Construction and validation of a scale of stigma against individuals diagnosed with schizophrenia

Antecedents: Individuals diagnosed with schizophrenia are not just dealing with their diagnoses. They are facing stigma due to their pathology. International research has proposed that individuals diagnosed with schizophrenia suffer more stigma than other types of mental issues. However, in Chile, a valid scale is not available to measure stigma against individuals diagnosed with schizophrenia. Objectives: To fill this gap, this research is aimed to develop and validate a scale to measure stigma against individuals diagnosed with schizophrenia. Methods: Two stages were completed to achieve the research objective. First, a pool of items was developed based on the three critical components of stigma, cognitive, affective and behavioral. Three independent judges were asked to assess the content aspects of the content validity of the items. Second, following an instrumental and longitudinal design with non-probabilistic with a quota sampling by gender (N = 607) the validity and reliability of the final scale was assessed. Results: A one-dimensional scale composed of 22 items showed good statistical boundaries. The observed factor loadings suggest that the items adequately represent the dimension (λ>, 6), and the reliability estimates are optimal (α>, 8; ω>, 8). Results suggest that the scale can be used the respondents' gender irrespectively.

Antecedentes: Las personas diagnosticadas con esquizofrenia no solo enfrentan su diagnóstico. Ellos también tienen que enfrentar el estigma producto de su patología. Investigaciones internacionales han propuesto que las personas diagnosticas con esquizofrenia sufren más de estigma que otras patologías mentales. Sin embargo, en Chile no existe una escala validada para medir el estigma hacia personas diagnosticadas con esquizofrenia. Objetivos: Para cubrir esta necesidad en la literatura, esta investigación tiene como objetivo desarrollar y validar un instrumento para medir el estigma hacia personas diagnosticadas con esquizofrenia. Métodos: Dos etapas fueron completadas para lograr el objetivo de investigación. En primer lugar, se desarrolló un set de ítems basados en los "tres componentes centrales del estigma: creencia, emoción y conducta". Se les solicitó a tres jueces independientes evaluar estas preguntas de acuerdo con su contenido y validez. En segundo lugar, siguiendo un diseño instrumental y longitudinal con muestreo no probabilístico por cuotas por género (N = 607) se evaluó la validez y confiabilidad de la escala final. Resultados: Una escala unidimensional compuesta por 22 ítems mostró buenos límites estadísticos. Las saturaciones de factores observadas sugieren que los ítems representan adecuadamente la dimensión (λ>, 6), y las estimaciones de confiabilidad son óptimas (α>, 8; ω>, 8). Los resultados sugieren que la escala se puede utilizar independientemente del género de los encuestados

Comparison between Wright and Shukla formulas: which is better for the placement of umbilical catheters in newborns ≤ 1500 g? / Comparación entre las fórmulas de Wright y de Shukla: ¿cuál es mejor para la colocación de catéteres umbilicales en recién nacidos ≤ 1500 g?

Abstract Background: Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. Methods: We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. Results: A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). Conclusions: We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

Resumen Introducción: La colocación de catéteres intravasculares venosos umbilicales (CVU) y arteriales (CAU) es el procedimiento invasivo más frecuente en la unidad de cuidados intensivos neonatales (UCIN). Para introducirlos se utilizan las fórmulas de Wright y de Shukla, aunque esta última podría estar asociada con una inserción incorrecta, especialmente en neonatos < 1500 g. El objetivo de este estudio fue determinar mediante radiografía de tórax cuál fórmula es mejor para la correcta colocación de catéteres umbilicales en recién nacidos ≤ 1500 g. Métodos: Se incluyeron los pacientes ingresados en la UCIN de un hospital de segundo nivel entre 2021-2022 que recibieron CVU o CAU mediante las fórmulas de Wrigth o Shukla. Resultados: Se incluyeron en total 129 recién nacidos: 78 CVU y 51 CAU. En CVU, Wright 50% y Shukla 36.8% tuvieron localización correcta, p = 0.24. En las CAU, Wright 56.6% y Shukla 52.4% tenían una ubicación correcta, p = 0.76. En CVU con peso < 1000 g, Wright 36.4% y Shukla 33.3% bien situados, p = 0.58. En CVU > 1000 g, Wright 66.6% y Shukla 38.4% bien situados, p = 0.065. En CAU < 1000 g, Wright 45% y Shukla 42.9%, p = 0.63. En CAU con peso > 1000 g, Wright 80% y Shukla 57.1%, p = 0.23. Conclusiones: La colocación del CVU fue 13% mejor con la fórmula de Wright. La fórmula de Wright superó en el 29% la colocación del CVU en los neonatos > 1000 g en comparación con la de Shukla, aunque no hubo diferencia significativa debido al tamaño de la muestra.

Menor aerolización con bloqueo del nervio laríngeo superior comparado con lidocaína intravenosa a la extubación / Less aerolization with superior laryngeal nerve block compared to intravenous lidocaine at extubation

Resumen: Introducción: La tos es una respuesta fisiológica de protección de la vía aérea, produce aerosoles que se identifican por imagen y alcanza una velocidad de hasta ocho metros por segundo. La extubación produce tos, hipertensión, taquicardia, apnea y laringoespasmo, existen métodos para minimizar su aparición. Debido a la pandemia de COVID-19 se han utilizado como profilaxis del reflejo tusígeno, la lidocaína intravenosa y el bloqueo del nervio laríngeo superior. El objetivo fue compararlos en la inhibición de la tos. Material y métodos: Se seleccionaron pacientes entre 18-60 años, cirugía electiva con anestesia general balanceada, ASA 1-3, con intubación menor a tres horas. Se aleatorizó un total de 90 pacientes, 45 en cada grupo, se eliminó un total de 10 pacientes por presentar inestabilidad hemodinámica al final de la cirugía o por no administrar dosis intravenosa de lidocaína en el tiempo establecido. Resultados: No hubo diferencia estadísticamente significativa en el número de pacientes que presentaron tos en ambos grupos (13 vs 10, p = 0.4684), de éstos se obtuvo una diferencia estadísticamente significativa en el número de decibeles a favor del grupo de bloqueo (75.6 vs 67, p < 0.001). Conclusiones: El bloqueo (selectivo) presenta menos aerolización que la lidocaína intravenosa en la extubación.

