Secondary Database Research Articles

Comparative Analysis of Epidemiological Outcome of Incidence, Mortality and Lethality by COVID-19 between the States of Espírito Santo and Minas Gerais, Brazil.

At the beginning of December 2019, a new type of coronavirus emerged, SARS-CoV-2. This virus causes COVID-19, a highly contagious disease that can initially present asymptomatically and can also lead to death. Our ecological study goal was to evaluate the incidence, mortality, and lethality rates for COVID-19 between the states of Espírito Santo and Minas Gerais, with time series analysis using secondary and public databases on COVID-19 from January 2020 to December 2022. Prais-Winsten linear regression was used for trend analyses. In 2020, the rate in Espírito Santo was 2.19 times greater than in Minas Gerais. This trend continued in 2021, with Espírito Santo's rate being 1.29 times greater. In 2022, Espírito Santo's rate remained 2.65 times higher than Minas Gerais. Furthermore, Espírito Santo had the highest mortality, with the exception of 2021. In turn, Minas Gerais had the highest fatality rate throughout the analyzed pandemic period. The state of Espírito Santo had a higher incidence of COVID-19, as well as higher mortality when compared to the state of Minas Gerais. Furthermore, both states showed similar trends for mortality, lethality, and incidence in the years 2020 and 2021.

Resting Energy Expenditure, comparison of predictive formulas with bioimpedance: Peruvian population

ntroduction: In areas with limited access to healthcare systems, Resting Energy Expenditure (REE) estimation is performed using predictive equations to calculate an individual’s caloric requirement. One problem is that these equations were validated in populations with different characteristics from those in Latin America, such as race, height, or body mass, leading to potential errors in the prediction of this parameter. Objective: To determine the REE using predictive formulas compared with bioimpedance in Peruvians. Materials and methods: A comparative analytical cross-sectional study with secondary database analysis of the CRONICAS cohort. Results: we worked with a total of 666 subjects. The Mjeor equation was the one with the highest rating of 0.95, a lower mean absolute percentage error (MAPE) of 4.69%, and equivalence was found with the REE values. In the multiple regression, it was observed that the Mjeor equation was the one that least overestimated the REE, increasing 0.77 Kcal/day (95% CI: 0.769-0.814; p<0.001) for each point that increased the REE determined by bioimpedance. The strength of association between Mjeor and bioimpedance was 0.9037. Furthermore, in the regression of the data (weight, height, age) in the Mjeor equation it was observed that the coefficients obtained were the same as those used in the original equation. Conclusions: The Mjeor equation seems to be the most adequate to estimate the REE in the Peruvian population. Future prospective studies should confirm the usefulness of this formula with potential utility in primary health care.

Quality Indicators for Residential Long-Term Care for the Elderly: A Scoping Review

The objective of this study was to review the existing literature on the evaluation of care in residential homes for elderly, considering its quality through quality indicators, using secondary databases. A systematic search was conducted, following the PRISMA guidelines for scoping reviews. One hundred and ten studies were included, in which 1,239 indicators were identified. More than half of the identified indicators (N=663, 53%) were linked to outcomes, with about 33% (N=413) related to structure, and 14% (N=175) to process indicators. The most frequently studied indicators as dependent variables were: "Pressure ulcer," "Staffing issues," and "Psychotropic Drug Use." As independent variables, indicators relating to structure were prominent: "Facility characteristics," "Resident characteristics," and "Staffing Issues”. There is a broad consensus around a care approach centered on clinical and structural aspects, in accordance with the profile of residents, and reflecting historical concerns about quality of care and patient safety that were the origin of quality assessment systems, and which remain the focus of concerns to this day.

