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Objetivo: Analisar os resultados de indicadores de desempenho hospitalar de uma unidade de urgência/emergência, que implantou o projeto "Lean nas Emergências". Métodos: Estudo descritivo, retrospectivo, do tipo transversal de abordagem quantitativa, em duas fases (antes e depois), cuja população foi composta por documentos de 7.590 internações nas clínicas médica, cirúrgica e ortopédica, atendidos no pronto-socorro. Os dados foram submetidos ao teste de normalidade e posteriormente, ao teste não paramétrico de Wilcoxon, considerando-se o nível de significância de 5% (p = 0,05). Resultados: As variáveis que apresentaram diferença significativa antes e depois da implantação do Projeto "Lean nas Emergências" foram: Nº de internações (p=0,03); Nº de Saídas (altas + óbitos) (p = 0,03); Giro de leito (p = 0,03); Intervalo de substituição de leitos (p=0,03) e Leitos operacionais disponíveis (p = 0,04). O número de internações; de saídas e o giro de leitos aumentaram em 13,2%, 20,6% e 11,7%, respectivamente e o tempo para o intervalo de substituição dos leitos diminuiu em 61,1%. Conclusão: Os indicadores que apresentaram significância nos resultados refletem a eficácia do projeto em quesitos importantes para o gerenciamento do número de leitos no pronto socorro, otimizando o tempo de estadia do paciente no ambiente hospitalar. (AU)

Objective: To compare the results of hospital performance indicators of an urgency/emergency unit that has implemented the "Lean in Emergencies" project. Methods: A descriptive, retrospective, cross-sectional study with a quantitative approach, in two phases (before and after), whose population was composed of documents from 7,590 admissions in medical, surgical, and orthopedic clinics, seen in the emergency room. The data were submitted to the normality test and later to the Wilcoxon non-parametric test, considering a 5% significance level (p = 0.05). Results: The variables that showed significant difference before and after the implementation of the Project "Lean in Emergencies" were: Number of admissions (p = 0.03); Number of Exits (discharges + deaths) (p = 0.03); Bed Turnover (p = 0.03); Interval for bed replacement (p = 0.03) and Available operational beds (p = 0.04). The number of admissions; outputs and bed turnover increased by 13.2%, 20.6% and 11.7%, respectively, and the time to bed replacement interval decreased by 61.1%. Conclusion: The indicators that presented significant results demonstrate the project's effectiveness in important aspects for managing the number of beds in the emergency room, optimizing the patient's length of stay in the hospital environment. (AU)

Objetivo: Analizar los resultados de los indicadores de desempeño hospitalario de una unidad de urgencia/emergencia, que implementó el proyecto "Lean en Emergencias". Métodos: Estudio descriptivo, retrospectivo, transversal con abordaje cuantitativo, en dos etapas (antes y después), cuya poplación fue compuesta por documentos de 7.590 internaciones en los consultorios médico, quirúrgico y ortopédico, atendidos en la sala de emergencias. Los datos fueran sometidos a la prueba de normalidad y posteriormente, a la prueba no paramétrica de Wilcoxon, considerando un nivel de significación del 5% (p = 0,05). Resultados: Las variables que presentaron diferencia significativa antes y después de la implementación del Proyecto "Lean en Emergencias" fueron: Número de internaciones (p=0,03); Número de Salidas (altas + óbitos) (p = 0,03); Rotación de camas (p = 0,03); Intervalo de reemplazo de camas (p=0,03) y Camas operativas disponibles (p = 0,04). El número de internaciones; de salidas y rotación de camas aumentaron en 13,2%, 20,6% e 11,7%, respectivamente, y el tiempo para el intervalo de reemplazo de camas disminuyó en 61,1%. Conclusión: Los indicadores que presentaron significación en los resultados reflejan la efectividad del proyecto en aspectos que son importantes para gestionar el número de camas en urgencias, optimizando el tiempo de estancia del paciente en el ambiente hospitalario. (AU)

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The objective of this study was to analyze the effectiveness of the implementation of the lean healthcare system at the emergency room of the Clinical Hospital of the Federal University of Uberlândia, based on a comparison of hospital indicators obtained over the three phases corresponding to the period of one year before the implementation (T1), the year during the implementation (T2) and one year after implementation (T3). The methodology applied through this study can be classified as a case study that is exploratory and descriptive and developed in stages. Based herein on the search for hospital indicators, as occurred in the implementation of a lean process at the Clinical Hospital Emergency Department, along with a description of the implemented lean system. During the collection period of data relevant to the National Emergency Department Overcrowding Score and Length of Stay Indicator, the motivation of the teams grew, but with a notable tension between municipal management and hospital management. It was found that, despite the fluctuations, the patient length of stay in the Emergency Room remained high. With the exception of the variable of female deaths before 24 h of hospitalization, all other variables showed percentage increases before and after the intervention. This study reported the difficulties encountered by HC-UFU in implementing the lean project in an emergency room, thus ensuring that other institutions that intend to implement this project do not make the same types of mistakes.

