Diagnostic costs: a research in a family medicine outpatient clinic

The aim of this study is to evaluate the direct diagnostic costs for disease groups and other variables (such as gender, age, seasons) that are related to the direct diagnostic costs based on a 3-year data. The population of the study consisted of 31,401 patients who applied to family medicine outpatient clinic in Turkey between January 1st, 2016 and December 31st, 2018. With this study, we determined in which disease groups of the family medicine outpatient clinic weremost frequently admitted. Then, total and average diagnostic costs for these disease groups were calculated. Three-year data gave us the opportunity to examine the trend in diagnostic costs. Based on this, we demonstratedwhich diseases' total and average diagnostic costs increased or decreased during 3 years. Moreover, we examined how diagnostic costs showed a trend in both Turkish liras and USA dollars' rate for 3 years. Finally, we analysedwhether the diagnostic costs differed according to variables such as age, gender and season. There has been relatively little analysis on the diagnostic costs in the previous literature. Therefore, we expect to contribute to both theoristsand healthcare managers for diagnostic costs with this study.

Alcohol use, abuse and dependence among elderly in outpatient treatment through the application of AUDIT

SUMMARY OBJECTIVE To identify or use alcohol abuse and abuse in the IAMSPE elderly, through the application of AUDIT, socioeconomic characterization of the elderly, and problems associated with drinking and weight, if there is a relationship between depression and alcohol abuse. METHODS This is a cross-sectional, exploratory, and descriptive study with a quantitative approach. One hundred elderly patients were interviewed to apply a socioeconomic form and to assess alcohol consumption from AUDIT. RESULTS correlation between alcohol consumption and female gender (p = 0.021). Most of the participants were between 60 and 79 years old, were female, had a partner, had completed elementary school, had income and selected house, were retired and unemployed. CONCLUSION In the present study, we found no correlation between alcohol abuse and depression; Only one correlation was found between male gender and higher alcohol abuse. However, a significant prevalence of moderate use of high alcohol was found (3.9% in women and 21.7% in men), i.e., it poses a risk to the health of the elderly.

RESUMO OBJETIVO Identificar o uso, abuso e dependência de álcool em idosos do ambulatório do Iamspe, por meio da aplicação do Audit, através da caracterização socioeconômica dos idosos e dos problemas associados pelo consumo e pesar se há relação entre depressão e uso abusivo ou dependência de álcool. MÉTODOS Trata-se de um estudo de corte transversal, exploratório e descritivo de abordagem quantitativa. Foram entrevistados cem pacientes idosos para aplicação de um formulário socioeconômico e de avaliação do consumo de álcool, a partir da Audit. RESULTADOS Verificou-se correlação entre o consumo de álcool e sexo feminino (p=0,021). A maioria dos participantes estava na faixa etária entre 60 e 79 anos, era do sexo feminino, tinha companheiro(a), com ensino fundamental completo, renda e casa próprias, era aposentada e desocupada. CONCLUSÃO No presente estudo não verificamos correlação entre abuso de álcool e depressão; somente foi encontrada a correlação entre sexo masculino e maior uso abusivo de álcool. No entanto, encontrou-se prevalência significativa de uso moderado a alto de álcool (3,9% em mulheres e 21,7% em homens), o que, por si, traz risco para a saúde de idosos.

Validez y consistencia de una escala rápida de satisfacción del paciente de consulta externa / Validity and consistency of an outpatient department user satisfaction rapid scale

Resumen Antecedentes: La satisfacción del usuario es clave para definir y valorar la calidad de la atención, sin embargo, no existe una escala rápida de satisfacción del paciente en México. El objetivo fue determinar la validez y consistencia de la Escala Rápida de Satisfacción del Paciente de Consulta Externa (ERSaPaCE). Método: Estudio comparativo, observacional, transversal, prolectivo. En la fase 1 se elaboró un modelo de escala rápida, que se sometió a la valoración de expertos en atención médica; se realizaron pruebas piloto con 10 pacientes por ronda, tantas veces como fuera necesario hasta lograr 20 aprobaciones. En la fase 2 se aplicó el cuestionario resultante y la escala de Satisfacción del Usuario de Consultas Externas (SUCE) a usuarios de consulta externa; la ERSaPaCE se reaplicó telefónicamente siete a 10 días después. Se utilizó estadística descriptiva, a de Cronbach, Spearman y coeficiente de correlación intraclase (CCI). Resultados: Se reclutaron 200 pacientes, 53 % con edad de 31 a 60 años, 51.5 % mujeres y 48.5 % hombres de la consulta externa de 13 especialidades; a de Cronbach de ERSaPaCE = 0.608, CCI = 0.98 (p = 0.000) y validez convergente = 0.681 (p = 0.000) por rho de Spearman. Conclusiones: ERSaPaCE fue un instrumento válido y consistente para evaluar la satisfacción del usuario de consulta externa.

Abstract Background: User satisfaction is key to define and assess the quality of care; however, there is no patient satisfaction rapid scale in Mexico. Our objective was to determine the validity and consistency of an outpatient department user satisfaction rapid scale (ERSaPaCE). Method: Comparative, observational, cross-sectional, prolective study. In phase 1, a rapid scale model was developed, which was submitted to experts in medical care for assessment; the instrument was pilot-tested in 10-patient groups, using as many rounds as required until it obtained 20 approvals. In phase 2, the resulting questionnaire and the Outpatient Service User Satisfaction (SUCE) scale were applied to outpatient department users. ERSaPaCE was reapplied by telephone 10 days later. Descriptive statistics, Cronbach’s a, Spearman’s correlation and intra-class correlation coefficient (ICC) were used. Results: Two-hundred patients were recruited, out of which 53 % were aged 31-60 years; 51.5 % were women and 48.5 % men, all of them users of the outpatient services from 13 specialties. Cronbach’s a for ERSaPaCE was 0.608, whereas ICC was 0.98 (p = 0.000). Convergent validity was 0.681 (p = 0.000) using Spearman’s rho. Conclusion: ERSaPaCE was a valid and consistent instrument for the assessment of outpatient department user satisfaction.

