Pediatric (Otolaryngology) at the Public Health System of a city in Southeastern Brazil

OBJECTIVE: To assess the suitability of referral from primary to secondary care in pediatric Otolaryngology. METHODS: The study was performed in the city of Belo Horizonte, in the state of Minas Gerais, from March 2004 to May 2005. A total of 408 pre-school children referred from primary care to secondary care in the department of Otolaryngology presenting with otitis, tonsillitis, sinusitis, allergic rhinitis, and tonsillar/adenoidal hypertrophy was assessed. The studied variables were: agreement between diagnoses in primary and secondary care; waiting time for doctor's appointment; follow-up, and professional (pediatrician or family physician) that examined children in primary care. Agreement of diagnoses was assessed using kappa statistics. RESULTS: Patients were five years old on average, 214 (52.5%) were boys, mean waiting time for appointment was 3.7 months. Diagnoses in primary and secondary care were respectively: otitis (44%, 49%), tonsillar/adenoidal hypertrophy (22%, 33%), tonsillitis (18%, 23%), sinusitis (13%, 21%), allergic rhinitis (3%, 33%). Agreement analysis of kappa was 0.15 for otitis with effusion, 0.35 for recurrent otitis, 0.04 for tonsillar/adenoidal hypertrophy, 0.43 for tonsillitis, 0.05 for allergic rhinitis, and 0.2 for sinusitis. Diagnoses in primary care referred to secondary care were in agreement when given either by pediatrician or family physician. CONCLUSIONS: Unsuitability of referrals from primary to secondary care in otolaryngology was expressed by the long time waiting for appointments and by the low agreement between diagnoses in different level of care for the same patients. Primary health care could be more efficient if professionals were better qualified in Otolaryngology.OBJETIVO: Analisar a adequação dos encaminhamentos da atenção primária para a secundária em otorrinolaringologia pediátrica. MÉTODOS: Estudo realizado em Belo Horizonte, estado de Minas Gerais, de março de 2004 a maio de 2005. Foram avaliadas 408 crianças pré-escolares encaminhadas da atenção primária para a secundária do setor de otorrinolaringologia com otite, faringoamigdalite, rinossinusite, rinite alérgica e hipertrofia de amígdala/adenóide. As variáveis analisadas foram: concordância dos diagnósticos na atenção primária e secundária, tempo de espera pela consulta, acompanhamento e especialista (médico de família ou pediatra) que examinou a criança na atenção primária. A concordância dos diagnósticos foi avaliada pela análise estatística de kappa. RESULTADOS: Os pacientes tinham em média cinco anos de idade, dos quais 214 (52,5%) eram meninos, o tempo médio de espera pela consulta foi de 3,7 meses. Os diagnósticos na atenção primária e secundária foram, respectivamente: otite (44%, 49%), hipertrofia de amígdala/adenóide (22%, 33%), faringoamigdalite (18%, 23%), rinossunusite (13%, 21%), rinite alérgica (3%, 33%). Análise de concordância kappa foi 0,15 para otite com efusão, 0,35 para otite recorrente, 0,04 para hipertrofia de amígdala/adenóide, 0,43 para faringoamigdalite, 0,05 para rinite alérgica; 0,2 para rinossinusite. Os diagnósticos na atenção primária para encaminhamento à secundária, definidos pelo médico de família ou pelo pediatra que avaliou a criança foram concordantes. CONCLUSÕES: A inadequação dos encaminhamentos da atenção primária para a secundária em otorrinolaringologia foi expressa pelo longo tempo de espera pela consulta e pela baixa concordância de diagnósticos firmados entre os níveis de atenção para os mesmos pacientes avaliados. A atenção primária poderia se tornar mais eficiente se os profissionais fossem mais bem capacitados em otorrinolaringologia

Capacidade resolutiva em Otorrinolaringologia do médico da atenção primária da rede pública de saúde do município de Belo Horizonte - Brasil