Assessing the Additional Benefits of Thailand’s Approaches to Reduce Motor Vehicle Emissions

Air pollutants and greenhouse gases (GHGs) represent major challenges in our era, contributing to climate change and global health issues. These problems arise from a variety of well-known sources, including motor vehicles. Almost all nations, Thailand included, have formulated and implemented policies to curb greenhouse gas (GHG) emissions in line with the requirements and commitments of the Paris Agreement. The evaluation of specific air pollutants and GHG emissions originating from road vehicles utilises the Thailand database, referencing the year 2019. Data intersections from 2019 to 2022 are grounded in actual data collected from relevant departments in Thailand, while projections for 2023–2030 are forecasted based on the baseline year. The secondary database used in the International Vehicle Emission model is adjusted according to real-world driving data to accurately reflect country-specific emission factors. Dynamic emission factors for specific air pollutants and GHGs are evaluated and integrated with the average Vehicle Kilometres Travelled (VKT) for each vehicle category. The Business-As-Usual (BAU) scenario is then examined, based on existing policies aimed at reducing air pollutants and GHG emissions in Thailand’s transport sector. These policies include strategies for the adoption of electric vehicles and the promotion of public transport to reduce VKT. Under the BAU scenario, the overall number of road vehicles in Thailand, including passenger cars, motorcycles, pickups, vans, trucks, and buses, is expected to increase by approximately 6.58% by 2030, leading to a rise in specific air pollutants and GHG emissions compared to the 2019 baseline. However, by adhering to Thailand’s strategies and transitioning to new electric passenger cars and buses, greenhouse gas emissions and specific air pollutants from the road transport sector will be significantly reduced.

Comprehensive analysis of cyanobacterial secondary metabolites distribution and toxicity in urban water bodies

This study addresses the increasing concern regarding cyanotoxin contamination of water bodies, highlighting the diversity of these toxins and their potential health implications. Cyanobacteria, which are prevalent in aquatic environments, produce toxic metabolites, raising concerns regarding human exposure and associated health risks, including a potential increase in cancer risk. Although existing research has primarily focused on well-known cyanotoxins, recent technological advancements have revealed numerous unknown cyanotoxins, necessitating a comprehensive assessment of multiple toxin categories. To enhance the cyanotoxin databases, we optimized the CyanoMetDB cyanobacterial secondary metabolites database by incorporating secondary fragmentation patterns using the Mass Frontier fragmentation data prediction software. Water samples from diverse locations in Shanghai were analyzed using high-resolution mass spectrometry. Subsequently, the toxicity of cyanobacterial metabolites in the water samples was examined through acute toxicity assays using the crustacean Thamnocephalus platyurus. After 24 h of exposure, the semi-lethal concentrations (LC50) of the water samples ranged from 0.31 mg L−1 to 1.78 mg L−1 (MC-LR equivalent concentration). Our findings revealed a critical correlation between the overall concentration of cyanobacterial metabolites and toxicity. The robust framework and insights of this study underscore the need for an inclusive approach to water quality management, emphasizing continuous efforts to refine detection methods and comprehend the broader ecological impact of cyanobacterial blooms on aquatic ecosystems.

Sociodemographic, clinical characteristics, and treatment patterns of endometrial cancer cases in Puerto Rico during the period 2009 to 2015: A retrospective study.

Over the past decades, the rising incidence rates of endometrial cancer have made it a significant public health concern for women worldwide. Treatment strategies for endometrial cancer vary based on several factors such as stage, histology, the patient's overall health, and preferences. However, limited amount of research on treatment patterns and potential correlations with sociodemographic characteristics among Hispanics is available. This study analyzes the treatment patterns for patients diagnosed with endometrial cancer in Puerto Rico. A secondary database analysis was performed on endometrial cancer cases reported to the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database from 2009 to 2015 (n = 2,488). The study population's sociodemographic and clinical characteristics were described, along with an overview of the therapy options provided to patients receiving care on the island. Logistic regression models were used to evaluate the association of sociodemographic/clinical characteristics with treatment patterns stratified by risk of recurrence. In our cohort, most patients were insured through Medicaid and had a median age of 60 years. Almost 90% of patients received surgery as the first course of treatment. Surgery alone was the most common treatment for low-risk patients (80.2%). High-risk patients were more likely to receive surgery with radiotherapy and chemotherapy (24.4%). Patients with Medicare insurance were five times (HR: 4.84; 95% CI: 2.45-9.58; p < 0.001) more likely to receive surgery when compared with patients insured with Medicaid. In contrast, those with private insurance were twice as likely to receive surgery (HR: 2.38; 95% CI: 1.40-4.04; p = 0.001) when compared to those with Medicaid. These findings provide insight into the treatment patterns for endometrial cancer in Puerto Rico and highlight the importance of considering factors such as disease risk when making treatment decisions. Addressing these gaps in treatment patterns can contribute to effective management of endometrial cancer.

