Validação de face, conteúdo e semântica da escala de avaliação do risco de quedas em pessoas idosas que vivem na comunidade / Face, content and semantic validation of the scale for assessing the risk of falls in community-dwelling elderly people / Validación facial, de contenido y semántica de la escala de evaluación del riesgo de caídas en ancianos residentes en la comunidad

Introdução: quedas em pessoas idosas constituem um sério problema de saúde e geram muitas preocupações para estudiosos e clínicos da geriatria e gerontologia. Objetivo: avaliar a validade de face e de conteúdo e a validade semântica de uma escala de avaliação do risco de quedas em idosos que vivem na comunidade. Método: trata-se de um estudo do tipo metodológico, com realização das seguintes etapas: validade de face e de conteúdo e análise semântica. Na análise de validade de face e de conteúdo, foram convidados sete juízes especialistas na área de saúde da pessoa idosa e do método em questão. Concernente à análise semântica, a referida escala foi aplicada em 20 idosos selecionadas por conveniência. Resultados: dos sete juízes contatados, cinco retornaram com os instrumentos. Na análise de aparência, cinco itens receberam concordância inferior a 80%. Na análise semântica, apenas dois itens foram identificados como de difícil compreensão pelas pessoas idosas. A segunda versão da escala apresentava 43 itens e, após avaliação dos juízes, passou a compor 44 itens. Conclusão: a escala apresenta validade de face, de conteúdo e semântica para o contexto atual e para a população-alvo estudada, sendo importante sua revisão e adequação em momentos pósteros a fim de acompanhar os avanços científicos da geriatria e gerontologia.

Introduction: falls in elderly people constitute a serious health problem and generate many concerns for scholars and clinicians in geriatrics and gerontology. Objective: to evaluate the face and content validity and semantic validity of a scale to assess the risk of falls in community-dwelling elderly people. Method: this is a methodological study, with the following stages: face and content validity and semantic analysis. For the face and content validity analysis, seven judges, experts in the area of elderly health and the method in question, were invited. Regarding the semantic analysis, the scale was applied to 20 elderly people selected by convenience. Results: of the seven judges contacted, five returned with the instruments. In the appearance analysis, five items received less than 80% agreement. In the semantic analysis, only two items were identified as difficult to understand by the elderly. The second version of the scale had 43 items and, after the judges' evaluation, it became 44 items. Conclusion: the scale presents face, content and semantic validity for the current context and for the target population studied, being important its revision and adequacy in later moments in order to follow the scientific advances in geriatrics and gerontology.

Introducción: las caídas en ancianos constituyen un grave problema de salud y generan muchas preocupaciones a los estudiosos y clínicos en geriatría y gerontología. Objetivo: evaluar la validez facial y de contenido y la validez semántica de una escala para evaluar el riesgo de caídas en ancianos residentes en la comunidad. Método: se trata de un estudio metodológico, con las siguientes etapas: validez facial y de contenido y análisis semántico. Para el análisis de la validez facial y de contenido se invitó a siete jueces, expertos en el ámbito de la salud de las personas mayores y en el método en cuestión. En cuanto al análisis semántico, la escala se aplicó a 20 ancianos seleccionados por conveniencia. Resultados: de los siete jueces contactados, cinco devolvieron los instrumentos. En el análisis de apariencia, cinco ítems recibieron menos del 80% de acuerdo. En el análisis semántico, sólo dos ítems fueron identificados como difíciles de entender por las personas mayores. La segunda versión de la escala tenía 43 ítems y, tras la evaluación de los jueces, pasó a tener 44 ítems. Conclusión: la escala presenta validez facial, de contenido y semántica para el contexto actual y para la población objetivo estudiada, siendo importante su revisión y adecuación en momentos posteriores para acompañar los avances científicos en geriatría y gerontología.

Costs analysis of spinal column metastases surgical treatment / Análise dos custos do tratamento cirúrgico das metástases da coluna vertebral

ABSTRACT Introduction End-of-life cancer treatment is associated with substantial healthcare costs. Objective This study aimed to analyze the surgical treatment cost of spinal metastasis and epidural compression patients undergoing surgical treatment. Methods A retrospective cost analysis of 81 patients with spinal metastasis and epidural compression undergoing surgical treatment. Cost evaluation was defined in the following categories: medications, laboratory and imaging tests, nursery, recovery room, intensive care unit, surgical procedure, and consigned material. The cost of pain improvement, functional activity, and survival was also evaluated. Results The total cost of surgical treatment for 81 patients was $3,604,334.26, and the average value for each patient was $44,497.95. The highest costs were related to implants (41.1%), followed by hospitalization (27.3%) and surgical procedure (19.7%). Conclusion The cost of surgical treatment for spinal metastases is one of the most expensive bone complications in cancer patients. The cost of treatment related to outcomes showed differences according to the outcome analyzed. Hospital stay, tests, drugs, and intensive care play an important role in some of the costs related to the specific outcome. Level of Evidence II, Retrospective Study.

