011, com cobertura mais alta nas microrregiões com menor desigualdade de renda e melhor acesso geral aos cuidados de saúde.

Resumen: Los objetivos de este estudio fueron describir la distribución espacial de la cobertura del cribado mamográfico, a través de pequeñas áreas geográficas (microrregiones) en Brasil, y examinar si las diferencias observadas estuvieron asociadas con inequidades espaciales, en términos de condiciones socioeconómicas, sistema de atención de salud, y utilización de servicios de salud. Se trata de un estudio ecológico, basado en áreas incluidas en la cobertura de cribado mamográfico durante 2010-2011 y relacionadas con variables socioeconómicas y de salud. Las unidades de análisis fueron 438 microrregiones de salud en Brasil. Se utilizaron modelos de regresión espacial para estudiar estas relaciones existentes. Hubo una variabilidad marcada en relación con la cobertura mamográfica a través de las microrregiones (media = 21.6%; rango intercuartílico: 8,1%-37,9%). Los análisis multivariables identificaron una alta inequidad en los ingresos por hogar, bajo número de radiólogos/100,000 habitantes, bajo número de máquinas de mamografía/10.000 habitantes, y un bajo número de mamografías realizadas por cada máquina, lo que está independiente correlacionado con la baja cobertura de mamografías en el nivel de microrregión. Hubo evidencias de una dependencia espacial fuerte de estas asociaciones, con cambios en una microrregión afectando a microrregiones vecinas, y también de heterogeneidades geográficas. Hubo inequidades sustanciales en el acceso al cribado mamográfico a través de las microrregiones en Brasil, en 2010-2011, con una cobertura superior en aquellas con pequeñas inequidades respecto a la riqueza y mejor acceso a los servicios de salud.

Impacto de la tuberculosis en el hospital de Puerto Montt / Impact of tuberculosis in Puerto Montt hospital, Chile

Resumen Objetivo: Dimensionar la demanda de atención y/u hospitalización de la tuberculosis (TBC) en el Hospital de Puerto Montt (HPM). Método: Revisión retrospectiva de los registros de TBC del Servicio de Salud del Reloncaví (SSDR) y del HPM entre los años 2011 y 2015. Se incluyeron todos los casos de TBC activa vistos en forma ambulatoria u hospitalizada en el HPM. Resultados: Se diagnosticaron en el SSDR 298 casos de TBC, y de ellos un 64% (192/298) fue pesquisado en el HPM. Se presentan datos socioeconómicos, epidemiológicos, clínicos, de laboratorio y forma de diagnóstico de 180 casos, que cumplieron criterios de inclusión: varones 62%, edad media 44 ± 19 años. El 72% correspondieron al estrato social de menores ingresos, 4% indigentes, solo 14% poseía enseñanza media completa, 11% analfabetos, ruralidad 19%. Las principales co-morbilidades fueron alcoholismo (17%), VIH (12%), Diabetes (10%). En aquellos con TBC pulmonar o pleural (128) el tiempo con síntomas con frecuencia era prolongado (15% > 90 días) y la radiología mostraba enfermedad avanzada: infiltrados bilaterales 73%, compromiso > 3 lóbulos 55%, una o más cavitaciones 34%. Se hospitalizó el 71% (126/180), 50% por necesidad de estudio, 48%por gravedad. El 8% necesitó Unidad de Paciente Crítico (UPC). Fallecieron 24 pacientes (13%). Se asoció significativamente a mortalidad el analfabetismo y necesidad de UPC. Conclusiones: En el SSDR la TBC es un problema sanitario que afecta principalmente a poblaciones más pobres y vulnerables.