Exportado OPUSMade available in DSpace on 2019-08-11T20:26:57Z (GMT). No. of bitstreams: 1 angela_francisca_marques_guerra.pdf: 606937 bytes, checksum: 7c35bfe1774c17d66db4de04292ec026 (MD5) Previous issue date: 6Doenças otorrinolaringológicas são freqüentes na atenção primária e representam problema de saúde pública. O objetivo do presente estudo foi avaliar a capacidade resolutiva e a validade diagnóstica em doenças otorrinolaringológicas na atenção primária. Foram avaliadas 408 crianças de Belo Horizonte, com doença em ouvido, nariz ou garganta, no período de março de 2004 a maio de 2005. Estas crianças foram examinadas inicialmente na atenção primária e encaminhadas paraa atenção secundária, onde foram novamente examinadas. Comparou-se o diagnóstico das doenças otorrinolaringológicas mais comuns na atenção primária em relação ao diagnóstico referência estabelecido na atenção secundária para o mesmo paciente em questão. As doenças consideradas nesse estudo foram: otiteexterna, otite média (aguda, recorrente, e com efusão), faringoamigdalites (recorrente e crônica), rinossinusite (aguda, recorrente e crônica), rinite alérgica e hipertrofia de amígdala e adenóide. Avaliou-se especialidade do profissional queencaminhou, período de espera pela consulta, gênero e idade do paciente, diagnóstico otorrinolaringológico na atenção primária e na secundária, concordância entre os profissionais envolvidos e validade do diagnóstico otorrinolaringológico na atenção primária. A idade média dos participantes foi de 5,3 anos (DP = 3,1), sendo 214 (52,5%) meninos e 194 (47,5%) meninas. O tempo médio de espera pela consulta foi de 3,77 meses (DP = 4,69). Os diagnósticosmais freqüentes foram: rinite alérgica (35,3%), otite média crônica (33,8%), faringoamigdalite recorrente (22,7%), hipertrofia de adenóide (19,1%), 10 rinossinusite recorrente (13,4%), hipertrofia de amígdala (2,4%), sendo realizados 1,59 diagnóstico por criança. Na avaliação da atenção primária, a capacidade de acertar o diagnóstico do médico pediatra foi semelhante a do médico de família (p=0.3). A concordância diagnóstica entre a atenção primária e secundária foi de 31,6%. A maioria dos casos que foram encaminhados para o especialistapoderiam ter sido resolvidos no nível primário de atenção à saúde, o que demonstra capacidade resolutiva limitada desse nível de atenção.Encaminhamento inadequado eleva desnecessariamente o custo da saúde pública. Ressalta-se a importância do ensino médico na graduação focalizar, do ponto de vista das especialidades, a capacitação em habilidades teórico-práticas baseadas na nosologia prevalente da atenção primária.Otorhinolaryngological diseases are frequent in primary care and represent a public health problem. The aim of the present study was to evaluate the resolvent capacity and the validity of the diagnosis in otorhinolaryngology in primary care. Four hundred eight children from Belo Horizonte, Brasil, with ear nose and throat complaints were enrolled from march, 2004, to may, 2005. They were firstly evaluated in primary care and referred to secondary care, where they where evaluated again. Diagnoses of the most common otorhinolaryngological illnessesdefined in primary care were compared with the diagnostic reference established in secondary care for the same patient. The chosen diagnoses were: otitis (acute, recurrence, and with effusion) tonsillitis (recurrence, and chronic) , sinusitis (acute, recurrence, and chronic) , allergic rhinitis, tonsillar hypertrophy and adenoidal hypertrophy. The following aspects were evaluated: the specialty of the health professional that referred the patient, the waiting period for consultation, patient gender and age, otorhinolaryngological diagnosis in primaryand in secondary care, general agreement of the involved professionals and validity of the primary care diagnosis. The children average age was 5,3 years (SD=3,1), 214 (52,5%) male and 194 (47,5%) female. The average waiting time for an otorhinolaryngological consultation was 3.77 months (SD = 4.69). The most frequent diagnoses among the diseases considered in this study were allergic rhinitis (35.3%), effusion otitis media (33.8%), recurring tonsillitis (22.7%), adenoidal hypertrophy (19.1%), sinusitis (13,4%) and tonsillar hypertrophy 12 (2,4%), with an average of 1.6 diagnoses per child. Evaluating the primary care, the capacity for correct diagnosis was similar for both pediatric and familyphysicians (P value=0.3). The diagnostic concordance between the primary and secondary care was of 31,6%. Most of the cases referred to a specialist could have been treated at the primary health care level, what demonstrated a limited capacity to solve otolaryngologycal problems at this level of attencion. Inadequate referrals increases unecessarily the costs of the public health system. From the perspective of specialties, it is important for medical teaching in graduate courses to emphasize training in theoretical-practical skills based on the prevalent nosology in basic care. Medical students would greatly benefit from internships in basic care facilities with emphasis in the most common specialties

