Search

O objetivo foi avaliar os atributos da Atenção Primária à Saúde (APS) no cuidado das crianças em Unidades Básicas de Saúde (UBS). Estudo transversal com abordagem quantitativa, desenvolvido em 13 UBS no município de São Paulo/ SP, no ano de 2021. Para a avaliação dos atributos da APS foi utilizado o instrumento PCATool-Brasil para crianças. Foram avaliados os escores de cada atributo separadamente e também os escores geral e essencial. A amostra foi caracterizada a partir da média e desvio padrão, mínimo e máximo, mediada e quartis, para as variáveis quantitativas, e pelas frequências absolutas e relativas para as variáveis qualitativas. Participaram 242 crianças, com idade média de 3,33 anos e os escores essencial com valores de (6,41) e geral (6,20) respectivamente. Os resultados dos escores apresentaram-se baixos e, portanto, com necessidade de melhorias nos serviços da APS. Os resultados dos escores essencial e geral apresentados como baixos e, portanto, com necessidade de melhorias nos serviços da APS evidenciam à busca constante por avaliações dos mesmos, objetivando uma gestão qualificada e que traga uma maior resolutividade à APS.

Background: Latin America has one of the highest COVID-19 mortality rates in the world, driven by inequality in its population. We aimed to analyze the spatial distribution and factors associated with the risk of SARS and death in COVID-19 cases using routine record data and to develop and validate a prognostic tool for risk of death by Covid-19. Methods: A cross-sectional study was conducted from March 2020 to April 2021 in the South Zone of the city of São Paulo, SP, Brazil, with 16,061 positive cases of COVID-19. The data were -obtained from the records of the Brazilian Ministry of Health notification systems for flu-like syndrome (eSUS-VE) and hospitalized SARS (SIVEP-Gripe). The spatial distribution of the cases is represented in 2D kernel density. To assess the possible factors associated with the outcomes, generalized linear and generalized additive logistic models were adjusted. To assess the discriminatory power the C-statistic was used. A calculator was developed based on a prognostic model for the risk of death, validated with accuracy measures in the sample, internal validation and temporal validation. Results: The average age of patients was 42.1 years. Evolved to SARS 925 (11.98%) and 375 (2.37%) died. The comorbidities associated with a higher risk of SARS were obesity (OR=25.32) and immunodepression (OR=12.15). The comorbidities associated with a higher risk of death were renal diseases (OR=11.8) and obesity (OR=8.49), with clinical and demographic information being more important than the spatial area. The COVID-19 risk of death calculator showed an accuracy of 92.2% in the sample build, 92.3% in the internal validation and 80% in the temporal validation.Conclusions: Age and comorbidities were identified as the most associated factors to the severity of the disease. For the death analysis, the socioeconomic condition is included in addition to these factors. The calculator can be used and implemented in services of varying complexity because it contains easily accessible information to guide prevention and care.

Introduction:Few studies in the literature discuss the benefits of compliance with sepsis bundles in hospitals in low- and middle-income countries, where resources are limited and mortality is high.Methods:This is a retrospective cohort study conducted at a public hospital in a low-income region in Brazil. We evaluated whether completion of a sepsis bundle is associated with reduced in-hospital mortality for sepsis, severe sepsis, and septic shock, as well as prevention of septic shock and organ dysfunction. Bundle compliance required the completion of three items: (1) obtaining blood count and culture, arterial or venous blood gases, and arterial or venous lactate levels; (2) antibiotic infusion within the first hour of diagnosis; and (3) infusion of 10–20 ml/kg saline solution within the first hour of diagnosis.Results:A total of 548 children with sepsis, severe sepsis, or septic shock who were treated at the emergency room from February 2008 to August of 2016 were included in the study. Of those, 371 patients were included in the protocol group and had a lower median length of stay (3 days vs. 11 days;p< 0.001), fewer organ dysfunctions during hospitalization (0 vs. 2,p< 0.001), and a lower probability of developing septic shock. According to a propensity score analysis, mortality was lower during the post-implementation period [2.75 vs. 15.4% (RR 95%IC 0.13 (0.06, 0.27);p< 0.001)].Conclusions:A simple and low-cost protocol was feasible and yielded good results at a general hospital in a low-income region in Brazil. Protocol use resulted in decreased mortality and progression of dysfunctions and was associated with a reduced probability of developing septic shock.

Background The balance between supply and demand for primary health care (PHC) services is one of the main challenges to the health system in Brazil. In this context, the application of planning methods could benefit the decision-making process for human resources organizations. Hence, the objective of this study was to assess the staffing needs for registered nurses (RNs) and licensed practical nurses (LPNs) at PHC services using the WISN method. Methods The Workload Indicators of Staffing Need (WISN) methodology was applied at 13 Primary Care Units (PCU) located in the city of São Paulo, Brazil. It included 87 RNs and 174 LPNs, and used data from 2017 to 2019. Results The WISN results found that RNs were under high workload pressure at 10 PCUs (77%) in 2017 and 2018, with a decrease to 8 PCUs (61%) in 2019. For LPNs, high workload pressure increased from 2 PCUs (15%) in 2017 to 13 PCUs (100%) in 2018, with a decrease to 11 (85%) in 2019. Conclusion The assessment of staffing needs for RNs and LPNs at the PCUs included in the study identified a consistent deficit in the number of professionals, and high workload pressure in most services throughout the study period.