RESUMO Introdução O tratamento do câncer em fim de vida está associado a custos substanciais em saúde. Objetivo O objetivo do estudo foi analisar o custo do tratamento cirúrgico de pacientes com metástase espinhal e compressão peridural submetidos ao tratamento cirúrgico. Métodos Uma análise retrospectiva de custos de 81 pacientes com metástase espinhal e compressão peridural submetidos a tratamento cirúrgico. A avaliação de custos foi definida nas seguintes categorias: medicamentos, exames laboratoriais e de imagem, enfermaria, sala de recuperação, unidade de terapia intensiva, procedimento cirúrgico e material consignado. O custo relacionado à melhora da dor, atividade funcional e sobrevida também foi avaliado. Resultados O custo total do tratamento cirúrgico de 81 pacientes foi de R $ 3.604.334,26 e o valor médio de cada paciente foi de R $ 44.497,95. Os maiores gastos foram relacionados com implantes (41,1%), seguidos de internação (27,3%) e procedimento cirúrgico (19,7%). Conclusão O custo do tratamento cirúrgico para metástases espinhais é um dos mais caros entre as complicações ósseas em pacientes com câncer. O custo do tratamento relacionado aos desfechos apresentou diferença de acordo com o desfecho analisado e a permanência hospitalar, exames, medicamentos e terapia intensiva tem papel importante em alguns dos custos relacionados ao desfecho específico. Nível de Evidência II, Estudo retrospectivo.

Seasonal variations in incidence of femoral fractures in the state of Rio Grande do Sul, southern Brazil / Variações sazonais na incidência de fraturas do fêmur no estado do Rio Grande do Sul, sul do Brasil

Abstract Introduction Femoral fractures are a major cause of morbidity and mortality, mainly among older people. Objective To examine the effect of seasonality on hospitalizations due to femur fracture among people residing in the Rio Grande do Sul state, southern Brazil, from 2008 to 2019. Methods Ecological study based on secondary data from the SUS Hospital Information System (SIH/SUS). A total of 74,374 reports of hospital admissions was considered. The generalized additive model (GAM) approach was employed to assess the seasonality of the time series, with stratification by sex and age groups and considering the monthly average number of events of femoral fractures per day as a dependent variable. Results A considerably higher incidence of femoral fractures in women aged 70 years or more was described. Among people aged less than 50 years, there is not an apparent seasonal effect. Men aged 70 years or older and women aged 50 years or older have a higher frequency of hospitalizations due to femur fractures in the colder months. Conclusion Among older people, more femoral fractures occurred during the winter compared to summer. This supports findings from other studies, although reasons for this seasonal variation are uncertain. The knowledge of these seasonal variations can help to plan the health care in the public health system.

Resumo Introdução As fraturas de fêmur são uma das causas principais de morbidade e mortalidade, principalmente entre as pessoas idosas. Objetivo Examinar o efeito da sazonalidade nas hospitalizações devido à fratura do fêmur entre residentes do estado do Rio Grande do Sul, sul do Brasil, de 2008 a 2019. Métodos Trata-se de um estudo ecológico baseado em dados secundários do Sistema de Informação Hospitalar do SUS (SIH/SUS). Um total de 74.374 relatórios de internações hospitalares foi considerado. O modelo aditivo generalizado (GAM) foi usado para avaliar a sazonalidade da série temporal, com estratificação por sexo e grupos etários e considerando a média mensal de eventos de fraturas do fêmur por dia como uma variável dependente. Resultados Descreveu-se uma incidência consideravelmente maior de fraturas do fêmur em mulheres com 70 anos de idade ou mais. Entre as pessoas com menos de 50 anos de idade, não há um efeito sazonal aparente. Homens com idade de 70 anos ou mais e mulheres com 50 anos ou mais têm maior frequência de hospitalizações devido a fraturas do fêmur nos meses mais frios. Conclusão Entre as pessoas mais idosas, as fraturas do fêmur ocorreram mais frequentemente durante o inverno em comparação ao verão. Isto reafirma os resultados de outros estudos, embora as razões para esta variação sazonal sejam incertas. O conhecimento destas variações sazonais pode ajudar no planejamento da assistência médica no sistema público de saúde.

Comorbidities and the risk of death among individuals infected by COVID-19 in Espírito Santo, Brazil

Abstract INTRODUCTION: We investigated the association of self-reported comorbidities with fatality risk among individuals infected with Coronavirus disease 2019 (COVID-19) in Espírito Santo State, Brazil. METHODS: We included 212,620 individuals, ≥30 years old. The data were obtained from the COVID-19 panel. Kaplan-Meier curves and Cox regression model were used. RESULTS: COVID-19-positive individuals presenting with chronic conditions were at a higher risk of fatality than individuals without these comorbidities. Age had a significant effect on these relationships. CONCLUSIONS: Comorbidities were associated with an increased risk of fatality. Middle-aged people (30-59 years) with comorbidities should also be considered as a vulnerable group.