Backgroud: Tuberculosis (TB) is still a problem that impacts on hospitals of high complexity. Aim: To assess demand for care and/or hospitalization because of TB in Puerto Montt Hospital (PMH), located in the southern of Chile. Patients and Methods: Retrospective study of all Reloncaví Health Service (RHS) and PMH clinical records, between 2011 and 2015. We include all ambulatory or hospitalized cases of active TB registered in PMH during the period of the study. Results: In RHS there were 298 cases of TB and 64% of them (192/298) was detected in HPM. We present social, economic, epidemiological, clinical, laboratory studies, and specific type of diagnosis of 180 cases that met inclusion criteria: men 62%, mean age 45 ± 19 years-old. The population with lower income was 72%, 4% homeless, 14% with complete high school, 11% illiterate and 19% lived at country side. Main co-morbidities were alcoholism 17%, HIV 12%, Diabetes Mellitus 10%. In the specific group of lung/pleural TB (128 cases) the time with symptoms was often prolonged (15% > 90 days) and imagen studies showed advanced pathology: bilateral infiltrates 73%>, affecting three or more lobes 55%, cavitations 34%. 71% (126/180) were hospitalized, because of necessity of more study (50%) or severity (48%), 8% required to enter to the Critical Care Unit (CCU). Twenty-four patients died (13%). Illiteracy and the need for CCU were associated with mortality. Conclusions: In RHS TB is a sanitary problem that affects principally the most poor and vulnerable populations.

Unmet need for assistance with activities of daily life among older adults in Brazil

ABSTRACT OBJECTIVE To estimate the proportion of unmet need for personal assistance for basic and instrumental activities of daily life and to evaluate socioeconomic inequalities related to the unmet need among community-dwelling Brazilian older adults. METHODS This was a cross-sectional study with data from the last National Health Survey in Brazil. Unmet need was considered as the presence of at least one unmet need for basic or instrumental activities of daily life among individuals reporting the need for assistance. Logistic regression models were used to assess the correlates and probabilities of unmet need. RESULTS The proportion of unmet need was 18% and 7.1% for basic and instrumental activities of daily life, respectively. Unmet need was significantly related to living arrangements and socioeconomic status. Individuals in the first quintile of wealth status had about 50% higher probability of having an unmet need. A family member was the most prevalent type of caregiver. CONCLUSIONS Long-term care policy is needed to reduce the proportion of unmet need, especially among socioeconomically disadvantaged groups. Future studies should address the availability, training, and remuneration of caregivers, as those are an indispensable labor force in an aging society.

Quedas com necessidade de procura de serviços de saúde entre idosos: uma análise da Pesquisa Nacional de Saúde, 2013 / Falls requiring use of health services by the older adults: an analysis of the Brazilian National Health Survey, 2013 / Caídas con necesidad de buscar servicios de salud entre ancianos: un análisis de la Encuesta Nacional de Salud, 2013

Objetivou-se analisar a prevalência de quedas com necessidade de procurar os serviços de saúde e os fatores sociodemográficos associados em idosos da Pesquisa Nacional de Saúde (PNS), 2013. Estudo transversal, de base populacional, utilizando dados de 23.815 idosos brasileiros da PNS 2013. A variável desfecho foi queda com necessidade de procurar serviço de saúde. Foram realizadas análises brutas e ajustada por meio de regressão de Poisson robusta, considerando-se a razão de prevalência como medida de efeito e seus respectivos intervalos de 95% de confiança (IC95%). Foi utilizado o método stepwise-forward para a inclusão das variáveis no modelo múltiplo. A prevalência de quedas com a necessidade de procurar serviços de saúde foi de 7,8% (IC95%: 7,3-8,4). A região administrativa que apresentou a menor ocorrência de quedas foi a Sudeste (7,3%) e entre os estados brasileiros, Rondônia com 5,3%. Na análise múltipla, a ocorrência de quedas associou-se com idade maior ou igual a 75 anos, sexo feminino e situação conjugal divorciado ou separado. As informações de abrangência nacional trazidas pela PNS podem potencializar ações de prevenção de quedas em todo o Brasil.

