Efetividade do serviço móvel de urgência (Samu): uso de séries temporais interrompidas

OBJETIVO: Avaliar o desempenho do serviço de atendimento móvel de urgência (Samu) na região do Grande ABC, utilizando como condição traçadora o infarto agudo do miocárdio. MÉTODOS: A análise de séries temporais interrompidas foi a abordagem de escolha para testar efeitos imediatos e graduais da intervenção na população de estudo. A pesquisa compreendeu séries temporais mensais ajustadas da taxa de mortalidade hospitalar por infarto agudo do miocárdio no período entre 2000 e 2011. Os dados foram extraídos do Sistema de Informações sobre Mortalidade, usando a análise de regressão segmentada para avaliar o nível e tendência da intervenção antes e após sua implementação. Para fortalecer a validade interna do estudo, foi incluída uma região controle. RESULTADOS: A análise de séries temporais interrompidas mostrou redução de 0,04 mortes por 100.000 habitantes na taxa de mortalidade em relação à tendência subjacente desde a implantação do serviço de atendimento médico de urgência (p = 0,0040; IC95% -0,0816 – -0,0162) e uma redução no nível de 2,89 mortes por 100.000 habitantes (p = 0,0001; IC95% -4,3293 – -1,4623), ambos com significância estatística. Em relação à região controle, a Baixada Santista, a diferença da tendência do resultado entre desfecho de intervenção e controle pós-intervenção de -0,0639 mortes por 100.000 habitantes mostrou-se estatisticamente significativa (p = 0,0031; IC95% -0,1060 – -0,0219). Não podemos excluir confundimentos, mas limitamos sua presença no estudo incluindo séries de região controle. CONCLUSÕES: Embora a análise de séries temporais interrompidas tenha limitações, essa modelagem pode ser útil para a análise de desempenho de políticas e programas. Apesar de a intervenção estudada não ser uma condição que por si só implica na efetividade, a efetividade não estaria presente sem essa intervenção, que, integrada a outras condições, gera um resultado positivo. O Samu é uma estratégia cuja expansão precisa ser levada em consideração ao formular e consolidar políticas com foco nas urgências e emergências.OBJECTIVE: To evaluate the performance of the Mobile Emergency Medical Services (SAMU) in the ABC Region, using myocardial infarction as tracer condition. METHODS: The analysis of interrupted time series was the approach chosen to test immediate and gradual effects of the intervention on the study population. The research comprised adjusted monthly time series of the hospital mortality rate by myocardial infarction in the period between 2000 and 2011. Data were extracted from the Mortality Information System (SIM), using segmented regression analysis to evaluate the level and trend of the intervention before and after its implementation. To strengthen the internal validity of the study, a control region was included. RESULTS: The analysis of interrupted time series showed a reduction of 0.04 deaths per 100,000 inhabitants in the mortality rate compared to the underlying trend since the implementation of the Emergency Medical Services (p = 0.0040; 95%CI: −0.0816 – −0.0162) and a reduction in the level of 2.89 deaths per 100,000 inhabitants (p = 0.0001; 95%CI: −4.3293 – −1.4623), both with statistical significance. Regarding the control region, Baixada Santista, the difference in the result trend between intervention outcome and post-intervention control of −0.0639 deaths per 100,000 inhabitants was statistically significant (p = 0.0031; 95%CI: −0.1060 – −0.0219). We cannot exclude confounders, but we limited their presence in the study by including control region series. CONCLUSIONS: Although the analysis of interrupted time series has limitations, this modeling can be useful for analyzing the performance of policies and programs. Even though the intervention studied is not a condition that in itself implies effectiveness, the latter would not be present without the former, which, integrated with other conditions, generates a positive result. SAMU is a strategy that must be expanded when formulating and consolidating policies focusing on emergency care

