Evaluation of the role of povidone­iodine in the prevention of surgical site infections.

Background: The occurrence of surgical site infections (SSIs) is associated with increased risk of mortality, development of other infections, and the need for reintervention, posing a significant health burden. The aim of this review was to examine the current data and guidelines around the use of antiseptic povidone­iodine (PVP-I) for the prevention of SSIs at each stage of surgical intervention. Methods: A literature search for selected key words was performed using PubMed. Additional papers were identified based on author expertise. Results: Scientific evidence demonstrates that PVP-I can be used at every stage of surgical intervention: preoperative, intraoperative, and postoperative. PVP-I is one of the most widely used antiseptics on healthy skin and mucous membranes for preoperative surgical site preparation and is associated with a low SSI rate. For intraoperative irrigation, aqueous PVP-I is the recommended agent and has been demonstrated to decrease SSIs in a range of surgical settings, and for postoperative wound healing, there is a growing body of evidence to support the use of PVP-I. Conclusions: There is a need for more stringent study designs in clinical trials to enable meaningful comparisons between antiseptic agents, particularly for preoperative skin preparation. The use of a single agent (PVP-I) at each stage of surgical intervention could potentially provide advantages, including economic benefits, over agents that can only be used at discrete stages of the surgical procedure. Key message: Evidence supports the use of PVP-I at all stages of surgical intervention, from preoperative measures (including skin preparation, preoperative washing, and nasal decolonization) to intraoperative irrigation, through to postoperative wound management. However, there is a need for more stringent study designs in clinical trials to enable meaningful comparisons between antiseptic agents, particularly for preoperative skin preparation.

Impact of expansion of primary care in child health: a population-based panel study in municipalities in the Brazilian Amazon.

OBJECTIVES: Considering the expansion of primary care in areas of difficult access in the Brazilian territory in recent decades, the aim of this study to evaluate the effect of the Family Health Strategy (FHS) expansion on hospitalisations due to ambulatory care-sensitive conditions (ACSCs) and mortality in children under 5 years of age in the state of Pará, Brazilian Amazon. METHODS: A longitudinal analysis from 2008 to 2017 was conducted for data collected from the SUS's database (DATASUS) using panel regression methods to determine the association between the expansion FHS coverage, ACSC rate, under 5 mortality rate and child mortality rate in municipalities of the state of Pará. RESULTS: There was an expansion of 40% of the population coverage of the FHS, in the same period there were 347 468.55 hospitalisations due to ASCSs of children under 5 years of age in the public health network in the state of Pará, which represented a reduction of almost 28% (p value <0001), and significant reduction of almost 57.67% in government hospital expenditures with hospitalisations between 2008 and 2017. In this period, there was also a significant decrease in the mortality rate in children under 5 years of age. CONCLUSIONS: Our findings reinforce the importance of the public health protection for the child population and the positive impacts of FHS in the state of Pará, in the Brazilian Amazon. The government actions aimed at reducing regional health disparities and the effort to strengthen primary care can improve health indicators of children and be an important strategy to developing countries.

Evidence of the effect of primary care expansion on hospitalizations: Panel analysis of 143 municipalities in the Brazilian Amazon.

BACKGROUND: The Family Health Strategy (FHS) became consolidated as a primary care model and gatekeeper for the Unified Health System (Sistema Único de Saúde, SUS) in the Brazil and it is considered one of the largest primary health care programmes in the world. Its rapid expansion allowed the SUS to meet the changing health care needs of the population remote localities of Brazilian municipalities. METHODS: In the present study, exploratory data analysis was performed using modelling to provide a general overview of the study and to delineate possible structural characteristics of the cross-sectional time-series data. Panel regression methods were used to assess the association between FHS coverage and ambulatory care-sensitive hospitalizations (ACSH rates) in the municipalities of Pará, in the Brazilian Amazon, from 2008 to 2017. RESULTS: The results showed strong evidence for the association between FHS coverage and ACSH rates, including reductions of 22% in preventable hospitalizations and 15% in hospital expenses that were directly linked to the 40% increase in FHS population coverage during the evaluated period. This expansion of primary care has mainly benefitted areas that are difficult to access and populations that were previously deprived of health care in the vast Amazon territory. CONCLUSIONS: The findings of this study show that the increase of the expansion of primary care reduces the preventable hospitalization and the hospital expenses. This reinforces the need for public protection of the health of populations at risk and the positive impacts of primary care in the Brazilian Amazon.

Establishing the Role of Unlinked Total Elbow Arthroplasty in Low Demand Patients: A Long-Term Follow-up Study.

INTRODUCTION: Experience with total elbow arthroplasty is scarce in most centers. It seems to have a significant rate of associated complications. Most studies are based on non-validated outcome measures and short-term results. MATERIAL AND METHODS: We selected patients undergoing unlinked total elbow arthroplasty, with a resultant sample of thirteen cases, with a mean postoperative follow-up of 72 months. We applied the Mayo Elbow Score and all patients underwent an X-ray study, prior to surgery and during the follow-up period. RESULTS: All patients have a systemic inflammatory condition. The mean Mayo score increased from 43 points preoperatively to 70 and 80 points at the intermediate follow-up period (with a mean of 15 months after the operation) and at the time of the latest follow-up evaluation (with a mean of 72 months after the operation). There was an increase in range of motion in all cases. There was one case of mechanical failure and two cases of transient ulnar neuropathy. DISCUSSION: Elbow dysfunction causes great loss in patient´s quality of life, incapacitating them for the simplest activities. Small improvements in range of motion and pain relief result in significant changes in the patient's functional ability. There is a demand to clarify the performance of total elbow arthroplasty in selected patient groups in order to throw more light on the relative roles of the available implants. CONCLUSIONS: The results obtained in this study seem to confirm the long-term benefit of the unlinked arthroplasty in severe joint dysfunction in patients with low physical demand, particularly in rheumatoid arthritis, a common and limiting condition in our population.