The aim was to analyze the prevalence of falls requiring visits to health services and associated sociodemographic factors in the elderly in the Brazilian National Health Survey (PNS), 2013. This was a cross-sectional population-based study using data on 23,815 elderly Brazilians from the PNS 2013 survey. The outcome variable was falls requiring use of a health service. Crude and adjusted analyses were performed with robust Poisson regression, with prevalence ratio as the measure of effect and the respective 95% confidence interval (95%CI). The stepwise-forward method was used for inclusion of the variables in the multivariate model. The prevalence of falls with the need to seek health services was 7.8% (95%CI: 7.3-8.4). The administrative region with the lowest occurrence of falls was the Southeast (7.3%), and Rondônia was the state with the lowest prevalence (5.3%). In the multivariate analysis, falls were associated with age 75 years or older, female sex, and divorced or separated marital status. The nationally representative data produced by the PNS survey can enhance measures to prevent falls throughout Brazil.

El objetivo fue analizar la prevalencia de caídas con necesidad de buscar servicios de salud, y sus factores sociodemográficos asociados, en ancianos de la Encuesta Nacional de Salud (PNS por sus siglas en portugués), 2013. Se trata de un estudio transversal, de base poblacional, utilizando datos de 23.815 ancianos brasileños de la PNS 2013. La variable desenlace fue: caída con necesidad de buscar un servicio de salud. Se realizaron análisis brutos y ajustados, mediante regresión de Poisson robusta, considerándose la Razón de Prevalencia como medida de efecto y sus respectivos intervalo de 95% de confianza (IC95%). Se utilizó el método stepwise-forward para la inclusión de las variables en el modelo múltiple. La prevalencia de caídas con la necesidad de buscar servicios de salud fue de 7,8% (IC95%: 7,3-8,4). La región administrativa que presentó la menor ocurrencia de caídas fue el Sudeste (7,3%) y entre los estados brasileños, Rondônia, con un 5,3%. En el análisis múltiple, la ocurrencia de caídas se asoció con una edad mayor o igual a 75 años, sexo femenino y situación conyugal divorciada o separada. La información de cobertura nacional presentada por la PNS puede potenciar acciones de prevención de caídas en todo Brasil.

Caring for critically ill patients outside intensive care units due to full units: a cohort study

OBJECTIVES: This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. METHODS: A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. RESULTS: Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. CONCLUSIONS: Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.

Análisis de Situación Integral de Salud (ASIS) de la comunidad del barrio Santa María, Bajo Boulogne, partido de San Isidro / Comprehensive health situation analysis of Santa María community, Bajo Boulogne, San Isidro district

Introducción: ASIS en un instrumento para conocer la realidad sanitaria que incluye la perspectiva de los actores, destinado a encaminar la planificación de las actividades en salud orientadas a la comunidad. Objetivo: recabar características sociodemográficas de la población, indagar los problemas de salud identificados por la comunidad, conocer qué estrategias utilizan para atenderlos y conocer sus recursos sociosanitarios. Material y métodos: Método de Análisis Rápido y Planificación Participativa (MARPP) implementado entre junio de 2013 y mayo de 2014 en la comunidad del barrio Santa María, Bajo Boulogne, San Isidro, República Argentina. Se integraron datos de tres fuentes: datos sociodemográficos del Censo Nacional 2010, encuesta domiciliaria para conocer los problemas de salud de la comunidad y un relevamiento de sus recursos sociosanitarios. Resultados: según los datos del Censo, los menores de 19 años representan el 33% de la población, mayoritariamente argentina y alfabetizada. Las viviendas disponen de conexión con agua corriente, desagüe cloacal y gas. Un 12,8% vive con necesidades básicas insatisfechas. Adicionalmente, se encuestaron 225 viviendas con una tasa de respuesta del 70%. El 30% (67/225) de los adultos y el 42% (52/122) de los niños (expresado por adultos responsables) informaron haber padecido algún problema de salud agudo en los últimos dos meses. Para ambos grupos, el principal problema de salud percibido fueron trastornos respiratorios; para los adultos, el segundo en frecuencia fueron los del aparato locomotor. El 55% de los adultos reconocieron padecer algún problema crónico, principalmente cardiovascular. Los problemas más destacados del barrio fueron la inseguridad y la violencia. El 73% refirió conocer el Centro de Medicina Familiar y Comunitaria San Pantaleón, y el 34% manifestó usarlo habitualmente. Conclusiones: este relevamiento representa una primera aproximación a la percepción y a las necesidades de la comunidad. (AU)

