Factors associated with time to initiate lung cancer treatment in Minas Gerais, Brazil. / Fatores associados ao tempo para o início do tratamento do câncer de pulmão em Minas Gerais, Brasil.

The aim was to verify the association of individual factors and healthcare system characteristics with time to initiate treatment of lung cancer by the Brazilian National Health System, in Minas Gerais state. A retrospective cohort study, with patients who initiated treatment for lung cancer by the SUS, from 2008 to 2015. Sociodemographic and clinical characteristics of patients, besides organizational variables of the healthcare system were selected. The logistic regression model evaluated the association of selected explanatory variables with the outcome of initiating treatment within 60 days after diagnosis. Odds ratio (OR) and respective 95% confidence interval were used to measure the power of association. Most treatments for lung cancer in the state of Minas Gerais initiated within 60 days after diagnosis. However, being male and diagnosed as stage IV increased the likelihood of starting treatment within 60 days. On the other hand, the patient's age, radiation therapy as first treatment, and the place of residence decreased such chance. Time to initiate treatment is associated with individual characteristics and provision of services in macroregions, and the observed inequalities possibly raised from the better or worse access of the population to the services provided by SUS.

O objetivo foi verificar a associação entre fatores individuais e organizativos do sistema de saúde com o tempo para o início do tratamento do câncer de pulmão pelo Sistema Único de Saúde (SUS) em Minas Gerais. Estudo de coorte retrospectiva com pacientes que iniciaram o tratamento para o câncer de pulmão pelo SUS de 2008 a 2015. Foram selecionadas variáveis sociodemográficas, clínicas e organizativas do sistema de saúde. O modelo de regressão logística avaliou a associação do desfecho do início do tratamento em até 60 dias após o diagnóstico com as variáveis explicativas selecionadas. Utilizou-se a odds ratio (OR) e o respectivo intervalo de confiança (95%) para mensurar a força de associação. A maioria dos tratamentos para o câncer de pulmão em Minas Gerais foram iniciados em até 60 dias após o diagnóstico, entretanto, ser do sexo masculino e diagnosticado em estadiamento IV aumentaram a chance de iniciar o tratamento em até 60 dias; todavia o aumento da idade, iniciar o tratamento por radioterapia, e o local de residência, diminuíram. O tempo para início do tratamento está associado a características individuais e à provisão de serviços nas macrorregiões, e as desigualdades observadas possivelmente se originam a partir do melhor ou pior acesso da população aos serviços prestados.

Fatores associados ao tempo para o início do tratamento do câncer de pulmão em Minas Gerais, Brasil / Factors associated with time to initiate lung cancer treatment in Minas Gerais, Brazil

Resumo O objetivo foi verificar a associação entre fatores individuais e organizativos do sistema de saúde com o tempo para o início do tratamento do câncer de pulmão pelo Sistema Único de Saúde (SUS) em Minas Gerais. Estudo de coorte retrospectiva com pacientes que iniciaram o tratamento para o câncer de pulmão pelo SUS de 2008 a 2015. Foram selecionadas variáveis sociodemográficas, clínicas e organizativas do sistema de saúde. O modelo de regressão logística avaliou a associação do desfecho do início do tratamento em até 60 dias após o diagnóstico com as variáveis explicativas selecionadas. Utilizou-se a odds ratio (OR) e o respectivo intervalo de confiança (95%) para mensurar a força de associação. A maioria dos tratamentos para o câncer de pulmão em Minas Gerais foram iniciados em até 60 dias após o diagnóstico, entretanto, ser do sexo masculino e diagnosticado em estadiamento IV aumentaram a chance de iniciar o tratamento em até 60 dias; todavia o aumento da idade, iniciar o tratamento por radioterapia, e o local de residência, diminuíram. O tempo para início do tratamento está associado a características individuais e à provisão de serviços nas macrorregiões, e as desigualdades observadas possivelmente se originam a partir do melhor ou pior acesso da população aos serviços prestados.

