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The objective of this study was to evaluate the effect of the transport distance and lairage time on behavioral indicators of zebu beef cattle in the resting pen of a slaughterhouse using the focal animal technique. Eight lots of male zebu cattle, Nelore, aged approximately 4 years old, weighing on average 500 ± 28.5 kg-1, from different municipalities, transported by land, were evaluated. The lots were grouped into two categories: short distance (> 500 km) and long distance (> 500 km). Five focal animals per evaluated lot were used in each cycle of behavior observation, randomly chosen, and visually identified. The animal focal sampling method was used, with instantaneous recording, every 5 min per animal/h. A video camera was used and placed at a fixed point in the corral. After slaughtering, bruises and carcass pH were evaluated. The respiratory rate (RR) was measured in two moments, 30 min after unloading (RR_I) and 1 h before slaughtering (RR_F); behavioral data were divided into four lairage periods (1st, 2nd, 3rd, and 4th) equally and evaluated as repeated measures over time. The lairage time lowered the behaviors of headbutting (NCHBs), pushing (PsH), mounting (MT), and chasing away (CA), (p = 0.0001), and these behaviors were more evident in animals transported for short distances in the initial resting times, decreasing as they remained in the resting pen. There was effect of distance on the initial and final pH of the carcass, being greater in the short distance (p = 0.047). There was no effect of distance or lairage time on initial or final RR (p > 0.05). In addition, animals transported over long distances showed less carcass injuries, which were observed during post mortem inspection. It is concluded that animals transported over short distances present a greater number of agonistic behaviors, such as NCHBs, MT, PsH, and CA, predisposing to higher rates of bruising during lairage and more accentuated changes in the final pH of the meat.

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Waiting time for chemotherapy infusion is a fundamental factor to measure quality of care. It has been shown that a prolonged waiting time is related to a higher incidence of anticipatory nausea and poor patient adherence to scheduled appointments and recommended oncology treatment programs. Some chemotherapy regimens can be prepared hours ahead-of-time, due to long stability. We aimed to study the effect of an informatic-led workflow redesign intervention, facilitating workflow changes in the Oncology Pharmacy, on patient waiting time. This intervention included changes on EHR processes and the chemotherapy CPOE. Their main effect was allowing ahead-of-time preparation of selected chemotherapy regimes. We conducted a cross sectional study, comparing waiting times pre and post intervention periods. A total of 4600 programmed chemotherapy episodes were included. We found a 26.5 % decrease in the mean wait time in the post intervention period (p > 0.02). We were able to show a decrease in waiting time and a measurable impact of the intervention. This evaluation produced valuable and actionable data for Oncology units and adds a valuable, Latin American experience to the literature.

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Resumen El proceso de adopción comprende cambios importantes en las familias adoptivas, pues implica una reestructuración y adaptación a una nueva organización del sistema familiar. Durante este proceso los padres elaboran expectativas y creencias respecto a cómo comportarse frente a los cambios y adaptarse a sus hijos, desde donde dirigen sus prácticas de crianza. La percepción del tiempo que tenga cada persona posee un papel en cómo se desarrolla la identidad tanto individual como familiar, pues las experiencias pasadas, vivencias actuales y expectativas del futuro influyen en sus acciones. Por lo tanto, es posible decir que los padres adoptivos elaboran teorías subjetivas sobre este proceso y especialmente en relación con el tiempo de espera de la adopción, explicaciones que podrían incidir en la forma en que enfrentan este nuevo desafío y se preparan para la parentalidad. El presente estudio tuvo por objetivo comprender las teorías subjetivas sobre el tiempo de espera y las experiencias de la parentalidad adoptiva. Participaron diez madres y padres adoptivos mediante entrevistas episódicas individuales. Se analizaron los datos obtenidos utilizando técnicas de tres procedimientos de análisis: de contenido basado en la Teoría Fundamentada, específico para las teorías subjetivas y de la perspectiva temporal. De los hallazgos se destacan teorías subjetivas de contenido emocional ansioso durante el proceso de adopción. Además, contar con una red de apoyo, compartir experiencias con otros padres y el uso de estrategias personales son las principales estrategias de adaptación de los padres adoptivos que les permiten sobrellevar los sentimientos negativos durante el proceso.