Association of congenital anomalies in live births with their obstetric-neonatal and sociodemographic profiles / Asociación entre anomalías congénitas en nacidos vivos y sus perfiles obstétrico-neonatal y sociodemográfico / Associação de anomalias congênitas em nascidos vivos com seus perfis obstétrico-neonatal e sociodemográfico

ABSTRACT Objective: to identify the association of congenital anomalies in live births with the obstetric-neonatal and sociodemographic profile. Methods: an ecological study, conducted in 2019, with 251,444 live births, identified through the database of the Live Birth Information System of the Minas Gerais Health Secretariat. Descriptive statistics and binary logistic regression were adopted for the analysis. Results: 1,865 cases of anomalies (0.7%) were found, with predominance of deformity of the musculoskeletal system in 789 (42.3%) live births. The variables that presented a significant association with congenital anomalies were single mothers, age ≥35 years old, inadequately performed prenatal care initiated in the third trimester of pregnancy, double (or more) pregnancy, preterm births, cesarean delivery, fetal breech presentation, exclusive assistance by the medical professional during delivery, newborn with high-risk 5-minute Apgar score, low birth weight, and male gender. Conclusion: in 2019, the congenital malformations in the state of Minas Gerais were associated with single women, aged ≥35 years old, who underwent inadequate and late prenatal care, and with double or more pregnancies. In relation to the newborns, the malformations were associated with a high risk for late sequelae, weight between ≤1,000 g and <2.500 g, and male gender.

RESUMEN Objetivo: identificar la asociación entre las anomalías congénitas en nacidos vivos y el perfil obstétrico-neonatal y sociodemográfico. Métodos: estudio ecológico realizado en el año 2019 con 251.444 nacidos vivos, identificados por medio de la base de datos del Sistema de Información sobre Nacidos Vivos de la Secretaría de Salud de Minas Gerais. Para el análisis, se adoptaron estadística descriptiva y regresión logística binaria. Resultados: se encontraron 1.865 casos de anomalías (0,7%), con predominio de deformidad del sistema osteomuscular en 789 (42,3%) nacidos vivos. Las variables que presentaron una asociación significativa con las anomalía congénitas fueron las siguientes: madres solteras, edad ≥35 años, cursar atención pre-natal inadecuada e iniciada en el tercer trimestre de embarazo, embarazo de gemelos o más bebés, nacimientos prematuros, parto por cesárea, presentación fetal pelviana, asistencia exclusiva de un médico durante el parto, recién nacido con Apgar de alto riesgo al quinto minuto, bajo peso al nascer y sexo masculino. Conclusión: en el año 2019, las malformaciones congénitas en el estado de Minas Gerais estuvieron asociadas a mujeres solteras, con edad ≥35 años, que cursaron atención pre-natal inadecuada y tardía, con embarazos de gemelos o más bebés. En relación con los recién nacidos, las malformaciones estuvieron asociadas con alto riesgo de secuelas tardías, peso entre ≤1.000 g y <2.500 g y ser del sexo masculino.

RESUMO Objetivo: identificar a associação das anomalias congênitas em nascidos vivos com o perfil obstétrico-neonatal e sociodemográfico. Método: estudo ecológico, realizado em 2019, com 251.444 nascidos vivos, identificados por meio do banco de dados do Sistema de Informações de Nascidos Vivos da Secretaria de Saúde de Minas Gerais. Para análise, adotaram-se a estatística descritiva e a regressão logística binária. Resultados: foram encontrados 1.865 casos de anomalias (0,7%), com predominância de deformidade do sistema osteomuscular em 789 (42,3%) nascidos vivos. As variáveis que apresentaram associação significativa com a anomalia congênita foram mães solteiras, idade ≥35 anos, pré-natal realizado de forma inadequada, iniciado no terceiro trimestre de gestação, gestação dupla ou mais, nascimentos pré-termo, parto cesárea, apresentação fetal pélvica, assistência exclusiva do profissional médico durante o parto, recém-nascido com Apgar de alto risco no quinto minuto, baixo peso ao nascer e sexo masculino. Conclusão: em 2019, as malformações congênitas no estado de Minas Gerais associaram-se às mulheres solteiras, com idade ≥35 anos, que realizaram pré-natal inadequado e tardio, com gestações duplas ou mais. Em relação aos recém-nascidos, as malformações foram associadas com alto risco para sequelas tardias, peso entre ≤1.000g e <2.500g e ser do sexo masculino.

Spatiotemporal distribution of acquired immunodeficiency syndrome incidence in Brazil between 2012 and 2016

Abstract INTRODUCTION: Acquired immunodeficiency syndrome (AIDS) remains a major public health issue in Brazil. This ecological study aimed to evaluate the spatiotemporal distribution of notified new AIDS cases in Brazil between 2012 and 2016. METHODS: A Bayesian spatiotemporal model based on the Poisson distribution was used to obtain smoothed incidence estimates of AIDS in each of the 133 Brazilian intermediate regions. RESULTS: Spatial distribution of new AIDS cases is highly heterogeneous. Regions with higher gross domestic product per capita tend to have higher incidence rates of AIDS. CONCLUSIONS: Strategies to prevent and control AIDS should consider regional differences.

