High Complexity Health Research Articles

Screening for Unhealthy Alcohol Use Among Patients With Multiple Chronic Conditions in Primary Care

IntroductionUnhealthy alcohol use (UAU) increases risk for and exacerbation of chronic health conditions. As such, screening, prevention, and management of UAU is especially critical to improving health outcomes for patients with multiple physical or mental chronic health conditions (MCC). It is unclear to what extent multiple chronic condition (MCC) status is a barrier to screening for UAU in the primary care setting. We hypothesized that patients with MCC would be at lower odds of being screened for UAU compared with patients with no MCC. MethodsWe performed a secondary analysis of electronic health record data for patients from 67 primary care practices in Virginia (2020-2023). Using the Center for Medicare and Medicaid Services’ chronic disease framework, we classified patients by MCC status: no MCC, physical MCC (P-MCC), mental health MCC (MH-MCC), and physical & mental health MCC (P&MH-MCC). We used multiple logistic regressions with an added practice-level random effect to analyze the relationship between MCC status and odds of receiving an alcohol-related assessment, of being screened for UAU with a U.S. Preventive Services Task Force (USPSTF)-recommended instrument, and of screening positive for UAU within the past 2 years. ResultsWithin a final cohort of n= 11,789, a total of 6796 patients (58%) had MCC (29% P-MCC, 4% MH-MCC, and 25% P&MH-MCC). In all, 69% of patients were screened for UAU, while 16% were screened with a USPSTF-recommended instrument and 7% screened positive for UAU. Relative to those with no MCC, patients with P&MH-MCC had 0.9 times lower odds of receiving any screening for UAU [95% CI: (0.8, 1.0), p = 0.0240], while patients with only P-MCC or only MH-MCC had similar odds. There was no difference in odds of being screened with a USPSTF-recommended instrument based on MCC status. Patients with MH-MCC and P&MH-MCC had 1.8 and 1.5 times greater odds, respectively, of screening positive for UAU [95% CI: (1.3, 2.7), p= 0.0014) and 95% CI: (1.2, 1.8), p=0.0003)]. ConclusionAlthough patients with chronic mental health conditions were more likely to screen positive for UAU than patients without MCC, Virginia primary care patients with P&MH MCC were less likely to receive an alcohol-related assessment during the past 2 years. Given the overall modest rate of screening with a USPSTF-recommended instrument, further efforts are needed to create the conditions for high quality alcohol-related preventive service delivery in primary care, particularly for patients with high complexity and/or mental health conditions.

Maintenance of medium- and high-complexity health services in the context of high patient transition: a time series ecological study of the state of Rio de Janeiro, Brazil.

The study addresses the historical disparities in the distribution of the medium- and high-complexity health network and the limits to budget adjustments between the municipality of Rio de Janeiro and its neighboring municipalities of the Metropolitan region 1. An ecological study was conducted with data related to the municipality of Rio de Janeiro, chosen because it has a large assistance network, while located on the borders of vulnerable and underprivileged areas, characterizing a locus that is representative of the situations faced throughout the country. A decrease in the gross values of the programmed quotas in all municipalities of Rio de Janeiro was observed from 2016 onwards. The temporal trend of the programmed quotas remained stable for all municipalities in the Metropolitan Region 1, even with significant increases in the accomplished quotas for neighboring municipalities. The resulting overload in local expenditure prevents the increase of capacity to anticipate fluctuations in demand, both known and unexpected ones, compromising the responsiveness of the health system regarding its regular operation, as well as the ability to adjust to cope with extraordinary events, essential characteristics of resilience.

