Relación entre la tasa de letalidad por COVID-19 y los recursos hospitalarios / Relation between COVID-19 fatality rate and hospital resources

Introducción: La tasa de letalidad por COVID-19 ha generado mucha preocupación entre los ciudadanos y los medios de comunicación con respecto a los números oficiales proporcionados por distintos gobiernos. La salud pública en la actualidad debe hacer frente a la pandemia más significativa del siglo xxi. Objetivo: Analizar la tasa de letalidad por COVID-19 y su relación con recursos hospitalarios críticos, en el contexto de la pandemia de la COVID-19. Métodos: Se analizó la tasa de letalidad sobre la base de datos oficiales. Se subestimó el número de casos para obtener una estimación más real del alcance de la infección, de los indicadores de recursos hospitalarios importantes (críticos) en transición pandémica que podrían elevar la tasa de letalidad posterior al estudio. Se emplearon curvas de tendencia exponencial doblemente suavizadas, distribución S y técnicas de regresión. Resultados: La curva que mejor explicó el comportamiento de fallecidos por COVID-19 en Chile fue una ecuación de regresión cúbica. La variable hospitalización básica se distribuyó como una curva S. Las variables hospitalización media, pacientes críticos, unidad tratamiento intensivo, unidad cuidado intensivo, ventiladores mecánicos totales y ventiladores mecánicos ocupados; se pudieron explicar mediante regresiones cúbicas. En todos los casos, los valores de R2 fueron superiores al 95 por ciento. Conclusiones: El número de fallecidos seguirá en aumento. Se sugiere fortificar las unidades de hospitalización básica para imposibilitar el colapso de la red sanitaria. Es necesario seguir creciendo en términos de hospitalización de media complejidad, unidad tratamiento intensivo, unidad cuidado intensivo y número total de ventiladores mecánicos para asegurar el soporte sanitario(AU)

Introduction: The fatality rate by COVID-19 has generated a lot of concern among citizens and the media regarding the official numbers provided by different governments. Public health today must cope with the most significant pandemic of the twenty-first century. Objective: Analyze the fatality rate due to COVID-19 and its relation with critical hospital resources, in the context of the COVID-19 pandemic. Methods: The fatality rate was analyzed on the basis of official data. The number of cases was underestimated to obtain a more real estimate of the extent of the infection, of the indicators of important (critical) hospital resources in pandemic transition that could raise the post-study fatality rate. Double-smoothed exponential trend curves, S-distribution and regression techniques were used. Results: The curve that best explained the behavior of COVID-19 deaths in Chile was a cubic regression equation. The basic hospitalization variable was distributed as an S-curve. The variables called mean hospitalization, critical patients, intensive treatment unit, intensive care unit, total mechanical ventilators and busy mechanical ventilators could be explained by cubic regressions. In all cases, R2 values were greater than 95percent. Conclusions: The number of deaths will continue to rise. It is suggested to fortify the basic hospitalization units to prevent the collapse of the health network. It is necessary to continue growing in terms of medium complexity hospitalization, intensive treatment unit, intensive care unit and total number of mechanical ventilators to ensure health support(AU)

Practical Considerations for Converting Operating Rooms and Post-anaesthesia Care Units into Intensive Care Units in the COVID-19 Pandemic - Experience from a Large Singapore Tertiary Hospital

COVID-19 has spread globally, infecting and killing millions of people worldwide. The use of operating rooms (ORs) and the post-anaesthesia care unit (PACU) for intensive care is part of surge response planning. We aim to describe and discuss some of the practical considerations involved in a large tertiary hospital in Singapore. Firstly, considerations for setting up a level III intensive care unit (ICU) include that of space, staff, supplies and standards. Secondly, oxygen supply of the entire hospital is a major determinant of the number of ventilators it can support, including those on non-invasive forms of oxygen therapy. Thirdly, air flows due to positive pressure systems within the OR complex need to be addressed. In addition, due to the worldwide shortage of ICU ventilators, the US Food and Drug Administration has granted temporary approval for the use of anaesthesia gas machines for patients requiring mechanical ventilation. Lastly, planning of logistics and staff deployment needs to be carefully considered during a crisis. Although OR and PACU are not designed for long-term care of critically ill patients, they may be adapted for ICU use with careful planning in the current pandemic.

