An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals.

BACKGROUND: Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil. METHOD: Evaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA-"Participation of women" and "Reorganization of care" - among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group "Exposed to the PPA model of care" and the group "Standard of care model". RESULTS: PPA had a low degree of implementation in both components "Reorganization of Care" (0.17 - 0.32) and "Participation of Women" (0.21 - 0.34). The combined implementation score was 0.39-0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA. CONCLUSION: The degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider.

The effects of a quality improvement project to reduce caesarean sections in selected private hospitals in Brazil.

BACKGROUND: Brazil is one of the countries with the highest rates of caesarean sections (CS), reaching almost 90% of births in the private sector. A quality improvement project called "Adequate Childbirth Project (PPA)" was conceived to reduce CS in the private sector. This project consisted of four primary components: "Governance", "Participation of Women", "Reorganization of Care" and "Monitoring". This paper aims to evaluate: (1) which specific activities of the PPA had the largest effect on the probability of a woman having a vaginal delivery; (2) which primary component of the PPA had the largest effect on the probability of vaginal delivery and (3) which scenarios combining the implementation of different activities planned in the PPA had a higher effect on the probability of vaginal delivery. METHODS: A sample of 12 private hospitals participating in the PPA was evaluated. We used a Bayesian Network (BN) to capture both non-linearities and complex cause-effect relations. The BN integrated knowledge from experts and data from women to estimate 26 model parameters. The PPA was evaluated in 2473 women belonging to groups 1-4 of the Robson classification, who were divided into two groups: those participating or not participating in the PPA. RESULTS: The probability of a woman having a vaginal delivery was 37.7% higher in women participating in the PPA. The most important component of the project that led to an increase in the probability of vaginal delivery was "Reorganization of Care", leading to a 73% probability of vaginal delivery among women in labor. The activity that had the greatest effect on the type of delivery was access to best practices during labor, with a 72% probability of vaginal delivery. Considering the 12 scenarios combining the different activities of the PPA, the best scenarios included: a non-scheduled delivery, access to information about best practices, access to at least 4 best practices during labor and respect of the birth plan, with an 80% probability of vaginal delivery in the best combinations. CONCLUSION: PPA has been shown to be an effective quality improvement program, increasing the likelihood of vaginal delivery in private Brazilian hospitals.

INTRODUCTION: Brazil boasts one of the highest rates of caesarean sections (CS) globally, with nearly 90% of births in private facilities being delivered via CS. In response, the 'Adequate Childbirth Project ­ PPA' was launched as a quality improvement initiative aimed at curbing CS rates in private healthcare. Its goal is to improve the quality of childbirth and reduce the number of CS in private healthcare. The project has four main parts: 'Governance', 'Participation of Women', 'Reorganization of Care', and 'Monitoring'. METHOD: an evaluative study was conducted across 12 private hospitals involved in the PPA, involving 2473 women who were categorized into PPA participants and non-participants. They used a method called a cause-effect network to see which parts of the PPA helped more women have vaginal deliveries. RESULTS: They found that women in the PPA were 37.7% more likely to have a vaginal delivery. Giving women access to good practices during labor and birth was really important. Also, 'Reorganization of Care' was the most important part of the project. It led to a 73% chance of vaginal delivery for women in labor. CONCLUSION: The PPA is effective in helping more women in private hospitals have vaginal deliveries. This means it's a good program for improving childbirth in Brazil's private hospitals.

Oral cancer patient's profile and time to treatment initiation in the public health system in Rio de Janeiro, Brazil.

BACKGROUND: This paper aims to describe the profile of oral cancer (OC) patients, their risk classification and identify the time between screening and treatment initiation in Rio de Janeiro Municipality. METHOD: Data were obtained from the healthcare Regulation System (SISREG) regarding the period January 2013 to September 2015. Descriptive, bivariate and multivariate analysis were performed identifying the factors associates with a diagnosis of OC as well as the time to treatment initiation (TTI) differences between groups. RESULTS: From 3,862 individuals with a potential OC lesion, 6.9 % had OC diagnosis. OC patients were 62.3 y.o. (mean), 64.7 % male, 36.1 % were white and 62.5 % of the records received a red/yellow estimated risk classification. Being older, male, white and receiving a high-risk classification was associated with having an OC diagnosis. OC TTI was in average 59.1 days and median of 50 days significantly higher than non-OC individuals (p = 0.007). TTI was higher for individuals older than 60 years old, male, and white individuals and for risk classification red and yellow, nevertheless while in average none of these differences were statistically significant, the median of individuals classified as low risk was significantly (p = 0.044) lower than those with high risk. CONCLUSIONS: Time to treatment initiation (TTI) was higher for OC patients related to non OC. Despite OC confirmed was associated with risk at screening classified as urgent or emergent, a high percentage of OC patients had their risk classified for elective care when specialized care was requested.

