Complicaciones quirúrgicas: un tema complicado / Surgical complications: A complicated topic

Introducción. Las complicaciones quirúrgicas son un tema relevante, difícil de abordar e inmerso en una cultura punitiva y vergonzosa hacia el médico. La ausencia de una medición sistemática, confiable y socializada es un desafío para los servicios quirúrgicos. El desconocimiento de las medidas de frecuencia y el impacto de las complicaciones quirúrgicas en las instituciones, y a su vez, dentro de los servicios quirúrgicos, evidencia la necesidad de abordar el tema desde una perspectiva de mejoramiento continuo. Métodos. Se hizo un análisis crítico y reflexivo sobre la conceptualización de las complicaciones quirúrgicas, los avances en su proceso de evaluación y su utilidad como indicador de calidad en los servicios quirúrgicos. Se ilustraron las metodologías con ejemplos clínicos que facilitan su entendimiento y aplicabilidad. Resultados. El trabajo inicial de los doctores Clavien & Dindo se ha fortalecido al considerar integralmente el proceso de atención quirúrgica como un indicador de calidad de la atención en salud. El desarrollo del Índice Integral de Complicaciones (CCI), para los eventos en el período posoperatorio, representa un paso adicional en el abordaje del problema. Su potencialidad en el análisis de los eventos ofrece una oportunidad para la implementación y la investigación en el tema. Conclusiones. Las complicaciones quirúrgicas representan un indicador robusto que permite evaluar el desempeño individual y grupal en un servicio quirúrgico. Hay metodologías recientes que deben ser incorporadas en la actividad asistencial de los cirujanos. Representan un insumo en la educación médica a todo nivel e, igualmente, un elemento de crecimiento personal y académico para todo cirujano.

Introduction. Surgical complications are a relevant topic, difficult to address and immersed in a punitive and shameful culture towards the doctor. The absence of systematic, reliable, and socialized measurement is a challenge for surgical services. The lack of knowledge of frequency measurements and the impact of surgical complications in institutions, and in turn, within surgical services, shows the need to address the issue from a perspective of continuous improvement. Methods. A critical and reflective analysis was carried out on the conceptualization of surgical complications, the advances in their evaluation process and their usefulness as an indicator of quality in surgical services. The methodologies were illustrated with clinical examples that facilitate their understanding and applicability. Results. The initial work of doctors Clavien & Dindo has been strengthened by comprehensively considering the surgical care process as an indicator of quality of health care. The development of the Comprehensive Complication Index (CCI), for events in the postoperative period, represents an additional step in addressing the problem. Its potential in the analysis of events offers an opportunity for implementation and research on the topic. Conclusions. Surgical complications represent a robust indicator that allows evaluating individual and group performance in a surgical service. There are recent methodologies that must be incorporated into the care activity of surgeons. They represent an input in medical education at all levels and equally, an element of personal and academic growth for every surgeon.

[Calculation of the alcohol per capita consumption in Brazil: using national dataCálculo del indicador del consumo de alcohol per cápita en Brasil: uso de datos nacionales]. / Cálculo do indicador de consumo de álcool per capita no Brasil: uso de dados nacionais.

Objective: To calculate the alcohol per capita consumption (APC) in Brazil (Brazil APC) using national data and to establish the Brazil APC as gold standard for the country, replacing the indicator previously calculated by the World Health Organization (WHO) based on international data. Method: The Brazilian public data sources necessary for calculating the recorded APC were selected, and the alcohol concentration was defined by beverage category. For the variables of tourist APC and unrecorded APC, which are unavailable in Brazil, estimates from the United Nations (UN) and the WHO were used. The Brazil APC indicator was calculated and compared to the indicator produced by the WHO through analysis of the medians obtained for the period from 2005 to 2020. Results: The national alcohol consumption indicator was 9.2 liters per capita in 2005, reaching 9.8 in 2020. The WHO indicator showed a consumption of 8.4 liters per capita in 2005, decreasing until 2016 and slightly increasing to 7.8 in 2020. Conclusion: The Brazil APC was calculated based on national sources and showed a distinct trend compared to the WHO indicator, which showed a decrease. The regular and transparent provision of this indicator through government channels will support the development of policies to address alcohol consumption in the country.

Objetivo: Calcular el indicador del consumo de alcohol per cápita en Brasil a partir de datos nacionales, con miras a establecerlo como patrón de referencia para el país en sustitución del indicador calculado anteriormente por la Organización Mundial de la Salud a partir de datos internacionales. Métodos: Se seleccionaron las fuentes públicas de datos de Brasil necesarias para estructurar el cálculo del consumo de alcohol per cápita registrado y se definió la concentración de alcohol por clase de bebida. Para las variables de consumo de alcohol per cápita por parte de turistas y consumo per cápita no registrado, que no están disponibles en Brasil, se utilizaron estimaciones de las Naciones Unidas y de la Organización Mundial de la Salud. Se calculó el indicador del consumo de alcohol per cápita en Brasil y se comparó con el indicador elaborado por la OMS mediante un análisis de las medianas correspondientes al período 2005-2020. Resultados: El indicador nacional del consumo de alcohol fue de 9,2 litros per cápita en el 2005, con un aumento a 9,8 en el 2020. El indicador de la Organización Mundial de la Salud mostró un consumo de 8,4 litros per cápita en el 2005, con una reducción hasta el 2016 y un leve aumento a 7,8 en el 2020. Conclusión: Se calculó el consumo de alcohol per cápita en Brasil a partir de fuentes nacionales, lo que mostró una tendencia distinta de la tendencia descendente del indicador de la Organización Mundial de la Salud. La disponibilidad transparente y regular de este indicador por medio de los canales gubernamentales permitirá su seguimiento, con lo cual se podrán formular políticas para enfrentar el consumo de alcohol en el país.

Maternal and perinatal health indicators in Brazil over a decade: assessing the impact of the COVID-19 pandemic and SARS-CoV-2 vaccination through interrupted time series analysis.

Background: Few studies have evaluated the effects of the Coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, on maternal and perinatal health at a populational level. We investigated maternal and perinatal health indicators in Brazil, focusing on the effects of the COVID-19 pandemic, and SARS-CoV-2 vaccination campaign for pregnant women. Methods: Utilizing interrupted time series analysis (January 2013-December 2022), we examined Maternal Mortality Ratio, Perinatal Mortality Rate, Preterm Birth Rate, Cesarean Section Rate, and other five indicators. Interruptions occurred at the pandemic's onset (March 2020) and pregnant women's vaccination (July 2021). Results were expressed as percent changes on time series' level and slope. Findings: The COVID-19 onset led to immediate spikes in Maternal Mortality Ratio (33.37%) and Perinatal Mortality Rate (3.20%) (p < 0.05). From March 2020 to December 2022, Cesarean Section and Preterm Birth Rates exhibited upward trends, growing monthly at 0.13% and 0.23%, respectively (p < 0.05). Post start of SARS-CoV-2 vaccination (July 2021), Maternal Mortality Ratio (-34.10%) and Cesarean Section Rate (-1.87%) promptly declined (p < 0.05). Subsequently, we observed a monthly decrease of Maternal Mortality Ratio (-9.43%) and increase of Cesarean Section Rate (0.25%) (p < 0.05), while Perinatal Mortality Rate and Preterm Birth Rate showed a stationary pattern. Interpretation: The pandemic worsened all analyzed health indicators. Despite improvements in Maternal Mortality Ratio, following the SARS-CoV-2 vaccination campaign for pregnant women, the other indicators continued to sustain altered patterns from the pre-pandemic period. Funding: No funding.

Sustainable Development Goals' health-related indicators for Brazil and Ecuador: an analysis for the period of 1990-2019.

