Inserção de profissionais de educação física no Sistema Único de Saúde: análise temporal (2007-2021) / Insertion of physical education professionals in the Unified Health System: temporal analysis (2007-2021)

O objetivo desta pesquisa foi descrever e analisar a série temporal da inserção de profissionais de educação física (PEF) no Sistema Único de Saúde (SUS) no período de 2007 a 2021, bem como apresentar a distribuição por regiões e estados de profissionais no território brasileiro. Trata-se de um estudo descritivo e de série temporal que utilizou dados secundários oriundos do sistema de consultas do Cadastro Nacional dos Estabelecimentos de Saúde (CNES). Analisou-se o quantitativo de PEF no SUS nas cinco regiões e nos vinte e seis estados e no Distrito Federal entre 2007 e 2021 e reali-zou-se a análise temporal para verificar a distribuição dos PEF nas regiões brasileiras. Os resultados apontam para um crescimento no número de PEF entre 2007 (n = 22) e 2020 (n = 7.560) em todo o país. Em 2021 observa-se uma redução de 2,8% no quantitativo de PEF. Entre as regiões, os maio-res quantitativos foram observados nas regiões Nordeste e Sudeste, enquanto nos estados a maior concentração foi em Minas Gerais, seguido de São Paulo, Pernambuco, Bahia e Rio Grande do Sul. Observou-se uma tendência crescente de PEF nas regiões Norte e Sul. Conclui-se que o quantitativo de PEF atuantes no SUS teve um crescimento expressivo durante o período analisado, sendo fruto das políticas públicas e programas voltados à promoção da atividade física constituídos ao longo do tempo. Apesar disso, há importantes disparidades geográficas que não devem ser desconsideradas, reforçando a necessidade de estratégias coletivas e investimentos em políticas públicas que fomentem a inserção dos PEF na rede assistencial e de fortalecimento do SUS

The aim of this study was to describe and analyze the time series of physical education professionals (PEF in Portuguese) in the Unified Health System (SUS in Portuguese) from 2007 to 2021, as well as to present their distribution by Brazilian regions and states. This is a time series study which used secondary data from the Consultation System of the National Registry of Health Establishments (CNES in Portuguese). We analyzed the number of PEF in the country, in the five Regions and in the twenty-six States and the Fed-eral District between 2007 and 2021 and the temporal analysis was carried out to verify the distribution of PEF in the Brazilian regions. The results point to an increase in the number of PEF between 2007 (n = 22) and 2020 (n = 7560). In 2021, there is a 2.8% reduction in the amount of PEF. Among the regions, the highest numbers were observed in the Northeast and Southeast regions, while in the states the highest con-centration was in Minas Gerais, followed by São Paulo, Pernambuco, Bahia and Rio Grande do Sul. There was an increasing trend in the distribution of PEF in the North and South regions. The number of PEF working in the SUS had an expressive growth during the analyzed period, being the result of public policies and programs aimed at promoting physical activity constituted over time. Despite this, there are important geographic disparities that should not be disregarded, reinforcing the need for collective strategies and financ-ing in public policies that encourage the insertion of PEFs in the care network and the strengthening of SUS

Manual de registro y codificación de la atención en salud bucal 2022 / Manual of registration and coding of oral health care 2022

La publicación describe y homogeniza los criterios en la recopilación y codificación de diagnósticos CIE 10 y Catálogo de Procedimientos médicos y estomatológicos del Ministerio de Salud. Asimismo, la metodología de registros estadísticos sanitarios en salud bucal, el cual se convierte en un sistema de información necesaria para la toma de decisiones en la solución de los problemas sanitarios en el marco del sistema de coordinación

Perguntar para quê? quesito raça/cor no cadastro único para programas sociais / ¿ por qué preguntar? cuestión raza/color en el registro único de programas sociales / Why do ask for it? race/color question in the single registration for social programs

Resumo A partir da análise do preenchimento do quesito raça/cor do Cadastro Único para Programas Sociais do Governo Federal (CadÚnico), realizado por entrevistadoras sociais em um Centro de Referência de Assistência Social, este artigo objetiva discutir o tensionamento racial presente no campo da Política Nacional de Assistência Social (PNAS). Assumindo uma política investigativa pautada nos estudos da Ciência, Tecnologia e Sociedade e da Teoria Ator-Rede, utilizamos o registro de diários de campo como ferramenta à produção de dados sobre o referido preenchimento. Nesse percurso, assinalamos que o racismo brasileiro e as ambiguidades ligadas ao quesito raça/cor se atualizam no preenchimento do CadÚnico, implicando diferentes performances à produção da autodeclaração racial. Frente a isso, a compreensão das questões raciais nos processos socioterritoriais e subjetivos, que atravessam os serviços da PNAS, é fundamental ao desenvolvimento de práticas ao exercício da cidadania que não corroborem com manutenção da desigualdade racial brasileira.

Resumen A partir del análisis del llenado de la pregunta raza/color del Registro Único de Programas Sociales del Gobierno Federal (CadÚnico), realizado por entrevistadores sociales en un Centro de Referencia de Asistencia Social, este artículo tiene como objetivo discutir la tensión racial presente en la Política Nacional de Asistencia Social (PNAS). Asumiendo una política de investigación basada en los estudios de Ciencia, Tecnología y Sociedad y la Teoría Actor-Red, utilizamos el registro de diarios de campo como herramienta para la producción de datos sobre dicho relleno. De esta manera, señalamos que el racismo brasileño y las ambigüedades relacionadas con la raza/color se actualizan en el llenado del CadÚnico, lo que implica diferentes actuaciones en la producción de la autodeclaración racial. Así, la comprensión de las cuestiones raciales en los procesos socio-territoriales y subjetivos que atraviesan los servicios del PNAS es fundamental para el desarrollo de prácticas para el ejercicio de la ciudadanía que no corroboren el mantenimiento de la desigualdad racial en Brasil.