Background The balance between supply and demand for primary health care (PHC) services is one of the main challenges to the health system in Brazil. In this context, the application of planning methods could benefit the decision-making process for human resources organizations. Hence, the objective of this study was to assess the staffing needs for registered nurses (RNs) and licensed practical nurses (LPNs) at PHC services using the WISN method. Methods The Workload Indicators of Staffing Need (WISN) methodology was applied at 13 Primary Care Units (PCU) located in the city of São Paulo, Brazil. It included 87 RNs and 174 LPNs, and used data from 2017 to 2019. Results The WISN results found that RNs were under high workload pressure at 10 PCUs (77%) in 2017 and 2018, with a decrease to 8 PCUs (61%) in 2019. For LPNs, high workload pressure increased from 2 PCUs (15%) in 2017 to 13 PCUs (100%) in 2018, with a decrease to 11 (85%) in 2019. Conclusion The assessment of staffing needs for RNs and LPNs at the PCUs included in the study identified a consistent deficit in the number of professionals, and high workload pressure in most services throughout the study period.

Objective To develop and validate a high-risk predictive model that identifies, at least, one common adverse event in older population: early readmission (up to 30 days after discharge), long hospital stays (10 days or more) or in-hospital deaths. Methods This was a retrospective cohort study including patients aged 60 years or older (n=340) admitted at a 630-beds tertiary hospital, located in the city of São Paulo, Brazil. A predictive model of high-risk indication was developed by analyzing logistical regression models. This model prognostic capacity was assessed by measuring accuracy, sensitivity, specificity, and positive and negative predictive values. Areas under the receiver operating characteristic curve with 95% confidence intervals were also obtained to assess the discriminatory power of the model. Internal validation of the prognostic model was performed in a separate sample (n=168). Results Statistically significant predictors were identified, such as current Barthel Index, number of medications in use, presence of diabetes mellitus, difficulty chewing or swallowing, extensive surgery, and dementia. The study observed discrimination model acceptance in the construction sample 0.77 (95% confidence interval: 0.71-0.83) and good calibration. The characteristics of the validation samples were similar, and the receiver operating characteristic curve area was 0.687 (95% confidence interval: 0.598-0.776). We could assess an older patient’s adverse health events during hospitalization after admission. Conclusion A predictive model with acceptable discrimination was obtained, with satisfactory results for early readmission (30 days), long hospital stays (10 days), or in-hospital death.

Background Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. However, there literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Hence, this psychometric study aimed at the development and evaluation of content and internal structure validity of the Dental Vulnerability Scale for Primary Health Care (PHC). Methods The items were developed based on a qualitative exploratory analysis. A total of 172 items were prepared and submitted to a panel of specialists, with content validity analyzed with the Content Validity Ratio (CVR), resulting in an the initial version of the instrument composed by 41 items. Internal structure validity was analyzed by Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and by applying 3 reliability indicators (Cronbach’s Alpha, McDonald's Omega and Greatest Lower Bound – GBL), with a sample of 1227 individuals. Results The final configuration indicated a scale of 15 items divided into 4 dimensions (overall health, oral health, infrastructure, and healthcare services) with explained variance of 72.11%. The factor loads varied from 0.37 to 0.96. The model adjustment indices were set at × 2/df(51) = 3.23, NNFI = 0.95, CFI = 0.98, GFI = 0.96, AGFI = 0.97, RMSEA = 0.04 and RMSR = 0.03. Conclusion DVS presented satisfactory evidence of validity, indicating its suitability to be used by healthcare professionals, students and managers to plan oral health actions and services at PHC.

Objective: To present a concept of dental vulnerability based on the opinion of oral health professionals in Brazil. Methods: A cross-sectional study performed in two stages: preparation of a questionnaire by literature search and its application with oral health specialists. The data were analyzed by means of Bardin technique and descriptive analysis. Results: A total of 188 professionals from all regions of Brazil responded to the questionnaire. The answers were classified into seven dimensions, conceptualizing dental vulnerability as a set of social, structural, overall health, mental, and oral health factors, in addition to factors involving the health services and public management that influence the health-disease process dynamic. Conclusion: The concept of dental vulnerability produced from the opinions of the professionals from different regions of Brazil allows advancement to new studies on the theme and the development of instruments aiming to measure the phenomenon. Objetivo: Presentar un concepto de vulnerabilidad dental con base en la opinión de los profesionales de salud bucal de Brasil. Métodos: Estudio transversal realizado en dos etapas: construcción de un cuestionario mediante investigación en la literatura y su aplicación a especialistas en salud bucal. Los datos se analizaron mediante la técnica de Bardin y análisis descriptivo. Resultados: 188 profesionales de todas las regiones de Brasil respondieron al cuestionario. Las respuestas se categorizaron en siete dimensiones, conceptualizando la vulnerabilidad dental como un conjunto de factores sociales, estructurales, de salud general, mental y bucal, además de factores que abarcan los servicios de salud y la gestión pública que inciden en la dinámica del proceso salud-enfermedad. Conclusión: El concepto de vulnerabilidad dental producido con base en la opinión de profesionales de diferentes regiones de Brasil permite avanzar en nuevos estudios sobre el tema y en el desarrollo de instrumentos que buscan medir el fenómeno. Objetivo: Apresentar um conceito de vulnerabilidade odontológica a partir da opinião dos profissionais de saúde bucal do Brasil. Métodos: Estudo transversal realizado em duas etapas: construção de questionário por meio de levantamento de literatura e sua aplicação em especialistas de saúde bucal. Os dados foram analisados por meio da técnica de Bardin e análise descritiva. Resultados: Responderam ao questionário 188 profissionais de todas as regiões do Brasil. As respostas foram categorizadas em sete dimensões, conceituando vulnerabilidade odontológica como um conjunto de fatores sociais, estruturais, de saúde geral, mental e bucal, além de fatores envolvendo os serviços de saúde e a gestão pública que influenciam a dinâmica do processo saúde-doença. Conclusão: O conceito de vulnerabilidade odontológica produzido a partir da opinião dos profissionais de diferentes regiões do Brasil possibilita avançar em novos estudos sobre o tema e no desenvolvimento de instrumentos que buscam mensurar o fenômeno.