OBJECTIVE: This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019. STUDY DESIGN: Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study. METHODS: Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries. RESULTS: Both countries have made progress on child stunting (Brazil: PC = -38%; Ecuador: PC = -43%) and child wasting prevalences (Brazil: PC = -42%; Ecuador: PC = -41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = -75%; Ecuador: PC = -60%) and neonatal mortality rates (Brazil: PC = -69%; Ecuador: PC = -51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = -40%; Ecuador: PC = -58%), tuberculosis (Brazil: PC = -27%; Ecuador: PC = -55%) and malaria incidences (Brazil: PC = -97%; Ecuador: PC = -100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = -89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = -37%; Ecuador: PC = -40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = -67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%). CONCLUSIONS: Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters.

[Quality of health information in Mexico in the OECD context: 2017-2021]. / Calidad de la información en salud de México en el contexto de la OCDE: 2017-2021.

OBJECTIVE: To evaluate the health information system (HIS) of Mexico according to the information reported to the Organization for Economic Co-operation and Development (OECD). The ultimate goal is to identify the improvements that should be considered. METHOD: Health indicators published by the OECD (2017 to 2021) are analyzed according to 11 thematic groups. Coverage (quantity and type of indicators reported by thematic group) and quality of information were assessed, according to OECD guidelines. RESULTS: Mexico reported annually 14 of 378 indicators (3.7%), and discontinuously 204. In no group were all indicators reported annually, except for the two on COVID-19. Three out of 88 were reported annually on use of services; and none on health status, quality of care and pharmaceutical market. Twelve indicators (5.5% of those reported by Mexico, 3.2% of the full OECD set) had optimal quality and annual reporting. 57.7% of the reported indicators had at least one quality defect. CONCLUSIONS: Within the framework of the standards set by the OECD, of which Mexico is a member, the Mexican HIS presents significant deficits in coverage and quality of information. These results should be considered to implement improvement initiatives.

Avaliação de indicadores sociais e de saúde em municípios de Minas Gerais conforme tipologia rural-urbano / Assessment of social and health indicators in municipalities of Minas Gerais according to the rural-urban typology

RESUMO O presente artigo tem o objetivo de avaliar indicadores sociais e de saúde de municípios conforme a tipologia rural-urbano. Trata-se de estudo ecológico que utilizou dados oficiais de acesso público dos 853 municípios do estado de Minas Gerais, Brasil. Foram conduzidas análises descritivas e bivariadas através da Regressão de Poisson e Teste de Kruskal-Wallis. Do total de municípios, 547 (64,12%) são rurais. A maior média do Índice de Desenvolvimento Humano Municipal (IDH-M) foi observada entre os municípios urbanos. A maior média de cobertura da Estratégia Saúde da Família (ESF) foi verificada entre os municípios rurais, nos quais também foram demonstrados os melhores resultados para os indicadores de mortalidades infantil, prematura e por causas evitáveis, homogeneidade vacinal e prevalência de desnutrição. Os achados deste estudo evidenciam que uma maior cobertura da ESF está associada à ocorrência de melhores condições gerais de vida e de saúde das populações atendidas em municípios de tipologia rural. Recomenda-se aos gestores de saúde o fomento à consolidação da ESF em comunidades com contextos socioeconômicos e culturais desfavoráveis, como localidades rurais remotas e aglomerados urbanos, e o estabelecimento de ações intersetoriais com impacto positivo na saúde.

ABSTRACT This article aims to evaluate social and health indicators of municipalities according to the rural-urban typology. This is an ecological study that used official publicly accessible data from the 853 municipalities in the state of Minas Gerais, Brazil. Descriptive and bivariate analysis were carried out using Poisson Regression and Kruskal-Wallis Test. 547 (64.12%) are rural municipalities. The highest average of the Municipal Human Development Index (MHDI) was observed among urban municipalities. The highest average coverage of the Family Health Strategy (FHS) was found among rural municipalities. In these municipalities, the best results were shown for the indicators of infant mortality, premature mortality and mortality from preventable causes, vaccine homogeneity and prevalence of malnutrition. The findings of this study show that greater FHS coverage is associated with the occurrence of better general living and health conditions in the populations served in rural municipalities. It is recommended that health managers encourage the consolidation of the FHS in communities with unfavorable socioeconomic and cultural contexts, such as remote rural locations and urban agglomerations, and the establishment of intersectoral actions with a positive impact on health.

Estimación del riesgo cardiovascular en pacientes con diabetes mellitus tipo 2

Introducción: Las personas diabéticas tienen entre dos y tres veces más riesgo de morbilidad y mortalidad cardiovascular que aquellas que no padecen la enfermedad. Objetivo: Estimar el riesgo cardiovascular en pacientes con diabetes mellitus tipo 2 atendidos en un Área de Salud. Métodos: Se realizó un estudio descriptivo y trasversal de 103 pacientes con diabetes mellitus tipo 2, pertenecientes al Consultorio Médico de la Familia No. 23 del policlínico Carlos J Finlay, municipio Songo-La Maya en la provincia Santiago de Cuba, desde enero hasta diciembre de 2023. Se estudiaron variables cualitativas y cuantitativas (edad, año de diagnóstico y duración de la enfermedad); se estimó el riesgo cardiovascular según el modelo para la predicción del riesgo en personas con diabetes tipo 2. Resultados: Se observó predominio del sexo femenino (58,3 %). La mayoría de los pacientes tenían hipertensión arterial (76 %) y microalbuminuria (31,2 %). La edad media de los pacientes fue de 65,5 años y como promedio tenían un tiempo de evolución de la diabetes de 8,6 años. La evaluación del riesgo cardiovascular ubicó a 43,3 % de la población en un nivel moderado y 25,7 % con alto riesgo. Conclusiones: Los pacientes diabéticos estudiados mostraron un riesgo de moderado a alto de presentar eventos cardiovasculares. Se hace necesario realizar intervenciones educativas en estos pacientes y sus familiares para lograr cambios favorables en los estilos de vida y mejorar el control de la enfermedad, previniendo así complicaciones y la ocurrencia de eventos fatales en los próximos años.

Introduction: Diabetic people have between two and three times more risk of cardiovascular morbidity and mortality than those who do not suffer from the disease. Objective: To estimate cardiovascular risk in patients with type 2 diabetes mellitus treated in a Health Area. Methods: A descriptive and cross-sectional study was carried out on 103 patients with type 2 diabetes mellitus, belonging to the Family Medical Office No. 23 of the Carlos J. Finlay polyclinic, Songo-La Maya municipality, Santiago de Cuba province, from January to December 2023. Qualitative variables and quantitative (age, year of diagnosis and duration of the disease) were studied; Cardiovascular risk was estimated according to the model for predicting cardiovascular risk in people with type 2 diabetes. Results: A predominance of the female sex was observed (58.3%). Most patients had arterial hypertension (76.0%) and microalbuminuria (31.2%). The average age of the patients was 65.5 years and on average they had a duration of diabetes of 8.6 years. The cardiovascular risk evaluation placed 43.3% of the population at a moderate level and 25.7% at high risk. Conclusions: The diabetic patients studied showed a moderate to high risk of presenting cardiovascular events. It is necessary to carry out educational interventions in these patients and their families to achieve favorable changes in lifestyles and improve disease control, thus preventing complications and the occurrence of fatal events in the coming years.