Abstract Based on the analysis of the filling out of the race/color question of the Federal Government Registry for the Social Programs (CadÚnico), carried out by social interviewers at a Social Assistance Reference Center, this article aims to discuss the racial tension present in the field of National Social Assistance Policy (PNAS). Assuming an investigative policy based on the studies of Science, Technology and Society and the Actor-Network Theory, we used field diaries registers as a tool for the production of data on the aforementioned filling. We point out that Brazilian racism and the ambiguities related to race/color are updated in filling out the CadÚnico, implying different performances in the production of racial self-declaration. In this view, the understanding of racial issues in the socio-territorial and subjective processes that cross the PNAS services is fundamental to the development of practices for the exercise of citizenship that do not corroborate the maintenance of Brazilian racial inequality.

Análisis epidemiológico multicéntrico de las fracturas de cadera en Uruguay: importancia y planificación de un registro nacional / Multicenter epidemiological analysis of hip fractures in Uruguay: importance and planning of a national register / Análise epidemiológica multicêntrica de fraturas de quadril no Uruguai: importância e planejamento de um registro nacional

Introducción: La incidencia de fracturas de cadera presenta un aumento dramático desde la mediana edad, constituyendo un problema de salud prevalente en adultos mayores. Se realizó una revisión bibliográfica de los registros internacionales de fracturas de cadera y un estudio epidemiológico multicéntrico para conocer la incidencia, los costos y la mortalidad de esta patología en nuestro país. Material y métodos: Se realizó una búsqueda, revisión y análisis de todos los registros internacionales de fracturas de cadera existentes en el mundo. Posteriormente, se llevó a cabo un análisis descriptivo observacional retrospectivo y multicéntrico en 4 instituciones de pacientes mayores de 50 años intervenidos quirúrgicamente con osteosíntesis por fractura de cadera en el año 2019. En los datos anonimizados se evaluaron edad, sexo, tipo de fractura, incidencia y costos. Se incluyeron y asociaron, además, datos estadísticos y económicos del Registro del Fondo Nacional de Recursos. Se utilizó el software estadístico SPSS para establecer asociaciones univariadas, bivariadas y multivariadas. Para comparar las proporciones se empleó el test estadístico de chi cuadrado. Resultados: Se resume la revisión de registros en una tabla. El análisis multicéntrico contó con 646 pacientes con fracturas de cadera. Destacamos la alta prevalencia de esta patología en pacientes mayores de 79 años (63,1%) y en el sexo femenino (77,6%), en concordancia con los registros internacionales, con asociación significativa entre ambas variables (p < 0,0001). A diferencia de otros registros, y quizás dato erróneo, la fractura más frecuente fue la del cuello de fémur (43%). El tiempo entre la fractura y la cirugía y los días de internación fueron de 2,6 y 7,2 días, respectivamente, en la institución de asistencia más efectiva. Nuestro cálculo mostró una incidencia de fractura de cadera en Uruguay que oscila entre 235 y 391 en 100.000 habitantes mayores de 50 años. El costo calculado de la serie evaluada fue de unos U$S 2.855.320 y, en general, esta patología provoca un gasto para nuestro país que se aproxima a U$S 20.000.000 por año. Conclusión: La fractura de cadera presenta una elevada incidencia, costos y morbimortalidad en la población de adultos mayores, comparable con datos internacionales. Es necesario contar con un Registro Nacional de Fracturas de Cadera que permita conocer datos estadísticos certeros para poder establecer políticas adecuadas de prevención, tratamiento y control de gastos.

Introduction: The incidence of hip fractures dramatically increases from middle age on, posing a prevalent health problem in elderly people. A literature review of the international hip fracture registers, as well as a multicenter, epidemiological study were carried out in order to assess the incidence, costs, and mortality of this pathology in our country. Material and methods: All international hip fracture registers in the world were searched, reviewed and analyzed. An observational, retrospective, multicenter descriptive analysis was then carried out in 4 health-care centers for patents over 50 years of age who underwent surgery with osteosynthesis due to hip fracture in 2019. Age, sex, type of fracture, incidence and costs were assessed from the anonymized data. Statistical and economic data from the National Resources Fund Register were also included and associated. The SPSS statistical software was used to establish univariate, bivariate, and multivariate associations. The chi-squared statistical test was used to compare proportions. Results: Review of the registers is summarized in a table. The multicenter analysis included 646 patients with hip fractures. Worth of note is the high prevalence of this pathology in patients over 79 years of age (63.1%) and females (77.6%), in line with the international registers, and a significant association between both variables (p < 0.0001). Unlike other registers, and probably due to inaccurate data, the most frequent fracture was that of femoral neck (43%). The time from fracture to surgery and inpatient days were 2.6 and 7.2 days, respectively, in the most effective health care center. Our calculation showed a hip fracture incidence in Uruguay between 235 and 391 per 100,000 inhabitants over 50 years of age. The estimated cost of the assessed series was about U$S 2,855,320, and in general this pathology generates an annual expense of about U$S 20,000,000 for our country. Conclusion: Hip fractures have high incidence, costs and mortality and morbidity in the elderly population comparable with international data. It is necessary to have a National Hip Fracture Register that provides accurate statistical data in order to establish adequate prevention, treatment and cost control policies.