Short-term forecasting of daily COVID-19 cases in Brazil by using the Holts model

Abstract: INTRODUCTION: We evaluated the performance of the Holt's model to forecast the daily COVID-19 reported cases in Brazil and three Brazilian states. METHODS: We chose the date of the first COVID-19 case to April 25, 2020, as the training period, and April 26 to May 3, 2020, as the test period. RESULTS: The Holt's model performed well in forecasting the cases in Brazil and in São Paulo and Minas Gerais states, but the forecasts were underestimated in Rio de Janeiro state. Conclusions: The Holt's model can be an adequate short-term forecasting method if their assumptions are adequately verified and validated by experts.

Clinical response to antibiotics in indigenous versus non-indigenous children under 5 years old with community-acquired pneumonia in Otavalo, Ecuador

Abstract INTRODUCTION: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality worldwide. This study compares the clinical response to antimicrobials between indigenous and non-indigenous Kichwa children under 5 years old with CAP in Otavalo, Ecuador. METHODS: All children with CAP who met the inclusion criteria and were admitted at the San Luis de Otavalo Hospital between March 2017 and June 2018 were evaluated. RESULTS: No significant differences were observed in clinical responses between indigenous and non-indigenous children. CONCLUSIONS: The improved healthcare access of the Otavalo's Kichwa population may have contributed to the observed clinical response to CAP treatment.

Long-term forecasts of the COVID-19 epidemic: a dangerous idea

Abstract INTRODUCTION: Mathematical models have been used to obtain long-term forecasts of the COVID-19 epidemic. METHODS: The daily COVID-19 case count in two Brazilian states was used to show the potential limitations of long-term forecasting through the application of a mathematical model to the data. RESULTS: The predicted number of cases at the end of the epidemic and at the moment that the peak occurs, is highly dependent on the length of the time series used in the predictive model. CONCLUSIONS: Predictions obtained during the course of the COVID-19 pandemic need to be viewed with caution.

Tendência temporal dos casos de HIV/aids no estado de Minas Gerais, 2007 a 2016 / Tendencia temporal de los casos de VIH/sida en el estado de Minas Gerais, Brasil, 2007-2016 / Temporal trend of HIV/AIDS cases in the state of Minas Gerais, Brazil, 2007-2016

Objetivo: analisar a tendência temporal dos coeficientes de incidência, detecção e mortalidade pelo vírus da imunodeficiência humana (HIV) e síndrome da imunodeficiência adquirida (aids) no estado de Minas Gerais, de 2007 a 2016. Métodos: estudo de séries temporais, com dados do Sistema de Informação de Agravos de Notificação (Sinan), por regressão de Prais-Winsten. Resultados: no período estudado, foram notificados 35.349 casos,entre os quais predominou a transmissão por via sexual (81,7%); destes, 50,3% foram entre heterossexuais e 22,8% entre homossexuais. Houve aumento da taxa de incidência de aids (variação anual 1,6%; IC95%0,0;3,3) e de detecção de HIV+ (variação anual 60,3%; IC95%22,9;109,0). A taxa de mortalidade foi estacionária. O percentual de notificações pelo critério HIV+ aumentou de 3,8% em 2007 para 65,1% em 2016. Conclusão: a tendência de crescimento da detecção de HIV coincide com a estratégia para identificação dos casos; a incidência de aids foi crescente.

Objetivo: analizar la tendencia temporal de los coeficientes de incidencia, detección y mortalidad por el Virus de la Inmunodeficiencia Humana (VIH) y Síndrome de Inmunodeficiencia Adquirida (Sida) en el estado de Minas Gerais, entre 2007-2016. Métodos: estudio de las series temporales de casos notificados del Sistema de Información de Agravamientos de Notificación (Sinan) por la regresión de Prais-Winsten. Se utilizó estadística descriptiva y análisis de series temporales. Resultados: había 35.349 casos y predominio de contaminación por vía sexual (81,7%), en heterosexuales (50,3%) y homosexuales (22,8%). Aumentó la tendencia de la incidencia de sida y detección de VIH +, con variación anual del 1,6% y del 60,3% (p <0,05), respectivamente. La mortalidad fue estacionaria. Aumentaron las notificaciones por el criterio de VIH +. Conclusión: el aumento de la tendencia de detección de VIH +, indica que la estrategia para identificación de portadores se ha mostrado apropiada, pero la incidencia de sida continua creciente.

Objective: to analyze the temporal trend of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) incidence, detection and mortality coefficients in the state of Minas Gerais between 2007 and 2016. Methods: this was a time series study of data held on the Notifiable Health Conditions Information System (Sinan) using Prais-Winsten regression. Results: in the period studied, 35,349 cases were notified, with predominance of sexually transmitted cases (81.7%), 50.3% of which were heterosexual cases and 22.8% were homosexual cases. AIDS incidence increased (annual change 1.6%; 95%CI 0.0;3.3) as did HIV detection (annual change 60.3%; 95%CI 22.9;109.0). The mortality rate was stationary; HIV+ notifications increased from 3.8% in 2007 to 65.1% in 2016. Conclusion: the growing trend of HIV+ detection coincided with the government strategy to identify cases. AIDS incidence increased.

