Aspectos clínico-epidemiológicos de pacientes con tuberculosis, Guantánamo 2013-2018

Introducción: A pesar de los esfuerzos de la ciencia para la eliminación de la tuberculosis, esta es considerada actualmente una enfermedad reemergente. En provincia Guantánamo no se encontraron investigaciones referida a este tema. Objetivo: Describir los aspectos clínico-epidemiológicos de pacientes con tuberculosis en el periodo comprendido de 2013-2018 en la provincia de Guantánamo. Método: Se realizó un estudio descriptivo, transversal retrospectivo de pacientes con tuberculosis. El universo de estudio quedó constituido por 103 pacientes (N꓿103) constatados en la base de datos del programa Centro Provincial de Higiene, Epidemiología y Microbiología Guantánamo. Las variables estudiadas fueron: edad, sexo, grupo de riesgo, municipio al que pertenece y formas clínicas. Se utilizó como medida de resumen la frecuencia absoluta y relativa. Resultados: El mayor número de pacientes con tuberculosis se encontró en el grupo de 40-49 años (28,16 %), se destacó el grupo de 50-59 del sexo masculino con un 15,53 %. El municipio que más casos aportó fue el de Guantánamo con 67 (65,04 %), seguido de Jamaica con 10 casos (9,70 %). De los pacientes diagnosticados: 43 fueron fumadores (50,0 %), 19 alcohólicos (22,10 %) y 11 desnutridos (12,79 %). Se obtuvo como resultado que 72 pacientes (69,90 %) presentaron la forma pulmonar y 31 (30,10 %) presentaron la forma extrapulmonar. Conclusiones: A pesar de una adecuada red de diagnóstico, tratamiento y seguimiento de la tuberculosis en la provincia de Guantánamo, existen condiciones que determinan la ocurrencia de esta: factores socioeconómicos, sanitarios e individuales inadecuados, hacinamiento, desnutrición, alcoholismo, predisponen a la enfermedad.

Introduction: Despite the scientific efforts to eliminate tuberculosis, it is currently considered as a reemerging disease. In Guantánamo province, no research closely related to the subject was found. Objective: To describe the clinical-epidemiologic aspects of patients with tuberculosis in Guantánamo province, period 2013-2018. Method: A descriptive, retrospective cross-sectional study of patients with tuberculosis was carried out. The study involved a total of 103 patients (N꓿103) recorded in a database manages at the Centro Provincial de Higiene, Epidemiología y Microbiología of Guantánamo. The variables studied were as follow: age, sex, risk group, municipality to which patients belong and, clinical forms. The absolute and relative frequencies were used as summary statistics method. Results: The highest number of patients with tuberculosis was found in 40 to 49 years age group (28.16%), and the male sex stood out in the group of age 50 to 59 (15.53%). The municipality with the highest number of cases was Guantánamo with 67 patients (65.04%), followed by Jamaica municipality with 10 patients (9.70%). Forty three of all the patients diagnosed with tuberculosis (50,0%) were addicted to smoking, 19 (22,10%) addicted to alcohol, and 11 (12,79%) in malnutrition state. As a result in the study, it was found in 72 patients (69.90%) presence of pulmonary tuberculosis and extrapulmonary tuberculosis in 31 active patients (30.10%). Conclusions: Despite of an adequate network of diagnosis, treatment and tuberculosis follow-up in the province of Guantánamo, there are several factors that determine the presence of the disease: for instance, the inadequate use of socioeconomic, sanitary and individual factors, including also aspects like overcrowding, malnutrition, and alcoholism.

Introdução: Apesar dos esforços da ciência para eliminar a tuberculose, atualmente é considerada uma doença reemergente. Na província de Guantánamo, não foram encontradas investigações relacionadas a este tema. Objetivo: Descrever os aspectos clínico-epidemiológicos de pacientes com tuberculose no período de 2013-2018 na província de Guantánamo. Método: Estudo descritivo, retrospectivo e transversal de pacientes com tuberculose. O universo do estudo foi composto por 103 pacientes (nº 103) encontrados no banco de dados do programa Centro Provincial de Higiene, Epidemiologia e Microbiologia de Guantánamo. As variáveis estudadas foram: idade, sexo, grupo de risco, município a que pertence e formas clínicas. Frequência absoluta e relativa foram usadas como medida sumária. Resultados: O maior número de doentes com tuberculose foi encontrado na faixa etária de 40 a 49 anos (28,16%), destacando-se a faixa de 50 a 59 anos do sexo masculino com 15,53%. O município que mais contribuiu com casos foi Guantánamo com 67 (65,04%), seguido de Jamaica com 10 casos (9,70%). Dos pacientes diagnosticados: 43 eram tabagistas (50,0%), 19 etilistas (22,10%) e 11 desnutridos (12,79%). Obteve-se como resultado que 72 pacientes (69,90%) apresentavam a forma pulmonar e 31 (30,10%) apresentavam a forma extrapulmonar. Conclusões: Apesar de uma rede adequada para o diagnóstico, tratamento e monitoramento da tuberculose na província de Guantánamo, existem condições que determinam sua ocorrência: fatores socioeconômicos, de saúde e individuais inadequados, superlotação, desnutrição, alcoolismo, predispõem à doença.