Abstract The adoption process includes important changes in adoptive families, since it implies a restructuring and adaptation to a new organization of the family system. The path to parenthood entails changes at levels of mental, physical and social health, which in the case of adoptive parents, the challenges are greater or are altered in some way due to the unique characteristics of their experiences and the obstacles they face. To these challenges are added the usual stressors that parents face, such as changes in roles, increased stress, lack of sleep, alterations in the relationship and intimacy of the couple and difficulties that arise in raising their children. On the other hand, time is configured as a concrete dimension through which life develop. The relationship between objective time and subjective or psychological time will shape the perception of time that each person has, which has a role in how both individual and family identity develops. This is because people´s actions are influenced by past experiences, current experiences and future expectations. One of the areas of the adoption process that has not yet been deepened is the waiting time, the period of time between obtaining the suitability and assignment of the minor to the adoptive family, which can be considered important for the future family depending on how adoptive parents face it, this because the way in which the adoption process is experienced impacts both the path to parenthood and post-adoption adaptation. In fact, it confirms that waiting time influences the psychological well-being of adoptive parents. Therefore, it is possible to say that adoptive parents elaborate subjective theories about this process and especially in relation to the waiting time for adoption, explanations that could influence the way in which they face this new challenge and prepare for parenthood. The present study aimed to understand subjective theories about the waiting time and experiences of adoptive parenting. Ten adoptive mothers and fathers participated in this study through individual episodic interviews. The data obtained were analyzed using techniques of three analysis procedures: content based on Grounded Theory, specific for subjective theories and time perspective.

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The automatic initiation of actions can be highly functional. But occasionally these actions cannot be withheld and are released at inappropriate times, impulsively. Striatal activity has been shown to participate in the timing of action sequence initiation and it has been linked to impulsivity. Using a self-initiated task, we trained adult male rats to withhold a rewarded action sequence until a waiting time interval has elapsed. By analyzing neuronal activity we show that the striatal response preceding the initiation of the learned sequence is strongly modulated by the time subjects wait before eliciting the sequence. Interestingly, the modulation is steeper in adolescent rats, which show a strong prevalence of impulsive responses compared to adults. We hypothesize this anticipatory striatal activity reflects the animals' subjective reward expectation, based on the elapsed waiting time, while the steeper waiting modulation in adolescence reflects age-related differences in temporal discounting, internal urgency states, or explore-exploit balance.

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INTRODUCCIÓN: la seguridad social se encarga de la atención médica de los trabajadores asalariados. OBJETIVOS: determinar los tiempos de espera en las programaciones de ecografía y conocer el nivel de satisfacción de pacientes asegurados en el Policonsultorio 20 de octubre de la Caja Petrolera de Salud. MÉTODOS: estudio descriptivo de corte transversal y cuantitativo. Se seleccionaron 1110 solicitudes de las gestiones 2012 ­ 2014 y 1110 pacientes que tenían su solicitud de ecografía en programación actual. Se revisó los expedientes clínicos y archivos de ecografía y se realizó cuestionarios estandarizados con escala Likert a los pacientes para medir el nivel de satisfacción. RESULTADOS: el 26% de los pacientes esperaron de 4.1 a 5.1 semanas (29-35 días), existieron 2.2 solicitudes de ecografía por cada paciente, el 93% de los pacientes no está nada o poco satisfecho con los periodos de espera y el 58% considera aceptable esperar entre 1.1 a 2.0 semanas (2-14 días) para la realización del estudio. DISCUSIÓN: se deben realizar acciones que mejoren la calidad de atención y satisfacción del paciente, una de ellas es disminuir los periodos de espera en las programaciones de ecografía.