Abstract: Introduction: Coughing is a physiological response to protect the airway, it produces aerosols that are identified by imaging reaching a speed of up to 8 meters per second. Extubation produces cough, hypertension, tachycardia, apnea and laryngospasm, there are methods to minimize its occurrence. Due to the COVID-19 pandemic, intravenous lidocaine and superior laryngeal nerve block have been used as cough reflex prophylaxis. The aim was to compare them in cough inhibition. Material and methods: Patients aged 18-60 years, elective surgery with balanced general anesthesia, ASA 1-3, with intubation less than 3 hours, were selected. A total of 90 patients were randomized, 45 in each group. A total of 10 patients were eliminated because they presented hemodynamic instability at the end of surgery, and because the intravenous dose of lidocaine was not administered within the established time. Results: There was no statistically significant difference in the number of patients who presented cough in both groups (13 vs 10, p = 0.4684), of these there was a statistically significant difference in the number of decibels in favor of the block group (75.6 vs 67, p < 0.001). Conclusions: Block presents less aerolization than intravenous lidocaine in extubation.

The relationship between academic psychological capital and academic coping stress among university students / La relación entre el capital psicológico académico y el afrontamiento de estrés académico en estudiantes universitarios

Abstract: Antecedents: University students confront academic stress in pursuing their academic goals, which may negatively affect their mental wellbeing. Consequently, it is relevant that students develop coping stress strategies to face students' daily stress in their academic life. Previous organisational research has proposed that the positive core construct of psychological capital (PsyCap) positively relates to effective coping strategies. This positive core construct has been identified in academic settings, and it has been called Academic PsyCap. However, the relationship between Academic PsyCap and Coping academic stress has not been deeply studied. Objectives: The primary purpose of this research is to explore if the Academic PsyCap is positively related to Academic coping stress strategies in university students. Methods: An exploratory study with a cross-sectional design was conducted to explore the relationship between the variable of interest in a sample of 102 Chilean university students from public and private institutions. Results: The results of the research showed a positive and significant relationship between Academic PsyCap and Coping academic stress. Furthermore, differences were identified between students from public and private universities and students with aboriginal and non-aboriginal heritage. These results are promising to effectively help university students to face academic stress based on Academic PsyCap.

Resumen: Antecedentes: Los estudiantes universitarios en la búsqueda de cumplir con sus metas académicas enfrentan el estrés académico que puede tener consecuencias negativas en su salud mental. En consecuencia, es relevante que los estudiantes logren desarrollar estrategias para enfrentar al estrés cotidiano asociado a su vida académica. Investigaciones en el campo de psicología organizacional con orientación positiva (POB) han propuesto que Capital Psicológico (PsyCap) es un constructo central positive que tiene una relación positiva con estrategias efectivas de afrontamiento de estrés. Este constructo central positive ha sido identificado También en el contexto académico, y se ha denominado como PsyCap Académico. Sin embargo, la relación entre PsyCap Académico y el afrontamiento del estrés académico no ha sido lo suficientemente estudiada. Objetivos: El propósito principal de esta investigación es explorar si PsyCap Académico esta positivamente relacionado con estrategias de afrontamiento de estrés académico en estudiantes universitarios. Método: Se realizo una investigación de tipo exploratoria con un diseño cross-sectional para explorar la relación entre las variables de interés en una muestra de 102 estudiantes universitarios Chilenos de instituciones públicas y privadas. Resultados: Los resultados de esta investigación muestran una relación positiva y significativa entre el PsyCap Académico y estrategias de afrontamiento de estrés académico. Adicionalmente, se encontraron diferencias entre estudiantes de universidades públicas y privadas, y entre estudiantes con ascendencia indígena y quienes no tienen esta ascendencia. Los resultados son promisorios para ayudar de forma efectiva a estudiantes universitarios a enfrentar el estrés académico por medio del PsyCap Académico.

Changes in chloremia, secondary to hydric reanimation during the first 24 hours, increases hospital stay and complications in patients with acute pancreatitis / Cambios en la cloremia secundaria a la reanimación hídrica, en las primeras 24 horas, incrementa la estancia hospitalaria y las complicaciones en los pacientes con pancreatitis aguda

Abstract Acute pancreatitis (AP) requires first-line treatment with intensive fluid resuscitation. Hydroelectrolyte changes secondary to this management could be related to an increase in hospital stay, complications, and mortality. The objective of this study was to correlate the increase in serum chlorine (> 8mEq / L) during the first 24 hours (ISC) with a longer hospital stay, complications and mortality in patients with AP. A total of 110 patients with AP admitted to the emergency room were included. Fluid management and serum chlorine were recorded on admission and after 24 hours; duration of hospital stay, complications and mortality, were also registered. 37 patients had ISC (age 56.4 ± 18.4 years; 51% women), there were no differences in age, sex or type of fluid management with patients without ISC. In bivariate analysis, ISC was associated with severe AP (30% vs 12%, p = 0.02), higher APACHE II score at admission (8 [6-15] vs 6 [4-9] points, p = 0.006), and longer hospital stay (9 [7-12] vs 7 [5-10] days, p = 0.03). The overall mortality and complications rate were 16% and 25%, respectively, with no differences between the groups (24% vs. 12%, p = 0.1 and 35% vs. 19%, p = 0.06). After multivariate adjustment, independent predictors of hospital stay were ISC> 8 mEq / L (p = 0.01) and APACHE II scores at 24 hours (p = 0.02). We conclude that ISC is associated with a longer hospital stay in patients with AP from a second-level hospital care population.

Resumen La pancreatitis aguda (PA) requiere tratamiento de primera línea con reanimación hídrica intensiva. Los cambios hidroelectrolíticos secundarios a este manejo podrían relacionarse a un incremento en la estancia hospitalaria, complicaciones y mortalidad. El objetivo de este estudio fue correlacionar el incremento de cloro sérico (>8mEq/L) en las primeras 24hrs (ICS), con una mayor estancia hospitalaria, complicaciones y mortalidad en pacientes con PA. Se incluyeron 110 pacientes con PA ingresados a urgencias, se registró el manejo hídrico y cloro sérico al ingreso y 24 horas después, la estancia hospitalaria, complicaciones y mortalidad. 37 pacientes tuvieron ICS (edad 56,4 ± 18,4 años; 51% mujeres) no hubo diferencias en edad, sexo o tipo de manejo hídrico en pacientes sin ISC. En el análisis bivariado, el ICS se asoció a PA grave (30% vs 12%, p = 0,02), mayor puntuación APACHE II al ingreso (8 [6-15] vs 6 [4-9] puntos, p = 0,006) y estancia hospitalaria más prolongada (9 [7-12] frente a 7 [5-10] días, p = 0,03). La tasa global de mortalidad y complicaciones fueron del 16% y el 25%, respectivamente, sin diferencias entre grupos (24% vs 12%, p = 0,1 y 35% vs 19%, p = 0,06). Después del ajuste multivariado, los predictores independientes de la estancia hospitalaria fueron ICS> 8 mEq/L (p = 0,01) y las puntuaciones APACHE II a las 24 horas (p = 0,02). Concluimos que el ICS se asocia a mayor estancia hospitalaria en pacientes con PA de una población de segundo nivel de atención hospitalaria.