Pattern Of Infections In Custodial Deaths � A Forensic Autopsy Study

Background: In a country like India, the prisoner cells are not well structured. For instance prisons are known to be a high risk environment for infections like tuberculosis (TB), HIV, HCV, HBV etc. due to overcrowding, low levels of nutrition, poor infection control and lack of accessible healthcare services. This study is an effort to know about the pattern of infections in custodial death cases detected during post mortem examination. Aims and Objectives: To determine the common infections and to know the mortality caused by infections among prisoners in custody, people in police custody and mentally ill patients in mental health institute in Punjab.Methods:This cross sectional study of 100 cases of custodial deaths from 1st Jan 2019 to 4thMay 2021, was carried out in the Forensic Medicine department in collaboration with department of Microbiology, Govt. Medical College, Amritsar.Results:Klebsiella Pneumoniae (37.5%) is more common in age group of 10-30 years while Staphylococcus Aureus (35.9%) infection was more common in the age group of 31 to 50 years. Incidence of positive growth of infections was slightly more in female inmates (76.9%) as compared to the males (75.9%). Inmates from urban area background showed more growth of Staphylococcus Aureus (35.7%) than from rural area background(25%).Conclusions:Timely medical diagnosis and treatment of each prisoner with availability of good doctors are the important issues relating to the healthcare of the individuals in custody.

Modelado dinámico del fenómeno criminal en Colombia para la toma de decisiones de política pública / Dynamic modeling of the criminal phenomenon in Colombia for public policy decision making / Modelagem dinâmica do fenômeno criminoso na Colômbia para decisões de política pública

El presente artículo se originó en la necesidad de entender el crimen como una problemática pública, que debe ser analizada a partir de una hipótesis causal que explique el fenómeno delictivo en Colombia con una perspectiva social con diferentes enfoques teóricos, con el fin de establecer líneas de acción para la toma de decisiones de política pública que contribuyan a su reducción. En la primera parte, se presenta la hipótesis causal propuesta y se desarrollan cada uno de sus componentes. Posteriormente, se desarrolla un análisis descriptivo de las denuncias por tipo de delito y de la población privada de la libertad, en la que se identifica las diferencias y las similitudes en las condiciones socioeconómicas para los delitos de mayor incidencia. Por último, se desarrolla un modelo de simulación continua y se analiza el resultado de posibles estrategias de política pública. El resultado obtenido reflejó la necesidad de diseñar políticas públicas pluralistas, que apunten a la solucionar las causas de raíz del fenómeno del crimen, en torno a la construcción social y a la reducción de la impunidad.

This article arose from the need to understand crime as a public problem, which should be analyzed on the basis of a causal hypothesis that explains the criminal phenomenon in Colombia from a social perspective with different theoretical approaches, in order to establish lines of action for public policy decisions that contribute to its reduction. In the first part, the proposed causal hypothesis is presented and each of its components is developed. Subsequently, a descriptive analysis of the reports by type of crime and of the population deprived of liberty is developed, identifying the differences and similarities in the socioeconomic conditions for the crimes with the highest incidence. Finally, a continuous simulation model is developed and the result of possible public policy strategies is analyzed. The result obtained reflected the need to design pluralistic public policies aimed at solving the root causes of the crime phenomenon, in terms of social construction and the reduction of impunity.

Este artigo surgiu da necessidade de entender o crime como um problema público, que deve ser analisado com base em uma hipótese causal que explique o fenômeno criminoso na Colômbia a partir de uma perspectiva social com diferentes abordagens teóricas, a fim de estabelecer linhas de ação para decisões de política pública que contribuam para sua redução. Na primeira parte, é apresentada a hipótese causal proposta e cada um de seus componentes é desenvolvido. Posteriormente, é desenvolvida uma análise descritiva dos relatórios por tipo de crime e da população privada de liberdade, identificando as diferenças e semelhanças nas condições sócio-econômicas para os crimes mais comuns. Finalmente, um modelo de simulação contínua é desenvolvido e o resultado de possíveis estratégias de políticas públicas é analisado. O resultado obtido reflete a necessidade de elaborar políticas públicas pluralistas que visem resolver as causas profundas do fenômeno do crime, em termos de construção social e de redução da impunidade.

Practice of relieving emergency overcrowding in Peking Union Medical College Hospital / 中华医院管理杂志

Peking Union Medical College Hospital, as one of the most stressful medical institutions in China, is facing the problem of emergency department overcrowding. In order to effectively alleviate the emergency overcrowding, improve the medical quality and patients′ medical experience, the hospital firmly grasped the two incremental links of " throughput" and " output" factors, established a multidisciplinary and multi-department cooperation team, constructed a close medical alliance cooperation mode, and innovated and explored a harmonious emergency overcrowding relief mode with the goal of unblocking the " exit" of patients. The practice showed that the comprehensive measures could effectively alleviate the problem of emergency overcrowding, and improve the medical environment and medical quality.

Efectividad de la política criminal colombiana hacia la prevención del delito / The Colombian Criminal Policy's Effectiveness Preventing Crime / Eficácia da política criminal colombiana para a prevenção do crime

Resumen El presente artículo desarrolla un análisis descriptivo cuantitativo sobre el desempeño del sistema a través del cual el Gobierno Colombiano implementa su política pública criminal: sistema judicial, penal y penitenciario. Este estudio no se realiza desde el punto de vista del derecho, sino desde la perspectiva de la evaluación de su efectividad, entendiendo la criminalidad como un problema social. El impacto de este artículo radica en la posibilidad de entender y abordar el fenómeno de la criminalidad desde un enfoque preventivo. Esto, al identificar un desequilibrio dinámico de los componentes del sistema que refuerza el problema, evidenciando deficiencias en la finalidad de la política criminal como política pública debería propender por la prevención del crimen y por el contrario refuerza un ciclo vicioso que incrementa impunidad. Este ciclo ha desgastado operativamente al Estado y ha generado un alto costo como resultado de los altos índices de criminalidad.

