scholarly journals Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System

2017 ◽  
Vol 54 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Elinton Adami CHAIM ◽  
José Carlos PAREJA ◽  
Martinho Antonio GESTIC ◽  
Murillo Pimentel UTRINI ◽  
Everton CAZZO
Keyword(s):  
Public Health ◽  
Bariatric Surgery ◽  
Health System ◽  
Public Health System ◽  
Wound Dehiscence ◽  
Pulmonary Complications ◽  
Multidisciplinary Program ◽  
The Impact ◽  
Access To Surgery

ABSTRACT BACKGROUND Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.

A sustainable community based model of non-communicable disease risk factor surveillance: “SHRADDHA-JAGRITHI project” (Preprint)

2021 ◽  
Author(s):  
Jaideep Menon ◽  
Mathews Numpeli ◽  
Sajeev.P. Kunjan ◽  
Beena.V. Karimbuvayilil ◽  
Aswathy Sreedevi ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
Health Workers ◽  
Communicable Disease ◽  
Community Based ◽  
Frontline Health Workers ◽  
The Individual ◽  
Non Communicable Disease

UNSTRUCTURED Abstract: India has a massive non-communicable disease (NCD) burden at an enormous cost to the individual, family, society and health system at large, in spite of which prevention and surveillance is relatively neglected. Risk factors for atherosclerotic cardiovascular disease if diagnosed early and treated adequately would help decrease the mortality and morbidity burden. India is in a stage of rapid epidemiological transition with the state of Kerala being at the forefront, pointing us towards likely disease burden and outcomes for the rest of the country, in the future. A previous study done by the same investigators, in a population of >100,000, revealed poor awareness and treatment of NCDs and also poor adherence to medicines in individuals with CVD. The investigators are looking at a sustainable, community based model of surveillance for NCDs with corporate support wherein frontline health workers check all individuals in the target group ( > age 30 years) with further follow up and treatment planned in a “spoke and hub” model using the public health system of primary health centres (PHCs) as spokes to the hubs of Taluk or District hospitals. All data entry done by frontline health workers would be on a Tab PC ensuring rapid acquisition and transfer of participant health details to PHCs for further follow up and treatment. The model will be evaluated based on the utilisation rate of various services offered at all tier levels. The proportions of the target population screened, eligible individuals who reached the spoke or hub centres for risk stratification and care and community level control for hypertension and diabetes in annual surveys will be used as indicator variables. The model ensures diagnosis and follow up treatment at no cost to the individual entirely through the tiered public health system of the state and country.

scholarly journals Population estimates and characteristics of Australians potentially eligible for bariatric surgery: findings from the 2011–13 Australian Health Survey

2018 ◽  
Vol 42 (4) ◽  
pp. 429 ◽  
Author(s):  
Melanie J. Sharman ◽  
Monique C. Breslin ◽  
Alexandr Kuzminov ◽  
Andrew J. Palmer ◽  
Leigh Blizzard ◽  
...  
Keyword(s):  
Public Health ◽  
Bariatric Surgery ◽  
Health System ◽  
Public Health System ◽  
Population Estimates ◽  
Eligibility Criteria ◽  
The Public ◽  
Australian Health ◽  
Potential Demand ◽  
Patient Prioritisation