Validação da Ferramenta de Rastreio de Risco de quedas (FRRISque) em pessoas idosas que vivem na comunidade / Validation of the Fall Risk Tracking Tool (FRRISque) in elderly community dwellers

Resumo Objetivou validar a Ferramenta de Rastreamento do Risco de Quedas (FRRISque) em pessoas idosas que vivem na comunidade. Realizou-se um estudo transversal, do tipo screening avaliativo. A amostra foi composta por 854 idosos. Além da versão piloto da FRRISque, foi aplicado o instrumento QuickScreen® como referência padrão no intuito de realizar a validade de critério concorrente, determinando os valores de sensibilidade e especificidade. A maioria das pessoas idosas era do sexo feminino (57,6%), com média de idade de 71,87 anos. Nas análises por regressão logística, evidenciou-se que apenas 10 itens da FRRISque contribuem para o aumento do risco de quedas em idosos e referem-se aos fatores de risco queda anterior, uso de dispositivo de auxílio à marcha, polifarmácia, uso de psicotrópicos, dificuldade para subir ou descer uma ladeira, dificuldade para andar 100 metros, déficit visual e auditivo, baixa atividade física e ambiente mal iluminado. Este modelo de estratificação de risco assume valores de sensibilidade de 91,3% e especificidade de 73,4%. A FRRISque se caracteriza como instrumento válido, simples, porém denso, de baixo custo e de fácil e rápida aplicação, podendo ser empregado por todos os profissionais de saúde da atenção básica, inclusive por agentes comunitários de saúde.

Abstract This study aimed to validate of Fall Risk Tracking Tool (FRRISque) in elderly community dwellers. A cross-sectional evaluative screening study was carried out on a sample of 854 elderly. In addition to the pilot version of FRRISque, the QuickScreen® tool was applied as a standard reference in order to validate a concurrent criterion, determining sensitivity and specificity values. Most of the elderly people were female (57.6%) with an average age of 71.87 years. The multivariate logistic regression analyses showed that only 10 FRRISque items contribute to increased elderly fall risk and they refer to the risk factors of previous falls, use of a walking aid device, polypharmacy, use of psychotropic substances, difficulty to ascend and descend a slope, difficulty to walk for a distance of 100 meters, visual and hearing impairment, low physical activity and poorly lit environment. This risk stratification model assumes sensitivity values of 91.3% and specificity values of 73.4%. The FRRISque is defined as a valid, simple, low-cost and of easy and rapid application tool that can be used by all primary health care professionals, including community health workers.

La Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, como herramientas para la toma de decisiones en la atención primaria y la salud pública / A Avaliação de Tecnologias em Saúde e Avaliações Econômicas, como ferramentas para tomada de decisões em atenção primária e saúde pública / The Evaluation of Health Technologies and Economic Evaluations, as tools for decision making in primary care and public health

Los sistemas de salud se enfrentan al reto de decidir cuáles de las nuevas tecnologías disponibles deben ser utilizadas y estar disponibles con carácter prioritario a través de la cobertura estatal. De esta manera la Organización Mundial de la Salud (OMS) ratifica la importancia de la Evaluación de la Tecnologías Sanitarias (ETS), con el objetivo de fortalecer los sistemas de información y la capacidad de investigación en salud. El proceso de la preparación de un informe de ETS, requiere una búsqueda exhaustiva de la evidencia disponible; para su posterior síntesis y presentación a los interesados. Este es un paso crucial para que una tecnología sea considerada para su introducción en un sistema de salud; convirtiéndose en la cuarta y última barrera (Calidad, Seguridad, Eficacia y Costo-Efectividad); para la implementación de nuevas intervenciones en salud. Sin embargo, para determinar mejor el impacto presupuestario de las intervenciones, la ETS se basa en las herramientas proporcionadas por las Evaluaciones Económicas en Salud (EES), que pueden analizar los costos y las consecuencias clínicas del uso de una determinada tecnología particular para un problema de salud particular en un contexto particular. Esta información resulta vital cuando se consideran principios como la equidad o el costo de oportunidad (lo que se gasta en una intervención no se puede utilizar en otra), y, en última instancia, el limitado presupuesto de salud de los sistemas de salud.

Health systems have the challenge of deciding which of the new available technologies should be used and be available as a priority through state coverage. In this way, the World Health Organization (WHO) ratifies the importance of the Health Technology Assessment (HTA), with the aim of strengthening information systems and health research capacity. The process of preparing an HTA report requires an exhaustive search of the available evidence; for its subsequent synthesis and presentation to those interested in it. This is a crucial step for a technology to be considered for its introduction into a health system; becoming the fourth and final barrier (Quality, Safety, Efficiency and Cost-Effectiveness); for the implementation of new health interventions. However, to better determine the budgetary impact of the interventions, the HTA relies on the tools provided by the Economic Health Assessments (EHA); which can analyze both the costs and the clinical consequences of the use of a certain technology for a particular health problem in a particular context. This information is vital, when we consider principles such as equity, or the opportunity cost (what is spent in one intervention, cannot be used in another), and ultimately the limited health budget of health systems.

