Health care logistics: mapping and optimization of patients logistics

Healthcare logistics play an important role in management, being attributed the activities of acquisition, distribution and movement of materials, professionals and patients. This work aims to develop a study, using the healthcare logistics in the movement of patients in the third health region of Paraná, proposing a linear programming problem that will pass through a computational simulation, considering the existing demands and constraints in the system, aiming to optimize the flow of patients from this region. The present study developed four mathematical models, based on demands and constraints followed by linear programming in order to find the best possible solution for the flow of patients from the third health region of the state of Paraná. The study developed reached its goal of optimization, generating an economy in the transportation of patients. Through the analysis of the results, it is concluded that the model that best suits the presented problem is the one of costs minimization, since the one of vehicles presented higher costs. Possibly the model that minimizes the vehicles would bring better results if the vehicles were not outsourced, but of the Ponta Grossa City Hall (PMPG). Was possible to verify the importance of the theme, especially when referring to the flow of patients in the health services due to the lack of studies with this specific approach. Even with the scarcity of data, it is possible to notice the potential for improvements on this patient transport system.

224. Evaluating the Epidemiology of Bloodstream Infections: A Population-Based Study

Background Bloodstream infections (BSI) are a major cause of morbidity, mortality, and health care costs worldwide. Population-based studies are key to assess BSI epidemiology over time while minimizing selection bias but remain limited. Therefore, we aimed to assess the incidence of BSI in a large Canadian health region in a contemporary period. We hypothesized that there would be significant age and sex-based differences including over time. Methods We conducted a retrospective cohort study from 2011 through 2018 using a population-based microbiology database to determine the annual age- and sex-specific BSI testing and case rates with the census as the population reference. BSI was defined as a positive blood culture for a pathogen. Episodes > 30 days apart were included for analysis. Incidence rate ratios (IRR) for testing and case rates including by sex were calculated to assess changes over time. All analyses were run at a two-sided α of 0.05 and were conducted with R 4.0.4. Results A total of 154,147 distinct individuals (49.9% male) were analyzed and 22,869 (14.8%) had a BSI at the first encounter in the study period. Overall BSI testing incidence ranged from 1529 to 1707 per 100,000 person-years and case incidence ranged from 180 to 292 per 100,000 person-years. Testing and case incidence for BSI was greatest in the 0-4 and 75+ years age groups (p < 0.01). Males compared to females had greater testing and case incidence rates in young and old age groups, but females had greater rates in the 15-44 years groups (p < 0.01). Overall IRR for cases comparing 2018 to 2011 was 0.62 (95% CI 0.59-0.65) reflecting a significant decrease over time. Testing also decreased over the study period with an IRR of 0.90 (95% CI 0.88-0.91). Testing and case IRRs were not significantly different stratified by sex. Incidence rates (per 100,000 person-years) of BSI testing and cases by sex from 2011 through 2018 in a Canadian health region Conclusion In our large population-based study of BSI, we identified that BSI remain frequent and the youngest and oldest age groups as well as males in these age groups have the greatest BSI incidence rates which may reflect both biological sex and gender-based differences. Encouragingly, BSI incidence rates have decreased over time at a greater increment relative to testing rates. Future studies of BSI should focus on pathogen and outcome-based evaluations. Disclosures All Authors: No reported disclosures

Smart Devices and Family Roles: A Study of Smart Device Use Among Children Aged 2-5 in Thailand’s Health Region 3

This research investigated smart device use among young Thai children. The study likewise explored the relationship between smart device screen time, family roles in smart device use, and effects of smart device use. In 2020, primary data were collected through questionnaires from 1,100 primary parents of 2-5-year-old children in five provinces in Health Region 3. A Mann-Whitney U Test and Median Test were used in data analyses of the associations. The results revealed that 2-5-year-old children had an average screen time per day of 1 hour and 33 minutes, with 54.3% spending more than 1 hour on smart devices daily. In addition, 21.5% reported owning a smartphone, of which 55.2% accessed YouTube to watch cartoons and movies. In terms of screen time, 21.7% of the children reported unrestricted use. In terms of effects from smart device use, children being easily irritated and moody was noted by most parents (61.5%). In addition, variables under family roles and effects of smart device use showed a statistically significant correlation with smart device screen time. However, median screen time varied by each variable under family roles and effects of smart device use. The findings are essential for future policy planning, which will enable families with young children to become aware of appropriate smartphone or tablet usage by their children.