Understanding Care Needs of Older Adults with Disabilities: A Scoping Review.

To conducted a scoping review of care needs of older adults with disabilities at home and in the community and provide a comprehensive understanding of the essential needs of older adults with disabilities. Eight databases were searched for relevant Chinese and English studies (supplemented by retrospective references of the included studies) from the establishment of the database to February 13, 2023. An thematic synthesis approach was used to qualitatively integrate the retrieved studies and identify need-related themes. A total of 6239 studies were retrieved, 2557 were de-weighted and excluded, and 56 were obtained after the double screening. Studies were from 11 countries. Thirty-three studies used a self-prepared survey instrument to investigate needs, and the other research tools commonly used were secondary databases and the Long-Term Care Needs of the Disabled Scale. A total of 78 specific need items were identified and summarized into three need themes based on the ICF framework: physical functioning needs, activity and participation needs, and environment needs. The complex physical and mental health conditions faced by older adults with disabilities result in multifaceted, integrated needs that are difficult to identify and meet. Current research on older adults with disabilities is limited to common care. Future research should focus on the specificities of the older disabled population and understand the diverse care needs of people with disabilities in order to better target care services for this group. Policymakers should formulate more operational and strategic measures based on the actual needs of older adults with disabilities to expand the coverage of services and to pinpoint care services.

Structure and process in primary health care for children and spatial distribution of infant mortality.

To identify the spatial patterns of the quality of the structure of primary health care services and the teams' work process and their effects on infant mortality in Brazil. An ecological study of spatial aggregates, using the 5,570 municipalities in Brazil as the unit of analysis. Secondary databases from the Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB - National Program for Improving Access and Quality of Primary Care), the Mortality Information System (SIM), and the Live Birth Information System (SINASC) were used. In 2018, the infant mortality rate was the outcome of the study, and the exposure variables were the proportion of basic health units (BHU) with adequate structure and work processes. Global and local Moran's indices were used to evaluate the degree of dependence and spatial autocorrelation. Spatial linear regression was used for data analysis. In 2018, in Brazil, the infant mortality rate was 12.4/1,000 live births, ranging from 10.6/1,000 and 11.2/1,000 in the South and Southeast, respectively, to 14.1/1,000 and 14.5/1,000 in the Northeast and North regions, respectively. The proportion of teams with an adequate work process (β = -3.13) and the proportion of basic health units with an adequate structure (β = -0.34) were associated with a reduction in the infant mortality rate. Spatial autocorrelation was observed between smoothed mean infant mortality rates and indicators of the structure of primary health care services and the team's work process, with higher values in the North and Northeast of Brazil. There is a relationship between the structure of primary health care services and the teams' work process with the infant mortality rate. In this sense, investment in the qualification of health care within the scope of primary health care can have an impact on reducing the infant mortality rate and improving child health care.

Factores sociodemográficos asociados a violencia intrafamiliar en mujeres en el Perú año 2021

Introduction: Domestic violence is based on phenomena that establish a relationship of subordination, whose behaviors are related to physical, psychological and sexual damage, through the actual or symbolic use of force, with the aim of dominating the will, mind and body of the victim. Objective: To determine the sociodemographic factors associated with women victims of domestic violence in Peru during the year 2021. Materials and Methods: This is an observational, retrospective, analytical and cross-sectional study, developed through the ENDES 2021 secondary databases, using information from 21,557 women. Said information was analyzed using the SPSS vers.27 statistical software and prevalence ratios were used through the Poisson regression model with robust variance. Results: A prevalence of 47.7% for psychological violence was determined. The multivariate analysis identified that the variables associated with psychological violence were the level of primary education (APR: 1.10) and the metropolitan Lima region (APR :1.14). Regarding sexual violence, the poor wealth level (APR: 2.35) was the associated variable, and for physical violence, the age of 20 to 29 years (APR: 1.21), poor wealth level (APR: 1.495) and the coastal region (APR: 0.79). Conclusions: Factors associated with psychological violence were identified as the level of education and the natural region, marital status was a protective factor against sexual violence, and the variables of age and wealth level were associated with physical violence.

