Guidelines on management of human infection with the novel virus influenza A (H1N1): a report from the Hospital das Clínicas of the University of São Paulo

The pandemic novel influenza A (H1N1) infection was considered widespread in Brazil on July, 2009. Since then, 9.249 cases were confirmed in Brazil, most of them concentrated in São Paulo. The Hospital das Clínicas of the University of São Paulo is a reference center for H1N1 cases in São Paulo. The purpose of this review is to analyze the evidence concerning diagnosis, prevention, and treatment of novel influenza A (H1N1) infection. In addition, we propose guidelines for the management of this pandemic emphasizing Hospital das Clínicas "bundles" for the control of the pandemic novel influenza A (H1N1).

Epidemiology of human infection with the novel virus influenza A (H1H1) in the Hospital das Clínicas, São Paulo, Brazil - june-september 2009

The pandemic novel influenza A (H1N1) infection was considered widespread in Brazil on July 16, 2009. Since then, 46,810 cases of acute respiratory syndrome have been reported in Brazil, most of them concentrated in São Paulo. Through September 16, we have confirmed 9,249 cases of novel influenza A H1N1in Brazil, including 699 deaths. The mortality rate observed in Brazil is 0.47/100,000 inhabitants and varies according to region. In this period, São Paulo registered 3733 cases (40.3 percent of the total) of novel influenza A (H1N1) infection and 327 deaths, reflecting a mortality rate of 0.79/100,000 inhabitants. The Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC) is a reference center for H1N1 cases in São Paulo. During the winter of 2009, 472 patients in this hospital were diagnosed with H1N1 infection; of these, 210 were admitted, and 16 died. To control this pandemic and to provide adequate care for these patients, the Hospital das Clínicas implemented "bundles" including prevention strategies, an epidemiologic surveillance service, availability of fast diagnosis, antiviral treatment and training of staff. The purpose of this manuscript is to describe the epidemiologic features of novel human influenza A (H1N1) infection in the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo during the winter period of the 2009 pandemic.

Do registro ao indicador: gestão da produção da informação assistencial nos hospitais / From records to indicators: the management of health care information production in hospitals

A valorização da utilização de indicadores assistenciais no monitoramento do desempenho dos sistemas de serviços de saúde cresceu de forma significativa nas últimas décadas. A expansão do Sistema Unico de Saúde/SUS e do Sistema de Saúde Suplementar, e as formas de gestão adotadas estimularam o uso de indicadores na avaliação do desempenho, qualidade e segurança nos hospitais, sendo propostos sistemas de indicadores. Não houve uma correspondente preocupação com as condições de produção dos dados e informações para esses indicadores nos serviços de saúde. O artigo discute algumas das condições necessárias para a qualidade nos indicadores para a gestão da assistência nos hospitais: uma cultura de valorização da informação clínica, administrativa e de pesquisa, compartilhada por todos, e a adequada gestão dos registros clínicos, estatísticas hospitalares e sistemas de informações hospitalares. Não existem propostas prontas para a gestão da informação nos hospitais, fazendo-se necessário desenvolver uma capacidade institucional de incorporar e utilizar, na forma mais adequada para cada instituição e contexto, competências e recursos materiais e humanos diversificados, para que a gestão da informação se transforme em um processo dinâmico e parte da gestão do serviço como um todo.

Utilization of health care indicators in the monitoring of health system performance has become increasingly important in the last decades. The expansion of the public National Health System, Sistema Unico de Saúde/SUS, growth of the private health sector and implementation of specific types of health care regulation models stimulated the utilization of indicators in the evaluation of hospital care quality and performance and proposals of national indicator systems. This was not accompanied with a corresponding investment in the conditions in which the needed data and information are produced in health services. The objective of this article is to identify some of the necessary conditions for health care performance indicator quality in hospitals: a pervasive institutional culture favoring clinical, administrative and research information and adequate organization and administration of clinical registers, hospital statistics and hospital information systems. No ready made universal hospital information packages will be able to achieve this, and each institution has to develop the ability to incorporate and use, according to specific needs and contexts, capabilities and material and human resources that will turn information management into a dynamic process and part of hospital management in general.

Fatores associados à realização de exames preventivos para câncer nas mulheres brasileiras, PNAD 2003 / Factors associated to the performance of preventive cancer exams in Brazilian women, PNAD 2003

Estudar fatores associados à realização dos exames Papanicolaou e mamografia por mulheres brasileiras. Foram analisadas informações sobre mulheres com 25 anos ou mais, no suplemento Saúde da Pesquisa Nacional de Amostras Domiciliares (PNAD) do IBGE 2003, de realização de Papanicolaou nos últimos 5 anos e mamografia nos últimos 2 anos, sua prevalência por variáveis demográficas, socioeconômicas e saúde, acesso e utilização de serviços de saúde. Foram realizadas análise estatística bivariada e regressão logística para os dois procedimentos. A prevalência para Papanicolaou foi 75,5 por cento e mamografia 36,1 por cento. A regressão logística mostrou como principais fatores preditivos para Papanicolaou: ter filhos, consulta médica no último ano, renda elevada, médio a alto grau de escolaridade, ter plano de saúde e morar em zona urbana. Para mamografia mostraram-se fatores preditivos importantes: distribuição etária (40-59 anos), consulta médica no último ano, morar em zona urbana, renda elevada e ter plano de saúde. No Papanicolaou há maior incorporação na assistência, e o acesso à consulta médica fator essencial para a realização do exame. Na mamografia, a prevalência é mais elevada nas faixas etárias recomendadas, perfil diferenciado por acesso à consulta médica e condição socioeconômica, e muitos exames em mulheres em faixas etárias não recomendadas.

