Análise do impacto das ações judiciais em um setor de referência de um hospital de grande porte de Juiz de Fora / Analysis of the impact of legal actions on a reference sector of a large hospital in Juiz de Fora

Objetivo: Avaliar o impacto das ações judiciais no setor de ortopedia da Santa Casa de Juiz de Fora/MG. Métodos: Foi realizada análise dos prontuários dos pacientes que passaram por cirurgia no setor de ortopedia da Santa Casa de Juiz de Fora no ano de 2016. E, logo após, os pacientes advindos de ação judicial foram identificados, dividindo-se, assim, a amostra em dois grupos. As variáveis analisadas foram: sexo e idade do paciente; tempo de internação, desfecho e custos, os quais foram desmembrados em diárias, honorários, procedimentos e materiais e medicamentos. Resultados: Os resultados demonstraram que os pacientes que realizaram cirurgias por via judicial são, em sua maioria, idosos, com leve predominância do sexo masculino. A maior das demandas é para a garantia de cirurgias do sistema osteomuscular de membros inferiores, representando 65,9% das cirurgias realizadas por ação judicial em 2016, que também são as cirurgias mais demandadas por via convencional. O custo direto das cirurgias por processos judiciais foi estimado em R$ 2.340.301,68. As diárias apresentaram o maior custo, sendo responsáveis por 90,7% de todo o custo estimado. Conclusão: A judicialização neste estudo expõe deficiências do Sistema Único de Saúde quanto à oferta de serviços, uma vez que todas as cirurgias demandadas por meio de ação judicial já são contempladas pelo sistema público de saúde. Assim, os aspectos judiciais da saúde, tais como a individualidade e os prazos para cumprimento, prevalecem sobre o coletivo e os que esperam nas filas.

Objective: Evaluate the impact of legal actions in the orthopedic sector of Santa Casa de Juiz de Fora/MG. Methods: An analysis was carried out of the medical records of patients who underwent surgery in the orthopedic sector of Santa Casa de Juiz de Fora in the year 2016. Soon afterwards, patients from a judicial action were identified, thus dividing the sample into two groups. The analyzed variables were: sex and age of the patient; time of hospitalization, outcome and costs, which were broken down into: daily, fees, procedures and materials and medicines. Results: The results showed that patients who underwent surgeries by judicial means are mostly elderly, with a slight predominance of males. The largest of the demands is to guarantee osteomuscular lower limb surgeries, accounting for 65.9% of surgeries performed by lawsuit in 2016, which are also the most commonly performed surgeries. The direct cost of surgeries for legal proceedings was estimated at R$ 2,340,301.68. The daily costs were those that presented the highest cost, accounting for 90.7% of the estimated cost. Conclusion: The judicialization in this study exposes deficiencies of the Unified Health System regarding the offer of services, once all the surgeries demanded by lawsuit are already contemplated by the public health system. Thus, the judicial aspects of health, such as: individuality and deadlines for compliance prevail over the collective and those waiting in the queues.

Dimorfismo sexual de la leptina, resistencia a la insulina y composición corporal en prepúberes normopeso / Leptin sexual dimorphism, insulin resistance, and body composition in normal weight prepubescent

