For appointments please call 865-238-1040. Metabolic disorder and obesity in 5027 Brazilian postmenopausal women. endstream endobj 60 0 obj <. PubMed (1998) highlighted the importance to provide an empirical context for the ongoing investigation of equity in the distribution of health care [29]. The authors wish to acknowledge the Dr. Claudio Leone, Associate Professor, Department of Public Health, University of Public Health of So Paulo. The research project was analyzed and approved by the Ethics Committee of the Medical School of the University of So Paulo, according to the protocol no. The Chi-square test was used for qualitative variables and Crude Relative Risk for the proportion of gynecology diagnosis in relation to the distribution of health sectors. What is AMB meaning in Neurosurgery? However, special attention is given to the need to optimize services and referral flows at different levels of attention to the quality of health care [13, 14], especially in womens health. 2007;13(2):11521. Camila Lohmann Menezes, Email: moc.liamg@sezenem.hol.alimac. Update: a review of Womens health fellowships, their role in interdisciplinary health care, and the need for accreditation. Health services were characterized by the type of provided care; this analysis focused on three different sectors: primary sector (basic health unit and school health center), secondary sector (university hospital, hospital of medium complexity, and specialty ambulatory clinics), and tertiary sector (hospital of high complexity and hospital with cancer support). ATMS, JMSJ, ECB, LCA and ICES were involved with editing the manuscript. The traditional health system information and care provided are limited due to lack of knowledge of the characteristics of those who do not seek health services. AMB Neurosurgery Abbreviation. The aim of ambulatory gynaecology is to admit, treat and discharge the patient on the same day in an outpatient setting. Int J Impot Res 2004;16(2):160166. An obstetrician-gynecologist, or OB-GYN, has expertise in female reproductive health, pregnancy, and childbirth. Diseases of the urinary system, general physical examination, contraception and procreation are health diagnoses that remain in the primary and secondary sectors in the distribution of health services. Nedel FB, Facchini LA, Martn-Mateo M, Vieira LAS, Thum E. Family health program and ambulatory care-sensitive conditions in southern Brazil. Mustard et al. 2002;100(4):6837. Some OB-GYNs offer a wide range of general health services similar to your primary care doctor. Spedo SM, Pinto NRS, Tanaka OY. Instead, descriptive studies of the use of health care services typically document higher per capita use by women during the adult reproductive period [14, 30,31,32]. Vital and health statistics Series 13, Data from the National Health Survey. 2008:284351. Ct I, Jacobs P, Cumming DC. Edige Felipe de Sousa Santos, Email: rb.psu@egide. Starfield B, Shi L, Macinko J. Others focus on the medical care of the female reproductive system. BMC Women's Health Rodriguez R, Myriam; Rodriguez V, Laura A.; Heredia-PI, Ileana. Rio de Janeiro: Fiocruz; 2008. p. 62773. Bagnoli VR, Fonseca AM, Arie WM, et al. PubMed RR=5.97 (1.45: 24.70) [Non-inflammatory disorders of female genital tract (N80-N99)]; RR=1.97 (0.52: 7.50) p=0.33 [Disorders of breast (N60-N64)], Proportion of gynecology diagnoses in relation to the distribution of health sectors at Womens Health Ambulatory Clinic of the University Hospital at So Paulo University, So Paulo -Brazil (20122014). The authors wish to acknowledge the Dr. Claudio Leone, Associate Professor, Department of Public Health, University of Public Health of So Paulo. Sort. CAS When the categories of the variables were analyzed, there were fields that were not filled. 2005. The framework builds on the Standards for Gynaecology report (PDF) published by the RCOG in 2008. Concerning sexual activity, 70.47% (n=253) had an active sexual life. http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Article Thus, the objective is analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory care, and their distribution in health services. 