Influenza A and B in a cohort of outpatient children and adolescent with influenza like-illness during two consecutive influenza seasons

ABSTRACT Introduction Influenza is an important cause of morbimortality worldwide. Although people at the extremes of age have a greater risk of complications, influenza has been more frequently investigated in the elderly than in children, and inpatients than outpatients. Yearly vaccination with trivalent or quadrivalent vaccines is the main strategy to control influenza. Objectives Determine the clinical and molecular characteristics of influenza A and B infections in children and adolescents with influenza-like illness (ILI). Methods: A cohort of outpatient children and adolescents with ILI was followed for 20 months. Influenza was diagnosed with commercial multiplex PCR platforms. Results: 179 patients had 277 episodes of ILI, being 79 episodes of influenza A and 20 episodes of influenza B. Influenza A and B cases were mild and had similar presentation. Phylogenetic tree of influenza B viruses showed that 91.6% belonged to the B/Yamagata lineage, which is not included in trivalent vaccines. Conclusions: Influenza A and B are often detected in children and adolescents with ILI episodes, with similar and mild presentation in outpatients. The mismatch between the circulating influenza viruses and the trivalent vaccine offered in Brazil may have contributed to the high frequency of influenza A and B in this population.

Pediatric asthma: impact of the disease in children receiving outpatient treatment in southern brazil / Asma pediátrica: impacto da doença em crianças em acompanhamento ambulatorial no sul do brasil

ABSTRACT Objective: To evaluate the impact of pediatric asthma on patients of a specialized outpatient clinic in Southern Brazil. Methods: The study included children aged 8 to 17 years old with asthma diagnosis (mild, moderate and severe) under treatment at the asthma clinic of Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil. Measurements of spirometry, quality of life, disease control and atopy tests were applied. Results: A total of 66 children were included in the study and divided into groups, according to the severity of the disease: mild, moderate or severe asthma. The results showed similarities in both the treatment and the impact of asthma between groups, except for adherence to treatment: the group with mild asthma showed least adherence to treatment, and the group with severe asthma, greater adherence (p=0.011). As to school absenteeism, the group with severe asthma showed higher frequency (p=0.012), with over 10 days per year (p=0.043). Spirometry showed lower volume/capacity for the group with moderate asthma, followed by the groups with severe and mild asthma. All groups had a high prevalence of allergic asthma, with mites as the main allergens. For quality of life (QOL), and health-related quality of life (HRQOL) levels, there were no differences between groups. In addition, the values were close to the acceptable levels for the total score and for each one of the six domains. The same occurred for the HRQOL-asthma module. Conclusions: QOL and HRQOL present acceptable levels regardless of the severity of the disease.

RESUMO Objetivo: Avaliar o impacto da asma pediátrica de pacientes em acompanhamento ambulatorial em um centro de referência em pneumopediatria do Sul do Brasil. Métodos: Participaram do estudo crianças com idade entre oito e 17 anos, com diagnóstico de asma (leve, moderada e grave), em acompanhamento no ambulatório de asma do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS). Foram verificadas medidas de espirometria, avaliação dos níveis de qualidade de vida, controle da doença e teste de atopia. Resultados: Sessenta e seis crianças participaram do estudo, divididas em três grupos (asma leve, moderada e grave). Evidenciaram-se semelhanças tanto no tratamento quanto no impacto da asma, exceto para a adesão ao tratamento (p=0,011), em que o grupo de asma leve é o que menos adere e o grupo de asma grave o que mais adere ao tratamento. Em relação ao absenteísmo escolar, o grupo de asma grave apresentou o maior valor (p=0,012), com mais de dez dias/ano (p=0,043). As espirometrias demonstram menor volume/capacidade para o grupo de asma moderada, seguido do grupo de asma grave e asma leve. Os grupos possuem alta prevalência de asma alérgica, tendo os ácaros como os principais alérgenos. Quanto à qualidade de vida (QV) e à qualidade de vida relacionada à saúde (QVRS), não houve diferença entre os grupos. Além disso, os valores apresentados estão próximos aos níveis aceitáveis, tanto para o escore total quanto para os seis domínios analisados. O mesmo ocorre para o módulo QVRS-asma. Conclusões: Os níveis de QV e de QVRS demonstram-se aceitáveis, independentemente da gravidade da doença.

Prevalence of dementia in patients seen at a private hospital in the Southern Region of Brazil / Prevalência de demência em pacientes atendidos em um hospital privado no sul do Brasil

ABSTRACT Objective To evaluate the epidemiological profile of patients seen at a dementia outpatient clinic. Methods A retrospective study conducted by medical record review searching data on sex, race, age, schooling level, and diagnosis of patients seen from 2008 to 2015. Results A total of 760 patients were studied, with a predominance of female (61.3%; p<0.0001). The mean age was 71.2±14.43 years for women and 66.1±16.61 years for men. The most affected age group was 71 to 80 years, accounting for 29.4% of cases. In relation to race, 96.3% of patients were white. Dementia was diagnosed in 68.8% of patients, and Alzheimer's disease confirmed in 48.9%, vascular dementia in 11.3%, and mixed dementia in 7.8% of cases. The prevalence of dementia was 3% at 70 years and 25% at 85 years. Dementia appeared significantly earlier in males (mean age 68.5±15.63 years). As to sex distribution, it was more frequent in women (59.6%) than in men (40.4%; p<0.0001; OR=2.15). People with higher schooling level (more than 9 years) had a significantly younger age at onset of dementia as compared to those with lower schooling level (1 to 4 years; p=0.0007). Conclusion Most patients seen in the period presented dementia, and Alzheimer was the most prevalent disease. Women were more affected, and men presented young onset of the disease. Individuals with higher schooling level were diagnosed earlier than those with lower level.

