Odontologia hospitalar: uma análise crítica sobre a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil / Hospital dentistry: a critical analysis of the role of the dental surgeon in tertiary care in the state of Rio Grande do Sul, Brazil

Objetivo: analisar a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil. Método: estudo descritivo ecológico, com uso de dados secundários registrados pelo Cadastro Nacional de Estabelecimentos de Saúde no ano de 2023. A coleta de dados foi realizada em duas etapas. Na primeira etapa também foram coletados os dados do CNES referentes à presença do cirurgião dentista, tipo de vínculo contratual e especialidades ofertadas pelos serviços. Já na segunda etapa os dados coletados foram referentes aos indicadores sociodemográficos dos profissionais com habilitação em odontologia hospitalar utilizando as informações disponibilizadas pelo Sistema WSCFO do Conselho Federal de Odontologia. A análise dos dados foi realizada com o suporte do software TabWin, versão 3.6, e do software estatístico R v. 4.2.3. Os dados foram analisados por meio de análise descritiva. Resultados: apenas 6,11% das instituições são certificadas e consideradas Hospitais de Ensino. A maioria dos estabelecimentos (87,14%) oferece atendimento pelo SUS. Quanto à presença de cirurgiões dentistas nos estabelecimentos, 64,63% dos estabelecimentos relataram tê-los, enquanto 35,37% não possuem esse profissional em sua equipe. Neste estudo, constatamos que uma correlação positiva do cirurgião dentista com o número de leitos de UTI adulto e ao maior porte do hospital. Conclusão: observa-se que ainda há necessidade de estruturação da atenção terciária no Estado do Rio Grande do Sul, no que se refere à odontologia hospitalar. Há poucos os cirurgiões dentistas com uma carga horária dedicada exclusivamente ao atendimento hospitalar clínico a beira leito.(AU)

Objective: To analyze the inclusion of dental surgeons in tertiary care in the state of Rio Grande do Sul, Brazil. Method: a descriptive ecological study using secondary data recorded by the National Register of Health Establishments in 2023. Data was collected in two stages. In the first stage, data was also collected from the CNES regarding the presence of a dental surgeon, the type of contractual relationship and the specialties offered by the services. In the second stage, data was collected on the sociodemographic indicators of professionals qualified in hospital dentistry using the information provided by the WSCFO System of the Federal Council of Dentistry. The data was analyzed using TabWin software, version 3.6, and R v. 4.2.3 statistical software. The data was analyzed using descriptive analysis. Results: only 6.11% of institutions are certified and considered Teaching Hospitals. The majority of establishments (87.14%) provide care through the SUS. As for the presence of dental surgeons in the establishments, 64.63% of the establishments reported having them, while 35.37% did not have this professional on their team. In this study, we found a positive correlation between the number of adult ICU beds and the size of the hospital. Conclusion: There is still a need to structure tertiary care in the state of Rio Grande do Sul, in terms of hospital dentistry. There are few dental surgeons with a workload dedicated exclusively to bedside clinical hospital care.(AU)

Modelo de manejo en red y por telemedicina de la retinopatía diabética en dos comunas del Servicio de Salud Metropolitano Oriente / Management of diabetic retinopathy using telemedicine and network integration

Background: If we are able to increase the resolution of complex medical problems at primary health care levels, we would improve the efficiency of the health care systems and would reduce the burden of specialists. Aim: To describe the result of a telemedicine and network management of diabetic retinopathy supervised by an ophthalmological service. Material and Methods: Diabetic patients attended in primary health care centers of the East Metropolitan Health Service in Santiago, Chile, derived for 45° digital retinographies were evaluated using telemedicine by the ophthalmologists of the base hospital. These professionals screened for diabetic retinopathy and classified it. Those patients with diabetic retinopathy were derived to the base hospital for specialized management. Results: Of 2,566 patients evaluated, 22% had signs of diabetic retinopathy, 75% did not have the condition and 2% could not be evaluated with retinography. Seventy percent of patients with retinopathy, equivalent to only fifteen percent of total diabetics, were referred to the specialists for treatment. Conclusions: This model allowed a reduction of referrals to ophthalmologists, reducing the burden of secondary and tertiary health care systems.

Health Care Network: Maternal perception regarding the quality of care to children with microcephaly / Red de Atención a la Salud: Percepción materna en cuanto a la calidad de atención de niños con microcefalia / Rede de Atenção à Saúde: Percepção materna quanto à qualidade de atendimento de crianças com microcefalia

Abstract Objective: To identify the perception of primary caregivers on the quality of the Health Care Network of children with microcephaly related to congenital infection. Methods: A cross-sectional study carried out from October 2017 to April 2018. Results: The 105 participants assessed the health of their children as reasonable (56.1%). The level of care which got the highest percentage - 57 (54.3%) - of participants' dissatisfaction was of Primary Health Care (p=0.0216). Most of the specialties of secondary health care services were classified as poor/very poor, regarding the quality of the consultation at the secondary level (p<0.05). For the majority - 61 (58%) - of the mothers, regarding this level of attention, the items waiting time and appointment scheduling were evaluated as excellent/good (p<0.05). Conclusion and implications for practice: There is dissatisfaction among mothers considering the quality of services provided by the health care network for children with microcephaly, mainly in primary care. There was easiness in the access to Secondary Care, and little use of Tertiary Care services. It is urgent to elaborate policies that better disseminate humanization and facilitate the accessibility to multiprofessional care for those children.