Abstract The aim was to verify the association of individual factors and healthcare system characteristics with time to initiate treatment of lung cancer by the Brazilian National Health System, in Minas Gerais state. A retrospective cohort study, with patients who initiated treatment for lung cancer by the SUS, from 2008 to 2015. Sociodemographic and clinical characteristics of patients, besides organizational variables of the healthcare system were selected. The logistic regression model evaluated the association of selected explanatory variables with the outcome of initiating treatment within 60 days after diagnosis. Odds ratio (OR) and respective 95% confidence interval were used to measure the power of association. Most treatments for lung cancer in the state of Minas Gerais initiated within 60 days after diagnosis. However, being male and diagnosed as stage IV increased the likelihood of starting treatment within 60 days. On the other hand, the patient's age, radiation therapy as first treatment, and the place of residence decreased such chance. Time to initiate treatment is associated with individual characteristics and provision of services in macroregions, and the observed inequalities possibly raised from the better or worse access of the population to the services provided by SUS.

Comorbidities and in-hospital death of viral pneumonia adults admitted to SUS (2002-2015).

OBJECTIVE: To identify demographic and clinical characteristics of adult patients hospitalized in the Brazilian Unified Health System (SUS) due to viral pneumonia and investigate the association between some comorbidities and death during hospitalization. METHODS: This retrospective cohort study was conducted with secondary data of adults admitted to SUS due to viral pneumonia between 2002 and 2015. Patient profile was characterized based on demographic and clinical variables. The association between the ten Elixhauser comorbidities and in-hospital death was investigated using Poisson regression models with robust standard errors. Results were quantified as incidence rate ratio (IRR) with 95% confidence intervals (CI), and we built five models using successive inclusion of variables blocks. RESULTS: Hospital admissions for viral pneumonias decreased throughout the study period, and it was observed that 5.8% of hospitalized patients had an in-hospital death. We observed significant differences in demographic and clinical characteristics by comparing individuals who died during hospitalization with those who did not, with the occurrence of one or more comorbidities being more expressive among patients who died. Although not considered risk factors for in-hospital death, chronic pulmonary disease and congestive heart failure were the most common comorbidities. Conversely, IRR for in-hospital death increased with other neurological disorders, diabetes, cancer, obesity, and especially with HIV/AIDS. CONCLUSIONS: Individuals presenting with pulmonary and cardiovascular diseases require proper attention during hospitalization, as well as those with other neurological diseases, diabetes, cancer, obesity, and especially HIV/AIDS. Understanding the influence of chronic diseases on viral infections may support the healthcare system in achieving better outcomes.

Psychiatric hospitalizations by the Unified Health System in Brazil between 2000 and 2014.

OBJECTIVE: To characterize the profile of patients hospitalized for mental and behavioral disorders by the Unified Health System (SUS) in Brazil between 2000 and 2014, and to verify how aspects of the new mental health policy influenced the rate of hospitalized patients in that period. METHODS: Non-concurrent prospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders between 01/01/2000 and 12/31/2014. Sociodemographic, clinical, and hospital characteristics variables were selected. Overall rates of hospitalized patients were calculated according to reason for admission, type of hospital, legal nature, and number of admissions per year for each patient. The association between rates of hospitalized patients, number of psychiatric beds per year, and number of Psychosocial Care Centers per year were tested. RESULTS: We selected a total of 1,549,298 patients, whose most frequent diagnoses on first admission were psychoactive substance use disorders, followed by schizophrenia and mood disorders. The median of hospitalizations per patient was 1.9 and the length of stay per patient was 29 days. The overall rate of hospitalized patients was reduced by almost half in the period. The number of beds per year was positively associated with the rates of hospitalized patients; the number of CAPS per year was negatively associated with some rates of hospitalized patients. CONCLUSION: Even in the face of adversity, the National Mental Health Policy has advanced in its goal of progressively reducing hospital beds and increasing the supply of substitute services such that both strategies were associated with the reduced inpatient rates. But the changes were felt with greater intensity in the first years of the policy's implementation, becoming less pronounced in recent years.