Tiempo en consultorios respiratorios en atención primaria ¿factor para infección por SARS-CoV-2? / Time in primary-care respiratory triage: risk for SARS-CoV-2 infection?

Introducción: la pandemia por COVID-19 es uno de los principales problemas de salud pública en el mundo. De las personas contagiadas, una gran cantidad son trabajadores de la salud de unidades de primer nivel. Objetivo: determinar la relación entre el tiempo de estancia en consultorios respiratorios y la infección de SARS-CoV-2 en trabajadores de la salud de un centro de primer nivel de atención. Material y métodos: estudio transversal analítico en trabajadores de primer nivel de atención de San Luis Potosí, México, que desarrollaron síntomas de COVID-19 de marzo de 2020 a enero de 2021. Se les realizó RT-PCR para SARS-CoV-2 y a partir del resultado se conformaron dos grupos. Se registraron variables demográficas, ocupación, área de trabajo, trabajo en consultorio respiratorio, horas de trabajo acumuladas en consultorio respiratorio/toma de muestra hasta el desarrollo de síntomas, fecha de desarrollo de síntomas. Resultados: de 350 trabajadores, 144 desarrollaron sintomatología respiratoria; de estos, 66 tuvieron RT-PCR positiva para SARS-CoV-2. Atender pacientes en un consultorio no respiratorio confiere una RM 2.49 (1.04-6.26) con respecto a los que trabajan en consultorio respiratorio para infección por SARS-CoV-2 (p 0.0446). Estar en filtro respiratorio confiere una RM protectora de 0.3062 (0.08-0.99) de infección por SARS-CoV-2 (p 0.0608). Cada hora acumulada en un consultorio respiratorio confiere una RM 1.001 (0.99-1.00) sin significación estadística (p 0.3046). Conclusión: trabajar en consultorio respiratorio y las horas acumuladas de trabajo en este no son factores de riesgo para desarrollar COVID-19 en los trabajadores de la salud.

Background: The pandemic caused by COVID-19 is one of the main problems of public health around the world. Of the individuals with infection, a large amount corresponds to first-level health workers. Objective: To determine the relationship between length of stay in respiratory offices and SARS-CoV-2 infection in health workers at a first-level health center. Material and methods: Cross-sectional analytic study in health workers of a first-level unit of San Luis Potosí, Mexico, who developed suspected symptomatology of SARS-CoV-2 infection from March 2020 to January 2021. Two groups were formed according to the result of the RT-PCR. Demographic variables, occupation, work area, work in respiratory area, hours of work accumulated within the respiratory area to develop symptomatology, and date of development of symptomatology were registered. Results: Of 350 health workers active, 144 developed respiratory symptomatology; of these, 66 had positive RT-PCR for SARS-CoV-2 infection. Working in an area with no respiratory patients but in contact with other patients confers an OR 2.49 (1.04-6.26), when compared with working in a respiratory area, p 0.0446. The length in a filter for respiratory patients gives a protective OR of 0.3062 (0.08-0.99) for developing SARS-CoV-2 infection, p 0.0608. Each hour accumulated in a respiratory area confers an OR 1.001 (0.99-1.00) without statistical significance, p 0.3046. Conclusion: Working in a respiratory area and the accumulated hours of work in this place are not risk factors for developing COVID-19 in health workers.

Câncer de Pele e Renda Familiar: um Estudo Ecológico / Skin Cancer and Family Income: an Ecological Study / Cáncer de Piel y Rendimiento Familiar: un Estudio Ecológico

Introdução: Recentemente, houve crescimento da incidência do câncer de pele. Radiação solar, história familiar, imunossupressão, pele clara e idade constituem fatores de risco da doença. Objetivo: Correlacionar a mortalidade do câncer de pele com variáveis socioeconômicas. Método: Estudo ecológico, utilizando a planilha de dados da incidência de radiação solar do projeto aquecedor solar de baixo custo (ASBC), e indicadores de condições de vida do Censo de 2010. Os dados foram exportados para o SPSS 14.0, para analisar a correlação (coeficiente de correlação de Spearman), e as variáveis foram comparadas. Resultados: Associações estatisticamente significantes ocorreram entre o coeficiente de mortalidade por câncer maligno de pele com a renda familiar média (r=-0,316, p<0,006) indicando que, quanto maior a renda, menor a mortalidade por neoplasia maligna, ocorrendo o mesmo com a proporção de óbitos evitáveis em menores de 4 anos (r=-0,292, p<0,01) e a proporção de mortes evitáveis entre 5 e 74 anos (r=-0,372, p<0,001). A proporção da população ganhando menos de 1/2 salário-mínimo (r=0,232, p<0,05) indica que, quanto maior a proporção populacional com renda inferior a 1/2 salário- -mínimo, maior será a mortalidade por neoplasia maligna, similar à proporção da população ganhando menos de 1/4 de salário-mínimo (r=0,229, p<0,05). Conclusão: Sendo um assunto de saúde pública intimamente relacionado à renda, o câncer de pele ainda carece de ações de prevenção primária e secundária.

Introduction: Recently, there has been an increase in the incidence of skin cancer. Solar radiation, family history, immunosuppression, fair skin and age are risk factors for the disease. Objective: To correlate skin cancer mortality with several socioeconomic variables. Method: An ecological study using the Solar Heating at Affordable (ASBC) Project Solar Radiation Incidence Worksheet, with indicators of living conditions from the 2010 Census. All the collected data were exported to SPSS 14.0, a tool where the correlation (Spearman correlation coefficient) was analyzed and the variables were compared. Results: Statistically significant associations between the mortality coefficient for malignant skin cancer, with mean family income (r=-0.316, p<0.006) were found, indicating that as high the income, lower is the mortality by malignant neoplasm, occurring the same with the proportion of avoidable deaths in children younger than 4 years (r=-0.292, p<0.01) and the proportion of avoidable deaths between 5 and 74 years (r=-0.372, p<0.001). The proportion of the population earning less than ½ minimum wage (r=0.232, p<0.05) indicates that as high the population proportion with income lower than ½ minimum wage, higher will be the mortality by malignant neoplasm, similar to the proportion of the population earning less than » of the minimum wage (r=0.229, p<0.05). Conclusion: Although is a public health issue closely related to income, skin cancer needs initiatives targeted to primary and secondary prevention of the disease.