Quality of healthcare services to reduce leprosy in Brazil: a trend analysis from 2001 to 2020 / Qualidade dos serviços de atenção à saúde para redução da hanseníase no Brasil: análise de tendência de 2001 a 2020

ABSTRACT Objective: To analyze the temporal trend of healthcare services quality indicators to reduce leprosy in Brazil, over a 20-year period. Methods: This is an epidemiological study with a temporal trend, whose data were extracted from the Notifiable Diseases Information System. Indicators were constructed from the Ministry of Health Technical-Operational Manual that presents the Guidelines for Surveillance, Care and Elimination of Leprosy as a Public Health Problem. For trend analysis of the selected indicators, the Prais-Winsten model was used and the Average Annual Growth Rate (AAGR) was also calculated. Results: In the 20-year time series investigated here, 732,959 cases of leprosy were reported in Brazil. The trend was stationary for: new leprosy cases cure rate (β=-0.000; p=0.196; AAGR=-0.2), new leprosy cases drop out rate (β=-0.001; p=0.147; AAGR=-0.4), new leprosy cases contact tracing rate (β=-0.001; p=0.112; AAGR=1.6), new cases of leprosy with degree physical disability assessment rate among new cases (β=-0.000; p=0.196; AAGR=-0.2) and cases cured in the year with the degree of physical disability assessed (β=0.002; p=0.265; AAGR=0.5); while the indicator of recurrence rate among cases reported in the year (β=0.019; p<0.001; AAGR=0.5) showed an increasing trend. Conclusion: Based on the evaluation of indicators to assess the quality of healthcare services to reduce leprosy, it was evident that Brazil has major challenges for its full implementation, with improvements being necessary in the quality of care service offered to the population.

RESUMO Objetivo: Analisar a tendência temporal dos indicadores de qualidade dos serviços de atenção à saúde para redução da hanseníase no Brasil, no período de 20 anos. Métodos: Trata-se de um estudo epidemiológico de tendência temporal, cujos dados foram extraídos do Sistema de Informação de Agravos de Notificação (SINAN). Foram construídos indicadores a partir do Manual Técnico-Operacional, que apresenta as Diretrizes para Vigilância, Atenção e Eliminação da Hanseníase como Problema de Saúde Pública do Ministério da Saúde. Para análise de tendência dos indicadores selecionados, utilizou-se o modelo de Prais-Winsten e calculou-se a Taxa de Incremento Anual (TIA). Resultados: Na série temporal de 20 anos aqui investigada, foram notificados no Brasil 732.959 casos de hanseníase. A tendência mostrou-se estacionária para cura de hanseníase entre os casos novos (β=-0,000; p=0,196; TIA=-0,2); casos de hanseníase em abandono de tratamento entre os casos novos (β=-0,001; p=0,147; TIA=-0,4); contatos examinados de casos novos de hanseníase (β=-0,001; p=0,112; TIA=1,6); casos novos de hanseníase com grau de incapacidade física avaliado no diagnóstico (β=-0,000; p=0,196; TIA=-0,2); e casos curados no ano com grau de incapacidade física avaliada (β=0,002; p=0,265; TIA=0,5); enquanto o indicador casos de recidiva entre os casos notificados no ano (β=0,019; p<0,001; TIA=0,5) apresentou tendência crescente. Conclusão: Com base na avaliação dos indicadores para mensurar a qualidade dos serviços de atenção à saúde para redução da hanseníase, ficou evidente que o Brasil possui grandes desafios para sua execução plena, sendo necessárias melhorias na qualidade do serviço ofertado à população.

Indicadores de desempeño de la Atención Primaria del Programa Previne Brasil / Performance indicators of Primary Care of the Previne Brasil Program / Indicadores de desempenho da Atenção Primária do Programa Previne Brasil

Objetivo: analizar el alcance de los indicadores de desempeño del Programa Previne Brasil de Atención Primaria a la Salud. Método: para ello, se realizó un estudio observacional, descriptivo, con abordaje cuantitativo, utilizando datos secundarios, referentes a los años 2020 y 2021, en las cinco regiones brasileñas (Norte, Nordeste, Sur, Sudeste y Centro Oeste), disponibles en el Sistema de Información de la Atención Primaria de Salud. Se utilizaron estadísticas descriptivas, frecuencias relativas y medidas de tendencia central y modelación semiparamétrica considerando un intervalo de confianza del 5%. Resultados: hubo evidencia de evolución en las tasas de los indicadores de desempeño en la mayoría de las regiones brasileñas en 2021, en comparación con 2020, sin embargo, las Regiones Norte y Centro Oeste presentaron tasas incipientes o negativas, en comparación con la Región Sudeste. A pesar de la evolución en las tasas de los indicadores, pocos estados lograron alcanzar las metas establecidas por el Ministerio de Salud para las acciones estratégicas de atención prenatal y salud de la mujer, mientras que ningún estado logró la meta en la acción estratégica de enfermedades crónicas. Conclusión: se considera importante acompañar la evolución de los indicadores actuales, previendo su calificación para que puedan evaluar el seguimiento y la atención primaria en salud, así como garantizar la consecución de las metas asegurando la financiación de las acciones de atención primaria.

Objective: to analyze the scope of the performance indicators of the Previne Brasil Program of Primary Health Care. Method: an observational, descriptive study with a quantitative approach was carried out using secondary data, referring to the years 2020 and 2021, in the five Brazilian regions (North, Northeast, South, Southeast and Midwest), available in the Primary Health Care Information System. Descriptive statistics, relative frequencies and measures of central tendency and semiparametric modeling were used considering a 5% confidence interval. Results: there was evidence of evolution in the rates of performance indicators in most Brazilian regions in 2021, compared to 2020, however, the North and Midwest regions had incipient or negative rates, compared to the Southeast region. Despite the evolution in the rates of the indicators, few States managed to reach the goals established by the Ministry of Health for the strategic actions of prenatal care and women's health; and no state achieved the goal in strategic action on chronic diseases. Conclusion: it is considered important to monitor the evolution of current indicators, envisioning their qualification so that they can evaluate primary health care and assistance, as well as guarantee the achievement of goals by ensuring funding for primary care actions.

Objetivo: analisar o alcance dos indicadores de desempenho do Programa Previne Brasil da Atenção Primária à Saúde. Método: realizou-se um estudo observacional, descritivo, com abordagem quantitativa, utilizando dados secundários referentes aos anos de 2020 e 2021, nas cinco regiões brasileiras (Norte, Nordeste, Sul, Sudeste e Centro-Oeste), disponíveis no Sistema de Informação da Atenção Primária à Saúde. Foram utilizadas estatística descritiva, frequências relativas e medidas de tendência central e modelagem semiparamétrica considerando o intervalo de confiança de 5%. Resultados: evidenciou-se a evolução nas taxas dos indicadores de desempenho na maioria das regiões brasileiras em 2021, comparadas com 2020, todavia as Regiões Norte e Centro-Oeste tiveram taxas incipientes ou negativas, se comparadas com a Região Sudeste. Apesar da evolução nas taxas dos indicadores, poucos estados conseguiram alcançar as metas estabelecidas pelo Ministério da Saúde para as ações estratégicas de pré-natal e saúde da mulher, enquanto nenhum estado alcançou a meta na ação estratégica de doenças crônicas. Conclusão: considera-se importante o acompanhamento da evolução dos atuais indicadores, vislumbrando a sua qualificação, para que possam avaliar a assistência e a atenção primária à saúde, bem como garantir o alcance das metas assegurando o financiamento para as ações da atenção primária.

[Basic health indicators in the NutrIMSS program: a retrospective study]. / Indicadores básicos de salud en el programa NutrIMSS: estudio retrospectivo.

Background: The NutrIMSS program is granted to populations with chronic conditions to improve basic health indicators and its effectiveness in this population is unknown. Objective: To analyze the change in the basic health indicators of patients who attended the NutrIMSS Program, at the UMF No. 2 of the IMSS in Mexico City, during the period 2018 to 2019. Material and methods: From 105 files of IMSS beneficiaries, a retrospective cohort study was carried out considering two measurements, before and after the NutrIMSS program. To evaluate the average change over time of health indicators, GEE models (Generalized Estimation Equations) and multiple linear regression models were used. Statistical analysis was used using the statistical program StataCorp 2015. Results: Patients who attended the Program showed changes between the beginning and end of the period with an average of three months of follow-up. They presented a decrease in the following health indicators: body weight of 1 kg, body mass index: 0.8 kg/m2, glucose of 13 mg/dL, triglycerides of 57 mg/dL and cholesterol of 17 mg/dL (p < 0.005 in all cases). There was no difference in the level of blood pressure. Conclusions: The NutrIMSS program influenced the improvement of the health indicators of the population of the program and is an ally to improve the health of the IMSS beneficiary population.