1998;338(23):167883. Gee RE, Rosenbaum S. The affordable care act: an overview for obstetricians and gynecologists. Luiz Carlos de Abreu, Email: rb.psu@solracziul. ISSNe. We have a secure online referral service to help you refer patients to Mayo Clinic and view their clinical results, including: Mayo Clinic has agreements with many insurance carriers, third-party administrators and employers. In conclusion, the attended and referenced women are in the late-reproductive period. The standardizing data abstraction tool had responses for categorical variables specify single responses, multiple responses or coded responses. Disclaimer. Interface (Botucatu). Fellowship Information Contact Us For additional information, please contact the administrative office for the Division of Maternal Fetal Medicine at 734-764-1406. Rev Saude Publica. J Women's Health. Tsai MC, Goldstein SR. Office diagnosis and Management of Abnormal Uterine Bleeding. Proportion of gynecology diagnoses in relation to the distribution of health sectors at Womens Health Ambulatory Clinic of the University Hospital at So Paulo University, So Paulo -Brazil (20122014). All the information regarding clinical-demographic and gynecological profiles, type of treatment, and medical referrals were extracted from standardized gynecologic medical records, and a database in Excel format was created. Ministrio da Sade. Therefore, population-based prevalence studies, when representative, have an advantage and allow estimates of epidemiological behavior for the entire community in which they were performed [16]. Vital and health statistics. Rawaf S, De Maeseneer J, Starfield B. The variables were grouped by demographic characteristics (age, ethnicity, profession) and clinical characteristics (main complaint, clinical and gynecological diagnosis, concomitant diseases multimorbidity, age of menarche and menopause, onset of sexual activity, parity and smoking). J Women's Health (Larchmt). If you have trouble please contact our office at 314-747-1402) Place Ambulatory Referral Order within EPIC using your groups referral order build. The authors declare that they have no competing interests. The studied women in this research are economically productive. 1), the non-oncological gynecological diagnoses mostly referred to the tertiary sector and the non-inflammatory disorders of the female genital tract (93.3%). Lei no 8.080, de 19 de setembro de 1990. Regarding clinical-gynecologic characteristics, they are in their late reproductive period, are sexually active, have formed offspring (multiparity), have at least one associated morbidity and are non-smokers. So Paulo: Universidade de So Paulo; 1997;1(5). Portuguese [. The main health diagnoses in gynecology found in our study, as non-inflammatory disorders of the female genital tract and diseases of the urinary system, have negative influences both on the health and quality of life of women in a late and non-reproductive period [38, 39]. Dias-da-Costa JS, Presser AD, Zanolla AF, et al. Regarding clinical-gynecologic characteristics, they are in their late reproductive period, are sexually active, have formed offspring (multiparity), have at least one associated morbidity and are non-smokers. Our study was conducted in a training program with an emphasis on womens health [18, 19], and the results therefore found in the main health diagnoses identified may be themes of continuing education. In relation to the presence of concomitant diseases, 17.78% (n=72) had two or more associated morbidities, and 79.48% (n=275) did not smoke. These include: Ambulatory referral to Mass General Pediatric Speech, Language and Swallowing; Ambulatory referral to Mass General Speech Language Swallowing Conselho Nacional de Secretrios de Sade. The new framework provides an up-to-date structure for the delivery of quality improvement and safe care in gynaecology. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. ATMS, JMSJ, ECB, LCA and ICES, were involved with data management. The .gov means its official. FOIA Dirio Oficial da Unio 1990. The research project was analyzed and approved by the Ethics Committee of the Medical School of the University of So Paulo, according to the protocol no. Shapley M, Jordan K, Croft PR. Forman MR, Mangini LD, Thelus-Jean R, Hayward MD. Social science & medicine, cial science & medicine. 2016;25(11):10834. BMC Health Serv Res,2016;16(1):576. The distribution of health services was based on the sector of origin (referencing) and the sector of destination, where the patient received care or returned to the place of origin (counter-referencing). CID-10 Classificao Estatstica Internacional de Doenas e. Problemas Relacionados Sade. Nedel et al. FOIA The distribution in health services was the following: 71.30% (n=305) in the primary sector, 21.70% (n=93) in the secondary sector and 7% (n=30) in the tertiary sector. Ct I, Jacobs P, Cumming DC. However, in order to generate reliable data from the experimental empirical basis, they were transformed into a missing category. Shi L.The Impact of Primary Care: A Focused Review. O difcil acesso a servios de mdia complexidade do SUS: o caso da cidade de So Paulo, Brasil. Patient