Desigualdad en recursos financieros de la Atención Primaria de Salud Municipal en Chile, 2001-2013 / Inequality of financial resources for primary health care

Background: The availability of health care resources is one of the main factors influencing health care inequalities. Aim: To evaluate communal inequality in financial resources for municipal primary care in Chile. Material and Methods: The evolution of income, expenditure and investment per subject enrolled was assessed for the period 2001-2013 in the 320 municipalities that administer municipal health. Inequality was evaluated using Lorenz curves and annual indicators (Gini, Theil, Coefficient of Variation and Reason 90/10). For a panel analysis with fixed effects, the association of these resources with socioeconomic variables and municipal health was evaluated. Results: The Gini of per capita spending increased 1.75 times, while the Gini investment grew by 30%. Per capita spending was significantly and inversely associated with poverty, dependency on the Municipal Common Fund, resources coming from the City Hall, spending per capita, expenses in personnel, performance and investment, rate of years of potential life lost and infant mortality. A direct and significant association was observed with global, less than two years and greater than 64 years urban population, destination of municipal revenue to health, per capita investment in health, rate of healthcare professionals, number of attentions and health care centers and availability of primary emergency facilities. Per capita investment was inversely associated with the number of health care centers and directly to the Fund dependency, municipal health coverage and personnel expenses. Conclusions: Inequality in municipal health funds increased substantially and were associated with social vulnerability, access to municipal health and community health outcomes.

La atención de la salud en Argentina: Al gran pueblo argentino... ¿Salud? ­Segunda entrega ­ Una torta suculenta, fragmentada, no planificada e ineficiente / Health care in Argentina: To the great Argentine people ... Health? - Second issue - A succulent, fragmented, unplanned and inefficient cake

En esta segunda, de una serie de artículos relacionados, el autor describe mediante la utilización de viñetas clínicas, los diferentes factores que hacen de la administración de salud argentina una "tragedia". Los factores descritos en esta entrega incluyen la fragmentación, ausencia de coordinación y planificación de la asignación de los recursos sanitarios que condicionan servicios redundantes, desarticulados e ineficientes en algunos sectores o carentes en otros. (AU)

In this second of a series of related articles, the author describes using clinical vignettes, the different factors that turns Argentine's health administration into a "tragedy". The factors described in this issue include fragmentation, disintegration, and lack of coordination and planning of health resources allocation, that end up conditioning redundant, disjointed and inefficient services in some areas or lacking in other. (AU)

Implementación de gestión por procesos en el Centro de distribución de la dirección de Atención Primaria de la Salud (DAPS), Municipalidad de Córdoba ano 2013 / Implementation of process management in the distribution center management Primary Health Care (DAPS), Municipality of Córdoba year 2013

El presente proyecto de tesis propone cambios en los procesos (selección, adquisición, recepción, almacenamiento, dispensación y distribución) del Sistema de Suministro de medicamentos e insumos que se llevan a cabo en el Centro de Distribución de la Dirección de Atención Primaria de la Salud (DAPS) para los 97 centros de salud del Departamento Capital de la Provincia de Córdoba, permitiendo que los medicamentos e insumos lleguen a los CAPS en tiempo y forma; apoyando a una de las tantas actividades que los CAPS tienen, que es la disponibilidad de medicamentos esenciales, contribuyendo a la salud de la población que concurre a nuestros centros y que tiene solamente la cobertura de seguro de salud pública. La manera de gestionar, actualmente los medicamentos e insumos responde a un modelo tradicional de gestión no pudiendo responder adecuadamente a la demanda creciente de los mismos. El enfoque a través de la Gestión por Procesos permite identificar los Puntos Críticos y proponer cambios que le brinden mayor eficiencia y flexibilidad a cada una de las áreas (recepción, armado, almacenamiento y distribución) del Centro de Distribución . La identificación de los distintos procesos –de gestión, clave y de apoyo- permite la elaboración del mapa de procesos con sus correspondientes fichas, diagramas de flujo, diseño de cronograma de armado de pedidos y planillas que permitan el buen desarrollo y funcionamiento...

This thesis project proposes changes to processes (selection, acquisition, receipt, storage, supply and distribution) System Supply of medicines and supplies that are held in the Distribution Center, Bureau of the Primary Health Care (DAPS) for the 97 health centers of the Departamento Capital Department of the Province of Córdoba, allowing the drugs and supplies reach the CAPS in a timely manner; supporting one of the many activities that have CAPS(Centers of Primary Health Care), which is the availability of essential drugs, contributing to the health of the population attending our centers and has only cover public health insurance. How to manage, medicines and supplies currently serves a traditional management model can not adequately respond to the growing demand for them. The approach through Process Management identifies the Critical Points and propose changes that give greater efficiency and flexibility to each of the areas (reception, assembly, storage and distribution) in the Distribution Center . The identification of the different processes - management, key and support-enables the mapping of processes and their records, flow charts, design of reinforced schedule orders and forms that allow the proper development and functioning...

