GESTÃO DOS CUIDADOS PRIMÁRIOS A PORTADORES DE DIABETES MELLITUS E INSUFICIÊNCIA RENAL EM UNIDADES BÁSICAS DE SAÚDE

Com o aumento da expectativa de vida das populações urbanas observa-se também o acréscimo na ocorrência das doenças crônicas degenerativas, sendo o Diabetes Mellitus (DM) uma das condições de agravo em que o impacto sobre a sociedade como um todo, e o Sistema de Saúde em particular, apresenta-se como elemento de difícil gerenciamento. Aspectos relacionados às condições socioeconômicas das populações, aos padrões de qualificação dos recursos humanos em saúde, aos padrões de consumo das famílias e ao acesso aos recursos de assistência farmacêutica, emergem como importantes fatores condicionantes da aderência aos protocolos de tratamento. O presente trabalho teve por objetivo avaliar o sistema de gerenciamento do DM e o número de pacientes portadores de insuficiência renal como um indicativo de deficiência de gerenciamento em uma cidade do interior do estado de São Paulo, assim como suas falhas e dificuldades, utilizando como ferramenta um questionário com perguntas específicas sobre o processo de gestão, aplicado aos profissionais coordenadores dos serviços de enfermagem. Evidenciou-se que 23% da população do município portava DM, e um volume variável de indivíduos apresentou como comorbidade a insuficiência renal. Das 4 unidades estudadas, as duas maiores  demonstraram falhas no processo gerencial, tendo sido apontadas como causas a alta demanda, a escassez de recursos humanos capacitados, a condição de carência social da população, a dificuldade de compreensão sobre a doença e seus agravos, a ausência de equipes multiprofissionais, e o baixo volume de investimentos em estruturas de saúde. Observou-se também a necessidade de incorporação de ferramenta de gestão sistêmica de informações que permita à equipe local melhor manejo e conhecimento dos dados epidemiológicos da população assistida

COMPARISON BETWEEN TWO METHODS OF METACERCARIAE OF Ascocotyle sp (Trematoda: Digenea) EXTRACTION FROM TISSUES OF Mugil liza Valenciennes, 1836 (Teleostei: Mugilidae)

The demand and consumption of fish and their derivatives has increased considerably in recent years. However, fish are ideal hosts of numerous parasites, highlighting the need to develop new research methodologies for its detection. The aim of present study was to compare the efficacy of Ascocotyle metacercariae (Trematoda: Digenea) extraction from visceral tissues of Mugil liza Valenciennes, 1836 (Teleostei: Mugilidae) by two methods: homogenization by blender or mixer. Twenty-six samples of M. liza were collected, being 16 liver samples and 10 samples of muscle tissue. Approximately 5g of each sample were processed by blender and mixer techniques homogenization for metacercariae extraction. In liver samples, up to 46 metacercariae were found in samples homogenized in blender. The lowest amount found was 2 metacercariae for blender and mixer techniques. In samples of muscle tissue, 4 metacercariae were observed in the mixer extraction. The lowest amount was found to be 2 parasites to blender and mixer. The mean metacercariae found and extracted from muscle tissue were 0.2 (+0.357) and 1.2 (+0.963) for blender and mixer, respectively. The averages of metacercariae found and extracted from fish liver, in blender and mixer, were 24 (+15.145) and 18 (+8.246), respectively. The homogenization techniques for blender and mixer were effective for the extraction of metacercariae of mullet fish tissues, suggesting that they may be directly applicable in the field of study, especially due to the ease of testing. KEYWORDS: Epidemiology, health management, homogenization, Metacercariae, Mugil liza.  

Indicações e Tempo de Permanência em Internação Pós-Cirúrgica em um Hospital Público da Cidade de São Paulo - SP

Introdução: A internação hospitalar no pós-operatório oferece ao paciente condições de recuperação rápida e pode evitar possíveis complicações decorrentes da cirurgia. Objetivo: Determinar o número de indicações e o tempo de permanência em internação durante o período pós-operatório imediato de pacientes submetidos a procedimentos cirúrgicos diversos. Método: Foram avaliados em um hospital público da região central da cidade de São Paulo - SP, pacientes que se submeteram à cirurgias de diversas especialidades entre janeiro e março de 2011. Resultados: Dos 10 pacientes acompanhados, 8 receberam indicação de internação no período pós-operatório e 2 receberam alta logo após o procedimento cirúrgico. Troca de valva cardíaca, desobstrução intestinal e cirurgia bariátrica foram, nesta sequência, os procedimentos que demandaram maior tempo de internação. Conclusão: A pré-admissão do paciente com necessidades cirúrgicas é muito importante no prognóstico dos mesmos e pode estar intimamente relacionada com a evolução do seu quadro clínico. Pacientes com mais comorbidades tendem a apresentar prognóstico mais reservado, o que per se aumenta o tempo de internação e, consequentemente, os custos e os riscos da prolongada permanência em ambiente hospitalar.DOI: 10.5585/rgss.v1i1.

