Cláudio Lima Souza

Inquérito de Saúde em Comunidades Quilombolas de Vitória da Conquista, Bahia, Brasil (Projeto COMQUISTA): aspectos metodológicos e análise descritiva

The scope of this article was to present the methodology, preliminary descriptive results and the reliability of the instruments used in the COMQUISTA Project. It involved a cross-sectional study with adults (>18 years) and children (up to 5 years old) of Quilombola communities in Vitoria da Conquista, Bahia. Data collection consisted of individual and household interviews, anthropometric and blood pressure measurements. A semi-structured questionnaire adapted from the Brazilian National Health Survey (PNS) was used and the interviews were conducted using handheld computers. 397 housing units were visited and 797 adults and 130 children were interviewed. The demographic profile of the Quilombolas was similar to the Brazilian population with respect to sex and age, however, they had precarious access to basic sanitation and a low socioeconomic status. The analysis of reliability revealed the adequacy of strategies adopted for quality assurance and control in the study. The methodology used was considered adequate to achieve the objectives and can be used in other populations. The results indicate the need for implementing strategies to improve the quality of life and reduce the degree of vulnerability of the Quilombolas.

Oportunidade perdida para diagnóstico oportunista de diabetes mellitus em comunidades quilombolas do sudoeste da Bahia, Brasil

The scope of this study was to estimate the prevalence and associated factors of missed opportunities for timely diagnosis of diabetes mellitus in Afrodescendant communities in Vitoria da Conquista in the state of Bahia. It involved a population-based cross-sectional study based on a probability sample (n=797), where 548 individuals were eligible for analysis considering the risk criteria: age of 45 years old and above, increased Body Mass Index and hypertension. The prevalence of diabetes mellitus was estimated at 42.6%. Logistic regression indicated the following statistically associated factors: self-assessed good/very good health conditions; not measuring blood pressure and not consulting with a physician in the past twelve months; and poor access to health services. The high prevalence was associated with factors related to low utilization and poor access to health services. Actions for the diagnosis and prevention of diabetes should prioritize populations at risk, including better education and training of family health care teams, and improvement of attendance at health care units. Enhanced integration between primary and secondary health care actions can positively impact early diagnosis, treatment and reduction of potential complications associated with diabetes in this population.

Prevalence of unnecessary laboratory tests and related avoidable costs in intensive care unit

Introduction:Because of the increase in diagnostic resources, laboratory tests have become an essential tool in diagnostic elucidation. Therefore, we observe an increase in the number of tests request.Objectives:To determine the prevalence of laboratory tests requests by the intensive care unit (ICU) of the General Hospital at southwest Bahia, and to anticipate the expenses with unnecessary laboratory tests, indicating avoidable costs, and aiming at rationalization of laboratory tests use.Methods:This is a cross-sectional retrospective study, in which a survey on medical records and laboratory tests results of patients admitted to the ICU was conducted, in the period from August to September 2013.Results:The sample consisted of 105 patients, 58.1% males, 47.6% aged between 18-59 years. During the period, 12.217 laboratory tests were ordered, of which 49.4% was within the normal limits. The more requested exams were: complete blood count, sodium, and potassium. A number of 1.750 laboratory tests could be evaluated according to criteria established in the literature, among them, 719 (41%) were considered unnecessary. A greater number of requests (29%) were observed on Mondays, compared with the average of the rest of the week.Conclusion:Significant number of unnecessary testing was found, with occurrence pattern on Monday and not dependent on age or length of stay. The data indicate the need to implement guidelines or protocols for ordering laboratory tests in the ICU, which have proven effective in helping the prescribing professional in their clinical practice, and contribute to optimize for health care spending.

Avaliação de náusea e êmese em pacientes sob quimioterapia em uma Unidade de Alta Complexidade Saúde de Vitória da Conquista/BA

Nausea and emesis assessment in patients undergoing chemotherapy at an oncological unit in Vitoria da Conquista/BA, Brazil

Revisão de lâminas hematológicas: avaliação da conformidade de critérios utilizados por analistas em um laboratório de um hospital público da Bahia, Brasil

Introduction: Recommendations in the literature and publications of scientific societies have proposed classification systems and levels to report blood cell changes in the complete blood count (CBC). Aiming to standardize the results released in the clinical laboratory, the standardization in hematoscopy is an important action within the quality assurance, contributing for diagnosis and appropriate followup of patients. Objective: To verify the adequacy of the classification criteria of the blood smear changes adopted by the laboratory professionals at the General Hospital of Vitória da Conquista, Bahia, Brazil. Material and method: In the 12-week period, 159 slides of CBC were selected from 53 patients from the four intensive care units (ICUs) at the hospital, three slides per patient. The readings of the slides were performed by the analysts on duty and by two other quality analysts-control who used the criteria standardized by Palmer (2015), all analyses were blind and independent. The results were compared using the Cohen’s kappa agreement tests between the analysts-control and between the quality control analysts and the analysts on duty. Results: For the analyzed parameters, there was moderate to excellent agreement among the quality analysts-control, and when they were compared to the analysts on duty, there was a slight to substantial agreement. Discussion: The lowest agreement occurred in the expression of poikilocytosis and lymphocytic atypia, which are not detected by the hemocytometer, and the analyst’s technical capacity is required. Conclusion: The study evidenced the need of standardization of the criteria for hematoscopy used by analysts to obtain reproducible results that reflect quality and reliability by the prescribing physician. Therefore, it is necessary to invest in training the professionals involved in revision of blood smear slides.