Situación de la Composición y Distribución del Recurso Humano de Enfermería en los Países de América Latina / Status of Composition and Distribution of Nursing Human Resources in Latin America

Los países de América Latina se enfrentan al reto de asegurar acceso a servicios de salud de calidad, sensibles a las necesidades y a las restricciones de los sistemas de salud. Autores expresan que el campo de los RecursosHumanos está en crisis, también lo afirman los estados miembros de la OPS-OMS y aquellos que trabajan en elsector. Uno de los problemas actuales más urgentes de recursos humanos es la escasez de enfermeras, son consideradas uno de los elementos cruciales, es reconocida su contribución como esencial para alcanzar las metas del desarrollo y para prestar cuidados eguros y eficaces. El Consejo Internacional de Enfermeras (2010),confirma que el número de enfermeras en muchos países no llega a mantener el ritmo de la creciente demanda, lo que amenaza conseguir resultados en la atención de salud. Objetivo fue conocer la situación de la composición y distribución del recurso humano de enfermería en servicios de salud de América Latina. Método: descriptivo, observacional, comparativo y analítico de corte transversal. Universo: instituciones de salud con y sin internación de los países de las sub-regiones de América Latina: N = 291 hospitales, N = 152 centros de salud y N = 291 enfermeras jefes. Resultados: la composición de enfermería fue de 41,06% profesionales y 58,94% auxiliares de enfermería en los hospitales y en los centros de salud, 48,72% y 51,28%respectivamente. En los hospitales las enfermeras jefas manifiestan insuficiencia en la dotación e inadecuadadistribución en el personal de enfermería, siendo los servicios de terapia intensiva y cirugía los únicos señalados con nivel de suficiencia. En los centros de salud son referidos como suficientes los programas de inmunizaciones y planificación familiar. Las razones que justifican esta roblemática son: complejidad de los pacientes y grado de dependencia, condiciones y medio ambiente de trabajo, aumento de la demanda, falta depolíticas de recursos humanos, presupuesto y normas de cálculo.

SUMMARY: Latin American countries face the challenge of ensuring access to quality health services, sensitive to the needs and constraints of health systems. Different authors state thatthe field of Human Resources is in crisis, so say the ember states of PAHO-WHO and those working in the area. One ofthe most urgent current problems in human resources is the shortage of nurses, who are considered one of the crucial elements and whose contribution is recognized as essential to achieve development goals and to provide safeand effective care. The International Council of Nurses (2010), confirms that the number of nurses in manycountries fails to keep pace with the growing demand, threatening good results in health care. Objective: todetermine the status of composition and distribution of human resources –nursesin health services in LatinAmerica. Method: A descriptive, observational, comparative, analytical cross-sectional study. Universe: health services with and without hospitalization in the countries of sub-regions in Latin America: N = 291 hospitals, N = 152 health centers and N = 291 head nurses. Results: Nursingcomposition was 41.06% qualified nurses and 58.94% nursing auxiliaries in hospitals and in health centers,48.72% and 51.28% respectively. In hospitals, head nurses say that staff supply is insufficient and that the distribution of nurses is inadequate. According to them, Intensive Careand Surgery are the only services with enough staff. In health centers, immunization and family planning rograms are considered adequate. The reasons for this problem are: patient complexity and degree of dependence, working conditions and environment, increased demand, lack of human resources policies, budget and calculation rules.

Condições de financiamento em saúde nos grandes municípios do Brasil / Health financing conditions in large cities in Brazil

O artigo analisa as condições de financiamento do Sistema Único de Saúde (SUS) nos municípios brasileiros com mais de 100 mil habitantes, procurando aferir os resultados das regras que definem os recursos vinculados à saúde nos orçamentos municipais. Para alcance dos objetivos, foi constituída uma base de dados a partir das receitas declaradas por meio do Sistema de Informações de Orçamentos Públicos em Saúde (SIOPS) em 2005. Os valores informados foram comparados e correlacionados por localização geográfica dos municípios. Aplicou-se, ainda, a técnica de análise de agrupamentos (cluster analysis) para a conformação de grupos homogêneos segundo condições de financiamento em saúde. Verificaram-se perfis variados de receitas municipais nas diversas regiões e estados do Brasil e distintos graus de dependência orçamentária dos municípios às principais fontes de recursos vinculados. Embora a diversidade de fontes indique múltiplos caminhos para obtenção de recursos, o estudo sugere alguns entraves para o financiamento da saúde nos municípios de grande porte no país.

We evaluated the funding of the Brazilian Unified National Health System (SUS) in municipalities with more than 100,000 inhabitants. The main goal was to evaluate the impact of policies for health resource allocation within the municipal budget. A database was organized with information from revenues reported by municipalities in the Information System on Government Health Budgets (SIOPS) for the year 2005. Reported budgets were compared and correlated to the municipalities' geographic location. We conducted a cluster analysis to create more homogeneous groups according to health-related budget. The study showed a major variability among different regions and States, with varying degrees of municipal dependence on external funds. Although the large variability in sources may indicate multiple strategies for ensuring the necessary budget funds, the study suggests some barriers to public health funding in larger municipalities.