Resumen Objetivo: Identificar la percepción de cuidadores principales sobre la calidad de la Red de Atención a la Salud de niños con microcefalia relacionada con infección congénita. Métodos: Investigación de corte transversal realizada entre octubre 2017 y abril de 2018. Resultados: Las 105 participantes evaluaron la salud de sus hijos como razonable (56,1%). El nivel de atención que obtuvo el mayor porcentaje de insatisfacción - 57(54,3%) - fue en la Atención Primaria (p=0,0216). La mayoría de las especialidades de la Atención Secundaria fueron clasificadas como mala/muy mala, sobre la calidad de la consulta en el nivel secundario (p<0,05). Para la mayoría - 61(58%) - de las madres, en cuanto a ese nivel de atención, los ítems tiempo de espera y programación de consulta fueron evaluados como excelente/bueno. Conclusión e implicaciones para la práctica: Hubo insatisfacción de las madres con la calidad de servicios prestados por la Red de Atención a la Salud del niño con microcefalia principalmente en la Atención Primaria. Hubo facilidad de acceso a la Atención Secundaria, y poca utilización de los servicios de la Atención Terciaria. Es urgente la elaboración de políticas que mejor difundan la humanización y faciliten la accesibilidad a la atención multiprofesional para estos niños.

Resumo Objetivo: Identificar a percepção de cuidadores principais sobre a qualidade da Rede de Atenção à Saúde de crianças com microcefalia relacionada à infecção congênita. Métodos: Estudo de corte transversal realizado no período de outubro de 2017 a abril de 2018. Resultados: As 105 participantes avaliaram a saúde de seus filhos como razoável (56,1%). O nível de atenção que obteve o maior percentual - 57(54,3%) - de insatisfação das participantes foi o da Atenção Primária à Saúde (p=0,0216). A maioria das especialidades da Atenção Secundária à Saúde foi classificada como ruim/muito ruim, quanto à qualidade da consulta no nível secundário (p<0,05). Para a maioria - 61(58%) - das mães, quanto a esse nível de atenção, os itens tempo de espera e agendamento de consulta foram avaliados como excelente/bom (p<0,05). Conclusão e implicações para a prática: Existe insatisfação das mães com a qualidade dos serviços prestados pela Rede de Atenção à Saúde da criança com microcefalia, principalmente na Atenção Primária. Houve facilidade no acesso à Atenção Secundária, e pequena utilização dos serviços da Atenção Terciária. É urgente a elaboração de políticas que melhor difundam a humanização e facilitem a acessibilidade ao atendimento multiprofissional para essas crianças.

Candida glabrata among Candida spp. from environmental health practitioners of a Brazilian Hospital

Abstract The incidence of the species Candida albicans and non-albicans Candida was evaluated in a Brazilian Tertiary Hospital from the environment and health practitioners. In a 12-month period we had a total positivity of 19.65% of Candida spp. The most recurring non-albicans Candida species was C. glabrata (37.62%), generally considered a species of low virulence, but with a higher mortality rate than C. albicans. Subsequently, C. parapsilosis (25.74%) and C. tropicalis (16.86%) were the second and third most commonly isolated species. Considering the total samples collected from the emergency room and from the inpatient and the pediatric sector, 19.10% were positive for Candida spp., with the predominance of non-albicans Candida species (89.42%). The high percentage of positivity occurred in the hands (24.32%) and the lab coats (21.88%) of the health care assistants. No sample of C. albicans presented a profile of resistance to the drugs. All the non-albicans Candida species presented a decreased susceptibility to miconazole and itraconazole, but they were susceptible to nystatin. Most of the isolates were susceptible to fluconazole and amphotericin B. As expected, a high resistance rate was observed in C. glabrata and C. krusei, which are intrinsically less susceptible to this antifungal agent. The contamination of environmental surfaces by Candida spp. through hand touching may facilitate the occurrence of Candida infections predominantly in immunocompromised patients. In addition to that, the antifungal agents used should be carefully evaluated considering local epidemiologic trends in Candida spp. infections, so that therapeutic choices may be better guided.