Results from the portuguese register

Objective Our aims were to evaluate the correlation between Juvenile Arthritis Disease Activity Score 27-joint reduced count (JADAS27) with erythrocyte sedimentation rate (ESR) and JADAS27 with C-reactive protein (CRP) scores and to test the agreement of both scores on classifying each disease activity state. We also aimed at verifying the correlation of the 2 scores across juvenile idiopathic arthritis (JIA) categories and to check the correlation between JADAS27-ESR and clinical JADAS27 (JADAS27 without ESR). Methods A nationwide cohort of patients with JIA registered in the Portuguese Register, Reuma.pt, was studied. JADAS27-CRP was adapted by replacing ESR with CRP level as the inflammatory marker. JADAS27-CRP was calculated similarly to JADAS27-ESR as the simple linear sum of its 4 components. Pearson's correlations and K statistics were used in the analyses. Results A total of 358 children had full data to calculate JADAS27; 65.4% were female and the mean ± SD disease duration was 11.8 ± 9.1 years. The correlation coefficient between JADAS27-ESR and JADAS27-CRP was 0.967 (P < 0.0001), although the correlation coefficient between ESR and CRP level was 0.335 (P < 0.0001). The strong correlation between JADAS27-ESR and JADAS27-CRP was maintained when compared within each JIA category. The agreement between JADAS27-ESR and JADAS27-CRP across the 4 activity states was very good, showing 91.1% of the observations in agreement; K = 0.867 (95% confidence interval 0.824-0.91). The correlation between JADAS27 with ESR and JADAS27 without ESR was high (r = 0.97, P < 0.0001). Conclusion JADAS27 based on CRP level correlated closely with JADAS27-ESR across all disease activity states and JIA categories, indicating that both measures can be used in clinical practice. Moreover, the correlation of JADAS27 with and without ESR was also high, suggesting that this tool might be useful even in the absence of laboratorial measures.publishersversionpublishe

Palliative patients in the portuguese public hospitals

Introdução: A identificação e referenciação precoce dos doentes com necessidades paliativas é fundamental para que em tempo útil possam usufruir da efetividade da intervenção precoce de cuidados paliativos. Referenciar para cuidados Paliativos é um importante, crescente e complexo desafio e processo para a prática dos profissionais de saúde, nomeadamente para os médicos. A falta de informação e formação podem impedir a proatividade no processo de referenciação precoce. Atualmente, existem já alguns instrumentos multidimensionais que ajudam a identificar a população com necessidades paliativas. A pergunta surpresa, validada para Portugal, “Ficaria surpreendido se este doente morresse durante o próximo ano?” é uma ferramenta importante, útil e fiável para esta identificação. Objetivo: determinar a prevalência de doentes adultos com necessidades paliativas internados em hospitais públicos. Como objetivos secundários, determinar o número de doentes referenciados para cuidados paliativos e identificar os motivos de não referenciação destes doentes. Materiais e Métodos: Estudo analítico, observacional e transversal, realizado no primeiro trimestre de 2015 em 11 hospitais do SNS. O instrumento de colheita de dados consistiu num questionário com caracterização demográfica e clinica, a pergunta surpresa relativa a 1 ano, 6 e 1 mês e, 15 dias, e 19 possíveis motivos para não referenciação dos doentes. Os dados recolhidos forma analisados com recurso à estatística descritiva e analítica, considerando-se significância estatística se p<0.05. Resultados: De um total de 1273 doentes, 51.4% eram doentes com necessidades paliativas, a maioria proveniente dos serviços de oncologia (79.3%) e medicina (62.3%), e maioritariamente com doença oncológica (67.2%). Apenas estavam referenciados 6.8 a 9.9% dos doentes, maioritariamente oncológicos (15.1%) ou com 15 ou menos dias de vida (9.8%). Os cinco principais motivos para não referenciação foram: ainda estar a fazer tratamento ativo (61.5%), “ainda se poder fazer alguma coisa do ponto de vista curativo” (40.9%), o doente estar controlado a nível sintomático (33.2%), ainda não estar a morrer (27.6%) e os cuidados paliativos não serem uma mais-valia para o doente (15.4%). Conclusão: Elevada prevalência de doentes e baixa taxa de referenciação. É necessária e imperiosa a formação e capacitação dos profissionais de saúde para uma adequada identificação e referenciação e tempo útil dos doentes com necessidades paliativas.Early identification and referral of patients with palliative needs is essential so they can benefit from the effectiveness of early intervention of palliative care. Referral for palliative care is an important, growing and complex challenge and process for the practice of health professionals, particularly for physicians. Lack of information and training may prevent proactivity in the process of early refer Currently, some multidimensional instruments help to identify the population with palliative needs. The surprise question, validated for Portugal, “Would you be surprised if this patient died during the next year?” is an important, useful and reliable tool for this identification.Aim: to determine the prevalence of adult patients with palliative needs hospitalized in public hospitals; to determine who were referenced for palliative care and to identify the reasons for non-referral of these patients.Material and Methods: an analytical, observational and cross-sectional study was performed in the first quarter of 2015 in 11 hospitals of the Portuguese Health System. The data collection instrument consisted of a questionnaire with demographic and clinical characterization, the surprise question regarding 1 year, 6 and 1 month and, 15 days, and 19 possible reasons for non-referral of patients. The collected data were analyzed using descriptive and analytical statistics, considering statistical significance if p <0.05.Results: From a total of 1273 patients, 51.4% were patients with palliative needs, the majority coming from the oncology (79.3%) and medicine services (62.3%), and mainly with oncological disease (67.2%). Only 6.8 to 9.9% of the patients were referred, mainly oncological (15.1%) or with 15 days or less of life (9.8%). The five main reasons for non-referral were: still being under active treatment (61.5%), “still able to do something from a curative point of view” (40.9%), the patient being symptomatically controlled (33.2%), not considered to be actively dying (27.6%) and not being an added value to the patient (15.4%).Conclusions: High prevalence of patients with palliative care need, low referral rate. The training and qualification of health professionals is necessary and imperative for an adequate identification and referral in a useful time of patients with palliative needs