INTRODUCTION: social security provides medical care for salaried workers. OBJECTIVES: to determine waiting times for scheduled ultrasound appointments and the level of satisfaction of insured patients at Policonsultorio 20 octubre, Caja Petrolera the Salud. METHODS: this is a descriptive, cross sectional, quantitative study. One thousand one hundred and ten ultrasounds orders from the 2012 ­ 2014 administration and 1110 patients who had ultrasounds orders currently scheduled were selected for review. Clinical records and ultrasounds files were reviewed and patients answers using a standardized questionnaire using the Likert scale were used to measure their level of satisfaction. RESULTS: twenty-six percent of the patients waited 4.1 to 5.1 weeks (29-35 days), there were 2.2 ultrasounds orders per patient, 93% of the patients are somewhat or completely dissatisfied with the waiting times, and 58% consider it acceptable to wait from 1.1 to 2.0 weeks (2-14 days) to undergo the study. DISCUSSION: Actions are needed to improve the quality of care and patient satisfaction, one of which is to shorten waiting times for scheduled ultrasound.

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BACKGROUND: To demonstrate the value of implementation of an artificial intelligence solution in health care service, a winning project of the Massachusetts Institute of Technology Hacking Medicine Brazil competition was implemented in an urgent care service for health care professionals at Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo during the COVID-19 pandemic. OBJECTIVE: The aim of this study was to determine the impact of implementation of the digital solution in the urgent care service, assessing the reduction of nonvalue-added activities and its effect on the nurses' time required for screening and the waiting time for patients to receive medical care. METHODS: This was a single-center, comparative, prospective study designed according to the Public Health England guide "Evaluating Digital Products for Health." A total of 38,042 visits were analyzed over 18 months to determine the impact of implementing the digital solution. Medical care registration, health screening, and waiting time for medical care were compared before and after implementation of the digital solution. RESULTS: The digital solution automated 92% of medical care registrations. The time for health screening increased by approximately 16% during the implementation and in the first 3 months after the implementation. The waiting time for medical care after automation with the digital solution was reduced by approximately 12 minutes compared with that required for visits without automation. The total time savings in the 12 months after implementation was estimated to be 2508 hours. CONCLUSIONS: The digital solution was able to reduce nonvalue-added activities, without a substantial impact on health screening, and further saved waiting time for medical care in an urgent care service in Brazil during the COVID-19 pandemic.

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PURPOSE: To evaluate the quality of referrals for a first Rheumatology consultation at a tertiary care center in a southern Brazilian capital (Porto Alegre, RS), having as background findings from a similar survey performed in 2007/2008. Since then, our state has implemented referral protocols and a triage system with teleconsulting support exclusively for referrals from locations outside the capital, permitting a comparison between patients screened and not screened by the new system. METHODS: Physicians of the Rheumatology Service at Hospital Nossa Senhora da Conceição prospectively collected information regarding first visits over a 6-month period (Oct 2017 to March 2018). We recorded demographic characteristics, diagnostic hypotheses, date of referral, and the municipality of origin (within the state of Rio Grande do Sul). We considered adequate referrals from primary health care when a systemic autoimmune inflammatory disease (SIRD) was suspected at first evaluation by the attending rheumatologist. RESULTS: Three hundred fifty-seven patients/appointments were eligible for analysis (193 from the capital and 164 from small and medium towns). In 2007/2008, suspected SIRD occurred in 76/260 (29.2%) and 73/222 (32.9%) among patients from the capital and outside counties, respectively (P = 0.387). In 2017/2018, suspected SIRD occurred in 75/193 (38.9%) and 111/164 (67.7%) in patients from the capital and outside counties, respectively (difference: 28.8, 95% CI: 19.0 to 38.9, P < 0.001), indicating a marked improvement in referrals submitted to the new triage system. CONCLUSION: The quality of Rheumatology referrals in our state improved over the 10-year interval under study, particularly among patients from locations submitted to referral protocols and teleconsulting support.