Evaluation of a quality improvement intervention for labour and birth care in Brazilian private hospitals: a protocol.

BACKGROUND: In Brazilian private hospitals, caesarean section (CS) is almost universal (88%) and is integrated into the model of birth care. A quality improvement intervention, "Adequate Birth" (PPA), based on four driving components (governance, participation of women and families, reorganisation of care, and monitoring), has been implemented to help 23 hospitals reduce their CS rate. This is a protocol designed to evaluate the implementation of PPA and its effectiveness at reducing CS as a primary outcome of birth care. METHODS: Case study of PPA intervention conducted in 2017/2018. We integrated quantitative and qualitative methods into data collection and analysis. For the quantitative stage, we selected a convenient sample of twelve hospitals. In each of these hospitals, we included 400 women. This resulted in a total sample of 4800 women. We used this sample to detect a 2.5% reduction in CS rate. We interviewed managers and puerperal women, and extracted data from hospital records. In the qualitative stage, we evaluated a subsample of eight hospitals by means of systematic observation and semi-structured interviews with managers, health professionals and women. We used specific forms for each of the four PPA driving components. Forms for managers and professionals addressed the decision-making process, implemented strategies, participatory process in strategy design, and healthcare practice. Forms for women and neonatal care addressed socio-economic, demographic and health condition; prenatal and birth care; tour of the hospital before delivery; labour expectation vs. real experience; and satisfaction with care received. We will estimate the degree of implementation of PPA strategies related to two of the four driving components: "participation of women and families" and "reorganisation of care". We will then assess its effect on CS rate and secondary outcomes for each of the twelve selected hospitals, and for the total sample. To allow for clinical, socio-demographic and obstetric characteristics in women, we will conduct multivariate analysis. Additionally, we will evaluate the influence of internal context variables (the PPA driving components "governance" and "monitoring") on the degree of implementation of the components "participation of women and families" and "reorganisation of care", by means of thematic content analysis. This analysis will include both quantitative and qualitative data. DISCUSSION: The effectiveness of quality improvement interventions that reduce CS rates requires examination. This study will identify strategies that could promote healthier births.

O perfil dos egressos de um mestrado profissional: uma contribuição para o entendimento da relação formação-trabalho no SUS / Profile of graduates of a Professional Master's Degree: a contribution to understanding the training-work relationship in the SUS

RESUMO Este artigo apresenta perfil dos egressos, efeitos da formação e trajetória profissional dos concluintes do Curso de Mestrado Profissional em Saúde Pública, do Instituto Aggeu Magalhães, parte de pesquisa avaliativa em desenvolvimento. Dos 99 egressos convidados que concluíram seus cursos entre 2013-2020, 54 responderam a um questionário aplicado por meio do software Lime Survey. O estudo descritivo e transversal utilizou frequência absoluta e relativa e cruzamento de variáveis na análise, cujo instrumento constou dos temas: identificação do egresso e do programa/curso; atividade profissional antes e ao término do curso e expectativas; condição empregatícia atual e efeitos da formação; avaliação da trajetória formativa. Entre os respondentes, a maioria é do sexo feminino, com idade entre 31-40 anos, enfermeiros de formação, autodeclarados pretos ou pardos, não ser pessoa com deficiência, predominantemente residentes em Pernambuco e não ingressaram mediante cota. Como efeito na vida profissional, encontrou-se que o curso aumentou o prestígio/reconhecimento dos colegas, qualificou para atividades que já exerciam e para atividades diferentes, e trouxe ganhos de remuneração, proporcionando mudanças na vida pessoal e profissional. Os resultados estão em conformidade com achados científicos desse mesmo contexto, e a ferramenta desenvolvida pela Fiocruz permitiu conhecer a relação entre formação e trabalho.

