BackgroundIn addition to mortality, Health Related Quality of Life (HRQOL) has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL) six months after discharge from an Intensive Care Unit (ICU), and to study its determinants.MethodsAll post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS), type and magnitude of surgical procedure, ICU and hospital length of stay (LOS), mortality and Simplified Acute Physiology Score II (SAPS II). Six months after discharge, a Short Form-36 questionnaire (SF-36) and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36.ResultsOut of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV), had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01 – 1.11, p = 0,016). Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI) and personal ADL (ADLP). ASA-PS (OR 3.00, 95%CI 1.31 – 6.87, p = 0.009) and age (OR 2.36, 95%CI, 1.04 – 5.34, p = 0.04) were associated with dependency in ADLI. For ADLP, only ASA-PS (OR 4.58, 95%CI, 1.68–12.46, p = 0.003) was associated with higher dependency.ConclusionASA-PS, age, type of surgery, ICU LOS and SAPS II could be seen as determinants of HRQOL.

There is often a negative association between the volume of medical procedures and hospital mortality rates. The objective of this study is to determine whether this association is observed in

Brazilian hospitals performing coronary artery by-pass graft surgery (CABG) from 1996 to 1998 and covered by the Ministry of Health were ranked according to their risk-adjusted hospital mortality rates. Seventy-six hospitals that performed more than 150 CABGs (total of 38,962 surgical interventions) were classified as low or high outliers according to the ratio between observed and expected hospital mortality rates. Overall hospital mortality rate was 7.20%. The rate was 3.48% among patients treated in the low outliers and 13.96% among the high outliers. The methodology was useful for discriminating Brazilian hospitals according to their post-CABG mortality rates and may be a useful tool for identifying hospitals with possible quality-of-care problems.

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RESUMOObjetivo: Analisar os fatores de risco para doenças crônicas não transmissíveis entre colaboradores de uma instituição privada. Trata-se de um estudo descritivo, documental, com abordagem quantitativa, realizado a partir de uma investigação em um banco de dados. Os dados foram tabulados por meio do Software de Gestão -Infomed e apresentados em gráficos e tabelas. O tratamento dos dados se deu através de análise estatística descritiva. Os resultados evidenciaram alta prevalência de excesso de peso (61%), tabagismo (2%), etilismo (58%), sedentarismo (72%) e alimentação não saudável (83%). Nas doenças já instaladas evidenciou-se hipertensão arterial sistêmica em 10% dos entrevistados, 11% com dislipidemia, 7% têm problemas respiratórios, 2,8% são diabéticos e 0,8% têm depressão. Foi possível constatar que os colaboradores apresentam alto risco para o desenvolvimento de doenças crônicas não transmissíveis em decorrência da alta prevalência dos fatores de risco observados no estudo. Descritores ABSTRACTObjective: To analyze the risk factors for chronic diseases among employees of a private institution. This is a descriptive study, documentary, with a quantitative approach, carried out from an investigation into a database. The data were tabulated through Management Software -Infomed and presented in graphs and tables. The processing of data through descriptive statistical analysis. The results showed a high prevalence of overweight (61%), smoking (2%), alcohol (58%), physical inactivity (72%) and unhealthy diet (83%). The already installed disease showed up arterial hypertension in 10% of subjects, 11% had dyslipidemia, 7% have respiratory problems, diabetics are 2.8% and 0.8% have depression. It was found that the employees have high risk for developing chronic non-communicable diseases due to the high prevalence of risk factors observed in the study.