Objective The aim of the present study was to determine the potential demand for publicly and privately funded bariatric surgery in Australia. Methods Nationally representative data from the 2011–13 Australian Health Survey were used to estimate the numbers and characteristics of Australians meeting specific eligibility criteria as recommended in National Health and Medical Research Council guidelines for the management of overweight and obesity. Results Of the 3 352 037 adult Australians (aged 18–65 years) estimated to be obese in 2011–13, 882 441 (26.3%; 95% confidence interval (CI) 23.0–29.6) were potentially eligible for bariatric surgery (accounting for 6.2% (95% CI 5.4–7.1) of the adult population aged 18–65 years (n = 14 122 020)). Of these, 396 856 (45.0%; 95% CI 40.4–49.5) had Class 3 obesity (body mass index (BMI) ≥40 kg m–2), 470945 (53.4%; 95% CI 49.0–57.7) had Class 2 obesity (BMI 35–39.9 kg m–2) with obesity-related comorbidities or risk factors and 14 640 (1.7%; 95% CI 0.6–2.7) had Class 1 obesity (BMI 30–34.9 kg m–2) with poorly controlled type 2 diabetes and increased cardiovascular risk; 458 869 (52.0%; 95% CI 46.4–57.6) were female, 404 594 (45.8%; 95% CI 37.3–54.4) had no private health insurance and 309 983 (35.1%; 95% CI 28.8–41.4) resided outside a major city. Conclusion Even if only 5% of Australian adults estimated to be eligible for bariatric surgery sought this intervention, the demand, particularly in the public health system and outside major cities, would far outstrip current capacity. Better guidance on patient prioritisation and greater resourcing of public surgery are needed. What is known about this topic? In the period 2011–13, 4 million Australian adults were estimated to be obese, with obesity disproportionately more prevalent in areas of socioeconomic disadvantage. Bariatric surgery is considered to be cost-effective and the most effective treatment for adults with obesity, but is mainly privately funded in Australia (>90%), with 16 650 primary privately funded procedures performed in 2015. The extent to which the supply of bariatric surgery is falling short of demand in Australia is unknown. What does this paper add? The present study provides important information for health service planners. For the first time, population estimates and characteristics of those potentially eligible for bariatric surgery in Australia have been described based on the best available evidence, using categories that best approximate the national recommended eligibility criteria. What are the implications for practitioners? Even if only 5% of those estimated to be potentially eligible for bariatric surgery in Australia sought a surgical pathway (44 122 of 882 441), the potential demand, particularly in the public health system and outside major cities, would still far outstrip current capacity, underscoring the immediate need for better guidance on patient prioritisation. The findings of the present study provide a strong signal that more funding of public surgery and other effective interventions to assist this population group are necessary.

PP155 The Impact Of Lawsuits In The Brazilian Public Health System

2017 ◽  
Vol 33 (S1) ◽  
pp. 141-141
Author(s):  
Carla Biella ◽  
Viviane Pereira ◽  
Fabiana Raynal ◽  
Jorge Barreto ◽  
Vania Canuto ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health System ◽  
Public Health System ◽  
Scientific Evidence ◽  
Health Technology ◽  
Health Technologies ◽  
Access To Health ◽  
The Right ◽  
The Impact

INTRODUCTION:The increase of litigation in Brazil on the right to health, and the Brazilian Public Health System (SUS) targets of litigation, are phenomena that generate discussions both in the judiciary, and among researchers and managers of health. The lawsuits are based on the integrality that includes the right to any health technology. Our aim was to gather information on the use of scientific evidence by judges and other law professionals to support their decisions in lawsuits involving health care in Brazil.METHODS:A narrative review by literature search using key terms of legalization in specific databases was conducted.RESULTS:Twenty-five studies showed litigation matters relating to health care which were focused on legal claims about drugs. In general, law operators used the scientific evidences in a limited way when making decisions, by considering the medical report and medication label indications and disregarding therapeutic alternatives contemplated in the SUS list. The access to health technologies, by litigation, reveals that the gap between scientific knowledge and legal practice are similar to those found between science and decision-making in the formulation and implementation of health policies. The Health Technology Assessment studies have high potential for use by the judiciary as a reference source to support technical and scientific decisions in lawsuits on health care.CONCLUSIONS:For the judiciary to ensure not only access to health technologies, but also the efficacy and safety of technologies to system users, their decisions must be substantiated by scientific evidence. The National Committee for Health Technology Incorporation (CONITEC) in SUS has established actions in conjunction with law operators and society, such as a communication using e-mail, aiding the decision for the injunction and elaboration of technical reports and a policy brief, with the intention that the decisions are taken with the greatest possible knowledge about technologies provided by SUS, and based on scientific evidence.

scholarly journals Breast Feeding in Pandemic Situation. How Does Sri Lanka Face the Challenge?

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 214-214
Author(s):  
Neerodha Dharmasoma
Keyword(s):  
Public Health ◽  
Sri Lanka ◽  
Health System ◽  
Breast Feeding ◽  
Public Health System ◽  
Feeding Practices ◽  
Health Staff ◽  
Emergency Situations ◽  
Public Health Staff ◽  
The Impact