Epidemiological characterization of congenital syphilis in a health region of the northern zone in the state of Ceará, Brazil

The study sought to investigate the epidemiological profile of congenital syphilis in a health region in the State of Ceará, in the period from 2015 to 2019. This is a descriptive epidemiological study, with a quantitative approach, with secondary data collected through the Health System. Information on Notifiable Diseases and Live Birth Information System. There were a total of 248 cases: 65 cases in 2015, 50 in 2016, 45 in 2017, 51 in 2018 and 37 in 2019. The incidence of congenital syphilis was: 8.1 (2015), 6.1 (2016), 5.1 (2017), 5.3 (2018) and 3.9 (2019). In 62.9% of cases from all the years, women were between 20 and 34 years old and in 45.5% of cases they had less than eight years of educational instruction. 57.2% never had a miscarriage, 63.3% had vaginal deliveries and 59.2% had full-term deliveries. Most women received prenatal care (95.9%). In 49.5% of cases, the diagnosis of maternal syphilis occurred during prenatal care. Only 67 (27%) of the pregnant women were treated properly and only 52 (29%) had their partners treated. The study shows a flaw in prenatal care with low effectiveness of the prevention actions, determining factors in the control of congenital syphilis.

Síndrome Metabólica em Portugal: Prevalência e Fatores Associados

Introduction: The metabolic syndrome consists of a set of factors that, when associated, are associated with a higher risk of developing cardiovascular diseases and type 2 diabetes, and is thus an important public health problem. The objective of this study was to estimate the prevalence of this syndrome in the Portuguese population, and to evaluate possible associations with demographic and socioeconomic determinants.Material and Methods: Based on the 1st National Health Survey with Physical Examination of 2015, a cross-sectional epidemiological study was conducted on a representative sample of the Portuguese population (n = 4797) aged between 25 and 74 years old. The prevalence was estimated for the total population and each gender, stratified by age group, health region, type of urban area, marital status, education, professional status, and risk of poverty. The magnitude of the associations was measured with adjusted prevalence ratios.Results: In the Portuguese population the estimated prevalence was 33.4% [95% CI, 31.7 – 35.1] [35.6% in men (95% CI, 31.9 – 39.2) and 31.3% in women (95% CI, 28.5 – 34.2)]. In both genders, the highest prevalence was significantly associated with increasing age, widowed/married/de facto partners and those with lower levels of education. There was no association with gender, health region, type of urban area, professional status or risk of poverty.Discussion: This syndrome was present in a third of the Portuguese population. The knowledge of its epidemiology enables the identification of population groups with higher cardiovascular and metabolic risk.Conclusion: Metabolic syndrome was independently associated with specific groups. This knowledge reinforces the importance of a holistic assessment of the health determinants associated with the metabolic syndrome.