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio

Mammals in Portugal: a data set of terrestrial, volant, and marine mammal occurrences in Portugal

Mammals are threatened worldwide, with ~26% of all species being included in the IUCN threatened categories. This overall pattern is primarily associated with habitat loss or degradation, and human persecution for terrestrial mammals, and pollution, open net fishing, climate change, and prey depletion for marine mammals. Mammals play a key role in maintaining ecosystems functionality and resilience, and therefore information on their distribution is crucial to delineate and support conservation actions. MAMMALS IN PORTUGAL is a publicly available data set compiling unpublished georeferenced occurrence records of 92 terrestrial, volant, and marine mammals in mainland Portugal and archipelagos of the Azores and Madeira that includes 105,026 data entries between 1873 and 2021 (72% of the data occurring in 2000 and 2021). The methods used to collect the data were: live observations/captures (43%), sign surveys (35%), camera trapping (16%), bioacoustics surveys (4%) and radiotracking, and inquiries that represent less than 1% of the records. The data set includes 13 types of records: (1) burrows | soil mounds | tunnel, (2) capture, (3) colony, (4) dead animal | hair | skulls | jaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8), observation in shelters, (9) photo trapping | video, (10) predators diet | pellets | pine cones/nuts, (11) scat | track | ditch, (12) telemetry and (13) vocalization | echolocation. The spatial uncertainty of most records ranges between 0 and 100 m (76%). Rodentia (n =31,573) has the highest number of records followed by Chiroptera (n = 18,857), Carnivora (n = 18,594), Lagomorpha (n = 17,496), Cetartiodactyla (n = 11,568) and Eulipotyphla (n = 7008). The data set includes records of species classified by the IUCN as threatened (e.g., Oryctolagus cuniculus [n = 12,159], Monachus monachus [n = 1,512], and Lynx pardinus [n = 197]). We believe that this data set may stimulate the publication of other European countries data sets that would certainly contribute to ecology and conservation-related research, and therefore assisting on the development of more accurate and tailored conservation management strategies for each species. There are no copyright restrictions; please cite this data paper when the data are used in publications

Bactericidal Pectin/Chitosan/Glycerol Films for Food Pack Coatings: A Critical Viewpoint