Diagnostic performance of the GGT/HDL-C ratio for NAFLD in adults with obesity undergoing bariatric surgery

BackgroundNon-alcoholic fatty liver disease (NAFLD) has become the most frequent liver disease, closely related with metabolic risk factors such as obesity, insulin resistance, dyslipidemia, diabetes mellitus, and metabolic syndrome. In this context, γ-Glutamyl transpeptidase (GGT) and high-density lipoprotein cholesterol (HDL-C) have shown correlations with steatosis severity and metabolic syndrome, respectively. This positions the GGT/HDL-C ratio as a potential diagnostic indicator for NAFLD. ObjectiveTo assess the diagnostic performance of the GGT/HDL-C ratio for NAFLD in adults with obesity undergoing bariatric surgery. MethodsWe conducted an analytical cross-sectional study, designed as a diagnostic test evaluation. A secondary database of 249 adults with obesity was analyzed. The optimal cut-off point was ascertained using three methodologies, and five adjustment models were constructed for the total population, further stratified by sex. ResultsThe optimal cut-off point was 20.5 U/mmol and the AUC of the ratio was 0.81 (95% CI: 0.64–0.98), with sensitivity and specificity being 82.5% and 77.8%, respectively. In the overall group with an elevated GGT/HDL-C ratio, the prevalence of NAFLD increased by 14% (PR: 1.14; 95% CI: 1.04–1.33). Specifically, women displaying this altered ratio showed a 19% increased prevalence (PR: 1.19; 95% CI: 1.07–1.42) compared to those with normal values. ConclusionsThe GGT/HDL-C ratio is a promising biomarker for the diagnosis of NAFLD in an adult population living with obesity.

Organizational Citizenship Behavior Scale for Knowledge Workers: Empirical Evidence and New Validations

In order to analyze the empirical instabilities and adopt new validation procedures for the Organizational Citizenship Behavior—Knowledge Workers (OCB-KW) Scale this study was organized in two stages. In the first stage, studies were read for a general characterization of the production of works that used the OCB-KW and from these data, it was possible to characterize applications of the scale and assess their possible instabilities. In the second stage of analysis, a secondary database was used and subjected to the parallel analysis, and then to the exploratory factor analysis for the initial estimation and validation of the constructs, and in a third moment, the confirmatory estimation of the constructs and the comparison of different models. From the comparison indices between models, it can be concluded that the best structure for the Organizational Citizenship Behavior—Knowledge Workers Scale is built from five dimensions correlated with each other.

Phytochemical and Pharmacological Review of the Genus Antidesma

Background Antidesma is a large genus consisting of around 100 species, which are widely distributed in the tropics and subtropics of Asia, some species can be found in Africa, the Pacific islands, and Australia. The uses of Antidesma plants range from food (for juice, jam, and red wine production) to medicinal purposes (for treatment of indigestion, pneumonia, menstrual regulation, and osteoarthritis). Methods The review was conducted by gathering relevant literature from secondary databases, including Web of Science, Google Scholar, and PubMed, as well as specialized books and websites. Results There have been more than 140 compounds reported as chemical constituents of the genus Antidesma, which mainly belonged to alkaloid, phenolic, flavonoid, lignan, and terpenoid classes. The high content of phenolic compounds was found in A. bunius and A. thwaitesianum fruits, which also correlates with the potential anti-oxidant activities of respective plants. Besides that, the antibiotic, antifungal, and anti-inflammatory activities, as well as effects on metabolism were also investigated and reported. Conclusion The plants of the Antidesma genus have a wide range of applications in food and medicine. The published results have shown that the genus is a precious source of bioactive natural compounds, which was shown beneficial for preventive medicine. Further research is required to promote the application in the healthcare system.