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Population and fertility by age and sex for 195 countries and territories, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. METHODS: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10-54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10-14 years and 50-54 years was estimated from data on fertility in women aged 15-19 years and 45-49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories

Agravos ortopédicos e doenças ocupacionais em funcionários de uma empresa de teleatendimento como indicadores para a gestão em saúde e melhoria na gestão de pessoas

Introdução: As Lesões por Esforços Repetitivos (LER) / Distúrbios Osteomusculares Relacionados ao Trabalho (DORT) caracterizam-se pela ocorrência de vários sintomas como dor, parestesia, sensação de peso e fadiga, e constituem-se em um dos principais motivos de absenteísmo entre trabalhadores do serviço de teleatendimento. Objetivo: Quantificar os agravos ortopédicos e identificar a prevalência de doenças ocupacionais do tipo LER/DORT em funcionários de uma empresa do setor de teleatendimento. Metodologia: Estudo descritivo, retrospectivo, transversal e de abordagem quantitativa, que avaliou 382 casos de afastamento do trabalho registrados na empresa avaliada no ano de 2012. Resultados: Observou-se que, dos 140 afastamentos em decorrência de agravos ortopédicos, 48 (34%) relacionaram-se a distúrbios osteomusculares, especialmente da coluna vertebral (24 casos, 17,14%). Conclusão: O número de indivíduos afastados em decorrência de LER/DORT mostrou-se consideravelmente elevado neste levantamento. Redução da carga horária, estímulo à mudanças na posição de trabalho e redução dos movimentos repetitivos são essenciais para ao menos minimizar o quadro aqui apresentado

Avaliação do nível de dor em pacientes submetidos a cirurgias plásticas estéticas ou reparadoras Pain assessment in patients undergoing cosmetic or reconstructive plastic surgery

INTRODUÇÃO: Estudos que quantificassem as cirurgias plásticas estéticas e reparadoras e avaliassem a dor pós-cirúrgica decorrente de tais procedimentos permitiriam a criação de protocolos de humanização do atendimento a esses pacientes, possivelmente sensibilizando os profissionais que com eles convivem diariamente. O objetivo deste estudo é avaliar o nível de dor em pacientes submetidos a cirurgias plásticas estéticas ou reparadoras. MÉTODO: Avaliação de 200 prontuários de pacientes operados no Hospital São Rafael (São Paulo, SP, Brasil), observando motivo de realização da cirurgia e quadro de dor. RESULTADOS: O número de pacientes que relatou dor forte ou intensa foi bastante reduzido. Dentre esses pacientes, todos foram submetidos a lipoaspiração, associada ou não à colocação de prótese de mama. CONCLUSÕES: Os protocolos pré, intra e pós-cirúrgicos relacionados aos procedimentos de lipoaspiração devem ser reavaliados, visando à redução da forte dor relatada pelos pacientes submetidos a esse tipo de procedimento.BACKGROUND: Quantifying aesthetic and reconstructive plastic surgery and assessing postoperative pain caused by these procedures would aid the creation of protocols to humanize nursing care for hospitalized patients, thus possibly making professionals who interact with such patients on a daily basis more compassionate. This study assessed the levels of pain in patients who underwent reconstructive or aesthetic plastic surgery. METHODS: The medical records of 200 patients operated at São Rafael Hospital were reviewed. The reasons for undergoing surgery and pain due to the procedure were also evaluated. RESULTS: The number of patients who reported strong or severe pain following the procedure was significantly lower; all patients who reported strong or severe pain following the procedure had undergone liposuction with or without breast prosthesis. CONCLUSIONS: Pre-, intra-, and postoperative protocols regarding liposuction should be reassessed in order to decrease the severe pain reported by patients undergoing this procedure

COMPARAÇÃO ENTRE OS MÉTODOS DE EXTRAÇÃO DE METACERCÁRIAS DE ASCOCOTYLE SP (TREMATODA: DIGENEA) DOS TECIDOS DE MUGIL LIZA VALENCIENNES, 1836 (TELEOSTEI: MUGILIDAE)

The demand and consumption of fish and their derivatives has increased considerably in recent years. However, fish are ideal hosts of numerous parasites, highlighting the need to develop new research methodologies for its detection. The aim of present study was to compare the efficacy of Ascocotyle metacercariae (Trematoda: Digenea) extraction from visceral tissues of Mugil liza Valenciennes, 1836 (Teleostei: Mugilidae) by two methods: homogenization by blender or mixer. Twentysix samples of M. liza were collected, being 16 liver samples and 10 samples of muscle tissue. Approximately 5g of each sample were processed by blender and mixer techniques homogenization for metacercariae extraction. In liver samples, up to 46 metacercariae were found in samples homogenized in blender. The lowest amount found was 2 metacercariae for blender and mixer techniques. In samples of muscle tissue, 4 metacercariae were observed in the mixer extraction. The lowest amount was found to be 2 parasites to blender and mixer. The mean metacercariae found and extracted from muscle tissue were 0.2 (+0.357) and 1.2 (+0.963) for blender and mixer, respectively. The averages of metacercariae found and extracted from fish liver, in blender and mixer, were 24 (+15.145) and 18 (+8.246), respectively. The homogenization techniques for blender and mixer were effective for the extraction of metacercariae of mullet fish tissues, suggesting that they may be directly applicable in the field of study, especially due to the ease of testing