Introdução: A incidência de fraturas de quadril apresenta um aumento dramático a partir da meia-idade, constituindo um problema de saúde prevalente em idosos. Uma revisão bibliográfica dos Registros Internacionais de Fratura de Quadril e um estudo epidemiológico multicêntrico foram realizados para determinar a incidência, os custos e a mortalidade dessa patologia em nosso país. Material e métodos: Foi realizada uma busca, revisão e análise de todos os Registros Internacionais de fraturas de quadril existentes no mundo. Posteriormente, foi realizada uma análise observacional descritiva retrospectiva e multicêntrica, em 4 Instituições, de pacientes maiores de 50 anos, submetidos à cirurgia com osteossíntese, para fratura de quadril em 2019. Nos dados anônimos foram avaliados idade e sexo, tipo de fratura , incidência e custos. Dados estatísticos e econômicos do Registro do Fundo Nacional de Recursos também foram incluídos e associados. O software estatístico SPSS foi usado para estabelecer associações univariadas, bivariadas e multivariadas. O teste estatístico do qui quadrado foi usado para comparar as proporções. Resultados: a revisão dos registros é resumida em uma tabela. A análise multicêntrica incluiu 646 pacientes com fraturas de quadril. Destaca-se a alta prevalência dessa patologia em pacientes maiores de 79 anos (63,1%) e no sexo feminino (77,6%), de acordo com registros internacionais, com associação significativa entre as duas variáveis ​​(p <0,0001). Ao contrário de outros registros, e talvez dados errôneos, a fratura mais frequente foi a do colo do fêmur (43%). O tempo decorrido entre a fratura e a cirurgia e os dias de internação foram de 2,6 e 7,2 dias, respectivamente, na instituição assistencial mais efetiva. Nosso cálculo mostrou uma incidência de fratura de quadril no Uruguai, variando entre 235 e 391 em 100.000 habitantes com mais de 50 anos de idade. O custo calculado da série avaliada foi em torno de US $ 2.855.320 e, em geral, essa patologia acarreta um gasto para o nosso país que é próximo a US $ 20.000.000 por ano. Conclusão: A fratura de quadril tem alta incidência, custo e morbimortalidade na população idosa, comparável a dados internacionais. É necessário um Cadastro Nacional de Fraturas de Quadril, que permita conhecer dados estatísticos precisos, para estabelecer políticas adequadas de prevenção, tratamento e controle de custos.

The REBECGA brazilian registry of pregnancy and heart disease: rationale and design

BACKGROUND: Maternal mortality rates in Brazil remain above the goals established by the United Nations Sustainable Development Goals. Heart disease is estimated to affect 4% of all pregnancies and remains by itself the main indirect obstetric cause of maternal death. In the last decades, a significant improvement in the prognosis of heart diseases has made pregnancy possible in women with heart disease and provided better maternal and fetal outcomes. OBJECTIVES: To establish a multicenter Brazilian Registry of pregnant women with heart disease; to study the causes of immediate and late maternal mortality; and to assess the prevalence of heart disease in the country's macro-regions. METHODS: This is an observational study, with retrospective and prospective stages, of the clinical and obstetric progression of pregnant women with heart disease. These women consecutively received care during pregnancy and will be followed up for up to a year after delivery at public and private hospitals with infrastructure for the execution of this project, a principal investigator, and approval by Ethics and Research Committees. RESULTS: Our results will be presented after data collection and statistical analysis, aiming to demonstrate immediate and late maternal mortality rates, as well as the prevalence of heart disease in the country and its cardiovascular and obstetric complications during pregnancy. CONCLUSIONS: REBECGA will be the Brazilian Registry of heart disease and pregnancy and it will contribute to planning preventive measures, raising financial resources for the improvement of high-risk prenatal care, and reducing immediate and late maternal mortality due to heart disease.

Infarto De Miocardio Sin Lesiones Coronarias. Subanálisis Del Registro CONAREC XVII / Myocardial infarction without coronary arteries lesions. Insights from the CONAREC XVII Registry

Los síndromes coronarios agudos sin lesiones coronarias han cobrado relevancia en los últimos años, pero aún no se dispone de datos locales. Analizamos un registro de pacientes con infarto agudo de miocardio, en 45 centros del país con residencias de cardiología. Se analizaron 1182 participantes de los cuales 33 (2.8%) no presentaron lesiones coronarias en angiografía, mientras que 89.5% tenían lesiones graves y 7.7% lesiones intermedias. La edad promedio de los pacientes sin lesiones coronarias fue 64.5 ± 13.0 años, 69.7% eran varones, sin diferencias respecto a aquellos con enfermedad epicárdica. La presentación electrocardiográfica más frecuente fue la desviación del segmento ST (13 supradesnivel y 10 infradesnivel del segmento). Además, este subgrupo presentó biomarcadores más bajos (CPK pico 203.5 UI/l, rango [RIC] 102- 422.5 vs. 895.5 UI/l RIC 350-1891, p < 0.0001). La mediana de días de internación fue 4.0 (RIC 3-5.5), siendo menor que la del grupo con enfermedad coronaria intermedia y grave (5.5 días, RIC 4-7, y 6 RIC 4-7, p = 0.003). Al alta, aquellos sin lesiones coronarias recibieron menor prescripción de IECA/ARA II (54.6% vs. 78.0% y 79.7%, p = 0.002) y estatinas (78.8% vs. 87.9% y 91.9%, p = 0.017). Ninguno de este subgrupo falleció durante la inter nación. Nuestros datos sugieren que los infartos sin lesiones coronarias significativas son frecuentes en nuestro medio, aunque probablemente se encuentren subdiagnosticados. Si bien su pronóstico parece más favorable, resulta importante señalar que recibieron menos fármacos para prevenir su recurrencia. Nuevos estudios son necesarios para profundizar el conocimiento de esta enfermedad.