Manutenção dos serviços de média e alta complexidade em contexto de alta transição de usuários: um estudo ecológico de séries temporais no Estado do Rio de Janeiro, Brasil

Abstract The study addresses the historical disparities in the distribution of the medium- and high-complexity health network and the limits to budget adjustments between the municipality of Rio de Janeiro and its neighboring municipalities of the Metropolitan region 1. An ecological study was conducted with data related to the municipality of Rio de Janeiro, chosen because it has a large assistance network, while located on the borders of vulnerable and underprivileged areas, characterizing a locus that is representative of the situations faced throughout the country. A decrease in the gross values of the programmed quotas in all municipalities of Rio de Janeiro was observed from 2016 onwards. The temporal trend of the programmed quotas remained stable for all municipalities in the Metropolitan Region 1, even with significant increases in the accomplished quotas for neighboring municipalities. The resulting overload in local expenditure prevents the increase of capacity to anticipate fluctuations in demand, both known and unexpected ones, compromising the responsiveness of the health system regarding its regular operation, as well as the ability to adjust to cope with extraordinary events, essential characteristics of resilience.

Analysis of Healthcare-associated Infections before and during the COVID-19 pandemic in a Colombian hospital

Introduction: Healthcare-associated infections pose a significant challenge, contributing to hospital morbidity and mortality. Objective: To describe the behavior of Healthcare Associated Infections before and during the pandemic reported to a high-complexity health institution in Colombia. Material and Methods: In our retrospective observational study on Healthcare-Associated Infections (HAIs), we analyzed data from all in-patients diagnosed with HAIs between 2018 and 2020. This included clinical, demographic, microbiological, and microbial susceptibility information collected from the Committee on Nosocomial Infections' prospective database. Data from 391 isolates were obtained using Whonet software for antimicrobial resistance surveillance. Results: We found 504 cases of HAIs (2018-2020) with an overall in-hospital infection rate of 2.55/1000 patient-days. The median age for pediatric patients was 5 years, and for adults, 56 years, with 57% male. The leading admission diagnoses were oncologic disease complications (31%). Bacteremia had a 30-day mortality rate of 13%, predominantly catheter-associated (37%). Gram-negative bacilli, notably Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, represented 58% cases of HAI. Discussion: The critical need for specific interventions and antimicrobial management to control HAIs, especially given the challenges posed by the COVID-19 pandemic, is highlighted. Conclusions: This is the first report on HAIs incidence at a tertiary hospital in Bucaramanga, Santander (Colombia). Bacteremia was predominant; 75% of HAIs patients had comorbidities. Gram-negative bacilli prevailed; a notable rise in ICU respiratory infections occurred during the 2020 COVID-19 pandemic. Resistance to cephalosporins and carbapenems was prevalent.

Risk of mortality of severe SARS-CoV-2 infection and other causes of viral pneumonia in Chile

Severe community-acquired pneumonia (CAP) due to respiratory viruses is highly prevalent in Chile. Common etiologies include Influenza A and B, respiratory syncytial virus (RSV), Hantavirus, and SARS-CoV-2 since 2020. To identify clinical and laboratory features associated with 20-day mortality in severe viral CAP in a high complexity health care center in southern Chile. The observational study included two cohorts of patients with severe CAP according to IDSA/ATS criteria: the years 2013-2018 (No COVID-19) and the year 2020 (COVID-19). Sociodemographic, clinical, laboratory, and 30-day mortality data were collected. We used Chi-square and Student's T for categorical and continuous variables. We used a binary logistic regression model for mortality analysis, reporting the results as Odd ratios (ORs). Mortality at 30 days was: Hantavirus 54.4%, Influenza H1N1 36.8%, other influenza 30.4%, RSV 25%, and COVID-19 23.6%. We found no significant difference regarding type of virus (COVID-19 or NO COVID-19). Mortality was associated with older age (OR: 4.6; p-value < 0.01), immunosuppression (OR: 5.8; p-value 0.01), and cyanosis (OR: 3.8, p-value 0.02). COVID-19 was not associated with an increased risk of 30-day mortality compared to other common respiratory viruses in our study. Older age, immunosuppression, and cyanosis were associated with higher risk among patients with severe viral CAP.

Central Oxygen Venous Saturation and Mortality in Patients Undergoing Coronary Artery Bypass Grafting.