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PURPOSE: There are no criteria to establish priority for bariatric surgery candidates in the public health system in several countries. The aim of this study is to identify preoperative characteristics that allow predicting the success after bariatric surgery. MATERIALS AND METHODS: Four hundred and sixty-one patients submitted to Roux-en-Y gastric bypass were included. Success of the surgery was defined as the sum of five outcome variables, assessed at baseline and 12 months after the surgery: excess weight loss, use of continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) as a treatment for obstructive sleep apnea (OSA), daily number of antidiabetics, daily number of antihypertensive drugs, and all-cause mortality. Partial least squares (PLS) regression and multiple linear regression were performed to identify preoperative predictors. We performed a 90/10 split of the dataset in train and test sets and ran a leave-one-out cross-validation on the train set and the best PLS model was chosen based on goodness-of-fit criteria. RESULTS: The preoperative predictors of success after bariatric surgery included lower age, presence of non-alcoholic fatty liver disease and OSA, more years of CPAP/BiPAP use, negative history of cardiovascular disease, and lower number of antihypertensive drugs. The PLS model displayed a mean absolute percent error of 0.1121 in the test portion of the dataset, leading to accurate predictions of postoperative outcomes. CONCLUSION: This success index allows prioritizing patients with the best indication for the procedure and could be incorporated in the public health system as a support tool in the decision-making process.

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Abstract Purpose: To evaluate the quality of referrals for a first Rheumatology consultation at a tertiary care center in a southern Brazilian capital (Porto Alegre, RS), having as background findings from a similar survey performed in 2007/2008. Since then, our state has implemented referral protocols and a triage system with teleconsulting support exclusively for referrals from locations outside the capital, permitting a comparison between patients screened and not screened by the new system. Methods: Physicians of the Rheumatology Service at Hospital Nossa Senhora da Conceição prospectively collected information regarding first visits over a 6-month period (Oct 2017 to March 2018). We recorded demographic characteristics, diagnostic hypotheses, date of referral, and the municipality of origin (within the state of Rio Grande do Sul). We considered adequate referrals from primary health care when a systemic autoimmune inflammatory disease (SIRD) was suspected at first evaluation by the attending rheumatologist. Results: Three hundred fifty-seven patients/appointments were eligible for analysis (193 from the capital and 164 from small and medium towns). In 2007/2008, suspected SIRD occurred in 76/260 (29.2%) and 73/222 (32.9%) among patients from the capital and outside counties, respectively (P = 0.387). In 2017/2018, suspected SIRD occurred in 75/193 (38.9%) and 111/164 (67.7%) in patients from the capital and outside counties, respectively (difference: 28.8, 95% CI: 19.0 to 38.9, P < 0.001), indicating a marked improvement in referrals submitted to the new triage system. Conclusion: The quality of Rheumatology referrals in our state improved over the 10-year interval under study, particularly among patients from locations submitted to referral protocols and teleconsulting support.

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Child sexual abuse (CSA) can cause negative outcomes on cognitive, emotional, physical, and social development of the victims. A significant amount of symptoms related to CSA can be minimized or even treated with professional interventions. Thereby, it is important to examine factors related to treatment response. This article aimed to identify the relationships between CSA characteristics (abuse form, age, relationship with the offender, context, and frequency), waiting time for psychotherapy, and treatment response. Zero-order correlation analysis and network analysis were performed. The analyses called the attention to two important aspects: victims' perception of guilt and waiting time for treatment. In conclusion, these results show that it is crucial to prioritize the development of guilt-related interventions on the treatment of CSA victims. Additionally, it also demonstrates that the immediate psychological care after the disclosure of the abuse can contribute for impact minimization of this experience on children and adolescents.

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En la actualidad, los ser-vicios de emergencias en los pacientes tienden a tener inconvenientes al acceso a la atención médica en distintas áreas del hospital, convirtiéndose en un problema de salud pública. Objetivo: Determinar el nivel de satisfacción del usuario ex-terno en tiempo de espera en la atención del servicio de emergencias del Hospital General IESS Milagro. Método: El diseño de investigación fue cuantitativo, descriptivo de cohorte transversal. La población fueron todos los pacientes que acudieron a emergencia en el periodo septiembre 2019, tomando una muestra de 170 pacientes. Como técnica se seleccionó la encuesta y como instrumento se elaboró un cuestionario con 15 preguntas valida-do por juicios de expertos en salud comprobando validez, pertinencia y coherencia. Resultados: Rango de edad mayor entre 40 a 49 años (38,8%), sexo masculino (70%), día en la semana que asisten frecuentemente; lunes (33,5%), Evaluación al personal médico; Bueno (47,6%), Compresión de la explicación que brindó el médico; Si (84,7%), Realización de examen físico; Si (72,4%), Compresión de la explicación que brindó el personal de enfermería; Si (87,1%), Evaluación al personal de enfermería; Bueno (55,5%), Evaluación al personal administrativo; Bueno (60,6%), Trato con amabilidad y paciencia; Si (88,2%), Brazalete asigna-do; Azul (64,7%), Tiempo de espera; 30 a 60 min (25,3%), Explicación de ruta a seguir; Siempre (82,4%), Señalética de orientación; A veces (37,6%), Personal para orientar en los servicios de emergencia; Nunca (62,4%). Conclusión. Se encontró altos niveles de insatisfacción en señaléticas y orientación en servicios de emergencia. Sin embargo, el tiempo de espera de los usuarios atendidos fue considerable(AU)