ABSTRACT This article presents the profile of graduates, the effects of training, and the professional trajectory of the Professional Master's Course in Public Health graduates at the Aggeu Magalhaes Institute. Of the 99 invited graduates who completed the program between 2013-2020, 54 responded to a questionnaire applied through the Lime Survey software. The descriptive and cross-sectional study used absolute and relative frequency cross-tabulation variables in the analysis, with the instrument covering the following themes: identification of the graduate and program/course; professional activity before and at the end of the program and expectations; current employment status and formation effects; evaluation of the formative trajectory. Among the respondents, most are female, aged between 31-40 years, trained as nurses, self-declared as black or brown-skinned, not having a disability, predominantly residing in Pernambuco, and did not enter through a quota system. As an effect on their professional life, it was found that the program increased prestige/recognition among colleagues, qualified them for activities they were already performing and also different activities, and brought salary increases leading to changes in personal and professional lives. The results are consistent with scientific findings in the same context, and the tool developed by FIOCRUZ made it possible to understand the relationship between education and work.

Cirurgia bariátrica: complexidades e caminhos para a atenção da obesidade no SUS / Bariatric surgery: complexities and pathways to care for obesity in the SUS

RESUMO Este ensaio objetivou analisar como o Sistema Único de Saúde (SUS) tem lidado com o aumento da obesidade com indicação para cirurgia bariátrica no Brasil e apontar caminhos para a atenção à saúde integral dessa população. Fez-se um resgate do momento político-histórico de transformação epistemológica da obesidade e suas repercussões para indivíduos, sociedade, sistema de saúde e outros setores; expuseram-se alguns ataques sofridos pelo SUS, em especial os mais recentes, que afetam o já dificultoso acesso à cirurgia bariátrica; e refletiu-se sobre estratégias que buscam garantia da atenção à essa população e a sustentabilidade do sistema de saúde. Destacam-se os documentos produzidos pelo próprio Ministério da Saúde para a orientação do cuidado da obesidade, haja vista sua consonância com as evidências científicas mais atuais e sua utilização por outros países na construção de suas políticas. Ademais, reforça-se a importância do compartilhamento de responsabilidades entre todos os atores envolvidos; a regulamentação da publicidade voltada ao público que possui obesidade; o mandatório aumento de financiamento do SUS; e a utilização da avaliação em saúde de políticas, serviços e ações, para que se façam os ajustes necessários em tempo oportuno, garantindo uma melhor gestão do cuidado em saúde.

ABSTRACT This essay aims to analyze how the Unified Health System (SUS) has dealt with the increase in obesity with indication for bariatric surgery in Brazil, and to point out pathways to provide comprehensive health care for such population. There was a rescue of the political-historic moment of epistemological transformation of obesity and its repercussions for individuals, society, the health system, and other sectors; some attacks suffered by the SUS were exposed, especially the most recent ones, which affect the already difficult access to bariatric surgery; and it reflect on strategies that seek to guarantee care for that population and the sustainability of the health system. The documents produced by the Ministry of Health to guide obesity care stand out, given their consonance with the most current scientific evidence, and their use by other countries in the construction of their policies. Furthermore, it is reinforced the importance of sharing responsibilities among all the actors involved; the regulation of advertising aimed at the public with obesity; the mandatory increase in SUS funding; and the use of health evaluation of policies, services, and actions, so that the necessary adjustments are made in a timely manner and guarantee a better management of health care.

Análise da contribuição de intervenções de promoção da saúde: o caso do Programa Academia da Cidade Recife, Pernambuco / Analysis of the contribution of health promotion interventions: the case of the Academia da Cidade program Recife, Pernambuco, Brazil