To study factors associated to prevalence of Papanicolaou and mammography, in Brazilian women. We analyzed information for women 25 years and more in Brazilian National Household Sample Survey (PNAD) of IBGE in 2003 for Papanicolaou in the last 5 years and mammography in the last 2 years, and their prevalence according to demographic, socioeconomic and health, access and health services utilization variables. Bivariate and logistic regression statistical analysis were performed. Papanicolaou exams prevalence was 75.5 percent and mammography 36.1 percent. Logistic regression indicated as the main predictive factors for Papanicolaou: having children, medical consultation in previous year, high income, medium to high schooling, private health care plan and living in an urban zone. For mammography the important predictive factors were age (40-59 years), medical consultation in previous year, living in an urban zone, high income and private health care plan. The results for Papanicolaou showed significant presence in care of the public health system, and access to medical consultation as essential. For mammography prevalence was higher for the recommended ages, and a very different prevalence profile according to access to medical consultation and socioeconomic condition. Large number of exams were made by women in not recommended ages.

Informação e gestão em saúde: diretrizes clínicas e monitoramento de programa de atenção ao câncer de mama / Information and health management: clinical guidelines and monitoring of assistance programs for breast cancer

Para desenvolver um modelo de monitoramento de programa de câncer de mama foram selecionadas e avaliadas, com instrumento validado internacionalmente, as diretrizes clínicas disponíveis na literatura. Procedeu-se à seleção e análise das diretrizes para câncer de mama identificadas na literatura nacional e internacional desenvolvidas por instâncias governamentais e/ou sociedades de especialistas de abrangência nacional. As principais diferenças encontradas entre as diretrizes foram na dimensão do instrumento relacionada ao rigor e desenvolvimento e a aplicabilidade das diretrizes. A partir da síntese dos parâmetros propostos nas diretrizes com maior validade, elaborou-se roteiro de revisão dos casos de câncer de mama, destinado a acompanhar as principais características da atenção dirigidas a pacientes portadores de câncer de mama, como instrumento de auditoria da qualidade. /Published guidelines for breast cancer care were reviewed to develop a monitoring model for breast cancer assistance programs. Guidelines supported by government programs or national societies of specialists were selected and analyzed using an internationally validated instrument. Variations among selected guidelines were mainly due to differences on quality domains rigor of development and applicability. Those with a better validation score had parameters included in a clinical audit form and minimum data set for assessing the main features of breast cancer assistance measuring the quality of care. Data on breast cancer assistance was extracted from the State of São Paulo (Brazil) health care system database for the years 2001 and 2002 using indicator indexes included on guidelines or supported by evidence. A guideline–based monitoring model was developed for hospital use and applied on the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo database for the years 2000 and 2001. The following hospital information systems were searched for breast cancer cases...

Clinical and epidemiological features of AIDS/tuberculosis comorbidity

Considering the relevance of AIDS/tuberculosis comorbidity worldwide, especially in Brazil, this study was developed to describe the clinical and epidemiological features of the comorbid cases identified from 1989 to 1997 by the epidemiology service of the Hospital das Clínicas of the Universidade de Säo Paulo. METHODS: Databases containing information on all identified AIDS/tuberculosis cases cared for at the hospital were used to gather information on comorbid cases. RESULTS: During the period, 559 patients were identified as presenting with AIDS/tuberculosis comorbidity. Risk behavior for AIDS was primarily heterosexual contact (38.9 percent), followed by intravenous drug use (29.3 percent) and homosexual/bisexual contact (23.2 percent). Regarding clinical features, there were higher rates of extrapulmonary tuberculosis when compared to tuberculosis without comorbidity. There was an increase in reporting of AIDS by ambulatory units during the period. Epidemiologically, there was a decrease in the male/female ratio, a predominance in the 20 to 39 year-old age group, and a majority of individuals who had less than 8 years of schooling and had low professional qualifications. CONCLUSIONS: High rates of AIDS/tuberculosis cases at our hospital indicate the need for better attention towards early detection of tuberculosis, especially in its extrapulmonary form. Since the population that attends this hospital tends to be of a lower socioeconomic status, better management of AIDS and tuberculosis is required to increase the rates of treatment adherence and thus lower the social costs

Avaliação dos sintomaticos respiratórios no Pronto-Socorro do Hospital das Clinicas da FMUSP: baixo indice de suspeita de tuberculose pulmonar / Evaluation of respiratory symptoms in the emergency department of Hospital das Clinicas da FMUSP: low clinical suscicion of tuberculosis

Pela importancia do diagnostico precoce da tuberculose pulmonar, a Organizacao Mundial de Saude (OMS) preconiza a investigacao de ...

Municipalização da vigilância epidemiológica: uma proposta em construçäo / The municipalization of epidemiologic surveillance: a proposal

Apresenta aspectos do processo de municipalizaçäo das atividades de vigilância epidemiológica no Estado de Säo Paulo, os entraves que o Sistema de Vigilância Epidemiológica tem na sua estrutura que dificultam a efetiva inclusäo destas atividades pelos municípios e quais as perspectivas existentes para sua superaçäo