ObjectiveThis study aimed to assess the space distribution and factors associated with the risk of severe acute respiratory syndrome (SARS) and death in COVID-19 patients, based on routine register data; and to develop and validate a predictive model of the risk of death from COVID-19.MethodsA cross-sectional, epidemiological study of positive SARS-CoV-2 cases, reported in the south region of the city of São Paulo, SP, Brazil, from March 2020 to February 2021. Data were obtained from the official reporting databases of the Brazilian Ministry of Health for influenza-like illness (ILI) (esus-VE, in Portuguese) and for patients hospitalized for SARS (SIVEP-Gripe). The space distribution of cases is described by 2D kernel density. To assess potential factors associated with the outcomes of interest, generalized linear and additive logistic models were adjusted. To evaluate the discriminatory power of each variable studied as well as the final model, C-statistic was used (area under the receiver operating characteristics curve). Moreover, a predictive model for risk of death was developed and validated with accuracy measurements in the development, internal and temporal (March and April 2021) validation samples.ResultsA total of 16,061 patients with confirmed COVID-19 were enrolled. Morbidities associated with a higher risk of SARS were obesity (OR=25.32) and immunodepression (OR=12.15). Morbidities associated with a higher risk of death were renal disease (OR=11.8) and obesity (OR=8.49), and clinical and demographic data were more important than the territory per se. Based on the data, a calculator was developed to predict the risk of death from COVID-19, with 92.2% accuracy in the development sample, 92.3% in the internal validation sample, and 80.0% in the temporal validation sample.ConclusionsThe risk factors for SARS and death in COVID-19 patients seeking health care, in order of relevance, were age, comorbidities, and socioeconomic factors, considering each discriminatory power.

Objective: To analyze the factors associated with the SARS-CoV-2 infection among oral health professionals. Material and Methods: This was a cross-sectional study in the city of São Paulo, São Paulo State, Brazil. Professionals from three different categories were included: dental surgeons (DS), dental assistants (DA), and dental hygienists (DH). A questionnaire was created on a digital platform and sent via institutional email to each subject. The questionnaire contained 32 questions about sociodemographic, work, and behavior factors. The data about SARS-CoV-2 infection was confirmed through RT-PCR exams. Descriptive (absolute and relative frequencies) and inferential analyses (chi-squared or Fisher’s exact test) (p

Issue Real-time access to up-to-date population information is essential to the strategic planning of primary health care (PHC). In the Brazilian public health system community-based health workers (CHWs), working as part of PHC teams, collect health, demographic and socio-economic data from individuals mainly through paper-based forms that are later entered manually into electronic information systems. Mobile applications could help to improve the quality and speed of this process facilitating the CHWs day-to-day work while improving the access to the collected information. Description of the Problem During September of 2019, a mobile application installed in tablets for the collection of health, demographic and socio-economic data was deployed for 432 CHWs of 87 PHC teams in the southern region of São Paulo, Brazil, serving a total population of 283,324 individuals. During implementation, the acceptability and challenges faced by CHWs were evaluated and the time taken to complete data entry. Results Seventy-two hours of training were offered to CHWs and other 139 professionals including managers, nurses and administrative staff (AS). Some CHWs reported concerns about the process change and fear of not being able to operate the application, especially those unfamiliar to the technology. With training and team support, fear was transformed into satisfaction with the realization of the benefits of the system. The main infrastructure challenge was the need for installation of Wi-Fi routers in some health care units, in addition to the replacement 4.4% of damaged tablets. In four months 97.6% of the total population was registered in the application. Lessons A WhatsApp group was created to clarify AS doubts, receive suggestions and disseminate guidelines. AS remained as the reference point at healthcare units and data completeness still needs to be reinforced. Key messages A mobile application was well-accepted by CHWs and could facilitate the collection of population data. A tablet app proved to be a useful tool to generate information for the PHC teams.

Background The four essential attributes of primary health care (PHC): access, longitudinality, comprehensiveness and coordination, guide the professional practices of service management and also the professionals of the family health strategy teams. Family medicine residence (FMR) is the speciality that trains medical practitioners capable of acting properly in PHC. It develops a person-centred approach, oriented towards the individual, his family and community, which dialogues with the PHC precepts of comprehensive patient care from a social point of view. Thus, the objective of this study was to verify whether there are differences in the PHC attributes perceived by patients treated by teams with FMR doctors and by the others. Methods This was an observed cross-sectional study conducted during 2019, which used the Adult Primary Care Assessment Tool (PCATool) to evaluate preliminarily 28 PHC teams working at the city of São Paulo, Brazil. The teams were compared based on 337 patient answers using domains medians and Mann-Whitney tests. The study was approved by the ethics committee. Results Eight teams (28.6%) had doctors trained in FMR. The attributes of longitudinality and access were very similar between the two groups. The teams with FMR doctors showed better evaluations in the components: information systems, median 7.78, versus 6.67 (p = 0.391); services available, median 6.52, versus 6.06 (p = 0.086); and services received, median 4.85, versus 3.85 (p = 0.180) of the coordination and comprehensiveness attributes. Conclusions We didn't find statistically significant results indicating better PHC attributes of teams with FMR doctors, based on user perception. A continuous study is recommended to follow the evolution of this speciality in the PHC context. Key messages FMR is a fundamental key to PHC and must be evaluated continuously. It is necessary to strengthen their insertion in the Brazilian health system and discuss the ways to do so.