RESUMO Objetivo Avaliar o perfil epidemiológico dos pacientes atendidos em um ambulatório de demência. Métodos Estudo retrospectivo realizado pela revisão de prontuários com busca de dados sobre sexo, raça, idade, escolaridade e diagnóstico de pacientes atendidos de 2008 a 2015. Resultados Foram estudados 760 pacientes, com predomínio do sexo feminino (61,3%; p<0,0001). A média de idade foi 71,2±14,43 anos, para as mulheres, e de 66,1±16,61 anos, para os homens. A faixa etária mais acometida foi de 71 a 80 anos, representando 29,4% dos casos. Em relação à etnia, 96,3% dos pacientes eram brancos. O quadro de demência foi diagnosticado em 68,8% dos pacientes, tendo sido a doença de Alzheimer confirmada em 48,9% dos casos, demência vascular em 11,3% e mista em 7,8%. A prevalência de demência foi de 3% aos 70 anos e de 25% aos 85 anos. O quadro demencial apareceu significativamente mais cedo no sexo masculino (média de idade 68,5±15,63 anos). A distribuição entre os sexos mostrou demência mais frequente em mulheres (59,6%) do que em homens (40,4%; p<0,0001; RC=2,15). Pessoas com maior escolaridade (acima de 9 anos) apresentaram idade de aparecimento da demência significativamente menor que aquelas de menor escolaridade (1 a 4 anos; p=0,0007). Conclusão Os pacientes atendidos no período apresentaram demência na maioria dos casos, sendo Alzheimer a doença mais prevalente. Mulheres foram mais acometidas, entretanto homens apresentaram a doença mais precocemente. Indivíduos com maior escolaridade foram diagnosticados mais cedo que aqueles com menor escolaridade.

Pharmaceutical care-based interventions in type 2 diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials / Intervenções farmacêuticas no diabetes mellitus tipo 2: uma revisão sistemática e metanálise de ensaios clínicos randomizados

ABSTRACT Objective To investigate the impact of pharmaceutical care-based interventions on type 2 diabetes mellitus . Methods PubMed®, Cochrane and Web of Science data bases were searched for randomized controlled clinical trials. Studies evaluating pharmaceutical care-based interventions in type 2 diabetes mellitus published between 2012 and 2017 were included. Glycated hemoglobin was defined as the primary endpoint; blood pressure, triglycerides and cholesterol as secondary endpoints. The random effects model was used in meta-analysis. Results Fifteen trials involving 2,325 participants were included. Meta-analysis revealed considerable heterogeneity (I2>97%; p<0.001), reduction in glycated hemoglobin (-1.07%; 95%CI: -1.32; -0.83; p<0.001), glucose (-29.91mg/dL; 95%CI: -43.2; -16.6; p<0.001), triglyceride (19.8mg/dL; 95%CI: -36.6; -3.04; p=0.021), systolic blood pressure (-4.65mmHg; 95%CI: -8.9; -0.4; p=0.032) levels, and increased HDL levels (4.43mg/dL; 95%CI: 0.16; 8.70; p=0.042). Conclusion Pharmaceutical care-based clincal and education interventions have significant impact on type 2 diabetes mellitus . The tools Summary of Diabetes Self-Care Activities and the Morisky Medication Adherence Scale may be useful to monitor patients.

RESUMO Objetivo Identificar o impacto das intervenções providenciadas pelo cuidado farmacêutico no diabetes mellitus tipo 2. Métodos Buscas por ensaios clínicos randomizados controlados foram realizadas nas bases PubMed®, Cochrane e Web of Science . Foram incluídos estudos publicados entre 2012 e 2017, que avaliaram o impacto do cuidado farmacêutico no diabetes mellitus tipo 2. A hemoglobina glicada foi o desfecho primário, e os secundários foram pressão arterial, triglicérides e colesterol. O modelo de efeitos aleatórios foi utilizado na metanálise. Resultados Foram incluídos 15 estudos envolvendo 2.325 participantes. A metanálise demonstrou heterogeneidade elevada (I2>97%; p<0,001), redução nos níveis de hemoglobina glicada (-1,07%; IC95%: -1,32; -0,83; p<0,001), glicose (-29,91mg/dL; IC95%: -43,2; -16,6; p<0,001), triglicérides (19,8mg/dL; IC95%: -36,6; -3,04; p=0,021), pressão arterial sistólica (-4,65mmHg; IC95%: -8,9; -0,4; p=0,032) e aumento do colesterol HDL (4,43mg/dL; IC95%: 0,16; 8,70; p=0,042). Conclusão As intervenções clínicas e educacionais providenciadas pelo cuidado farmacêutico têm impacto significativo no diabetes mellitus tipo 2. Ferramentas como o Summary of Diabetes Self-Care Activities e a Morisky Medication Adherence Scale podem ser úteis no acompanhamento dos pacientes.

Outpatient analytic assessment of anorexia nervosa — the importance of venous blood gases / Avaliação laboratorial em ambulatório na anorexia nervosa: a importância da gasometria venosa

ABSTRACT Objective: To evaluate serum biochemical parameters' evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. Methods: Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. Results: A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). Conclusions: Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.