PREVALÊNCIA E FATORES ASSOCIADOS À ANEMIA EM CRIANÇAS DE CRECHES: UMA ANÁLISE HIERARQUIZADA

ABSTRACT Objective: To determine the prevalence and factors associated with anemia in children younger than five years old enrolled in public daycare centers in a city in southwestern Bahia, in the northeast of Brazil. Methods: This was a cross-sectional study that included a sample of 677 children enrolled in public daycare centers in Vitória da Conquista, Bahia, Brazil. A portable hemoglobinometer was used to measure hemoglobin. The concentration of <11 g/dL was considered the cutoff point for a diagnosis of anemia. A questionnaire was applied to parents/guardians in order to collect socioeconomic data, maternal characteristics and information on the child’s health and nutrition. Height and weight were measured to assess the child’s nutritional status. Poisson regression with robust variance and hierarchical selection of variables was used to identify factors associated with anemia. Results: The prevalence of anemia was 10.2% and was more frequent in children whose homes had no sanitary facilities (PR 3.36; 95%CI 1.40-8.03); in those who did not exclusively breastfeed (PR 1.80; 95%CI 1.12-2.91); in children aged less than 36 months (PR 1.85; 95%CI 1.19-2.89) and those who had low height for age (PR 2.06; 95%CI 1.10-3.85). Conclusions: The prevalence of anemia is considered to be a mild public health problem in the children, who are enrolled in daycare centers. Children with inadequate sanitary conditions, and that were not exclusively breastfed, as well as younger children and children with a nutritional deficit, were more likely to present the condition.OBJECTIVE To determine the prevalence and factors associated with anemia in children younger than five years old enrolled in public daycare centers in a city in southwestern Bahia, in the northeast of Brazil. METHODS This was a cross-sectional study that included a sample of 677 children enrolled in public daycare centers in Vitoria da Conquista, Bahia, Brazil. A portable hemoglobinometer was used to measure hemoglobin. The concentration of <11 g/dL was considered the cutoff point for a diagnosis of anemia. A questionnaire was applied to parents/guardians in order to collect socioeconomic data, maternal characteristics and information on the childs health and nutrition. Height and weight were measured to assess the childs nutritional status. Poisson regression with robust variance and hierarchical selection of variables was used to identify factors associated with anemia. RESULTS The prevalence of anemia was 10.2% and was more frequent in children whose homes had no sanitary facilities (PR 3.36; 95%CI 1.40-8.03); in those who did not exclusively breastfeed (PR 1.80; 95%CI 1.12-2.91); in children aged less than 36 months (PR 1.85; 95%CI 1.19-2.89) and those who had low height for age (PR 2.06; 95%CI 1.10-3.85). CONCLUSIONS The prevalence of anemia is considered to be a mild public health problem in the children, who are enrolled in daycare centers. Children with inadequate sanitary conditions, and that were not exclusively breastfed, as well as younger children and children with a nutritional deficit, were more likely to present the condition.

Excess weight and factors associated in preschool of southwest of Bahia

Objetivos: avaliar a prevalencia e os fatores associados ao excesso de peso em pre-esco-lares do sudoeste da Bahia. Metodos: estudo transversal envolvendo 664 pre-escolares matriculados em periodo inte-gral em creches publicas de Vitoria da Conquista (BA). O excesso de peso foi definido considerando o indice IMC/idade maior que + 2 escore Z. As variaveis independentes foram agrupadas em caracteristicas maternas, socioeconomica, relacionadas a crianca e a creche. Realizou-se regressao logistica multipla para verificar a associacao entre excesso de peso e as variaveis estudadas. Resultados: a prevalencia de excesso de peso foi de 5,7%, sendo 3,9% de sobrepeso e 1,8% de obesidade. Os fatores associados ao excesso de peso infantil foram o parto cesareo (Odds Ratio - OR: 2,59; Intervalo de Confianca - IC95%: 1,11; 6,01), ser filho unico (OR: 3,32; IC95%: 1,44; 7,67) e aleitamento materno exclusivo inferior a 4 meses (OR: 2,59; IC95%: 1,12; 5,99). Conclusoes: os resultados mostram que intervencoes para reducao e/ou prevencao do excesso de peso devem comecar no pre-natal com incentivo ao aleitamento materno exclu-sivo e ao parto vaginal, alem de orientacoes nutricionais para maes com apenas um filho.

Repetition of biochemistry tests in a laboratory of public hospital in southwest of Bahia, Brazil, and associated cost

Introduction: Test repetitions are an age-old practice common to clinical laboratories used primarily for confirmation of results. However, knowing the history of patients, the repetitions become avoidable. They impair the time to release results, increase input consumption, and cost of services. Objectives: to evaluate the difference between the results of the laboratory tests repetitions and the expenditure generated by each additional test. Materials and methods: Data from repeated tests from September to November 2015 were used in the laboratory of a public hospital in the state of Bahia, Brazil. The classification of necessary or unnecessary repetition of these tests was performed according to international criteria, with subsequent cost estimation. Results: A total of 1,350 samples were analyzed, with a total of 1,429 repetitions; 1,162 (81.31%) were classified as unnecessary repetitions, generating an additional cost of R

Pseudotrombocitopenia: incidência e estratégia para resolução em laboratório de análises clínicas

1,198.00 to the service. The repetitions that made up the study generated a cost of R

COMPARAÇÃO DE METÓDOS DE IDENTIFICAÇÃO DE Streptococcus pyogenes ISOLADOS EM OROFARINGE DE ESTUDANTES SAUDÁVEIS DA ÁREA DE SAÚDE

1,488.61, the expense should be only R