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Introducción: A pesar de los esfuerzos de la ciencia para la eliminación de la tuberculosis, esta es considerada actualmente una enfermedad reemergente. En provincia Guantánamo no se encontraron investigaciones referida a este tema. Objetivo: Describir los aspectos clínico-epidemiológicos de pacientes con tuberculosis en el periodo comprendido de 2013-2018 en la provincia de Guantánamo. Método: Se realizó un estudio descriptivo, transversal retrospectivo de pacientes con tuberculosis. El universo de estudio quedó constituido por 103 pacientes (N꓿103) constatados en la base de datos del programa Centro Provincial de Higiene, Epidemiología y Microbiología Guantánamo. Las variables estudiadas fueron: edad, sexo, grupo de riesgo, municipio al que pertenece y formas clínicas. Se utilizó como medida de resumen la frecuencia absoluta y relativa. Resultados: El mayor número de pacientes con tuberculosis se encontró en el grupo de 40-49 años (28,16 %), se destacó el grupo de 50-59 del sexo masculino con un 15,53 %. El municipio que más casos aportó fue el de Guantánamo con 67 (65,04 %), seguido de Jamaica con 10 casos (9,70 %). De los pacientes diagnosticados: 43 fueron fumadores (50,0 %), 19 alcohólicos (22,10 %) y 11 desnutridos (12,79 %). Se obtuvo como resultado que 72 pacientes (69,90 %) presentaron la forma pulmonar y 31 (30,10 %) presentaron la forma extrapulmonar. Conclusiones: A pesar de una adecuada red de diagnóstico, tratamiento y seguimiento de la tuberculosis en la provincia de Guantánamo, existen condiciones que determinan la ocurrencia de esta: factores socioeconómicos, sanitarios e individuales inadecuados, hacinamiento, desnutrición, alcoholismo, predisponen a la enfermedad.

Introduction: Despite the scientific efforts to eliminate tuberculosis, it is currently considered as a reemerging disease. In Guantánamo province, no research closely related to the subject was found. Objective: To describe the clinical-epidemiologic aspects of patients with tuberculosis in Guantánamo province, period 2013-2018. Method: A descriptive, retrospective cross-sectional study of patients with tuberculosis was carried out. The study involved a total of 103 patients (N꓿103) recorded in a database manages at the Centro Provincial de Higiene, Epidemiología y Microbiología of Guantánamo. The variables studied were as follow: age, sex, risk group, municipality to which patients belong and, clinical forms. The absolute and relative frequencies were used as summary statistics method. Results: The highest number of patients with tuberculosis was found in 40 to 49 years age group (28.16%), and the male sex stood out in the group of age 50 to 59 (15.53%). The municipality with the highest number of cases was Guantánamo with 67 patients (65.04%), followed by Jamaica municipality with 10 patients (9.70%). Forty three of all the patients diagnosed with tuberculosis (50,0%) were addicted to smoking, 19 (22,10%) addicted to alcohol, and 11 (12,79%) in malnutrition state. As a result in the study, it was found in 72 patients (69.90%) presence of pulmonary tuberculosis and extrapulmonary tuberculosis in 31 active patients (30.10%). Conclusions: Despite of an adequate network of diagnosis, treatment and tuberculosis follow-up in the province of Guantánamo, there are several factors that determine the presence of the disease: for instance, the inadequate use of socioeconomic, sanitary and individual factors, including also aspects like overcrowding, malnutrition, and alcoholism.

Introdução: Apesar dos esforços da ciência para eliminar a tuberculose, atualmente é considerada uma doença reemergente. Na província de Guantánamo, não foram encontradas investigações relacionadas a este tema. Objetivo: Descrever os aspectos clínico-epidemiológicos de pacientes com tuberculose no período de 2013-2018 na província de Guantánamo. Método: Estudo descritivo, retrospectivo e transversal de pacientes com tuberculose. O universo do estudo foi composto por 103 pacientes (nº 103) encontrados no banco de dados do programa Centro Provincial de Higiene, Epidemiologia e Microbiologia de Guantánamo. As variáveis estudadas foram: idade, sexo, grupo de risco, município a que pertence e formas clínicas. Frequência absoluta e relativa foram usadas como medida sumária. Resultados: O maior número de doentes com tuberculose foi encontrado na faixa etária de 40 a 49 anos (28,16%), destacando-se a faixa de 50 a 59 anos do sexo masculino com 15,53%. O município que mais contribuiu com casos foi Guantánamo com 67 (65,04%), seguido de Jamaica com 10 casos (9,70%). Dos pacientes diagnosticados: 43 eram tabagistas (50,0%), 19 etilistas (22,10%) e 11 desnutridos (12,79%). Obteve-se como resultado que 72 pacientes (69,90%) apresentavam a forma pulmonar e 31 (30,10%) apresentavam a forma extrapulmonar. Conclusões: Apesar de uma rede adequada para o diagnóstico, tratamento e monitoramento da tuberculose na província de Guantánamo, existem condições que determinam sua ocorrência: fatores socioeconômicos, de saúde e individuais inadequados, superlotação, desnutrição, alcoolismo, predispõem à doença.

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BACKGROUND: Overcrowding is a serious problem that impacts the ability to provide optimal level of care in a timely manner. High patient volume is known to increase the boarding time at the emergency department (ED), as well as at post-anesthesia care unit (PACU). Furthermore, the same high volume increases inpatient bed transfer times, which causes delays in elective surgeries, increases the probability of near misses, patient safety incidents, and adverse events. OBJECTIVE: The purpose of this study is to develop a Machine Learning (ML) based strategy to predict weekly forecasts of the inpatient bed demand in order to assist the resource planning for the ED and PACU, resulting in a more efficient utilization. METHODS: The data utilized included all adult inpatient encounters at Geisinger Medical Center (GMC) for the last 5 years. The variables considered were class of inpatient encounter, observation, or surgical overnight recovery (SORU) at the time of their discharge. The ML based strategy is built using the K-means clustering method and the Support Vector Machine Regression technique (K-SVR). RESULTS: The performance obtained by the K-SVR strategy in the retrospective cohort amounts to a mean absolute percentage error (MAPE) that ranges between 0.49 and 4.10% based on the test period. Additionally, results present a reduced variability, which translates into more stable forecasting results. CONCLUSIONS: The results from this study demonstrate the capacity of ML techniques to forecast inpatient bed demand, particularly using K-SVR. It is expected that the implementation of this model in the workflow of bed capacity management will create efficiencies, which will translate in a more reliable, inexpensive and timely care for patients.