Introducción: Recientemente, ha habido un aumento en la incidencia de cáncer de piel. La radiación solar, historia familiar, inmunosupresión, piel clara y la edad constituyen los factores de riesgo para esta enfermedad. Objetivo: Correlacionar la mortalidad por cáncer de piel con varias variables socioeconómicas. Método: Se realizo un estudio ecológico usando la base de datos de la incidencia de la radiación solar del proyecto calentador solar de bajo costo (ASBC), adicionando los indicadores del censo de 2010 relativos a las condiciones de vida. Todos los datos recolectados fueron exportados a SPSS 14.0, herramienta que analizó la correlación (coeficiente de correlación de Spearman) y comparar todas las variables de la base de datos. Resultados: Fueran encontró asociaciones estadísticamente significativas entre el coeficiente de mortalidad debido al cáncer maligno de la piel y el ingreso familiar promedio (r=-0,316, p<0,006), lo mismo ocurre con la proporción de muertes prevenibles en niños menores de 4 años de edad (r=-0,292, p<0,01) y la proporción de muertes prevenibles entre 5 y 74 años (r=-0,372, p<0,001). La proporción de la población que gana menos de 1/2 salario mínimo (r=0,232, p<0,05) indica que cuanto mayor es la proporción de la población con ingresos por debajo de 1/2 salario mínimo, mayor es la mortalidad por neoplasia maligna, similar a proporción de la población que gana menos de 1/4 del salario mínimo (r=0,229, p<0,05). Conclusión: A pesar de ser un problema de salud pública y estrechamente relacionado con los ingresos, el cáncer de piel todavía carece de acciones encaminadas a la prevención primaria y secundaria de la enfermedad.

Correlación del índice de perfusión con la repercusión del conducto arterioso en prematuros / Correlation of perfusion index with patent ductus arteriosus repercussion in premature newborns

Resumen Antecedentes: El conducto arterioso es una estructura necesaria en la circulación fetal, su persistencia puede provocar alteraciones hemodinámicas. El estándar de oro diagnóstico es la ecocardiografía, no siempre disponible. Las unidades de cuidados intensivos neonatales (UCIN) cuentan con oximetría de pulso, que mide el índice de perfusión (IP), el cual podría funcionar como auxiliar en el diagnóstico de persistencia del conducto arterioso hemodinámicamente significativo (PCAHs). Objetivo: Correlacionar el incremento del índice de perfusión (ΔIP) a las 24 y 72 h de vida extrauterina con PCAHs en recién nacidos prematuros de la UCIN de un hospital de segundo nivel. Material y métodos: Estudio de cohorte analítico prospectivo donde se incluyeron neonatos de 26 a 34 semanas de gestación, sin comorbilidades, a quienes se les realizó ecocardiograma y medición de IP en brazo y pierna a las 24 y 72 h. Se efectuó análisis bivariante con Y2/prueba exacta de Fisher y t de Student/U de Mann-Whitney, además correlación de Spearman y regresión lineal para predicción de valores. Resultados: Se incluyeron 39 prematuros. No se encontró diferencia significativa entre los pacientes sin y con PCAHs (mediana: 0.22 [0.06, 0.58] vs. 0.03 [–0.27, 0.2]; p = 0.09) a las 24 h de vida y tampoco a las 72 h de vida (mediana: 0.2 [0, 0.47] vs. 0.45 [–0.37, 0.76], p = 0.47). Se encontró una correlación positiva entre el diámetro del conducto arterioso (DCA) y el ΔIP (r: 0.78; IC 95%: 0.60-0.88; p = 0.01). La fórmula de predicción por regresión lineal se expresa así: DCA = 1.31 + (2.05 x ΔIP). Conclusiones: El IP no permite discriminar entre pacientes sin y con PCAHs. El ΔIP podría ser una herramienta para la monitorización del diámetro del conducto en neonatos después de las 72 h de vida.

Abstract Background: The ductus arteriosus is a necessary structure in fetal circulation, and its patency can produce hemodynamic alterations. The diagnostic gold standard is echocardiography, not always available. In the neonatal intensive care unit (NICU) they have pulse oximetry that measures perfusion index (PI), which could be used as a diagnostic tool in hemodynamic significant patent ductus arteriosus (HSPDA). Objective: To correlate the perfusion index increment (ΔPI) in 24 and 72 h after birth with HSPDA in premature newborns of NICU in a second level hospital. Materials and methods: This is an analytic prospective study which included neonates of 26-34 weeks of gestational age, without comorbidities, who underwent echocardiography and measurement of PI in arm and leg, 24 and 72 h after birth. We did bivariate analysis with Y2/exact Fisher test and Student t-test/Mann-Whitney U test, besides Spearman correlation and linear regression for value prediction. Results: We included 39 premature newborns. We did not find significant differences between patients without and with HSPDA (Median: 0.22 [0.06-0.58] vs. 0.03 [–0.27-0.2]; p = 0.09) at 24 h neither 72 h after birth (Median: 0.2 [0-0.47] vs. 0.45 [–0.37-0.76]; p = 0.47). We found a positive correlation between ductus arteriosus diameter (DAD) and ΔPI (r: 0.78; CI 95%: 0.6-0.88; p = 0.01). The prediction formula with linear regression is expressed this way: DAD = 1.31 + (2.05 x ΔIP). Conclusions: The PI doesn´t allow us to discriminate between patient without and with HSPDA. The ΔPI could be a tool for the monitorization of DAD in neonates 72 h after birth.

