IntroductionHigher mortality for patients admitted to intensive care units (ICUs) during the weekends has been occasionally reported with conflicting results that could be related to organisational factors. We investigated the effects of ICU organisational and staffing patterns on the potential association between weekend admission and outcomes in critically ill patients.MethodsWe included 59 614 patients admitted to 78 ICUs participating during 2013. We defined ‘weekend admission’ as any ICU admission from Friday 19:00 until Monday 07:00. We assessed the association between weekend admission with hospital mortality using a mixed logistic regression model controlling for both patient-level (illness severity, age, comorbidities, performance status and admission type) and ICU-level (decrease in nurse/bed ratio on weekend, full-time intensivist coverage, use of checklists on weekends and number of institutional protocols) confounders. We performed secondary analyses in the subgroup of scheduled surgical admissions.ResultsA total of 41 894 patients (70.3%) were admitted on weekdays and 17 720 patients (29.7%) on weekends. In univariable analysis, weekend admitted patients had higher ICU (10.9% vs 9.0%, P<0.001) and hospital (16.5% vs 13.5%, P<0.001) mortality. After adjusting for confounders, weekend admission was not associated with higher hospital mortality (OR 1.05, 95% CI 0.99 to 1.12, P=0.095). However, a ‘weekend effect’ was still observed in scheduled surgical admissions, as well as in ICUs not using checklists during the weekends. For unscheduled admissions, no ‘weekend effect’ was observed regardless of ICU’s characteristics. For scheduled surgical admissions, a ‘weekend effect’ was present only in ICUs with a low number of implemented protocols and those with a reduction in the nurse/bed ratio and not applying checklists during weekends.ConclusionsICU organisational factors, such as decreased nurse-to-patient ratio, absence of checklists and fewer standardised protocols, may explain, in part, increases in mortality in patients admitted to the ICU mortality on weekends.

O presente estudo teve por objetivo relacionar a incidência do dengue com variáveis demográficas, temporais e meteorológicas, a fim de identificar as áreas com as mais elevadas incidências e determinar os sorotipos mais prevalentes, no período de 2002 a2012, no Município de São Luís, MA. Os dados foram extraídos dos boletins dos casos de dengue até então notificados, disponíveis na Secretaria Municipal de Saúde e Vigilância Epidemiológica e Sanitária do Município de São Luís, MA. Foi calculada estatística descritiva para todas as variáveis relevantes, como idade, sexo, condições climáticas, distribuição dos sorotipos e índice de infestação predial (IIP) pela larva de Aedes aegypti. Um total de 21.986 casos de dengue foi notificado ao Sistema de Vigilância Epidemiológica da Secretaria de Saúde e Vigilância Epidemiológica de São Luís, MA, o que correspondeu a 34,3% dos casos notificados no estado do Maranhão durante o período estudado.A faixa etária mais atingida foi a de 20 a49 anos, sem predomínio de sexo. A correlação entre os casos de dengue registrados e as condições meteorológicas, como pluviosidade, temperatura e umidade do ar, mostrou que a incidência de casos flutuou com essas variáveis climáticas. Assim, verificou-se ter ocorrido um aumento de casos de dengue durante o primeiro semestre dos anos estudados, que corresponde ao período chuvoso e de elevação de temperaturas, ao passo que, em intervalos de estiagem, a tendência foi de queda (meses de julho a dezembro). Nas mesmas condições, verificou-se um aumento da forma grave do dengue, como a febre hemorrágica do dengue, em população previamente exposta aos sorotipos 1, 2 e 3. O IIP pelo A. aegypti foi maior no período de2001 a 2007 e no ano de 2011. Nos anos em que foi registrada elevação dos índices de IIP, ocorreram os números mais elevados de casos de dengue no município de São Luis, MA.

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Objective To assess the quality of adult intensive care units. Methods This population-based, cross-sectional, observational, analytical study evaluated management type in Maranhão, Brazil. An assessment instrument was applied that assigned scores to each service (maximum 124 points). The units were categorized as insufficient (< 50% of the maximum score), typical (≥ 50% and <80% of the maximum score), or sufficient (≥ 80% of the maximum score). Results Of the 26 intensive care units in Maranhão, 23 were evaluated; 15 (65.2%) were located in the state capital, and 14 (60.9%) were public. The mean final score was 67.2 (54.2% of the maximum). The worst performance was observed with regard to processes (50.9%) in the units located outside the capital (p = 0.037) and for hospitals with 68 beds or fewer (p = 0.027). The result of the assessment categorized services as a function of the overall total points earned. Specifically, 8 (34.8%) services were assessed as insufficient, 13 (56.5%) were assessed as typical, and 2 (8.7%) were assessed as sufficient. Conclusion The majority of the intensive care units in this study were assessed as typical. These services must be better qualified. The priorities are the processes of the units located outside the capital and in small hospitals.

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