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OBJECTIVES: The SARS-CoV-2 virus continues wreaking worldwide havoc on health and between March and August 2020, the first outbreak of COVID-19 hit Chile. The pregnant population is especially vulnerable to infection. Studies have been published that associate socioeconomic status, overcrowding, and poverty with a higher prevalence of SARS-CoV-2 infection. There are few studies about the development of this pandemic in Latin American countries so far. This study seeks to show the prevalence and sociodemographic and perinatal characteristics in pregnant women at the time of delivery, comparing both groups with positive and negative COVID-19 PCR results. METHODS: A prospective, cross-sectional study of pregnant women who delivered at the San Juan de Dios Hospital in Santiago between April 15, 2020 and June 15, 2020. Analysis of epidemiological, sociodemographic, obstetric, perinatal and sociodemographic data of patients with positive and negative COVID-19 PCR results. RESULTS: There were 701 patients included in the study. The prevalence of those with a positive COVID-19 PCR was 9.7% and 67.7% being asymptomatic. Pre-term delivery was significantly higher in the group of positive patients (23.5%) vs. negative patients (8.7%), which was not the same rate as with cesarean sections (C-sections). A 13.2% of patients required management of the pathology in the Critical Care Unit (CCU) and there were no cases of maternal or fetal deaths. We found no significant difference between both groups when analyzing socioeconomic variables, though we noted a trend of greater overcrowding among the group of patients with infection. CONCLUSIONS: The majority of pregnant patients with SARS-CoV-2 infection are asymptomatic. COVID-19 increases the rate of premature births, but this rate is not same with C-sections. Sociodemographic conditions and overcrowding do not show a higher infection rate in a homogeneous population in relation to the economic, social and demographic level.

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El presente artículo se originó en la necesidad de entender el crimen como una problemática pública, que debe ser analizada a partir de una hipótesis causal que explique el fenómeno delictivo en Colombia con una perspectiva social con diferentes enfoques teóricos, con el fin de establecer líneas de acción para la toma de decisiones de política pública que contribuyan a su reducción. En la primera parte, se presenta la hipótesis causal propuesta y se desarrollan cada uno de sus componentes. Posteriormente, se desarrolla un análisis descriptivo de las denuncias por tipo de delito y de la población privada de la libertad, en la que se identifica las diferencias y las similitudes en las condiciones socioeconómicas para los delitos de mayor incidencia. Por último, se desarrolla un modelo de simulación continua y se analiza el resultado de posibles estrategias de política pública. El resultado obtenido reflejó la necesidad de diseñar políticas públicas pluralistas, que apunten a la solucionar las causas de raíz del fenómeno del crimen, en torno a la construcción social y a la reducción de la impunidad.

This article arose from the need to understand crime as a public problem, which should be analyzed on the basis of a causal hypothesis that explains the criminal phenomenon in Colombia from a social perspective with different theoretical approaches, in order to establish lines of action for public policy decisions that contribute to its reduction. In the first part, the proposed causal hypothesis is presented and each of its components is developed. Subsequently, a descriptive analysis of the reports by type of crime and of the population deprived of liberty is developed, identifying the differences and similarities in the socioeconomic conditions for the crimes with the highest incidence. Finally, a continuous simulation model is developed and the result of possible public policy strategies is analyzed. The result obtained reflected the need to design pluralistic public policies aimed at solving the root causes of the crime phenomenon, in terms of social construction and the reduction of impunity.

Este artigo surgiu da necessidade de entender o crime como um problema público, que deve ser analisado com base em uma hipótese causal que explique o fenômeno criminoso na Colômbia a partir de uma perspectiva social com diferentes abordagens teóricas, a fim de estabelecer linhas de ação para decisões de política pública que contribuam para sua redução. Na primeira parte, é apresentada a hipótese causal proposta e cada um de seus componentes é desenvolvido. Posteriormente, é desenvolvida uma análise descritiva dos relatórios por tipo de crime e da população privada de liberdade, identificando as diferenças e semelhanças nas condições sócio-econômicas para os crimes mais comuns. Finalmente, um modelo de simulação contínua é desenvolvido e o resultado de possíveis estratégias de políticas públicas é analisado. O resultado obtido reflete a necessidade de elaborar políticas públicas pluralistas que visem resolver as causas profundas do fenômeno do crime, em termos de construção social e de redução da impunidade.