Referral Information A p value <0.05 was considered to be statistically significant. Demand for gynecologic and obstetric care services is projected to rise from 6 to 10% in developed and developing countries [10, 11], and 5081% of the time of checkups by obstetrician-gynecologists (OB-GYNs) is currently dedicated to women of reproductive age (1844years old) with a growth estimate of 7% in the non-reproductive period [12, 13]. This number is staffed 8:00 a.m. - 5:30 p.m., Monday through Friday. The return to low assistance complexity was present in most cases regarding the distribution of the utilization of services. The studied women presented non-inflammatory disorders of the female genital tract and diseases of the urinary system as determined by gynecological diagnoses. Telephone consultations are available in most medical and surgical specialties at Mayo Clinic 24 hours a day, seven days a week. CAS and transmitted securely. Wang ET, Cirillo PM, Vittinghoff E, Bibbins-Domingo K, Cohn BA, Cedars MI. With regard to the destination of the patients, following the distribution of health services utilization since the Womens Health Ambulatory Clinic of the University Hospital at So Paulo University (Fig. The Brazilian health system: history, advances, and challenges. The female patients present non-inflammatory disorders of the female genital tract (81.07%, n=347) and diseases of the urinary system (22.66%, n=97) among the gynecological diagnoses. Clinical-demographic characteristics, gynecological and obstetric history of patients seen at the Womens Health Ambulatory Clinic of the University Hospital at So Paulo University, So Paulo, Brazil (20122014). INRAE center Clermont-Auvergne-Rhne-Alpes Cheon C, Maher C. Economics of pelvic organ prolapse surgery. Please visit insurance at Mayo Clinic for more information. The group was based on similarities in clinical symptoms and patient presentation and similarities in management or diagnostic assessment. For Example "Ambulatory Referral to Urogynecology" Open Order Ensure Performing Region is Set to: External Order as the order is leaving your facility Premenstrual syndrome and increased blood pressure: a new risk factor for cardiovascular disease in women? Would you like email updates of new search results? Clinical and demographic information, gynecological diagnoses (International Classification of Diseases), and distribution of health services (primary, secondary, and tertiary) were described. In cases where a single patient presented two or more diagnoses, each of these was described separately. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). CID-10 Classificao Estatstica Internacional de Doenas e. Problemas Relacionados Sade. The ethics committee waived the need for informed consent by participants in the current study. Further evaluation of the connection between changes in the health system and the observed trends and guidelines could not be assessed given that several different guidelines on womens health screening were issued in our country [27, 28]. Life-course origins of the ages at menarche and menopause. 3. (415) 353-2722 Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Koo M, Chen CH, Tsai KW, MC L, Lin SC. [. Soc Sci Med. Thus, the clinical control of these patients through the incorporation of drug therapy, which can be performed in the primary and tertiary sectors, is fundamental to avoid high costs and reduce morbidities. Ministrio da Sade. What does OB / GYN stand for in medical category? 2014;30(10):71720. Think before you speak. Nicholson et al. Bethesda, MD 20894, Web Policies In Table2, the main health diagnoses for non-oncological gynecology, considering both reproductive and non-reproductive periods, were the non-inflammatory disorders of the female genital tract (81.07%, n=347) and diseases of the urinary system (22.66%, n=97). In: Giovanella L, et al., editors. dos Santos Fernandes AM, Yamada EM, de Azevedo Sollero C, Lemes LCP. The ethics committee waived the need for informed consent by participants in the current study. Breast cancer incidence in a cohort of women with benign breast disease from a multiethnic, primary health care population. Vote. Foreman H, Weber L, Thacker HL. The https:// ensures that you are connecting to the Call the Referring Provider Office to arrange. Menstrual irregularity and cardiovascular mortality. Nicholson et al. hbbd```b`` ">Rof`+]`L`?Ya \`@!lS f?