Institutional and matrix support and its relationship with primary healthcare

OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams.METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support – 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was “level of support” (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23).CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.</sec

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

History of water quality parameters – a study on the Sinos River/Brazil

Water is increasingly becoming a valuable resource, constituting one of the central themes of environmental, economic and social discussions. The Sinos River, located in southern Brazil, is the main river from the Sinos River Basin, representing a source of drinking water supply for a highly populated region. Considering its size and importance, it becomes necessary to conduct a study to follow up the water quality of this river, which is considered by some experts as one of the most polluted rivers in Brazil. As for this study, its great importance lies in the historical analysis of indicators. In this sense, we sought to develop aspects related to the management of water resources by performing a historical analysis of the Water Quality Index (WQI) of the Sinos River, using statistical methods. With regard to the methodological procedures, it should be pointed out that this study performs a time analysis of monitoring data on parameters related to a punctual measurement that is variable in time, using statistical tools. The data used refer to analyses of the water quality of the Sinos River (WQI) from the State Environmental Protection Agency Henrique Luiz Roessler (Fundação Estadual de Proteção Ambiental Henrique Luiz Roessler, FEPAM) covering the period between 2000 and 2008, as well as to a theoretical analysis focusing on the management of water resources. The study of WQI and its parameters by statistical analysis has shown to be effective, ensuring its effectiveness as a tool for the management of water resources. The descriptive analysis of the WQI and its parameters showed that the water quality of the Sinos River is concerning low, which reaffirms that it is one of the most polluted rivers in Brazil. It should be highlighted that there was an overall difficulty in obtaining data with the appropriate periodicity, as well as a long complete series, which limited the conduction of statistical studies such as the present one.</p