Currently, emergency ser-vices for patients tend to have difficulties in accessing medical care in different areas of the hospital, becoming a public health problem. Objective. To determine the external user satisfaction level in wai-ting time, in the General Hospital IESS Milagro emergency service attention. Me-thod. The research design was quantita-tive, descriptive of the cross-sectional co-hort. The population was all the patients who went to the emergency in the period September 2019, taking a sample of 170 patients. As a technique, the survey was selected and as an instrument, a question-naire with 15 questions was prepared, va-lidated by the opinions of health experts, checking validity, relevance and coheren-ce. Results. Older age range between 40 to 49 years (38.8%), male sex (70%), day in the week that they attend frequently; Monday (33.5%), Evaluation to medical personnel; Good (47.6%). Compression of the explanation provided by the doctor; Yes (84.7%), Performing physical exa-mination; Yes (72.4%), Compression of the explanation provided by the nursing staff; Yes (87.1%), Evaluation of nursing staff; Good (55.5%), Evaluation to admi-nistrative staff; Good (60.6%), I treat with kindness and patience; Yes (88.2%), as-signed bracelet; Blue (64.7%), Waiting time; 30 to 60 min (25.3%), Explanation of the route to follow; Always (82.4%), Orientation signage; Sometimes (37.6%), Personnel to guide emergency services; Never (62.4%). Conclusion. High levels of dissatisfaction were found in signs and orientation in emergency services. Howe-ver, the waiting time of the users served was considerable(AU)

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Antecedentes: la demora en el tratamiento de la litiasis vesicular sintomática (LVS) aumenta el riesgo de complicaciones biliares. Se plantea la hipótesis de que existen diferencias en el tratamiento de la LVS entre el sector público y el de obras sociales del Gran Buenos Aires (GBA). Objetivo: comparar la proporción de pacientes con litiasis biliar complicada (LBC) que presentaban diagnóstico previo de LVS, y evaluar la historia previa de la LBC según la presencia de síntomas y la relación con el sistema de salud. Material y métodos: estudio de corte transversal comparativo entre un hospital público (HPu) y otro privado (HPr) del GBA. Se analizó la historia clínica y se realizó una encuesta a pacientes colecistectomizados por LBC (colecistitis aguda, pancreatitis aguda y coledocolitiasis). Resultados: se incluyeron 105 pacientes del HPu y 136 del HPr. Las características basales difirieron en la edad, nivel educativo, distancia domicilio-hospital y ASA. El diagnóstico previo de LVS fue más frecuente en el HPu (60% vs. 39,7%; p = 0,02), diferencia que se mantuvo luego del ajuste multivariable (OR 2,14; IC 95%: 1,1 a 4,1; p = 0,02). Los pacientes del HPu mostraron una mayor frecuencia de dolores abdominales, tiempo desde el diagnóstico, número de consultas de urgencia luego del diagnóstico y mayor tiempo en lista de espera. Conclusiones: ell HPu mostró mayor pérdida de oportunidad quirúrgica de la litiasis vesicular en un estadio previo no complicado. Las causas podrían ser multifactoriales, pero se necesitan más estudios para corroborar esta hipótesis.