Abstract This article performs a descriptive, quantitative analysis of the performance of the system through which the Colombian Government implements its criminal public policy: judicial, criminal justice and penitentiary systems. This study is not performed from the point of view of law, but from a perspective evaluating its effectiveness, considering crime a social issue. This article impacts the possibility of understanding and facing the phenomenon of crime from a preventive approach. This, upon identifying a dynamic imbalance of the system's components, which strengthens the problem, shows deficiencies in the purpose of criminal policy as a public policy that promotes prevention and emphasizes a vicious cycle that increases impunity. This cycle has operationally worn-out the Government and has generated high costs as a result of high crime indices.

Resumo Este artigo desenvolve uma análise descritiva quantitativa sobre o desempenho do sistema por meio do qual o Governo colombiano implementa sua política pública criminal: sistema judicial, penal e penitenciário. Este estudo não é realizado do ponto de vista do direito, mas da perspectiva de avaliar sua eficácia, entendendo o crime como problema social. O impacto deste artigo reside na possibilidade de compreender e abordar o fenómeno do crime a partir de uma abordagem preventiva. Isto, ao identificar um desequilíbrio dinâmico dos componentes do sistema que reforça o problema, mostra deficiências na finalidade da política criminal como política pública que visa à prevenção e acentua um ciclo vicioso que aumenta a impunidade. Este ciclo desgastou operacionalmente o Estado e gerou um custo elevado em decorrência dos altos índices de criminalidade.

Factores de riesgo de Bronquiolitis en pacientes menores de 2 años

Resumen Introducción: Se estima que a nivel mundial, cada año alrededor del 10% de los lactantes tienen bronquiolitis. Se produce un pico entre los 2 y los 6 meses de edad. Objetivo: Determinar los factores de riesgo de bronquiolitis en menores de dos años que consultaron al servicio de Pediatría del Instituto de Medicina Tropical entre el 2018 y 2019. Método: Estudio de tipo descriptivo, transversal en el que se incluyeron pacientes menores de 2 años internados en el Servicio de Pediatría del Instituto de Medicina Tropical de enero de 2018 a febrero de 2019 con diagnóstico de bronquiolitis en el que se analizaron los factores de riesgo de la enfermedad. Resultados: Se estudió una población de 38 pacientes que presentaron bronquiolitis antes de los 2 años, 19 fueron niños (50%) La edad media al ingreso fue de 3,5 ± 2,8 meses (límites, 1-10 meses). No se han encontrado datos de tabaco en el embarazo. Se detectó VRS en el aspirado nasofaríngeo de 8 niños (21%), la detección viral fue negativa en 14 niños (37%) y no se realizó la determinación en 18 casos (47%). Los siguientes factores de riesgo se asociaron de forma independiente con la bronquiolitis: Asma de los padres, infección por VSR, sibilancia, cianosis y hacinamiento. Los factores de riesgo estudiado, exposición al tabaco, sexo, edad en el momento de la bronquiolitis o lactancia materna exclusiva, no se asociaron con el ingreso a UTI de los pacientes con bronquiolitis. Conclusión: Hemos encontrado factores de riesgo asociado relacionados al huésped como asma de los padres, y otros como sibilancia, cianosis, hacinamiento e infección por VRS.

Abstract Introduction: It is estimated that globally, each year around 10% of infants have bronchiolitis. A peak occurs between 2 and 6 months of age Objective: To determine the risk factors of bronchiolitis in children less than two years of age who admitted at the pediatric service of the Institute of Tropical Medicine between 2017 and 2019 Method: A descriptive, cross-sectional study in which patients under 2 years of age admitted to the Pediatric Service of the Institute of Tropical Medicine from January 2018 to February 2019 were included with a diagnosis of bronchiolitis in which the risk factors of the disease were analyzed. Results: We studied a population of 38 patients who presented bronchiolitis before 2 years, 19 were children (50%) The average age at admission was 3.5 ± 2.8 months (range, 1-10 months). No tobacco data were found in pregnancy. RSV was detected in the nasopharyngeal aspirate of 8 children (21%), viral detection was negative in 14 children (37%) and the determination was not made in 18 cases (47%). The following risk factors were independently associated with bronchiolitis: Asthma of the parents, RSV infection, wheezing, cyanosis and overcrowding. The risk factors studied exposure to tobacco, sex, age at the time of bronchiolitis or exclusive breastfeeding were not associated with admission to the ICU of patients with bronchiolitis. Conclusion: We have found associated risk factors related to the host such as asthma of the parents, and others such as wheezing, cyanosis, overcrowding and RSV infection.