INTRODUCCIÓN: La etapa prepuberal es un periodo crítico del desarrollo de la grasa corporal, en el cual la leptina y la resistencia a la insulina han sido asociados, sin embargo, hay pocos estudios en prepúberes normo- peso. OBJETIVO: Evaluar la relación de leptina con composición corporal y resistencia a la insulina en un grupo de prepúberes normopeso. PACIENTES Y MÉTODO: Estudio transversal analítico en 128 pre púberes saludables, normopeso, entre 6 y 10 años. Se midieron, talla, peso, índice de masa corporal (IMC), porcentaje de grasa corporal (PGC), perímetro abdominal (PA) y perímetro de cadera (PC). Se determinó leptina (ng/ml) e Insulina (μU/L) en plasma por inmunoensayo y glicemia (mmol/L) por método enzimático. Se calculó HOMA-IR. Se hizo análisis de comparación y de correlación por sexo. RESULTADOS: Se confirmó en niñas un mayor nivel de leptina (6,8 ± 5 vs 3,3 ± 3,7; p = 0,000), insulina (7,1 ± 4,5 vs 5,2 ± 2,5; p = 0,016), PGC (22,4 ± 4,3 vs 18,6 ± 3,9; p = 0,000) y PC (67 ± 5,7 vs 65,0 ± 4,5; p = 0,019), y un menor índice cintura/cadera (0,84 ± 0,04 vs 0,88 ± 0,04; p = 0,000) comparado con varones. Las correlaciones de leptina con variables antropométricas fueron signifi cantes en ambos sexos, con mayor asociación en sexo femenino. La asociación del HOMA-IR con la leptina fue similar en ambos sexos. CONCLUSIONES: En prepúberes normopeso de 6 a 10 años, hay diferencias por sexo en adiposidad y en niveles de leptina, no asociadas con diferencias en el IMC ni en la resistencia a la insulina. La mayor asociación de leptina con adiposidad en las niñas podría estar relacionada con una elevada tasa de adipogénesis inducida por esta hormona.

INTRODUCTION: The prepubertal stage is a critical period of body fat development, in which leptin and insulin re sistance has been associated, however, there are few studies in normal-weight prepubescents. OBJECTIVE: To assess the relationship between leptin and body composition and insulin resistance in a group of normal-weight prepubescents. PATIENTS AND METHOD: Analytical cross-sectional study with 128 healthy prepubescents of normal weight, aged between 6 and 10 years. Height, weight, body mass index (BMI), body fat percentage (BFP), waist circumference (WC), and hip circumference (HC) were measured. Plasma leptin (ng/mL) and insulin (mU/L) were evaluated by immunoassay and glycemia (mmol/L) by enzymatic method. HOMA-IR was calculated. A comparison study and correlation analysis by sex were performed. RESULTS: Females presented higher values than males of leptin (6.8 ± 5 vs 3.3 ± 3.7; p = 0.000), insulin (7.1 ± 4.5 vs 5.2 ± 2.5; p = 0.016), BFP (22.4 ± 4.3 vs 18.6 ± 3.9; p = 0.000), and HC (67 ± 5.7 vs 65.0 ± 4.5; p = 0.019), and a lower waist/hip ratio (0.84 ± 0.04 vs 0.88 ± 0.04; p = 0.000). Leptin correlations with anthropometric variables were significant in both sexes, with greater association in females. The association of HOMA-IR with leptin was similar in both sexes. CONCLUSIONS: in normal-weight prepubescents aged between 6-10 years, there are sex differences in adiposity and leptin levels not associated with differences in BMI or insulin resistance. The greater association of leptin with adiposity in girls could be related to a high rate of adipogenesis induced by this hormone.

Análise do custo-efetividade da implantação de uma Unidade de Prática Integrada no cuidado de idosos com fratura do quadril / Cost-effectiveness analysis of the implantation of a Multidisciplinary Unit for elderly with hip fracture

Objetivo: Avaliar o custo-efetividade da internação de idosos com fratura do quadril antes e após a implantação de uma unidade multidisciplinar em um serviço de Ortopedia. Métodos: Estudo observacional retrospectivo de caráter quantitativo. Cinquenta e três idosos foram submetidos ao tratamento usual e 219 foram assistidos pela equipe multidisciplinar. Para avaliação dos custos e efetividade, foram utilizados os testes t de Student e qui-quadrado, com nível de significância de 0,05. Para a análise de custo-efetividade, com perspectiva do prestador de saúde, considerando os custos diretos médicos, foi utilizado o modelo estatístico do tipo árvore de decisão. A comparação entre as duas alternativas foi medida pela razão de custo-efetividade incremental. Resultados: Após a introdução da unidade multidisciplinar, o tempo entre o trauma e a cirurgia diminuiu de 4,21 dias para 2,47 (p < 0,001), a permanência, de 8,78 dias para 6,58 (p = 0,041) e a mortalidade, de 22,6% para 8,2% (p < 0,001). O custo do tratamento nos dois grupos não apresentou diferença significativa (p = 0,838). Conclusão: A introdução da unidade multidisciplinar se mostrou custo-efetiva, uma vez que presultou em menor tempo de internação hospitalar e menor mortalidade intra-hospitalar.

