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Models of Emergency Departments for Reducing Patient Waiting Times

In this paper, we apply both agent-based models and queuing models to investigate patient access and patient flow through emergency departments. The objective of this work is to gain insights into the comparative contributions and limitations of these complementary techniques, in their ability to contribute empirical input into healthcare policy and practice guidelines. The models were developed independently, with a view to compare their suitability to emergency department simulation. The current models implement relatively simple general scenarios, and rely on a combination of simulated and real data to simulate patient flow in a single emergency department or in multiple interacting emergency departments. In addition, several concepts from telecommunications engineering are translated into this modeling context. The framework of multiple-priority queue systems and the genetic programming paradigm of evolutionary machine learning are applied as a means of forecasting patient wait times and as a means of evolving healthcare policy, respectively. The models' utility lies in their ability to provide qualitative insights into the relative sensitivities and impacts of model input parameters, to illuminate scenarios worthy of more complex investigation, and to iteratively validate the models as they continue to be refined and extended. The paper discusses future efforts to refine, extend, and validate the models with more data and real data relative to physical (spatial–topographical) and social inputs (staffing, patient care models, etc.). Real data obtained through proximity location and tracking system technologies is one example discussed

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Motor intervention in children with school learning difficulties

This study sought to evaluate motor development in children aged 6 to 11 years with learning\ud difficulties and school characteristics of delayed motor development, before and after application of\ud a motor intervention program. The sample consisted of 28 children with a mean age of 107.21 ±\ud 16.56 months, who were evaluated by the Motor Development Scale and received motor intervention\ud for 6 months, followed by reassessment. We observed a statistically significant difference between\ud the average of the motor activity ratios in all areas of the evaluation and reevaluation. Also verified\ud in the evaluation were the concentration ratios of children with motor activity greater than or equal\ud to 80 and there was a revaluation increase in this concentration on re-evaluation, the areas with the\ud greatest increase in concentration and significant differences being: Body Schema, Space and temporal\ud Organization. In the overall evaluation of MDS, most children presented the classification of “low\ud normal”. However, in the reassessment most have evolved into the “average normal”, only 4 of\ud themremaining in the same classification. Therefore, in this study, children with learning disabilities\ud also showed motor deficits and the intervention applied contributed to an increase in the motor\ud ratios with consequent improvement in motor development. Besides psychopedagogical asistance,\ud it is essential to reassess them and if necessary apply the intervention in the motor development of\ud children with learning difficultie

Delta Narratives: Saving the Historical and Cultural Heritage of The Sacramento-San Joaquin Delta

From August 2014 through July 2015, the Delta Narratives project, on contract to the Delta Protection Commission, addressed two questions. First, in what ways does the historical experience of the Sacramento-San Joaquin Delta contribute to an understanding of key themes in regional and American history? Second, how might Delta stories gain wider appreciation within the region, throughout Northern California, and among people in the rest of California and beyond? Scholars on the project team documented ways the history of the Delta illustrates trends in land management and reclamation, technological shifts in transportation and agriculture, the impact of ethnicity and labor specialization on community building, and finally, the shifting visioning of America\u27s promise and fall from grace by artists and writers in response to the intense cultivation of the Delta and the conditions which workers there endured. Their essays testify to the intrinsic value of Delta stories and to the additional perspectives they bring to regional and national history. With these essays in hand, the project team investigated the current infrastructure for the preservation and dissemination of historical and cultural information in the Delta. It created a directory of institutions committed to promoting Delta stories. In order to stimulate conversations between these stakeholders, the team organized two workshops at which the scholars and archivists shared insights and invited commentary and conversation. Subsequently, with the support of the Center for California Studies at Sacramento State University, a conference entitled “More than H2O: Saving the History and Culture of the Sacramento-San Joaquin Delta” presented findings and discussed strategies with an audience of state and local stakeholders. Delta Narratives culminated with a conference organized around an American Assembly model. The conference generated a list of suggestions for further action regarding the recognition, preservation, and dissemination of Delta stories. High on the list of initiatives were adequate mapping of historically significant locations, an organization that would draw together the many cultural and historical groups in the Delta toward common action, the initiation of annual Delta Days to celebrate the region, and the creation of educational materials including web applications (apps), and a website devoted to the region