Work-related hand injuries treated at a tertiary care hospital

The hands are known to be the most commonly injured body parts in traumatic occupational injuries. They can be disabling, leading to major adverse social and economic consequences for the worker and for his or her family. The aim of the study was to describe work-related hand injuries and their potential risk factors and also investigate lines of management in relation to the type of injury. Patients who presented to the emergency room of a tertiary hospital over a 6-month period with occupational hand injuries were interviewed using a predesigned questionnaire. It included questions pertaining to the sociodemographic, occupational, and medical aspects related to the injury. A total of 163 patients were interviewed. More than 50% had injuries from cuts. Almost 60% of work-related hand injuries occurred in the absence of machines. The most common causes of hand injuries mentioned by workers were lack of concentration [68.7%], wearing no or ill-fitting gloves [63.2%], and a defect in the work place [51.5%]. On examination, fingers were the most affected site [66.7%]. About half of the cases were managed in the emergency room, 28.8% were managed with minor procedures, and 21.9% were managed with major procedures. Work-related hand injuries have multifactorial causes; lack of concentration was the most common in this study. Injuries from cuts were the most common and fingers were the most affected part. Modifications of the possible risk factors may reduce the incidence of acute hand injury at work

Array-Based Comparative Genomic Hybridization in 190 Korean Patients with Developmental Delay and/or Intellectual Disability: A Single Tertiary Care University Center Study

PURPOSE: This study analyzed and evaluated the demographic, clinical, and cytogenetic data [G-banded karyotyping and array-based comparative genomic hybridization (array CGH)] of patients with unexplained developmental delay or intellectual disability at a single Korean institution. MATERIALS AND METHODS: We collected clinical and cytogenetic data based on retrospective charts at Ajou University Medical Center, Suwon, Korea from April 2008 to March 2012. RESULTS: A total of 190 patients were identified. Mean age was 5.1+/-1.87 years. Array CGH yielded abnormal results in 26 of 190 patients (13.7%). Copy number losses were about two-fold more frequent than gains. A total of 61.5% of all patients had copy number losses. The most common deletion disorders included 22q11.2 deletion syndrome, 15q11.2q12 deletion and 18q deletion syndrome. Copy number gains were identified in 34.6% of patients, and common diseases among these included Potocki-Lupski syndrome, 15q11-13 duplication syndrome and duplication 22q. Abnormal karyotype with normal array CGH results was exhibited in 2.6% of patients; theses included balanced translocation (n=2), inversion (n=2) and low-level mosaicism (n=1). Facial abnormalities (p<0.001) and failure to thrive were (p<0.001) also more frequent in the group of patients with abnormal CGH findings. CONCLUSION: Array CGH is a useful diagnostic tool in clinical settings in patients with developmental delay or intellectual disability combined with facial abnormalities or failure to thrive.

Extranjeros no residentes y cobertura de salud. Un conflicto entre principios / Non-resident foreigners and health care coverage. A conflict of principles

La atención de extranjeros no residentes en hospitales públicos de alta complejidad es un problema de salud pública presente en la Argentina desde hace mucho tiempo, pero que se ha agravado en los últimos años. Es un tema sobre el que no se ha profundizado y sobre el cual no se encuentra bibliografía. El objetivo del presente estudio fue describir los motivos de internación y la ocupación de camas en el Hospital Garrahan, de niños extranjeros no residentes durante el año 2006, y comparar los resultados obtenidos con los mismos datos correspondientes al año 2004 para observar la tendencia. Material y Métodos: Se obtuvieron mediante registros informáticos todos los datos de los pacientes extranjeros hospitalizados en dos períodos: desde el 1 de enero al 31 de diciembre de los años 2004 y 2006 respectivamente. Se analizaron el número de camas ocupadas por extranjeros, en los diferentes sectores de internación durante los años 2004 y 2006. Resultados: Durante en año 2004 se internaron 389 niños extranjeros no residentes, con edades comprendidas entre 1 mes y 19 años. (2,1% de los egresos anuales) Durante el año 2006 se internaron un total de 1446 niños En el primer período (2004 )los días totales de internación de estos niños fueron 3.828 mientras en el año 2006 el número total de días de internación ascendió a 7.329 días, que significa un incremento del 91% con respecto al 2004, siendo el área donde se observó el aumento más importante la correspondiente a cuidados intermedios y moderados(CIM): 5.335 días (72,7%). Conclusiones: Dada la magnitud del problema, se deben pensar soluciones viables a mediano y largo plazo, pero el reconocimiento del problema es la primera etapa necesaria para su solución (AU)

Health care for non-resident foreigners at public tertiary care hospitals has been a public health problem for many years and has aggravated over the past time. However, the subject has not been the subject of debate no articles regarding this topic have been published in the literature The aim of the present study was to describe the reasons for admission and occupation of hospital beds in the Garrahan Hospital of non-resident foreign children during 2006 and to compare these results with data from 2004 to observe if there is a trend. Material and Methods: From computerized records all data of foreign patients hospitalized during two different periods were obtained: Between January 1 and December 31 of 2004 and 2006, respectively. The number of beds occupied by foreigners in different in-patient sectors during 2004 and 2006 was analyzed. Results: In 2004, 389 non-resident foreign children aged between 1 month and 19 years were admitted (2.1% of the yearly discharges). In 2006 a total of 1446 children were admitted. In the first period (2004), the total number of hospital days of these children was 3828, while in 2006 the total number of hospital days increased to 7329, a 91% increased compared to 2004. The highest increase was observed in the area of intermediate and moderate care (CIM): 5335 days (72.7%). Conclusions: Given the size of the problem, adequate medium- and long-term solutions should be developed, however, recognition of the problem is the first necessary step (AU)