Pectin and chitosan films containing glycerol (Gly) at 5, 10, 15, 20, 30, and 40 wt % were prepared in an aqueous HCl solution (0.10 M) by the solvent evaporation method. The unwashed film (UF) containing 40 wt % Gly (UF40) had elongation at break (&epsilon;, %) of 19%. Washed films (WFs) had high tensile strength (&sigma; &gt; 46 MPa) and low elongation at break (&epsilon;, &lt;5.0%), enabling their use in food packaging applications. The polymers&rsquo; self-assembling occurred during the washing, increasing the stiffness. The XPS analysis suggests that some HCl is lost during the drying process, resulting in a low acid content on the UF surfaces. The UF40 (at 5.0 mg/mL) exhibits cytocompatibility toward mammalian cells and antimicrobial and anti-adhesive properties against Escherichia coli. The remaining HCl in the UF40 can be a disadvantage for food packaging applications; the UF40 (&empty; = 8.5 mm; 55 &mu;m thickness) releases H3O+/HCl, reducing the pH to approximately 3.0 when kept in 200 mL distilled water for approximately 30 min. Therefore, we propose the use of UF40 to coat commercial food packaging. The UF40 has low permeability to water vapor and oxygen and works as a barrier against ultraviolet light. The UF40 is also colorless and completely transparent. The UF40 maintained tomatoes&rsquo; structural integrity for 18 days at room temperature with no oxidation or microorganism contamination. This paper presents a critical viewpoint concerning chitosan-based films with antimicrobial activities

Gerenciamento de tecnologia em terapia intensiva Gerenciamiento de tecnología en terapia intensiva Management of technology in Intensive Care Units

A vida do paciente no hospital depende dos procedimentos diagnóstico-terapêuticos e cuidado da equipe de saúde, além da qualidade e disponibilidade de fatores como: estrutura física, recursos materiais, humanos e financeiros. A necessidade de otimizar estes recursos e restaurar a saúde, fez surgir as Unidades de Terapia Intensivas (UTI's), cujo projeto deve considerar o ambiente físico e equipamentos clínicos indispensáveis ao cuidar. Objetivando identificar o nível de conhecimento dos profissionais de saúde sobre as informações técnico-operacionais contidas nos manuais dos equipamentos e a percepção dos entrevistados quanto a adequação das instalações físicas e elétricas destas unidades, realizamos um estudo descritivo numa UTI de um hospital público de Salvador. Os resultados mostraram que estas instalações foram consideradas inadequadas ao desempenho seguro de suas atividades, e que a maioria desconhece as especificações técnico-operacionais dos manuais dos equipamentos.<br>La vida del enfermo en el hospital depende de los procedimientos diagnóstico- terapéuticos y del esmero del equipo de salud, además de la calidad y disponibilidad de factores como: organismo físico, recursos materiales, humanos y financieros. La necesidad de mejorar estos recursos y restaurar la salud, hizo surgir las Unidade de Terapia Intensiva (UTIS) cuyo proyecto debe considerar el ambiente físico y los equipos clínicos indispensables para el cuidado. Con el objeto de identificar los conocimientos de los profesionales de salud sobre las informaciones técnico-operacionales existentes en los manuales de los equipos y la percepción de los entrevistados en relación con la adecuación de las instalaciones físicas y eléctricas (de estas unidades), hicimos un análisis en una UTI de un hospital general de Salvador. Los resultados mostraron que estas unidades son inseguras para las actividades y que la mayor parte de las personas desconoce las especificaciones técnico- operacionales de los manuales de los equipos.<br>The lives of hospitalized patients depend on diagnostic-therapeutic procedures and on the care provided by the health team. It also depends on the quality and availability of factors such as: physical structure and material and human and financial resources. The need to optimize these resources and re-establish patients' health has brought about the Intensive Care Units (ICU), whose design must consider the physical environment and clinical equipment which are indispensable in health care. Aiming at identifying the level of knowledge of health professionals as to technical and operational information in equipment manuals and the perception of the interviewed professionals in relation to the adequacy of the physical and electrical installations of such units, we conducted a descriptive study in an ICU of a public hospital in Salvador, Brazil. The results show that such installations were considered to be unsuitable for the safe development of activities and that most of the health team members did not know the technical or operational specifications in the equipment manuals