Introducción: el programa NutrIMSS se otorga a población con padecimientos crónicos para mejorar los indicadores básicos de salud; sin embargo, se desconoce su efectividad en esta población. Objetivo: analizar el cambio en los indicadores básicos de salud de pacientes que acudieron al programa NutrIMSS, en la UMF No. 2 del Instituto Mexicano del Seguro Social (IMSS) en la Ciudad de México, durante el periodo 2018 a 2019. Material y métodos: a partir de 105 expedientes de derechohabientes del IMSS se realizó un estudio de cohorte retrospectiva, considerando dos mediciones, antes y después del programa NutrIMSS. Para evaluar el cambio promedio en el tiempo de los indicadores de salud se utilizaron modelos GEE (Ecuaciones de Estimación Generalizadas) y modelos de regresión lineal múltiple. Para el análisis estadístico se utilizó el programa estadístico StataCorp 2015. Resultados: los pacientes que acudieron a NutrIMSS mostraron cambios entre el inicio y el fin del periodo, con un promedio de seguimiento de tres meses. Presentaron una disminución en los siguientes indicadores de salud: peso corporal de 1 kg, índice de masa corporal: 0.8 kg/m2, glucosa de 13 mg/dL, triglicéridos de 57 mg/dL y colesterol de 17 mg/dL (p < 0.005, en todos los casos). No se presentó diferencia en el nivel de la tensión arterial. Conclusiones: el programa NutrIMSS influyó para mejorar los indicadores de salud de la población del programa y es un aliado en la mejora de la salud de la población derechohabiente del IMSS.

O HIV/Aids no Estado do Rio de Janeiro: cenário clínico-epidemiológico e rede de tratamento e internação / HIV/AIDS in the State of Rio de Janeiro: clinical-epidemiological scenario and treatment and hospitalization network

O Brasil vem incorporando, desde o início da epidemia de Aids até os dias atuais, tecnologias mais modernas para o controle do HIV/Aids e para o adequado diagnóstico. Os recursos de diagnóstico e tratamento disponíveis no SUS oferecem tratamento para a infecção, permitindo que as pessoas vivendo com HIV/Aids (PVHA) tenham boa qualidade de vida. O cenário epidemiológico atual do HIV/Aids no Estado do Rio de Janeiro apresenta taxas de detecção e mortalidade maiores que a média nacional, a despeito de esforços e investimentos. Assim, este trabalho apresenta o cenário epidemiológico do HIV/Aids no Estado do Rio de Janeiro no período de 2017 a 2022; caracteriza, através dos dados coletados nos sistemas de informação, as etapas do cuidado do HIV/Aids no ERJ em 2022 e descreve a rede de tratamento e internação para as PVHA no Estado do Rio de Janeiro em 2022. Trata-se de pesquisa exploratória, com dados secundários oriundos dos sistemas de informação utilizados no cuidado às PVHA (SICLOM ­ Sistema de controle logístico de medicamentos e SISCEL ­ Sistema de Controle de Exames Laboratoriais da Rede Nacional de Contagem de Linfócitos CD4+/CD8+ e Carga Viral) além do SINAN e do SIM. De 2017 até 2022, foram notificados no SINAN 27.548 casos de HIV, 17.254 casos de Aids e 4.833 gestantes infectadas pelo HIV. No mesmo período, foram registrados no SIM 8.492 óbitos por Aids no ERJ, com decréscimo de aproximadamente 10% de 2017 para 2021. Em 2021, 18,9% das Declarações de Óbito (D.O.) por Aids tinham menção de tuberculose. Foi identificado que aproximadamente 46% das pessoas diagnosticadas com HIV no ERJ apresentaram-se tardiamente a um serviço de saúde (CD4<350cels/ml). Em 2022, uma pessoa levava em média 26 dias para iniciar o tratamento após realizar o 1º CD4 no ERJ, 10 dias a mais que no Estado de São Paulo. Atualmente, o país conta com um total de 1.314 unidades distribuidoras de medicamentos (UDM), 19,4% das quais localizadas no Rio de Janeiro e 18,2% em São Paulo. Considerando o cenário apresentado, uma das hipóteses levantadas são a possibilidade de a coinfecção TB HIV contribuir para a mortalidade acima da média nacional. Outra possibilidade é que nossa ampla rede de tratamento não acarreta maior acesso e a rede de internação possui uma concentração de leitos na capital, exigindo bom sistema de regulação para que o acesso possa ser equânime. (AU)

Since the beginning of the Aids epidemic to the present day, Brazil has been incorporating more modern technologies for the control of HIV/Aids and for adequate diagnosis. The diagnostic and treatment resources available in the SUS offer treatment for the infection, allowing people living with HIV/Aids (PLWHA) to have a good quality of life. The current epidemiological scenario of HIV/Aids in the State of Rio de Janeiro presents detection and mortality rates higher than the national average, despite efforts and investments. The clinical monitoring indicators for PLWHA residing in the State of Rio de Janeiro (ERJ) do not present results compatible with the epidemiological scenario. Therefore, this work presents the epidemiological scenario of HIV/Aids in the State of Rio de Janeiro from 2017 to 2022; characterize, through data collected in information systems, the stages of HIV/Aids care in ERJ in 2022 and describe the treatment and hospitalization network for PLWHA in the State of Rio de Janeiro in 2022. This is exploratory research, with secondary data originating from information systems used in the care of PLWHA (SICLOM ­ Medication Logistics Control System and SISCEL ­ Laboratory Testing Control System of the National CD4+/CD8+ Lymphocyte Count Network and Viral Load) in addition to SINAN and SIM. From 2017 to 2022, 27,548 cases of HIV, 17,254 cases of Aids and 4,833 pregnant women infected with HIV were reported on SINAN. In the same period, 8,492 deaths due to Aids were registered in the SIM in ERJ, with a decrease of approximately 10% from 2017 to 2021. In 2021, 18.9% of Death Certificates (D.O.) due to Aids mentioned tuberculosis. It was identified that approximately 46% of people diagnosed with HIV in ERJ presented to a health service late (CD4<350cells/ml). In 2022, it took an average of 26 days for a person to start treatment after undergoing the 1st CD4 in ERJ, 10 days longer than in the State of São Paulo. Currently the country has a total of 1,314 Medicine Distribution Units (UDM), 19.4% of which are located in Rio de Janeiro and 18.2% in São Paulo. Considering this scenario, one hypothesis is the possibility that TB HIV co-infection contributes to mortality above the national average. Another possibility is that our wide treatment network does not lead to greater access and the hospitalization network has a concentration of beds in the capital, requiring a good regulation system so that access can be equitable. (AU)

Comportamiento de algunos indicadores del Programa Materno Infantil en un consultorio médico de la familia. Cienfuegos, 2013-2022

Fundamento el Consultorio del Médico de la Familia resulta uno de los eslabones de esa larga cadena que es el Sistema Nacional de Salud. El funcionamiento de cada uno de ellos en el contexto de las comunidades guarda una relación directa con los resultados de trabajo a través de los años. Objetivo caracterizar el comportamiento de algunos indicadores del Programa Materno Infantil en un consultorio del médico de la familia. Métodos se realizó un estudio descriptivo, en el consultorio número 11 del área de Salud 5, en Cienfuegos, en el período 2013-2022. Fueron incluidas las embarazadas captadas en ese tiempo (n=163) y los nacidos en igual periodo (n=162). Las variables estudiadas: edad materna, número de partos, edad gestacional al parto, nacidos vivos, peso al nacer, lactancia materna, cifras de hemoglobina y alteraciones genéticas. Resultados predominaron los embarazos en mujeres de 20-24 años de edad (38 %). El 98 % de los embarazos fueron a término. Las alteraciones genéticas no fueron frecuentes (0,6 %). El 94 % de los niños que recibieron lactancia materna exclusiva mostraron cifras de hemoglobina mayores o iguales a 110g/l. La adherencia a la lactancia materna exclusiva hasta los seis meses alcanzó el 65 % en todo el periodo. Conclusiones el embarazo en adolescentes, el bajo peso al nacer, la prematuridad y las alteraciones genéticas no constituyeron problemas de salud en la población y periodo de estudio. Hubo una estrecha relación entre la lactancia materna exclusiva y las cifras de hemoglobina normales al sexto mes del nacimiento.