Abstract Acute coronary syndromes without coronary lesions have gained relevance in recent years. However, local data on this condition is scarce. We aimed to explore this entity in a National registry of acute myocardial infarction that was carried out prospectively in hospitals with cardiology residence programs from Ar gentina. We included 1182 patients from 45 centers, where 33 did not present coronary lesions on angiography. The mean age was 64.5 ±13.0 and 69.7% were male, without differences compared to participants with epicardial disease. The most common electrocardiographic presentation was ST segment deviation. In addition, presented lower biomarkers (peak CPK 203.5 IU / l, range [IQR] 102-422.5 vs. 895.5 IU / l IQR 350-1891, p < 0.0001). The median hospitalization was 4.0 days (IQR 3-5.5), lower than the group with intermediate and severe coronary disease (5.5 days, RIC 4-7, and 6, RIC 4-7, p = 0.003). At discharge, less use of ACE/ARB (54.6% vs.78.0% y 79.7%, p = 0.002) and statins (78.8% vs. 87.9% y 91.9%, p = 0.017). No deaths during hospitalization were reported. Our data suggested that infarcts without significant coronary lesions are frequent, although they are probably underdiagnosed. Their prognosis seems to be more favorable, but they receive fewer drugs to prevent recurrence. New studies are necessary to deepen the knowledge of the disease.

Treatment of individual predictors with neural network algorithms improves Global Registry of Acute Coronary Events score discrimination / El tratamiento con redes neuronales de las variables del Global Registry of Acute Coronary mejora la discriminación del score

Abstract Objective: The aim of this study was to develop, train, and test different neural network (NN) algorithm-based models to improve the Global Registry of Acute Coronary Events (GRACE) score performance to predict in-hospital mortality after an acute coronary syndrome. Methods: We analyzed a prospective database, including 40 admission variables of 1255 patients admitted with the acute coronary syndrome in a community hospital. Individual predictors included in GRACE score were used to train and test three NN algorithm-based models (guided models), namely: one- and two-hidden layer multilayer perceptron and a radial basis function network. Three extra NNs were built using the 40 admission variables of the entire database (unguided models). Expected mortality according to GRACE score was calculated using the logistic regression equation. Results: In terms of receiver operating characteristic area and negative predictive value (NPV), almost all NN algorithms outperformed logistic regression. Only radial basis function models obtained a better accuracy level based on NPV improvement, at the expense of positive predictive value (PPV) reduction. The independent normalized importance of variables for the best unguided NN was: creatinine 100%, Killip class 61%, ejection fraction 52%, age 44%, maximum creatine-kinase level 41%, glycemia 40%, left bundle branch block 35%, and weight 33%, among the top 8 predictors. Conclusions: Treatment of individual predictors of GRACE score with NN algorithms improved accuracy and discrimination power in all models with respect to the traditional logistic regression approach; nevertheless, PPV was only marginally enhanced. Unguided variable selection would be able to achieve better results in PPV terms.

Resumen Objetivo: El objetivo fue desarrollar, entrenar y probar diferentes modelos basados en algoritmos de redes neuronales (RN) para mejorar el rendimiento del score del Registro Global de Eventos Coronarios Agudos (GRACE) para predecir la mortalidad hospitalaria después de un síndrome coronario agudo. Métodos: Analizamos una base de datos prospectiva que incluía 40 variables de ingreso de 1255 pacientes con síndrome coronario agudo en un hospital comunitario. Las variables incluidas en la puntuación GRACE se usaron para entrenar y probar tres algoritmos basados en RN (modelos guiados), a saber: perceptrones multicapa de una y dos capas ocultas y una red de función de base radial. Se construyeron tres RN adicionales utilizando las 40 variables de admisión de toda la base de datos (modelos no guiados). La mortalidad esperada según el GRACE se calculó usando la ecuación de regresión logística. Resultados: En términos del área ROC y valor predictivo negativo (VPN), casi todos los algoritmos RN superaron la regresión logística. Solo los modelos de función de base radial obtuvieron un mejor nivel de precisión basado en la mejora del VPN, pero a expensas de la reducción del valor predictivo positivo (VPP). La importancia normalizada de las variables incluidas en la mejor RN no guiada fue: creatinina 100%, clase Killip 61%, fracción de eyección 52%, edad 44%, nivel máximo de creatina quinasa 41%, glucemia 40%, bloqueo de rama izquierda 35%, y peso 33%, entre los 8 predictores principales. Conclusiones: El tratamiento de las variables del score GRACE mediante algoritmos de RN mejoró la precisión y la discriminación en todos los modelos con respecto al enfoque tradicional de regresión logística; sin embargo, el VPP solo mejoró marginalmente. La selección no guiada de variables podría mejorar los resultados en términos de PPV.

Aspectos clínicos y demográficos de los pacientes con esclerosis múltiple secundaria progresiva en Argentina / Clinical and demographic aspects of secondary progressive multiple sclerosis in Argentina

Resumen El objetivo del estudio fue evaluar los aspectos clínicos y demográficos de los pacientes con esclerosis múltiple (EM) secundaria progresiva (EMSP) en los pacientes incluidos en el Registro Argentino de EM (RelevarEM, número de registro de Clinical Trials 03375177). RelevarEM es un registro longitudinal, estrictamente observacional, de pacientes con EM y trastornos del espectro de neuromielitis óptica. Los aspectos clínicos y demográficos fueron descriptos en pacientes con EMSP respecto a aquellos con EM recaída en remisión (EMRR). Se incluyeron 1723 pacientes con EM (1605, 93.2% EMRR y 118, 6.8%, EMSP). En el grupo con EMSP la mediana de edad fue de 53 (intervalo inter-cuartil [IIQ] 47-62) años, 67% eran mujeres, mediana de tiempo de evolución de enfermedad 19.5 (IIQ 14-26) años, EDSS (expanded disability status scale), 6.5 y 48.3% estaban en tratamiento para su EM. Solo el 23.7% con EMSP estaban trabajando activamente y el 86% tenía certificado de discapacidad. Un 35.6% con EMSP presentaron nuevas lesiones en resonancia magnética y 5% tuvo recaídas clínicas en los 12 meses previos al análisis, mostrando una actividad de la enfermedad significativamente menor respecto a la forma EMRR (p < 0.01).