Saturación y hacinamiento del servicio de emergencia de un hospital urbano / Saturation And Overcrowding Of The Emergency Service Of An Urban Hospital

Introducción: La saturación y hacinamiento de pacientes son un problema en el servicio de emergencia. Objetivo: Describir las características de la demanda de atención médica al servicio de emergencia de un hospital terciario de la seguridad social y evaluar su hacinamiento. Métodos: Estudio observacional realizado en el hospital Rebagliati, primer trimestre 2019. Se evaluaron variables sociodemográficas, de tiempo e indicadores de emergencia del sistema estadístico institucional. Se realizó estadística descriptiva con IBM SPSS 24.00. Resultados: 51294 atenciones en pacientes entre 14 y 102 años (mediana 60), 56,7% de sexo femenino. 18% registró más de una atención en el trimestre. El día de mayor demanda fue el lunes y el horario entre 08 y 13 horas. Las atenciones de prioridad III y IV fueron el 83,5% del total. En los tópicos de medicina y de alivio se realizaron el 63% de atenciones. En unidad de trauma-shock se realizaron el 3% de las atenciones. Se admitieron en las salas de observación el 13% de las atenciones de emergencia. Los diagnósticos más frecuentes fueron insuficiencia respiratoria, infecciones y accidentes cerebrovasculares. El 88% de las admisiones se realizaron en salas comunes con una estancia entre 4,4 y 7,0 días. Falleció el 0,8% de los atendidos, se realizó intervención quirúrgica en el 0,7% y se transfirió a otro establecimiento al 0,1% respectivamente. Conclusión: La demanda al servicio de emergencia es principalmente por problemas médicos (de prioridad 3 y 4), predominando pacientes adultos mayores y de sexo femenino. Se admitió al 13% de los atendidos con estancia prolongada, baja mortalidad, muy pocas transferencias y alta tasa de retorno

Introduction: The saturation and overcrowding of patients are problem in the emergency service. Objective: To describe the characteristics of the demand for medical attention to the emergency service of an urban hospital and to assess its overcrowding. Methods: Observational study carried out at the Rebagliati hospital, first quarter 2019. Sociodemographic variables, time and emergency indicators of the institutional statistical system were evaluated. Descriptive statistics were performed with IBM SPSS 24. Results: Of 5,1244 attentions in patients between 14 and 102 years (median 60), 56.7% were female. 18% recorded more than one service in the quarter. The day of greatest demand was Monday and the hours between 08 and 13 hours. Priority care III and IV were 83.5% of the total. In the topics of medicine and relief, 63% of care was performed. In the trauma-shock unit, 3% of the care was performed. 13% of emergency care were admitted to observation rooms. The most frequent diagnoses were respiratory failure, infections and strokes. 88% of admissions were made in common rooms with a stay between 4.4 and 7.0 days. 0.8% of those seen died, surgery was performed in 0.7%, and 0.1% was transferred to another facility, respectively. Conclusion: The demand to the emergency service is mainly due to medical problems (priority 3 and 4), predominantly elderly and female patients. 13% of those attended were admitted with a long stay, low mortality, very few transfers and a high rate of return

Evaluation of the risk factors associated with emergency department boarding: A retrospective cross-sectional study / 中华创伤杂志(英文版)

PURPOSE@#Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center.@*METHODS@#All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test.@*RESULTS@#Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age.@*CONCLUSION@#The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.

Prevalence of acute respiratory infections among under five children in a rural area of Kozhikode district, Kerala

Background: Although childhood acute respiratory infections (ARI) is a significant public health problem in India, robust epidemiological data on its prevalence is not available. This study was done to estimate the prevalence of ARI in under five children and study the factors responsible for the same in a rural area of Kozhikode District.Methods: This cross sectional study was conducted in 386 under-5 children in Kunnamangalam panchayat of Kozhikode district from June 2015 to June 2016. Employing cluster sampling technique, data regarding socio demographic factors, prevalence of ARI and selected factors were collected using a pre tested semi structured questionnaire.Results: The overall prevalence of ARI in children was 31.9 %. Prevalence was slightly higher in boys (32.7%) than in girls (31.1%). The prevalence of ARI was more in lower social class children (36.1%), compared to those from upper social class (26.3%). ARI was higher in children living in overcrowded houses (40.2%), poorly ventilated houses (37.8%), houses in which there were no smoke outlets (43.1%), houses having pets (58.6%). Underweight children were also found to have higher rates of ARI (46.5%). Binary logistic regression revealed that after adjusting for all other factors, age less than 1 year (OR 0.48, p=0.02) and nuclear family (OR 0.10, p=0.01) are significant independent protective factors for ARI.Conclusions: Among under-5 children, younger age and membership in a nuclear family are significant protective factors for ARI

Factors associated with overcrowded pediateric emergency rooms in Northern India and possible solutions: a medical school setting

Background: To quantify the extent of emergency department overcrowding in a tertiary care hospital and to identify possible solutions.Methods: A retrospective hospital record-based study was conducted at Government Medical College Jammu, Jammu and Kashmir, India from the Department of Pediaterics and comprised data of all the patients presenting to the emergency department between 1st January 2018 to 31st December 2018. Demographic characteristics, length of stay (LOS), revisit frequency and consultation status of the patients were determined.Results: Of the 1,17,035 patients, 25,223 (43.89%) were discharged straight away while 24,113 (41.95%) were admitted to different wards and subspecialties. Besides, 6464 (11.25%) patients left the department against medical advice, 861 (1.5%) expired, 741 (1.29%) were referred to other hospitals and 67 (0.12%) were dead on arrival. Of those who were admitted, 1,4498 (60.13%) patients stayed for more than 10 hours before getting the main hospital bed. Mostly, the delays observed were due to delay in getting lab reports, already preoccupied ventilators and incubators in pediatric and neonatal intensive care units, not using checklist for proper reassessment of patients and early discharge, overburdened by patients coming in just for nebulization and intravenous or intramuscular medications, the admitting residents detain the unstable patient longer in emergency department before admission to wards.Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.