The Lipodystrophy Syndrome as a Risk Marker for Cardiovascular Disease in Patients with HIV/AIDS Treated with HAART

Introduction: The classic risk factors for cardiovascular disease in healthy individuals are well known, however, it lacks in the literature the mechanisms that predicts cardiovascular disease in the population living with HIV-AIDS treated with HAART and presenting syndrome lipodystrophy. We aimed to investigate the risk of cardiovascular disease in HIV-AIDS patients treated with HAART and lipodystrophy syndrome. Methods: A search was performed in Medline, SciELO, Lilacs and Cochrane using the intersection between the keywords: "cardiovascular disease", "HIV", "AIDS", "HAART" and "lipodystrophy syndrome". Results: The selected studies demonstrated that metabolic disorders such as hyperlipidemia, central adipose hypertrophy and peripheral lipoatrophy, besides the metabolic syndrome and lipodystrophy are maker clear risks of developing cardiovascular disease in these individuals. Conclusion: The metabolic alterations in HIV-AIDS treated with HAART and presenting lipodystrophy syndrome may potentiate the development of cardiovascular diseases

Transmission of anogenital warts in children and association with sexual abuse

INTRODUÇÃO: A incidência do condiloma acuminado anogenital em crianças mostra notável aumento nas últimas duas décadas, bem como o interesse por sua associação com o abuso sexual. No entanto, essa relação apresenta controvérsias quanto à etiologia da infecção, o que torna o atendimento desafiador, particularmente nos aspectos ético-legais. OBJETIVO: Revisão da literatura sobre transmissão do HPV em crianças e relação com abuso sexual. MÉTODO: Síntese de dados da consulta ao Journal Citation Reports (JCR-ISI), Medical Literature Analysis and Retrieval System Online (Medline), Scientific Eletronic Library Online (Scielo) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). Foram utilizados descritores MeSH Terms com sintaxes (HPV [All Fields]) AND ("Child Abuse, Sexual" [MeSH Terms]). Artigos relevantes entre 1989 e 2009 foram selecionados. Aspectos ético-legais foram consultados na legislação penal e Estatuto da Criança e do Adolescente. RESULTADOS: Diferentes formas de transmissão não sexual do HPV em crianças estão documentadas, destacando-se a transmissão vertical, auto e heteroinoculação de verrugas cutâneas, e aquisição por instrumentos. Estudos são discordantes quanto à aplicabilidade do DNA-HPV para diferenciar a transmissão sexual e não sexual das verrugas anogenitais. CONCLUSÃO: Evidências indicam que em crianças com menos de dois anos de idade a transmissão não sexual do HPV deve ser fortemente considerada na ausência de lesões genitais, de outra DST, ou de história consistente de abuso. A probabilidade de associação entre HPV e abuso sexual aumenta diretamente com a idade, principalmente após os cinco anos.INTRODUCTION: the incidence of anogenital condyloma acuminata in children shows remarkable increase in the last two decades, as well as by its association with sexual abuse. However, this relationship presents controversies regarding the etiology of infection, which makes answering challenging, particularly in legal-ethical aspects. OBJECTIVE: review of the literature about HPV transmission in children and relationship with sexual abuse. METHODS: synthesis of data from the query to Journal Citation Reports (JCR-ISI), Medical Literature Analysis and Retrieval System Online (Medline), Scientific Electronic Library Online (Scielo) and the Latin American and Caribbean Health Sciences (Lilacs). MeSH descriptors were used Terms with syntax (HPV [All Fields]) AND ("Child Sexual Abuse," [MeSH Terms]). Relevant articles between 1989 and 2009 were selected. Legal-ethical aspects were consulted in the criminal law and Brazilian Child and Adolescent Statute. RESULTS: different forms of non-sexual transmission of HPV in children are documented, including the vertical transmission, self and hetero inoculation of cutaneous warts, and acquisition by instruments. Studies are conflicting as to the applicability of HPV-DNA to differentiate the sexual transmission and not sexual anogenital warts. CONCLUSION: evidence indicates that in children under two years non-sexual transmission of HPV should be strongly considered in the absence of genital lesions, another STD, or consistent history of abuse. The likelihood of association between HPV and sexual abuse increases directly with age, especially after five years