Abstract The objective of the study was to describe the clinical and demographic aspects of patients with secondary progressive multiple sclerosis (SPMS) included in the Argentine MS Registry (RelevarEM, Clinical Trials registry number 03375177). RelevarEM is a longitudinal, strictly observational registry of patients with MS and neuromyelitis optica spectrum disorders. Clinical and demographic aspects were described in patients with SPMS and compared with relapsing remitting MS patients (RRMS). A total of 1723 patients with MS were included (1605, 93.2% RRMS and 118, 6.8%, SPMS). In SPMS, the median age was 53 (inter quartile range [IQR] 47-62) years, 67% were women, median disease duration of 19.5 (IQR 14-26) years, median EDSS (expanded disability status scale) 6.5 and 48.3% were under treatment for their MS. Only 23.7% of patients with SPMS were actively working and 86% had a disability certificate; 35.6% of patients with SPMS presented new lesions in MRI and 5% had clinical relapses during the past 12 months of the registry entry showing a significantly lower disease activity compared with RRMS (p < 0.01).

Arritmias cardíacas en habitantes de gran altura con diagnóstico de corazón pulmonar crónico / Cardiac arrhythmias in highlanders with a diagnosis of chronic cor pulmonale

Resumen Antecedentes: El corazón pulmonar crónico (CPC) muestra un incremento en habitantes que viven en grandes altitudes. Objetivo: Investigar la frecuencia de arritmias cardíacas y factores de riesgo para su desarrollo. Métodos: Estudio descriptivo y transversal; se revisó el registro de pacientes internados del Departamento de Cardiología del Instituto Nacional de Tórax, La Paz, Bolivia, entre enero de 2017 y junio de 2018; se incorporó a todos los individuos con diagnóstico de CPC, definido por criterios clínicos, electrocardiográficos y ecocardiográficos; se incluyó a 162 pacientes que cumplieron los criterios en el análisis; se utilizaron la t de Student y ANOVA. Resultados: Arritmias: fibrilación auricular (FA), 125 (75%); aleteo auricular (AA), 17 (10.5%); taquicardia auricular (TA), 17 (10.5%); extrasístoles, 3 (1.9%). Según el análisis univariado, los factores relacionados con el desarrollo de arritmias fueron: eritrocitosis: FA, RR: 1.33, otras arritmias (RR: 1.67), p = 0.0001; hipertensión arterial pulmonar: FA, RR: 3.10, otras arritmias (RR: 3.21), p = 0.0001; dilatación de aurícula derecha (AD): FA, RR: 1.92, otras arritmias (RR: 2.13), p = 0.0001; obesidad: FA, RR: 3.47, p = 0.001, otras arritmias (RR: 3.70), p = 0.001; hipertensión arterial sistémica: FA, RR: 3.10, p = 0.001, otras arritmias (RR: 3.21), p = 0.001. Según el análisis multivariado: eritrocitosis (RR: 2.2), dilatación de AD (RR: 1.2), p = 0.0001. Conclusiones: Se encontró FA con mayor frecuencia en los pacientes con CPC; los factores de riesgo con mayor significancia estadística para su presentación fueron la eritrocitosis y la dilatación de la AD.

Abstract Background: Chronic cor pulmonale (CPC), with increased presentation in high-altitude inhabitants. Objectives: Investigating the frequency of cardiac arrhythmias, and risk factors for its development. Methods: Descriptive, cross-sectional study, the inpatient registry of the Department of Cardiology of the National Institute of Torax, La Paz-Bolivia, from January 2017 to June 2018 was reviewed, all were incorporated with the diagnosis of CPC, defined by clinical criteria, electrocardiographic and echocardiographic, 162 patients who met the criteria were taken, the student's t-test and ANOVA were used for the analysis. Results: Arrhythmias: atrial fibrillation (AF) 125 (75%), atrial flutter (AA) 17 (10.5%), atrial tachycardia (AT) 17 (10.5%), extrasystoles 3 (1.9%). Univariate analysis of factors related to the development of arrhythmias: erythrocytosis: FA, RR: 1.33, other arrhythmias RR: 1.67, p = 0.0001, pulmonary arterial hypertension: FA, RR: 3.10, other arrhythmias RR: 3.21, p = 0.0001, right atrial dilation (AD): FA, RR: 1.92, other arrhythmias RR: 2.13, p = 0.0001, obesity: FA, RR: 3.47, p = 0.001, other arrhythmias RR: 3.70, p = 0.001, systemic arterial hypertension: FA: RR: 3.10, p = 0.001, other arrhythmias RR: 3.21, p = 0.001. Multivariate analysis: erythrocytosis (RR: 2.2), AD dilation (RR: 1.2), p = 0.0001. Conclusions: AF was found more frequently in patients with CPC, the risk factors with the greatest statistical significance for presentation were: erythrocytosis and AD dilation.

Manual de registro y codificación de la atención de Salud en la consulta externa. Sistema de Información HIS: Etapa de vida adolescente / Manual of registration and coding of health care in the outpatient clinic. HIS Information System: Adolescent life stage

La publicación describe y homogeniza los criterios en la recopilación y codificación de diagnósticos CIE 10 y Catálogo de Procedimientos médicos y estomatológicos del Ministerio de Salud. Asimismo, la metodología de registros estadísticos sanitarios en salud del adolescente, el cual se convierte en un sistema de información necesaria para la toma de decisiones en la solución de los problemas sanitarios en el marco del sistema de coordinación.