RESUMO Objetivo: Avaliar a evolução laboratorial, particularmente da gasometria venosa, na anorexia nervosa (AN), correlacionando os achados com parâmetros clínicos. Métodos: Estudo retrospetivo com adolescentes com AN seguidos em ambulatório, entre janeiro de 2014 e maio de 2017. Foram comparadas três avaliações: (t1) primeira consulta; (t2) consulta com escore Z de índice de massa corpórea (IMC) mais baixo; e (t3) consulta com escore Z de IMC mais elevado. Resultados: Incluídos 24 adolescentes, 87,5% do sexo feminino, idade média de apresentação de 14,9±1,7 anos, início dos sintomas 6,4±3,2 meses antes da primeira consulta. Em t1, escore Z de IMC de -1,91±1,11 kg/m2 e % de peso ideal de 84,3±9,2. Tinham amenorreia 88%. Em t2 as alterações laboratoriais encontradas foram: gasometria venosa alterada em 100%, ferritina alterada (72% elevada), função tiroideia alterada (53% com diminuição da tiroxina), dislipidemia (31% com elevação de lipoproteína de alta densidade, 25% com hipercolesterolemia), elevação da ureia (25%), elevação da alanina aminotransferase (14%), hipoglicemia (14%) e anemia (9%). A acidose respiratória esteve presente em 91% em t1, 100% em t2 e 94% em t3. Verificou-se diminuição significativa entre t2 e t3 da pressão parcial de CO2 (pCO2) média (57,2 versus 53,6 mmHg; p=0,009) e HCO3 médio (30,0 versus 28,8 mEq/L; p=0,023). Conclusões: A acidose respiratória e o aumento da ferritina foram comuns nesse grupo. Acidose respiratória foi a alteração mais frequente, com variação significativa de pCO2 e HCO3 na fase de recuperação. A gasometria venosa deve ser considerada na avaliação laboratorial na AN, pois parece ser importante na avaliação da gravidade e monitorização da doença.

The use of geographical analysis in assessing the impact of patients' home addresses on their participation in outpatient cardiac rehabilitation: a prospective cohort study

PURPOSE@#Geographical analysis is becoming a powerful tool for evaluating the quality of medical services and acquiring fundamental data for medical decision-making. Using geographical analysis, we evaluated the impact of the distance from patients' homes to the hospital on their participation in outpatient cardiac rehabilitation (OCR).@*METHODS@#All patients hospitalized for percutaneous coronary intervention, coronary artery bypass grafting, valvular surgery, congestive heart failure, and aortic diseases were advised to participate in an OCR program after discharge. Using the dataset of our cohort study of OCR from 2004 to 2015 (n = 9,019), we used geographical analysis to investigate the impact of the distance from patients' homes to hospital on their participation in our OCR program.@*RESULTS@#Patients whose road distance from home to hospital was 0-10 km, 10-20 km, and 20-30 km participated more in OCR than those whose road distance was ≧ 30 km (OR 4.34, 95% CI 3.80-4.96; OR 2.98, 95% CI 2.61-3.40; and OR 1.90, 95% CI 1.61-2.23, respectively). Especially in patients with heart failure, the longer the distance, the lesser the participation rate (P < .001).@*CONCLUSIONS@#Using geographical analysis, we successfully evaluated the factors influencing patients' participation in OCR. This illustrates the importance of using geographical analysis in future epidemiological and clinical studies.@*TRIAL REGISTRATION@#UMIN000028435.

Prevalencia y manejo de condilomas en población consultante en Chile: estudio "DIACON" / Prevalence and management of condylomas in consulting population in Chile: "DIACON study"

Resumen Introducción: Los condilomas o verrugas genitales (VG) son la infección de transmisión sexual (ITS) más diagnosticada en los centros de ITS en Chile, pero no existen estadísticas poblacionales. Objetivos: Describir la prevalencia de VG en pacientes de 18-60 años que acuden a consulta ambulatoria de dermatología, ginecología y urología; características demográficas de los pacientes y prácticas de diagnóstico y tratamiento. Material y Métodos: A una muestra de especialistas chilenos estratificados por región, población y sexo de pacientes se les proporcionó un diario de registro y aplicó un cuestionario. Resultados: Prevalencia VG grupo total: 2,4%; en grupo etario 18-34 años: 3,7%; en grupo etario 35-60 años: 1,29% (p = 0,0000). La edad media de los pacientes con VG fue 29,4 años en mujeres y 32,7 años en hombres (p = 0,019); la distribución por edad fue diferente según sexo y sistema de salud. La inspección visual fue el método diagnóstico más frecuente y la crema de imiquimod el tratamiento más común. Hubo diferencias en el uso de herramientas diagnósticas y terapéuticas según sexo del paciente, especialidad del médico y sistema de salud. Conclusiones: Existe una alta prevalencia de VG, que debería ser tomada en cuenta para planificar las intervenciones de salud pública para abordar este problema.

Introduction: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. Objectives: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. Methods: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. Results: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. Conclusions: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.

Factors associated with inadequate follow-up of children with congenital syphilis / Fatores associados ao seguimento não adequado de crianças com sífilis congênita

ABSTRACT OBJECTIVE To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson's chi-square and Fisher's exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.