Overweight in preschool children: analysis of a possible intervention

INTRODUÇÃO: a obesidade vem aumentando progressivamente na infância. Em resposta a essa tendência, diversas instituições têm realizado programas de prevenção à obesidade infantil. OBJETIVO: elaborar um projeto de intervenção voltado para a prevenção do excesso de peso de crianças de 2 e 3 anos de idade de creches públicas e analisar a viabilidade de sua implantação. MÉTODO: foram sorteadas probabilisticamente nove creches: quatro compondo a amostra objeto da intervenção e cinco para o grupo sem intervenção. Realizaram-se observações sistematizadas para reconhecimento da rotina de alimentação e de atividades físicas nas creches, a partir das quais se delineou e implantou uma intervenção. Foi pré-estabelecido que a intervenção devesse ser simples, de baixo custo, praticamente não elevar a carga de trabalho local e resultar num processo participativo. RESULTADOS: a alimentação era programada pela empresa de merenda escolar terceirizada pela Prefeitura, que oferecia porções superdimensionadas. As atividades físicas eram restritas e sem programação regular. A intervenção nutricional adequou às porções oferecidas no almoço, inclusive evitando a repetição da refeição. Para as atividades físicas, estabeleceu-se que seriam diárias, com 30 minutos de duração e de elevado gasto energético. Todas as alterações foram elaboradas e implantadas com participação efetiva do pessoal das creches em, no máximo, 12 semanas. CONCLUSÃO: é possível elaborar e implantar uma intervenção simples, feita sob medida para a realidade local de creches, visando a melhoria do estado nutricional das crianças em idade pré-escolar.INTRODUCTION: Obesity is increasing progressively in childhood. In response to this trend, several institutions have carried out programs to prevent childhood obesity. OBJECTIVE: To develop an intervention project aimed at the overweight prevention in 2-3 year-old children at public daycare centers and analyze the feasibility of its implementation. METHODS: nine daycare centers were randomly selected probabilistically: four composing the sample object of intervention and five in the group without intervention. There have been comments systematized for the recognition of the routine of feeding and physical activity of daycare centers, from which was outlined and implemented an intervention. It was predefined that the intervention should be simple, of low cost, hardly raising the burden of local labor and result in a participatory process. RESULTS: Food was scheduled by the school lunch company outsourced by the city, which offered oversized portions. Physical activities were restricted and without regular schedule. The nutritional intervention adapted the quantity of food served at lunch, also avoiding the repetition of the meal. For physical activities, it was established that they would be daily, during 30 minutes and of high energy expenditure. All changes were designed and implemented with effective participation of staff in the daycare, in a maximum of 12 weeks. CONCLUSION: it is possible to develop and deploy a simple intervention, tailored to local realities of daycare centers, aimed at improving the nutritional status of children