Background Offering equitable access to dental care remains a challenge and methods to risk-stratify individuals to prioritize care could help to attain that goal. The interaction of multiple risk factors associated with oral disease vulnerability can outweigh protective factors conferring resilience and resistance to individuals and their communities; however, there is no validated instrument for measuring oral disease vulnerability. Hence, the objective of this study was to develop a Dental Vulnerability Scale (EVO) for primary health care (PHC) and evaluate its content validity and internal structure. Methods This was a psychometric study conducted in São Paulo, Brazil, in 2019. During content validation, 172 items were evaluated by a panel of 40 judges with diverse background and with the application of the Content Validity Ratio (CVR), considering a critical CVR value> 0.26. During the internal structure evaluation, the EVO was applied to a sample of 1227 individuals in the PHC setting and the results were analyzed using Exploratory and Confirmatory Factor Analysis, in addition to the application of 3 reliability indicators (Cronbach's alpha, McDonald's Omega and Greatest Lower Bound). Results The CVR was 0.33 for relevance and 0.39 for clarity, resulting in 41 items. The final EVO was composed of 4 dimensions (general health, oral health, infrastructure and health services) with a total of 15 items. Factor loadings ranged from 0.37 to 0.96, with R-squared values ranging from 0.14 to 0.91. The reliability indicators values were α = 0.64, ω = 0.99 and GLB=0.82. The Goodness of fit were NNFI = 0,95, CFI = 0,98, GFI = 0,96 and AGFI = 0,97. The EVO instrument was considered valid to be used among oral health professionals in the PHC setting. Conclusions The EVO showed satisfactory psychometric properties and could be employed by health professionals and managers to plan actions and*inform* policies related to oral health. Key messages The EVO could be used to risk-stratify individuals in the PHC setting. The EVO could help to inform oral health policies.

Background Measuring the structure and processes of healthcare services form the basis of improvement efforts and make it possible to hold organizations accountable for the services they provide. Besides having a positive impact in different health outcomes, primary health care (PHC) could also affect experiences in secondary and tertiary care through its coordinating role, therefore efforts to assess the quality of the delivery of its services are important. Hence, the study objectives were to evaluate the PHC attributes of PHC teams and the correlation of these attributes with different health outcomes. Methods This was a cross-sectional study conducted during 2019, which used the Adult Primary Care Assessment Tool (PCATool) to evaluate 28 PHC teams working on the public healthcare sector at the city of São Paulo, Brazil. The Spearman's correlation coefficient was used to evaluate the association between each PCATool dimension and referral rates, hypertension, diabetes, prenatal care and gestational outcomes. The study was approved by the local ethics committee. Results A statistically significant positive correlation was identified between controlled hypertension and care coordination (rho=0.396; 95% CI:0.012-0.678; p = 0.036), and between 6 or more prenatal care visits and comprehensive care (rho=0.441; 95% CI:0.063-0.708; p = 0.018). A statistically significant negative correlation was identified between low birth weight and care coordination (rho=-0.502; 95% CI:-0.748- -0.136; p = 0.006) and between referral rates and comprehensive care (rho=-0.499; 95%CI:-0.753- -0.114); p = 0.009). Conclusions This study reinforces the importance of the PHC attributes for different relevant health outcomes and of their continuous evaluation for services improvement. Key messages The quality of PHC attributes has a direct impact on different relevant health outcomes. Ways to improve the PHC performance must be considered based on its attributes.

Background The quality of patient medical records is intrinsically related to patient safety, clinical decision-making, communication between health providers, and continuity of care. Additionally, its data are widely used in observational studies. However, the reliability of the information extracted from the records is a matter of concern in audit processes to ensure inter-rater agreement (IRA). Thus, the objective of this study is to evaluate the IRA among members of the Patient Health Record Review Board (PHRRB) in routine auditing of medical records, and the impact of periodic discussions of results with raters. Methods A prospective longitudinal study was conducted between July of 2015 and April of 2016 at Hospital Municipal Dr. Moysés Deutsch, a large public hospital in São Paulo. The PHRRB was composed of 12 physicians, 9 nurses, and 3 physiotherapists who audited medical records monthly, with the number of raters changing throughout the study. PHRRB meetings were held to reach a consensus on rating criteria that the members use in the auditing process. A review chart was created for raters to verify the registry of the patient’s secondary diagnosis, chief complaint, history of presenting complaint, past medical history, medication history, physical exam, and diagnostic testing. The IRA was obtained every three months. The Gwet’s AC1 coefficient and Proportion of Agreement (PA) were calculated to evaluate the IRA for each item over time. Results The study included 1884 items from 239 records with an overall full agreement among raters of 71.2%. A significant IRA increase of 16.5% (OR = 1.17; 95% CI = 1.03—1.32; p = 0.014) was found in the routine PHRRB auditing, with no significant differences between the PA and the Gwet’s AC1, which showed a similar evolution over time. The PA decreased by 27.1% when at least one of the raters was absent from the review meeting (OR = 0.73; 95% CI = 0.53—1.00; p = 0.048). Conclusions Medical record quality has been associated with the quality of care and could be optimized and improved by targeted interventions. The PA and the Gwet’s AC1 are suitable agreement coefficients that are feasible to be incorporated in the routine PHRRB evaluation process.