Revascularização Completa Versus Tratamento da Artéria Culpada no Infarto com Supradesnivelamento do Segmento ST: Registro Multicêntrico / Complete Revascularization Versus Treatment of the Culprit Artery Only in ST Elevation Myocardial Infarction: A Multicenter Registry

Resumo Fundamento São restritos os dados sobre o manejo e o prognóstico dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) com acometimento multiarterial no Brasil, o que mostra a necessidade de investigar as estratégias de revascularização disponíveis. Objetivo Avaliar os desfechos relacionados à revascularização completa em comparação com o tratamento da artéria culpada em pacientes multiarteriais com IAMCSST. Métodos Foi realizada um estudo de coorte prospectiva em dois centros de hemodinâmica do Sul do Brasil, com seguimento de 1 ano após a intervenção índice. O desfecho primário foi composto de óbito cardiovascular, reinfarto ou angina recorrente e secundários acidente vascular encefálico, parada cardiorrespiratória não fatal, sangramento maior ou necessidade de reintervenção. A probabilidade de ocorrência de desfechos foi comparada entre os grupos através de regressão logística binária. Considerou-se como estatisticamente significativo o valor de probabilidade < 0,05. Resultados Participaram 85 pacientes, com média de idade de 62±12 anos, sendo 61 (71,8%) do sexo masculino. Cinquenta e oito (68,2%) pacientes receberam a estratégia de revascularização completa e 27 (31,8%), a de revascularização incompleta. A chance de ocorrência tanto do desfecho primário quanto do secundário foi significativamente maior entre os indivíduos tratados com revascularização incompleta quando comparados com os tratados com estratégia completa [razão de chances (OR) 5,1, intervalo de confiança de 95% (IC95%) 1,6-16,1 vs. OR 5,2, IC95% 1,2-22,9, respectivamente], assim como os óbitos cardiovasculares (OR 6,4, IC95% 1,2-35,3). Conclusão Dados deste registro regional, de dois centros do Sul do Brasil, demonstram que a estratégia de revascularização completa esteve associada à redução significativa dos desfechos primário e secundário no seguimento de 1 ano quando comparada à estratégia de revascularização incompleta. (Arq Bras Cardiol. 2020; 115(2):229-237)

Abstract Background Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated Objective To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease. Methods A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant. Results Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3). Conclusion Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy (Arq Bras Cardiol. 2020; 115(2):229-237)

Tasas regionales de hospitalización y mortalidad por asma infantil en Chile / Regional asthma hospitalization rates and global asthma mortality rate in Chilean children

INTRODUCCIÓN: En los últimos años se ha observado un aumento significativo de la tasa de hospitalización por asma en niños. En la actualidad se desconocen las tasas regionales y la tasa de mortalidad. OBJETIVO: Conocer las tasas regionales de hospitalización por asma en niños y determinar la mortalidad en este grupo etario. PACIENTES Y MÉTODO: Se calculó la tasa de hospitalización por asma en las 15 regiones del país existentes al momento de realizar el estudio, entre el año 2008 y 2014, en base al número de egresos hospitalarios por región y de las poblaciones expuestas al riesgo de hospitalización. La tasa de mor talidad se obtuvo calculando el cociente entre el número de defunciones por asma en niños de 5 a 15 años y la población expuesta. RESULTADOS: La tasa más alta de hospitalización la presentó la V región con 7,6 por 10.000 habitantes. La tasa media de hospitalización en las distintas regiones fue similar a la de la Región Metropolitana, con la excepción de 4 regiones. La tasa global de mortalidad por asma en niños de 5 a 15 años para el periodo analizado es de 0,37 por 100.000 habitantes. CONCLUSIONES: La mayoría de las regiones del país presentan tasas de hospitalización similares a la Región Metropolitana. La V Región presenta la tasa más alta de hospitalización. La tasa global de mortalidad por asma en niños de 5 a 15 años es de 0,37 por 100.000 habitantes.

INTRODUCTION: In recent years, there has been a significant increase in asthma hospitalization rates in children, however, regional and mortality rates are yet unknown. OBJECTIVE: To determine regional asth ma hospitalization rates in children and the global mortality rate in this age group. PATIENTS AND METHOD: We determined asthma hospitalization rates in the 15 regions of the country existing at the time of the study, between 2008 and 2014, based on the number of hospital discharges in each region and the population at risk of hospitalization. The mortality rate was obtained using the ratio between deaths due to asthma in children aged 5 to 15 and the exposed population. RESULTS: the 5th region presented the highest hospitalization rate (7.6 per 10,000 inhabitants). Except for 4 regions, the median hospitalization rates of the different regions were similar to those found in the Metropolitan Region. The overall mortality rate due to asthma in 5 to 15-year-old children was 0.37 per 100,000 inhabitants in the analyzed period. CONCLUSIONS: most regions of the country have similar hospitalization rates to the Metropolitan Region and the 5th region presents the highest hospitali zation rate due to asthma. The global mortality rate in children between 5 and 15 years old is 0.37 per 100,000 inhabitants.

Sobrevida de pacientes com câncer colorretal em um Cancer Center / Survival of patients with colorectal cancer in a cancer center

ABSTRACT BACKGROUND: Hospital-based studies recently have shown increases in colorectal cancer survival, and better survival for women, young people, and patients diagnosed at an early disease stage. OBJECTIVE: To describe the overall survival and analyze the prognostic factors of patients treated for colorectal cancer at an oncology center. METHODS: The analysis included patients diagnosed with colon and rectal adenocarcinoma between 2000 and 2013 and identified in the Hospital Cancer Registry at A.C.Camargo Cancer Center. Overall 5-year survival was estimated using the Kaplan-Meier method, and prognostic factors were evaluated in a Cox regression model. Hazard ratios (HR) are reported with 95% confidence intervals (CI). RESULTS: Of 2,279 colorectal cancer cases analyzed, 58.4% were in the colon. The 5-year overall survival rate for colorectal cancer patients was 63.5% (65.6% and 60.6% for colonic and rectal malignancies, respectively). The risk of death was elevated for patients in the 50-74-year (HR=1.24, 95%CI =1.02-1.51) and ≥75-year (HR=3.02, 95%CI =2.42-3.78) age groups, for patients with rectal cancer (HR=1.37, 95%CI =1.11-1.69) and for those whose treatment was started >60 days after diagnosis (HR=1.22, 95%CI =1.04-1.43). The risk decreased for patients diagnosed in recent time periods (2005-2009 HR=0.76, 95%CI =0.63-0.91; 2010-2013 HR=0.69, 95%CI =0.57-0.83). CONCLUSION: Better survival of patients with colorectal cancer improves with early stage and started treatment within 60 days of diagnosis. Age over 70 years old was an independent factor predictive of a poor prognosis. The overall survival increased to all patients treated in the period 2000-2004 to 2010-2013.