Resumo Políticas de promoção da saúde em diversos países propõem a prática de atividade física em suas diretrizes. Avaliar os resultados dessas intervenções, ao mesmo tempo em que se constitui em importante apoio às decisões, pode ser desafiador. Para este estudo, utilizou-se uma avaliação baseada na teoria, a análise da contribuição. Foi explicitada a cadeia de resultados da intervenção e a teoria da mudança (TM), para analisar os elementos relacionados à sustentabilidade dos resultados do Programa Academia da Cidade (PAC) do município de Recife-PE, entre 2002 e 2016. Para validação da TM, procedeu-se a entrevistas com dez informantes-chave e realização de quatro grupos focais de junho a agosto de 2016. O teste da TM deu-se pela integração dos dados qualitativos produzidos, assim como a revisão de documentos provenientes da literatura e documentos oficiais e técnicos. Empregou-se a análise de conteúdo temática. Os resultados indicaram que a maior parte dos pressupostos foi confirmada na presença de outros fatores de influência (contextuais e explicações rivais). A testagem da TM revelou plausabilidade e validade da teoria do programa, permitindo concluir que a sustentabilidade de fatores estruturantes para o PAC contribuiu na manutenção dos resultados esperados, apesar da instabilidade ocorrida entre os anos de 2012 e 2016.

Abstract Health promotion policies in several countries propose the practice of physical activity in their guidelines. Assessing the results of these interventions, while providing important decision support, can be challenging. For this study, a theory-drive-evaluation was used, analysis of the contribution. The intervention results chain, the theory of change (ToC), was explained to analyze the elements related to the sustainability of the results of a program called Academia da Cidade (PAC), from 2002 to 2016. For ToC validation, interviews with ten key informants were carried out, and four focus groups were held from June to August 2016. The ToC test was carried out by integrating the qualitative data produced, as well as by performing a literature review and the review of official and technical documents. Thematic content analysis was used. The results indicated that most of the assumptions were confirmed in the presence of other influencing factors (contextual and rival explanations). ToC testing revealed the plausibility and validity of the program's theory, allowing us to conclude that the sustainability of PAC structuring factors contributed to the maintenance of the expected outcomes, despite the instability that occurred from 2012 to 2016.

Strategic factors for the sustainability of a health intervention at municipal level of Brazil.

The present study aims to describe the evolution of an intervention, using a methodology that adopts the critical event as the unit of analysis, and to identify strategic factors that facilitate the continuation of the interventions. Six critical events were identified: dispute care models for health; area of advice: dispute field; change policy; break of interorganizational relations; lack of physical structure and turnover of staff; difficulty in organizing practices in the work process. these are developed into strategic factors: enabling network of allies; meetings and educational activities/building capacity; benefits perceived by community members; mobilization of key actors; intervention's compatibility with the government's vision; restoration of interrelationship; and stability of the workforce. These strategic factors form a group of interrelated conditions that provide the strengthened linkages between elements in the intervention, supporting the hypothesis that they collaborate for the sustainability of the interventions in health. Tracking down the transformations of an intervention set by the critical events, it was verified that these factors performed a protective role at times of changes in the intervention process.

A tool for exploring the dynamics of innovative interventions for public health: the critical event card.

OBJECTIVES: Public health interventions are increasingly represented as complex systems. Research tools for capturing the dynamic of interventions processes, however, are practically non-existent. This paper describes the development and proof of concept process of an analytical tool, the critical event card (CEC), which supports the representation and analysis of complex interventions' evolution, based on critical events. METHODS: Drawing on the actor-network theory (ANT), we developed and field-tested the tool using three innovative health interventions in northeastern Brazil. Interventions were aimed to promote health equity through intersectoral approaches; were engaged in participatory evaluation and linked to professional training programs. The CEC developing involve practitioners and researchers from projects. Proof of concept was based on document analysis, face-to-face interviews and focus groups. RESULTS: Analytical categories from CEC allow identifying and describing critical events as milestones in the evolution of complex interventions. Categories are (1) event description; (2) actants (human and non-human) involved; (3) interactions between actants; (4) mediations performed; (5) actions performed; (6) inscriptions produced; and (7) consequences for interventions. CONCLUSIONS: The CEC provides a tool to analyze and represent intersectoral internvetions' complex and dynamic evolution.