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BACKGROUND: Overcrowding in emergency departments (EDs) is a worldwide challenge. As a result of the increased demand for EDs, slow internal patient flow, and unavailability of hospital beds, patients are kept in the corridors, causing a boarding effect. Studies have associated boarding in EDs with unfavorable clinical outcomes and adverse events. Thus, the purpose of this systematic review was to describe the effects of ED boarding on the occurrence of adverse events. DESIGN: We followed the Meta-Analysis of Observational Studies in Epidemiology checklist and registered this systematic review with PROSPERO (CRD42020117915). METHODS: Literature searches were performed using the databases PubMed, Scopus, Latin American and Caribbean Center on Health Sciences Information (LILACS), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane, as well as Google Scholar, OpenThesis, and the Brazilian Digital Library of Theses and Dissertations from September to November 2019. Cohort or case control studies that evaluated the occurrence of adverse events in patients who remained in an ED, waiting for a hospital bed, were included in the review. RESULTS: Seven studies met our eligibility criteria. Boarding in EDs may be related to a reduction in the quality of care, resulting in unfavorable clinical outcomes and adverse events. CONCLUSIONS: Boarding in EDs may be related to increases in adverse incidents and events. CLINICAL RELEVANCE: The evidence in this review suggests that ED boarding increases the occurrence of unfavorable outcomes and identifies important considerations for future research.

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An outbreak of coronavirus disease began in a large penitentiary complex in Brazil on April 1, 2020. By June 12, there were 1,057 confirmed cases among inmates and staff. Nine patients were hospitalized, and 3 died. Mean serial interval was ≈2.5 days; reproduction number range was 1.0-2.3.

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PURPOSE: Although suicide rates of prison populations and incidence factors have been reported for high-income countries, data from low- and middle-income regions are lacking. The purpose of the study was to estimate suicide rates among prison populations in South America, to examine prison-related factors, and to compare suicide rates between prison and general populations. METHODS: In this observational study, we collected the numbers of suicides in prison, rates of prison occupancy, and incarceration rates from primary sources in South America between 2000 and 2017. We compared suicide rates among prisoners with incidence rates in the general populations by calculating incidence rate ratios. We assessed the effect of gender, year, incarceration rates and occupancy on suicide rates in the prison populations using regression analyses. RESULTS: There were 1324 suicides reported during 4,437,591 person years of imprisonment between 2000 and 2017 in 10 South American countries. The mean suicide rate was 40 (95% CI 16-65) per 100,000 person years for male and female genders combined. The pooled incidence rate ratio of suicide between prison and general populations was 3.9 (95% CI 3.1-5.1) for both genders combined, 2.4 (95% CI 1.9-3.1) for men and a higher ratio in women (13.5, 95% CI 6.9-26.9). High occupancies of prisons were associated with lower incidence of suicide (ß = - 58, 95% CI - 108.5 to - 7.1). CONCLUSIONS: Suicides during imprisonment in South America are an important public health problem. Suicide prevention strategies need to target prison populations.

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Resumen El presente artículo desarrolla un análisis descriptivo cuantitativo sobre el desempeño del sistema a través del cual el Gobierno Colombiano implementa su política pública criminal: sistema judicial, penal y penitenciario. Este estudio no se realiza desde el punto de vista del derecho, sino desde la perspectiva de la evaluación de su efectividad, entendiendo la criminalidad como un problema social. El impacto de este artículo radica en la posibilidad de entender y abordar el fenómeno de la criminalidad desde un enfoque preventivo. Esto, al identificar un desequilibrio dinámico de los componentes del sistema que refuerza el problema, evidenciando deficiencias en la finalidad de la política criminal como política pública debería propender por la prevención del crimen y por el contrario refuerza un ciclo vicioso que incrementa impunidad. Este ciclo ha desgastado operativamente al Estado y ha generado un alto costo como resultado de los altos índices de criminalidad.

Abstract This article performs a descriptive, quantitative analysis of the performance of the system through which the Colombian Government implements its criminal public policy: judicial, criminal justice and penitentiary systems. This study is not performed from the point of view of law, but from a perspective evaluating its effectiveness, considering crime a social issue. This article impacts the possibility of understanding and facing the phenomenon of crime from a preventive approach. This, upon identifying a dynamic imbalance of the system's components, which strengthens the problem, shows deficiencies in the purpose of criminal policy as a public policy that promotes prevention and emphasizes a vicious cycle that increases impunity. This cycle has operationally worn-out the Government and has generated high costs as a result of high crime indices.

Resumo Este artigo desenvolve uma análise descritiva quantitativa sobre o desempenho do sistema por meio do qual o Governo colombiano implementa sua política pública criminal: sistema judicial, penal e penitenciário. Este estudo não é realizado do ponto de vista do direito, mas da perspectiva de avaliar sua eficácia, entendendo o crime como problema social. O impacto deste artigo reside na possibilidade de compreender e abordar o fenómeno do crime a partir de uma abordagem preventiva. Isto, ao identificar um desequilíbrio dinâmico dos componentes do sistema que reforça o problema, mostra deficiências na finalidade da política criminal como política pública que visa à prevenção e acentua um ciclo vicioso que aumenta a impunidade. Este ciclo desgastou operacionalmente o Estado e gerou um custo elevado em decorrência dos altos índices de criminalidade.