Central venous oxygen saturation (ScvO2) has been reported as a prognostic marker of in-hospital mortality when it is below 60% in certain situations. Nevertheless, it has not been widely reported in patients undergoing coronary artery bypass graft (CABG). The study determined the association between ScvO2 and in-hospital mortality in patients undergoing CABG in a high-complexity health institution in Santiago de Cali, Colombia. A retrospective cohort study was conducted with patients undergoing isolated CABG. The subject sample included 515 subjects aged 18 years or older. Exposure was defined as ScvO2 <60% upon admission to the intensive care unit (ICU) following surgery. The major outcome was mortality rates after 30 days. Furthermore, exposure variables were measured at preoperative, intra-operative, and postoperative time points. A total of 103 exposed and 412 unexposed subjects were included. The final model revealed a higher mortality risk in individuals with ScvO2 <60% upon ICU admission compared with those with higher saturation levels (relative risk 4.2, 95% confidence interval: 2.4-7.2; p = 0.001). Values were adjusted using variables such as age (>75 years), low socioeconomic stratum, chronic kidney failure before surgery, unstable angina before surgery, ischemia time (>60 min), and intra-operative inotrope use. The primary cause of death was cardiogenic shock (54.7%), followed by sepsis (25.0%) and postoperative bleeding (17.2%). The study identified an association between ScvO2 <60% and in-hospital mortality in patients undergoing CABG.

Caracterización de los mecanismos de afrontamiento de los pacientes hospitalizados en la unidad de trasplante de médula ósea de una institución de alta complejidad en Cali (Colombia) entre febrero y junio de 2022

IntroductionInformation about coping mechanisms of patients who are taken to bone marrow transplant (BMT) are limited. Besides, the long hospitalization has a high emotional impact. We characterize coping mechanisms and evaluate hopelessness, anxiety and depression of patients who were taken to bone marrow transplant (BMT) in a high complexity health institution in the department of Valle del Cauca between February 1 and June 30, 2022 MethodsDescriptive cross-sectional design, with convenience sampling of patients over 18 years of age who were admitted for BMT. Participants filled out five questionnaires (sociodemographic data, Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder (GAD-7), the Beck hopelessness scale and The mental adjustment to cancer scale (MAC-s). The qualitative variables were summarized with absolute frequencies and percentages, the quantitative variables were summarized in medians and interquartile ranges. For the correlation of variables, Spearman's correlation coefficients were used. OutcomesFrom 34 participants, 61.5% were men. The MAC-s scale found fighting spirit as the main coping style, no correlation was found between the scale MAC-s and the clinical variables evaluated. The PHQ-9 and GAD-7 scale showed depressive and anxiety symptoms in 20.8% of the participants. The correlation was positive between those with symptoms of depression (PHQ-9 scale) and those with anxiety (GAD-7 scale) (Spearman's coefficient 0.8). ConclusionThis study found fighting spirit as the main coping style. High frequency of anxiety and depression. The high frequency of anxiety and depression raises the need for screening and preventive strategies.

Epidemiological characteristics of Omicron and Delta SARS-CoV-2 variant infection in Santiago, Chile.

The variant of concern (VOC) SARS-CoV-2 Omicron (B.1.1529) has been described as a highly contagious variant but less virulent than the current variant being monitored (VBM) Delta (B.1.617.2), causing fewer cases of hospitalizations, symptomatology, and deaths associated with COVID-19 disease. Although the epidemiological comparison of both variants has been previously reported in other countries, no report indicates their behavior and severity of infection in Chile. In this work, we report for the first time the effect of the Omicron and Delta variants in a cohort of 588 patients from the Hospital de Urgencia Asistencia pública (HUAP), a high-complexity health center in Santiago, Chile. This report is framed at the beginning of Chile's third wave of the COVID-19 pandemic, with a marked increase in the Omicron variant and a decrease in the circulating Delta variant. Our results indicated a similar proportion of patients with a complete vaccination schedule for both variants. However, the Delta variant was associated with a higher prevalence of hospitalization and more significant symptomatology associated with respiratory distress. On the other hand, our data suggest that vaccination is less effective in preventing infection by the Omicron variant. This antecedent, with a low severity but high contagiousness, suggests that the Omicron variant could even collapse the primary health care service due to the high demand for health care.