RESUMO CONTEXTO: Estudos hospitalares recentes têm demonstrado aumento da sobrevida do câncer colorretal e melhor sobrevida para mulheres, jovens e pacientes diagnosticados em estágio precoce da doença. OBJETIVO: Descrever a sobrevida global e analisar os fatores prognósticos de pacientes tratados para câncer colorretal em um centro de oncologia. MÉTODOS: Foram incluídos pacientes com diagnóstico de adenocarcinoma de cólon e reto entre 2000 e 2013, identificados no Registro Hospitalar de Câncer do A.C.Camargo Cancer Center. A sobrevida global aos 5 anos foi estimada pelo método de Kaplan-Meier e os fatores prognósticos foram avaliados pelo modelo de Cox. As razões de risco (HR) são relatadas com intervalos de confiança (IC) de 95%. RESULTADOS: Dos 2.279 casos de câncer colorretal analisados, 58,4% eram de cólon. A taxa de sobrevida global aos 5 anos para pacientes com câncer colorretal foi de 63,5% (65,6% e 60,6% para câncer de cólon e retal, respectivamente). O risco de óbito foi elevado para pacientes na faixa etária de 50-74 anos (HR=1,24; IC95% =1,02-1,51) e ≥75 anos (HR=3,02; IC95% =2,42-3,78), para pacientes com câncer retal (HR=1,37; IC95% =1,11-1,69) e para aqueles cujo tratamento foi iniciado >60 dias após o diagnóstico (HR=1,22; IC95% =1,04-1,43). O risco diminuiu para pacientes diagnosticados em períodos recentes (2005-2009 HR=0,76; IC95% =0,63-0,91; 2010-2013 HR=0,69; IC95% =0,57-0,83). CONCLUSÃO: A sobrevida dos pacientes com câncer colorretal é maior naqueles em estágio inicial e com início do tratamento antes dos 60 dias.. Idade acima de 70 anos foi fator independente preditivo de mau prognóstico. A sobrevida global aumentou para todos os pacientes tratados no período de 2000-2004 a 2010-2013.

Renal osteodystrophy and clinical outcomes: data from the Brazilian Registry of Bone Biopsies - REBRABO / Osteodistrofia renal e desfechos clínicos: dados do Registro Brasileiro de Biópsias Ósseas - REBRABO

ABSTRACT Introduction: Mineral and bone disorders (MBD) are major complications of chronic kidney disease (CKD)-related adverse outcomes. The Brazilian Registry of Bone Biopsy (REBRABO) is an electronic database that includes renal osteodystrophy (RO) data. We aimed to describe the epidemiological profile of RO in a sample of CKD-MBD Brazilian patients and understand its relationship with outcomes. Methods: Between August 2015 and March 2018, 260 CKD-MBD stage 3-5D patients who underwent bone biopsy were followed for 12 to 30 months. Clinical-demographic, laboratory, and histological data were analyzed. Bone fractures, hospitalizations, and death were considered the primary outcomes. Results: Osteitis fibrosa, mixed uremic osteodystrophy, adynamic bone disease, osteomalacia, osteoporosis, and aluminum (Al) accumulation were detected in 85, 43, 27, 10, 77, and 65 patients, respectively. The logistic regression showed that dialysis vintage was an independent predictor of osteoporosis (OR: 1.005; CI: 1.001-1.010; p = 0.01). The multivariate logistic regression revealed that hemodialysis treatment (OR: 11.24; CI: 1.227-100; p = 0.03), previous parathyroidectomy (OR: 4.97; CI: 1.422-17.241; p = 0.01), and female gender (OR: 2.88; CI: 1.080-7.679; p = 0.03) were independent predictors of Al accumulation; 115 patients were followed for 21 ± 5 months. There were 56 hospitalizations, 14 deaths, and 7 fractures during follow-up. The COX regression revealed that none of the variable related to the RO/turnover, mineralization and volume (TMV) classification was an independent predictor of the outcomes. Conclusion: Hospitalization or death was not influenced by the type of RO, Al accumulation, or TMV classification. An elevated prevalence of osteoporosis and Al accumulation was detected.

RESUMO Introdução: Os distúrbios minerais e ósseos (DMO) são importantes complicações da doença renal crônica (DRC) associadas à desfechos adversos. O Registro Brasileiro de Biópsia Óssea (REBRABO) é um banco de dados eletrônico que inclui dados sobre osteodistrofia renal (OR). Nosso objetivo foi descrever o perfil epidemiológico da OR em uma amostra de pacientes brasileiros com DMO-DRC e entender sua associação com os desfechos. Métodos: Entre agosto de 2015 e março de 2018, 260 pacientes com DMO-DRC estágio 3-5D submetidos à biópsia óssea foram acompanhados por 12 a 30 meses. Dados clínico-demográficos, laboratoriais e histológicos foram analisados. Fraturas ósseas, hospitalizações e óbito foram considerados como desfechos primários. Resultados: Osteíte fibrosa, osteodistrofia urêmica mista, doença óssea adinâmica, osteomalácia, osteoporose e acúmulo de alumínio (Al) foram detectados em 85, 43, 27, 10, 77 e 65 pacientes, respectivamente. A regressão logística mostrou que o tempo em diálise foi um preditor independente de osteoporose (OR: 1.005; IC: 1.001-1.010; p = 0,01). A regressão logística multivariada revelou que o tratamento hemodialítico (OR: 11,24; IC: 1,227-100; p = 0,03), paratireoidectomia prévia (OR: 4,97; IC: 1,422-17,241; p = 0,01) e sexo feminino (OR: 2,88; IC: 1,080-7,679; p = 0,03) foram preditores independentes de acúmulo de Al; 115 pacientes foram acompanhados por 21 ± 5 meses. Houve 56 internações, 14 óbitos e 7 fraturas durante o seguimento. A regressão COX revelou que nenhuma das variáveis relacionadas ao tipo de OR/remodelação-mineralização-volume (classificação TMV) foi um preditor independente de desfechos. Conclusão: A hospitalização ou óbito não foram influenciadas pelo tipo de OR, acúmulo de Al ou classificação de TMV. Foi detectada uma prevalência elevada de osteoporose e acúmulo de Al.