Introduction: ASIS is an instrument to know the health situation including the perspective of the actors, and to guide the planning of activities in health-oriented community. Aims: to collect socio-demographic characteristics of the community population, to investigate health problems identified by the community and learn what strategies used to solve them, and know their health resources. Methods: Rapid Rural Appraisal (RRA) methodology implemented between June 2013 and May 2014 in the Santa María community, Bajo Boulogne, Argentina. Data were collected from three sources: socio-demographic data from the 2010 National Census, we conducted a survey ad hoc on a sample to know the health problems of the community, and we described their health resources. Results: according to Census data, under age 19 account for 33% of the population, mainly from Argentina and alphabetized. Their houses have connection with running water, sewerage and gas. 12.8% live with unsatisfied basic needs. In addition, 225 homes were surveyed with a response rate of 70%: 30% (67/225) of adults and 42% (52/122) of children (expressed by responsible adults) reported having had an acute health problem in the past two months. For both, the main perceived health problem was respiratory; for adults, the second in frequency were of musculoskeletal problems. Fifty-five percent of adults suffer from some recognized, mainly cardiovascular chronic problem. The major problems reported were insecurity and violence. 73% reported knowledge of the Centro de Medicina Familiar y Comunitaria San Pantaleón, although it usually uses only 34% of respondents. Conclusions: it represents a first approach to the perception and the needs of the community. (AU)

Brazilian infectious diseases specialists: who and where are they?

Abstract Background The infectious diseases specialist is a medical doctor dedicated to the management of infectious diseases in their individual and collective dimensions. Objectives The aim of this paper was to evaluate the current profile and distribution of infectious diseases specialists in Brazil. Methods This is a cross-sectional study using secondary data obtained from institutions that register medical specialists in Brazil. Variables of interest included gender, age, type of medical school (public or private) the specialist graduated from, time since finishing residency training in infectious diseases, and the interval between M.D. graduation and residency completion. Maps are used to study the geographical distribution of infectious diseases specialists. Results A total of 3229 infectious diseases specialist registries were counted, with 94.3% (3045) of individual counts (heads) represented by primary registries. The mean age was 43.3 years (SD 10.5), and a higher proportion of females was observed (57%; 95% CI 55.3–58.8). Most Brazilian infectious diseases specialists (58.5%) practice in the Southeastern region. However, when distribution rates were calculated, several states exhibited high concentration of infectious diseases specialists, when compared to the national rate (16.06). Interestingly, among specialists working in the Northeastern region, those trained locally had completed their residency programs more recently (8.7 yrs; 95% CI 7.9–9.5) than physicians trained elsewhere in the country (13.6 yrs: 95% CI 11.8–15.5). Conclusion Our study shows that Brazilian infectious diseases specialists are predominantly young and female doctors. Most have concluded a medical residency training program. The absolute majority practice in the Southeastern region. However, some states from the Northern, Northeastern and Southeastern regions exhibit specialist rates above the national average. In these areas, nonetheless, there is a strong concentration of infectious diseases specialists in state capitals and in metropolitan areas.

Lack of access and continuity of adult health care: a national population-based survey / Falta de acesso e de continuidade da atenção à saúde em adultos: inquérito nacional

OBJECTIVE To describe the lack of access and continuity of health care in adults.METHODS A cross-sectional population-based study was performed on a sample of 12,402 adults aged 20 to 59 years in urban areas of 100 municipalities of 23 states in the five Brazilian geopolitical regions. Barriers to the access and continuity of health care and were investigated based on receiving, needing and seeking health care (hospitalization and accident/emergency care in the last 12 months; care provided by a doctor, by other health professional or home care in the last three months). Based on the results obtained by the description of the sample, a projection is provided for adults living in Brazilian urban areas.RESULTS The highest prevalence of lack of access to health services and to provision of care by health professionals was for hospitalization (3.0%), whilst the lowest prevalence was for care provided by a doctor (1.1%). The lack of access to care provided by other health professionals was 2.0%; to accident and emergency services, 2.1%; and to home care, 2.9%. As for prevalences, the greatest absolute lack of access occurred in emergency care (more than 360,000 adults). The main reasons were structural and organizational problems, such as unavailability of hospital beds, of health professionals, of appointments for the type of care needed and charges made for care.CONCLUSIONS The universal right to health care in Brazil has not yet been achieved. These projections can help health care management in scaling the efforts needed to overcome this problem, such as expanding the infrastructure of health services and the workforce.