Comorbidities and in-hospital death of viral pneumonia adults admitted to SUS (2002-2015)

ABSTRACT OBJECTIVE To identify demographic and clinical characteristics of adult patients hospitalized in the Brazilian Unified Health System (SUS) due to viral pneumonia and investigate the association between some comorbidities and death during hospitalization. METHODS This retrospective cohort study was conducted with secondary data of adults admitted to SUS due to viral pneumonia between 2002 and 2015. Patient profile was characterized based on demographic and clinical variables. The association between the ten Elixhauser comorbidities and in-hospital death was investigated using Poisson regression models with robust standard errors. Results were quantified as incidence rate ratio (IRR) with 95% confidence intervals (CI), and we built five models using successive inclusion of variables blocks. RESULTS Hospital admissions for viral pneumonias decreased throughout the study period, and it was observed that 5.8% of hospitalized patients had an in-hospital death. We observed significant differences in demographic and clinical characteristics by comparing individuals who died during hospitalization with those who did not, with the occurrence of one or more comorbidities being more expressive among patients who died. Although not considered risk factors for in-hospital death, chronic pulmonary disease and congestive heart failure were the most common comorbidities. Conversely, IRR for in-hospital death increased with other neurological disorders, diabetes, cancer, obesity, and especially with HIV/AIDS. CONCLUSIONS Individuals presenting with pulmonary and cardiovascular diseases require proper attention during hospitalization, as well as those with other neurological diseases, diabetes, cancer, obesity, and especially HIV/AIDS. Understanding the influence of chronic diseases on viral infections may support the healthcare system in achieving better outcomes.

Contribution of community health workers to primary health care performance in Brazil.

OBJECTIVE: To associate the strength of community health workers interventions with primary health care strategies for women's and children's health, diabetes, and hypertension. METHODS: This is a cross-sectional study assessing 29,778 family health teams working in primary health care in Brazil in 2014. The association between community health workers activity levels and primary health care facilities was analyzed using multiple logistic regression. RESULTS: We found higher levels of community health workers activities strongly associated with primary health care practices (OR = 6.88) for those activities targeting hypertension management, followed by children's health (OR = 6.56), and women's health (OR = 6.21). CONCLUSIONS: At a time when Brazil discusses whether community health workers should or should not remain in the same scale-up and skill level as they currently are, our results reinforce the importance of these workers for the care model advocated by the Brazilian Unified Health System.

Implementation of Telehealth Resources in Primary Care in Brazil and Its Association with Quality of Care.

Background:Although several reviews on the relation between telemedicine and health care outcomes have pointed out some evidence, they have also underscored the need for further investigation.Introduction:Brazil has a national telehealth program implemented in 2007, involving teleconsulting and distance education actions in primary care.Objective:This study aims to describe the implementation of telehealth in primary care in Brazil and to identify if there is an association between telehealth and quality of care.Methods:A cross-sectional study analyzing data from interviews with 29,778 primary care team professionals in Brazil in 2014, which represents 92.5% of existing health care teams, on aspects of information technology, telehealth, and care was carried out. A multiple binary regression analysis was performed to study the associations between the extent of health care actions and using telehealth.Results:Of the 24,055 primary care units in Brazil where teams worked, only 50.1% (n: 12,055) had internet access, and 32.71% of teams claimed to be involved in telehealth actions in 2014. Between 2012 and 2014 there was an expansion in the use of telehealth resources in all regions of Brazil. The highest magnitude was observed for the association between employment of telehealth and improvement in child care (odds ratio [OR] = 2.09), followed by diabetes mellitus care (OR = 1.91), hypertension (OR = 1.89), and finally, women's health (OR = 1.86).