Abstract Objectives Sri Lanka has been awarded the first-ever ‘Green’ breastfeeding (BF) nation status by the World Breastfeeding Trends Initiative (WBTi) in January 2020 (1) with the support of public health system. But, deviating attention of health services towards emergency pandemic situation has resulted in strained health systems and interruptions in humanitarian response leading to eroding access to essential and often life-saving nutrition services. Therefore, optimal breast feeding practices are at risk due to infected mothers’ isolation practices, exhausted public health system and misbeliefs among the community (2). This finds out how Sri Lanka plans to maintain high standards of breast feeding in pandemic situation. Methods We searched for the publications on breast feeding, Sri Lanka in pandemic situation from January 2020 to date. Results As a low and middle income country with an unbeatable public health system, Sri Lanka has already issued an interim guideline for public health staff in continuation maternal and child care services (3). It ensures domiciliary visits by public health midwives (PHMs), although the clinic based teaching sessions on breast feeding have been cancelled. Community awareness has been created that no evidence of transmission of SARS COV-2 via breast milk is available and how the benefits of breast feeding outweigh the risk of infection (4). It is recommended that breast feeding shouldn't be interrupted at all and hand hygienic practices before touching the baby are ideal. Infected mothers can wear a protective mask and rooming in, and kangaroo mother care should be practiced. Sri Lanka already had guidelines on ensuring adequate and appropriate infant feeding guidelines in emergency situations (5). Conclusions Despite the challenges faced by community and public health staff, Sri Lanka make efforts to maintain the achieved breast feeding standards. Further studies are needed to assess the impact of the pandemic on breast feeding practices in near future. Funding Sources None

scholarly journals Path taken by morbidly obese people in search of bariatric surgery in the public health system

2020 ◽  
Vol 28 ◽  
Author(s):  
Claudete Aparecida Conz ◽  
Maria Cristina Pinto de Jesus ◽  
Estela Kortchmar ◽  
Vanessa Augusta Souza Braga ◽  
Renata Evangelista Tavares Machado ◽  
...  
Keyword(s):  
Public Health ◽  
Bariatric Surgery ◽  
Health System ◽  
Professional Training ◽  
Social Inequalities ◽  
Public Health System ◽  
Morbidly Obese ◽  
Obese People ◽  
The Public ◽  
The Social

Objective: to understand the path taken in the public health system by people with morbid obesity in the search for bariatric surgery. Method: qualitative research based on the social phenomenology of Alfred Schütz, with 17 hospitalized morbidly obese people, with a scheduled date for bariatric surgery. The phenomenological interview with open questions was used and the statements were analyzed in the light of the theoretical-methodological framework and literature related to the theme. Results: the participants were able to schedule bariatric surgery by referring friends, family and public people. The waiting list for the procedure generated anguish and anxiety due to fear of surgery, weight gain, risk of worsening health and physical limitations, but it helped prepare for its performance. The experience lived in the search for bariatric surgery led these people to want continuity of care in the Basic Health Unit, after the surgery, by professionals trained to meet their needs. Conclusion: the aspects inscribed in the path of people in search of bariatric surgery signal the need to strengthen the assistance-related flows of the public health system and to invest in professional training to reduce the social inequalities in access to bariatric surgery and increased quality of services.

scholarly journals BARIATRIC SURGERY IN BRAZILIAN PUBLIC HEALTH SYSTEM: THE GOOD, THE BAD AND THE UGLY, OR A LONG WAY TO GO. YELLOW SIGN!

2019 ◽  
Vol 32 (4) ◽  
Author(s):  
Antoninho José TONATTO-FILHO ◽  
Felipe Melloto GALLOTTI ◽  
Marcio Fernandes CHEDID ◽  
Tomaz de Jesus Maria GREZZANA-FILHO ◽  
Ana Maria Stapasolla Vargas GARCIA
Keyword(s):  
Public Health ◽  
Bariatric Surgery ◽  
Health System ◽  
Public Health System ◽  
Descriptive Analysis ◽  
Age Groups ◽  
Surgical Techniques ◽  
Current Status ◽  
The Public ◽  
Health Registry

ABSTRACT Background: In Brazil, there has been a significant increase in obesity rates in all age groups. Data from 2017 show that obesity affects 19% of the population. Due to the magnitude of the problem, public health policies have aimed to prevent complications related to obesity by increasing the offerfor bariatric surgeries. Aim: To analyze the current status of bariatric surgery performed in the Brazilian public health system, including data from macroregions and also the effect of digestive surgery training on the number of procedures. Methods: The database of the public health registry (DATASUS) was assessedbetween 2008 and 2018 for descriptive analysis of data and evaluation of the selected parameters. The main surgical techniques, comorbidities, mortality and the costs profile of the system were evaluated. Results: There was a 339% increase in the number of bariatric surgeries in the period evaluated. Gastric bypass was performed in 94% of cases whereas sleeve in 2.4%. Other techniques were used in 3.6%. There were discrepancies in the number of surgeries performed in different regions of the country. Conclusion: There was a considerable advance in the number of bariatric surgeries performed by the public health system between 2008 and 2018. However, there is a need to increase the offer of this service and alsospecialized training, as well as a correction in the distribution of these procedures in the national territory to achieve integrality among its users.