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Resumen Introducción: Se estima que a nivel mundial, cada año alrededor del 10% de los lactantes tienen bronquiolitis. Se produce un pico entre los 2 y los 6 meses de edad. Objetivo: Determinar los factores de riesgo de bronquiolitis en menores de dos años que consultaron al servicio de Pediatría del Instituto de Medicina Tropical entre el 2018 y 2019. Método: Estudio de tipo descriptivo, transversal en el que se incluyeron pacientes menores de 2 años internados en el Servicio de Pediatría del Instituto de Medicina Tropical de enero de 2018 a febrero de 2019 con diagnóstico de bronquiolitis en el que se analizaron los factores de riesgo de la enfermedad. Resultados: Se estudió una población de 38 pacientes que presentaron bronquiolitis antes de los 2 años, 19 fueron niños (50%) La edad media al ingreso fue de 3,5 ± 2,8 meses (límites, 1-10 meses). No se han encontrado datos de tabaco en el embarazo. Se detectó VRS en el aspirado nasofaríngeo de 8 niños (21%), la detección viral fue negativa en 14 niños (37%) y no se realizó la determinación en 18 casos (47%). Los siguientes factores de riesgo se asociaron de forma independiente con la bronquiolitis: Asma de los padres, infección por VSR, sibilancia, cianosis y hacinamiento. Los factores de riesgo estudiado, exposición al tabaco, sexo, edad en el momento de la bronquiolitis o lactancia materna exclusiva, no se asociaron con el ingreso a UTI de los pacientes con bronquiolitis. Conclusión: Hemos encontrado factores de riesgo asociado relacionados al huésped como asma de los padres, y otros como sibilancia, cianosis, hacinamiento e infección por VRS.

Abstract Introduction: It is estimated that globally, each year around 10% of infants have bronchiolitis. A peak occurs between 2 and 6 months of age Objective: To determine the risk factors of bronchiolitis in children less than two years of age who admitted at the pediatric service of the Institute of Tropical Medicine between 2017 and 2019 Method: A descriptive, cross-sectional study in which patients under 2 years of age admitted to the Pediatric Service of the Institute of Tropical Medicine from January 2018 to February 2019 were included with a diagnosis of bronchiolitis in which the risk factors of the disease were analyzed. Results: We studied a population of 38 patients who presented bronchiolitis before 2 years, 19 were children (50%) The average age at admission was 3.5 ± 2.8 months (range, 1-10 months). No tobacco data were found in pregnancy. RSV was detected in the nasopharyngeal aspirate of 8 children (21%), viral detection was negative in 14 children (37%) and the determination was not made in 18 cases (47%). The following risk factors were independently associated with bronchiolitis: Asthma of the parents, RSV infection, wheezing, cyanosis and overcrowding. The risk factors studied exposure to tobacco, sex, age at the time of bronchiolitis or exclusive breastfeeding were not associated with admission to the ICU of patients with bronchiolitis. Conclusion: We have found associated risk factors related to the host such as asthma of the parents, and others such as wheezing, cyanosis, overcrowding and RSV infection.

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Introducción: La saturación y hacinamiento de pacientes son un problema en el servicio de emergencia. Objetivo: Describir las características de la demanda de atención médica al servicio de emergencia de un hospital terciario de la seguridad social y evaluar su hacinamiento. Métodos: Estudio observacional realizado en el hospital Rebagliati, primer trimestre 2019. Se evaluaron variables sociodemográficas, de tiempo e indicadores de emergencia del sistema estadístico institucional. Se realizó estadística descriptiva con IBM SPSS 24.00. Resultados: 51294 atenciones en pacientes entre 14 y 102 años (mediana 60), 56,7% de sexo femenino. 18% registró más de una atención en el trimestre. El día de mayor demanda fue el lunes y el horario entre 08 y 13 horas. Las atenciones de prioridad III y IV fueron el 83,5% del total. En los tópicos de medicina y de alivio se realizaron el 63% de atenciones. En unidad de trauma-shock se realizaron el 3% de las atenciones. Se admitieron en las salas de observación el 13% de las atenciones de emergencia. Los diagnósticos más frecuentes fueron insuficiencia respiratoria, infecciones y accidentes cerebrovasculares. El 88% de las admisiones se realizaron en salas comunes con una estancia entre 4,4 y 7,0 días. Falleció el 0,8% de los atendidos, se realizó intervención quirúrgica en el 0,7% y se transfirió a otro establecimiento al 0,1% respectivamente. Conclusión: La demanda al servicio de emergencia es principalmente por problemas médicos (de prioridad 3 y 4), predominando pacientes adultos mayores y de sexo femenino. Se admitió al 13% de los atendidos con estancia prolongada, baja mortalidad, muy pocas transferencias y alta tasa de retorno

Introduction: The saturation and overcrowding of patients are problem in the emergency service. Objective: To describe the characteristics of the demand for medical attention to the emergency service of an urban hospital and to assess its overcrowding. Methods: Observational study carried out at the Rebagliati hospital, first quarter 2019. Sociodemographic variables, time and emergency indicators of the institutional statistical system were evaluated. Descriptive statistics were performed with IBM SPSS 24. Results: Of 5,1244 attentions in patients between 14 and 102 years (median 60), 56.7% were female. 18% recorded more than one service in the quarter. The day of greatest demand was Monday and the hours between 08 and 13 hours. Priority care III and IV were 83.5% of the total. In the topics of medicine and relief, 63% of care was performed. In the trauma-shock unit, 3% of the care was performed. 13% of emergency care were admitted to observation rooms. The most frequent diagnoses were respiratory failure, infections and strokes. 88% of admissions were made in common rooms with a stay between 4.4 and 7.0 days. 0.8% of those seen died, surgery was performed in 0.7%, and 0.1% was transferred to another facility, respectively. Conclusion: The demand to the emergency service is mainly due to medical problems (priority 3 and 4), predominantly elderly and female patients. 13% of those attended were admitted with a long stay, low mortality, very few transfers and a high rate of return