Objective: Evaluating the cost-effectiveness of the hospitalization of elderly with hip fracture before and after the implantation of a multidisciplinary unit in a service of orthopedics. Methods: Quantitative retrospective observational study. Fifty-three elderly were submitted to the usual treatment and 219 were assisted by the multidisciplinary team. The t Student test and the chisquared test were used to assess factors associated with cost variation and effectiveness, with a significance level of 0.05. For the cost-effectiveness analysis, from the perspective of the health provider considering the direct medical costs, the decision tree statistical model was used. The comparison between the two alternatives was measured by the incremental cost-effectiveness ratio. Results: After introduction of the multidisciplinary unit, the time between trauma and surgery decreased from 4.21 days to 2.47 (p < 0.001), the length of stay from 8.78 days to 6.58 (p = 0.041) and mortality from 22.6% to 8.2% (p < 0.001). The cost of treatment in the two groups did not present a significant difference (p = 0.838). Conclusion: The introduction of the multidisciplinary unit was cost-effective, as it resulted in shorter hospital stay and lower in-hospital mortality

Factores psicosociales y síndrome de Burnout en médicos generales de Tepic, Nayarit (México) / Psychosocial variables and Burnout syndrome in general physicians in Tepic, Nayarit (México)

Objetivo: Analizar los factores psicosociales que se asocian al síndrome de burnout en los médicos generales que laboran para una institución pública de salud en Tepic, Nayarit (México). Material y métodos: El estudio fue transversal analítico. La población la conformaron 97 médicos generales de manera voluntaria y bajo consentimiento informado. Para captar la información se emplearon dos instrumentos: la guía de identificación de factores psicosociales del Instituto Mexicano del Seguro Social y la escala de "Maslach Burnout Inventory (MBI)". Resultados: La prevalencia global para los factores psicosociales fue del 23.7% y del 32% para el síndrome de burnout. Se obtuvieron asociaciones significativas entre algunas áreas de los factores psicosociales con diferentes dimensiones del síndrome de burnout. Se demostró evidencia significativa entre ambas escalas, con un OR de 2.70, IC=1.02-4.30 y p= 0.0441. Conclusiones: Los médicos probablemente manifiestan el síndrome de burnout debido a la exigencia que implica velar la salud y el bienestar de las personas, adecuar las áreas laborales y organización del trabajo y las tareas podría ser una estrategia importante.

Objective: To examine the psychosocial factors that are associated with burnout syndrome in the general physicians who work for a public health institution in Tepic (Nayarit, Mexico). Material and methods: A cross-sectional analytical study was performed. The population was comprised of 97 general physicians who participated voluntarily and signed an informed consent. To collect the information, two instruments were used: the identification of psychosocial factors guide of the Mexican Social Security Institute and the scale of "Maslach Burnout Inventory (MBI). Results: The overall prevalence of psychosocial factors was 23.7% and 32% for the burnout syndrome. Significant associations were obtained between some areas of psychosocial factors with different dimensions of burnout syndrome. It showed significant evidence between both scales, with an OR of 2.70 and a value of p = 0.0441. Conclusions: The physicians may manifest burnout syndrome due to the requirement that deserves health care and welfare of people. Adjustment of work area, job organization and tasks could be an important strategy.