scholarly journals OPEN VS LAPAROSCOPIC HERNIA REPAIR IN THE BRAZILIAN PUBLIC HEALTH SYSTEM. AN 11-YEAR NATIONWIDE POPULATION-BASED STUDY

2020 ◽  
Vol 57 (4) ◽  
pp. 484-490
Author(s):  
Eduardo Morais EVERLING ◽  
Daniela Santos BANDEIRA ◽  
Felipe Melloto GALLOTTI ◽  
Priscila BOSSARDI ◽  
Antoninho José TONATTO-FILHO ◽  
...  
Keyword(s):  
Public Health ◽  
Minimally Invasive ◽  
Hernia Repair ◽  
Health System ◽  
Public Health System ◽  
Laparoscopic Hernia Repair ◽  
Dominant Group ◽  
The Public ◽  
Early Return ◽  
The Impact

ABSTRACT BACKGROUND: Abdominal wall hernia is one of the most common surgical pathologies. The advent of minimally invasive surgery raised questions about the best technique to be applied, considering the possibility of reducing postoperative pain, a lower rate of complications, and early return to usual activities. OBJECTIVE: To evaluate the frequency of open and laparoscopic hernioplasties in Brazil from 2008 to 2018, analyzing the rates of urgent and elective surgeries, mortality, costs, and the impact of laparoscopic surgical training on the public health system. METHODS: Nationwide data from 2008 to 2018 were obtained from the public health registry database (DATASUS) for a descriptive analysis of the selected data and parameters. RESULTS: 2,671,347 hernioplasties were performed in the period, an average of 242,850 surgeries per year (99.4% open, 0.6% laparoscopic). The economically active population (aged 20-59) constituted the dominant group (54.5%). There was a significant reduction (P<0.01) in open surgeries, without a compensatory increase in laparoscopic procedures. 22.3% of surgeries were urgent, with a significant increase in mortality when compared to elective surgeries (P<0.01). The distribution of laparoscopic surgery varied widely, directly associated with the number of digestive surgeons. CONCLUSION: This study presents nationwide data on hernia repair surgeries in Brazil for the first time. Minimally invasive techniques represent a minor portion of hernioplasties. Urgent surgeries represent a high percentage when compared to other countries, with increased mortality. The data reinforce the need for improvement in the offer of services, specialized training, and equalization in the distribution of procedures in all regions.

Equestrian-related injuries, predictors of fatalities, and the impact on the public health system in Sweden

Public Health ◽  
2019 ◽  
Vol 168 ◽  
pp. 67-75 ◽  
Author(s):  
L. Meredith ◽  
R. Thomson ◽  
R. Ekman ◽  
J. Kovaceva ◽  
H. Ekbrand ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
The Public ◽  
The Impact

Analysis of the Challenges and Problems in the Development of Public Health System in Beijing, China

2020 ◽  
Author(s):  
Ayan Mao ◽  
Cordia Chu ◽  
Yujie Yang ◽  
Yueli Meng ◽  
Wuqi Qiu
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
Municipal Government ◽  
Legal Framework ◽  
System Capacity ◽  
Health Staff ◽  
The Public ◽  
Information Strategies ◽  
The Impact

Abstract Background: To discern the main problems of Beijing’s public health service system, in order to provide suggestions to modernize the public health system and to enforce the implementation of the “Health Beijing 2030” plan. Methods: We carried out a quantitative study mostly based on interviews. There are over 40 directors and scholars who came from public health institutions and government sectors or organization that related to the public health work in Beijing were interviewed. The interview records were summary analyzed on key issues in accordance with the interview outline. Results: The challenges for the system include the change of structure of the population, the impact of the changing spectrum of diseases and changing environmental factors, and macro-institutional changes. The main problems include structure of the public health system, capacity of public health staff, systems for information management and legal framework for public health. On this basis, several relevant policy recommendations are put forward. Conclusion: To improve the public health system, the Beijing municipal government should design and construction of a system planning and perfecting their investment mechanism on public health. Stability of personnel and encouragement of innovation in scientific research and reliable health information strategies are also urgent needed.

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