Overcrowding and possible solutions for a busy gynecological emergency department: a hospital-based setting

Background: The objective of this study is to determine the trends of patients presenting in Obstetrics and Gynecology emergency department and to identify possible solutions.Methods: This retrospective hospital record-based study was conducted at Government Medical College Jammu, Jammu and Kashmir, India from the department of Gynecology and Obstetrics and comprised data of all patients presenting to the emergency department between 1st January 2018 to 31st December 2018.  Patients were assessed in terms of demographic features, presenting complaints, admission types (urgent, non-urgent), referral from other hospitals or coming from home. The total number of patients admitted and the number of patients sent home was also recorded.Results: A total of 1,46,366 patients were analyzed retrospectively. Out of which 63,004 (43.05%) were send home from the OPD while 83,362 (56.95%) presented to the emergency department. Of them, 49,383 (59.24%) were discharged straight away from the ED after emergency treatment and care while 339,79 (40.76%) were admitted. Out of 339,79 patients, 24,932 (73.37%) stayed in the emergency whereas 9047 (26.63%) admitted into different wards for elective procedures. Majority of the patients 26,098 (89.92%) came from home and 2927 patients (10.08%) were referred from other hospitals. Labour pains 7833 (31.42%) was the most common presentation. Trauma was the reason for admission in 112 (0.45%) patients out of 29025. 971 (3.89%) patients presented with gynecological problems. 4093 (14.10%) patients presented with non-urgent indications. Rest of all patients presented with indications which were categorized as urgent and were admitted. All data was analysed using SPSS version 20.Conclusions: To reduce the overcrowding in the emergency department and improve quality of obstetrics and gynecological services, Inpatients and Outpatient departments at primary and secondary care levels need to be strengthened. Patients with non-urgent problems should be provided adequate care at primary and secondary health care centers.

Causes and countermeasures of emergency department overcrowding / 中国中西医结合急救杂志

With the progresses of aggravation of social population aging degree and elevation of health awareness, the emergency medical resources are difficult to meet the increasing demand for emergency medical services of patients, leading to the increase of congestion in the Department of Emergency that has threatened the safety of the entire medical and health system. Among the patients, because the elderly patient diseases are characterized by coexistence of multiple diseases, the complexity of diagnosis and treatment, etc, they occupy a large number of emergency medical resources, resulting in the main important factor affecting the overcrowding in emergency department. Therefore, we have comprehensively analyzed the domestic and foreign researches related to the overcrowding in emergency departments, summarized the effect of elderly patients on the overcrowding and reviewed the corresponding mitigation measures, expecting to provide a reference for the study of emergency department overcrowding in China.

The influence of Beijing medical care reform on crowded Emergency Department in the tertiary hospital / 中华急诊医学杂志

Objective To explore the influence of medical care reform on crowded emergency department in the tertiary hospital.Methods The 8 April 2017 was considered as turning point when Beijing began to implement medical care reform.The research subgroups consisted of pre-medical reform group,intra-medical reform group and post-medical reform group,according to the date 20 days before the medical reform,20 days after the medical reform and 21-40 days after the medical reform.During this period,The NEDOCS scores(The National Emergency Department Overcrowding Scale) were calculated at 10:00,14:00,18:00 in the Emergency Department of Peking University Third Hospital every day,the mean of which assessed the degree of crowding.The key indicators in the NEDOCS scoring formula were compared to find the reasons for the change of emergency crowding.All statistical analyses were performed using SPSS version 25.0.Continuous data presented as means ± standard deviation (normal distribution),analyzed by t-tests or median ± quartile(abnormal distribution),analyzed by Mann-Whitney U test.Results The NEDOCS scores in the intra-medical reform group were statistically higher than that in the pre-medical reform group (401.69 vs 339.68,P＜0.05).The NEDOCS scores in the post-medical reform group were higher than that in the pre-medical reform group,but the difference was not statistically significant (380.83 vs 339.68,P＞0.05).The number of ventilated patients (Rn) significantly increased after the reform (P＜0.05).Conclusions The degree of emergency department crowding in the tertiary hospital has increased after the Beijing medical care reform in 2017.The increase in the number of critically ill patients may be the reason for the increased overcrowding in the emergency department.

Política Criminal Reactiva frente al tráfico, fabricación y porte de estupefacientes y su impacto negativo en la reincidencia de la población carcelaria / Reactive criminal policy to tackle the traffic, manufacture and possession of narcotic drug and its negative impact in the prison population recidivism / Política criminal reativa relacionada ao tráfico, à fabricação e ao porte de entorpecentes, e seu impacto negativo na reincidência da população prisional

Resumen El presente artículo tiene como objetivo analizar el impacto negativo que guarda la política criminal y los sistemas penitenciarios de Colombia, en especial frente aquellas personas que han cometido delitos relacionados con el narcotráfico, cuya persecución altamente represiva contra la fabricación, posesión o tráfico de estupefacientes, no ha tenido ningún efecto significativo en reducir las estructuras delictivas que se han generado en torno al negocio de narcóticos. Lo que ha generado, es un aumento de la población carcelaria, personas que presentan una alta probabilidad de recaída cuando recobran su libertad, -reincidencia delictiva-, motivada por diferentes factores; pero especialmente por el tiempo y la influencia negativa que les ha generado la prisión, ello derivado de las fallas estructurales dentro de las prisiones, lo cual frena la prevención especial positiva, a falta de un tratamiento de resocialización.