Introdução: Na maioria dos centros a experiência com a artroplastia total do cotovelo é escassa, parecendo existir taxas significativas de complicações associadas. A maioria dos estudos realizados até à data baseia-se em scores não validades e em resultados a curto prazo. Material e Métodos: Selecionamos doentes submetidos a artroplastia total do cotovelo, com uma amostra resultante de treze artroplastias, recorrendo ao mesmo tipo de prótese - não restritiva, de baixa demanda física, com seguimento médio pós-operatório de 72 meses. Aplicamos o score de Mayo e efetuamos um estudo radiográfico pré operatoriamente e durante o período de seguimento. Resultados: Todos os doentes possuem uma patologia inflamatória sistémica. O score de Mayo médio evoluiu de 43 pontos préoperatoriamente para 70 e 80 pontos no período de seguimento intermédio (em média 15 meses após a artroplastia) e no momento da última avaliação (em média 72 meses após a artroplastia) respetivamente. Registamos um aumento na amplitude de movimentos em todos os casos. Registamos um caso de falência mecânica e dois de neuropatia cubital transitória. Discussão: A disfunção do cotovelo acarreta grande perda na qualidade de vida do doente, incapacitando-o para atividades simples da sua vida diária. Pequenas melhorias na amplitude de movimentos e alívio da dor resultam em alterações significativas na capacidade funcional. Este estude surgiu da necessidade de esclarecer o resultado dos implantes existentes nos diferentes grupos populacionais. Conclusão: Bons resultados no alívio da dor e na capacidade funcional são obtidos a longo prazo com a artroplastia total do cotovelo não restritiva, que assim demonstra ser uma excelente opção terapêutica nos doentes de baixa demanda física com artropatia do cotovelo, nomeadamente na artrite reumatoide, condição comum e limitante na nossa população.

Development of an information system at the Strategic Management Support Office of the Brazilian Ministry of Health / Desarrollo de un sistema de información en la Sala de Apoyo a la Gestión Estratégica del Ministerio de Salud en Brasil / Desenvolvimento de um sistema de informações na Sala de Apoio à Gestão Estratégica do Ministério da Saúde do Brasil

The development of an information system is essential for the generation of information to support the decision-making process, extending its benefits throughout the public sector especially to healthcare related organisms. To guarantee a timely government intervention, it is essential to identify problems, develop and evaluate public policy and activity, coordinate implementation, and monitor and control the provision of related services. The objective of the present study is to describe the development of a public health care information system in the Brazilian Health Ministry. In order to achieve that, a study was conducted on the development of the information system in the Strategic Management Support Office of the aforementioned Ministry. The results show that the development of an information system expands the array of relevant and reliable information through the systemic collection, integration, analysis and data presentation, which can be a key factor for the improvement of health services to the Brazilian population.

El desarrollo del sistema de información es esencial para generar información destinada al proceso de toma de decisiones, cuyos beneficios también se aplican al sector público y especialmente en lo que a la salud se refiere, considerando que la intervención oportuna es fundamental para la identificación de problemas, desarrollar y evaluar las políticas y acciones, organizar la ejecución y supervisar y controlar la prestación de servicios en este campo. El presente estudio tiene por objetivo la descripción del desarrollo de un sistema de información dentro del Ministerio de la Salud en Brasil. Se realizó un estudio sobre el desarrollo del sistema de información en la Sala de Apoyo a la Gestión Estratégica de dicho Ministerio. Los resultados muestran que el desarrollo del sistema de información en el Ministerio de Salud amplía el espectro de información relevante y confiable a través de la recaudación, integración, análisis y presentación de los datos, desde diferentes ángulos, que puede ser un factor clave en la mejora de los servicios de salud a la población.

O desenvolvimento de sistema de informações é fundamental para gerar informações ao processo de tomada de decisão, isto se aplica também ao setor público e, principalmente na área da saúde, cuja intervenção em tempo oportuno é essencial para identificar problemas, desenvolver e avaliar as políticas e ações, organizar a execução, além de acompanhar e controlar a prestação dos serviços de saúde. O objetivo do estudo é descrever o desenvolvimento de um sistema de informações para a área de saúde pública do Brasil. Para atingir o objetivo foi realizado um estudo sobre o desenvolvimento do sistema de informações na Sala de Apoio à Gestão Estratégica do Ministério da Saúde. Os resultados mostram que o desenvolvimento de SI no Ministério da Saúde amplia o espectro de informação relevante e fidedigna por meio da coleta, integração, análise e apresentação dos dados, sob diferentes prismas, o que pode ser um fator chave na melhoria dos serviços de saúde a população brasileira.