Maria Sumie Koizumi

Gastos governamentais do SUS com internações hospitalares por causas externas: análise no Estado de São Paulo, 2000

INTRODUCAO: No Brasil, vem ocorrendo importante crescimento das causas externas, afetando a morbimortalidade da sua populacao. Essas causas impoem onus economicos e sociais elevados, incluindo gastos hospitalares. OBJETIVO: conhecer as internacoes por lesoes e envenenamentos em hospitais proprios ou conveniados com o SUS no Estado de Sao Paulo, buscando determinar o custo dessas hospitalizacoes para o poder publico, segundo algumas variaveis consideradas importantes. MATERIAL: internacoes hospitalares em hospitais proprios ou conveniados com o SUS, no ano 2000, obtidas no Banco de Dados do Datasus para o Brasil e o Estado de Sao Paulo. RESULTADOS E CONCLUSOES: comparando causas naturais (excluidas gravidez, parto e puerperio) e causas externas, as ultimas representaram menos de 10% do total de internacoes, tiveram permanencia menor e gastaram cerca de 10% do valor total pago para todas as internacoes. Embora a permanencia seja menor, os gastos do SUS medidos pelo custo-dia e gasto medio, foram superiores aos das internacoes por causas naturais. As causas mais frequentes de internacao foram quedas e acidentes de transporte e apresentaram custo-dia e gasto medio superior as medias obtidas. Segundo o desfecho, os que vieram a falecer durante a internacao tiveram gastos triplicados se comparados aos que receberam alta hospitalar.

[Morbidity and mortality from external causes in Brazil, 2000].

Since the early 1980s, external causes have been the second greatest cause of death in Brazil. They also place a growing demand on health care services. The current study analyzes morbidity and mortality from external causes in Brazil. The study material consists of 118,367 deaths and 652,249 hospitalizations due to external causes during the year 2000. The data are from the National Mortality Information System and Hospital Information System. The mortality coefficient from external causes was 69.7/ 100 thousand (119.0/100 thousand for males and 21.8/100 thousand for women). Homicides were the leading cause of death (38.3% of the total), with a high coefficient of 26.7/100 thousand, while falls were the leading cause of hospitalizations (42.8% of the total). Motor vehicle accidents were a major cause of both morbidity and mortality. Fractures, mostly occurring in the upper and lower limbs, accounted for 42.6% of hospitalizations. Based on the findings, preventive programs should aim to decrease both mortality and morbidity, with special emphasis on homicides, traffic accidents, and falls.

Injury among the elderly: the challenge to integrate preventive activities in public and individual levels

BACKGROUND In Brazil and all over the world the elderly are increasing as a result of the raise in life expectancy. This group still faces a significant risk for some diseases as well as injuries. The proposal of this study was to describe fatal and nonfatal injuries among people aged 60 years and older in Brazil. SETTING Brazil, the last year available was 2000. METHODS The data from 13,383 injury deaths and 87,177 outcomes among people aged 60 years and older were analyzed. The data sets were obtained from Federal Health Department of Brazil from Mortality System Information (from death certificates) and Hospitalization Information System (from discharges registered in public hospitals). RESULTS The mortality rate is 92.1/100,000 (135.3/100,000 for male and 56.8/100,000 for female) that are higher than overall population rates, especially for women. The lead cause is transport accidents (27.5% of total injury deaths) which mortality rate is 25.3/100,000 and 48.2% are pedestrian. Homicides rate is 9.5/100,000, it is almost three times lower than for total population in Brazil. Falls rate is 14.0/100,000, it is the third place in injury deaths for men and women and suicide rate is 6.9/100,000, lower than developed countries. Opposite to mortality, falls are the major cause of nonfatal injuries hospitalization for both men and women, accounting for 48,940 discharges (56.1%). Fractures are 52.8% of all injuries, especially in falls and transport accidents. CONCLUSIONS It is crucial to develop injury preventive activities in both public and individual level. Falls should receive emphasis in injury prevention efforts.

Injury patterns in motorcycle accident victims

An analysis of the injury patterns presented by inpatients of a government teaching hospital, known as one of the emergency centers of S. Paulo city, Brazil, is given the majority of victims are young, male adults and most of them were later discharged from the hospital. In relation to the injuries the majority of the patients were classified as being of minor injury grade (ISS between 1 and 9) and the most frequent injuries were extremity and pelvic fractures, surface trauma, traumatic brain injury and extremity and pelvic dislocations. Besides extremity and pelvic fractures, the victims who died showed abdominal organ injury and traumatic brain injury and the ISS was over 20. Head injury patients who had a high Glasgow Coma Scale score had a low ISS and vice-versa.