Abstract The objective of this work is to analyze the negative impact that the criminal policy and the Colombian penitentiary systems hold, mainly against people who have committed drug trafficking offences, whose highly repressive persecution against the manufacture, possession or narcotic drugs traffic, have not got any significant effect in criminal structures reduction. These criminal structures have been produced on the narco-trafficking business. This has generated an increase in the prison population. These people have a high probability of relapse upon release from prison -criminal recidivism-; it is incited by different factors, particularly the time and the negative influence of prison on them, due to structural problems within the prisons which slow down the special positive prevention, in the absence of a resocialization treatment.

Resumo O objetivo deste trabalho é analisar o impacto negativo da política criminal e dos sistemas prisionais da Colômbia, em especial em relação àquelas pessoas que têm cometido crimes vinculados ao narcotráfico, cuja perseguição, altamente repressiva contra a fabricação, posse ou tráfico de entorpecentes, não tem tido nenhum efeito significativo na redução das estruturas delitivas do negócio dos narcóticos. No entanto, verifica-se um aumento da população prisional, composta por pessoas que apresentam uma probabilidade alta de reincidir quando recobram a liberdade - reincidência delitiva -, motivada por diferentes fatores, sobretudo pelo tempo e pela influência negativa causada pela prisão, devido às falhas estruturais dentro das cadeias, que impedem a prevenção especial positiva, a falta de um tratamentode ressocialização.

Saturación en los servicios de urgencias: Análisis de cuatro hospitales de Medellín y simulación de estrategias / Emergency Department Overcrowding: A Four-Hospital Analysis in Medellín and a Strategy Simulation / Saturação nos serviços de urgência: Análise de quatro hospitais de Medellín e simulação de estratégias

Resumen Las urgencias médicas pueden saturarse debido a factores externos e internos al servicio. Esto se refleja en congestión, tiempos de espera elevados e insatisfacción de los usuarios. Identificar y simular estrategias para gestionar las urgencias médicas, procurando atenuar la saturación. Investigación exploratoria y analítica, con trabajo de campo en cuatro unidades de urgencias de Medellín y simulación de estrategias contra la saturación mediante dinámica de sistemas. Las estrategias utilizadas son: reorganizar el registro, remitir los pacientes que no requieren atención urgente, implementar consultorio fast-track e incrementar el traslado a pisos. Esta última es la estrategia más efectiva en la simulación. Aunque las estrategias de flujo pueden ayudar a resolver la saturación a partir de sus causas internas, como lo sugiere la literatura, su alcance es limitado. Se requieren estrategias de entrada, que no están al alcance del servicio, y estrategias de salida del sistema hospitalario. Es posible disminuir la saturación, concibiendo las urgencias y el hospital como dos elementos de un mismo sistema, de modo que se agilice el flujo de pacientes y se cuente con oferta adecuada de camas hospitalarias sin sobredimensionar la capacidad instalada.

Abstract Medical emergency services can be overcrowded due to both external and internal service factors. This is evinced in the congestion, longer waits, and dissatisfaction by the users. To identify and simulate strategies for processing medical emergency requests in order to mitigate the overcrowding. An exploratory and analytical research was conducted based on the field work at four emergency rooms in hospitals of Medellín; simulation strategies were then proposed against the overcrowded service with system dynamics. The strategies included: to reorganize the sign-in, refer to other places those patient not requiring emergency services, implement fast-track services, and increase the inpatient capacity. The last one becomes the most effective strategy in the simulation. While the flow strategies can help to solve the service overcrowding due to internal causes as suggested in the literature, these strategies are limited in their scope. The required patient sign-in strategies as well as the patient discharge strategies are not easy-to-do in these emergency rooms. Overcrowding can be reduced by thinking of the hospital and the emergency room as two elements in a single system, so that the patient flow can be speeded up; the bed number for inpatients must be improved without overflowing the hospital capacity.

Resumo As urgências médicas podem se saturar devido a fatores externos e internos ao serviço. Isso se reflete em congestão, tempos de espera elevados e insatisfação dos usuários. Identificar e simular estratégias para gerir as urgências médicas, procurando atenuar a saturação. Pesquisa exploratória e analítica, com trabalho de campo em quatro unidades de urgências de Medellín e simulação de estratégias contra a saturação mediante dinâmica de sistemas. As estratégias utilizadas são: reorganizar o cadastro, reencaminhar os pacientes que não precisam atendimento urgente, implementar clínica ambulatória fast-track e facilitar o traslado aos quartos. Esta última é a estratégia mais efetiva na simulação. Ainda que as estratégias de fluxo possam ajudar a resolver a saturação a partir de suas causas internas, como sugere a literatura, seu escopo é limitado. Precisam-se estratégias de entrada, que no estão dentro do escopo do serviço e estratégias de saída do sistema hospitalar. Conclusões: é possível diminuir a saturação, concebendo as urgências e o hospital como dois elementos de um mesmo sistema, de jeito de agilitar o fluxo de pacientes e contar com oferta adequada de leitos hospitalares sem superdimensionar a capacidade instalada.