IQG-607 is an anti-tuberculosis drug candidate, with a promising safety and efficacy profile in models of tuberculosis infection both in vitro and in vivo . Here, we evaluated the safety and the possible toxic effects of IQG-607 after acute and 90-day repeated administrations in minipigs. Single oral administration of IQG-607 (220 mg/kg) to female and male minipigs did not result in any morbidity or mortality. No gross lesions were observed in the minipigs at necropsy. Repeated administration of IQG 607 (65, 30, or 15 mg/kg), given orally, for 90 days, in both male and female animals did not cause any mortality and no significant body mass alteration. Diarrhea and alopecia were the clinical signs observed in animals dosed with IQG-607 for 90 days. Long-term treatment with IQG-607 did not induce evident alterations of blood cell counts or any hematological parameters. Importantly, the repeated schedule of administration of IQG-607 resulted in increased cholesterol levels, increased glucose levels, decrease in the globulin levels, and increased creatinine levels over the time. Most necropsy and histopathological alterations of the organs from IQG-607-treated groups were also observed for the untreated group. In addition, pharmacokinetic parameters were evaluated. IQG-607 represents a potential candidate molecule for anti-tuberculosis drug development programs. Its promising in vivo activity and mild to moderate toxic events detected in this study suggest that IQG-607 represents a candidate for clinical development.

Objetivo avaliar o efeito de um programa educativo sobre o registro da pressão arterial para profissionais de enfermagem em relação ao conhecimento teórico e à qualidade desses registros. Método estudo quase-experimental conduzido em um serviço hospitalar localizado no município de São Paulo. O conhecimento teórico de 101 profissionais foi mensurado por meio de questionário validado antes e após a intervenção educativa. A qualidade dos registros da pressão arterial foi avaliada utilizando-se formulário validado e aplicado a 354 prontuários no período pré-intervenção e 288 no período pós-intervenção. O programa educativo foi fundamentado em metodologias ativas de ensino-aprendizagem e constituído por duas estratégias: aula expositiva-dialogada e um jogo de tabuleiro. Os testes de Wilcoxon, Mann-Whitney, Fisher e Qui-Quadrado foram utilizados para comparações, adotando-se um nível de significância de α=0,05. Resultados a mediana de acertos dos profissionais passou de 19 para 22 pontos no período pós-intervenção (p

BackgroundNoncommunicable diseases (NCDs) were responsible for 72.3% of global deaths in 2016, with cardiovascular diseases accounting for almost half of those deaths and low- and middle-income countries carrying the biggest burden. As a result, the prevention and control of NCDs is recognized as urgent, while better surveillance at the country level could result in more effective policies. Hence, the objective of this study was to obtain more detailed information on the distribution of the prevalence of hypertension and diabetes among the population of two large districts of the city of São Paulo in Brazil, and to compare these findings to the results of a citywide health survey.Methods and findingsThis cross-sectional study used primary health care (PHC) routinely-collected data. The study population included 187,110 individuals 20 years of age or older registered in 13 public PHC facilities at two districts of the city of São Paulo in 2015. Data extracted from SIAB, a primary care database, was used to calculate age and sex directly standardized prevalences for diabetes and hypertension for each PHC facility. The prevalence of hypertension among women was significantly higher than the prevalence among men in the entire study population, and in every PHC facility. There was great variation among PHC facilities that was more pronounced among women. The prevalence of diabetes among women was significantly higher than the prevalence among men in the entire study population, and in every PHC facility, but there was little variation among PHC facilities.ConclusionsThis study provided information that could help with policy planning and allocation of resources, and demonstrated the use of PHC routinely-collected data to generate important insights that if replicated could have a substantial impact given the broad coverage of the national public PHC program in Brazil.

RESUMO: Introdução: A glicemia de jejum é um teste usado para o monitoramento do diabetes mellitus, bem como para seu rastreamento e diagnóstico. O objetivo do estudo foi analisar resultados de glicemia de jejum de pacientes da rede pública e sua correlação com hemoglobina glicada e lipídios. Métodos: Estudo transversal, com 77.581 pacientes, atendidos em 2014. Resultados: A maioria é do sexo feminino (65%), com idade entre 18 e 115 anos (53 ± 15,5 anos). A concordância entre glicemia de jejum e hemoglobina glicada foi moderada (Kappa = 0,416), entretanto foi substancial para níveis compatíveis com diabetes (Kappa = 0,689) e pobre para pré-diabetes (Kappa = 0,188). Glicemia de jejum ≥ 100 mg/dL foi encontrada em 41,1% dos pacientes e hemoglobina glicada ≥ 5,7% em 61,5%. As alterações lipídicas são mais frequentes nos indivíduos com alterações na glicemia. Dos 14.241 indivíduos com glicemia de jejum ≥ 126 mg/dL, a microalbuminúria foi pesquisada em apenas 883 (6,2%) indivíduos, com resultado alterado em 201 (22,8%). Conclusões: Nos indivíduos que realizaram mais de uma dosagem de glicemia de jejum, a maioria permaneceu com exames alterados, principalmente os que apresentavam valores compatíveis com o diagnóstico de diabetes, sugerindo que não conseguem um controle adequado. A baixa frequência de pesquisa de microalbuminúria em indivíduos com glicemia de jejum sugestiva de diabetes reflete a pequena preocupação com o rastreio de suas complicações crônicas. A elevada frequência de dislipidemia nesses indivíduos evidencia ser uma população de elevado risco cardiovascular. ABSTRACT: Introduction: Fasting glucose is a test used for monitoring diabetes mellitus, as well as its screening and diagnosis. The objective of this study was to evaluate fasting glucose results and their correlation with glycated hemoglobin and lipids. Methods: Cross-sectional study, involving 77,581 patients, attended in 2014. Results: The majority of the patients are women (65%). The age of the patients ranged from 18 to 115 years (mean of 53 ± 15.5). The agreement between fasting glucose and glycated hemoglobin was moderate (kappa = 0.416); however, it was substantial for the levels used for the diagnosis of diabetes (kappa = 0.689) and poor for pre-diabetes (kappa = 0.188). Fasting glucose ≥ 100 mg/dL was observed in 41.1% of the patients and 61.5% present glycated hemoglobin ≥ 5.7%. Lipid abnormalities are likeliest in patients with elevated fasting glucose. From those 14,241 individuals that had fasting glucose ≥ 126 mg/dL, the microalbuminuria test was performed in only 883 (6.2%) patients, with abnormal results in 201 (22.8%). Conclusions: The high frequency of fasting glucose with abnormal results may reflect the high proportion of exams performed by individuals with diagnosis of diabetes, to evaluate their glycemic control. The low frequency of requests for microalbuminuria tests in those with probable diagnosis of diabetes reflects the little attention paid for the screening of chronic complications of diabetes. It calls attention the high frequency of dyslipidemia in those individuals, highlighting the fact that this is a population with high cardiovascular risk.