Exploring Socio-Economic Changes: Demographic Transitions of Syrian Christians in Kerala with special reference to Nordic Model

Abstract: The present study investigates socio-economic changes and demographic transitions of Syrian Christian community in Kerala with a special focus on Nordic Model, which is practised in Scandinavian nations. The theoretical framework draws from the Nordic Model, renowned for its emphasis on social welfare and economic prosperity to analyze its applicability and relevance to the Syrian Christian community in Kerala. This conceptual study delves into the socio-economic transformations occurring within the Syrian Christian community in Kerala with a focal point on demographic shifts, while drawing insights from the Nordic Model. Leveraging secondary databases and existing literature, the research endeavors to discern the intricate relationship between socio-economic variables and demographic trends among Syrian Christians. The conceptual framework integrates theoretical perspectives from sociology, economics, and demography to analyze how socio-economic factors intersect with religious and cultural norms, influencing demographic behaviors among Syrian Christians. Furthermore, this study endeavors to offer theoretical insights and methodological considerations for future empirical research on the topic. This study critically examining existing data and synthesizing relevant literature contributes to a deeper understanding of the complex interplay between socio-economic changes, religious identity, and demographic transitions among Syrian Christians in Kerala.

Struktur Hirarki Wilayah Kabupaten Pidie Jaya

This research aims to analyze the leading sectors per sub-district in Pidie Jaya Regency and analyze the hierarchy and interactions between sub-district areas in Pidie Jaya Regency. This research uses quantitative analysis methods with secondary data bases. To analyze the hierarchy in this study, scalogram analysis and Marshall centrality index were used, regional interactions were determined by gravity analysis and breaking point analysis. The results of the research show that the regions in Pidie Jaya Regency have a superior sector, namely agriculture, which is run as the center of their economy.

Drug utilization studies from secondary databases in latent tuberculosis: a scoping review protocol

This article introduces a protocol for a scoping review that aims to map and synthesize Drug utilization studies from secondary databases in latent tuberculosis The protocol is intended to document the processes involved in the methodological planning and execution of a scoping review guided by Joanna Briggs Institute guidelines and developed using the 2015 PRISMA-Protocols (PRISMA-P) checklist. The PCC strategy (population, concept and context) systematized the search for studies published in Pubmed, Scopus, BVS, Embase and Web of Science from January 2015 to December 2022. The selection of articles will be carried out in two steps (titles and abstracts, followed by the assessment of the full text of the articles), by two independent reviewers, with the resolution of disagreements by a third reviewer. The results will be analyzed qualitatively/quantitatively and will be organized by themes. The checklist present in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) will be used to guide the final review report. We hope that this scoping review will shed light on Drug Utilization Research in the field of latent tuberculosis, which is still understudied, especially in Brazil.

Study of neutrophil/lymphocyte and platelet/lymphocyte ratios in type 2 diabetes mellitus

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are potential inflammatory biomarkers for prognostic analysis in several diseases, such as type 2 diabetes mellitus (T2DM). This study analyzed NLR and PLR as possible T2DM biomarkers. A cross-sectional study was conducted with a secondary database that included laboratory test results from two healthcare units in Goiânia, GO, Brazil, between 2015 and 2016. The participants were normoglycemic (NG), prediabetic (preDM), and had controlled DM (CDM) and uncontrolled DM (UDM). NLR and PLR were compared between study groups according to sex and age group. NLR was higher in group UDM than preDM (1.88 vs. 1.62, p &lt;0.05) and lower in group preDM than NG (1.62 vs. 1.80, p &lt;0.05). NG women aged ≥65 years were six times more likely to present PLR ≤91.83 than preDM ones (OR: 6.34; CI: 1.98 - 20.55; sensitivity = 41.5%, PPV = 84.6, and LR + = 4.15). NG men aged &lt;65 years were almost four times more likely to present PLR ≤120 (OR: 3.64; CI: 1.21 - 10.89; sensitivity = 80%, PPV = 37.7, and LR + 1.53) than preDM ones. NLR and PLR increases are directly proportional to DM severity, except for group preDM compared to NG for NLR values. These biomarkers can help estimate T2DM prognosis.