Transferencia articular vascularizada: Reporte de caso / Free vascularized joint transfer: Case report

La articulación interfalángica proximal otorga la mayor contribución al arco total de movimiento digital, por lo tanto, la pérdida de movimiento normal de la articulación tiene un impacto considerable en la función y fuerza de agarre. El único método que asegura la preservación a largo plazo de la arquitectura cartilaginosa, así como una curación ósea rápida tras destrucción articular traumática o patológica es la transferencia articular vascularizada. Es definida como un trasplante articular parcial o completo con preservación o restauración inmediata del flujo de sangre. Se presenta el caso de un masculino de 20 años, con antecedente de trauma contuso-cortante en borde cubital de 3er dedo de mano izquierda zona II a quien se realiza cierre primario. Siete meses después a presentó deformidad articular e incapacidad funcional para la flexión de articulación interfalángica proximal. Se realizó procedimiento de reconstrucción articular, mediante transferencia articular vascularizada de 2° dedo del pie derecho. Posteriormente se dio seguimiento a través de consulta externa a las 2, 4, 6 y 8 semanas, 6 meses y 12 meses. A los 6 meses fue sometido a capsulotomía, liberación de placa volar, retiro de placas de osteosíntesis y adelgazamiento de isla cutánea. Se alcanzaron rangos de movimiento pasivo de extensión de 85° y activo de 70°. En base a la experiencia de nuestro centro se demuestra que el uso de transferencia articular en 2 etapas de reconstrucción, se pueden mantener rangos de movimiento tanto activo como pasivo suficiente para una adecuada función.

The proximal interphalangeal joint provides the greatest contribution to the total arc of digital movement, therefore, the loss of normal movement of the joint has a considerable impact on function and grip strength. The only method that ensures the long-term preservation of the cartilaginous architecture, as well as a rapid recovery of traumatic or pathological joint destruction, is vascularized joint transfer. It is defined as a partial or complete partial transplant with preservation or immediate restoration of blood flow. We present the case of a 20-year-old man, with a history of contusive-cutting trauma on the ulnar border of the third finger of the left hand, area II, who underwent primary closure. Seven months after the presentation of the joint and functional disability for proximal interphalangeal joint flexion. A joint reconstruction process was performed, by means of a vascularized joint transfer of the 2nd toe of the right foot. Subsequently, follow-up was carried out through the outpatient clinic at 2, 4, 6 and 8 weeks, 6 months and 12 months. At 6 months he was subjected capsulotomy, volar plate release, osteosynthesis plates removal and cutaneous island thinning. Ranges of passive movement of extension of 85° and active of 70° were reached. Based on the experience of our center, it is shown that the use of the transfer was made in 2 stages of reconstruction, the range of both active and passive movements can be maintained for an adequate function.

Evaluación comparativa de descompresión lumbar primaria por técnica mínima invasiva versus convencional / Comparative evaluation of primary lumbar decompression by minimally invasive vs conventional technique

Resumen Introducción La descompresión lumbar es una de las principales cirugías programadas en ortopedia, es necesario identificar los beneficios y complicaciones de cada tipo de abordaje. Objetivo Comparación del abordaje convencional y mínimamente invasivo (MI). Material y métodos Estudio transversal, descriptivo y comparativo de descompresión lumbar primaria mínima invasiva vs. convencional. Resultados 36 pacientes divididos en dos grupos, 28 (77.7%) fueron abordaje convencional y ocho (22.3%) por mínima invasión, edad promedio de siete años menor en MI (MI media de 52.2 ± 8 años contra 59.8 ± 9, t Student p = 0.04), la disfunción medida similar. Inician deambulación 24 horas antes (mediana de 24 horas contra 48 horas en convencional, U de Mann Whitney p = 0.012), reducción de 1.5 días de estancia (mediana de 2.5 contra = cuatro días en convencional, p = 0.017), y del dolor postquirúrgico en la MI. Pérdida hemática menor en MI (medianas de 200 en convencional contra 65 mL, U de Mann Whitney p = 0.09), complicaciones, una infección del sitio quirúrgico, un hematoma de lecho quirúrgico, una inadecuada colocación de implantes y una lesión de dura. Conclusiones Se demostró la superioridad de la MI en varios aspectos, y la eficacia del test de Oswestry para la evaluación funcional del canal lumbar estrecho.

Abstract Introduction Lumbar decompression is one of the main surgeries scheduled in orthopedics, it is necessary to identify the benefits and complications of each type of approach. Objective Comparison of conventional and minimally invasive (MI) approaches. Material and methods Cross-sectional, descriptive, comparative study of minimally invasive versus conventional primary lumbar decompression. Results 36 patients divided into 2 groups, 28 (77.7%) were conventional and 8 (22.3%) were minimally invasive, average age 7 years younger in MI (MI average 52.2 ± 8 years versus 59.8 ± 9, t Student p = 0.04), similarly measured dysfunction. They begin wandering 24 hours before (median of 24 hours against 48 hours in conventional, Mann Whitney U p = 0.012), reduction of 1.5 days of stay (median of 2.5 versus = five days in conventional, p = 0.017), and post-surgical pain in MI. Minor blood loss in MI (median of 200 in conventional versus 65 mL, Mann Whitney U p = 0.09), complications, 1 surgical site infection, 1 surgical site hematoma, 1 inadequate implant placement and 1 dura mater lesion. Conclusions It was demonstrated the superiority of the MI in several aspects, and the effectiveness of the Oswestry test for the functional evaluation of the strait lumbar channel.

Apendicitis perforada en una hernia incisional recidivante / Perforated apendicitis in a recurrent incisional hernia

RESUMEN Las hernias incisionales son la complicación más común a largo plazo en las laparotomías con una incidencia hasta 20 por ciento. Se ha descrito la presencia de casi todos los órganos intrabdominales en el interior de una hernia. Presentamos el caso de un paciente con apendicitis aguda en una hernia incisional recidivante, su presentación clínica y una revisión de la literatura acerca de esta patología. Femenino de 75 años de edad presentó una hernia incisional recidivante estrangulada, se realizó una laparotomía exploradora, encontrando el apéndice cecal perforado. Se realizó la apendicectomía y una desbridación amplia de la piel y la grasa alrededor de la herida. Durante el internamiento se colocaron 4 sistemas de cicatrización asistida con presión negativa. Se tomó un injerto de espesor parcial del muslo izquierdo y se cubrió el defecto. Es importante estar consciente de las posibles complicaciones para determina la mejor estrategia en la cirugía(AU)

ABSTRACT Incisional hernia is the most long-term common complication in laparotomies with an incidence rate up to 20 percent. The presence of almost all intra-abdominal organs inside a hernia has been described. Here is a 75 years-old female patient with acute appendicitis in a recurrent incisional hernia, its clinical presentation and the literature review about this pathology. This patient had strangulated recurrent incisional hernia and she underwent exploratory laparotomy to find perforated cecal appendix. Appendicectomy and extensive debridement of skin and fat around the wound were performed. During the hospitalization period, four negative pressure-assisted wound closure systems were placed. A partially thick graft was taken from the left thigh to cover the defect. It is important to be aware of the possible complications in order to determine the best surgical strategy(AU)