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Purpose Little is known about the health status of prisoners in low-income countries. In Haiti, prisons typically lack adequate medical care, clean water and food, though some prisoners receive additional food from visitors. The purpose of this paper is to characterize the physical and mental health of Haitian prisoners in three select prisons and examine the effects of having visitors and length of detention on health status. The authors hypothesized that prisoners with more visitors and shorter detention times would have better overall health status. Design/methodology/approach The authors conducted a cross-sectional study of 290 male inmates in three regional prisons in Haiti. Data were collected on prisoners' sociodemographic characteristics, number of visitors, length of detention, body mass index (BMI), self-reported physical and mental health status, and food insecurity. Findings Overall, prisoners at all three prisons had poor health outcomes. Prisoners with more visitors were significantly less likely to be underweight and more likely to have a higher BMI, better self-reported physical function and lower levels of food insecurity. The length of incarceration was negatively associated with physical function and self-rated health, but positively associated with BMI. These results suggest that prisoners who do not receive supplemental food from visitors are at increased risk for food insecurity and poor nutritional and physical health status. Originality/value These findings demonstrate the importance of supplemental food from visitors in stabilizing prisoner health in Haiti and emphasize the need for the provision of adequate nutrition to all prisoners. This study also suggests that policies that reduce incarceration times could improve health status among prisoners.

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Resumen El presente artículo tiene como objetivo analizar el impacto negativo que guarda la política criminal y los sistemas penitenciarios de Colombia, en especial frente aquellas personas que han cometido delitos relacionados con el narcotráfico, cuya persecución altamente represiva contra la fabricación, posesión o tráfico de estupefacientes, no ha tenido ningún efecto significativo en reducir las estructuras delictivas que se han generado en torno al negocio de narcóticos. Lo que ha generado, es un aumento de la población carcelaria, personas que presentan una alta probabilidad de recaída cuando recobran su libertad, -reincidencia delictiva-, motivada por diferentes factores; pero especialmente por el tiempo y la influencia negativa que les ha generado la prisión, ello derivado de las fallas estructurales dentro de las prisiones, lo cual frena la prevención especial positiva, a falta de un tratamiento de resocialización.

Abstract The objective of this work is to analyze the negative impact that the criminal policy and the Colombian penitentiary systems hold, mainly against people who have committed drug trafficking offences, whose highly repressive persecution against the manufacture, possession or narcotic drugs traffic, have not got any significant effect in criminal structures reduction. These criminal structures have been produced on the narco-trafficking business. This has generated an increase in the prison population. These people have a high probability of relapse upon release from prison -criminal recidivism-; it is incited by different factors, particularly the time and the negative influence of prison on them, due to structural problems within the prisons which slow down the special positive prevention, in the absence of a resocialization treatment.

Resumo O objetivo deste trabalho é analisar o impacto negativo da política criminal e dos sistemas prisionais da Colômbia, em especial em relação àquelas pessoas que têm cometido crimes vinculados ao narcotráfico, cuja perseguição, altamente repressiva contra a fabricação, posse ou tráfico de entorpecentes, não tem tido nenhum efeito significativo na redução das estruturas delitivas do negócio dos narcóticos. No entanto, verifica-se um aumento da população prisional, composta por pessoas que apresentam uma probabilidade alta de reincidir quando recobram a liberdade - reincidência delitiva -, motivada por diferentes fatores, sobretudo pelo tempo e pela influência negativa causada pela prisão, devido às falhas estruturais dentro das cadeias, que impedem a prevenção especial positiva, a falta de um tratamentode ressocialização.

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Resumen Las urgencias médicas pueden saturarse debido a factores externos e internos al servicio. Esto se refleja en congestión, tiempos de espera elevados e insatisfacción de los usuarios. Identificar y simular estrategias para gestionar las urgencias médicas, procurando atenuar la saturación. Investigación exploratoria y analítica, con trabajo de campo en cuatro unidades de urgencias de Medellín y simulación de estrategias contra la saturación mediante dinámica de sistemas. Las estrategias utilizadas son: reorganizar el registro, remitir los pacientes que no requieren atención urgente, implementar consultorio fast-track e incrementar el traslado a pisos. Esta última es la estrategia más efectiva en la simulación. Aunque las estrategias de flujo pueden ayudar a resolver la saturación a partir de sus causas internas, como lo sugiere la literatura, su alcance es limitado. Se requieren estrategias de entrada, que no están al alcance del servicio, y estrategias de salida del sistema hospitalario. Es posible disminuir la saturación, concibiendo las urgencias y el hospital como dos elementos de un mismo sistema, de modo que se agilice el flujo de pacientes y se cuente con oferta adecuada de camas hospitalarias sin sobredimensionar la capacidad instalada.

Abstract Medical emergency services can be overcrowded due to both external and internal service factors. This is evinced in the congestion, longer waits, and dissatisfaction by the users. To identify and simulate strategies for processing medical emergency requests in order to mitigate the overcrowding. An exploratory and analytical research was conducted based on the field work at four emergency rooms in hospitals of Medellín; simulation strategies were then proposed against the overcrowded service with system dynamics. The strategies included: to reorganize the sign-in, refer to other places those patient not requiring emergency services, implement fast-track services, and increase the inpatient capacity. The last one becomes the most effective strategy in the simulation. While the flow strategies can help to solve the service overcrowding due to internal causes as suggested in the literature, these strategies are limited in their scope. The required patient sign-in strategies as well as the patient discharge strategies are not easy-to-do in these emergency rooms. Overcrowding can be reduced by thinking of the hospital and the emergency room as two elements in a single system, so that the patient flow can be speeded up; the bed number for inpatients must be improved without overflowing the hospital capacity.