Background During in situ simulation, interprofessional care teams practice in an area where clinical care occurs. This study aimed to detect latent safety threats (LST) in a training program, which combined in situ simulation scenarios with just-in-time and just-in-place self-directed task training in an emergency department. We hypothesized this simulation-based training in actual care areas allows the detection of at least one LST per simulation scenario. Methods This prospective observational study (April 2015–March 2016) involved 135 physicians, nurses, and nurse technicians. Training themes selected were arrhythmia, respiratory insufficiency, shock, and cardiopulmonary resuscitation. Simulation weeks occurred every 3 months, with three 10-min scheduled in situ simulation scenarios alternating for each theme daily. The scenarios were followed by co-debriefing by two facilitators (a physician and a nurse). LST were identified by facilitators using a debriefing checklist. Additionally, a room was set up with task-trainers related to each theme. Results The number participants in scenarios was 114 (84% of the population) and in task-training, 101. The number of scenario cancelations was nine, making the final total number to 49 of 58 proposed. Fifty-six LST were observed, with an average of 1.1 per scenario. LST were divided into four categories: equipment (n = 23, 41.1%), teamwork (n = 12, 21.4%), medication (n = 11, 19.6%), and others (n = 10, 17.9%). There was a higher proportion in equipment-related LST (p

Background Influenza A H1N1 infections carry a significant mortality risk. This study describes inpatients with suspected and confirmed Influenza A H1N1 infection who were prescribed oseltamivir, the risk factors associated with infection, the association between infection and mortality, and the factors associated with in-hospital mortality in infected patients. Methods This study was a matched case-control study of hospitalized patients who underwent real-time polymerase chain reaction testing for Influenza A H1N1 and were treated with oseltamivir from 2009 to 2015 in a tertiary care hospital. Cases (patients with positive Influenza A H1N1 testing) were matched 1:1 to controls (patients with negative test results). Results A total of 1405 inpatients who underwent PCR testing and received treatment with oseltamivir were identified in our study and 157 patients confirmed Influenza A H1N1. Almost one third of patients with Influenza A H1N1 were diagnosed in the pandemic period. There was no difference in mortality between cases and controls. Immunocompromised status, requirement of vasoactive drugs, mechanical ventilation, acute hemodialysis, albumin administration, surgical procedures and thoracic procedures and length of stay were associated with increased risk of death in Influenza A H1N1 infected patients. Conclusions We found no increased risk of mortality for patients with proven Influenza A H1N1 when compared to similar patients without confirmed Influenza. Electronic supplementary material The online version of this article (10.1186/s12879-018-3492-z) contains supplementary material, which is available to authorized users.

Background Candida bloodstream infections carry a significant mortality risk, justifying the importance of adequate antifungal therapy. This study describes trends in antifungal consumption using the Defined Daily Dose (DDD) and Days of Therapy (DOT) metrics, identifies the microbiological profile, the time to initiation of empirical therapy, the adjustment after positive blood culture results for Candida, and the impact on in-hospital mortality rate in patients with candidemia. Methods An analysis of antifungal consumption from 2008 to 2016, and of candidemia cases from 2012 to 2016 was carried out in a private tertiary hospital. Results A total of 11,273 admissions were identified with a prescription for at least one type of antifungal therapy. Fluconazole was the most prescribed antifungal drug in terms of general consumption. Through the DDD and DOT metrics, we observed that over time, there was an increase in the consumption of liposomal amphotericin B, micafungin and voriconazole. Candida albicans was the most isolated species in blood cultures. Regarding candidemia, we analyzed samples from 115 patients. Empirical therapy was started within 24 h of blood culture in 44.3% of the cases, and in 81.7% of the cases, the antifungal was deemed to be adequate based in antifungal susceptibility testing, both of which were not associated with the in-hospital mortality rate. Conclusions Our study reinforces the importance of monitoring the consumption of antifungal agents, which helps in proposing actions that lead to their rational use and, consequently, reduces the appearance of resistant strains.

Several lines of indirect evidence, such as mutations or dysregulated expression of genes related to cytoskeleton, have suggested that cytoskeletal dynamics, a process essential for axons and dendrites development, is compromised in autism spectrum disorders (ASD). However, no study has yet examined whether cytoskeleton dynamics is functionally altered in cells from ASD patients. Here we investigated the regulation of actin cytoskeleton dynamics in stem cells from human exfoliated deciduous teeth (SHEDs) of 13 ASD patients and 8 control individuals by inducing actin filament depolymerization and then measuing their reconstruction upon activation of the RhoGTPases Rac, Cdc42 or RhoA. We observed that stem cells from seven ASD individuals (53%) presented altered dymanics of filament reconstruction, including a patient recently studied by our group whose iPSC-derived neuronal cells show shorten and less arborized neurites. We also report potentially pathogenic genetic variants that might be related to the alterations in actin repolymerization dynamics observed in some patient-derived cells. Our results suggest that, at least for a subgroup of ASD patients, the dynamics of actin polymerization is impaired, which might be ultimately leading to neuronal abnormalities.

