The harsh reality of children and youth emergency care showing the health status of a city.

OBJECTIVE: To analyze the epidemiological profile of children and adolescents aged between 0 to 19 years, assisted by the emergency department of a City School Hospital in order to monitor the health care system of São Carlos, São Paulo, Southeast Brazil. METHODS: This is a descriptive and cross-sectional study that collected data from medical records, from August 2008 to September 2009 (14 months). The random sample was taken from 15 days of each month, 50% of the total of 26,678 patients seen during that period of time, accounting for 13,339 medical records. The Epi-Info software was used to build the database; results were evaluated by descriptive statistical analysis. RESULTS: Among the analyzed medical reports, 48.3% were female patients, 55% of the patients were aged between 0 and 4 years. Most of the children (95%) came by spontaneous demand. During that period, 41% of the population aged 0 to 19 years-old sought for only this type of health care. The most prevalent diseases were respiratory diseases, which showed 48.5% incidence during fall and winter. Most patients came from the north, northeast, and northwest regions of São Carlos, which have high-population density. CONCLUSIONS: The results showed a sad reality, with high spontaneous demand of children aged from zero to four years-old for pediatric emergency care. Most patients had not received prior care from other doctors. The health network situation indicates the need for urgent measures to strengthen the primary care assistance for basic health care centers and family physicians.

A difícil realidade do pronto atendimento infantojuvenil mostrando a situação de saúde de uma cidade / The harsh reality of children and youth emergency care showing the health status of a city / La dura realidad del servicio de urgencias infantojuvenil mostrando la situación de salud de una ciudad

OBJETIVO: Analisar o perfil epidemiológico de crianças e adolescentes na faixa etária de 0 a 19 anos atendidos no pronto atendimento do Hospital Escola Municipal, de maneira a monitorar a rede de saúde de São Carlos, no estado de São Paulo. MÉTODOS: Estudo descritivo e transversal com coleta dos dados de prontuários, entre agosto de 2008 e setembro de 2009 (14 meses), sendo uma amostra aleatória, ao acaso, de 15 dias dos atendimentos em 50% das consultas mensais, somando-se 13.339 prontuários de um total de 26.678 atendimentos. Foi construído um banco de dados no programa Epi-Info para análise descritiva. RESULTADOS: Do total, 48,3% dos pacientes eram do sexo feminino, 55% com idades entre zero e quatro anos e 95% oriundos de demanda espontânea. Isso corresponde a um esboço de 41% da população entre 0 e 19 anos de idade que teve somente este tipo de atendimento. Houve predomínio das doenças do aparelho respiratório (48,5%), nos meses de outono e inverno. As regiões que mais utilizaram o pronto atendimento compreenderam bairros das regiões norte, nordeste e noroeste de São Carlos, as quais possuem ampla densidade populacional. CONCLUSÕES: Os resultados apontaram a difícil realidade, com alta demanda espontânea, de crianças de zero a quatro anos no pronto atendimento pediátrico, sem acolhimento prévio a esses pacientes. A situação da rede de saúde aponta para a necessidade de medidas urgentes que fortaleçam a assistência das unidades básicas de saúde e de saúde da família.

OBJECTIVE: To analyze the epidemiological profile of children and adolescents aged between 0 to 19 years, assisted by the emergency department of a City School Hospital in order to monitor the health care system of São Carlos, São Paulo, Southeast Brazil. METHODS: This is a descriptive and cross-sectional study that collected data from medical records, from August 2008 to September 2009 (14 months). The random sample was taken from 15 days of each month, 50% of the total of 26,678 patients seen during that period of time, accounting for 13,339 medical records. The Epi-Info software was used to build the database; results were evaluated by descriptive statistical analysis. RESULTS: Among the analyzed medical reports, 48.3% were female patients, 55% of the patients were aged between 0 and 4 years. Most of the children (95%) came by spontaneous demand. During that period, 41% of the population aged 0 to 19 years-old sought for only this type of health care. The most prevalent diseases were respiratory diseases, which showed 48.5% incidence during fall and winter. Most patients came from the north, northeast, and northwest regions of São Carlos, which have high-population density. CONCLUSIONS: The results showed a sad reality, with high spontaneous demand of children aged from zero to four years-old for pediatric emergency care. Most patients had not received prior care from other doctors. The health network situation indicates the need for urgent measures to strengthen the primary care assistance for basic health care centers and family physicians.

OBJETIVO: Analizar el perfil epidemiológico de niños y adolescentes en la franja de edad de 0 a 19 años, atendidos en el Servicio de Urgencias (SU) del Hospital Escuela Municipal, de modo a monitorear la red de salud de esa ciudad. MÉTODO: Estudio descriptivo y transversal con recolección de datos de prontuarios, entre agosto de 2008 y septiembre de 2009 (14 meses), con muestra aleatoria, al azar, de 15 candidatos de los servicios en 50% de las consultas mensuales, sumando 13.339 prontuarios de un total de 26.678 atenciones. Se construyó una base de datos en el EpiInfo para análisis descriptivo. RESULTADOS: Del total, el 48,3% de los pacientes eran del sexo femenino, el 51,7% del sexo masculino, el 55% con edad entre 0-4 años y el 95% originarios de demanda espontánea, correspondiendo a un bosquejo del 41% de la población entre 0 a 19 años de edad que tuvo solamente ese tipo de atención. En 48,5%, hubo predominio de las enfermedades del sistema respiratorio los meses de otoño e invierno. Las regiones que más utilizaron el SU comprendieron barrios de la región norte, nordeste y noroeste de la ciudad, que poseen gran densidad de población. CONCLUSIONES: Los resultados señalaron la dura realidad, con alta demanda espontánea, en niños de 0 a 4 años de edad en el servicio de urgencias pediátrico, sin acogida previa a esos pacientes. La situación de la red de salud apunta a la necesidad de medidas urgentes para el fortalecimiento de la asistencia en unidades básicas de salud y de salud de la familia.

Shared decision making in Brazil: history and current discussion.

There is no SDM in clinical practice in Brazil. The first steps have been taken towards research and tool development recently. Likewise, our society is starting to get involved with decision making in health care. This paper aims to offer an overview of the Brazilian health system history, its values, and its influence on SDM. The participative social control concept is introduced as a result of the movement against the dictatorship era. In addition, the influence of social changes on the Medical Ethical Code is delineated. SDM state of the art in Brazil is also discussed and the challenges to implement it on clinical practice are described. Regardless the challenges, it is possible to make a positive assessment of SDM in Brazil.