Os sistemas de saúde enfrentam o desafio de decidir quais das novas tecnologias disponíveis devem ser usadas e estar disponíveis como prioridade através da cobertura do estado. Dessa forma, a Organização Mundial da Saúde (OMS) ratifica a importância da Avaliação de Tecnologias em Saúde (ATS), com o objetivo de fortalecer os sistemas de informação e a capacidade de pesquisa em saúde. O processo de preparação de um relatório de ATS requer uma pesquisa exaustiva das evidências disponíveis; para sua síntese e apresentação seguintes aos interessados. Este é um passo crucial para que uma tecnologia seja considerada para sua introdução em um sistema de saúde; tornando-se a quarta e última barreira (Qualidade, Segurança, Eficiência e Custo-Eficácia); para a implementação de novas intervenções de saúde. No entanto, para melhor determinar do impacto orçamentário das intervenções, a ATS conta com as ferramentas fornecidas pelas Avaliações Econômicas de Saúde (AES); que pode analisar os custos e as consequências clínicas do uso de uma determinada tecnologia para um problema de saúde particular em um contexto particular. Esta informação é vital, quando consideramos princípios como a equidade, ou o custo de oportunidade (o que é gasto em uma intervenção, não pode ser usado em outra) e em última instância, o orçamento limitado em saúde dos sistemas de saúde.

Seasonal variation of femoral fractures in the state of São Paulo, Southeast Brazil

ABSTRACT OBJECTIVE To examine the effect of seasonality on femoral fracture incidence among people residing in the state of São Paulo, Brazil. METHODS Ecological study based on a consecutive series of 216,348 reports of hospital admissions caused by femoral fractures. A Bayesian statistical model was used for time series analysis, considering the monthly average number of events of femoral fractures per day as a dependent variable. RESULTS Among the female population, significant seasonal effects were observed only for older women, aged 60 years or more. Among younger men (aged less than 20 years) there is not a clear seasonal effect, but among the other age groups there seems to exist a higher number of cases of femoral fractures during the coldest months of the year. CONCLUSIONS In general, more cases of fractures occur during the coldest months of the year; however, men and women have different patterns of incidence according to each age group.

Impact of vaccination on the incidence of varicella hospitalizations in a state in Southeast Brazil

Abstract INTRODUCTION: This study aimed to analyze cases of complicated varicella and the impact of varicella vaccination in Minas Gerais, Brazil. METHODS: This was a time series study of a territorial basis using data on varicella cases from 2010 to 2016, which was provided by the State Health Department of Minas Gerais on . Descriptive statistics were used for the analysis, and the generalized linear regression model proposed by Prais-Winsten was used for the time tendency, adopting a significance level of 5% and the integrated autoregressive modeling of moving averages. RESULTS: There were 1,635 cases of varicella; out of which cellulitis (44%) was the predominant complication. The home-acquired cases were 38.9% and 464 cases (40.6%) were not previously vaccinated. There was a significant decrease in the incidence coefficient when comparing the pre- and post- immunization periods, from 1.95 cases/100,000 inhabitants in 2010 to 0.24 cases/100.000 inhabitants in 2016 (p<0.05). There was a higher incidence of cases recorded among males, with higher prevalence in the age group of 1-4 years (54.7%). Lethality was higher between 5-9 years of age (44%). Mortality was higher in the age group of 0-4 years and among females (2.58/100,000 inhabitants/year). The overall trend of the incidence coefficient was a decreasing one, with an annual percentage variation. CONCLUSIONS: The number of complicated varicella cases notified decreased, coincidentally, in the post-immunization period. However, the immunization coverage period was restricted for the assessment of the correlation between immunization coverage and incidence.

Notificação de eventos adversos: caracterização dos eventos ocorridos em um complexo hospitalar / Notificación de eventos adversos: caracterización de los eventos ocurridos en un complejo hospitalario / Notifications of adverse events: characterization of the events that occurred in a hospital complex

Resumo OBJETIVO Analisar as notificações de incidentes relacionados à segurança do paciente. MÉTODOS Estudo transversal com abordagem quantitativa, baseado nos dados do Gerenciamento de Risco de um complexo hospitalar, localizado no noroeste paulista, de agosto/2015 a julho/2016. RESULTADOS Foram analisadas 4.691 notificações. O enfermeiro foi a categoria profissional que mais notificou (71%), seguido do médico (8%). O período mais frequente em que ocorreram as notificações foi o diurno. Houve diferença significativa da proporção de notificações entre os dias da semana. As notificações foram classificadas por motivo, com destaque para os medicamentos (17%), seguido de lesões de pele (15%) e flebite (14%). A maior frequência de notificações ocorreu nas unidades de Internação. Quanto à gravidade 344 eventos ocasionaram dano ao paciente, sendo a maioria de intensidade leve (65%). CONCLUSÃO As notificações espontâneas são uma importante fonte de informações e evidenciam a magnitude do problema relacionado aos incidentes em saúde.