OBJETIVO Descrever a falta de acesso e de continuidade da atenção à saúde de adultos.MÉTODOS Estudo transversal de base populacional com 12.402 adultos entre 20 e 59 anos, residentes em áreas urbanas de 100 municípios de 23 estados brasileiros, nas cinco regiões geopolíticas. Investigaram-se as barreiras no acesso e na continuidade da atenção a partir do recebimento, necessidade e busca de algum atendimento de saúde (internação hospitalar e pronto-socorro nos 12 meses prévios ao estudo; atendimento médico, de outro profissional de saúde e domiciliar nos três meses prévios). A partir dos resultados obtidos na descrição da amostra, apresenta-se uma projeção para os adultos residentes em áreas urbanas no território nacional.RESULTADOS A prevalência de falta de acesso aos serviços e aos atendimentos com profissionais de saúde mais expressiva foi de 3,0%, para internação hospitalar, enquanto a menor prevalência foi para atendimento médico (1,1%). A falta de acesso para o atendimento com outro profissional de saúde foi de 2,0%; em pronto-socorro, 2,1%; e domiciliar, 2,9%. Quanto às prevalências, o maior número absoluto de falta de acesso foi para atendimentos de urgência (mais de 360.000 adultos). Os principais motivos foram problemas estruturais e organizacionais, como falta de leito, de profissionais, de ficha/vaga do tipo de atendimento necessário e cobrança pelo atendimento.CONCLUSÕES O direito universal à saúde no Brasil ainda não foi alcançado. As projeções podem apoiar a gestão no dimensionamento de esforços dirigidos ao seu enfrentamento, como a ampliação da estrutura física dos serviços e da força de trabalho.

Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil / Fluxo de hospitalização nos sistemas público e privado no estado de São Paulo

OBJECTIVE To describe the migration flows of demand for public and private hospital care among the health regions of the state of Sao Paulo, Brazil. METHODS Study based on a database of hospitalizations in the public and private systems of the state of Sao Paulo, Southeastern Brazil, in 2006. We analyzed data from 17 health regions of the state, considering people hospitalized in their own health region and those who migrated outwards (emigration) or came from other regions (immigration). The index of migration effectiveness of patients from both systems was estimated. The coverage (hospitalization coefficient) was analyzed in relation to the number of inpatient beds per population and the indexes of migration effectiveness. RESULTS The index of migration effectiveness applied to the hospital care demand flow allowed characterizing health regions with flow balance, with high emigration of public and private patients, and with high attraction of public and private patients. CONCLUSIONS There are differences in hospital care access and opportunities among health regions in the state of Sao Paulo, Brazil.

OBJETIVO Descrever os fluxos migratórios de demanda por assistência hospitalar pública e privada entre as regiões de saúde no estado de São Paulo, Brasil. MÉTODOS Estudo com base em banco de dados de hospitalizações nos sistemas público e privado, no estado de São Paulo, em 2006. Foram analisados dados de 17 regiões de saúde do estado, considerando aqueles hospitalizados na própria região de saúde e os que migraram para fora (evasão) ou vieram de outras regiões (invasão). Calculou-se o índice de eficácia migratória de pacientes de ambos os sistemas. Foi analisada a cobertura (coeficiente de hospitalização) em relação ao número de leitos por habitantes e os índices de eficácia migratória. RESULTADOS O índice de eficácia migratória aplicado ao fluxo de demanda da assistência hospitalar permitiu caracterizar as regiões de saúde com equilíbrio de fluxos, com alta evasão de pacientes públicos e privados, e com alta atração de pacientes públicos e privados. CONCLUSÕES Há diferenças de acesso e oportunidades à assistência hospitalar entre as regiões de saúde no estado de São Paulo.