Background: Delays in the treatment of symptomatic cholelithiasis (SCL) increases the risk of biliary complications. There may be differences in the treatment of SCL between the public sector and the social security in the Greater Buenos Aires (GBA). Objectives: The aim of this study was to compare the proportion of patients with complicated gallstone disease (CGD) with previous diagnosis of SCL and to evaluate the history of CGD according to the presence of symptoms and its relation with the health care system. Material and methods: We conducted a cross-sectional study comparing a public hospital (PH) versus a private center (PrH) in the GBA. The clinical records were analyzed and patients with a history of cholecystectomy due to CGD (acute cholecystitis, acute pancreatitis and acute choledocholithiasis) were surveyed. Results: A total of 105 PH patients and 136 PrH patients were included. The baseline characteristics differed in terms of age, educational level, distance from home to hospital and ASA physical status classification. The previous diagnosis of SCL was more common in the PH (60% vs. 39.7%; p = 0.02) and this difference persisted after multivariate adjustment (OR 2.14; 95% CI, 1.1-4.1; p = 0.02). The PH presented more patients with abdominal pain and more visits to the emergency department (ED) after the diagnosis; time after the diagnosis was greater and these patients spent more time on the waiting list. Conclusions: The PH showed greater loss of surgical opportunity of uncomplicated cholelithiasis. This may be due to multiple factors, but further studies are necessary to confirm this hypothesis.

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This document highlights the major achievement of the Ministry of Health for the period 2017-2018. Contains information about compassionate care, the strengthening of the health system , treatment of non-communicable, combating communicable diseases, protecting the health of mothers and children and rehabilitation and new investment in critical health infrastructure.

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PURPOSE: We retrospectively examined the potential effect on overall survival (OS) of delaying radiotherapy to administer neoadjuvant therapy in unresected glioblastoma patients. PATIENTS AND METHODS: We compared OS in 119 patients receiving neoadjuvant therapy followed by standard treatment (NA group) and 96 patients receiving standard treatment without neoadjuvant therapy (NoNA group). The MaxStat package of R identified the optimal cut-off point for waiting time to radiotherapy. RESULTS: OS was similar in the NA and NoNA groups. Median waiting time to radiotherapy after surgery was 13 weeks for the NA group and 4.2 weeks for the NoNA group. The longest OS was attained by patients who started radiotherapy after 12 weeks and the shortest by patients who started radiotherapy within 4 weeks (12.3 vs 6.6 months) (P = 0.05). OS was 6.6 months for patients who started radiotherapy before the optimal cutoff of 6.43 weeks and 19.1 months for those who started after this time (P = 0.005). Patients who completed radiotherapy had longer OS than those who did not, in all 215 patients and in the NA and NoNA groups (P = 0.000). In several multivariate analyses, completing radiotherapy was a universally favorable prognostic factor, while neoadjuvant therapy was never identified as a negative prognostic factor. CONCLUSION: In our series of unresected patients receiving neoadjuvant treatment, in spite of the delay in starting radiotherapy, OS was not inferior to that of a similar group of patients with no delay in starting radiotherapy.

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This document highlights the major achievement of the Ministry of Health for the period 2016-2017. Contains information about compassionate care, the strengthening of the health system , treatment of non-communicable diseases, combating communicable diseases, protecting the health of mothers and children, rehabilitation and new investment in critical health infrastructure.

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Contexto: los tiempos de espera para la atención son una de las principales barreras en el acceso a los servicios de salud en Argentina. Objetivo: analizar los tiempos diferenciales que la población tuvo que aguardar en la sala de espera y entre la solicitud de un turno y la atención con un médico especialista, según sus características socioeconómicas, demográficas, el tipo de cobertura de salud y el lugar de residencia. Método: cuantitativo, basado en el análisis de datos secundarios. Se utilizó la Encuesta de la Deuda Social Argentina del año 2013, realizada por el Observatorio de la Deuda Social Argentina de la Universidad Católica Argentina. Resultados: los tiempos de espera para consultar con un médico estuvieron estratificados socialmente, según las características socioeconómicas, tipo de cobertura y lugar de residencia de la población. No existieron diferencias significativas según el sexo y entre los grupos etarios.