Morbimortalidade por traumatismo crânio-encefálico no município de São Paulo, 1997

There are few epidemiological studies on traumatic brain injury (TBI), and those that allow broad comparative analyses of this problem are even more scarce, due to methodological obstacles. Usually, the studies address head injury (they include the cranial envelopments and content) but are reported as TBI, given the difficulty of mutual exclusion. It is also common for them to be centered at specific severity levels, only for hospitalized victims or according to the external cause, such as traffic accidents. With full respect to these limits, this study had as its objective the estimation of the TBI incidence in patients resident and in-hospital, in the hospital network in the city of São Paulo, Brazil, in 1997, as well as the estimation of TBI-caused mortality amongst external causes, at this same time and locale. Data for the study consisted of Ministério da Saúde data on hospital discharges, analyzed based on Autorizações de Internação Hospitalar (AIH) and obituary data on external causes, contained in the Programa de Aprimoramento das Informações de Mortalidade (PROAIM) data base. It was found that 29 717 patients were hospitalized due to lesions and poisoning; of these 3 635 (12%) had TBI; the hospitalization rate was 0.36/1000 pop.; and hospital mortality was 10%. The mortality coefficient due to external causes was 87.3/100 000 pop. Minimum TBI mortality rate is estimated at a minimum of 26.2 and a maximum of 39.3/100000 pop.

Traumatismo crânio-encefálico: diferenças das vítimas pedestres e ocupantes de veículos a motor

OBJECTIVE The purpose of this study was to discover the differences among victims who had traumatic brain injury due to traffic accidents. METHODS Medical record of the head injury patients were analyzed according to their classification as traffic accident victims (pedestrian, motorcyclist or passenger and other motor vehicle deriver or passenger), age, gender, admission type (admitted from scene of the injury or from another hospital), duration of hospitalization, type of head injury, types of lesions present in other body segments and mortality. Patients injury severity was measured by Injury Severity Score and head injury severity was analyzed using the ranking on the Glasgow Coma Scale, recorded by neurosurgeons during their first neuro assessment. All head injured patients admitted to a trauma center in S. Paulo city over a four-month period from March through June 1993, were included in the study. The sample was of 156 victims, with subsets of 80 pedestrians, 26 occupants of motorcycles and 50 occupants of other motor vehicles. RESULTS AND CONCLUSION The results of this study showed that the mortality rate was higher in the pedestrian subset (25.0%) than among other victims and higher for motorcycle occupants (19.2%) than for motor vehicle victims (8.0%). Statistical differences between the subsets were established when the head injury severity variable was analyzed using the Glasgow Coma Scale. On the other hand, the differences between the three subsets was not statistically significant when the measurement used was the Injury Severity Score. Analyses of other variables showed important differences among subset distributions.

Dor crônica e depressão: estudo em 92 doentes

Was examined the influence of depression in the occurrence and pain intensity. Patients presenting advanced cancer (n = 92) were evaluated. The patients were divided in 2 groups, with or without pain during the week preceding the interview. Pain and depression were evaluated. Pain was observed in 62.0% of the cases and lasted 10 months as an average. It was moderate in the majority of patients and severe in 1/5 of them. Depression was related with the presence and intensity of pain. Patients with pain presented higher depression scores than patients without pain (p < 0.05). Higher pain scores were also correlated with higher depressive scores (p < 0.05).O estudo objetivou analisar a existencia de relacoes entre dor e depressao em noventa e dois doentes com doenca oncologica avancada. Os doentes foram divididos em 2 grupos, com ou sem dor na semana anterior a entrevista. Havia dor em 62,0% dos avaliados, a duracao media do quadro algico foi 10 meses e a maioria referiu dor moderada. Os individuos do grupo com dor apresentaram escores de depressao significativamente mais altos que os do grupo sem dor (p<0,05). Doentes com mais altos escores de depressao experienciaram dor de maior intensidade (p<00,5). Sintomas depressivos associaram-se e agravaram a experiencia dolorosa.

Acidentes de motocicleta no município de São Paulo, SP (Brasil): 1. caracterização do acidente e da vítima

Estudo descritivo, feito por meio de dados oficiais, dos acidentes de motocicleta com vitimas (3.390), incluindo atropelamentos, ocorridos no municipio de Sao Paulo, SP (Brasil), em 1982, e que tiveram como consequencia 4.480 vitimas. Destas, 166 faleceram dentro do periodo de ate 180 dias apos o evento. Esses acidentes foram mais frequentes e mais graves do que aqueles relativos aos demais veiculos a motor. Suas vitimas se caracterizaram como predominantemente do sexo masculino, das faixas etarias de 15 a 24 anos, e cerca de dois tercos da populacao estudada foi de motociclistas. Em relacao ao momento do acidente, constatou-se um pico nos fins de semana e uma distribuicao nao havendo diferencas significantes em relacao aos meses e periodos do dia.This is a descriptive study of official data on those motorcycle accidents with casualties riders and/or pedestrians (3,390) which occurred during 1,982 in S. Paulo city, Brazil. There were 4,480 casualties and 166 of these died within 180 days of the event. These accidents were more frequent and serious than those involving any other kind of motor vehicle. The casualties were, in their majority, males aged between 15 and 24, and two-thirds of this population were motorcyclists. The results of a study of the accidents themselves demonstrated that the peak occurred at weekends and there was no significant variations with regard to months or times of day.