Geographical variation in demand, utilization, and outcomes of hospital services for COVID-19 in Brazil: A descriptive serial cross-sectional study

Objective To analyze the geographical variation in the provision of health services, namely in demand, patterns of utilization, and effectiveness in the Brazilian Health Regions in four different periods of the COVID-19 pandemic, from February 2020 to March 2021. Methods Descriptive serial cross-sectional study based on secondary data on COVID-19 hospitalizations from SIVEP-Gripe, a public and open-access database of Severe Acute Respiratory Illness records collected by the Brazilian Ministry of Health, and COVID-19 case notification data from Brasil.io, a repository of public data. Fifty-six epidemiological weeks were split into four periods. The following variables were considered for each Brazilian Health Region, per period: number of hospitalizations, hospitalizations per 100,000 inhabitants, hospitalizations per 100 new cases notified in the Health Region, percentage of hospitalizations with ICU use, percentages of hospitalizations with invasive and non-invasive ventilatory support, percentage of hospitalizations resulting in death and percentage of hospitalizations with ICU use resulting in death. Descriptive statistics of the variables were obtained across all 450 Health Regions in Brazil over the four defined pandemic periods. Maps were generated to capture the spatiotemporal variation and trends during the first year of the COVID-19 pandemic in Brazil. Results There was great variation in how COVID-19 hospitalizations grew and spread among Health Regions, with higher numbers between June and August 2020, and, especially, from mid-December 2020 to March 2021. The variation pattern in the proportion of ICU use in the hospitalizations across the Health Regions was broad, with no intensive care provision in large areas in the North, Northeast, and Midwest. The proportions of hospitalizations and hospitalizations with ICU use resulting in deaths were remarkably high, reaching medians of 34.0% and 62.0% across Health Regions, respectively. Conclusion The Heath Regions in Brazil are highly diverse, showing broad disparities in the capacity to respond to the demands imposed by COVID-19, services provided, use and outcomes.

Adherence to Treatment for Hypothyroidism in Pregnancy and Relationship With Thyrotropin Control: a Retrospective Observational Cohort Study

Background: Hypothyroidism is the second most common endocrinological disease during pregnancy, with percentages that can range between 3.2 and 5.5%. A good maternal and foetal health outcome depends on thyroid hormone replacement therapy. The goal of such therapy is to maintain thyrotropin (TSH) in a range that is specific for pregnant women and varies between the trimesters of pregnancy. In our study, we wanted to analyse the adherence to hypothyroidism treatment among pregnant women and to evaluate the degree of control of the disease.Methods: We performed a retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Therapeutic adherence was analysed by the proportion of days covered (PDC). The relationship with other variables was assessed using the regression coefficients and their 95% confidence interval (CI).Results: We examined a sample of 17281 women, representing more than 92% of the pregnant women in the Lleida health region in the period analysed. Among this sample, the mean prevalence of hypothyroidism was 6.52% (0.07% clinical and 6.45% subclinical). 3.3% of the 17281 pregnant women were treated. Among them, the mean adherence score was 79.6 ± 22.2. Of these, 54% presented high adherence. The latter had a higher mean age and better TSH control, in comparison to the ones showing low adherence. Conclusions: Half of the treated patients had good adherence to treatment and a better TSH control, in comparison to the others. Most of them achieved a good control at the third trimester of pregnancy.

Regional inter-managers commission: local space for agreement and inter-federative articulation?

The Regional Intermanagers Commission (CIR) configures the space for agreement, articulation, cooperation and strengthening of the health region. The aim of this study was to reflect on the normative provisions that underlie the construction of the commission as a place of consolidation of regional management attenuating interfederative conflicts. Having as a guide question: how do the Regional Inter-Management Commissions provide local spaces of agreement and interfederative articulation? Qualitative study, based on documentary research, based on the analysis of the resolutions of the Regional Inter-Management Commissions of Alagoas, corresponding to the period from 2017 to 2019, using Decree 7.508/11 as a reference standard. The results were organized into four categories: Regional Health Planning; organization of health care actions and services: health region; Federalism, CIR and the financing of health services; governance and CIR: channel of negotiation and decision between municipal managers and the State within the Health Region. The Regional Inter-Management Commissions develop significant work in the discussions of regional policies, being a fundamental tool for strengthening governance in the territories, by negotiating the allocation and distribution of resources, essential for planning, interfederative pacts, and health financing, playing a key role for the regional health system of Alagoas, democratic, political and cooperative space.