Avaliação dos usos e influências de pesquisas sobre prevenção e controle da anemia em crianças / Evaluation of the uses and influences of researches on prevention and control of anemia in children

RESUMO A pesquisa no Brasil é geralmente financiada com recursos públicos. A expectativa é de que o conhecimento produzido auxilie os tomadores de decisão na melhoria de programas e políticas visando ao alcance dos resultados esperados. Porém, a produção e a tradução do conhecimento em ação não é um processo linear, mas condicionado pelas opções dos pesquisadores e potenciais usuários em interação. Com o objetivo de compreender como agem os envolvidos na demanda, produção e utilização de resultados de estudos, este artigo apresenta a avaliação dos mecanismos envolvidos nos usos e influências do conhecimento produzido por pesquisas sobre anemia em crianças. Trata-se de pesquisa avaliativa, com estudo de caso único, níveis de análise imbricados e método qualitativo. Empregaram-se análise documental e entrevistas semiestruturadas, sendo as categorias de análise os modos de usos (instrumental, conceitual e simbólico) e influência (segundo o tempo e a fonte). Observaram-se as três formas de usos do conhecimento científico das pesquisas selecionadas pelos tomadores de decisão em diferentes momentos. Verificou-se maior influência do conhecimento em decisões de gestores quanto maior a aproximação entre gestão e pesquisa. Assim, o envolvimento de todos os atores para produção e uso efetivo do conhecimento faz-se necessário para que ocorra a translação do conhecimento.

ABSTRACT Research in Brazil is usually publicly funded; the knowledge produced is expected to assist decision makers in improving programs and policies to achieve the expected results. However, the production and translation of knowledge in action is not a linear process, but conditioned by the researchers choices and potential users interactions. In order to understand how those involved in the demand, production and use of study results act, this paper presents the evaluation of the mechanisms involved in the uses and influences of knowledge produced by research about anemia in children. This is an evaluative research, with a single case study, imbricate levels of analysis and qualitative method. Document analysis and semi-structured interviews were used, and the categories of analysis were the modes of use (instrumental, conceptual and symbolic) and influence (according to time and source). The three forms of scientific knowledge uses of the researches selected by the decision makers were observed at different times. There was a greater influence of knowledge on manager decisions how closer the approach between management and research. Thus, the involvement of all actors for the production and effective use of knowledge is necessary for the knowledge translation to take place.

Análise da sustentabilidade de uma intervenção de promoção da saúde no município de Recife, Pernambuco / Sustainability analysis of a health promotion intervention in Recife-PE, Brazil

Resumo Iniciativas de promoção de atividade física têm sido apontadas como relevantes na promoção da saúde. O município de Recife, Pernambuco, idealizou e implantou em 2002 política dessa natureza, denominada Programa Academia da Cidade (PAC). A sustentabilidade de intervenções de promoção da saúde constitui um desafio à manutenção dos seus resultados. Objetivou-se analisar o percurso dos eventos relativos à sustentabilidade do PAC Recife no período de 2002 a 2016. Trata-se de pesquisa avaliativo-qualitativa, tendo como estratégia de estudo o caso único. Para a análise dos dados, empregou-se a análise de conteúdo temática. Recolheram-se dados por meio da técnica do incidente crítico, em 14 entrevistas com informantes-chave e seis grupos focais, em dois períodos: de agosto a dezembro de 2010 e de junho a agosto de 2016, e em documentos oficiais e técnicos. Construiu-se a linha do tempo dos eventos/incidentes críticos relativos à sustentabilidade do programa. Os dados foram analisados conforme as seguintes categorias: eventos de implementação, mistos e de sustentabilidade. Os eventos ficaram classificados de acordo com suas consequências em favoráveis ou desfavoráveis à sustentabilidade. Os resultados indicaram ocorrência de 14 eventos/incidentes críticos, na maior parte com consequências positivas para a continuidade do programa no período estudado.

Abstract Initiatives for promotion of physical activity have been identified as relevant practices in health promotion. The city of Recife-PE, devised and implemented in 2002 a policy called Academia da Cidade Program (ACP). The sustainability of health promotion interventions imposes a challenge to the maintenance of its results. The goal was to analyze the course of events related to the sustainability of the ACP Recife from 2002 to 2016. It is a qualitative evaluative research with a single case study strategy. For data analysis, the thematic content was used. Data was collected using the critical incident technique from 14 interviews with key informants and six focal groups in two periods: from August to December 2010, and June to August 2016; and technical and official documents. A timeline for critical events/incidents related to the program sustainability was created. Data were analyzed according to the following categories: sustainability, mixed and implementation events. Events were classified according to their consequences: favorable or unfavorable to sustainability. The results pointed out to the occurrence of 14 critical events/incidents, most of them with positive consequences to the continuity of the program in the period.