Uso de recursos de salud por parte de pacientes adultos con cardiopatía congénita en Chile / Health resources used by adults with congenital heart disease in Chile

Reportes internacionales han descrito el mayor uso de recursos de salud por parte de los pacientes adultos con cardiopatía congénita (CC). Objetivo: Describir el uso de recursos de salud por parte de esta población en términos de frecuencia de controles médicos, consultas a servicio de urgencia, hospitalizaciones y procedimientos realizados. También se buscó explorar la frecuencia de control odontológico y la indicación de profilaxis de endocarditis como una medida de calidad de atención. Metodología: Se realizó un estudio cuantitativo de corte transversal, analítico e individual en pacientes controlados en el Instituto Nacional del Tórax, durante el período 2014-2015. Los pacientes respondieron una encuesta en forma autónoma. Se realizó análisis por grupos según sexo y tipo de CC según el consenso de Bethesda (simple, moderada o compleja). El análisis estadístico se realizó a través del programa SPSS. Resultados: Se recolectaron 363 encuestas válidas que correspondieron a 180 hombres (49,6%) y con una edad promedio de 29,2±13,3 años. Según el tipo de CC: simple 78 pacientes (21,5%), moderada 161 (44,4%) y compleja 124 (34,2%). 296 pacientes (84,6%) tuvieron el último control médico hace menos de un año. 151 pacientes (41,6%) han consultado una o más veces al servicio de urgencia. 76 pacientes (20,9%) han sido hospitalizados una o más veces y 54 pacientes (14,9%) se han realizado uno o más procedimientos en el último año. En el análisis por tipo de CC no se encontraron diferencias significativas en ninguno de los parámetros evaluados. En el análisis según sexo, se observó que las mujeres consultan más al servicio de urgencia que los hombres (48,1% vs 35%, p<0,05). En cuanto a salud oral, 122 pacientes (33,6%) no ha realizado un control odontológico hace más de 1 año y de aquellos pacientes que asistieron al dentista, 165 de ellos (45,5%) no recibió profilaxis antibiótica para endocarditis en su última atención. Conclusiones: Los adultos con CC reportan una demanda de recursos de salud expresada en controles médicos, consultas de urgencia, hospitalizaciones y procedimientos, que aparentemente no es sólo por factores relacionados a sus patologías. Es necesario elaborar estrategias de atención en salud para responder a las necesidades de esta creciente población y que permitan un uso razonable de recursos. Es perentorio estimular el control periódico dental y la profilaxis de endocarditis.

A greater use of health resources by adults with congenital heart disease has been reported in international studies. Aim: to describe the use of health resources by adults with CHD in Chile including frequency of medical controls, emergency consultations, hospitalization and medical procedures. Dental consultations and prophylaxis for infective endocarditis were also evaluated Methods: a cross sectional analytic study was per-formed on patients with CHD followed in the Instituto Nacional del Tórax, Santiago, Chile, during 2014 and 2015. Patients were asked to answer a questionnaire and data was analyzed according to gender, and type of CHD (Bethesda classification). Statistics were computed using SPSS. Results: Valid answers were obtained from 363 sub-jects, 180 males (49.6%). Mean age was 20.2 ± 13.3 years. 78 patients (21.5%) had simple, 161 (44.4%) moderate and 124 (34.2%) severe CHD. 296 (84.6%) patients had a medical control within the last year. 151 (41.6%) had attended a medical emergency service > 1 occasion, 76 (20.9% had >= 1 hospitalizations and 54 (14.9%) had been subjected to a medical procedure related to their CHD. Women had more medical controls than males (48,1% vs 35%, p<0,05). 122 (33.6%) had no dental control in the last year and 45% of those attending had no prophylaxis for IE Conclusión: Adults with CHD use health resources including medical visits, hospitalizations and procedures, apparently not all of them related to their CHD. Strategies to optimize use of health resources should be designed. Emphasis on dental controls and prophylaxis for infective endocarditis is needed.