Clinical impact and cost analysis of the use of either the Xpert MTB Rif test or sputum smear microscopy in the diagnosis of pulmonary tuberculosis in Rio de Janeiro, Brazil

Abstract INTRODUCTION: The molecular test Xpert MTB/RIF (Xpert) has been recommended for use in the diagnosis of pulmonary tuberculosis (PTB); however, data on the cost of incorporating it under routine conditions in high-burden countries are scarce. The clinical impact and costs incurred in adopting the Xpert test in routine PTB diagnosis was evaluated in a prospective study conducted from November 2012 to November of 2013, in the City of Rio de Janeiro, Brazil. METHODS: The diagnostic and therapeutic cascade for TB treatment was evaluated using Xpert in the first stage (S1), and sputum smear microscopy (SSM) in the second stage (S2). The mean costs associated with each diagnostic test were calculated including equipment, human resources, supplies, and infrastructure. RESULTS: We included 232 subjects with probable TB (S1 = 87; S2 = 145). The sensitivities of Xpert and SSM were 91.7% (22/24) and 79.1% (34/43), respectively. The median time between triage and TB treatment initiation in S1 (n = 24) was 14.5 days (IQR 8-28.0) and in S2 (n = 43) it was 8 days [interquartile range (IQR) 6-12.0]. The estimated mean costs per examination in S1 and S2 were US$24.61 and US$6.98, respectively. CONCLUSIONS: Compared with SSM, Xpert test showed a greater sensitivity, but it also had a time delay with respect to treatment initiation and a higher mean cost per examination.

Tratamiento de esguince de tobillo grado II en adultos laboralmente activos: Inmovilización contra vendaje funcional / Grade II ankle sprain treatment in working adults: immobilization versus functional bandage

Resumen Introducción El esguince de tobillo es una patología frecuente y uno de los principales motivos de incapacidad laboral, a pesar de ello, no se cuenta con un tratamiento estandarizado y existe controversia con respecto a la inmovilización o una movilización temprana. Objetivo Determinar el mejor tratamiento para los esguinces de tobillo grado II, ofreciendo un resultado satisfactorio con periodos de incapacidad más cortos. Material y métodos Ensayo clínico-aleatorizado, ciego simple de enero a junio de 2016. Dos grupos: inmovilización y vendaje funcional. Se interrogó dolor inicial y al término del tratamiento con escala de EVA, ambos grupos con mismo manejo analgésico, antiinflamatorio y rehabilitación, se evaluó funcionalidad al mes del inicio del padecimiento con escala de Karlsson. Resultados Todos los pacientes con dolor inicial arriba de 70 (de moderado a severo), sin diferencia en media entre grupos (férula 86.3 ± 9.6 contra vendaje de 86.1 ± 8.5; p = 0.95), ambos con disminución del dolor; el grupo con vendaje obtuvo niveles más bajos (férula media 55.2 ± 15.5 contra vendaje 40.3 ± 12.8, p ≤ 0.001). Grupo con férula 24 (88.9%) al final calificaron su dolor como moderado y tres (11.1%) como leve contra el grupo con vendaje, de los cuales, 17 (73.1%) tuvieron dolor moderado y siete (26.9%) leve (p = 0.15). Conclusión El vendaje funcional es una excelente opción de manejo para esguince de tobillo grado II, ofrece buenos resultados con periodos de incapacidad y costos más reducidos.

Abstract Background The grade II ankle sprain it is one of the most frequent pathologies in the musculoskeletal system and one of the principal motives of laboral inability. Despite the fact this pathology is one of the most common reasons for ER visiting there is not a standard treatment for it, and exist controversy about the immobilization vs. an early mobilization. Objective Determine the best treatment for grade II ankle sprains, offering a satisfactory result with a minor time of labor inability. Material and methods Single-blind randomized controlled clinical trial with two groups immobilization versus functional bandage, both groups with VAS evaluation at the beginning and at the end of treatment, same AINES management and rehabilitation, 30 days after the injury we evaluate the functional outcome with Karlsson score. Results At the beginning all patients report pain over 70 (moderate-severe) without difference in the average of both groups (immobilization 86.3 ± 9.6 versus functional bandage treatment of 86.1 ± 8.5; p = 0.95). Both groups present less pain at the end of the treatment, the bandage group present lower values, (Immobilization average 55.2 ± 15.5 versus functional bandage treatment 40.3 ± 12.8, p ≤ 0.001). In the immobilization group 24 (88.9%) at the end of the treatment had moderate pain and 3 (11.1%) light pain against the functional treatment group where 17 (73.1%) had moderate pain and 7 (26.9%) light (p = 0.15). Conclusion Functional bandage is an excellent treatment option for grade II ankle sprain, offering good results with a lower time of inability and cost.

Oral mucosa: an alternative epidermic cell source to develop autologous dermal-epidermal substitutes from diabetic subjects

Abstract Oral mucosa has been highlighted as a suitable source of epidermal cells due to its intrinsic characteristics such as its higher proliferation rate and its obtainability. Diabetic ulcers have a worldwide prevalence that is variable (1%-11%), meanwhile treatment of this has been proven ineffective. Tissue-engineered skin plays an important role in wound care focusing on strategies such autologous dermal-epidermal substitutes. Objective The aim of this study was to obtain autologous dermal-epidermal skin substitutes from oral mucosa from diabetic subjects as a first step towards a possible clinical application for cases of diabetic foot. Material and Methods Oral mucosa was obtained from diabetic and healthy subjects (n=20 per group). Epidermal cells were isolated and cultured using autologous fibrin to develop dermal-epidermal in vitro substitutes by the air-liquid technique with autologous human serum as a supplement media. Substitutes were immunocharacterized with collagen IV and cytokeratin 5-14 as specific markers. A Student´s t- test was performed to assess the differences between both groups. Results It was possible to isolate epidermal cells from the oral mucosa of diabetic and healthy subjects and develop autologous dermal-epidermal skin substitutes using autologous serum as a supplement. Differences in the expression of specific markers were observed and the cytokeratin 5-14 expression was lower in the diabetic substitutes, and the collagen IV expression was higher in the diabetic substitutes when compared with the healthy group, showing a significant difference. Conclusion Cells from oral mucosa could be an alternative and less invasive source for skin substitutes and wound healing. A difference in collagen production of diabetic cells suggests diabetic substitutes could improve diabetic wound healing. More research is needed to determine the crosstalk between components of these skin substitutes and damaged tissues.