Implementation of diagnosis related groups in a high-complexity health institution in Colombia

One of the greatest challenges for health care institutions is to know the hospital product (HP), defined as patients, diagnoses and resources used in health care. Proper measurement of HP allows an effective resource management. The Diagnosis Related Groups (DRG) system facilitates the measurement of HP, classifying patients according to their characteristics, complexity, and resource consumption. To describe the implementation of DRGs in a high complexity health care institution in Colombia and to describe the incidence of coding errors. A random sample of 98 episodes was selected out of 3802 episodes registered from June to September 2019. We described the cumulative incidence of errors in the assignment of main diagnoses, procedures and the variable "Present on admission" (POA). An incorrect assignment of the main diagnosis was found in 18/98 episodes (18%, 95% confidence intervals (CI)11-27). Seventeen of 98(17%-95% CI10.4-26) and 8/98(8%-95% CI 3.6-15) had incorrect assignment of POA ("NO" or "YES" respectively). Eighteen episodes had at least one procedure incorrectly assigned (19% - 95%CI (11.4 - 28.5)). The use of DRGs improves hospital efficiency. Its implementation is possible in health care institutions in Colombia. However, the commitment of the institution's clinical and administrative staff is essential.

Equipos de trauma: realidad mundial e implementación en un país en desarrollo. Descripción narrativa

Introducción. El trauma es una de las entidades con mayor morbimortalidad en el mundo. Los equipos especializados en la atención del paciente traumatizado son llamados &lt;&lt;equipos de trauma&gt;&gt;. Dichos equipos surgieron de la necesidad de brindar tratamiento oportuno multidisciplinario a individuos con heridas que condicionan gran severidad en la guerra; sin embargo, con el paso del tiempo se trasladaron al ámbito civil, generando un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad.&#x0D; El objetivo de este estudio fue describir el proceso de desarrollo de los equipos de trauma a nivel mundial y la experiencia en nuestra institución en el suroccidente colombiano.&#x0D; Métodos. Se realizó una búsqueda en la base de datos PUBMED, que incluyó revisiones sistemáticas, metaanálisis, revisiones de Cochrane, ensayos clínicos y series de casos.&#x0D; Resultados. Se incluyeron 41 estudios para esta revisión narrativa, y se observó que el tiempo de permanencia en el Emergencias, el tiempo de traslado a cirugía, la mortalidad y las complicaciones asociadas al trauma fueron menores cuando se implementan equipos de trauma.&#x0D; Discusión. El diseño de un sistema de atención y valoración horizontal de un paciente con traumatismos severos produce un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. Se hace necesario establecer los parámetros operativos necesarios en las instituciones de salud de alta y mediana complejidad en nuestro país para implementar dichos equipos de trabajo.

Um olhar crítico à descentralização de serviços públicos de saúde em atenção hospitalar

Este trabalho objetiva identificar o panorama de contratação do setor privado sem fins lucrativos pelo Sistema Único de Saúde para realização de serviços de saúde de média e alta complexidade em atenção hospitalar, e a relação desse panorama com a diretriz de descentralização do sistema, que deve garantir atendimentos dos grandes centros urbanos às zonas onde os serviços públicos são mais escassos. Questiona-se se a contratação expandida de serviços hospitalares privados representa um afastamento das direções nacional e estadual da execução dos serviços de saúde a partir da municipalização generalizada. A metodologia de pesquisa é exploratória e descritiva, com base bibliográfica na literatura dos direitos Sanitário e Administrativo. A partir da análise dos gastos públicos com serviços hospitalares,nos últimos cinco anos, identifica-se que as entidades sem fins lucrativos tiveram mais investimento em produção hospitalar do que as esferas da administração pública direta e indireta de todos os entes. A título de contribuição para a busca de soluções para o problema, conclui-se que a menor participação da gestão nacional do SUS na prestação de serviços de saúde acarreta maior compra de serviços da iniciativa privada pelos entes, descumprindo a determinação constitucional de complementariedade da participação do setor privado no SUS. Ademais, a prestação de serviços hospitalares nesses moldes promove a falta de equilíbrio na alocação de leitos hospitalares, comprometendo a igualdade de condições no acesso às ações e aos serviços de saúde, objetivo da descentralização, e o adequado funcionamento do sistema.