Work ability of school servants and the mediating effects between personal characteristics, work conditions, and sickness absence1.

School servants are professionals involved with cleaning and feeding activities in schools. Exposed to conditions of physical and psychosocial overload at work, they may face situations of morbidity and functional restrictions. To evaluate personal and work characteristics and work ability index (WAI) of school servants in Brazil and test the mediating effect of WAI in the duration of sickness absence. 163 Brazilian school servants participated in this cross-sectional study, that including the self-completion of a sociodemographic questionnaire, information about the Work Environment, the Protocol of Psychosocial Risks at Work's Evaluation, and the Work Ability Index. Also was collected, in a secondary health database, information about sickness absence. A linear regression model was constructed to identify the predictors of the duration of absence, followed by the analysis of mediation with the Path Analysis method. The study found that the WAI partially mediates the relation of the personal characteristics and the work conditions with the duration of absence of the school servants. The predictors included the organizational aspects of work, mental exhaustion, physical damage, health self-evaluation, availability of personal protective equipment, and the need to assume inadequate postures at work. These predictors explained 33% of the duration of absence and 53% of the WAI of these workers. This study indicated that inadequate working conditions and low WAI impact in the sickness absence, increasing by 33% the length of time off work of school servants.

Effectiveness of Pressure Relief Pads in Preventing Bi-Level Positive Airway Pressure- Related Injuries: A Secondary Database Analysis

&lt;p&gt;目的：透過雙相型陽壓呼吸器(BiPAP)通報資料庫分析，探討減壓墊於BiPAP相關壓傷之預防成效。方法：方便取樣南部某區域教學醫院成人內科加護病房之BiPAP通報資料庫，次級資料分析減壓墊於BiPAP相關壓傷之預防成效。結果：減壓墊組的壓傷發生率為6.06%，無減壓墊組為7.78%，兩組無統計顯著差異(p =.5863)。壓傷個案相關變項比較，減壓墊組比無減壓墊組平均延緩21.18小時產生壓傷(p =.8660)，平均減少0.12個壓傷(p =.5501)、減少1.96 cm2的壓傷表面積(p =.7334)，較低的重度壓傷發生風險(risk ratio = 0.44, p =.1666)，然礙於臨床發生壓傷的個案數偏少，故成效比較尚未達顯著差異。結論：兩組比較雖未達顯著差異，但次級資料庫的真實世界數據顯示減壓墊組具有較佳的預防壓傷臨床效益，建議臨床仍可善用減壓墊於預防BiPAP相關壓傷。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;&amp;quot;Purpose: To compare the effectiveness of pressure relief pads in preventing bi-level positive airway pressure-related injuries by analyzing data from a medical reporting database. Methods: The authors took a convenience sample of records from the medical reporting database of the adult medical intensive care unit of a regional teaching hospital in southern Taiwan. Secondary database analysis was employed to examine the effectiveness of pressure relief pads in preventing pressure injuries. Results: The incidence of pressure-related injuries in the pressure relief pads group was 6.06%, whereas the incidence in the no relief pads group was 7.78% (p = .5863). Pressure relief pads delayed the occurrence of pressure injuries by 21.18 hours (p = .8660), reduced the number of pressure injury lesions by 0.12 (p = .5501), reduced the surface area of pressure injuries by 1.96 cm2 (p = .7334), and reduced the risk of severe pressure injury (risk ratio = 0.44, p = .1666). Due to the small number of clinical incident pressure injuries reported, the comparison of effectiveness did not reach statistical significance. Conclusion: Although no significant difference was observed between the two groups, real-world data from the secondary database revealed that the pressure relief pads effectively and safely prevented pressure injuries.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Representation of the hierarchical and functional structure of an ambulatory network of medical consultations through Social Network Analysis, with an emphasis on the role of medical specialties.