Mercury Exposure in a Riverside Amazon Population, Brazil: A Study of the Ototoxicity of Methylmercury

Introduction Mercury poisoning causes hearing loss in humans and animals. Acute and long-term exposures produce irreversible peripheral and central auditory system damage, and mercury in its various forms of presentation in the environment is ototoxic. Objective We investigated the otoacoustic emissions responses in a riverside population exposed to environmental mercury by analyzing the inhibitory effect of the medial olivocochlear system (MOCS) on transient otoacoustic emissions (TEOAE). Methods The purpose of the research was to evaluate the entire community independently of variables of sex and age. All of the participants were born and lived in a riverside community. After otolaryngologic evaluation, participants were received tympanometry, evaluation of contralateral acoustic reflexes, pure tone audiometry, and recording of TEOAEs with nonlinear click stimulation. Hair samples were collect to measure mercury levels. Results There was no significant correlation between the inhibitory effect of the MOCS, age, and the level of mercury in the hair. Conclusions The pathophysiological effects of chronic exposure may be subtle and nonspecific and can have a long period of latency; therefore, it will be important to monitor the effects of mercury exposure in the central auditory system of the Amazon population over time. Longitudinal studies should be performed to determine whether the inhibitory effect of the MOCS on otoacoustic emissions can be an evaluation method and diagnostic tool in populations exposed to mercury. .

Zumbido em uma população ribeirinha exposta ao metilmercúrio / Tinnitus in a riverside population exposed to methyl-mercury

Objetivo : Estudar a prevalência de zumbido, verificando se há associação entre a queixa desse sintoma e o teor de mercúrio e mensurar seu impacto na qualidade de vida. Métodos : Estudo seccional em toda a população do Lago do Puruzinho, localizada na margem esquerda do Rio Madeira, cidade de Humaitá, Estado do Amazonas, Brasil. Todos os residentes maiores de 18 anos, de ambos os gêneros, foram submetidos à anamnese, avaliação otorrinolaringológica e exame audiológico. Os indivíduos que apresentaram queixa de zumbido responderam à versão traduzida do questionário Tinnitus Handicap Inventory (THI). Também foram pesquisados os teores de mercúrio total no cabelo desses indivíduos. Resultados: Para análise dos resultados sobre a queixa de zumbido, os sujeitos foram divididos em dois grupos quanto à presença ou não de zumbido. O Grupo 1 foi composto por indivíduos que apresentaram queixa de zumbido e o Grupo 2, por indivíduos sem zumbido. Foi observado que 40% dos indivíduos apresentaram escores do THI compatíveis com handicap leve. A análise da associação da presença de zumbido com os teores de mercúrio total no cabelo mostrou que ambos os grupos apresentaram níveis elevados de mercúrio, porém não ocorreram diferenças entre os grupos. Conclusão : Um quarto dos ribeirinhos apresentou queixa de zumbido e exposição significativa ao mercúrio, mas não houve associação entre o zumbido e os níveis elevados de mercúrio. .

Purpose : To study the association between the prevalence of tinnitus and mercury exposure and measure the influence of tinnitus on the quality of life. Methods : We conducted a cross-sectional study of men and women aged above 18 years residing in the Lake Puruzinho region, which is located on the left bank of the Rio Madeira, Humaita city, Amazonas state, Brazil. All subjects underwent anamnesis, otorhinolaryngologic evaluation, and an audiology test. Individuals who experienced tinnitus completed the translated Tinnitus Handicap Inventory (THI). We also examined the levels of total mercury in the hair of these individuals. Results : To analyze the results regarding the prevalence of tinnitus, the subjects were divided into two groups according to the presence or absence of tinnitus. Group 1 was composed of subjects with tinnitus and Group 2 was composed of subjects without tinnitus. Consequently, 40% of individuals had scores consistent with mild handicap according to the THI. The analysis of the association between tinnitus and levels of total mercury in hair samples showed that both groups had high levels of mercury. However, this finding was not significantly different between groups. Conclusion : Herein, 25% of the subjects complained of tinnitus and significant exposure to mercury; however, there was no association between the prevalence of tinnitus and high levels of mercury. .

Consulta ginecológica sob a ótica de estudantes do ensino médio do Rio de Janeiro, RJ / High school students' opinions of gynecological consultations in Rio de Janeiro, Southeastern Brazil / Consulta ginecológica bajo la óptica de estudiantes de educación secundaria en Rio de Janeiro, RJ

OBJETIVO: Analisar diferenças socioculturais e percepções sobre a consulta ginecológica por adolescentes. MÉTODOS: Estudo transversal com 418 alunas do ensino médio de três escolas de diferentes perfis, localizadas na cidade do Rio de Janeiro, RJ, em 2010. Aplicou-se questionário estruturado, abordando características sociodemográficas, comportamento sexual e avaliação da consulta ginecológica. Utilizou-se o teste de Qui-quadrado (Yates) e o t de Student, adotando-se p < 0,05. RESULTADOS: Alunas dos colégios privado e público apresentaram perfis semelhantes e diferiram daquelas da rede pública estadual que tiveram nível socioeconômico mais baixo, menor escolaridade dos responsáveis, predominância da raça negra, maior número de parceiros, gestações e histórico de violência sexual. As médias de idades da menarca e sexarca foram semelhantes entre as estudantes e a primeira consulta ginecológica foi significativamente mais tardia nas alunas da rede estadual. A maioria referiu conhecimento sobre anticoncepção e doenças sexualmente transmissíveis, porém pequena parte obteve essas orientações na consulta. As estudantes manifestaram desejo de que o profissional investisse mais tempo, paciência e disponibilidade no atendimento. CONCLUSÕES: O atendimento ginecológico na adolescência é insatisfatório segundo a avaliação das adolescentes estudadas. As usuárias dos serviços privados submetem-se à consulta ginecológica em idade mais precoce do que aquelas que têm acesso apenas à rede pública. É necessário criar mecanismos que facilitem o acesso e a adesão desse grupo etário à rotina preventiva ginecológica.