Propuesta de una solución tecnológica como alternativa a los problemas de saturación en las salas de urgencias de Bogotá, Colombia / Proposal of a technological solution to overcrowding in emergency departments of Bogotá, Colombia

En este trabajo ofrecemos una propuesta de solución tecnológica al problema asociado a la saturación de las salas de urgencias en Bogotá. Se realizó un estudio diagnóstico durante el primer semestre del año 2015 en tres servicios de urgencias de Bogotá. Del estudio realizado se pudo determinar que existen elevados tiempos de atención y asimetrías de información entre los diferentes actores del sistema. Asimismo, se observó que el sistema de atención primaria no está coordinado con el de atención de urgencias, lo que crea incentivos para acudir directamente a este servicio. La solución propuesta consiste en un sistema no invasivo al sistema de urgencias, que se compone principalmente de: 1) dispositivos inteligentes de medición de signos vitales, 2) un sistema de telecomunicaciones, 3) un servidor para el procesamiento y análisis de los datos y generación de alertas. Con esta solución se busca contribuir con la reducción de la asimetría de información.

A proposal is presented of a technological solution to overcrowding in emergency departments of Bogotá. A diagnostic study was conducted at three emergency departments of Bogotá during the first semester of the year 2015. The study revealed that waiting times are long and there is information asymmetry between the various actors in the system. It was also found that the primary care system is not well coordinated with the emergency services, creating an incentive for patients to go directly to the latter. The solution proposed is a non-invasive system to support the emergency service, which is mainly composed of: 1) smart devices for the measurement of vital signs, 2) a telecommunications system, 3) a server for data processing and analysis, and alert generation. This solution is expected to contribute to reduce information asymmetry.

Hacinamiento en los servicios de emergencia / Overcrowding in the hospital emergency services

Existe hacinamiento de pacientes en los servicios de emergencia de nuestros hospitales públicos; sin embargo, se trata de un problema presente en otros países, cuya mención aparece en la literatura médica foránea como crowding. Se presenta una breve revisión de la literatura médica que trata su aparición en el tiempo. Se exponen causas, consecuencias y alternativas de solución. Ante la carencia de trabajos de investigación nacionales, se tomó como fuente informes de Contraloría General de la República sobre implementación y cumplimiento de las normas técnicas en áreas críticas de 8 hospitales públicos de Lima y Callao el año 2012. Se analizó el informe de Defensoría del Pueblo, inspección de 149 hospitales a nivel nacional el mismo año. Se describe las brechas presentes entre las ofertas de cama y sobredemanda de atenciones en los servicios de emergencia inspeccionados, así como las condiciones en que permanecen los pacientes y trabaja el personal de salud en los servicios de emergencia. Se expone otras situaciones que comprometen el acceso y la atención oportuna de personas que demandan ser atendidos. Se resume las recomendaciones presentadas por ambos entes inspectores en torno a la congestión de pacientes dentro de los servicios de emergencia. El hacinamiento es un grave problema de salud pública. Los principales prestadores públicos de salud tienen que priorizar la realización de estudios al respecto y proponer soluciones, con planes de desarrollo y mejora progresiva en el corto y mediano plazo.

There is overcrowding of patients in the emergency services of our public hospitals. However, it is a problem that occurs in other countries and appears in the foreign medical literature as crowding. A brief review of the literature is presented discussing time of appearance, causes, consequences and possible solutions. Inthe absence of national research, sources used were the Comptroller General of the Republic (Contraloría General de la República) on the implementation of and compliance with technical standards in critical areas of 12 public hospitals in Lima and Callao 2012, and the report of the Office of the Ombudsman (Defensoría del Pueblo) on the nationwide inspection of 149 hospitals nationwide in 2012. The gaps between supply of bedsand care excess demand in the emergency services inspected and conditions for both inpatients stay and health personnel working in the emergency services are described. Other situations that compromise access and timely attention of people are exposed. The recommendations presented by the two inspecting entities on the congestion of patients within the emergency services are summarized. Overcrowding is a serious public health problem. The main public health providers have to prioritize studies on this matter and propose solutions with plans of development and gradual improvement in the short and medium term.

The mitigation strategy of emergency department overcrowding / 中国实用护理杂志

Objective To investigate the present situation and reasons of emergency department overcrowding, and put forward effective mitigation strategy. Methods By using input-throughput-outputmodel and choosing the method of fishbone diagram analysis, detaily analysis factors of emergency department overcrowding, then implement three- dimensional intervention in hospital, department, personal. Results Patients who stay>48 h in the emergency department(ED) decreased from 11.9％(15225/127941) to 5.3％(7245/136698); patients who stay > 6 h in the Frist Aid Room of ED decreased from 54.6％(3016/5526)to 17.8％(987/5526), both have statistically significant (χ2=3705.04, χ2=1186.32, P<0.01);before the intervention the National ED Overcrowding Study (NEDOCS) index at 0900, 1300, 2100, 0100 was 234.22 ± 62.31, 253.55 ± 59.26, 303.73 ± 160.24, 187.36 ± 25.73; after the intervention the degree of crowdedness of ED at this four points of time was significantly alleviated, NEDOCS index was 193.09 ± 31.87, 187.09 ± 22.65, 187.36 ± 25.73, 154.03 ± 21.56;there were significant differences between the two groups before and after the intervention (t=2.35-4.32, P<0.05). Conclusions To study and discuss the reasons of emergency department overcrowding, it can effectively relieve the happening of emergency department overcrowding through comprehensive intervention measures such as improve the environment, optimize the process, strengthen emergency medical personnel training and management, improve the service level hospital auxiliary support system.