Contexto: os tempos de espera para os cuidados são um dos principais obstáculos no acesso aos serviços de saúde na Argentina. Objetivo: analisar os tempos diferenciais que as pessoas tiveram que esperar na sala de espera e entre o pedido para um compromisso e cuidado com um médico especialista, de acordo com suas características demográficas, socioeconómicas, tipo de cobertura de saúde e residência. Método: quantitativo, com base na análise de dados secundários. Foi utilizada a pesquisa "Encuesta de la Deuda Social Argentina" 2013, realizada pelo "Observatorio de la Deuda Social Argentina (Universidad Católica Argentina)". Resultado: os tempos de espera para ver um médico estiveram socialmente estratificados de acordo com as características socioeconómicas, tipo de cobertura e residência da população. Não houve diferenças significativas por sexo e grupos etários.

Context: The waiting times for medical attention constitutes one of the main barriers to access to the Healthcare System in Argentina. Objective: Analyse different times that people have to keep in the waiting room and between the request for an appointment and the medical attention with a specialist according to their socio-economic and demographic characteristics, the type of health coverage and place of residence. Method: quantitative, based on the analysis of secondary data. It was implemented in the Survey of "La Deuda Social Argentina" of the year 2013, conducted by the "Observatorio de la Deuda Social Argentina (Universidad Católica Argenitna)". Results: The waiting time to see a doctor it's socially stratified according to socioeconomic characteristics, type of medical coverage and place of residence of the population. There are no significant differences between gender and across age groups.

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Objective To evaluate the effect of waiting time (WT) to radiotherapy (RT) on overall survival (OS) of glioblastoma (GBM) patients as a reliable prognostic variable in Brazil, a scenario of medical disparities. Method Retrospective study of 115 GBM patients from two different health-care institutions (one public and one private) in Brazil who underwent post-operative RT. Results Median WT to RT was 6 weeks (range, 1.3-17.6). The median OS for WT ≤ 6 weeks was 13.5 months (95%CI , 9.1-17.9) and for WT > 6 weeks was 14.2 months (95%CI, 11.2-17.2) (HR 1.165, 95%CI 0.770-1.762; p = 0.470). In the multivariate analysis, the variables associated with survival were KPS (p < 0.001), extent of resection (p = 0.009) and the adjuvant treatment (p = 0.001). The KPS interacted with WT to RT (HR 0.128, 95%CI 0.034-0.476; p = 0.002), showing that the benefit of KPS on OS depends on the WT to RT. Conclusion No prognostic impact of WT to RT could be detected on the OS. Although there are no data to ensure that delays to RT are tolerable, we may reassure patients that the time-length to initiate treatment does not seem to influence the control of the disease, particularly in face of other prognostic factors. .

Objetivo Avaliar o efeito do tempo de espera (TE) até radioterapia na sobrevida global de pacientes com glioblastoma como um fator prognóstico confiável. Método Estudo retrospectivo de 115 pacientes com glioblastoma, que foram submetidos à radioterapia pós-operatória, em dois serviços diferentes no Brasil (um público e outro privado). Resultados Mediana de TE para radioterapia foi de 6 semanas (variação, 1,3-17,6). A mediana de sobrevida para TE ≤ 6 semanas foi de 13,5 meses (IC95%, 9,1-17,9) e para TE > 6 semanas foi de 14,2 meses (IC95%, 11,2-17,2) (HR 1,165, 0,770-1,762; p = 0,470). Na análise multivariada, as variáveis associadas à sobrevida foram perfomance status (p < 0,001), extensão da ressecção (p = 0,009) e tratamento adjuvante (p = 0,001). Conclusão Não se observou impacto prognóstico para TE até a radioterapia na sobrevida. Diante de outros fatores prognósticos, é possível assegurar de que o espaço de tempo até a radioterapia não parece influenciar o controle da doença. .