OBJECTIVE: To analyze sociocultural differences and perceptions of gynecological consultations for high school girls. METHODS: A transversal study with 418 high school girls from three schools of different profiles in the city of Rio de Janeiro, Southeastern Brazil in 2010. A structured questionnaire encompassing socio-demographic characteristics, sexual behavior and evaluation of gynecological consultations was completed. Yates' Chi-square test and the Student's t-test were utilized adopting a value of p < 0.05. RESULTS: The students of private and federal public schools presented similar profiles but both were different from the state school girls. The latter had lower socioeconomic status, and their parents had lower levels of education, the predominance of afro-descendants was observed, as were a larger number of sexual partners, pregnancy and cases of sexual violence. The average age of menarche and sexarche among the students were similar, but the first gynecological consultation was significantly later among the state school students. The majority showed some knowledge of contraception and STDs, although only a minority received guidance from the consultations. Students expressed the desire that the professionals dedicate more time, patience and availability to them during consultations. CONCLUSIONS: The provision of gynecological services for teenagers is not satisfactory, according to the teenagers' evaluations. Users of the private health system have gynecological consultations earlier than those who only have access to the public system. It is necessary to create mechanisms that facilitate access and adhesion to a routine of gynecological prevention for this age group.

OBJETIVO: Analizar diferencias socioculturales y percepciones sobre la consulta ginecológica en adolescentes. MÉTODOS: Estudio transversal con 418 alumnas de educación secundaria de tres escuelas con diferentes perfiles, localizadas en la ciudad de Rio de Janeiro, RJ, en 2010. Se aplicó cuestionario estructurado, abordando características sociodemográficas, comportamiento sexual y evaluación de la consulta ginecológica. Se utilizó la prueba de Chi-cuadrado (Yates) y el t de Student, adoptándose un p<0,05. RESULTADOS: Alumnas de los colegios privado y público presentaron perfiles semejantes y se diferenciaron de las que estudian en la red pública estatal quienes presentaron nivel socioeconómico más bajo, menor escolaridad de los representantes, predominancia de raza negra, mayor número de parejas, gestaciones e historia de violencia sexual. El promedio de edades de las menarca y sexarca fueron semejantes entre las estudiantes y la primera consulta ginecológica fue significativamente más tardía en las alumnas de la red estatal. La mayoría mencionó tener conocimiento sobre la anticoncepción y enfermedades transmitidas sexualmente, sin embargo, un pequeño número tuvo esas orientaciones en la consulta. Las estudiantes manifestaron interés por disponer de más tiempo, paciencia y atención por parte del profesional. CONCLUSIONES: La atención ginecológica en la adolescencia es insatisfactoria de acuerdo con la evaluación en las adolescentes estudiadas. Las usuarias de los servicios privados acuden a la consulta ginecológica en edad más precoz que las que tienen acceso a la red pública. Es necesario crear mecanismos que faciliten el acceso y la adhesión de ese grupo etario a la rutina preventiva ginecológica.

Diagnóstico precoce de surtos de Infecção Hospitalar: Um método simples de séries temporais e avaliação de qualidade dos serviços ambulatoriais / Early detection of Hospital Infection Outbreak: a simple time series model and outpatient health quality control

O estudo das infecções nosocomiais é extremamente complexo, envolvendo diversas áreas do conhecimento. O sistema NISS (National Infection Surveillance System, desenvolvido pelo Centro de Controle de Doenças de Atlanta – CDC, EUA) atualmente National Healthcare Safety Network (NHSN), apesar de introduzir uma padronização nos dados das Infecções Hospitalares (IH), não consegue resolver a questão da detecção de surtos. O diagrama de controle exponencial com média móvel (EWMA) foi utilizado em séries de dados do Hospital Federal de Bonsucesso com o objetivo de predizer o número ou taxa de IH para diagnosticar surtos o mais precocemente possível. A exclusão de surtos anteriores permitiu que o EWMA detectasse precocemente 100 porcento dos surtos num período de 12 anos. Desde 1988, com a criação do Sistema Único de Saúde (SUS), a atenção médica no Brasil vem apresentando aumento de cobertura,. todavia, isto não implica necessariamente que estes sejam efetivos e eficientes. A necessidade premente de se estabelecer métodos pelos quais estes serviços possam ser avaliados de forma rotineira, a nível local, motivou o estudo de uma amostra aleatória de 1262 prontuários, totalizando 2865 consultas, obtida de uma Unidade Mista situada no Rio de Janeiro, entre setembro de 2005 e setembro de 2006. Dados relativos à primeira consulta, bem como aquelas imediatamente posteriores (com até um ano de observação para cada paciente) foram analisados. A proporção média de exame físico por consulta foi de 0,28 +/- 0,36 para pacientes hipertensos, 0,28 +/- 0,34 para os diabéticos e de 0,23 +/- 0,35 para as demais doenças crônicas não transmissíveis (DCNT), indicando que um paciente portador de qualquer uma destas condições necessitava de 3 a 4 consultas, em média, para que um exame físico ou laboratorial fosse realizado...

Preventing health-care associated infections (HAIs) is extremely complex, gathering avariety of health sciences. The National Nosocomial Infection Surveillance System (NISSCDC) has changed over the years but remains active as the National Healthcare SafetyNetwork (NHSN), allows physicians to standardize hospital infection data. Albeit NHSNintroduces essential knowledge for nosocomial infection control, outbreak detectionremains an important issue yet to be solved. This study uses exponentially weightedmoving average (EWMA) to readily detect outbreaks in hospital settings. Our data showsthat a slightly modified EWMA (i.e. eliminating previous outbreaks from our data source)was able to ascertain all (100 percent) existing outbreaks in a twelve-year period.Although an important issue for surveillance is based on rapid detection of an outbreak (orepidemic), solving the outbreak itself is the sole reason for surveillance.Since 1988, when all public health in Brazil was gathered in SUS (Sistema Único deSaúde), healthcare coverage has dramatically increased throughout the country. However,the existence of medical coverage does not necessarily imply that medical services areeffective or even efficient, which requires a constant routine to curb these medical services,especially at the local levels (small health units).A random sample of 1,262 outpatients charts (totaling 2,865 medical visits), was drawnfrom a Health Clinic (Outpatient and Emergency wards) in Rio de Janeiro, betweenSeptember 2005 and September 2006. Data regarding first and subsequent visits (up to oneyear for each patient) were gathered.The proportion of physical exams for each visit was 0.28 +/- 0.36 (Hypertension), 0.28 +/-0.34 (Diabetes) and 0.23 +/- 0.35 (Other chronic diseases). In other words, a patient afflictedwith any of the above conditions will need about three or four visits to a physician, before aphysical or laboratory exam is performed...