Resumen OBJETIVO Analizar las notificaciones de incidentes relacionados con la seguridad del paciente. MÉTODOS Estudio transversal con abordaje cuantitativo, basado en los datos del Gestión de Riesgos de un complejo hospitalario, ubicado em el noroeste paulista, de agosto de 2015 a julio de 2016. RESULTADOS Se analizaron 4.691 notificaciones. El enfermero fue la categoría profesional que más notificó (71%), seguido del médico (8%). El período más frecuente en que ocurrieron las notificaciones fue el diurno. Hubo una diferencia significativa de la proporción de notificaciones entre los días de la semana. Las notificaciones se clasificaron por motivo, con destaque para los medicamentos (17%), seguido de lesiones de piel (15%), flebitis (14%). La mayor frecuencia de notificaciones ocurrió en las unidades de Internación. En cuanto a la gravedad 344 eventos ocasionaron daño al paciente, siendo la mayoría de intensidad leve (65%). CONCLUSIÓN Las notificaciones espontáneas son una importante fuente de información, y evidencia la magnitud del problema relacionado con los incidentes en salud.

Abstract OBJECTIVE Analyze incident notifications related to the patient's safety. METHOD Cross-sectional study with quantitative approach, based on data from the risk Management of a hospital complex, located in northwest São Paulo, from August 2015 to July 2016. RESULTS 4,691 notifications were analyzed. Nurses were the professionals who notified the most (71%), followed by physicians (8%). The most frequent period in which the notifications occurred was the daytime. There was significant difference in the proportion of notifications between the days of the week. The notifications were classified by reason and the most prevalent were those related to medication (17%), followed by skin lesions (15%), and phlebitis (14%). The highest frequency of notifications occurred in the hospitalization units. In relation to severity, 344 events caused damage to the patient, most of which were of mild intensity (65%). CONCLUSION Spontaneous notifications are an important source of information, and highlight the magnitude of the problem related to health incidents.

Spatiotemporal patterns of AIDS incidence among adults in São Paulo, Brazil

Abstract INTRODUCTION: AIDS remains a major public health concern in Brazil. METHODS: This study investigated spatiotemporal patterns of reported AIDS cases among adults in São Paulo between 2000 and 2016, and their associations with human development index. RESULTS: In the early 20th century, the more developed administrative districts (ADs) indicated higher AIDS incidences among men. From the 2010s, ADs with lower development indicate higher rates of the disease among women. CONCLUSIONS: The results are useful to support the planning of actions aimed at controlling the incidence and transmission of AIDS in certain areas, based on diversification by gender and risk populations.

HIV/AIDS case definition criteria and association between sociodemographic and clinical aspects of the disease reported in the State of Minas Gerais from 2007 to 2016

Abstract INTRODUCTION: Over 30 years after the acquired immunodeficiency syndrome epidemic, several strategies have been implemented to verify the trend of the infection, the profile of the affected individuals, and the impact of prevention and control measures, with notification of asymptomatic carriers being the most recent measure. This study aimed to verify the geographic distribution of human immunodeficiency virus/acquired immunodeficiency syndrome and analyze the association between case definition criteria, sociodemographic data, and clinical aspects of the disease in the State of Minas Gerais between 2007 and 2016. METHODS: In this ecological and analytical study, 35,349 cases of human immunodeficiency virus/acquired immunodeficiency syndrome reported in the State of Minas Gerais between 2007 and 2016 were analyzed. The data were analyzed using multiple correspondence factor analysis, time series analysis, descriptive statistics, and spatial distribution of the cases by macro-region. RESULTS: The majority of the patients were brown-skinned individuals, alive, diagnosed with human immunodeficiency virus/acquired immunodeficiency syndrome on the basis of the criteria adapted from the Centers for Disease Control and Prevention, and living in municipalities with more than 50,000 (80.5%) inhabitants. Between 2007 and 2016, there was an increase in the number of criteria used for diagnosing human immunodeficiency virus. By contrast, a consequent decrease was observed in the number of criteria used for defining cases, which were adapted from the Centers for Disease Control and Prevention, Rio de Janeiro/Caracas, and for identifying AIDS-related deaths. Young people aged between 13 and 29 years, individuals whose education level is compatible with the observed age, and homosexual men were associated with the HIV+ criterion. CONCLUSIONS: Out study showed that after the mandatory notification of human immunodeficiency virus-positive cases in 2014, there was a decrease in other criteria for defining human immunodeficiency virus/acquired immunodeficiency syndrome cases and changes in the profile of people living with human immunodeficiency virus/acquired immunodeficiency syndrome.