#cn;%t@ 7|Q Referral gynecological ambulatory clinic: principal diagnosis and The non-inflammatory disorders of the female genital tract were 71.52% (n=236); diseases of the urinary system were 13.33% (n=44); inflammatory diseases of female pelvic organs were 6.67% (n=22); general physical examination, contraception and procreation were 4.85% (n=16) and diseases of the breast were 3.64% (n=12); these are the most frequent non-oncological gynecological diagnoses during the reproductive period in the visits of these women. Inclusion in an NLM database does not imply endorsement of, or agreement with, Thus, the objective is to analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory settings, and their distribution in health services. 1Division of Gynecology, Medical School, University of So Paulo, So Paulo, SP Brazil, 2Laboratory of Study Design and Scientific Writing, ABC Medical School, So Paulo, SP Brazil, 3Avenida Enas de Carvalho Aguiar, 255 10 andar sala 10166, So Paulo, SP CEP: 05403000 Brazil. We grouped the principal diagnoses in five disease categories [14]: 1) Diseases of the urinary system (N30 - N39) urinary incontinence, cystitis, neuromuscular disorders of the bladder, other disorders of the urinary system, urethritis and urethral syndrome, urethral stricture, other urethral disorders, bladder disorders; 2) Disorders of the breast (N60 - N64) - benign mammary dysplasias, inflammatory disorders of breast, hypertrophy of breast, unspecified lump in breast, fistula and fissure of the nipple, fatty necrosis of the breast, atrophy of breast, non-associated to birth galactorrhoea, mastodynia, solitary cyst of the breast; 3) Inflammatory diseases of female pelvic organs (N70 - N77) - lower genital tract infections (herpes, gonorrhea, chlamydia, Trichomonas, Candida, vulvovaginitis, syphilis), infectious vulvar lesions, inflammatory disease of the upper genital tract, such as disease of the uterus, ovaries, fallopian tubes including cervicitis, salpingitis, endometritis, and tube-ovarian abscess, diseases of Bartholin gland, vulvovaginal ulceration and inflammation; 4) Non-inflammatory disorders of the female genital tract (N80 - N99) genital dysplasia (precancerous lesions of the vulva, vagina, and cervix), menopausal disorders, menstrual disorders and hormonal dysfunction (dysfunctional uterine bleeding, ovarian hyperestrogenism, ovarian dysfunction, or irregular menstrual Cycles), endometriosis, malignancy of the reproductive tract (carcinoma in situ and invasive disease of the genital tract) benign disorders of the uterus and ovaries (benign ovarian cysts or tumors, leiomyomas, endometrialpolyps, orhyperplasia), infertility; 5) General physical examination, contraception and procreation (Z00 - Z31) general examination and investigation of people without complaints about contraception, general advice about contraception, insertion of contraceptive devices (intrauterine), sterilization and measures of procreation [10, 11]. Referrals Obstetrics and Gynecology - Mayo Clinic 2013;22(7):6438. Rodrigues et al. Casas RS, Hallett LD, Rich CA, Gerber MR, Battaglia TA. Mayo Clinic obstetric and gynecology physicians are committed to collaborating with referring physicians. GIPSA-lab | LinkedIn Ateno ambulatorial especializada. When demographic factors were analyzed, it was verified that 56.64% (n=251) were White, and in relation to remunerate activity, 57.42% (n=236) were economically active. Obstet Gynecol. Therefore, population-based prevalence studies, when representative, have an advantage and allow estimates of epidemiological behavior for the entire community in which they were performed [16]. %%EOF There were a higher proportion of non-inflammatory disorders of the female genital tract (62.36%, n=111) and diseases of the urinary system (29.78%, n=53) in the non-reproductive period. The chances of diagnosis of non-inflammatory disorders of the female genital tract and general physical examination, contraception and procreation are significantly different (p<0.05) during the non- reproductive period. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. Appointments and Referrals to the Speech, Language and Swallowing Male and female morbidity in general practice: the nature of sex differences. Technical efficiency of womens health prevention programs in Bucaramanga, Colombia: a four-stage analysis. The world health report 2003: shaping the future. Male and female morbidity in general practice: the nature of sex differences. The use of ambulatory and hospital care services has limited results in the capacity to describe the search behavior of women in relation to obtaining integral health care [16, 17]; the gynecological concerns most often cited are menstrual disorders, other forms of normal bleeding of the female genital tract, inflammatory processes, and urogenital dysfunctions [1316].
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