Resumo: A transição demográfica aponta para um quadro de envelhecimento populacional cada vez mais marcante, desta forma torna-se imprescindível garantir aos idosos não só uma maior sobrevida, mas também melhorias na qualidade de vida (QV) que lhes possibilitem uma velhice bem sucedida. O estudo objetivou mensurar os níveis de qualidade de vida de idosos participantes de um grupo de convivência de São Mamede-PB. A amostra foi composta por 30 idosos. Utilizou-se uma ficha de dados biodemográficos e a versão em português do WHOQOL-OLD. Verificou-se que os idosos que participaram da pesquisa tinham uma média de idade de 72,8 anos (±5,18), com predomínio do gênero feminino 93,33%, a maioria, 46,6% eram viúvas, 73,3% com baixo nível de escolaridade, 36,6% do total de idosos vivem sozinhos, outros 36,6% vivem com o cônjuge, e têm a aposentadoria como principal fonte de renda. A média da QV geral encontrada nesta pesquisa foi de 4,2 (±0,4), o que corresponde a 81,4%, indicando que os idosos estudados apresentaram uma boa QV. Todas as facetas foram bem avaliadas exceto a faceta intimidade com menor pontuação 2,2 (±1,7), a que mais contribuiu na QV foi autonomia com média de 4,8 (±0,3). Conclui-se que a inserção dos idosos em grupos de convivência é um ponto chave muito importante para a melhoria da QV dos mesmos, principalmente, nos aspectos referentes à saúde física e mental.Palavras-chave: Idosos.Qualidade de Vida. WHOQOL-OLD. Abstract:The demographic transition points to a population aging framework increasingly marked, so it is essential to ensure the elderly not only to live longer, but also improvements in quality of life (QOL) to enable them a successful old age. The study aimed to measure the levels of quality of life of elderly participants of a support group to São Mamede-PB. The sample consisted of 30 elderly. We used a biodemographical data sheet and the Portuguese version of the WHOQOL-OLD. It was found that seniors who participated in the survey had an average age of 72.8 years (± 5.18), with a predominance of females 93.33%, the majority, 46.6% were widowed, 73.3 % with low level of education, 36.6% of the elderly live alone, some 36.6% live with their spouse, retirement as the main source of income. The average overall QoL found in this study was 4.2 (± 0.4), which corresponds to 81.4%, indicating that the elderly studied showed a good QoL. All facets were well judged except facet intimacy with lower scores 2.2 (± 1.7), the largest contributor in QOL was autonomy with an average of 4.8 (± 0.3). It concluded that the inclusion of older people in community groups is a very important key to improving the QOL of the same, especially in aspects related to physical and mental health. Given that these groups seek to increase the period of active life, preventing functional loss and retrieving capabilities, and serve as emotional and motivational support for these seniors.

Introduction: COVID-19 requires governmental measures to protect healthcare system access for people. In this process, the collision of fundamental rights emerges as a crucial challenge for decision-making.Policy Options and Implications: This policy review analyzes selected articles by the PubMed searcher about extreme measures taken in several countries during precedent pandemics and the current pandemic, and selects hard decisions relating to the exceptional measures taken by judicial departments in Brazil, connecting them to the “collision of fundamental rights and law principles.” The collision of rights and principles imposed on decision makers a duty to provide balanced rights, and to adopt the enforcement of some rights prioritization. Ethical concerns were also verified in this field involving rights limitations. During a pandemic, the importance of extreme measures to protect health rights and healthcare systems is instrumental for focused, fast, and correct decision making to avoid loss of life and the collapse of healthcare systems. The main goals of this research are to discuss the implications and guidelines for public health decision making, the indispensable ethical and legal aspects for safeguarding health systems and the lives of people, and the respect of the Justice principle and of fundamental health and dignity rights. We conclude that COVID-19 justifies the prioritization of collective and individual health access rights. Acceptable standards of fundamental rights restrictions are established at the constitutional and international levels and must be enforced by rules and governmental action, to ensure fast and accurate decision making during a pandemic. Freedom rights exercises must be linked to solidarity for the realization of social welfare, for the health rights of all individuals and for health systems to function well during a pandemic.Actionable Recommendations: All individuals are free and equal, therefore social exclusion is prohibited. Institutions must consider social inequalities when discussing public health measures and be guided by ethical standards, by law principles, and rules recognized by constitutional and international law for the benefit of all during a health pandemic.Conclusions: Collective and individual health rights prevail over the collision of rights when facing pandemic occurrences, case by case, in health systems protection, based on the literature, on precedent pandemics and on legitimate Public Health efforts.