[Uses and influence of health evaluation in two studies on the Brazilian National Dengue Fever Control Program]. / Usos e influência da avaliação em saúde em dois estudos sobre o Programa Nacional de Controle da Dengue.

Evaluation aims to provide information, promote improvement in programs, and determine the merit and value of the object of evaluation. However, the challenge for evaluators is not only to promote, but also to document the usefulness of studies. Given this challenge, the article aimed to systematize the uses and influence of the process and findings in two evaluations on Brazilian National Dengue Fever Control Program, for decision-making by the respective public health administrators and professionals. Based on a theoretical analytical model, an exploratory study was performed with documental analysis for identification of events and registrations in the evaluations and their circulation in terms of possible uses and influence, from 2007 to 2010. Favorable factors for the use of evaluations were the mode of production of contextual knowledge and definition of evaluations with a focus on utility. The results, indicating greater instrumental use and immediate process and collective use may indicate the studies' pertinence to stakeholders and their usefulness to program management at different levels in the health system.

Análise estratégica da Vigilância Epidemiológica em tuberculose: uma experiência local / Strategic analysis of tuberculosis Epidemiological Surveillance: a local experience

RESUMO Esta análise estratégica teve por objetivo apreciar a adequação das ações de Vigilância Epidemiológica de tuberculose em município prioritário do estado do Rio de Janeiro. É um estudo de caso que emprega métodos mistos envolvendo revisão bibliográfica, análise documental, observação direta e entrevista semiestruturada com profissionais de saúde e gestores. As evidências indicam que, apesar de as ações serem realizadas conforme as recomendações nacionais, não têm sido suficientes para o controle da doença localmente em razão da adoção de perspectiva restrita de Vigilância Epidemiológica e da dificuldade dos profissionais de saúde de incorporar tais ações.

ABSTRACT This strategic analysis aimed at assessing the adequacy of Tuberculosis Epidemiological Surveillance actions in a priority municipality in the State of Rio de Janeiro. The case study employed mixed methods involving literature review, document analysis, direct observation and semi-structured interview with health professionals and health managers. Evidences indicate that, in spite of the actions have been carried out following national recommendations, they are not sufficient for the local control of the disease. This may be due to both the adoption of a limited perspective of Epidemiological Surveillance activities and the difficulty of health professionals to incorporate such actions.

Strategic factors for the sustainability of a health intervention at municipal level of Brazil / Fatores estratégicos para a sustentabilidade de uma intervenção na saúde em nível municipal no Brasil / Factores estratégicos para la sostenibilidad de una intervención en el ámbito de la salud a nivel municipal en Brasil

Abstract: The present study aims to describe the evolution of an intervention, using a methodology that adopts the critical event as the unit of analysis, and to identify strategic factors that facilitate the continuation of the interventions. Six critical events were identified: dispute care models for health; area of advice: dispute field; change policy; break of interorganizational relations; lack of physical structure and turnover of staff; difficulty in organizing practices in the work process. these are developed into strategic factors: enabling network of allies; meetings and educational activities/building capacity; benefits perceived by community members; mobilization of key actors; intervention's compatibility with the government's vision; restoration of interrelationship; and stability of the workforce. These strategic factors form a group of interrelated conditions that provide the strengthened linkages between elements in the intervention, supporting the hypothesis that they collaborate for the sustainability of the interventions in health. Tracking down the transformations of an intervention set by the critical events, it was verified that these factors performed a protective role at times of changes in the intervention process.