The use of health services by non-resident patients in a border region with mixed health systems

Abstract Background Access to health services in Brazil is universal, comprehensive, and equate, offering free healthcare to anyone, regardless of its country of residence. Cross-border patients may theoretically overload the healthcare services, mainly when the health systems or healthcare quality differ between countries. Sometimes, Brazilian politicians of border areas claim that non-residents overload local health services. Methods We collected data on the medium and high complexity Oncology and Cardiology care provided to in-patients by a reference Brazilian hospital located in the most populous international border of the country. This border is a conurbation that includes the cities of Foz do Iguassu (Brazil), Ciudad del Este (Paraguay), and Puerto Iguazu (Argentina), totaling around 900,000 inhabitants, of which 264,044 live in Foz do Iguassu. In addition to the poor migration control of citizens crossing these borders - especially the border with Paraguay - the Brazilian Unified Health System differs from that of the other two countries for being free of charge, and also for offering better healthcare. Results From January 2014 to December 2018, 107,434 procedures were performed, of which 240 (0.22%) on non-resident patients (Paraguay, [n = 236]; Argentina [n = 4]). Additionally, 238 (0.22%) other procedures were performed on foreign patients who did not declare their city/country of origin (Paraguay [n = 229]; Argentina [n = 8]; Portugal [n = 1]). Conclusions The use of medium and high complexity procedures by the non-residents on the Brazilian side of its most populous international border is low. Non-residents may benefit from medium and high complexity healthcare services of neighboring countries without overloading the health system. Key messages Advocating that non-residents overload medium and high complexity health services in Brazil is dishonest and may segregate people. Efforts should move toward integrating healthcare in border regions.

Diagnosis and referral flow in the single health system for climacteric women.

The association between gynecological diagnoses and their distribution across healthcare sectors benefits health promotion and the identification of topics for continued education of gynecological care. This study aimed to identify healthcare diagnoses and referral flow in climacteric women. This is a cross-sectional study conducted at the Women's Health Clinic of the University Hospital, University of São Paulo, with a reference to gynecology and training for Residents of Family and Community Medicine, between 2017 and 2018. The medical records of 242 women whose sociodemographic and clinical information, gynecological diagnoses, and distribution of healthcare services (primary, secondary, and tertiary) had been processed were collected. Statistical analysis included the chi-square test and odds ratio. Smoking (OR = 2.27, 95% CI 1.05-4.89; p = 0.035) was associated with the referral of climacteric women to higher complexity services. Considering the distribution of non-oncological diagnoses in climacteric patients, the chance of women being referred to medium- and high-complexity health services presented a 2-fold increase in cases of breast diseases, a 2.35-fold increase in cases of noninflammatory disorders of the female genital tract, and a 3-fold increase in cases of inflammatory diseases of the pelvic organs. Climacteric women aged over 55 years, postmenopausal women, and smoking women were most frequently referred to medium- and high-complexity outpatient surgery.

Intervenção educativa acerca dos cuidados paliativos voltados à pessoa com ferida tumoral maligna cutânea: vivência de Enfermeiros

Objetivo: analisar a vivência de enfermeiros depois de participar de uma intervenção educativa acerca dos cuidados paliativos voltados à pessoa com ferida tumoral maligna cutânea. Método: Trata-se de uma pesquisa exploratória, com abordagem qualitativa, realizada com 11 enfermeiras que atuavam na Atenção à Saúde de Alta Complexidade em Oncologia da Paraíba entre os meses de junho e julho de 2018 e analisadas com a técnica de análise de conteúdo de Bardin. Resultados: A partir da análise, emergiram duas categorias: Categoria 1 – Há sempre o que aprender: desconstruindo, reconstruindo e transformando saberes, que se dividiu em três subcategorias e Categoria 2 - Ressignificando o saber-fazer: transformando o cuidado. Conclusões: Constatou-se que o processo de aprendizagem significativa foi fio condutor para uma prática reflexiva, uma vez que ressignificaram saberes e práticas relativos aos cuidados paliativos e transformaram a assistência de enfermagem voltada para a pessoa com ferida tumoral maligna cutânea.

