Characterization of the variation of health care taking into account the costs of hospital admissions for acute myocardial infarction in Brazilian Unified Health System

[Factors associated with the cost of hospitalization for diseases sensitive to Primary Care in the Unified Health System]

The scope of this article is to identify the factors associated with the costs of hospital admissions for Conditions Sensitive to Primary Care (CSPC) in the Unified Health System (SUS). It involved a cross-sectional, analytical study with random samples of hospitalizations in the SUS over the period of two years. The distribution of costs and the duration of 414 hospitalizations were evaluated according to sex, age group and CSPC. The high cost had a prevalence of 37.8% and was associated with being over 40 years of age and unmarried, with an income below 1.5 minimum wages, hospitalization longer than 7 days and admission to the ICU. The average period of hospitalizations was 9.35 days, and the average cost was R$3,606.09. The hospitalization of youths had a cost/day of R$207.08, while for the elderly the cost/day was R$399.53. Men had a higher prevalence of hospitalizations and were responsible for the elevated average cost of hospitalization. Cardiac, pulmonary, and cerebrovascular diseases were prevalent, and cardiac diseases were responsible for the highest cost of hospitalization. These results point to the urgent need to bolster Primary Health Care, with constant monitoring of these diseases, thereby ensuring that available resources are sufficient to treat them, without the need for hospitalization and unnecessary expenses.

Fatores associados à fragilidade em idosos acompanhados na Atenção Primária à Saúde

Resumo Objetivo Verificar a associação entre os marcadores de fragilidade e as características sociodemográficas e clínicas em idosos na Atenção Primária à Saúde. Método Pesquisa transversal, realizada com 356 idosos cadastrados em unidades de saúde da família, no Nordeste do Brasil. Os instrumentos de coleta utilizados foram o Índice de Vulnerabilidade Clínico-Funcional e outro de perfil socioeconômico e de saúde. Analisaram-se os dados pela estatística inferencial, utilizando o teste do Qui-quadrado, com nível de significância 0,05. Resultados A média de idade foi de 72,85 anos (±8,965); 63,8% eram do sexo feminino, 39% apresentaram risco de fragilização e 22,5% demonstraram fragilidade. Houve associação entre fragilidade, sexo, faixa etária, estado civil, escolaridade, renda, presença de doença cardíaca e hipertensão. Conclusões e implicações para a prática Os marcadores de fragilidade nos idosos evidenciaram associação entre as características sociodemográficas e clínicas, indicando a necessidade de rastreio precoce no nível primário de atenção à saúde.

Quality of Intra-Hospital Nutritional Counseling in Patients with STEMI in the Public and Private Health Networks of Sergipe: The VICTIM Register

BACKGROUND

Having appropriate dietary habits is part of the recommendations after ST-Elevation Myocardial Infarction (STEMI), however, the quality of intra-hospital nutritional counselling in the different health services has been minimally explored.

OBJECTIVE

To evaluate the quality of intra-hospital nutritional counselling among patients with STEMI in the public and private health systems in Sergipe.

METHODS

A cross-sectional, with data from the Via Crucis for the Treatment of Myocardial Infarction (VICTIM) Register, conducted from April to November of 2017, with individuals aged ≥ 18 years diagnosed with STEMI, in one public health service hospital and three private hospitals. The occurrence and quality of nutritional counselling were analyzed based on current guidelines and the administration of questionnaires. A significance level of 0.05 was adopted.

RESULTS

A total of 188 patients were analyzed; 80.3% were from the public health service facility. Among the interviewees, 57.6% of the public health service, and 70.3% of the private hospital patients received intra-hospital nutritional counselling (p = 0.191). The documentation of this practice, in medical records, was lower in the public service (2.6% vs. 37.8%, p < 0.001). A predominance of restrictive orientations was found in the public and private sectors, mainly regarding salt and fat, 52.3% and 70.3% respectively (p = 0.064). Patients from the private service were more counselling to introduce of cardioprotective foods, mainly fruit, vegetable/legume consumption (48.6% vs. 13.2%, p < 0.001). Among those who received counselling, nutritional knowledge was higher in the private sector (68.2% vs. 26.3%, p < 0.001).

CONCLUSION

The intra-hospital nutritional counselling provided to patients with STEMI, in Sergipe, still presents poor quality in both services, especially in the public health system.

HDL Particle Size and Functionality Comparison between Patients with and without Confirmed Acute Myocardial Infarction

Introduction

Cardiovascular diseases (CVDs) continue to be the most common cause of death worldwide, and acute myocardial infarction (AMI) is noteworthy due to its great magnitude.

Objectives

This study was carried out to evaluate the structure (molecular and particle size) and functionality of high-density lipoprotein (HDL) shortly after AMI, in the presence of acute inflammatory response.

Casuistic and Methods

A cross-sectional, observational study was conducted between January 2015 and August 2016, with a total convenient sample of 85 patients. The patients' data were segregated according to the Registry of Acute Myocardial Infarction (REAMI), with 45 confirmed AMI patients. The study groups consisted of patients from both sexes, older than 35 years, presented to the Hospital São Rafael (HSR) initially with AMI clinical symptoms. In addition, 40 nonischemic control patients (CPs), without AMI symptomatology, and according to previous inclusion criteria, were selected for convenience in an outpatient care unit. The HDL particle size was measured by laser light scattering (LLS), after separation of HDL from apoB-rich lipoproteins. The paraoxonase-1 (PON-1) activity was determined in a spectrophotometer by using paraoxon as a substrate. The other laboratory marker information, secondary data, was obtained in the laboratory system.

Results

The HDL particle size, free cholesterol, and hs-CRP analysis showed significant differences when compared between REAMI and CP groups (p < 0.0001, p=0.007, and p < 0.0001; two-tailed unpaired t-test, respectively). Regarding paraoxonase, the data comparison between REAMI and CP groups was also significantly different (p < 0.0067; two-tailed unpaired t-test).

Conclusion

Despite an important current database on the HDL cholesterol role, our study provides relevant complementary information about the HDL particle susceptibility to the inflammation following AMI. The HDL particles' quantitative and functional attributes should be measured as markers of HDL functionality.

Diagnósticos de enfermagem segundo a teoria do autocuidado em pacientes com infarto do miocárdio

Objetivo: identificar los diagnósticos de enfermería en personas con infarto de miocardio en emergencia hospitalaria, según la teoría del autocuidado de Orem. Materiales y método: estudio transversal, realizado de febrero a agosto del 2016, con 50 pacientes infartados y que estaban en condiciones de participar en la investigación. La recolección de datos ocurrió a través de entrevista, utilizando cuestionario según la teoría del autocuidado, y se formularon diagnósticos de enfermería con base en la Taxonomía de la NANDA-I. Resultados: la mayoría de los pacientes eran mujeres (54 %), con edades de 60 a 69 años (34 %), ingreso familiar de uno a dos salarios mínimos (88 %), con enseñanza básica (70 %) y jubilados (76 %). Hubo alta frecuencia de hipertensión arterial (62 %), inactividad física (76 %) y tabaquismo (70 %). La prueba rápida para troponina fue positiva en 16 personas (32 %). Muchos infartados presentaban déficits de autocuidado que apuntaron 10 diagnósticos de enfermería, destacándose estilo de vida sedentario (80 %), movilidad física perjudicada (76 %) y riesgo de intolerancia a la actividad (76 %). Los comportamientos de salud propensos al riesgo y la autonegligencia tuvieron relación con tres requisitos de autocuidado. Conclusión: los pacientes necesitaban de asistencia en salud para cambios en el estilo de vida, medidas de confort y realización de actividad y reposo.