Resumo: O estudo busca descrever a evolução de uma intervenção, utilizando uma metodologia que adota o evento crítico como unidade de análise, além de identificar fatores estratégicos que facilitam a continuação das intervenções. Foram identificados seis eventos críticos: modelos em disputa na assistência à saúde; área de conselhos: campo de disputa; mudanças de políticas; quebra de relações entre organizações; falta de infraestrutura física e rotatividade de equipes e dificuldade na organização das práticas no processo de trabalho. Os eventos foram desdobrados em fatores estratégicos: potencialização de uma rede de aliados; reuniões e atividades educacionais ou de capacitação; benefícios percebidos pelos membros da comunidade; mobilização de atores-chave; compatibilidade da intervenção com a visão do governo; restauração do inter-relacionamento e estabilidade da força de trabalho. Esses fatores estratégicos formam um grupo de condições inter-relacionadas que fortalecem a articulação entre os elementos da intervenção, sustentando a hipótese de que colaboram com a sustentabilidade das intervenções na saúde. Ao identificar as transformações de uma intervenção relacionadas aos eventos críticos, verificou-se que esses fatores desempenharam papel protetor em momentos de mudanças no processo da intervenção.

Resumen: El estudio busca describir la evolución de una intervención, utilizando una metodología que adopta el evento crítico como unidad de análisis, además de identificar factores estratégicos que facilitan la continuación de las intervenciones. Se identificaron seis eventos críticos: modelos en disputa en la asistencia a la salud; área de consejos: campo de disputa; cambios de políticas; ruptura de relaciones entre organizaciones; falta de infraestructura física y rotatividad de equipos y dificultad en la organización de las prácticas en el proceso de trabajo. Los eventos fueron desdoblados en factores estratégicos: potencialización de una red de aliados; reuniones y actividades educacionales o de capacitación; beneficios percibidos por los miembros de la comunidad; movilización de actores-clave; compatibilidad de la intervención con la visión del gobierno; restauración de la interrelación y estabilidad de la fuerza de trabajo. Estos factores estratégicos forman un grupo de condiciones interrelacionadas que fortalecen la articulación entre los elementos de la intervención, manteniendo la hipótesis de que colaboran con la sostenibilidad de las intervenciones en la salud. Al identificar las transformaciones de una intervención relacionadas con los eventos críticos, se verificó que esos factores desempeñaron un papel protector en momentos de cambios en el proceso de la intervención.

Disseminação e uso dos resultados de pesquisas financiadas pela Secretaria de Ciência, Tecnologia e Insumos Estratégicos do Ministério da Saúde, Brasil, 2004 a 2007 / Dissemination and use of the research results funded by the Department of Science, Technology and Strategic Inputs of the Ministry of Health, Brazil, 2004 to 2007

RESUMO Este artigo verifica a disseminação e o uso das pesquisas financiadas pelo Departamento de Ciência e Tecnologia do Ministério da Saúde. Trata-se de um estudo de seis casos com análise imbricada, em que se verifica que a política de descentralização do fomento contribuiu para a redução da desigualdade na produção de conhecimento em saúde, embora haja desigualdade no volume de recursos alocados. A disseminação dos resultados foi o limitador da incorporação dos resultados de pesquisa. Os formatos de acompanhamento das pesquisas devem ser melhorados. O fator determinante na incorporação de conhecimentos e tecnologias pelo sistema de saúde é a intencionalidade técnica e política para o uso dos resultados.

ABSTRACT This article verifies the dissemination and use of the researches funded by the Department of Science and Technology of the Ministry of Health. It is a study of six cases with imbricated analysis, where it is verified that the decentralization policy of the promotion contributed to the reduction of inequality in the production of health knowledge, although there is inequality in the volume of resources allocated. The dissemination of results was the limiting factor of the incorporation of the research results. Survey monitoring formats should be improved. The determinant factor in the incorporation of knowledge and technologies by the health system is the technical and politic intentionality for the use of the results.

Avaliação da Rede Programa de Desenvolvimento e Inovação Tecnológica em Saúde Pública - Teias: inovação e produtos em questão / Evaluation of Development Program and Technological Innovation in Public Health Network - Teias: innovation and public health products

RESUMO O sistema de saúde requer inovações em processos e produtos para melhoria da gestão, da atenção e do estado de saúde da população. Nesse sentido, implementou-se a Rede Programa de Desenvolvimento e Inovação Tecnológica em Saúde Pública (PDTSP-Teias/Fundação Oswaldo Cruz - Fiocruz), voltada para criação de produtos inovadores para o território de Manguinhos, Rio de Janeiro. A avaliação da rede objetivou mapear os produtos dos projetos como Inovação em Saúde Pública. Considerou-se que os conceitos 'Inovação' e 'Produtos de saúde pública' estavam insuficientemente definidos nos documentos e entendimento de gestores e pesquisadores. Esse fato se mostrou relevante para a não entrega dos produtos acordados, sendo as publicações científicas entendidas como principal produto de pesquisa.