Análise espacial da qualidade da Atenção Básica em Saúde no Brasil / Spatial analysis of the quality of Primary Health Care in Brazil

RESUMO Este artigo teve como objetivo analisar a distribuição espacial das equipes de Atenção Básica em Saúde (ABS) avaliadas pelo Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB) segundo as categorias de desempenho para certificação no Programa. Realizou-se uma caracterização da distribuição espacial dos municípios mediante a avaliação do PMAQ-AB, bem como a identificação da presença de padrões espaciais a partir de um indicador de correlação espacial para avaliar o grau de influência do espaço para a certificação das equipes de ABS. Observou-se presença de padrões de natureza espacial em relação à qualidade da ABS. Municípios com valor baixo no indicador cujos vizinhos também apresentam nível baixo foram encontrados em boa parte dos estados do Acre, do Amazonas, de Roraima e do Amapá, bem como no Rio de Janeiro e no Espírito Santo. Foram observados clusters de padrão alto-alto em municípios de São Paulo, Minas Gerais e Rio Grande do Sul, com destaque para Santa Catarina. A identificação de padrões espaciais de qualidade da ABS pode representar um recurso valioso para o aperfeiçoamento do PMAQ-AB. Com isso, é possível desenvolver análises que incorporem variáveis com potencial explicativo para os padrões espaciais de qualidade de ABS encontrados em municípios brasileiros.(AU)

ABSTRACT This article aims to analyze the spatial distribution of the Primary Health Care (ABS) teams evaluated by the National Program for Access and Quality Improvement in Primary Health Care (PMAQ-AB) according to the categories of performance for certification in the Program. A spatial distribution profile of the municipalities according to the PMAQ-AB evaluation was carried out, as well as the identification of spatial patterns from a spatial correlation indicator to evaluate the degree of space influence for the certification of ABS teams. It was found presence of spatial patterns in relation to ABS quality. Municipalities with low values in the indicator, whose neighbors are also low, are found in most of the states of Acre, Amazonas, Roraima and Amapá, as well as in Rio de Janeiro and Espírito Santo. High-high standard clusters were observed in the municipalities of São Paulo, Minas Gerais and Rio Grande do Sul, especially in Santa Catarina. The identification of the spatial quality standards of ABS can be a valuable resource for the further PMAQ-AB development. It will be possible, thus, to develop analyses that incorporate variables with explanatory potential for the spatial patterns of ABS quality found in Brazilian municipalities.(AU)

Mental health in primary care: an evaluation using the Item Response Theory.

OBJECTIVE To determine the items of the Brazilian National Program for Improving Access and Quality of Primary Care that better evaluate the capacity to provide mental health care. METHODS This is a cross-sectional study carried out using the Graded Response Model of the Item Response Theory using secondary data from the second cycle of the National Program for Improving Access and Quality of Primary Care, which evaluates 30,523 primary care teams in the period from 2013 to 2014 in Brazil. The internal consistency, correlation between items, and correlation between items and the total score were tested using the Cronbach's alpha, Spearman's correlation, and point biserial coefficients, respectively. The assumptions of unidimensionality and local independence of the items were tested. Word clouds were used as one way to present the results. RESULTS The items with the greatest ability to discriminate were scheduling of the agenda according to risk stratification, keeping of records of the most serious cases of users in psychological distress, and provision of group care. The items that required a higher level of mental health care in the parameter of location were the provision of any type of group care and the provision of educational and mental health promotion activities. Total Cronbach's alpha coefficient was 0.87. The items that obtained the highest correlation with total score were the recording of the most serious cases of users in psychological distress and scheduling of the agenda according to risk stratification. The final scores obtained oscillated between -2.07 (minimum) and 1.95 (maximum). CONCLUSIONS There are important aspects in the discrimination of the capacity to provide mental health care by primary health care teams: risk stratification for care management, follow-up of the most serious cases, group care, and preventive and health promotion actions.