Padrões de utilização de atendimento médico-ambulatorial no Brasil entre usuários do Sistema Único de Saúde, da saúde suplementar e de serviços privados / Patterns in the use of outpatient care in Brazil by patients treated through the Brazilian Unified National Health System, private health insurance, and out-of-pocket medical care / Los patrones de uso de atención médica ambulatoria en Brasil entre el Sistema Único de Salud, la salud y los servicios privados suplementarios

Indicadores de oferta, acesso e utilização são úteis para caracterizar os serviços, planejar ações e organizar a demanda. Este estudo descreve padrões de utilização de atendimento médico-ambulatorial e associação com variáveis sociodemográficas, de morbidade, porte do município e região, de acordo com a natureza jurídica do serviço. Trata-se de um estudo transversal de base populacional com 12.402 adultos brasileiros entre 20 e 59 anos, residentes nas áreas urbanas de 100 municípios nas cinco regiões brasileiras. A prevalência de atendimento médico-ambulatorial nos três meses anteriores à entrevista foi de 34,6%. O Sistema Único de Saúde foi responsável por mais da metade (53,6%) dos atendimentos, algum convênio de saúde foi utilizado por 34% da amostra e os serviços privados por 12,4%, independentemente da região, do porte populacional e da morbidade referida. Os padrões de utilização de serviços de saúde continuam socialmente determinados, resultando da oferta, das características sociodemográficas e do perfil de saúde dos usuários.

Indicators of supply, access, and use of healthcare are helpful for characterizing services, planning activities, and organizing demand. This study describes patterns of use of outpatient care and the associations with demographic and socioeconomic factors, morbidity, population size of the municipality and region, and administrative and financial classification of the provider. This was a population-based cross-sectional study with a sample of 12,402 Brazilian adults from 20 to 59 years of age living in urban areas of 100 municipalities from five regions. Prevalence of outpatient care in the three months prior to the interview was 34.6%. The Brazilian Unified National Health System (SUS) accounted for more than half (53.6%) of the cases, health insurance was used by 34% of the sample, and out-of-pocket services 12.4%, regardless of region, population size, and morbidity profile. Patterns of use of health services remain socially determined, resulting from the supply, demographic and socioeconomic characteristics, and health profile of users.

Indicadores de la oferta, acceso y uso son útiles para caracterizar los servicios, las actividades de planificación y organización de la demanda. El estudio describe los patrones de uso de tratamiento ambulatorio y su asociación con variables sociodemográficas, morbilidad, tamaño del municipio y de la región, de acuerdo con la naturaleza jurídica del servicio. Se trata de una base poblacional transversal 12.402 adultos brasileños, entre 20 y 59 años, que viven en zonas urbanas de 100 municipios en cinco regiones. La prevalencia de tratamiento ambulatorio en los tres meses anteriores a la entrevista fue del 34,6%. El Sistema Único de Salud fue responsable de más de la mitad (53,6%) de los casos, un plan de salud fue utilizado por el 34% de la muestra y los servicios privados representaron el 12,4%, con independencia de la región, el tamaño de la población y la morbilidad anteriormente. Los patrones de uso de los servicios de salud siguen siendo socialmente determinados, lo que resulta en la oferta, el perfil sociodemográfico y la salud de los usuarios.

La perspectiva de los nefrólogos acerca de la donación y el trasplante renal en la Argentina