Resumo As urgências médicas podem se saturar devido a fatores externos e internos ao serviço. Isso se reflete em congestão, tempos de espera elevados e insatisfação dos usuários. Identificar e simular estratégias para gerir as urgências médicas, procurando atenuar a saturação. Pesquisa exploratória e analítica, com trabalho de campo em quatro unidades de urgências de Medellín e simulação de estratégias contra a saturação mediante dinâmica de sistemas. As estratégias utilizadas são: reorganizar o cadastro, reencaminhar os pacientes que não precisam atendimento urgente, implementar clínica ambulatória fast-track e facilitar o traslado aos quartos. Esta última é a estratégia mais efetiva na simulação. Ainda que as estratégias de fluxo possam ajudar a resolver a saturação a partir de suas causas internas, como sugere a literatura, seu escopo é limitado. Precisam-se estratégias de entrada, que no estão dentro do escopo do serviço e estratégias de saída do sistema hospitalar. Conclusões: é possível diminuir a saturação, concebendo as urgências e o hospital como dois elementos de um mesmo sistema, de jeito de agilitar o fluxo de pacientes e contar com oferta adequada de leitos hospitalares sem superdimensionar a capacidade instalada.

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BACKGROUND: Throughput might be partially responsible for sub-optimum organisational and medical outcomes. The present study examined throughput and the challenges to ensuring optimum throughput in hospitals, and determined the effectiveness of a throughput intervention in reducing overcrowding in a public healthcare institution in Trinidad and Tobago. METHODS: First, a literature review of throughput and its processes in relation to improving hospital care was conducted. Second, the challenges to throughput in healthcare were reviewed. Data were also collected from print media, hospital records, and the central statistical office in Trinidad and Tobago to discuss throughput and describe the throughput status in hospitals. Finally, the effect of a throughput intervention on overcrowding was determined. The intervention was implemented over six months, from October 2010 to March 2011, and comprised three stages of a five-stage throughput process: transferring patients to a specific medical ward, bedside electrocardiograms (ECG), and promptly obtaining patient investigative reports and patient files. RESULTS: Problems with the throughput process led to prolonged delays or failures in obtaining lab reports, radiology services, ECGs, and pharmaceutical supplies, as well as inadequate social work services and other specialised services. During the throughput intervention, there was a reduction in overcrowding/overflow to 5-10 patients per day with a daily admission rate of 58. However, at post-intervention, there was increased overcrowding/overflow to 20-30 per day but fewer admissions (52 per day) i.e. similar to pre-intervention period. Additionally, there was an increase in bed complement in the department of medicine from 209 (2011) to 227 (2012). Overcrowding continued into 2016 and beyond: medical admissions in 2016 were 46.4 per day and the medical bed capacity was 327 (indicating a 44% increase in capacity from 2012). CONCLUSION: Hospital throughput processes are currently suboptimum. Improving specific throughput processes or targeting the greatest primary constraints might help decrease overcrowding.

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En este trabajo ofrecemos una propuesta de solución tecnológica al problema asociado a la saturación de las salas de urgencias en Bogotá. Se realizó un estudio diagnóstico durante el primer semestre del año 2015 en tres servicios de urgencias de Bogotá. Del estudio realizado se pudo determinar que existen elevados tiempos de atención y asimetrías de información entre los diferentes actores del sistema. Asimismo, se observó que el sistema de atención primaria no está coordinado con el de atención de urgencias, lo que crea incentivos para acudir directamente a este servicio. La solución propuesta consiste en un sistema no invasivo al sistema de urgencias, que se compone principalmente de: 1) dispositivos inteligentes de medición de signos vitales, 2) un sistema de telecomunicaciones, 3) un servidor para el procesamiento y análisis de los datos y generación de alertas. Con esta solución se busca contribuir con la reducción de la asimetría de información.

A proposal is presented of a technological solution to overcrowding in emergency departments of Bogotá. A diagnostic study was conducted at three emergency departments of Bogotá during the first semester of the year 2015. The study revealed that waiting times are long and there is information asymmetry between the various actors in the system. It was also found that the primary care system is not well coordinated with the emergency services, creating an incentive for patients to go directly to the latter. The solution proposed is a non-invasive system to support the emergency service, which is mainly composed of: 1) smart devices for the measurement of vital signs, 2) a telecommunications system, 3) a server for data processing and analysis, and alert generation. This solution is expected to contribute to reduce information asymmetry.

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Respiratory syncytial virus (RSV) is the main viral cause of hospitalization due to acute lower respiratory tract infections in infants worldwide. Several vaccines against RSV are under research and development, which are about to be approved. We evaluated transmission patterns in different settings to determine age-specific vaccination targets from a viral perspective. We sequenced the G glycoprotein's ectodomain of a constant clinical sampling between two epidemic outbreaks in a limited geographical region and performed phylogeographic analyses. We described a spatio-temporal transmission between local strains, which were originated in the center of the analyzed area and then spread to others. Interestingly, that central area reported the highest population density of the region and also showed overcrowding. This information should be considered by public health systems to evaluate vaccination at all ages in those areas to decrease viral transmission and in lower density populations only susceptible children should be vaccinated.