RESUMO OBJETIVO Analisar fatores associados ao seguimento ambulatorial não adequado de crianças notificadas com sífilis congênita. MÉTODOS Estudo de coorte não concorrente, realizado em unidades de atenção primária e três maternidades de referência de Fortaleza (Ceará). Os dados foram coletados de setembro de 2013 a setembro de 2016 nas fichas de notificação e nos prontuários médicos de internamento e de seguimento ambulatorial, e apresentados considerando o seguimento adequado e não adequado. Foram consideradas adequadamente seguidas as crianças que compareceram à unidade de atenção primária ou ao ambulatório de referência no período recomendado pelo Ministério da Saúde e realizaram os exames preconizados. Utilizou-se os testes qui-quadrado de Pearson e exato de Fisher na análise comparativa. O risco estimado de não seguimento adequado foi verificado por regressão logística simples e múltipla. RESULTADOS Foram notificadas 460 crianças com sífilis congênita, das quais 332 (72,2%) retornaram para pelo menos uma consulta e fizeram parte do estudo. Compareceram à unidade primária de saúde 287 (86,4%) crianças; entretanto, não havia referência à sífilis congênita em 236 (71,1%) prontuários e não foram encontradas informações acerca da solicitação do exame venereal disease research laboratory (VDRL) em 264 (79,5%). Houve não adesão às consultas subsequentes por parte de 272 (81,9%) indivíduos. As seguintes variáveis apresentaram associação estatisticamente significativa com o seguimento não adequado das crianças: estado civil das genitoras, número de consultas no pré-natal, número de gestações, hemograma e radiografia de ossos longos. CONCLUSÕES A maioria das crianças notificadas com sífilis congênita comparecem à atenção primária para seguimento, porém os serviços não atendem às recomendações do Ministério da Saúde para o seguimento adequado.

Estudo do impacto da fragilidade, multimorbidade e incapacidade funcional na sobrevida de idosos ambulatoriais / Survival of elderly outpatients: effects of frailty, multimorbidity and disability

Resumo O objetivo deste estudo foi analisar o impacto da fragilidade, da multimorbidade e da incapacidade funcional na sobrevida de idosos assistidos em ambulatório de geriatria e identificar os fatores clínicos de risco associados ao óbito. Estudo longitudinal, com 133 idosos avaliados inicialmente em relação à fragilidade, multimorbidade (presença simultânea de 3 doenças crônicas ou mais) e perda funcional nas Atividades de Vida Diária. Utilizou-se o método Kaplan Meier, para a análise de sobrevida, e a regressão de Cox, para a associação dos fatores clínicos com o óbito. Após seguimento de seis anos, 21,2% dos participantes faleceram, sendo a sobrevida menor entre os idosos frágeis (p < 0,05). As variáveis fragilidade (HR = 2,26; IC95%: 1,03-4,93) e Insuficiência Renal Crônica (HR = 3,00; IC95%: 1,20-7,47) foram fatores de maiores riscos para óbito na análise multivariada. A fragilidade impactou negativamente na sobrevida desses pacientes, porém não foi observada associação estatisticamente significativa em relação à multimorbidade e perda funcional. O rastreio de vulnerabilidades no serviço ambulatorial de geriatria é relevante, em virtude do número expressivo de idosos portadores de síndromes geriátricas que utilizam este tipo de atendimento e do direcionamento dos cuidados desses indivíduos.

Abstract This study aims to analyze the impact of frailty, multimorbidity and disability on the survival of elderly people attended in a geriatric outpatient facility, and identify the clinical risk factors associated with death. It is a longitudinal study, with 133 elderly people initially evaluated in relation to frailty, multimorbidity (simultaneous presence of three or more chronic diseases) and disability in Daily Life Activities. The Kaplan Meier method was used to analyze survival time, and the Cox regression was used for association of the clinical factors with death. In follow-up over six years, 21.2% of the participants died, survival being lowest among those who were fragile (p < 0.05). The variables frailty (HR = 2.26; CI95%: 1.03-4.93) and Chronic Renal Insufficiency (HR = 3.00; CI95%: 1.20-7.47) were the factors of highest risk for death in the multivariate analysis. Frailty had a negative effect on the survival of these patients, but no statistically significant association was found in relation to multimorbidity or disability. Tracking of vulnerabilities in the outpatient geriatric service is important, due to the significant number of elderly people with geriatric syndromes that use this type of service, and the taking of decisions on directions for care of these individuals.

Sex effects on the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults: data from the SARCOS study

ABSTRACT Objective: The objective was to evaluate the association between sarcopenia (EWGSOP) and osteoporosis in older adults. Subjects and methods: This is a cross sectional analysis of a baseline evaluation of the SARCopenia and OSteoporosis in Older Adults with Cardiovascular Diseases Study (SARCOS). Three hundred and thirty-two subjects over 65 years of age were evaluated. Sarcopenia was determined by EWGSOP flowchart and Osteoporosis was established by WHO's criteria. Physical function, comorbidities and medications were evaluated. Results: Women were older (79.8 ± 7.2 years) than men (78.21 ± 6.7 years) (p = 0.042). Osteoporosis occurred in 24.8% of men, and in 42.7% of women (p < 0.001); sarcopenia occurred in 25.5% of men and in 17.7%, of women (p = 0.103). Osteoporosis was diagnosed in 68% of sarcopenic women, however only 20.7% (p = 0.009) of women with osteoporosis had sarcopenia; in older men, 44.7% of individuals with sarcopenia presented osteoporosis and 42.9% (p = 0.013) of men with osteoporosis showed sarcopenia. In an adjusted logistic regression analyses for sarcopenia, osteoporosis presented a statistically significant association with sarcopenia in men [OR: 2.930 (95% CI: 1.044-8.237; p = 0.041)] but not in women [OR: 2.081 (0.787-5.5; p = 0.142)]; in the adjusted logistic regression analyses for osteoporosis, a statistically significant association occurred in men [OR: 2.984 (95% CI: 1.144-7.809; p = 0.025)], but not in women [OR: 2.093 (0.962-3.714; p = 0.137)]. Conclusion: According to sex, there are significant differences in the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults. It is strong and significant in males; in females, despite showing a positive trend, it was not statistically significant.