Perfiles de salud en pacientes con enfermedades crónicas en una institución de salud de alta complejidad

Objective: to describe the different profiles in terms of health-related quality of life found in patients with chronic diseases in a high-complexity health institution. Methodology: cross-sectional descriptive study that evaluated the health-related quality of life through the EQ-5D instrument, in patients with chronic diseases that consulted Internal Medicine and its subspecialties in the outpatient service of a highly-complexity health institution in the city of Medellin, during the year 2017. Results: 158 patients between the ages 46-68 (an average of 58-year-old) were surveyed. A total of 117 patients (74.1%) were female. The time of evolution from the age when the diagnostic was run to the actual age of the patient when surveyed was 8.7 years. The general health status of the patients from Endocrinology and Rheumatology was found to be of 80 points, being the feelings of “pain or discomfort” and “anxiety or depression” the ones that most affected the quality of life. Additionally, in patients with infectious pathologies the general health status was the lowest (62.5); the most common factor was “pain or discomfort). Conclusions: it is evident that there is greater alteration in the variables of the EQ-5D of “pain or discomfort” and “anxiety or depression” in the general population, as well as in the females and the areas of Endocrinology and Rheumatology.

Rede urbana, serviços de saúde e o transporte intermunicipal de beneficiários do SUS: aproximações de análise ao caso da Região Metropolitana do Vale do Paraíba e Litoral Norte, SP.

O objetivo do artigo é analisar o serviço de transporte intermunicipal de beneficiários do SUS, no quadro da distribuição desigual dos estabelecimentos de saúde de média e alta omplexidade entre diferentes municípios. As aproximações de análise efetivam-se no contexto da rede urbana regional do Vale do Paraíba e Litoral Norte (SP) e dos municípios de Aparecida e Caraguatatuba. A metodologia utilizada é de caráter exploratório e busca estabelecer apontamentos gerais para discussões sobre a integração regional e a interdisciplinaridade do conhecimento. Para isso, parte-se de quantificação estatística, informações oficiais e considerações sobre o interesse comum aos estudos urbanos-regionais e da saúde, articulando as preocupações com a questão da regionalização, da rede urbana e da organização dos serviços de saúde.

Drivers of High-cost Medical Complexity in a Medicaid Population.

Efforts to improve outcomes for the 10% of patients using two thirds of health care expenditures increasingly include addressing social determinants. Empiric evidence is needed to identify the highest impact nonmedical drivers of medical complexity and cost. This study examines whether complex, highest cost patients have different patterns of critical life adversity than those with better health and lower utilization. Using a validated algorithm we constructed a complexity/cost risk patient profile. We developed and fielded a life experience survey (Supplemental Digital Content 1, http://links.lww.com/MLR/B920) to a representative sample, then examined how the prevalence of specific adversities varied between complex, high-cost individuals, and others. Surveys were sent to 9176 adult Medicaid members in Portland, Oregon. Our primary variable was high medical complexity health cost risk; an alternative specification combined health cost risk and actual utilization/cost. Our survey instrument measured exposure to early and later-life adversities. Compared with healthy individuals in our population, medically complex individuals had significantly higher rates of adversity. The greatest risk of medical complexity and cost was associated with substance use [odds ratio (OR), 4.1], homelessness (OR, 3.0), childhood maltreatment (OR, 2.8), and incarceration (OR 2.4). Those with the highest prior year acute care utilization and cost had the highest rates of these same factors: substance use (62.5%), homelessness (61.7%), childhood maltreatment (55.5%), and incarceration (52.1%). Clinical and policy strategies that mitigate high-impact social drivers of poor outcomes are likely critical for improving both health and costs for complex, high-needs patients.