Avaliação de custo-utilidade como mecanismo de alocação de recursos em saúde: revisão do debate / Cost-utility analysis as a mechanism for allocation of health care resources: a review of the debate

Estabelecer prioridades em saúde traduz-se em escolhas entre programas alternativos e/ou entre pacientes ou grupos de pacientes. Tradicionalmente, os economistas da saúde propuseram a agregação dos ganhos de saúde, avaliados em QALYs, como forma de estabelecer prioridades e maximizar o bem-estar social. Isso requer que o valor social dos ganhos de saúde seja um produto dos ganhos em anos de vida, qualidade de vida e número de pessoas tratadas. Resultados da revisão de literatura sugerem que nem os potenciais ganhos de saúde são, por si só, um determinante significativo de valor nem a regra da maximização dos ganhos de saúde parece suficiente. O valor social de um ganho de saúde parece não ser uma função linear dos ganhos de mortalidade e morbidade, nem parece neutral às características dos doentes ou à distribuição final de saúde entre a população. Paralelamente à revisão do debate sobre o papel e limitação dos QALYs para a priorização dos recursos da saúde, o artigo procura justificar a controvérsia de alguns resultados empíricos, em particular, no que se refere à formação e manifestação das preferências sociais.

Priority setting in health care involves choosing between alternative health care programs and/or patients or groups of patients who will receive care. Traditionally, health economists have proposed maximizing the additional health gain measured in QALYs as a way of setting priorities and maximizing social welfare. This requires that the social value from health improvements be a product of gains in years of life, quality of life, and number of people treated. The results of a literature review suggest that potential health gain is not a single relevant determinant of value, nor is the rule of maximizing this gain sufficient. The social value of a health gain appears not to be linear in terms of mortality and morbidity, or neutral vis-à-vis people's characteristics or the ultimate distribution of health in society. In parallel with the review of the debate on the role and limitation of QALYs for prioritizing health care resources, the article attempts to justify the controversy over some empirical results, particularly in relation to the construction and expression of social preferences.

Compliance with hepatitis B and hepatitis C virus infection screening among HIV-1 infected patients in a resource-limited setting.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important risk factors for mortality among HIV-infected patients. We assessed compliance with screening for HBV and HCV infection prior to initiation of ART in a resource-limited setting. Six hundred thirty-eight patients with a mean age of 38.4 years (53% males) were studied. Prior to initiation of antiretroviral therapy (ART) 371 patients (58%) were screened for HBV and 273 (43%) were screened for HCV infection. Of those screened, 9.7% had HBV infection and 8.8% had HCV infection. Given the relatively high prevalence of HBV and HCV infection among HIV-infected patients, screening for HBV and HCV infections prior to ART initiation should not be omitted in the resource-limited setting.

Modelo de asignación de recursos en atención primaria / A model for resource allocation in primary health care

Resource allocation in primary health care is a worldwide issue. In Chile, the state allocates resources to city halls using a mechanism called "per capita". However, each city hall distributes these resources according to the historical expenses of each health center. None of these methods considers the epidemiological and demographic differences in demand. This article proposes a model that allocates resources to health centers in an equitable, efficient and transparent fashion. The model incorporates two types of activities; those that are programmable, whose demand is generated by medical teams and those associated to morbidity, generated by patients. In the first case the health promotion, prevention and control activities are programmed according to the goals proposed by health authorities. In the second case, the utilization rates are calculated for different sociodemographic groups. This model was applied in one of the most populated communities of Metropolitan Santiago and proved to increase efficiency and transparency in resource allocation.

Avaliaçäo do distrito sanitário Cabula/Beiru - 1989 / Health actions in the health District of Cabula/beiru - 1989

Foi realizada uma avaliaçäo do Distrito Sanitário Cabula/Beiru, localizado em Salvador - Bahia, relativa ao ano de 1989, utilizando indicadores do impacto das açöes sobre o nível de saúde da populaçäo, da oferta de serviços e da reorganizaçäo do sistema. O processo de avaliaçäo baseou-se em proposta metodológica elaborada pela Gerência de Organizaçäo de Serviços da Secretaria da Saúde do Estado da Bahia e Departamento de Medicina Preventiva da Universidade Federal da Bahia, e desenvolveu-se com a participaçäo dos servidores em todos os seus momentos. Os resultados apontaram deficiências nos três planos analisados, devidas, em parte, à falta de condiçöes e de autonomia da Gerência do Distrito para solucionar os problemas, às precárias condiçöes de vida e de saúde de grande parte da populaçäo da área e à insuficiente disponibilidade de recursos financeiros para investimento e manutençäo do setor público de saúde. Concluiu-se pela importância do processo contínuo de avaliaçäo para instrumentalizar a Gerência do Distrito, recomendando-se que o mesmo seja institucionalizado e transformado em atividade sistemática nos Distritos Sanitários