Mental health in primary care: an evaluation using the Item response theory / Saúde mental na atenção básica: uma avaliação por meio da teoria da resposta ao Item

ABSTRACT OBJECTIVE To determine the items of the Brazilian National Program for Improving Access and Quality of Primary Care that better evaluate the capacity to provide mental health care. METHODS This is a cross-sectional study carried out using the Graded Response Model of the Item Response Theory using secondary data from the second cycle of the National Program for Improving Access and Quality of Primary Care, which evaluates 30,523 primary care teams in the period from 2013 to 2014 in Brazil. The internal consistency, correlation between items, and correlation between items and the total score were tested using the Cronbach's alpha, Spearman's correlation, and point biserial coefficients, respectively. The assumptions of unidimensionality and local independence of the items were tested. Word clouds were used as one way to present the results. RESULTS The items with the greatest ability to discriminate were scheduling of the agenda according to risk stratification, keeping of records of the most serious cases of users in psychological distress, and provision of group care. The items that required a higher level of mental health care in the parameter of location were the provision of any type of group care and the provision of educational and mental health promotion activities. Total Cronbach's alpha coefficient was 0.87. The items that obtained the highest correlation with total score were the recording of the most serious cases of users in psychological distress and scheduling of the agenda according to risk stratification. The final scores obtained oscillated between -2.07 (minimum) and 1.95 (maximum). CONCLUSIONS There are important aspects in the discrimination of the capacity to provide mental health care by primary health care teams: risk stratification for care management, follow-up of the most serious cases, group care, and preventive and health promotion actions.

RESUMO OBJETIVO Determinar os itens do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica que melhor avaliam a capacidade de oferta de cuidados em saúde mental. MÉTODOS Estudo transversal efetuado por meio do Modelo de Resposta Gradual da Teoria da Resposta ao Item, utilizando dados secundários do segundo ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, tendo sido avaliadas 30.523 equipes de atenção básica no período de 2013 a 2014. A consistência interna, a correlação entre os itens e dos itens com o escore total foram testadas usando os coeficientes alfa de Cronbach, correlação de Spearman e ponto bisserial, respectivamente. Foram testados os pressupostos de unidimensionalidade e independência local dos itens. Utilizaram-se como uma das formas de apresentação dos resultados as nuvens de palavras. RESULTADOS Programar a agenda de acordo com a estratificação de risco, manter registro dos casos mais graves de usuários em sofrimento psíquico e ofertar algum atendimento em grupo foram os itens com maior capacidade de discriminação. Ofertar alguma modalidade de atendimento em grupo e ofertar ações educativas e de promoção de saúde mental foram os itens que requereram maior nível de oferta de cuidados em saúde mental no parâmetro de locação. O coeficiente alfa de Cronbach total foi 0,87. Realizar o registro dos casos mais graves de usuários em sofrimento psíquico e programar a agenda de acordo com a estratificação de risco foram os itens que obtiveram maior correlação com o escore total. Os escores finais obtidos oscilaram entre -2,07 (mínimo) e 1,95 (máximo). CONCLUSÕES São aspectos relevantes na discriminação da capacidade de ofertar cuidados em saúde mental pelas equipes de atenção básica: a estratificação do risco para gestão do cuidado, o acompanhamento dos casos mais graves, o atendimento em grupo e as ações preventivas e de promoção da saúde.

Articulações em saúde: contribuições para o fortalecimento do trabalho em rede entre centro de atenção psicossocial e estratégia de saúde da família / Articulations in health: contributions to the strengthening of networking between the center for psychosocial care and the family health strategy

O presente trabalho foi desenvolvido por meio da Extensão Universitária da PUC Minas em Arcos/MG, tendo sido originalmente intitulado "Articulações em Saúde Mediadas pela PUC: Centro de Atenïção Psicossocial (CAPS) e Estratatégia de Saúde da Família (ESF) para fortalecimento dos serviços em rede no SUS". O projeto ocorreu durante o ano de 2011, atuando junto aos serviços de saúde desse município - tendo esses oito equipes da Estratégia de Saúde da Família e uma equipe do Centro de Atenção Psicossocial. O trabalho em questão tinha como objetivo analisar o funcionamento da rede entre os serviços de saúde do município e fornecer contribuições que pudessem aprimorar e fortalecer o seu funcionamento. Caracterizou-se como uma pesquisa-ação, a qual contou com uma etapa de diagnóstico acerca da articulação entre esses serviços, seguida de uma etapa de atividades interventivas, e finalmente uma etapa de avaliação da ação. (..)