Evaluation of the frequency of Candida spp. in hospitalized and non-hospitalized subjects / Avaliação da frequência de candida spp. em indivíduos hospitalizados e não hospitalizados

Abstract The aim of this study was to evaluate the frequency of Candida species between a non-hospitalized and a hospitalized population. For this purpose, samples of saliva were sampled through sterile swabs, moistened in peptone water and rubbed in the oral cavity of 140 individuals, from which, 70 were hospitalized patients from the Medical Clinic of a Teaching Hospital and the other 70 were non-hospitalized subjects. All saliva samples were plated in Sabouraud Dextrose agar added with Chloramphenicol and incubated at 36 °C for 48 hours. The morphology identification was performed through macroscopic and microscopic characterization, the CHROMagar Candida medium and the VITEK® system Yeast Biochemical Card (bio Mérieux SA, France). The results showed a colonization of Candida spp. in 85.7% the hospitalized individuals, where the species found were C. albicans (60%), C. tropicalis (23.4%), C. krusei (3.3%) and Candida spp. (13.3%). In the non-hospitalized individuals the colonization by Candida spp was 47.1%, and the species found were: C. albicans (45.5%), C.krusei (9.1%), C. guilliermondii (9.1% %), C. tropicalis (3.0%), C. famata (3.0%) and Candida spp. (30.3%). In spite of their presence in oral cavity in both groups, Candida spp. was more frequently isolated in hospitalized individuals, who were 6.73 times more likely to have this fungus in the oral cavity and were 3.88 times more likely to have Candida albicans.

Resumo O objetivo deste estudo foi avaliar a frequência de espécies de Candida entre uma população de indivíduos não-hospitalizados e hospitalizados. Para isto, amostras de saliva foram coletadas através de swabs estéreis, umedecidas em água de peptona e friccionadas na cavidade bucal de 140 indivíduos, dos quais 70 eram pacientes internados em uma Clínica Médica de um Hospital Escola e os outros 70 eram indivíduos não hospitalizados sem contato com ambiente hospitalar. Todas as amostras de saliva foram plaqueadas em ágar Sabouraud dextrose adicionadas de cloranfenicol e incubadas a 36 °C durante 48 horas. A identificação morfológica foi realizada através da caracterização macroscópica e microscópica, com o meio CHROMagar Candida e do sistema VITEK® Biochemical Card (bio Mérieux SA, França). Os resultados mostraram uma colonização de Candida spp. em 85,7% dos indivíduos hospitalizados, onde as espécies encontradas foram: C.albicans (60%), C. tropicalis (23,4%), C. krusei (3,3%) e Candida spp. (13,3%). Nos indivíduos não-hospitalizados a colonização por Candida spp foi de 47,1%, e as espécies encontradas foram: C. albicans (45,5%), C. krusei (9,1%), C. guilliermondii (9,1%), C. tropicalis (3,0%), C. famata (3,0%) e Candida spp. (30,3%). Apesar de sua presença na cavidade oral em ambos os grupos, Candida spp. foi mais freqüentemente isolada em indivíduos hospitalizados, que foram 6,73 vezes mais propensos a ter este fungo na cavidade oral e foram 3,88 vezes mais propensos a ter Candida albicans.

Produção especializada no SUS em capitais brasileiras com centros de especialidades odontológicas: uma análise descritiva / Specialized production in the unified health system in Brazilian capitals with dental specialty centers: a descriptive analysis

Centros de especialidades odontológicos (CEOs) são estabelecimentos de saúde de âmbito especializado que devem realizar uma quantidade mínima de procedimentos. Objetivos: descrever a produção odontológica especializada e reportar o cumprimento das metas nas capitais brasileiras com CEOs. Materiais e método: foi conduzido um estudo do tipo longitudinal retrospectivo, sendo realizada uma busca por CEOs cadastrados no Cadastro Nacional de Estabelecimentos de Saúde (CNES). A produção odontológica foi pesquisada no Sistema de Informações Ambulatoriais do Sistema Único de Saúde (SIASUS), de maio de 2015 a abril de 2016. Resultados: foram encontrados e considerados elegíveis para o presente estudo 59 CEOs, localizados em 19 capitais brasileiras e no Distrito Federal, sendo 48% CEOs tipo II. Cerca de 730 mil procedimentos especializados foram realizados durante os 12 meses avaliados. Uma taxa de 86% das metas foi cumprida, sendo que cirurgia foi à área com maior cumprimento (92%), seguida de periodontia (89%) e endodontia (76%). Uma das capitais apresentou apenas 33% das metas cumpridas. Três capitais não atingiram nenhuma das metas estabelecidas em procedimentos de endodontia. Conclusão: foi observada uma grande variação no cumprimento das metas entre as capitais com CEOs. Enquanto algumas capitais apresentaram elevado cumprimento das metas, outras exibiram dados preocupantes, principalmente nos procedimentos de endodontia. (AU)