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ANTECEDENTES Considerando a la Atención Primaria de Salud (APS) como el primer contacto que un paciente tiene con el sistema público de salud, la satisfacción y el trato que los usuarios reciban en este nivel es importante para entregar una atención de calidad. Un estudio realizado por el MINSAL el año 2013 muestra que, si bien la evaluación que los usuarios hacen del trato en la APS tiene una puntuación media aceptable, aún es posible mejorar la satisfacción percibida. En este contexto se solicita esta síntesis de evidencia con el objetivo de informar la toma de decisiones respecto del efecto de una política para contar con recepcionistas en el primer contacto del usuario con la atención primaria. METODOLOGÍA Se formuló una estrategia de búsqueda para ser utilizada en las bases de datos PubMed, Cochrane Library y PdQ Evidence con el objetivo de identificar revisiones sistemáticas del tema. Como no se encontraron, se procedió a seleccionar estudios primarios seleccionando preferentemente aquellos que incluían información relevante. RESULTADOS El resumen utiliza no utiliza revisiones sistemáticas -El apoyo que el recepcionista otorga al paciente se relaciona con la satisfacción global del usuario con el servicio entregado. -Los usuarios tienen un alto nivel de satisfacción con la ayuda y amabilidad de los recepcionistas, lo que en algunos casos podría llegar a ser superior a la de otros profesionales de la salud. -Los recepcionistas se involucran exitosamente en el manejo emocional de pacientes, no obstante, son susceptibles de recibir maltrato y violencia al estar en el primer contacto con usuarios. -Los problemas que los pacientes atribuyen a los recepcionistas se centran en labores administrativas que no siempre se relacionan con el comportamiento de éste en el establecimiento de salud.

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INTRODUCTION: Waiting time in the Emergency Departments is a major source of patient dissatisfaction in hospitals. Triage attempts to have the most critically ill patients seen first with an overall reduction in waiting time. Triage teams may include specially trained nurses or alternatively a specialist physician. The aim of this study was to determine if inclusion of a specialist physician on the triage team at the University Hospital of the West Indies (UHWI) in Kingston Jamaica reduced waiting time and improved patient satisfaction. METHODS: A prospective, cross sectional survey of ambulatory care patients was undertaken in 2006. Triage was completed by a team consisting of a doctor and two nurses during the first week and by nurses only during the second week. RESULTS: The study showed that there was no significant difference in the length of time patients spent in the emergency department based on whether or not they were triaged by a physician led team or by a team of nurses only. Type of triage team did not affect the level of patient satisfaction. Waiting time was significantly influenced by factors which came into play after triage such as the wait for X-ray and laboratory services. CONCLUSIONS: There appears to be no reduction in waiting times experienced by patients at the UHWI emergency department as a result of inclusion of a specialist emergency physician in the triage process. This suggests that specialist emergency department nurses are adequately trained in triage, and that delays in the triage process at UHWI are due to other factors.

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INTRODUÇÃO: A eqüidade na atenção à saúde tem sido alvo de grande preocupação, incluindo países em desenvolvimento e desenvolvidos. A eqüidade horizontal, entendida como tratamento igual de indivíduos que se encontram na mesma situação de saúde, tem sido investigada nos diferentes níveis de atenção à saúde. OBJETIVOS: O presente estudo busca verificar se existem disparidades no tempo de espera para cirurgias eletivas (safenectomia, colecistectomia, hemorroidectomia e histerectomia) segundo o tipo de hospital, público ou privado. METODOLOGIA: Realizou-se, em Sorocaba, um estudo transversal com 40 pacientes atendidos por hospital privado e 40 atendidos por hospital público, no período de outubro e novembro de 2005. Além do tempo de espera e tipo de hospital, foram pesquisados sexo, idade, escolaridade, renda, situação conjugal, procedência, tipo de cirurgia realizada e presença de determinadas comorbidades. RESULTADOS: Observou-se um tempo de espera maior nas categorias: hospital público (5,5 meses; p<0,001), baixa escolaridade (3,5 meses; p<0,001), menor renda (Spearman=-0,4426; p<0,001), procedência de outros municípios (2 meses; p=0,009), e cirurgia de safenectomia (5 a 7 meses; p=0,04). Após o ajuste para as variáveis comorbidade, renda, escolaridade ou procedência, o tempo de espera no hospital público se manteve significantemente maior (diferença mínima de 4,93 meses quando ajustada por renda; IC95 por cento 3,4-6,4; p<0,001). CONCLUSÃO: Verifica-se relevante iniqüidade na atenção à saúde relacionada ao tipo de prestador de serviços de saúde.

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