ABSTRACT Health system requires proposals for innovations in processes and products to improve management, care and population's health status. In this sense the Development and Technological Innovation Program in Public Health Network (PDTSP-Teias/Oswaldo Cruz Foundation - Fiocruz) was implemented as to create innovative products for Manguinhos's territory, Rio de Janeiro, Brazil. The evaluation of the Network aimed at mapping the products of the projects such as Innovation in Public Health. The concepts of 'Innovation' and 'Public health products' were considered poorly defined both in the documents and in the understanding of managers and researchers. This fact revealed to be relevant to the non-delivery of the agreed products. Scientific publications were considered sufficient as research product.

[Death from dengue fever as a sentinel event for evaluation of quality of healthcare: a case study in two municipalities in Northeast Brazil, 2008]. / Óbito por dengue como evento sentinela para avaliação da qualidade da assistência: estudo de caso em dois municípios da Região Nordeste, Brasil, 2008.

Despite the existing resources for adequate dengue patient care in the Brazilian healthcare system, the case-fatality rate for the disease is still high in the country. In order to identify factors associated with dengue-related death, this study evaluated quality of care according to the degree of implementation of specific measures, the technical and scientific quality of care, and access to health services in two municipalities (counties) in Northeast Brazil. An evaluative study of the implementation analysis type was performed, with death from dengue as the sentinel event for quality of care. To assess the degree of implementation and quality of care, the study scored the interview criteria and patient chart analysis; access was evaluated by thematic analysis. As for structure and process, the health services were found to be partially adequate (70%). No geographic or economic barriers were found to explain the occurrence of deaths. Technical and scientific quality failed to achieve adequate levels in the municipalities (46% and 30%) or in the specific services, and clinical management of dengue by the health services proved insufficient.

Estudo de avaliabilidade do Programa Academia Carioca da Saúde: desafios para a promoção da saúde / Evaluability study of the Carioca Health Academy Program: challenges for health promotion

Este artigo tem como objetivo apresentar os resultados do estudo de avaliabilidade do Programa Academia Carioca da Saúde visando ampliar a compreensão sobre a intervenção e maximizar a utilidade da avaliação. Foram realizadas as seguintes etapas: análise documental, entrevista com informantes-chave, modelização da intervenção e formulação das perguntas avaliativas. A construção do Modelo Lógico do Programa permitiu descrever as dimensões e os componentes do programa, as ações estratégicas e os efeitos esperados com ênfase no acesso regular às praticas corporais e de atividade física, nos grupos de promoção da saúde e no fortalecimento da participação comunitária.

This article aims to present the results of the evaluability study of the Carioca Health Academy Program in order to expand the comprehension about the intervention and to maximize the utility of the evaluation. The study was divided into the following steps: documental analyses, interviews with key informants, intervention modeling and elaboration of the evaluative questions. The construction of the Logic Model allowed to describe the dimensions and components of the program, the strategic actions and expected results with emphasis on the regular access to body practices and physical activities, on the health promotion groups and on the strengthening of community participation.

Meta-evaluation of baseline studies of the Brazilian Family Health Strategy Expansion Project: a participatory and formative approach.

A participatory, formative meta-evaluation of baseline studies in Brazil is presented. International standards recommended by associations of evaluators were used, along with "specificity" criteria built up using the terms of reference for proposals for the selection of studies. The methodological approach combined a "peer review" of baseline study reports, with a participatory (self) assessment for "primary" evaluators, the average of which provided the final score. Results revealed a classification of "good" and "very good" for the set of standards. The differences between the attribution of scores further highlight the importance of taking into account multiple points of view. Given the lack of pre-existing standards for the reports, the absence of standards and the incipient nature of evaluation focusing on utility, this meta-evaluation does not adequately reflect the quality or potential utility of the baseline studies, however, it will certainly contribute to overcoming these limitations and improving future impact studies of the Brazilian Family Health Strategy Expansion Project (PROESF).