Dental Specialty Centers (Centros de Especialidades Odontológicas ­ CEOs) are specialized health facilities that should perform a minimum number of procedures. Objectives: this study aimed to describe the specialized dental production and report the achievement of goals in Brazilian capitals with CEOs. Materials and method: a retrospective longitudinal study was performed with a search for the CEOs listed in the National Registry of Health Establishments. The dental production was searched in the Outpatient Information System of the Brazilian Unified Health System for the period from May 2015 to April 2016. Results: fifty-nine CEOs were found and considered eligible for the present study. They were located in 19 Brazilian capitals and in the Federal District, whereas 48% were CEOs Type II. Approximately 730 thousand specialized procedures were performed during the 12 months evaluated. A rate of 86% of goals was met and surgery presented the highest achievement (92%), followed by periodontics (89%) and endodontics (76%). One of the capitals achieved only 33% of the goals. Three capitals did not achieve any of the goals set for endodontic procedures. Conclusion: there was a great variation in the achievement of goals among capitals with CEOs. While some capitals showed high achievement of goals, others presented concerning data, especially for endodontic procedures. (AU)

Multiple myeloma: burden of disease analysis in some countries of latin america

In Latin America, there is no systematic information to determine and monitor multiple myeloma. The objective of this study was estimate the annual burden of multiple myeloma disease in five Latin American healthcare systems through the number of attended patients, hospitalizations and specific deaths, by age group. Using specific ICD-10:C90 coded registries from National Healthcare Systems' databases of Argentina, Colombia, Peru, Ecuador and Venezuela, we retrieved/analyzed 2015 complete year data for: attended and hospitalized patients stratified by age groups, and for specific deaths. In 2015, the total number of cases attended (prevalence of cases attended) was: Argentina 1.278 (2.96), Colombia 875 (1.82), Ecuador 311 (1.91), Peru 603 (1.94) and Venezuela 758 (2.48); ≥50 years, represented on average for the five countries 86.88% (81.94%-91.83%) of total. Hospitalized cases were (average hospitalization rate): Argentina 1.002 (1.31), Colombia 639 (1.51), Ecuador 218 (1.48), Peru 452 (1.52) and Venezuela 559 (1.34); on average ≥50 years, represented 86.21% (80.12%-92.29%) of total. Hospitalization for ≥60 years vs. 50-59 years (62.86% [53.20%-72.52%] vs. 23.35% [18.67%-28.03%]) increased ~2.7 times, and this population (≥ 60 years) is expected to increase ~41% by 2025. Average mortality rate was 1.28 [0.82-2.62]. Multiple myeloma represents a burden on the health of elderly population and healthcare systems, and is expected to grow as the population ages (AU)

En Latinoamérica no existe información sistematizada para determinar/monitorizar el mieloma múltiple. El objetivo del estudio fue estimar la carga anual de enfermedad del mieloma múltiple en cinco sistemas de salud latinoamericanos mediante el número de pacientes atendidos, hospitalizaciones y muertes específicas, por grupo de edad. Utilizando registros específicos codificados por CIE-10: C90 de bases de datos de los Sistemas Nacionales de Salud de Argentina, Colombia, Perú, Ecuador y Venezuela, obtuvimos y analizamos datos de 2015 (año completo) para pacientes atendidos y hospitalizados estratificados por grupo etario y para muertes específicas. En 2015, el número total de casos atendidos (prevalencia de casos atendidos) fue: Argentina 1.278 (2.96), Colombia 875 (1.82), Ecuador 311 (1.91), Perú 603 (1.94) y Venezuela 758 (2.48); ≥50 años, representaron en promedio para los cinco países 86.88% (81.94% - 91.83%) del total. Los casos hospitalizados fueron (tasa promedio de hospitalización): Argentina 1.002 (1.31), Colombia 639 (1.51), Ecuador 218 (1.48), Perú 452 (1.52) y Venezuela 559 (1.34); en promedio ≥50 años, representaron 86.21% (80.12%-92.29%) del total. La hospitalización de ≥ 60 años vs. 50-59 años (62.86% [53.20% - 72.52%] vs. 23.35% [18.67%-28.03%]) aumentó ~2.7 veces, y esta población (≥ 60 años) se espera aumente ~41% para 2025. La tasa de mortalidad promedio fue 1.28 [0.82-2.62]. El mieloma múltiple representa una carga para la salud de los adultos mayores y los sistemas de salud, y se espera aumente conforme envejece la población (AU)

Predictores de remisión del trastorno depresivo mayor en tratamiento en el nivel secundario de atención / Predictors of remission from major depressive disorder in secondary care

Background The knowledge of predictive factors in depression should help to deal with the disease. Aim To assess potential predictors of remission of major depressive disorders (MDD) in secondary care and to propose a predictive model. Material and Methods A 12 month follow-up study was conducted in a sample of 112 outpatients at three psychiatric care centers of Chile, with baseline and quarterly assessments. Demographic, psychosocial, clinical and treatment factors as potential predictors, were assessed. A clinical interview with the checklist of DSM-IV diagnostic criteria, the Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results The number of stressful events, perceived social support, baseline depression scores, melancholic features, time prior to beginning treatment at the secondary level and psychotherapeutic sessions were included in the model as predictors of remission. Sex, age, number of previous depressive episodes, psychiatric comorbidity and medical comorbidity were not significantly related with remission. Conclusions This model allows to predict depression score at six months with 70% of accuracy and the score at 12 months with 72% of accuracy.