Ambulatory Health Care Networks (Amb-HCN) are circuits of patient referral and counter-referral that emerge, explicitly or spontaneously, between doctors who provide care in their offices. Finding a meaningful analytical representation for the organic and hierarchical functioning of an Amb-HCN may have managerial and health policymaking implications. We aimed to characterize the structural and functional topology of an Amb-HCN of a private health insurance provider (PHIP) using objective metrics from graph theory. This is a cross-sectional quantitative study with a secondary data analysis study design. A Social Network Analysis (SNA) was conducted using office visits performed between April 1, 2021 and May 15, 2022, retrieved from secondary administrative claim databases from a PHIP in Belo Horizonte, Southeastern Brazil. Included were beneficiaries of a healthcare plan not restricting the location or physician caring for the patient. A directional and weighted network was constructed, where doctors were the vertices and patient referrals between doctors, within 7-45 days, were the network edges. Vertex-level SNA measures were calculated and grouped into three theoretical constructs: patient follow-up (aimed at assessing the doctor's pattern of patient follow-up); relationship with authorities (which assessed whether the doctor is an authority or contributes to his or her colleague's authority status); and centrality (aimed at positioning the doctor relative to the network graph). To characterize physician profiles within each dimension based on SNA metrics results, a K-means cluster analysis was conducted. The resulting physician clusters were assigned labels that sought to be representative of the observed values of the vertex metrics within the clusters. Overall, 666,263 individuals performed 3,863,222 office visits with 4,554 physicians. A total of 577 physicians (12.7%) had very low consultation productivity and contributed very little to the network (i.e., about 1.1% of all referrals made or received), being excluded from subsequent doctor profiles analysis. Cluster analysis found 951 (23.9%) doctors to be central in the graph and 1,258 (31.6%) to be peripheral; 883 (22.2%) to be authorities and 266 (6.7%) as seeking authorities; 3,684 (92.6%) mostly shared patients with colleagues, with patient follow-up intensities ranging from weak to strong. Wide profile dispersion was observed among specialties and, more interestingly, within specialties. Non-primary-care medical specialties (e.g., cardiology, endocrinology etc.) were associated with central profile in the graph, while surgical specialties predominated in the periphery, along with pediatrics. Only pediatrics was associated with strong and prevalent (i.e., low patient sharing pattern) follow-up. Many doctors from internal medicine and family medicine had unexpectedly weak and shared patient follow-up profiles. Doctor profiles exhibited pairwise relationships with each other and with the number of chronic comorbidities of the patients they treated. For example, physicians identified as authorities were frequently central and treated patients with more comorbidities. Ten medical communities were identified with clear territorial and specialty segregation. Viewing the Amb-HCN as a social network provided a topological and functional representation with potentially meaningful and actionable emerging insights into the most influential actors and specialties, functional hierarchies, factors that lead to self-constituted medical communities, and dispersion from expected patterns within medical specialties.

Glosses in health establishments under state management and consortium management, in Ceará

As part of its regionalization process, Ceará was divided into five Health Regions, which decentralized health services, actions and agreement processes between municipalities and the state. As coordinator of the Health Regions, it has invested in strengthening the internalization of health through the construction of Regional Polyclinics and Regional Dental Specialty Centres (CEOR), enabling the formation of inter-municipal consortia. This is an exploratory, quantitative and descriptive study with a retrospective approach, analyzing the provision of health care costs through a partial economic evaluation. This study aimed to analyze the disallowances and outpatient production presented/informed, the relationship between them and the value of these disallowances, carried out in the 41 establishments of the five health regions under state management and consortium management in the State of Ceará, whose value in the Unified Health System (SUS) table is different from zero, during the years 2019 and 2020. Secondary databases were used from the SUS Outpatient Information System (SIA/SUS) and the website of the Coordination of Regulation, Control, Evaluation and Audit (CORAC). The results were presented by comparing the value of what was presented to the Ministry of Health (MoH) and the value of the disallowances. It was concluded that these establishments need to be monitored in terms of feeding information into systems, in order to show the Ministry of Health that there are insufficient resources to meet the needs that are increasingly growing in quantity and diversity.