Evaluación de instituciones de cuidados prolongados para ancianos en el Distrito Federal. Una visión crítica / Evaluation of long-term care institutions for the elderly in Mexico City. A critical viewpoint

Analizar la infraestructura, el personal y la organización aistencial de las institutciones de cuidados prolongados para ancianos en el Distrito Federal y describir el estado funcional y los requerimientos asistenciales de sus beneficiarios. Material y métodos. Se censaron las instituciones ubicadas en el área metropolitana de la Ciudad de México (115), y se clasificaron en tres categorías: instituciones privadas con fines lucrativos, instituciones de la Junta de Asistencia Privada (JAP) y las gubernamentales. A partir de esta clasificación, se seleccionaron aleatoriamente 33 instituciones que fueron evaluadas mediante la encuesta de firevicius. Asimismo, se aplicó la escala de Kuntzman para evaluar a 617 residentes (31.5 por ciento del total). Resultados. El promedio de calificación se ubicó por debajo de 50 por ciento respecto a una puntaje total máximo de 280. Las instituciones privadas con fines lucrativos y un subgrupo de instituciones oficiales obtuvieron los más bajos puntajes; los más elevados fueron para las institutiones de la JAP y del Sistema Nacional para el Desarrollo Integral de la Familia. En general, las carencias más signficativas se ubicaron en infraestructura, calidad de personal y formación profesional. La edad promedio de los residentes es de 76 años; al contrastrar el estado funcional promedio de los ancianos con las características de la institución, encontramos una absoluta falta de correlación entre los recursos asistenciales disponibles y los requerimientos de la población. Conslusiones. La calidad de la atención que se brinda en instituciones de cuidados prolongados es con frecuencia deplorable, en particular dentro de las privadas. La ausencia de una normatividad y supervisión adecuadas ha permitido la proliferación de instituciones no calificadas para brindar sus servicios. Ante la disordancia entre los recursos disponibles y los requerimientos asistenciales, es necesario revisar las políticas de selección para el acceso de los ancianos a las instituciones, así como crear modalidades de capacitación en el trabajo

To critically analyze the level and quality of infrastructure, human resources and organization of long term care institutions for the elderly in Mexico City and to describe the functional status and care requirements of their residents. Material and methods. A census was made of the institutions located in the metropolitan area of Mexico City which totalled 115. These were classified according to their belonging to the public or private sector (for profit and non-profit). In each category we made a random selection of 33 institutions which were all assessed according to the methodology described by Firevicius and applied by paho in several countries in Latin- America. This questionnaire was applied by a single interviewer. Within the selected institutions, 30% of the residents, who were also randomly selected, were assessed by means of the Kuntzman's care requirements scale. Out of a total population of 1955, 617 (34%) residents were assessed. Results. The mean score obtained by the institutions was under 50% of the maximum possible score with a great deal of dispersion of the results. The lowest scores were identified in the private for profit sector and in a subgroup of public institutions. The highest scores were found among private non-profit institutions and a sector of the public institutions. The most important shortcomings identified were related to infrastructure and quality of human resources. The mean age of the institutionalized elderly is 76; 48.1% are functionally independent, 21.3% partially dependent and 30.6% totally dependent. When trying to correlate the mean functional status of the population of a given institution with its resources for care-giving we usually found no correlation. It is commonplace to find highly dependent populations living in poorly staffed or inadequately equipped institutions and vice versa. Conclusions. Quality of care in long term care institutions in Mexico City is often poor and this is particularly true for private for profit institutions. Lack of norms and supervision pertaining to the functioning of such institutions contributes greatly to this reality.

Niveles de IgM en sangre del cordón umbilical / Levels of IgM in the umbilical cord

Se determinaron los niveles de IgM en el cordón umbilical de 42 niños, 25 sanos y 17 cuyas madres tenían de patología durante el embarazo. Dos muestras de los casos con historia de patología resultaron elevadas para un 11.8%