AimTo report an evaluation of health professionals’ participation in a distance-learning physical activity training course developed in a low socio-economic region of São Paulo city, Brazil.BackgroundIn countries with public universal health systems, physical activity promotion in primary health care settings can reap results, particularly given that such interventions have the potential to reach a large percentage of the population. However, few studies proposed physical activity training for health professionals in low- and middle-income countries. Brazil is a continental country and has the Unified Health System which incorporates family health teams in over 85% of Brazilian cities.MethodsThe physical activity training was part of the fifth module of an educational intervention throughout a distance-learning course focusing on health professionals at M’Boi Mirim district in São Paulo city. The training totaled 3 h and had five themes of physical activity: (1) concepts, definitions benefits; (2) evaluation; (3) recommendation; (4) interventions; (5) physical activity counseling. The opinion of health professionals was evaluated after training by two open questions.FindingsOut of 106 professionals who took part of the course, only 22.6% (n=24) had accessed the fifth module. These professionals were predominantly female (79.2%), nurses (66.7%) and aged 30 years or older. Responses highlighted the course approach focused on physical activity for improving patient’s quality of life and well-being, disease prevention and health improvements. Regarding the themes for improvement, the health professionals identified that there was a need to experience physical activity classes first-hand, and the need to link physical activity counseling to the local venues that provide structured physical activity programs. We recommend that further training courses can be conducted based on this model for health professionals to promote physical activity to the community in Brazil.

Background The diagnosis of Clostridium difficile infection (CDI) increases concern that asymptomatic carriers of toxigenic C. difficile may be diagnosed with CDI. Methods A matched case control study was conducted in inpatients in a tertiary care center. The first 50 patients with diarrhea and a positive polymerase chain reaction (PCR) test beginning February 1, 2015, were identified as cases. Control patients were hospitalized patients receiving antibiotics, but with no diarrhea, housed in a room as close as possible to each case during the same admission time. A convenience sample of healthcare workers who cared for C. difficile infected patients was also tested. Results We found two positive PCR results for C. difficile in controls (4.1%). None of these healthcare workers were positive for C. difficile by PCR. There was no difference between groups with respect to overall antibiotic use before the requested PCR for Clostridium difficile (p = 0.359). The majority of cases had a high proportion of gastrointestinal disorders (71.4%) compared with control (8.2%), p < 0.001. Patients with neoplasia had a higher chance of being identified as cases (p = 0.041). Conclusions PCR should not be the only diagnostic tool but should be complementary to other methods and to the medical history.

Fasting glucose is a test used for monitoring diabetes mellitus, as well as its screening and diagnosis. The objective of this study was to evaluate fasting glucose results and their correlation with glycated hemoglobin and lipids.Cross-sectional study, involving 77,581 patients, attended in 2014.The majority of the patients are women (65%). The age of the patients ranged from 18 to 115 years (mean of 53 ± 15.5). The agreement between fasting glucose and glycated hemoglobin was moderate (kappa = 0.416); however, it was substantial for the levels used for the diagnosis of diabetes (kappa = 0.689) and poor for pre-diabetes (kappa = 0.188). Fasting glucose ≥ 100 mg/dL was observed in 41.1% of the patients and 61.5% present glycated hemoglobin ≥ 5.7%. Lipid abnormalities are likeliest in patients with elevated fasting glucose. From those 14,241 individuals that had fasting glucose ≥ 126 mg/dL, the microalbuminuria test was performed in only 883 (6.2%) patients, with abnormal results in 201 (22.8%).The high frequency of fasting glucose with abnormal results may reflect the high proportion of exams performed by individuals with diagnosis of diabetes, to evaluate their glycemic control. The low frequency of requests for microalbuminuria tests in those with probable diagnosis of diabetes reflects the little attention paid for the screening of chronic complications of diabetes. It calls attention the high frequency of dyslipidemia in those individuals, highlighting the fact that this is a population with high cardiovascular risk.A glicemia de jejum é um teste usado para o monitoramento do diabetes mellitus, bem como para seu rastreamento e diagnóstico. O objetivo do estudo foi analisar resultados de glicemia de jejum de pacientes da rede pública e sua correlação com hemoglobina glicada e lipídios.Estudo transversal, com 77.581 pacientes, atendidos em 2014.A maioria é do sexo feminino (65%), com idade entre 18 e 115 anos (53 ± 15,5 anos). A concordância entre glicemia de jejum e hemoglobina glicada foi moderada (Kappa = 0,416), entretanto foi substancial para níveis compatíveis com diabetes (Kappa = 0,689) e pobre para pré-diabetes (Kappa = 0,188). Glicemia de jejum ≥ 100 mg/dL foi encontrada em 41,1% dos pacientes e hemoglobina glicada ≥ 5,7% em 61,5%. As alterações lipídicas são mais frequentes nos indivíduos com alterações na glicemia. Dos 14.241 indivíduos com glicemia de jejum ≥ 126 mg/dL, a microalbuminúria foi pesquisada em apenas 883 (6,2%) indivíduos, com resultado alterado em 201 (22,8%).Nos indivíduos que realizaram mais de uma dosagem de glicemia de jejum, a maioria permaneceu com exames alterados, principalmente os que apresentavam valores compatíveis com o diagnóstico de diabetes, sugerindo que não conseguem um controle adequado. A baixa frequência de pesquisa de microalbuminúria em indivíduos com glicemia de jejum sugestiva de diabetes reflete a pequena preocupação com o rastreio de suas complicações crônicas. A elevada frequência de dislipidemia nesses indivíduos evidencia ser uma população de elevado risco cardiovascular.