Foundation the Family Doctor's Office is one of the links in that long chain that is the National Health System. The operation of each one of them in the communities context is directly related to the work results over the years. Objective to characterize the behavior of some Maternal and Child Program indicators in a family doctor's office. Methods a descriptive study was carried out in the doctor's office 11 from the Health area 5, in Cienfuegos, from 2013 to 2022. Pregnant women captured at that time (n=163) and those born in the same period (n=162) were included. The studied variables: maternal age, number of deliveries, gestational age at delivery, live births, birth weight, breastfeeding, hemoglobin levels and genetic alterations. Results there was a predominance of pregnancies in women 20-24 years of age (38%). 98% of pregnancies were at term. Genetic alterations were not frequent (0.6%). 94% of the children who received exclusive breastfeeding had hemoglobin levels greater than or equal to 110g/l. Adherence to exclusive breastfeeding up to six months reached 65% throughout the period. Conclusions adolescent pregnancy, low birth weight, prematurity and genetic alterations did not constitute health problems in the population and study period. There was a close relationship between exclusive breastfeeding and normal hemoglobin levels at the sixth month after birth.

Social inequalities in self-perceived health in Chile, does the urban environment matter?: a cross-sectional study.

BACKGROUND: The health of a population is determined by urban factors such as the physical, social and safety environment, which can be modified by urban regeneration policies. The aim of this study was to analyze the associations of elements of the social, physical and safety environment of the neighborhood in the urban context with self-perceived health (SPH), according to axes of inequality, such as gender and educational level in Chile in 2016. METHODS: Cross-sectional study using a nationally representative population-based survey of Chile. We used data from the 2016 National Survey of Quality of Life and Health. Poor SPH in the urban population older than 25 years was analyzed in relation to social, physical and safety environment variables. Poisson multilevel regression models were estimated to obtain prevalence ratios (PR) and their respective 95% confidence intervals (95%CI). All analyses were stratified by sex and educational level. RESULTS: SPH was worse in women than in men, especially in those with a lower education level. Poor SPH was associated with lack of support networks (PR = 1.4; 95%CI = 1.1-1.7), non-participation in social organizations (PR = 1.3; 95%CI = 1.1-1.6) and perceived problems with the quality of public space (PR = 1.3; 95%CI = 1.2-1.5) in women with a medium-high educational level and with a feeling of not belonging to the neighborhood (PR = 1.5; 95%CI = 1.2-1.8) and the perception of pollution problems (PR = 1.2; 95%CI = 1.0-1.4) in women with a low educational level. A feeling of unsafety was associated with both educational levels (PR = 1.3; 95%CI = 1.0-1.5). Poor SPH was associated with the feeling of not belonging (PR = 1.7; 95%CI = 1.2-2.5), and unsafety (PR = 2.1; 95%CI = 1.8-2.4) in men with a medium-high educational level, while there were fewer associations in men with a lower education level. CONCLUSIONS: Urban interventions are recommended to improve the health of the resident population and should take into account axes of inequality.

Alcohol preparation consumption for hand hygiene in outpatient clinics and Day Hospitals: an integrative review / Consumo de preparação alcoólica para higienização das mãos em ambulatórios e Hospitais-Dia: revisão integrativa / Consumo de preparados alcohólicos para higiene de manos en Hospitales-Día y ambulatorios: revisión integradora

Background and Objective: the alcoholic preparation consumption indicator is a measure that can help monitor compliance with hand hygiene, however there is no guidance regarding the profile for application of consumption reference published by the World Health Organization for many health institutions. Thus, the study sought information available in scientific literature to support the definition of alcohol preparation consumption for hand hygiene in outpatient clinics and Day Hospitals. Method: an integrative review for the period between 2010 and 2021, conducted in the Scopus, Web of Science, SciELO, PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Database on Nursing and Latin American and Caribbean Literature on Health Sciences databases, through the Virtual Health Library. Five articles were selected, being divided into two categories: Milliliters of alcoholic preparation for each hand hygiene, identifying the expected average volume of 3 ml, and Consumption of alcohol-based hand rub per patient-day, observing the prevalence of studies in general hospitals. A study brought the perspective regarding consumption in a Nursing Home. Conclusion: in the review, no articles related to outpatient clinics and Day Hospitals were found. The selected studies demonstrate that alcohol preparation consumption for hand hygiene is different depending on the profile of the sector and the patient treated and that both the minimum volume for each hand hygiene and the opportunities are not considered for analysis of the indicator.(AU)

Justificativa e Objetivo: o indicador de consumo de preparação alcoólica é uma medida que pode auxiliar no monitoramento da adesão à higienização das mãos, entretanto não existe direcionamento quanto ao perfil para aplicação da referência de consumo publicada pela Organização Mundial da Saúde para muitas instituições de saúde. Assim, o estudo buscou analisar as informações disponíveis na literatura científica para subsidiar a definição do consumo de preparação alcoólica para higienização das mãos em instituições ambulatoriais e Hospitais-Dia. Método: revisão integrativa referente ao período entre 2010 e 2021, realizada nas bases de dados Scopus, Web of Science, SciELO, PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Banco de Dados em Enfermagem e Literatura Latino-Americana e do Caribe em Ciências da Saúde, através da Biblioteca Virtual em Saúde. Foram selecionados cinco artigos que abordam o tema, sendo divididos em duas categorias: Mililitros de preparação alcoólica para cada higienização das mãos, identificando-se o volume médio previsto de 3 ml, e Consumo de preparação alcoólica por paciente/dia, observando-se a prevalência de estudos em hospitais gerais. Um estudo trouxe a perspectiva referente ao consumo em uma Instituição de Longa Permanência. Conclusão: na revisão, não foram encontrados artigos relacionados a ambulatórios e Hospitais-Dia. Os estudos selecionados demonstram que o consumo de preparação alcóolica é diferente dependendo do perfil do setor e do paciente atendido e que tanto o volume mínimo para cada higienização das mãos quanto as oportunidades geralmente não são considerados para análise do indicador.