Variabilidad terapéutica en lactantes con bronquiolitis hospitalizados en unidades de cuidados intensivos latinoamericanas / Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis

Resumen: Objetivo: describir las terapias utilizadas en lactantes con bronquiolitis aguda admitidos en 20 Uni dades de Cuidados Intensivos (UCI) pediátricos miembros de LARed en 5 países latinoamerica nos. Pacientes y Método: Estudio observacional retrospectivo, multicéntrico, de datos del Registro Latinoamericano de Falla Respiratoria Aguda Pediátrica. Se incluyeron niños menores de 2 años ingresados a UCI pediátrica por bronquiolitis aguda comunitaria entre mayo-septiembre 2017. Se recolectaron datos demográficos, clínicos, soporte respiratorio, terapias utilizadas y resultados clí nicos. Se realizó análisis de subgrupos según ubicación geográfica, tipo financiación y presencia de academia. Resultados: Ingresaron al registro 1155 pacientes con falla respiratoria aguda. Seis casos fueron excluidos por no tener formulario completo. De los 1147 pacientes, 908 eran menores de 2 años. De ellos, 467 tuvieron diagnóstico de bronquiolitis aguda, correspondiendo a la principal causa de ingreso a UCI pediátrica por falla respiratoria aguda (51,4%). Las características demográficas y de gravedad entre los centros fueron similares. El soporte máximo respiratorio más frecuente fue cánula nasal de alto flujo (47%), seguido por ventilación mecánica no invasiva (26%) y ventilación mecánica invasiva (17%), con un coeficiente de variación (CV) amplio entre los centros. Hubo una gran dispersión en uso de terapias, siendo frecuente el uso de broncodilatadores, antibióticos y corticoides, con CV hasta 400%. El análisis de subgrupos mostró diferencias significativas en soporte respiratorio y tratamientos utilizados. Un paciente falleció en esta cohorte. Conclusión: Detectamos gran variabilidad en el soporte respiratorio y tratamientos entre UCI pediátricas latinoamericanas. Esta variabilidad no es explicada por disparidades demográficas ni clínicas. Esta heterogeneidad de tratamientos debería promover iniciativas colaborativas para disminuir la brecha entre la evidencia científica y la práctica asistencial.

Abstract: The objective of this study was to describe the management of infants with acute bronchiolitis admit ted to 20 pediatric intensive care units (PICU) members of LARed in 5 Latin American countries. Pa tients and Method: Retrospective, multicenter, observational study of data from the Latin American Registry of Acute Pediatric Respiratory Failure. We included children under 2 years of age admitted to the PICU due to community-based acute bronchiolitis between May and September 2017. Demo graphic and clinical data, respiratory support, therapies used, and clinical results were collected. A subgroup analysis was carried out according to geographical location (Atlantic v/s Pacific), type of insurance (Public v/s Private), and Academic v/s non-Academic centers. Results: 1,155 patients were included in the registry which present acute respiratory failure and 6 were excluded due to the lack of information in their record form. Out of the 1,147 patients, 908 were under 2 years of age, and out of those, 467 (51.4%) were diagnosed with acute bronchiolitis, which was the main cause of admission to the PICU due to acute respiratory failure. The demographic and severity characteristics among the centers were similar. The most frequent maximum ventilatory support was the high-flow nasal can nula (47%), followed by non-invasive ventilation (26%) and invasive mechanical ventilation (17%), with a wide coefficient of variation (CV) between centers. There was a great dispersion in the use of treatments, where the use of bronchodilators, antibiotics, and corticosteroids, representing a CV up to 400%. There were significant differences in subgroup analysis regarding respiratory support and treatments used. One patient of this cohort passed away. Conclusion: we detected wide variability in respiratory support and treatments among Latin American PICUs. This variability was not explained by demographic or clinical differences. The heterogeneity of treatments should encourage collabora tive initiatives to reduce the gap between scientific evidence and practice.

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.

Valve heart surgery in Brazil - the bypass registry analysis

Abstract Objective: To analyze the profile and outcomes of patients who underwent valve heart surgery in Brazil, using information retrieved from the Brazilian Registry of Cardiovascular Surgeries in Adults (BYPASS Registry) database. Methods: This is a multicenter cohort study, evaluating 920 patients submitted to heart valve surgery. Demographics and postoperative clinical outcomes were assessed and compared to estimate mortality risk using the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Results: Isolated aortic valve replacement was the most frequently performed surgery (34%), followed by isolated mitral valve replacement (24.9%). Valve repair was performed in 21% of mitral procedures. Minimally invasive access was performed in 1.6% and the most frequent postoperative complications were arrhythmias (22.6%), infections (5.7%), and low-output syndrome (5.1%). Operations covered by the public health system accounted for 80.8% and the hospital mortality rate was 7.3%. Conclusion: The most frequent isolated valve surgery in Brazil is the aortic valve replacement by conventional open access and the rheumatic disease is still the main etiology for valve surgery. The BYPASS Registry has a fundamental role to provide information on the profile of patients with valve heart disease in our country in order to delineate adequate strategies for health promotion and resource allocation for cardiac surgery.