Indenizações em obstetrícia: estudo das decisões do superior tribunal de justiça do Brasil de 2004 a 2014 / Indemnities in obstetrics: A study of the decisions of the Court of Justice of Brazil 2004-2014

Este artigo tem por objetivo identificar, nas decisões do Superior Tribunal de Justiça (STJ), as principais causas dos danos decorrentes da prática médica obstétrica no momento do parto. O estudo analisou 21 decisões julgadas pela corte entre 2004 e 2014 relacionadas a indenizações judiciais na obstetrícia. O critério de seleção dos casos utilizou como método a busca de decisões no site do STJ, cujos descritores foram: "parto", "erro médico"; "médico"; "paciente"; "profissional da saúde"; "dano moral"; "dano material"; "SUS"; "responsabilidade civil" e "indenização por erro médico". O Rio de Janeiro foi o estado com maior número de ações indenizatórias (28,6%) apreciadas pelo STJ, seguido de São Paulo e Minas Gerais, com 14,3% cada um. No tocante aos réus que figuraram no polo passivo das demandas, 38,1% eram médicos e hospitais. Verificou-se que 71% das supostas falhas médicas que originaram as ações ocorreram durante a realização do parto natural, contra 29% dos casos de cesariana. A principal causa dos danos relatados foi a demora na realização do parto, seguida dos traumatismos. Apesar de pesquisas demonstrarem que a cesariana oferece maiores riscos para a parturiente e o feto, os resultados obtidos das decisões judiciais analisadas pelo STJ evidenciaram que os danos que resultaram sequelas irreversíveis no nascituro foram recorrentes nos casos relacionados ao parto natural, sugerindo que atenção especial deve ser dada à formação médica obstétrica, bem como à compreensão dos aspectos socioculturais envolvendo a indicação e a escolha pelo tipo de parto.

This article intends to identify the main reasons of damage caused by obstetric medical practice during childbirth, on the decisions of the Supreme Court of Justice of Brazil. The study analyzed 21 decisions judged between 2004 and 2014 related to legal compensations concerning obstetrics. The criteria for the selection of cases was to search the Supreme Court's website, for decisions containing descriptors such as: "birth", "medical error"; "doctor"; "patient"; "health professional"; "moral damage"; "property damage"; "SUS"; "Liability" and "compensation for medical error". Rio de Janeiro was the state with the largest number of compensation claims (28.6%) appreciated by the court, followed by São Paulo and Minas Gerais with 14.3%. Among the defendants listed on the demands, 38.1% were doctors and hospitals. It was found that 71% of the alleged malpractices that led to these actions occurred during vaginal delivery and 29% of cases correspond to caesarean section. The main cause of damages reported was the delays in performing delivery, followed by trauma. Although research has shown that the cesarean section poses greater risks to the woman and the fetus, the results obtained from the decisions analyzed by the court showed that damages resulting in irreversible sequelae in unborn children were recurrent in natural birth related cases, suggesting that special attention should be given to obstetric medical training as well as to the understanding of the sociocultural aspects that surround medical indication and choice of the type of childbirth method

Community Care Administration of Spinal Deformities in the Brazilian Public Health System

OBJECTIVE: Underfunding of the surgical treatment of complex spinal deformities has been an important reason for the steadily growing waiting lists in publicly funded healthcare systems. The aim of this study is to characterize the management of the treatment of spinal deformities in the public healthcare system. METHODS: A cross-sectional study of 60 patients with complex pediatric spinal deformities waiting for treatment in December 2013 was performed. The evaluated parameters were place of origin, waiting time until first assessment at a specialized spine care center, waiting time for the surgical treatment, and need for implants not reimbursed by the healthcare system. RESULTS: Ninety-one percent of the patients lived in São Paulo State (33% from Ribeirão Preto - DRS XIII). Patients waited for 0.5 to 48.0 months for referral, and the waiting times for surgery ranged from 2 to 117 months. Forty-five percent of the patients required implants for the surgical procedure that were not available. CONCLUSION: The current management of patients with spinal deformities in the public healthcare system does not provide adequate treatment for these patients in our region. They experience long waiting periods for referral and prolonged waiting times to receive surgical treatment; additionally, many of the necessary procedures are not reimbursed by the public healthcare system.

Cost-consequence analysis of Pharmaceutical Care program for systemic arterial hypertension in the public health system in Brazil

ABSTRACT In Brazil, 80% of hypertensive patients have no blood pressure controlled, this fact has caused severe financial consequences for the public health system (PHS) and the Pharmaceutical Care (PC) has emerged as an effective alternative. The aim of this study was to analyze the costs and outcomes of systemic arterial hypertension (SAH) for conventional assistance compared to assistance with PC in the PHS. This is a pharmacoeconomic study with cost-consequence analysis nested to clinical trial. Hypertensives patients were followed-up from 2006 to 2012. During 2009 they were assisted by the PC program in Ribeirão Preto-SP, Brazil. Clinical indicators, systolic and diastolic blood pressure (SBP and DBP), triglycerides, total cholesterol (TC) and its fractions and healthcare indicators, consumption of antihypertensive medication and consultations were analyzed. Costs were listed as direct medical and direct non-medical. The average cost of conventional care for 104 patients followed-up was US$ 198.97, in the PC period and after discharge was US$ 407.91 and US$ 214.96 patient/year. After discharge of patients from PC there was reduction of SBP, DBP, TC and cardiovascular risk, 9.4 mmHg, 4.6 mmHg, 12.0 mg/dL, and 23% [p<0.005], respectively. The PC program optimized clinical and healthcare indicators and impacted in the SAH costs for the PHS.