Justificación y Objetivos: el indicador de consumo de preparados alcohólicos es una medida que ayuda a monitorear la adherencia a la higiene de manos, pero no existe una orientación respecto al perfil de aplicación de la referencia publicada por la Organización Mundial de la Salud para muchas instituciones de salud. Así, el estudio buscó información disponible en la literatura científica para sustentar la definición del consumo de preparados alcohólicos en instituciones ambulatorias y Hospitales Día. Método: una revisión integrativa para el período comprendido entre 2010 y 2021, realizada en bases de datos Scopus, Web of Science, SciELO, PubMed/MEDLINE; Cumulative Index to Nursing and Allied Health Literature, Base de Datos de Enfermería y Literatura Latinoamericana y del Caribe en Ciencias de la Salud, a través de la Biblioteca Virtual en Salud. Se seleccionaron cinco artículos que abordaban el tema y se dividieron en dos categorías: Mililitros de preparación alcohólica para cada higiene de manos, identificando el volumen promedio esperado de 3 ml, y Consumo de preparación alcohólica por paciente-día, observando la prevalencia de estudios en hospitales generales. Un estudio trajo la perspectiva sobre el consumo en una Institución de Larga Estancia. Conclusión: en la revisión, no se encontraron artículos relacionados con ambulatorios y Hospitales Día. Los estudios seleccionados demuestran que el consumo de preparados alcohólicos para la higiene de manos es diferente según el perfil del sector y del paciente tratado y que tanto el volumen mínimo como las oportunidades no suelen ser considerados para el análisis del indicador.(AU)

Características demográficas, socioeconômicas e da procura dos usuários em um serviço de reabilitação física de referência estadual, Mato Grosso, 2021 / Demographic, socioeconomic and service demand features of users in a state reference physical rehabilitation service, Mato Grosso, 2021 / Características demográficas, socioeconómicas y de la demanda de los usuarios en un servicio de rehabilitación física de referencia estatal, Mato Grosso, 2021

Introdução: O estudo dos fatores sociodemográficos e socioeconômicos de usuários doSistema Único de Saúde éimportante para o planejamento e a avaliação das ações dos serviços de saúde procurados por esta população. Objetivo:Descrever as características demográficas, socioeconômicas e da procura dos usuários adultos com demanda dereabilitação física ortopédica e neurológica emum Centro Especializado em Reabilitação de referência no Estado de Mato Grosso. Metodologia:Estudo observacional descritivo baseado nos prontuários dosetor de acolhimento de um Centro Especializado em Reabilitação de Mato Grosso,de fevereiro a maio de 2021. Foram analisados dados demográficos e socioeconômicos de usuários adultos de ambos os sexos. Utilizou-se o teste de qui-quadrado de Pearson para as associações entre as variáveis segundo eixo de reabilitação (ortopédica e neurológica). Resultados:Dos196 prontuários analisados,94% dos usuários eram procedentes de Cuiabá, comidade média de 50,3 anos, sendo 52,55% do sexo feminino. Aprocura pelo serviçofoi de 69%pela reabilitação ortopédica (69%) e de 31%reabilitação neurológica. Observaram-se diferenças estatisticamente significantes entre as frequências nos dois eixos dereabilitação física estudados nas variáveis idade (p=0,0005), escolaridade (p=0,0031), principal atividade de trabalho (p=0,0045), doenças concomitantes (p=0,0016), tratamento em outro estabelecimento de saúde (p=0,0041) e motivo da procura pela reabilitação (p<0,0001). Conclusões:Osresultados mostraram que os casos neurológicos possuem maior idade, baixo nível de escolaridadeepequeno percentual de trabalho remuneradoem relação aos casos ortopédicos. Tais resultados sugerem que as necessidades de saúde e de reabilitação dependem da singularidade dos casos e podem subsidiara efetivação depolíticas públicas que favoreçam a reorganização dos serviços e a articulação intersetorial entre saúde, educação emercado de trabalho (AU).

Introduction: Assessing sociodemographic and socioeconomic factors related to Unified Health System's users is essential to plan and evaluate the actions by the health services sought by them.Aim: Describing the demographic and socioeconomic features of adult users, and their search for having their orthopedic and neurological-physical rehabilitation demands fulfilled by a Specialized Center in Orthopedic and Neurological Rehabilitation in Mato Grosso State.Methodology: Observational descriptive study based on medical records collected between February and March 2021, provided by the welcoming sector of a Specialized Center in Rehabilitation in Mato Grosso State. Demographic and socioeconomic records of adult users belonging to both sexes were analyzed. Person's chi-square test was adopted to associate the variables based on the orthopedic and neurological rehabilitation axes.Results: In total, 94% of the 196 analyzed medical records regard patients from Cuiabá, in the mean age group 50.3 years; 52.55% of them belonged to the female sex. The search for orthopedic rehabilitation reached 69% and that for neurological rehabilitation recorded 31%. There were significant statistical differences between frequencies on the two assessed physical rehabilitation axes based on variables such as age (p=0.0005), schooling (p=0.0031), main labor activity (p=0.0045), concomitant diseases (p=0.0016), treatment provided in another health establishment (p=0.0041) and reason for seeking rehabilitation (p<0.0001). Conclusions: Results have shown that neurological cases are linked to older age, low schooling and low rate of paid work in comparison to orthopedic cases. These results have suggested that health and rehabilitation needs depend on cases' particularities; moreover, they can subsidize the process to make public policies to reinforce services'organization, as well as inter-sectoral articulation among health, education and labor market, effective (AU).

Introducción: El estudio de los factores sociodemográficos y socioeconómicos de los usuarios del Sistema Único de Salud es importante para planificar y evaluar las acciones de los servicios de salud buscados por esta población.Objetivo: Describir las características demográficas, socioeconómicas y de demanda de usuarios adultos con demanda de rehabilitación física ortopédica y neurológica en un Centro Especializado de Rehabilitación de Referencia en el Estado de Mato Grosso.Metodología: Estudio observacional descriptivo basado en las historias clínicas del sector de acogimiento de un Centro Especializado de Rehabilitación en Mato Grosso, de febrero a mayo de 2021. Se analizaron datos demográficos y socioeconómicos de usuarios adultos de ambos sexos. Se utilizóla prueba de chi-cuadrado de Pearson para las asociaciones entre las variables según el eje de rehabilitación (ortopédico y neurológico).Resultados: De las 196 historias clínicas analizadas, 94% de los usuarios provenían de Cuiabá, con una edad promedio de 50,3 años, de los cuales 52,55% eran de sexo femenino. La demanda del servicio fue del 69% para la rehabilitación ortopédica (69%) y del 31% para la rehabilitación neurológica. Se observaron diferencias estadísticamente significativas entre las frecuencias en los dos ejes de rehabilitación física estudiados en las variables edad (p=0,0005), escolaridad (p=0,0031), actividad laboral principal (p=0,0045), enfermedades concomitantes (p=0,0016), tratamiento en otro establecimiento de salud (p=0,0041) y motivo de búsqueda de rehabilitación (p <0,0001). Conclusiones:Los resultados mostraron que los casos neurológicos tienen mayor edad, bajo nivel de educación y un pequeño porcentaje de trabajo remunerado en relación con los casos ortopédicos. Estos resultados sugieren que las necesidades de salud y rehabilitación dependen de la singularidad de los casos y pueden apoyar la implementación de políticas públicas que favorezcan la reorganización de los servicios y la articulación intersectorial entre salud, educación y mercado laboral (AU).

Self-rated health status and associated factors in rural workers.

BACKGROUND: Self-rated health status can be considered a good predictor of morbidity and mortality and has been used due to its easy assessment and applicability. The instrument is efficient for understanding sociodemographic, environmental and clinical conditions that may be related to the self-rated health status. Thus, this study aims to analyze the self-assessment of health status in rural workers and its association with socioeconomic characteristics, lifestyle, clinical condition and work characteristics. METHODS: This is a cross-sectional study carried out with 787 male and female rural reporting agriculture as their main source of income in the municipality of Santa Maria de Jetibá. A simple and direct question was used "In general, compared to people your age, how do you rate your own state of health?" to see how rural workers rate their current health status. The independent variables analyzed were socioeconomic, clinical, health and work conditions. The magnitude of the associations was evaluated by means of hierarchical logistic regression. RESULTS: It was found that 42.1% of rural workers self-rated their health status as regular or poor. Belonging to socioeconomic classes C (OR = 1.937; 95% CI = 1.009-3.720) or D/E (OR = 2.280; 95% CI = 1.178-4.415), being overweight (or having excess weight) (OR = 1.477; 95% CI = 1.086-2.008), multimorbidity (OR = 1.715; 95% CI = 1.201-2.447) and complex multimorbidity (OR = 1.738; 95% CI = 1.097-2.751) were risk factors for worse self-rated health. CONCLUSION: It was concluded that chronic diseases, socioeconomic status and overweight are risk factors for negative self-rated health. The identification of these determinants through self-rated status can support the planning of actions aimed at improving the health of the rural population. TRIAL REGISTRATION: This study was approved by the Research Ethics Committee of the Health Sciences Center of the Federal University of Espírito Santo (Protocol No. 2091172; CAAE No. 52839116.3.0000.5060). All research participants gave their informed consent.