Quality of the ophthalmological service to outpatients of the public and private healthcare systems / Qualidade do serviço oftalmológico prestado aos pacientes ambulatoriais dos sistemas de saúde público e privado

ABSTRACT Purpose: To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. Methods: This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Results: Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Conclusions: Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

RESUMO Objetivo: Comparar a percepção da qualidade dos serviços oftalmológicos prestado aos pacientes ambulatoriais do sistema público com a do sistema privado e detectar quais ações são percebidas como necessárias e prioritárias para melhorar a qualidade do atendimento. Métodos: Foi realizado estudo prospectivo observacional de 200 pacientes sendo 101 do sistema público de saúde e 99 do sistema privado submetidos a exame oftalmológico em Hospital Especializado em Oftalmologia (HEO) - Belo Horizonte - MG - Brasil. Realizaram-se entrevistas pessoais, mediante a aplicação de dois questionários estruturados adaptados da escala SERVQUAL modificada. Resultados: No geral, detectou-se que pacientes do sistema de saúde privado, estão significativamente mais insatisfeitos que aqueles do sistema público de saúde. Em ambos os sistemas a confiabilidade foi considerada o determinante de qualidade mais importante e o que apresentou o maior índice de insatisfação. No sistema público a satisfação foi significativamente superior à do sistema privado a nível dos determinantes da escala SERVQUAL: tangibilidade, confiabilidade, atendimento e segurança. Conclusões: A instituição deve planejar, executar, avaliar e monitorar ações que busquem melhorar a satisfação geral dos pacientes com a qualidade do serviço recebido, principalmente do sistema privado, com atenção especial à confiabilidade nos dois sistemas. A identificação e monitorização da qualidade dos serviços de saúde, empregando periodicamente a escala SERVQUAL, poderá fornecer informações à administração dos serviços de saúde para que possam detectar, planejar e monitorizar as ações necessárias e prioritárias, podendo funcionar como chave estratégica para o aprimoramento da qualidade dos serviços de saúde ambulatoriais públicos e privados.

Dependência alcoólica em ambulatório de gastroenterologia de um hospital público / Alcohol dependence in gastroenterology outpatient on a public hospital

ABSTRACT BACKGROUND: Alcoholism and alcoholic liver disease are both considered worldwide health problems. OBJECTIVE: The prevalence of alcohol dependence, the associated risk factors and the concordance between the prevalence found and the data collected during the medical visit were evaluated. METHODS: A prospective study evaluating gastroenterology outpatients at a public tertiary hospital was conducted. Two specific questionnaires to assess alcohol dependence were applied: Cut down, Annoyed by criticism, Guilty, Eye-opener (CAGE) and The Alcohol Use Disorder Identification Test (AUDIT). Data on comorbidities, clinical diagnosis and assessment of alcohol consumption by the attending physician were collected through medical records. RESULTS: One hundred and seventy eight patients were interviewed, of which 119 (66.9%) were women and 59 (33.1%) were men, with mean age of 57 years. Thirty-three (18.5%) of the 178 patients were considered alcohol-dependent by the CAGE questionnaire. Thirteen (7.3%) patients scored 8 points or more on the AUDIT questionnaire. The agreement (kappa) between these questionnaires was 0.37 (P<0.001). The most consumed drink was beer. The median daily consumption of dependent patients was 64 g. None of the patients were undergoing treatment in a specific treatment center, and 14/33 (42.4%) patients considered themselves alcoholics. Only in 17/33 (51.5%) there was information about alcoholism in their respective medical records. In the bivariate analysis, male gender (P<0.001), onset of alcohol consumption before the age of 15 (P=0.003), daily alcohol consumption in the last 12 months (P<0.001) and smoking (P<0.001) were identified as risk factors. After multivariate analysis, only male gender (P=0.009) and smoking (P=0.001) were associated with alcoholism. CONCLUSION: The present study demonstrated a high prevalence of alcohol dependence in the gastroenterology outpatient clinic, being predominantly associated with male gender and smoking. It is worth noting that approximately half of the dependents were not identified as such in the medical appointment, evidencing the importance of the diagnostic approach in the alcoholic outpatient.

RESUMO CONTEXTO: O alcoolismo e a doença hepática alcoólica são considerados problemas de saúde de relevância mundial. OBJETIVO: Avaliar a prevalência de dependência alcoólica, os fatores de risco associados e a concordância entre a prevalência encontrada e os dados coletados na consulta médica. MÉTODOS: Estudo prospectivo, avaliando pacientes de ambulatório de gastroenterologia de um hospital terciário, composto por um questionário geral e dois específicos para avaliar a dependência de álcool: Cut down, Annoyed by criticism, Guilty, Eye-openner (CAGE) e o Alcohol Use Disorder Identification Test (AUDIT). Dados sobre comorbidades, diagnóstico clínico e aferição sobre o consumo de álcool pelo médico assistente, foram coletados através de revisão de prontuário. RESULTADOS: Foram entrevistados 178 pacientes, 119 (66,9%) mulheres e 59 (33,1%) homens com média de idade de 57 anos. Trinta e três (18,5%) dos 178 pacientes foram considerados dependentes alcoólicos pelo questionário CAGE. Treze (7,3%) pacientes fizeram oito ou mais pontos no questionário AUDIT. A concordância (kappa) entre os testes foi 0,37 (P<0,001). A bebida mais consumida foi a cerveja. A mediana de consumo diário dos pacientes dependentes foi de 64 g, nenhum destes estava em tratamento em centro específico, 14/33 (42,4%) pacientes seconsideravam alcoolistas e em apenas 17/33 (51,5%) havia registro no prontuário sobre alcoolismo. Na análise bivariada, gênero masculino (P<0,001), início de consumo de álcool antes dos 15 anos (P=0,003), consumo diário de bebida alcoólica nos últimos 12 meses (P<0,001) e tabagismo (P<0,001) foram identificados como fatores de risco. Após análise multivariada, permaneceram associados: gênero masculino (P=0,009) e tabagismo (P=0,001). CONCLUSÃO: O presente estudo demonstrou alta prevalência de dependência alcoólica no ambulatório geral de gastroenterologia, estando associada predominantemente ao gênero masculino e ao tabagismo. Ressalta-se que aproximadamente metade dos dependentes não foram identificados como tal na consulta médica, evidenciando a importância da abordagem diagnóstica no paciente alcoolista.