Realidad penitenciaria en Colombia: la necesidad de una nueva política criminal / The reality of the penitentiary system in Colombia: the need to introduce a new criminal policy / Realidade penitenciária na Colômbia: a necessidade de uma nova política criminal

El hacinamiento carcelario, presente en la mayor parte de los países latinoamericanos, es un problema de gran calado social que genera el sufrimiento de miles de personas privadas de libertad. El lamentable estado de las infraestructuras penitenciarias y las condiciones deshumanizantes en las que transcurre el día a día de los internos comprometen la posición del Estado como garante de derechos fundamentales. Esta circunstancia ha trascendido a la opinión pública, de modo que se ha suscitado un debate -ya antiguo- sobre las políticas públicas desarrolladas en materia penal y penitenciaria. El presente trabajo tiene como objetivo principal aproximarse a la realidad del sistema penitenciario colombiano, con el fin de analizar, desde una perspectiva descriptiva y longitudinal, el fenómeno del hacinamiento carcelario para formular propuestas de mejora. Para tal fin se examinan fuentes de información secundarias provenientes de distintos ámbitos, como: fuentes estadísticas oficiales, disposiciones legales nacionales e internacionales, así como estudios de investigación elaborados por académicos e instituciones públicas. Los principales resultados ponen de relieve los efectos negativos que ha ocasionado la política criminal en el ámbito penitenciario y la necesidad urgente de una nueva orientación.

Overcrowding in prisons as a common condition in most Latin American countries is an extremely serious problem, since it causes unimaginable suff ering upon thousands of individuals deprived of freedom. The deplorable state of penitentiary infrastructures and the dehumanizing conditions that inmates have to endure every single day tend to compromise the position and reputation of the State as a true guarantor of fundamental rights. This circumstance has leaked to the public and helped trigger the -already old- debate about the state policies developed around criminal and prison matters. This work is mainly aimed at approaching the reality of the penitentiary system in Colombia by analyzing the prisonovercrowding phenomenon from a descriptive and longitudinal perspective, in order to put forward improvement proposals. For this purpose, secondary information sources from diff erent domains like official statistics and national and international provisions have been examined, as well as research studies prepared by academics and public institutions. Major results highlight the negative impacts and implications of the present criminal policy in the penitentiary environment, and the imperative need for new thinking along with a revised and well-planned orientation.

A superlotação das prisões, presente na maioria dos países da América Latina, é um problema de grande importância social que gera o sofrimento de milhares de detidos. O estado lamentável de infra-estrutura carcerária e as condições desumanas em que transcorre o dia dos internos comprometem a posição do Estado como garantidor dos direitos fundamentais. Esta circunstância transcendeu a opinião público, de modo que tem provocado discussão - já antigo - sobre as políticas públicas desenvolvidas em matéria penal e penitenciária. Este trabalho tem como principal objetivo aproximar a realidade do sistema penitenciário colombiano a fim de analisar, de uma perspectiva descritiva e longitudinal, o fenómeno da sobrelotação prisional para formular propostas de melhoria. Para este fim, fontes de informação secundária de diferentes áreas, tais como fontes estatísticas oficiais, as disposições legais nacionais e internacionais, assim como estudos da pesquisa elaborados pelos acadêmicos e instituições pública são discutidos. Os principais resultados destacam os efeitos negativos que causaram a política criminal nas prisões e a necessidade urgente de uma nova orientação.

Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

<p><b>INTRODUCTION</b>Unscheduled reattendances at the paediatric emergency department may contribute to overcrowding, which may increase financial burdens. The objectives of this study were to determine the rate of reattendances and characterise factors influencing these reattendances and hospital admission during the return visits.</p><p><b>METHODS</b>Medical records of all patients who attended the emergency department at KK Women's and Children's Hospital, Singapore, from 1 June 2013 to 31 May 2014 were retrospectively reviewed. We collected data on patient demographics, attendance data and clinical characteristics. Planned reattendances, recalled cases, reattendances for unrelated complaints and patients who left without being seen were excluded. A multivariate analysis was conducted to determine the odds ratio of variables associated with hospital admission for reattendances.</p><p><b>RESULTS</b>Of 162,566 children, 6,968 (4.3%) returned within 72 hours, and 2,925 (42.0% of reattendance group) were admitted on their return visits. Children more likely to reattend were under three years of age, Chinese, triaged as Priority 2 at the first visit, and were initially diagnosed with respiratory or gastrointestinal conditions. However, children more likely to be admitted on their return visits were over 12 years of age, Malay, had a higher triage acuity or were uptriaged, had the presence of a comorbidity, and were diagnosed with gastrointestinal conditions.</p><p><b>CONCLUSION</b>We identified certain subgroups in the population who were more likely to be admitted if they reattended. These findings would help in implementing further research and directing strategies to reduce potentially avoidable reattendances and admissions.</p>