Perfil bioquímico de pessoas com diabetes mellituse hipertensão na atenção primária à saúde / Biochemical profile of people with diabetes mellitusand hypertension in primary health care

Introdução: O diabete mellitus (DM) e a hipertensão arterial sistêmica (HAS) são doenças crônicas não-transmissíveis que se associam a alto risco de mortalidade. Objetivo: Analisar o perfil laboratorial de pessoas com DM e HAS acompanhados na atenção primária à saúde. Método: Estudo descritivo e transversal, com a amostra de 345 pessoas em acompanhamento pelas estratégias de saúde da família pertencentes a duas Unidades Básicas de Saúde da zona urbana do município de Santarém, Pará, Brasil. Os participantes foram divididos em quatro grupos conforme diagnóstico: HAS; DM; ambas (DM-HAS); ou nenhuma (SEM). Foram coletadas informações socioeconômicas e clínicas dos participantes, com posterior coleta de sangue para as variáveis bioquímicas. Para a análise de dados foi realizada a estatística descritiva e inferencial, adotando-se significância de p<0,05. Resultados: Em todos os grupos predominaram participantes do sexo feminino, casados, pardos, com renda até dois salários, com 4-7 anos de estudo, não tabagistas e não estilistas. Em relação ao SEM, o DM se associou com valores alterados para glicose (p<0,0001), HDL-c (p=0,0481), ureia (p=0,0252), creatinina (p=0,0006) e hemoglobina (p=0,0024). Já o DM-HAS se associou com a presença de alteração para glicose (p<0,0001), ureia (p=0,0009), creatinina (p=0,0059) e taxa de filtração glomerular (p=0,0048). Conclusão: Conclui-se, conforme o método proposto, que a presença da DM e/ou HAS são capazes de modificar o perfil bioquímico de maneira negativa, bem como se ressalta a importância do acompanhamento desta pessoa pela atenção primária à saúde, visto que algumas pessoas apresentaram alterações bioquímicas que chamam atenção e não estão em acompanhamento (AU).

Introduction:Diabetes mellitus (DM) and systemic arterial hypertension (SAH) are chronic non-communicable diseases that are associated with a high risk of mortality. Objective: To analyze the laboratory profile of people with DM and SAH followed up in primary health care. Methods: Descriptive and cross-sectional study, with a sample of 345 people being monitored by family health strategies belonging to two Basic Health Units in the urban area of the city of Santarém, Pará, Brazil. Participants were divided into four groups according to their diagnosis: SAH; DM; both (DM-SAH); or neither (NO). Socioeconomic and clinical information was collected from the participants, with subsequent blood collection for biochemical variables. Descriptive and inferential statistics were used for data analysis, adopting a significance of p<0.05. Results: In all groups, female participants, married, brown, with an income of up to two salaries, 4-7 years of schooling, non-smokers, and non-alcoholics predominated. Compared to NO, DM was associated with altered values for glucose (p<0.001), HDL-c (p=0.048), urea (p=0.025), creatinine (p<0.001), and hemoglobin (p=0.002). DM-SAH was associated with the presence of alterations in glucose (p<0.001), urea (p<0.001), creatinine (p=0.005), and glomerular filtration rate (p=0.004). Conclusion: In conclusion, the results using the proposed method indicate that the presence of DM and/or SAH is able to negatively modify the biochemical profile. In addition, the importance of monitoring this population in primary health care was demonstrated, since some people presented potentially worrying biochemical alterations that are not being followed up (AU).

Evaluación del cumplimiento de registros clínicos de enfermería en un hospital de segundo nivel atención / Evaluation of compliance with clinical nursing records in a secondary care hospital

Introducción: los registros clínicos de enfermería conforman la evidencia escrita de los cuidados otorgados al paciente, son medio de comunicación y coordinación entre profesionales de la salud; los registros están orientados a documentar los cuidados en un marco ético legal, además de ser un indicador para la calidad del cuidado. Objetivo: evaluar el cumplimiento de los registros clínicos de enfermería. Metodología: estudio cuantitativo, de diseño transversal descriptivo. Se realizó en el Hospital General de Zona No. 2 del IMSS de Fresnillo, México. Se utilizó el total de los registros clínicos de enfermería del tablero de control, se capturaron en el instrumento de evaluación de los registros clínicos de enfermería, y se analizaron mediante estadística descriptiva, medidas de tendencia central. Resultados: el porcentaje de cumplimiento de los registros clínicos de enfermería es de 8.03%, el porcentaje de congruencia de indicaciones médicas con los registros clínicos de enfermería es de 84.48%, por lo que queda en el parámetro de 80% con base en lo estipulado en el indicador institucional clave 2660-021-002. Conclusiones: dentro del indicador de evaluación por rubro, 15 de 18 se encuentran en suficiente y tres en insuficiente; respecto al cumplimiento es suficiente, al igual que en el porcentaje de congruencia de indicaciones médicas con registros clínicos de enfermería.

Introduction: Clinical nursing records make up the written evidence of the care given to the patient, they are a means of communication and coordination between health professionals; the records are aimed at documenting care in a legal ethical framework, as well as being an indicator for the quality of care. Objective: To evaluate the compliance of the clinical nursing records. Methodology: Quantitative study, descriptive cross-sectional design. It was carried out at the General Hospital of Zone No. 2 of the Instituto Mexicano del Seguro Social in Fresnillo, Mexico. The total number of clinical nursing records from the control panel were used, they were captured in the evaluation instrument of clinical nursing records, and they were analyzed using descriptive statistics, measures of central tendency. Results: The percentage of compliance of the clinical nursing records is 8.03%, the percentage of congruence of medical indications with the clinical nursing records is 84.48%, so it remains within the parameter of 80% based on the stipulated in the key institutional indicator 2660-021-002. Conclusions: within the evaluation indicator by category, 15 of 18 are found to be sufficient and three are insufficient; Regarding compliance, it is sufficient, as is the percentage of congruence of medical indications with clinical nursing records.

Vigilância da dor de dente no Brasil: um estudo a partir dos dados do SISAB / Toothache surveillance in Brazil: a study based on SISAB data