El objetivo de este trabajo cualitativo fue explorar y describir la perspectiva de los nefrólogos acerca de la situación de la donación y el trasplante en la Argentina. Participaron 22 jefes de equipo de trasplante y/o profesionales a cargo de la toma de decisiones sobre la aceptación de injertos, donantes y candidatos a trasplante, de una muestra intencional. Se realizaron entrevistas en profundidad, semi-estructuradas, que se grabaron, transcribieron, analizaron y codificaron temáticamente. Más de la mitad de los participantes coincidió en la necesidad de promover la donación de órganos; casi la mitad dijo que los centros de diálisis no enviaban todos los pacientes que deberían a realizar estudios para trasplante. La mitad de los participantes confirmó que la información brindada por el equipo de procuración no era confiable. Se identificó la falta de adherencia de los pacientes al tratamiento como un problema serio, principalmente a causa de la situación socio-económica. 5/22 participantes expresaron que la cantidad de trasplantes no aumentaba por bajas tasas de donación, entrenamiento deficiente o falta de información de los nefrólogos. Los participantes percibieron una necesidad de información, entrenamiento y compromiso de los profesionales de la salud en la identificación y derivación de posibles donantes y receptores y señalaron que los problemas socioeconómicos afectan al proceso en diferentes etapas. Estos temas deberían ser tenidos en cuenta para mejorar los resultados del trasplante en un contexto de transparencia y equidad.

Our aim was to explore and describe Argentine transplant nephrologists' perspectives on the renal transplant situation. Professionals (n = 22) in charge of teams and/or responsible for accepting grafts, donors, and transplant candidates, were specifically chosen. In-depth semistructured interviews were recorded, transcribed, analyzed and thematically coded. More than 50% of these professionals agreed on the need to promote organ donation. Almost half felt that dialysis centers did not refer their patients to transplant centers for their evaluation; as they should. Half of participants stated that the information provided by the allocation team was unreliable. Patients' non-compliance was identified as a major problem, mainly due to socio economic issues. Participants (n = 5/22) maintained that transplantation procedures were stagnant mainly due to low donor rates, poor training or lack of information at hand for nephrologists and transplant nephrologists. Participants alleged the need of further information, training and commitment of health professionals in the identity and referral of donors and transplant candidates. Also, it must be taken into account that socioeconomic difficulties affect the process at different stages. These issues need to be addressed in order to improve transplantation outcome where transparency and equality are concerned.

Atenção Primária a Saúde voltada as necessidades dos idosos: da teoria à prática / Primary healthcare geared to the needs of the elderly: from theory to practice

O objetivo deste artigo é estabelecer uma confrontação entre teoria e prática no que tange ao cuidado com a saúde de pessoas idosas. A teoria foi avaliada através de um estudo de documentos que compõem o arcabouço teórico-legal relacionado com a saúde do idoso e que gerou a construção de uma matriz com as seguintes categorias: Acesso Universal, Equidade, Integralidade e Qualidade do Cuidado. Já a prática foi avaliada por um estudo de base populacional realizado junto a 862 idosos e por um censo que avaliou unidades de atenção primária (APS), ambos em dois distritos sanitários de Porto Alegre (RS). As variáveis que avaliaram as categorias foram respectivamente: tipo de serviço acessado, atributo de primeiro contato, acessibilidade de cadeirantes; presença de acesso prioritário; atributo integralidade e presença de restos radiculares; escore essencial da APS, adequação das estruturas das unidades de APS e capacitação profissional e variáveis transversais: grupos de idosos e visita domiciliar. Verificou-se um descompasso entre o preconizado e o estabelecido em alguns aspectos e observaram-se avanços em relação à equidade e à qualidade do cuidado em relação à capacitação dos profissionais.

This article seeks to establish a confrontation between theory and practice with respect to healthcare for the elderly. The theory was evaluated by a study of documents that comprise the legal and theoretical framework related to the health of the elderly, which generated a matrix to assess universal access, equity, comprehensiveness and quality of care. However, the practice of healthcare was evaluated by a population-based study conducted on 862 elderly individuals and a census that assessed primary healthcare (PHC) units in two districts of Porto Alegre in the state of Rio Grande do Sul, Brazil. The variables chosen to verify the categories were type of care accessed, first contact attribute, wheelchair accessibility and availability of priority access. Other variables include comprehensive care and the presence of dental root remains, basic PHC score, the adequacy of health facilities and ongoing professional training, as well as cross-sectional categories, elderly groups and home care. A mismatch was found between recommendation and practice in some factors and advances were observed in the equity and quality of care regarding the ongoing training of professionals.