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Existe hacinamiento de pacientes en los servicios de emergencia de nuestros hospitales públicos; sin embargo, se trata de un problema presente en otros países, cuya mención aparece en la literatura médica foránea como crowding. Se presenta una breve revisión de la literatura médica que trata su aparición en el tiempo. Se exponen causas, consecuencias y alternativas de solución. Ante la carencia de trabajos de investigación nacionales, se tomó como fuente informes de Contraloría General de la República sobre implementación y cumplimiento de las normas técnicas en áreas críticas de 8 hospitales públicos de Lima y Callao el año 2012. Se analizó el informe de Defensoría del Pueblo, inspección de 149 hospitales a nivel nacional el mismo año. Se describe las brechas presentes entre las ofertas de cama y sobredemanda de atenciones en los servicios de emergencia inspeccionados, así como las condiciones en que permanecen los pacientes y trabaja el personal de salud en los servicios de emergencia. Se expone otras situaciones que comprometen el acceso y la atención oportuna de personas que demandan ser atendidos. Se resume las recomendaciones presentadas por ambos entes inspectores en torno a la congestión de pacientes dentro de los servicios de emergencia. El hacinamiento es un grave problema de salud pública. Los principales prestadores públicos de salud tienen que priorizar la realización de estudios al respecto y proponer soluciones, con planes de desarrollo y mejora progresiva en el corto y mediano plazo.

There is overcrowding of patients in the emergency services of our public hospitals. However, it is a problem that occurs in other countries and appears in the foreign medical literature as crowding. A brief review of the literature is presented discussing time of appearance, causes, consequences and possible solutions. Inthe absence of national research, sources used were the Comptroller General of the Republic (Contraloría General de la República) on the implementation of and compliance with technical standards in critical areas of 12 public hospitals in Lima and Callao 2012, and the report of the Office of the Ombudsman (Defensoría del Pueblo) on the nationwide inspection of 149 hospitals nationwide in 2012. The gaps between supply of bedsand care excess demand in the emergency services inspected and conditions for both inpatients stay and health personnel working in the emergency services are described. Other situations that compromise access and timely attention of people are exposed. The recommendations presented by the two inspecting entities on the congestion of patients within the emergency services are summarized. Overcrowding is a serious public health problem. The main public health providers have to prioritize studies on this matter and propose solutions with plans of development and gradual improvement in the short and medium term.

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El hacinamiento carcelario, presente en la mayor parte de los países latinoamericanos, es un problema de gran calado social que genera el sufrimiento de miles de personas privadas de libertad. El lamentable estado de las infraestructuras penitenciarias y las condiciones deshumanizantes en las que transcurre el día a día de los internos comprometen la posición del Estado como garante de derechos fundamentales. Esta circunstancia ha trascendido a la opinión pública, de modo que se ha suscitado un debate -ya antiguo- sobre las políticas públicas desarrolladas en materia penal y penitenciaria. El presente trabajo tiene como objetivo principal aproximarse a la realidad del sistema penitenciario colombiano, con el fin de analizar, desde una perspectiva descriptiva y longitudinal, el fenómeno del hacinamiento carcelario para formular propuestas de mejora. Para tal fin se examinan fuentes de información secundarias provenientes de distintos ámbitos, como: fuentes estadísticas oficiales, disposiciones legales nacionales e internacionales, así como estudios de investigación elaborados por académicos e instituciones públicas. Los principales resultados ponen de relieve los efectos negativos que ha ocasionado la política criminal en el ámbito penitenciario y la necesidad urgente de una nueva orientación.

Overcrowding in prisons as a common condition in most Latin American countries is an extremely serious problem, since it causes unimaginable suff ering upon thousands of individuals deprived of freedom. The deplorable state of penitentiary infrastructures and the dehumanizing conditions that inmates have to endure every single day tend to compromise the position and reputation of the State as a true guarantor of fundamental rights. This circumstance has leaked to the public and helped trigger the -already old- debate about the state policies developed around criminal and prison matters. This work is mainly aimed at approaching the reality of the penitentiary system in Colombia by analyzing the prisonovercrowding phenomenon from a descriptive and longitudinal perspective, in order to put forward improvement proposals. For this purpose, secondary information sources from diff erent domains like official statistics and national and international provisions have been examined, as well as research studies prepared by academics and public institutions. Major results highlight the negative impacts and implications of the present criminal policy in the penitentiary environment, and the imperative need for new thinking along with a revised and well-planned orientation.

A superlotação das prisões, presente na maioria dos países da América Latina, é um problema de grande importância social que gera o sofrimento de milhares de detidos. O estado lamentável de infra-estrutura carcerária e as condições desumanas em que transcorre o dia dos internos comprometem a posição do Estado como garantidor dos direitos fundamentais. Esta circunstância transcendeu a opinião público, de modo que tem provocado discussão - já antigo - sobre as políticas públicas desenvolvidas em matéria penal e penitenciária. Este trabalho tem como principal objetivo aproximar a realidade do sistema penitenciário colombiano a fim de analisar, de uma perspectiva descritiva e longitudinal, o fenómeno da sobrelotação prisional para formular propostas de melhoria. Para este fim, fontes de informação secundária de diferentes áreas, tais como fontes estatísticas oficiais, as disposições legais nacionais e internacionais, assim como estudos da pesquisa elaborados pelos acadêmicos e instituições pública são discutidos. Os principais resultados destacam os efeitos negativos que causaram a política criminal nas prisões e a necessidade urgente de uma nova orientação.

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