Pregnancy resulting from sexual abuse: Reasons alleged by Brazilian women for carrying out the abortion - Pregnancy and violence

http://www.healthmedjournal.com/vol06-no3.pd

Social representation of the hospital ludic: look of the child

Introdução: o brincar tem se tornado objeto de estudo nos diversos setores da sociedade, sendo considerado como uma atividade espontânea inata ao ser humano e necessário ao desenvolvimento infantil físico, social, emocional e cognitivo, facilita comunicação, ajuda na socialização e adaptação a ambientes e pessoas. Quando hospitalizadas, as criança se sentem vulneráveis, com pessoas desconhecidas, procedimentos invasivos e dolorosos, e a limitação das atividades exercidas por ela, tendem a tornar a situação pior. Objetivos: descrever a percepção da criança, acerca do lúdico no ambiente hospitalar e verificar a representação social da brinquedoteca para as crianças internadas a partir da técnica de Desenho-Estória com tema. Método: tratou-se de um estudo qualitativo e exploratório que utilizou como instrumento de coleta de dados a técnica do Desenho – Estória com tema, tendo como sujeitos 12 crianças com idade entre 06 e 11 anos. A análise dos dados foi realizada a partir da discussão com subsídios teóricos estudados, além da observação dos pesquisadores, que possibilitou encontrar respostas ao problema pesquisado, estabelecendo as relações necessárias entre os dados obtidos e as hipótesesformuladas. Resultados: para as crianças o lúdico no contexto hospitalar estava ligado ao espaço da brinquedoteca, de forma que, a maior parte relatou que não brincavam no quarto, ou em qualquer outro local do hospital. Logo, sua representação social para as crianças foi identificada como um lugar onde acontece socialização, recuperação, onde se pode manipular imaginariamente o ambiente para aproximar-se da realidade cotidiana, ou transformar a situação vivenciada em algo familiar. Percebeu-se que a ludicidade mudam as idéias previamente formadas pela criança sobre o hospital, passando este, a ser percebido como um espaço que proporciona bem-estar e prazer, e onde se pode brincar. O desenho contextualiza e revela simbolicamente a situação de hospitalização, além de apresentar-se como elementoestruturante para a criança do ponto de vista emocional. Conclusões: a brinquedoteca é capaz de aumentar a adaptação da criança à nova situação que vivencia, e inclusive atuar sobre o restabelecimento de sua saúde. Por fim, constatamos que o lúdico é fator de proteção para crianças durante a hospitalização. Embora a obrigatoriedade da presença das brinquedotecas hospitalares em instituições de saúde com atendimento pediátrico seja um grande avanço para as políticas públicas, há ainda alguns desafios que necessitam ser superados, dentre eles a necessidade de engajamento dos profissionais de saúde e estabelecimento de uma rotina de funcionamento.Introduction: Play has become an object of study in various sectors of society, as it is viewed as an innate, spontaneous activity that is critical for a child’s physical, social, emotional and cognitive development, which facilitates communication, socialisation and adaptation to environments and people. During hospitalisation, children feel vulnerable as they have to cope with strange carers, invasive and painful procedures. Barriers to their regular activities tend to make the situation worse. Objectives: To describe the child’s view of his/her playfulness in the hospital environment and investigate the social representation of a hospital playroom for children exposed  to the story-drawing technique. Methods: This qualitative exploratory research used storydrawing as a tool for data collection with a sample of 12 children aged 6 to 11 years, while they were hospitalised. Data analysis was supported by a literature review and direct observation, which allowed the researchers to draw relationships between theory, the research hypotheses and the data collected. Findings: The children’s construction and representation of playfulness while in hospital was directly related to the playroom, since most of them reported not conceiving of the possibility to play in bed or elsewhere in the hospital. Soon the playroom was further viewed as a place for socialising and recovering from illness as they approximated this environment to their reality in an attempt to make it a closest-as-possible representation of their homes. It was observed that play changed the children’s preconceived ideas of the hospital, as they began to view the playroom as an environment in which they felt able to play and consequently well. Their story-drawings contextualised symbolically their current hospitalisation situation and became a scaffolding tool for their emotional well-being. Conclusions: The playroom can effectively aid hospitalised children to cope better with the new situation and support the restoration of their health. Play is an emotionally protective factor for children during hospitalisation. Although in Brazil it is now mandatory for health institutions to have a playroom with paediatric care, this breakthrough policy is still challenging for some institutions with respect to being staffed with engaged health professionals and establishing routine procedures