Internamentos evitáveis múltiplos por doença pulmonar obstrutiva crónica ou asma : um estudo transversal nas unidades locais de saúde

RESUMO - Introdução: Os Internamentos Evitáveis Múltiplos (IEM) correspondem à recorrência de internamentos potencialmente evitáveis pelos mesmos indivíduos, sugerindo dificuldades sistemáticas nos cuidados de saúde que lhes são prestados. Uma vez que as Unidades Locais de Saúd(ULS) pretendem alcançar uma integração vertical de cuidados, esperar-se-ia a redução de IEM nestas unidades. A presente dissertação tem como objetivo geral caraterizar os IEM por Doença Pulmonar Obstrutiva Crónica (DPOC) ou asma nas ULS e em hospitais não integrados verticalmente. Metodologia: Realizou-se um estudo observacional e retrospetivo utilizando os dados administrativos das altas do internamento de hospitais públicos de Portugal Continental, entre 2013 e 2015. Os internamentos por DPOC ou asma em indivíduos com 40 ou mais anos de idade foram identificados através do Prevention Quality Indicator 5 (AHRQ). Os episódios de doentes internados duas ou mais vezes por DPOC ou asma, neste triénio, foram classificados como IEM. Os internamentos foram associados às ULS ou a um grupo de hospitais não integrados com base nos concelhos de residência dos utentes da sua área de influência. Efetuou-se uma análise descritiva univariada. Resultados: De um total de 3.944 e 6.481 internamentos por DPOC ou asma nas ULS e no grupo controlo, 43,8% e 47,2% corresponderam a IEM, respetivamente. A duração média destes episódios foi significativamente inferior nas ULS em relação ao controlo (9 e 10 dias), totalizando 15.474 e 29.386 dias de internamento em cada um dos grupos de unidades de saúde. O impacto financeiro dos IEM por DPOC ou asma foi superior a 3,8 e 6,4 milhões de euros nas ULS e no controlo. Nas ULS registaram-se 2,78 episódios por utilizador múltiplo do internamento e uma taxa padronizada de 22,67 IEM por 10.000 habitantes, em comparação com 2,83 e 32,89 internamentos no grupo controlo. Conclusões: Para ambos os modelos organizacionais analisados, a utilização múltipla e potencialmente evitável do internamento por DPOC ou asma foi um evento frequente e associado a um elevado consumo de recursos. As ULS apresentaram uma taxa de IEM inferior em 31,1% face ao grupo controlo, sugerindo benefícios da integração vertical de cuidados de saúde. Conclui-se a existência de uma potencial melhoria na gestão da DPOC e da asma, na qual a integração de cuidados pode contribuir para a qualidade de vida dos utentes e para a sustentabilidade dos sistemas de saúde.ABSTRACT - Introduction: Multiple avoidable hospitalizations refer to the recurrence of potentially avoidable hospitalizations among the same individuals, hinting systematic difficulties in the delivery of healthcare to patients. Since Local Health Units (LHU) aim to achieve vertical integration of healthcare, it would be expected a reduction of the previous hospitalizations in these units. The aim of this study is to characterize the multiple avoidable hospitalizations for Chronic Obstructive Pulmonary Disease (COPD) or asthma in LHU and hospitals not vertically integrated. Methods: An observational and retrospective study was conducted using administrative discharge dataset from public hospitals of mainland Portugal, between 2013 and 2015. Avoidable hospitalizations for COPD or asthma of patients aged 40 years or older were identified using Prevention Quality Indicator 5 (AHRQ). Inpatient episodes from patients who had two or more admissions for COPD or asthma in the study period were classified as multiple avoidable hospitalizations. Hospitalizations were associated with LHU or a group of hospitals not vertically integrated based on patients’ counties of residence that form their catchment area. Univariate descriptive analysis was performed. Results: Of 3,944 and 6,481 admissions for COPD or asthma corresponding to LHU and the control group, 43.8% and 47.2% were multiple avoidable hospitalizations, respectively. The average length of stay was significantly lower in LHU than in the control group (9 and 10 days), representing 15,474 and 29,386 inpatient days in each group of units. The financial impact of multiple hospitalizations for COPD or asthma exceeded 3.8 and 6.4 million euros in LHU and the control group. LHU exhibited 2.78 inpatient episodes per multiple user and a standardized rate of 22.67 episodes per 10,000 capita in comparison to 2.83 and 32.89 episodes in the control group. Conclusions: For both organizational models, multiple avoidable hospitalizations for COPD or asthma were a frequent event and required a high consumption of healthcare resources. LHU presented a rate of multiple hospitalizations 31.1% lower than hospitals not vertically integrated, suggesting benefits from the vertical integration of healthcare. There is still a considerable chance to improve the management of COPD and asthma, in which healthcare integration can contribute to the patients’ quality of life and the sustainability of healthcare systems. Keywords: ; ; ; ;

Internamentos hospitalares durante a primeira vaga de COVID-19 em Portugal

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In vitro Evaluation of Isoniazid Derivatives as Potential Agents Against Drug-Resistant Tuberculosis

Funding Information: Financed by Fundação para a Ciência e a Tecnologia, I.P./MCTES through national funds (PIDDAC, PT2020) under projects PTDC/MED-QUI/29036/2017, PTDC/BIA-MIC-30692/2017, EXPL/BIA-BFS/1034/2021, UIDB/00100/2020, UIDP/00100/2020, LA/P/0056/2020, UID/Multi/04413/2020, CEECIND/03247/2018 and DL57/CEECIND/0256/2017. Publisher Copyright: Copyright © 2022 Marquês, Frazão De Faria, Reis, Machado, Santos, Santos, Viveiros, Martins and De Almeida.The upsurge of multidrug-resistant tuberculosis has toughened the challenge to put an end to this epidemic by 2030. In 2020 the number of deaths attributed to tuberculosis increased as compared to 2019 and newly identified multidrug-resistant tuberculosis cases have been stably close to 3%. Such a context stimulated the search for new and more efficient antitubercular compounds, which culminated in the QSAR-oriented design and synthesis of a series of isoniazid derivatives active against Mycobacterium tuberculosis. From these, some prospective isonicotinoyl hydrazones and isonicotinoyl hydrazides are studied in this work. To evaluate if the chemical derivatizations are generating compounds with a good performance concerning several in vitro assays, their cytotoxicity against human liver HepG2 cells was determined and their ability to bind human serum albumin was thoroughly investigated. For the two new derivatives presented in this study, we also determined their lipophilicity and activity against both the wild type and an isoniazid-resistant strain of Mycobacterium tuberculosis carrying the most prevalent mutation on the katG gene, S315T. All compounds were less cytotoxic than many drugs in clinical use with IC50 values after a 72 h challenge always higher than 25 µM. Additionally, all isoniazid derivatives studied exhibited stronger binding to human serum albumin than isoniazid itself, with dissociation constants in the order of 10−4–10−5 M as opposed to 10−3 M, respectively. This suggests that their transport and half-life in the blood stream are likely improved when compared to the parent compound. Furthermore, our results are a strong indication that the N′ = C bond of the hydrazone derivatives of INH tested is essential for their enhanced activity against the mutant strain of M. tuberculosis in comparison to both their reduced counterparts and INH.publishersversionpublishe