Background. The diagnosis of Clostridium difficile infection (CDI) increases concern that asymptomatic carriers of toxigenic C. difficile may be diagnosed with CDI. Methods. A matched case control study was conducted in inpatients in a tertiary care center. The first 50 patients with diarrhea and a positive polymerase chain reaction (PCR) test beginning February 1, 2015, were identified as cases. Control patients were hospitalized patients receiving antibiotics, but with no diarrhea, housed in a room as close as possible to each case during the same admission time. A convenience sample of healthcare workers who cared for C. difficile infected patients was also tested. Results. We found two positive PCR results for C. difficile in controls (4.1%). None of these healthcare workers were positive for C. difficile by PCR. There was no difference between groups with respect to overall antibiotic use before the requested PCR for Clostridium difficile (p=0.359). The majority of cases had a high proportion of gastrointestinal disorders (71.4%) compared with control (8.2%), p<0.001. Patients with neoplasia had a higher chance of being identified as cases (p=0.041). Conclusions. PCR should not be the only diagnostic tool but should be complementary to other methods and to the medical history.

To associate blood pressure (BP) documentation with adverse outcomes in an emergency department (ED).This is a retrospective observational study, and 642 records of patients admitted to the ED of a tertiary hospital in Brazil were used. We included medical records of patients of both sexes aged over 18 years, who were allocated in general wards in the period December 2015-June 2016. Association between BP measurements with length of stay (LOS), worsening of clinical presentation, unplanned patient transfer, readmission, stroke or transient ischemic attack, cardiorespiratory arrest, and death were investigated.Association was observed between worsening of clinical presentation and systolic (p = 0.003) or diastolic (p = 0.001) BP values. The association between LOS and worsening of clinical presentation with the number of BP measurements or mean time between BP measurements was statistically significant (p 0.001). Unplanned patient transfer was associated with an increase in the number of BP measurements (p 0.001). The mean time between BP measurements was higher among patients who returned to the ED within 48-72 h (p = 0.030).The results of this study showed association between BP documentation with adverse outcomes in the ED, reinforcing the need to develop educational strategies regarding nursing records and monitoring of vital signs.

ObjectiveTo propose a consensus for prevention of vaginal stenosis in patients submitted to pelvic radiotherapy.MethodIn this methodological study, Delphi technique was applied for content validation on vaginal stenosis prevention. Data regarding content validation were collected from 32 specialists practicing in the oncology profession. The content validity index of items in the consensus was calculated based on the evaluations by the specialists.ResultsIn the first round, of the 38 items evaluated, 29 items reached a Content Validity Index (CVI-I) greater than 80%, and 9 items had a CVI lower than 80%. Of the items that did not obtain agreement, 2 items were excluded, and 7 were reformulated and included in the second round. In the second round, all 7 items obtained a CVI-I greater than 80%. The final instrument consisted of 29 items validated in the first round, plus 7 items reformulated and consolidated in the second round. The judges agreed that it is the responsibility of the health professionals to consult the patients undergoing radiation therapy in the area of sexuality to patients. The radiation oncologist should be the first professional to address this issue and the nurse oncologist in the follow-up consultation should pass the guidelines to the patients as comprehensively as possible. Patients should be informed about vaginal dilation, regardless of whether they are sexually active or have a partner. They should also be informed of when they can resume sexual activity. The procedure of vaginal dilation should be individualized. The prescribed vaginal dilators should be used with a lubricant for a duration of at least 5-10 minutes, 2-3 times a week, as per the need of each patient (sexual activity and/or clinical follow-up) for an indefinite time. Patients should seek medical help in case they experience pain, discomfort, or bleeding during dilation.ConclusionThe Brazilian version of the consensus for vaginal stenosis prevention in patients submitted to pelvic radiotherapy was validated with 36 items in 7 categories related to Responsibility; Target population; Rationale; Vaginal dilator; Content instructions; Information provision; and Patient support. In Brazil, the educational practices on vaginal dilation for patients submitted to radiotherapy partly revealed similar difficulties as identified in other studies as well as countries with reference to specific guidelines for the start and duration of vaginal dilation. The final consensus developed in this study could strengthen the guidelines for education of patients in Brazil and provide a future scope to establish a single and safe guideline.

ObjectiveTo identify spatial variation in the risk for metabolic complications (RMC) by means of a semi-parametric approach for multinomial data.DesignCross-sectional study.SettingWe visited 730 households selected in the first of a two-stage sample in South health district in Campinas, São Paulo, Brazil, 2006–2007.SubjectsWe interviewed 651 individuals and obtained their respective anthropometric measures and geographical coordinates of their house location. They were classified according to a combination of BMI and abdominal circumference as having no risk, increased, high or very high RMC.ResultsGender, age and schooling were associated with RMC. Crude spatial risk for the three levels of RMC in relation to the absence of risk suggested different patterns in each level. Adjusted spatial risk for the RMC showed smaller significant areas, but the pattern remained similar to crude risk.ConclusionsSpatial point analysis with a multinomial approach improves the understanding of differences in RMC found, as we could identify specific areas in which to intervene. The public health significance of these findings may lie in the additional evidence provided that spatial location and its features can influence patterns of RMC.

Lack of coordination between primary and secondary care can have adverse effects for patients. Our research project consists of a multi-strategy intervention to connect the healthcare professionals of one hospital and 18 primary care units (PCUs) in the southern neighborhood of M'boi Mirim, in the city of Sao Paulo, Brazil. The focus of this paper is a privacy-oriented and feature-rich online collaboration network, set up for professionals to provide more continuous care to patients as they cycle between PCUs and hospital care. Besides the network, a capacity building online course is being offered and a telemedicine service made available. Results will follow from outcomes of patients with conditions sensitive to primary care, from gains in efficiency of procedures, and from exchange patterns between professionals plus their overall condition at work.