Esta dissertação foi desenvolvida como parte de uma pesquisa de avaliação de serviços de saúde bucal no nível da Atenção Primária à Saúde (APS), que criou uma matriz avaliativa de indicadores e ferramentas digitais para o monitoramento dos serviços usando dados rotineiros do atendimento dos usuários no sistema público de saúde e disponibilizados no Sistema de Informação em Saúde para a Atenção Básica (SISAB). O produto científico é um artigo proveniente do estudo ecológico de âmbito nacional que análisou a morbidade atendida por dor de dente por porte populacional dos municípios brasileiros (2018 a 2022). O indicador taxa de atendimento odontológico por dor de dente (por 1000 usuários) foi calculado para cada município brasileiro, em 15 quadrimestres (Q1-2018 a Q3-2022) e segundo o porte populacional (< 5 mil; 5 a 9,9 mil; 10 a 49,9 mil; 50 a 99,9 mil; > 100 mil habitantes). Modelo de regressão para dados longitudinais estimou a variação quadrimestral ao longo do tempo por porte populacional antes e após o Q2-2020, pois houve um padrão de redução da taxa até este momento. Foram analisados os registros obtidos de 5.332 municípios (95,72%). A taxa média de atendimento por dor de dente (por 1000 usuários) variou de 9,65 (Q2-2020) a 27,24 (Q1-2018). Em todo o período, municípios de maior porte apresentaram as menores taxas. Antes do Q2-2020, a taxa média nos municípios com >100 mil hab. apresentou uma redução quadrimestral média de 20,56%, maior do que a variação de 7,25% dos nos municípios de < 5 mil hab. Após o Q2-2020, a taxa dos municípios < 5 mil hab. aumentou 2,27%, valor menor do que a variação nos municípios de maior porte. Em média, foram realizados de 10 a 30 atendimentos por dor de dente em 4 meses para 1000 usuários cadastrados no Brasil, com as maiores taxas nos municípios de menor porte. Houve uma redução geral nas taxas até o Q2-2020, coincidindo com a suspensão dos serviços de saúde bucal devido à pandemia de COVID-19, sendo essa redução mais acentuada nos municípios de maior porte. Após esse período, o crescimento das taxas foi menos pronunciado, especialmente nos municípios de pequeno porte. A dissertação apresenta também a matriz avaliativa sistematizada como um Dicionário de Indicadores e as ferramentas digitais desenvolvidas como produto técnico. O dicionário descreve o referencial para desenvolvimento da matriz e as fichas de qualificação dos 54 indicadores mensuráveis com dados do SISAB. O Painel de Indicadores para o Monitoramento dos Serviços de Saúde Bucal na APS é uma ferramenta interativa com automatização da obtenção dos dados, cálculo dos 54 indicadores tempestivamente e demonstração de resultados por regiões, Unidades da Federação e municípios brasileiros, por meio de tabelas, gráficos e mapas, com filtros geográficos e temporais. A Calculadora de Indicadores de Saúde Bucal buscou superar a lacuna da obtenção dos indicadores no nível das eSB, usando relatórios gerenciais locais. Os resultados da taxa de atendimento odontológico por dor de dente na APS sinalizam a persistência deste agravo nos serviços públicos de saúde.

This dissertation was developed as part of research to evaluate oral health services at the Primary Health Care (PHC) level, which created an evaluation matrix of indicators and digital tools for monitoring services using routine data from users' care in the public health system and made available in the Health Information System for Primary Care (SISAB). The scientific product is an article from a nationwide ecological study that analyzed morbidity due to toothache by population size in Brazilian municipalities (2018 to 2022). The indicator rate of dental care due to toothache (per 1000 users) was calculated for each Brazilian municipality, in 15 four months (1st quarter of 2018 to 3rd quarter of 2022) and according to population size (< 5 thousand; 5 to 9, 9 thousand; 10 to 49.9 thousand; 50 to 99.9 thousand; > 100 thousand inhabitants). Regression model for longitudinal data estimated the four-monthly variation over time by population size before and after the second quarter of 2020, as there was a pattern of rate reduction up to this point. Records obtained from 5,332 municipalities (95.72%) were analyzed. The average toothache attendance rate (per 1000 users) ranged from 9.65 (2nd quarter of 2020) to 27.24 (1st quarter of 2018). Throughout the period, larger municipalities received lower rates. Before the second quarter of 2020, the average rate in municipalities with >100 thousand inhabitants. presented an average quarterly reduction of 20.56%, greater than the 7.25% variation in our municipalities with < 5 thousand inhabitants. After the second quarter of 2020, the rate of municipalities < 5 thousand inhabitants. increased by 2.27%, a value lower than the variation in larger municipalities. On average, 10 to 30 consultations for toothache were provided in 4 months for 1000 registered users in Brazil, with the highest rates in smaller municipalities. There was a general reduction in rates until the second quarter of 2020, coinciding with the suspension of oral health services due to the COVID-19 pandemic, with this reduction being more pronounced in larger municipalities. After this period, rate growth was less anticipated, especially in small municipalities. The dissertation also presents the evaluation matrix systematized as a Dictionary of Indicators and the digital tools developed as a technical product. The dictionary describes the framework for developing the matrix and the qualification sheets for the 54 indicators measurable with SISAB data. The Indicator Panel for Monitoring Oral Health Services in PHC is an interactive tool with automated data collection, calculation of 54 indicators in a timely manner and demonstration of results by regions, Federation Units and Brazilian municipalities, through tables, graphs and maps, with geographic and temporal filters. The Oral Health Indicator Calculator sought to overcome the gap in providing indicators at the eSB level, using local management reports. The results of the rate of dental care for toothache in PHC indicate the persistence of this problem in public health services.

Influence of sports elective courses on college students' physical health / Influência dos cursos eletivos esportivos sobre a saúde física dos estudantes universitários / Influencia de las asignaturas deportivas optativas en la salud física de los estudiantes universitarios

ABSTRACT Introduction The college sports environment is characterized by breadth, diversity, and personality. This is an important period to develop students' physical ability and improve their personality. Objective Compare the effects of different exercise methods on students' health status. Methods 2991 college students participated in different sports activities. These sports were conducted based on the selection course (PE), all during one semester. The students' physical health status was observed through experiments performed before and after the intervention. Results Activities such as basketball and soccer showed high effectiveness in improving students' vital capacity index, volleyball expressively improved students' performance in the long jump, tennis and table tennis were effective in improving students' strength and adherence index, being lower in other indices. Martial arts also stood out in improving the students' vital capacity index. Conclusion Improving physical health should be an overall process of students' fitness development, and universities should actively encourage college students to participate in long-term sports to improve their health. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução O ambiente do esporte universitário é caracterizado pela abrangência, diversidade e personalidade. Este é um período importante para desenvolver a capacidade física dos estudantes e melhorar a sua personalidade. Objetivo Comparar os efeitos de diferentes métodos de exercício sobre o estado de saúde dos estudantes. Métodos 2991 estudantes universitários participaram de diferentes atividades esportivas. Estes esportes foram conduzidos com base no curso de seleção (PE), todos durante um semestre. O estado de saúde física dos estudantes foi observado através de experimentos executados previa e posteriormente à intervenção. Resultados Atividades como basquetebol e futebol demonstraram alta efetividade para melhorar o índice de capacidade vital dos estudantes, voleibol melhorou expressivamente o desempenho dos alunos no salto em distância, o tênis e o tênis de mesa foram efetivos para aprimorar o índice de força e de adesão dos alunos, sendo inferior noutros índices. Também as artes marciais se destacaram ao melhorar o índice de capacidade vital dos alunos. Conclusão O aprimoramento da saúde física deve ser um processo global de desenvolvimento da aptidão física dos estudantes e as universidades devem encorajar ativamente os estudantes universitários a participar de esportes de longo prazo para melhorar sua saúde. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción El entorno del deporte universitario se caracteriza por su alcance, diversidad y personalidad. Es un periodo importante para desarrollar la capacidad física de los alumnos y mejorar su personalidad. Objetivo Comparar los efectos de diferentes métodos de ejercicio sobre el estado de salud de los estudiantes. Métodos 2991 estudiantes universitarios participaron en diferentes actividades deportivas. Estos deportes se llevaron a cabo basándose en el curso de selección (PE), todo ello durante un semestre. El estado de salud física de los alumnos se observó mediante experimentos realizados antes y después de la intervención. Resultados Actividades como el baloncesto y el fútbol mostraron una alta eficacia para mejorar el índice de capacidad vital de los alumnos, el voleibol mejoró expresivamente el rendimiento de los alumnos en salto de longitud, el tenis y el tenis de mesa fueron eficaces para mejorar el índice de fuerza y adherencia de los alumnos, siendo inferiores en otros índices. También las artes marciales se destacaron en la mejora del índice de capacidad vital de los alumnos. Conclusión La mejora de la salud física debería ser un proceso global del desarrollo de la forma física de los estudiantes y las universidades deberían animar activamente a los universitarios a participar en deportes de larga duración para mejorar su salud. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.