Biomedical subjects

E Harzheim

Publications and source records attributed to E Harzheim.

3 recordsLinked to original sources

PubMed2002

The relevance of continuity of care: a solution for the chaos in the emergency services.

BACKGROUND: In Brazil, there continues to be an excessive use of emergency services by patients with elective medical problems. Those patients who report having a primary care physician are less likely to utilize the emergency department for non-urgent consultations. OBJECTIVE: The objective of this study was to compare patients who have a primary care physician with those who do not in relation to severity of their chief complaint at presentation in the emergency department. METHODS: The study was carried out as a cross-sectional interview-based survey at the Conceição Hospital Emergency Service in Porto Alegre (Brazil). The sample was 553 patients selected through a systematic random sampling, and the response rate was 88%. The data entry and analysis were performed using the software Epi-info, EGRET and SPSS. The analysis included simple statistics to determine the prevalence of the conditions being investigated and the effect of independent variables (regular doctor) in relation to the dependent variable (severity of disease) through logistic regression. RESULTS: The chief complaints were divided up as follows: 15% emergency cases, 46% urgent cases and 39% elective. The chief complaint was defined as urgent or emergency if it exhibited a significantly statistical association with the following independent variables, after being analysed by a logistic regression model: patients who reported having a primary care physician [odds ratio (OR) = 2.98, 95% confidence interval (CI) = 1.84-4.80] and patients who usually go to the emergency room by car (OR = 2.67, 95% CI = 1.75-4.05). CONCLUSION: One strategy to reduce the number of non-urgent consultations at emergency rooms is to establish a close out-patient relationship between patients and physician. There is a need to optimize the health care of patients who have non-urgent problems but still seek the emergency department through strategies at the primary health care level-especially when continuous care is available-and where a comprehensive approach with an emphasis on prevention would stimulate better quality of care at a lower cost.

Brazil↗

PubMedDate not supplied

[The pyramid trap].

This paper discusses the impact of globalization on public health practice. Neoliberal supremacy has resulted in both greater interdependence between countries and increasing inequalities. Globalization of health risks and the dependence of local health conditions on external forces precludes the use of local/national solutions for global problems. In this context, the classical organization of public health services in a hierarchical pyramid based on geographically defined areas (from the local to the regional and national levels) no longer makes sense. We thus suggest some characteristics of a different type of organization based on new information technologies: a transnational network, horizontally shaped, more independent from political power, allowing for exchange of information and good practices, promoting dissemination of knowledge and producing "glocal" solutions. Through the creation of work opportunities between health professionals, the model will permit the creation of common strategies and increase the power of their political demands, perhaps allowing for the collective development of a more equitable world.

Brazil↗

PubMedDate not supplied

[Risk factors related to esophageal cancer in Rio Grande do Sul, Brazil].

BACKGROUND: Rio Grande do Sul, a State in southern Brazil, shows high mortality rates for esophageal cancer. Important geographical variations suggest external factors in the etiology. OBJECTIVE: The relationship between smoking, alcohol and "mate" to esophageal cancer. METHOD: 55 patients with esophageal cancer were interviewed, soon after the endoscopy, about risk factors; 110 patients who did not showed esophageal tumor in the endoscopy were the controls. RESULTS: Among the patients with esophageal cancer there were more farmer-workers (OD 3.3; 95% CI 0.9-11.2), father with antecedent cancer (OD 6.9; 95% CI 1.9-25.6), smoking and ex-smoking (OD 2.5; 95% CI 1.1-5.9), drinkers and ex- of alcohol (OD 5.3; 95% CI 2.6-11.0), drinkers and ex- of "mate" (OD 3.6; 95% CI 1.3-9.8). Others variables more frequent in the cases were: smoking for > 20 years; kind of alcohol (spirits), drinking alcohol every day, drinking "mate" every day and adding salt to food. CONCLUSIONS: Smoking, alcohol, "mate", farmer-workers and antecedent of father with cancer were significantly more frequent in the cases of esophageal cancer than in the controls.

Adult↗