Educação continuada da equipe de enfermagem nas UTIs do município de São Paulo

Este estudo e parte de um projeto maior sobre os recursos estruturais das UTIs no Municipio de Sao Paulo, incluindo a analise de sua estrutura fisica, recursos humanos, materiais e equipamentos. Os aspectos relativos as atividades de educacao continuada da equipe de enfermagem sao analisados neste artigo. A amostra estudada foi de 43 UTIs e um questionario respondido pela enfermeira responsavel pela Unidade, o instrumento usado para a coleta de dados. Do total de Unidades estudadas, 34 (79,1%) responderam ter treinamento inicial especifico e 18 (41,9%), programas de atualizacao, os quais enfocam principalmente, revisao de tecnicas e rotinas e atualizacao de patologias. As atividades de educacao continuada sao desenvolvidas predominantemente por enfermeiros das UTIs. Em relacao aos enfermeiros, alem das atividades de educacao continuada desenvolvidas pelo proprio hospital, 50,2% assinalaram ter feito cursos de especializacao ou aprimoramento em enfermagem medico-cirurgica ou em outras areas ou tanto em enfermagem medico-cirurgica como em outras areas. Face ao detectado e considerando o desenvolvimento do enfermeiro de UTI como o de um especialista, algumas sugestoes para o aprimoramento das atividades de educacao continuada nessas Unidades sao apresentadas.This study is part of a project about ICUs characteristics in São Paulo city. This article describes the continuing education programs for nursing staff. 43 ICUs were analysed and the questionnaire answered by the ICU nurse coordinator was used to collect data. Results showed that 34 (79.1%) of the ICUs have initial program for training each nursing staff category and 18 (41.9%) had regular continuing education program focusing primarily on nursing procedures and routines and the update in pathologies. Continuing education programs are developed primarily by ICUs nurses. 50.2% of the nurses answered that they attended specialisation/extension courses too, in Medical Surgical Nursing or in other areas or in both areas. Due to this result and the development of the ICUs nurses as specialists, some suggestions are presented to improve the continuing education program in these Units.

Escala de Coma de Glasgow: subestimação em pacientes com respostas verbais impedidas

Cuestionamiento frecuente en el uso de la Escala de Coma de Glasgow (ECG), en la fase aguda, en pacientes internados debido al trauma craneoencefalico es la subestimacion decorrient de situaciones impeditivas como intubacion endotraqueal/traqueostomia, sedacion y edema palpebral. El objetivo de ese estudio fue identificar y determinar la subestimacion en la puntuacion total de la ECG cuando es utilizada la puntuacion 1 en las situaciones de impedimiento para su avaliacion. La muestra estudiada fue de 76 pacientes internados por TEC en el Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. En 42 (55.3%) pacientes, no habia impedimientos y fueron realizadas 136 avaliaciones. Em 34 (44,7%), habia impedimientos caracterizados por intubacion o traqueostomia, estando o no asociados con edema palpebral y sedacion y el total de avaliaciones fue de 310. En eses, la puntuacion total vario de 3 para 11 con los escores mas frecuentes en 3 y 6. Por los valores estimados por la regresion linear a partir de las puntuaciones obtenidas en AO y MRM, fueron obtenidas las seguintes subestimaciones: media=1.03±1.36, mediana=0.54 (intubation o traqueostomia), media=0,40±0.79, mediana=0,00 (intubation o traqueostomia + sedation), media=0.57± 0.96, mediana=0.27 (intubation o traqueostomia + sedation + edema palpebral). Fue concluido que, en el TEC grave, la puntuacion total de la ECG1 mantenendo la MRV en 1, mismo subestimada, se encuentra projima de la real.Frequent question in the use of Glasgow Coma Scale (GCS), on the acute phase, on inpatients due to encephalic cranial trauma (TBI) is the subestima because of the impeditive situations such as tracheostomy/endotracheal intubation, sedation and palpebral edema. The aim of this study was identify and determining the subestima on the total score of GCS when the score 1 is used on the impediment situations for your assessment. The sample studied had 76 inpatients for TBI at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. Within 42 (55,3%) inpatients, there are not impediments and were carried out 136 assessments. In 34 (44,7%), there are impediments characterized by intubation or tracheostomy, being or not related to palpebral edema and sedation and the total evaluation was 310. Within them, the total score varied of 3 to 11 with the more frequent scores in 3 and 6. Through estimated values by linear regression since the scores obtained in EO and VRM, the following subestimas were obtained: mean=1.03±1.36, median=0.54 (intubation or tracheostomy), mean=0,40±0.79, median=0,00 (intubation or tracheostomy + sedation), mean=0.57±0.96, median=0.27 (intubation or tracheostomy + sedation + palpebral edema). It was concluded that, in the serious ECT, the total score of GCS maintained a VRM in 1, although underestimated, it is near the real one.