Factors associated with failure of postoperative nausea and vomiting prophylaxis in a high complexity health center in Cali, Colombia

Introduction: Postoperative nausea and vomiting (PONV) negatively impact patients undergoing surgical procedures under anesthesia. The scientific evidence on the risk factors for PONV after antiemetic prophylaxis is unsatisfactory, so there is a need to identify the factors associated with the occurrence of PONV. Objective: To identify the factors associated with failed prophylaxis for PONV in patients at Fundacion Valle del Lili in 2017. Methods: Case-control study. Patients admitted to the post anesthesia care unit after having undergone surgery under general anesthesia were included. The cases were patients who, despite receiving antiemetic prophylaxis, had PONV, and those who did not develop these symptoms after prophylaxis, were considered the control group. A bivariate analysis was conducted using the Mann-Whitney U test, Fisher's exact test, or x2, according to the type of variable. Finally, crude odds ratios were estimated and subsequently adjusted via a logistic regression. Results: A total of 80 cases and 332 controls were included. The median age for all patients was 47 years. Women represented 61.6% (n = 254). The variables associated with PONV were age (odds ratio [OR] = 0.98, 95% confidence interval [CI] 0.96-0.99, P = 0.013), female (OR = 3.02, 95% CI 1.66-5.47, P < 0.001) and the use of desflurane during surgery (OR = 2.82, 95% CI 1.097.30, P < 0.032). Conclusion: Female sex and the use of desflurane during surgery increase the odds of experiencing PONV, regardless of pharmacological antiemetic prophylaxis. Moreover, elderly patients show lower odds of developing this complication.

Knowledge about Neonatal Screening among Postpartum Women and Complexity Level of Birthing Facilities.

Background: To ascertain the degree of knowledge of postpartum women about important aspects related to the neonatal screening process and whether differences of opinion exist between those who deliver in low-complexity versus high-complexity health facilities (low-risk versus high-risk pregnancies, respectively). Methods: This was a prospective, cross-sectional, questionnaire-based study. The sample consisted of postpartum women recruited from 2013 to 2015 at public maternity hospitals in the city of Niterói, Brazil. Participants were divided into two groups and completed a questionnaire consisting of Likert-scored items. Continuous variables were analyzed with the Mann-Whitney test, and categorical variables, with Fisher’s test. A confirmatory factor analysis of participants’ answers was performed. Results: Of 188 women enrolled, 54 (28.7%) had incomplete elementary education; 119 (62.2%) had attended more than six antenatal care visits. The mean age was 25.57 years. Nearly all women (n = 179, 95.2%) were roomed-in with their infants. Knowledge of neonatal screening was very similar in the high-complexity and low-complexity groups. Divergences were limited to items regarding the risks of neonatal screening. Conclusions: The degree of knowledge among postpartum women was similar among high- and low-complexity facilities. Those who attended high-complexity facilities had longer hospital stays and greater adherence to ethical issues regarding neonatal screening.

Questão territorial, processo de regionalização do SUS e financiamento das redes temáticas

Objetivo: Sistematizar as principais características das portarias que orientam a transferências de recursos para a rede de cuidado obstétrico e neonatal (Rede Cegonha), a Rede de Atenção à Urgência (RAU), a Rede de Atenção Psicossocial (RAPS) e a Rede de Atenção à Pessoa com Deficiências (Viver sem limites). Métodos: As portarias foram analisadas a partir de três eixos estruturais: i) perfil assistencial dos elementos financiados, sendo observados os componentes e os equipamentos, insumos e ações; ii) o montante de recursos financeiros disponível para cada um dos elementos financiados, discriminado em investimentos e custeio; e iii) o comprometimento de cada um dos entes federativos no financiamento e execução do recurso. Resultados: A análise permite evidenciar três principais aspectos no repasse de recursos financeiros federais para os entes subnacionais: i) preponderância de recursos para o cuidado especializado, cuja configuração produtiva exige economia de escala, tendendo a se concentrar em municípios que apresentam maior centralidade; ii) indução ao comprometimento de recursos, financeiros ou não, dos entes subnacionais; e iii) grande fragmentação nos repasses financeiros. Conclusão: O financiamento das redes temáticas, além de favorecer o modelo médico assistencial por meio da transferência de recurso prioritariamente para a atenção à saúde voltada à média e alta complexidade, parece tender às regiões privilegiadas.