Otorrinolaringologia pediátrica no Sistema Público de Saúde de Belo Horizonte Pediatric (Otolaryngology) at the Public Health System of a city in Southeastern Brazil

OBJETIVO: Analisar a adequação dos encaminhamentos da atenção primária para a secundária em otorrinolaringologia pediátrica. MÉTODOS: Estudo realizado em Belo Horizonte, estado de Minas Gerais, de março de 2004 a maio de 2005. Foram avaliadas 408 crianças pré-escolares encaminhadas da atenção primária para a secundária do setor de otorrinolaringologia com otite, faringoamigdalite, rinossinusite, rinite alérgica e hipertrofia de amígdala/adenóide. As variáveis analisadas foram: concordância dos diagnósticos na atenção primária e secundária, tempo de espera pela consulta, acompanhamento e especialista (médico de família ou pediatra) que examinou a criança na atenção primária. A concordância dos diagnósticos foi avaliada pela análise estatística de kappa. RESULTADOS: Os pacientes tinham em média cinco anos de idade, dos quais 214 (52,5%) eram meninos, o tempo médio de espera pela consulta foi de 3,7 meses. Os diagnósticos na atenção primária e secundária foram, respectivamente: otite (44%, 49%), hipertrofia de amígdala/adenóide (22%, 33%), faringoamigdalite (18%, 23%), rinossunusite (13%, 21%), rinite alérgica (3%, 33%). Análise de concordância kappa foi 0,15 para otite com efusão, 0,35 para otite recorrente, 0,04 para hipertrofia de amígdala/adenóide, 0,43 para faringoamigdalite, 0,05 para rinite alérgica; 0,2 para rinossinusite. Os diagnósticos na atenção primária para encaminhamento à secundária, definidos pelo médico de família ou pelo pediatra que avaliou a criança foram concordantes. CONCLUSÕES: A inadequação dos encaminhamentos da atenção primária para a secundária em otorrinolaringologia foi expressa pelo longo tempo de espera pela consulta e pela baixa concordância de diagnósticos firmados entre os níveis de atenção para os mesmos pacientes avaliados. A atenção primária poderia se tornar mais eficiente se os profissionais fossem mais bem capacitados em otorrinolaringologia.<br>OBJECTIVE: To assess the suitability of referral from primary to secondary care in pediatric Otolaryngology. METHODS: The study was performed in the city of Belo Horizonte, in the state of Minas Gerais, from March 2004 to May 2005. A total of 408 pre-school children referred from primary care to secondary care in the department of Otolaryngology presenting with otitis, tonsillitis, sinusitis, allergic rhinitis, and tonsillar/adenoidal hypertrophy was assessed. The studied variables were: agreement between diagnoses in primary and secondary care; waiting time for doctor's appointment; follow-up, and professional (pediatrician or family physician) that examined children in primary care. Agreement of diagnoses was assessed using kappa statistics. RESULTS: Patients were five years old on average, 214 (52.5%) were boys, mean waiting time for appointment was 3.7 months. Diagnoses in primary and secondary care were respectively: otitis (44%, 49%), tonsillar/adenoidal hypertrophy (22%, 33%), tonsillitis (18%, 23%), sinusitis (13%, 21%), allergic rhinitis (3%, 33%). Agreement analysis of kappa was 0.15 for otitis with effusion, 0.35 for recurrent otitis, 0.04 for tonsillar/adenoidal hypertrophy, 0.43 for tonsillitis, 0.05 for allergic rhinitis, and 0.2 for sinusitis. Diagnoses in primary care referred to secondary care were in agreement when given either by pediatrician or family physician. CONCLUSIONS: Unsuitability of referrals from primary to secondary care in otolaryngology was expressed by the long time waiting for appointments and by the low agreement between diagnoses in different level of care for the same patients. Primary health care could be more efficient if professionals were better qualified in Otolaryngology

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Proceedings Of The 23Rd Paediatric Rheumatology European Society Congress: Part Two

PubMe

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora