Economic burden of colorectal and breast cancers attributable to lack of physical activity in Brazil.

BACKGROUND: The increasing number of cancer patients has an escalating economic impact to public health systems (approximately, International dollars- Int$ 60 billion annually in Brazil). Physical activity is widely recognized as one important modifiable risk factor for cancer. Herein, we estimated the economic costs of colon and post-menopausal breast cancers in the Brazilian Unified Health System (SUS) attributable to lack of physical activity. METHODS: Population attributable fractions were calculated using prevalence data from 57,962 adults who answered a physical activity questionnaire in the Brazilian National Health Survey, and relative risks of colon and breast cancer from a meta-analysis. Annual costs (1 Int$ = 2.1 reais) with hospitalization, chemotherapy and radiotherapy were obtained from the Hospital and Ambulatory Information Systems of the Brazilian SUS. Two counterfactual scenarios were considered: theoretical minimum risk exposure level (≥8000 MET-min/week) and physical activity guidelines (≥600 MET-min/week). RESULTS: Annually, the Brazilian SUS expended Int$ 4.5 billion in direct costs related to cancer treatment, of which Int$ 553 million due to colon and breast cancers. Direct costs related to colon and breast cancers attributable to lack of physical activity were Int$ 23.4 million and Int$ 26.9 million, respectively. Achieving at least the physical activity guidelines would save Int$ 10.3 mi (colon, Int$ 6.4 mi; breast, Int$ 3.9 mi). CONCLUSIONS: Lack of physical activity accounts for Int$ 50.3 million annually in direct costs related to colon and post-menopausal breast cancers. Population-wide interventions aiming to promote physical activity are needed to reduce the economic burden of cancer in Brazil.

The decline in mortality due to acute complications of diabetes mellitus in Brazil, 1991-2010.

BACKGROUND: Mortality from acute complications of diabetes, a predominantly preventable condition, although controlled in high income countries, remains a major challenge for low/middle income countries. The aim of this study is to describe trends in mortality from acute complications of diabetes between 1991 and 2010 in Brazil, a period during which a national health system was implemented offering broad access to diabetes treatment. METHODS: We obtained the number of deaths listed in the Brazilian Mortality Information System between 1991 and 2010 as due to acute complications of diabetes (ICD-9 250.1, .2, or .3 and ICD-10 E10-14.0 or 1), corrected this number for ill-defined causes of death and incompleteness in mortality reporting, and calculated mortality rates standardized to the world's population. We describe mortality trends with Joinpoint regressions. RESULTS: Over this 20 year period, mortality due to the acute complications of diabetes fell 70.9 % (95 % CI 67.2 to 74.5 %), from 8.42 (95 % CI 8.27 to 8.57) deaths per 100000 inhabitants in 1991 to 2.45 (95 % CI 2.38 to 2.52) per 100000 in 2010. The reduction occurred in men and women, in all age groups, and in all regions of Brazil. CONCLUSIONS: Mortality from acute complications of diabetes in Brazil has declined markedly in parallel with the implementation of a national health system providing access to insulin and organization of health care. Further decline is possible and necessary.

Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019.

OBJECTIVE: To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019. METHODS: This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression. RESULTS: A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend. CONCLUSION: The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend. MAIN RESULTS: From 2011 to 2019, the diabetes mellitus hospitalization rate was 6.77 per 10,000 inhabitants, with a falling trend. Total expenditure was US$420,692.23 and it showed a rising trend. IMPLICATIONS FOR SERVICES: The study warns of the increase in child and adolescent hospitalizations, which indicates the need to invest in preventive actions and early diagnosis. PERSPECTIVES: The increase in length of hospital stay and related costs indicates a worrying scenario for the Brazilian National Health System and emphasizes the need to improve access to and quality of care, with a focus on diabetes education, so as to avoid complications and hospitalizations.

Hospital admissions for treatment of ruptured and unruptured cerebral aneurysms within the Brazilian National Health System, 2009-2018: a descriptive study. / Internações hospitalares para tratamento de aneurismas cerebrais rotos e não rotos no Sistema Único de Saúde do Brasil, 2009-2018: um estudo descritivo.

OBJECTIVE: To analyze hospital admissions for treatment of ruptured and unruptured cerebral aneurysms with embolization and brain microsurgery performed within the Brazilian National Health System (SUS), 2009-2018. METHODS: This was a descriptive study, using data from the SUS's Hospital Information System. Frequency of hospital admissions, procedures, use of intensive care unit (ICU), case fatality ratio and expenditures were described. RESULTS: Of the 43,927 hospital admissions, 22,622 (51.5%) resulted in microsurgery. Embolization and cerebral microsurgery were more frequent among females. Length of hospital stay with embolization procedure was 7.7 days (±9.0), and with microsurgery, 16.2 (±14.2) days, frequency of ICU admission, 58.6% and 85.3%, and case fatality ratio, 5.9% and 10.9% respectively. Of the total expenditure, USD 240 million, 66.3% corresponded to hospitalizations with embolization procedure. CONCLUSION: Hospital admissions with embolization procedure for treatment of cerebral aneurysms within the SUS showed a shorter length of stay, less frequent use of ICU and lower case fatality ratio, but higher expenditure when compared to brain microsurgery.

Costs of cancer attributable to excess body weight in the Brazilian public health system in 2018.

OBJECTIVES: The prevalence of excess body weight (EBW) has increased over the last decades in Brazil, where 55.4% of the adult population was overweight in 2019. EBW is a well-known risk factor for several types of cancer. We estimated the federal cost of EBW-related cancers in adults, considering the medical expenditures in the Brazilian Public Health System. METHODS: We calculated the costs related to 11 types of cancer considering the procedures performed in 2018 by all organizations that provide cancer care in the public health system. We obtained data from the Hospital and Ambulatory Information Systems of the Brazilian Public Health System. We calculated the fractions of cancer attributable to EBW using the relative risks from the literature and prevalence from a nationally representative survey. We converted the monetary values in Reais (R$) to international dollars (Int$), considering the purchasing power parity (PPP) of 2018. RESULTS: In Brazil, the 2018 federal cost for all types of cancers combined was Int$ 1.73 billion, of which nearly Int$ 710 million was spent on EBW-related cancer care and Int$ 30 million was attributable to EBW. Outpatient and inpatient expenditures reached Int$ 20.41 million (of which 80% was for chemotherapy) and Int$ 10.06 million (of which 82% was for surgery), respectively. Approximately 80% of EBW-attributable costs were due to breast, endometrial and colorectal cancers. CONCLUSION: A total of 1.76% of all federal cancer-related costs could be associated with EBW, representing a substantial economic burden for the public health system. We highlight the need for integrated policies for excess body weight control and cancer prevention.

[Manager profile and practices of county health management in the Unified Health System (SUS) according to population size in the municipalities of the Rio Grande do Sul state]. / Perfil do gestor e práticas de gestão municipal no Sistema Único de Saúde (SUS) de acordo com porte populacional nos municípios do estado do Rio Grande do Sul.

This study intended to gather who are the county health managers and the practices performed in management. It is based on a cross-sectional design. The methodology involved the use of electronic questionnaire, which was sent to the health departments of the 497 municipalities of the state of Rio Grande do Sul (RS). Of these, 297 were answered (59.75%). However, only those with more than 50% of valid answers (n = 264) were included in the statistical analysis. The analysis included the calculation of the distribution of variables and chi-square testes, taking population size as an independent variable. Most managers were women; graduated; from different professional backgrounds; average age of 43.76 years-old, and white. The average health expenditure in the municipalities was ≈ 20% of revenues. There was a consensus on the insufficiency of resources. With regards to population size, 79.92% presented with ≤ 20,000 inhabitants. Statistically significant differences were found in the management of municipalities of different sizes, both in terms of priorities and difficulties. The study allowed to partially understanding the reality of municipal management. These results indicate the need to further investigate the feminization of health management, working process assessment, and the impacts of economical austerity policy.

O estudo buscou conhecer quem são os gestores municipais de saúde e práticas realizadas no âmbito de gestão. Possuiu delineamento transversal. A metodologia contou com o envio de um questionário eletrônico às secretarias de saúde dos 497 municípios do estado do Rio Grande do Sul (RS). Destes, 297 retornaram (59,75%). Contudo, foram considerados na análise estatística apenas os questionários com mais de 50% de respostas válidas (n = 264). A análise contou com o cálculo da distribuição das variáveis e com testes de qui-quadrado, onde o porte populacional foi considerado variável independente. A maioria foi composta por mulheres, com escolaridade alta e distintas formações, média de idade de 43,76 anos, cor branca. A média de gastos com saúde foi de ≈20% das receitas. Houve consenso quanto na insuficiência dos recursos. Quanto ao porte populacional, 79,92% possuíam ≤ 20.000 habitantes. Diferenças significativas foram observadas na gestão de municípios de distintos portes, tanto nas prioridades, quanto nas dificuldades. O estudo permitiu conhecer parcialmente a realidade da gestão municipal. Além disso, os resultados sugeriram a necessidade de novas pesquisas sobre a feminilização da gestão, avaliação de processos de trabalho e impactos da política de austeridade.

Vaccine dose usage and wastage in the Metropolitan Region of Porto Alegre, Rio Grande do Sul, Brazil: a descriptive study, 2015-2017. / Utilização e perda de doses de vacinas na Região Metropolitana de Porto Alegre, Rio Grande do Sul: um estudo descritivo de 2015-2017.

OBJECTIVE: to estimate usage and wastage of multi-dose and single-dose vaccine vials in the Metropolitan Region of Porto Alegre, Rio Grande do Sul, Brazil, from 2015 to 2017. METHODS: a descriptive study was carried out based on secondary data from the National Immunization Program Information System (SIPNI) and the Strategic Health Supplies Information System (SIES). RESULTS: a total of 12,342 records were examined; mean wastage rate was 45.8% (95%CI 39.5;51.7), while usage rate was 54.2% (95%CI 48.3;60.5); vaccines with the highest mean annual wastage rate were MMR (68.8% - 95%CI 66.5;71.1), BCG (68.1% - 95%CI 65.4;70.7), Hepatitis B (56.4% - 95%CI 53.0-59.7) and Yellow Fever (55.9% - 95%CI 51.4;60.4). CONCLUSION: the highest rates of vaccine wastage were for multi-dose vials; although single-dose vaccines also exceeded the acceptable limit defined by the World Health Organization.

Bariatric surgeries performed by the Brazilian National Health System in the period 2010-2016: a descriptive study of hospitalizations. / Cirurgias bariátricas realizadas pelo Sistema Único de Saúde no período 2010-2016: estudo descritivo das hospitalizações no Brasil.

OBJECTIVE: to characterize Brazilian National Health System (SUS) hospitalizations for bariatric surgeries in Brazil, in the period 2010-2016. METHODS: this was a descriptive study of time series using data from the SUS Hospital Information System (SIH/SUS); the target population consisted of patients aged 16 years and older. RESULTS: there were 46,035 hospitalizations (6,576/year; 4.3/100,000 inhabitants/year); average age was 39.0 years old (SD:10.4); female sex predominated (85.4%), and the 35-39 age group accounted for 18.0% of cases; 16,923 patients (36.8%) needed to be admitted to the intensive care unit (ICU); there were 99 (0.2%) in-hospital deaths; the median hospital stay was 3 days, and the interquartile range was 2 days; average annual expense was R$ 39,410,919.37 and the average cost of hospitalization was R$ 5,992.75 (R$ 1,464.15/day). CONCLUSION: bariatric surgeries were characterized as procedures involving young female adults, frequent ICU use and low lethality.

Economic burden of diabetes in Brazil in 2014.

BACKGROUND: Diabetes and its complications produce significant clinical, economic and social impact. The knowledge of the costs of diabetes generates subsidies to maintain the financial sustainability of public health and social security systems, guiding research and health care priorities. AIMS: The aim of this study was to estimate the economic burden of diabetes in Brazilian adults in 2014, considering the perspectives of the public health care system and the society. METHODS: A prevalence-based approach was used to estimate the annual health resource utilization and costs attributable to diabetes and related conditions. The healthcare system perspective considered direct medical costs related to outpatient and hospitalization costs. The societal perspective considered non-medical (transportation and dietary products) and indirect costs (productivity loss, disability, and premature retirement). Outpatient costs included medicines, health professional visits, exams, home glucose monitoring, ophthalmic procedures, and costs related to end stage renal disease. The costs of hospitalization attributed to diabetes related conditions were estimated using attributable risk methodology. Costs were estimated in Brazilian currency, and then converted to international dollars (2014). RESULTS: Based on a national self-reported prevalence of 6.2%, the total cost of diabetes in 2014 was Int$ 15.67 billion, including Int$ 6.89 billion in direct medical costs (44%), Int$ 3.69 billion in non-medical costs (23.6%) and Int$ 5.07 billion in indirect costs (32.4%). Outpatient costs summed Int$ 6.62 billion and the costs of 314,334 hospitalizations attributed to diabetes and related conditions was Int$ 264.9 million. Most hospitalizations were due to cardiovascular diseases (47.9%), followed by diabetes itself (18%), and renal diseases (13.6%). Diet and transportation costs were estimated at Int$ 3.2 billion and Int$ 462.3 million, respectively. CONCLUSIONS: Our results showed a substantial economic burden of diabetes in Brazil, and most likely are underrated as they are based on an underestimated prevalence of diabetes. Healthcare policies aiming at diabetes prevention and control are urgently sought.

Bariatric surgeries performed by the Brazilian National Health System in residents of the Metropolitan Region of Porto Alegre, Rio Grande do Sul, Brazil, 2010-2016. / Cirurgias bariátricas realizadas pelo Sistema Único de Saúde em residentes da Região Metropolitana de Porto Alegre, Rio Grande do Sul, 2010-2016.

OBJECTIVE: to characterize caracterize by Brazilian National Health System (SUS) hospitalizations for bariatric surgeries in residents of the Metropolitan Region of Porto Alegre, RS, Brazil, from 2010 to 2016. METHODS: data analysis of the National Hospital Information System (SIH/SUS); calculation of indicators by sex, age groups, use of Intensive Care Unit and hospitalization expenses; the target population were patients aged 15 years and older. RESULTS: there were 1,249 hospitalizations (178.4/year; 5.4/100 thousand inhab./year), and the average age was 41.3±10.3 years old (average±standard deviation); the female sex was more prevalent (85.0%) and the age group 35-39 years accounted for 234 cases (18.7%); 227 patients (18.2%) needed ICU; there were 2 (0.2%) deaths; the mean for hospital stay was 5.1±3.2 days; the average annual expense was BRL1,073.830.29±223,791.48; and the average cost for hospitalization was BRL6,018.26±851,34 (BRL1,171.03/day). CONCLUSION: bariatric surgeries were characterized as procedures undergone by young female adults, with relatively frequent use of ICU and low fatality.

Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019 / Tendencia temporal y costos de las hospitalizaciones con el diagnóstico principal de diabetes mellitus en el Sistema Único de Salud de Brasil, de 2011 a 2019 / Tendência temporal e gastos das internações com diagnóstico principal por diabetes mellitus no Sistema Único de Saúde do Brasil, 2011 a 2019

ABSTRACT Objective To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019. Methods This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression. Results A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend. Conclusion The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend.

RESUMEN Objetivo Analizar la tendencia temporal y los costos de las internaciones por diabetes mellitus (DM) en Brasil, por región, Unidades Federativas (UF) y características poblacionales, de 2011 a 2019. Métodos Estudio ecológico con datos del Sistema de Información Hospitalaria, analizando la tendencia anual de las tasas de hospitalización (TH) por DM según sexo, edad, raza/color y región/UF mediante regresión de Prais-Winsten. Resultados Se registraron 1.239.574 hospitalizaciones por DM en el país y la TH fue de 6,77/10 mil habitantes en el período. La tendencia de TH por DM fue decreciente en ambos sexos y en la mayoría de las regiones y creciente en la población más joven y en la duración de la estancia. El gasto total fue de 420.692.238 dólares y fue creciente. Conclusión La tendencia temporal de TH por DM fue decreciente, con diferencias según región/UF y grupo de edad. La duración media de la estancia y los gastos mostraron una tendencia creciente.

RESUMO Objetivo Analisar a tendência temporal e gastos das internações por diabetes mellitus (DM) no Brasil, por região, Unidades da Federação (UFs) e características populacionais, de 2011 a 2019. Métodos Estudo ecológico com dados do Sistema de Informações Hospitalares, analisando a tendência anual das taxas de internação (TIs) por DM segundo sexo, idade, raça/cor e região/UF pela regressão linear generalizada de Prais-Winsten. Resultados Foram registradas 1.239.574 internações por DM no país e a TI foi de 6,77/10 mil habitantes, no período. A tendência das TIs por DM foi decrescente nos dois sexos e na maioria das regiões, e crescente na população mais jovem e no tempo de internação (média de 6,17 dias). O gasto total foi de US$ 420.692,23 e apresentou tendência crescente. Conclusão A tendência temporal da TI por DM foi decrescente, com diferenças segundo região/UF e grupo etário. O tempo médio de internação e os gastos apresentaram tendência de aumento.

Disease and Economic Burden of Hospitalizations Attributable to Diabetes Mellitus and Its Complications: A Nationwide Study in Brazil.

Diabetes is associated with a significant burden globally. The costs of diabetes-related hospitalizations are unknown in most developing countries. The aim of this study was to estimate the total number and economic burden of hospitalizations attributable to diabetes mellitus (DM) and its complications in adults from the perspective of the Brazilian Public Health System in 2014. Data sources included the National Health Survey (NHS) and National database of Hospitalizations (SIH). We considered diabetes, its microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications (coronary heart disease, cerebrovascular disease, and peripheral arterial disease), respiratory and urinary tract infections, as well as selected cancers. Assuming that DM patients are hospitalized for these conditions more frequently that non-DM individuals, we estimated the etiological fraction of each condition related to DM, using the attributable risk methodology. We present number, average cost per case, and overall costs of hospitalizations attributable to DM in Brazil in 2014, stratified by condition, state of the country, gender and age group. In 2014, a total of 313,273 hospitalizations due to diabetes in adults were reported in Brazil (4.6% of total adult hospitalization), totaling (international dollar) Int$264.9 million. The average cost of an adult hospitalization due to diabetes was Int$845, 19% higher than hospitalization without DM. Hospitalizations due to cardiovascular diseases related to diabetes accounted for the higher proportion of costs (47.9%), followed by microvascular complications (25.4%) and DM per se (18.1%). Understanding the costs of diabetes and its major complications is crucial to raise awareness and to support the decision-making process on policy implementation, also allowing the assessment of prevention and control strategies.

Internações hospitalares para tratamento de aneurismas cerebrais rotos e não rotos no Sistema Único de Saúde do Brasil, 2009-2018: um estudo descritivo / Ingresos hospitalarios para el tratamiento de aneurismas cerebrales rotos y no rotos en el Sistema Único de Salud de Brasil, 2009-2018: un estudio descriptivo / Hospital admissions for treatment of ruptured and unruptured cerebral aneurysms within the Brazilian National Health System, 2009-2018: a descriptive study

Objetivo: Analisar internações para tratamento de aneurismas cerebrais rotos e não rotos com realização de embolização e de microcirurgia cerebral no Sistema Único de Saúde (SUS), Brasil, 2009-2018. Métodos: Estudo descritivo, utilizando dados do Sistema de Informações Hospitalares do SUS. Descreveu-se a frequência das internações, procedimentos, utilização de unidade de tratamento intensivo (UTI), letalidade e gastos. Resultados: Das 43.927 internações, 22.622 (51,5%) resultaram em microcirurgia. Embolização e microcirurgia foram mais frequentes no sexo feminino. A duração das internações com embolização foi de 7,7 dias (±9,0), e com microcirurgia, 16,2 (±14,2) dias, a frequência de admissão em UTI, 58,6% e 85,3%, e a letalidade, 5,9% e 10,9%, respectivamente. Do gasto total, US$ 240 milhões, 66,3% corresponderam às internações com embolização. Conclusão: As internações com embolização para tratamento de aneurismas cerebrais no SUS apresentaram menor duração, menor frequência de utilização de UTI e menor letalidade, porém maior gasto em relação à microcirurgia cerebral.

Objetivo: Analizar las internaciones para tratamiento de aneurismas cerebrales rotos y no rotos en cuanto a embolización y microcirugía cerebral en el Sistema Único de Salud (SUS), Brasil, de 2009 a 2018. Métodos: Estudio descriptivo utilizando datos del Sistema de Información Hospitalaria (SIH)/SUS relacionados con la frecuencia de hospitalizaciones, procedimientos, uso de la unidad de cuidados intensivos (UCI), letalidad y gastos. Resultados: De los 43.927 ingresos, 22.622 (51,5%) correspondieron a microcirugía. Hubo una mayor frecuencia de procedimientos de embolización y microcirugía entre las personas del sexo femenino. De las hospitalizaciones con embolización y microcirugía, respectivamente, la duración de la estadía fue de 7,7 (±9,0) y 16,2 (±14,2) días, la frecuencia de ingreso en la UCI fue del 58,6% y el 85,3% y la letalidad del 5,9% y el 10,9%. El gasto total fue de US$ 240 millones, de los cuales el 66,3% correspondió a hospitalizaciones con embolización. Conclusión: Las hospitalizaciones con embolización, para el tratamiento de aneurismas cerebrales en el SUS, tuvieron menor tiempo de estadía, menor frecuencia de uso de la UCI y menor letalidad, pero mayores gastos en relación a la microcirugía cerebral.

Objective: To analyze hospital admissions for treatment of ruptured and unruptured cerebral aneurysms with embolization and brain microsurgery performed within the Brazilian National Health System (SUS), 2009-2018. Methods: This was a descriptive study, using data from the SUS's Hospital Information System. Frequency of hospital admissions, procedures, use of intensive care unit (ICU), case fatality ratio and expenditures were described. Results: Of the 43,927 hospital admissions, 22,622 (51.5%) resulted in microsurgery. Embolization and cerebral microsurgery were more frequent among females. Length of hospital stay with embolization procedure was 7.7 days (±9.0), and with microsurgery, 16.2 (±14.2) days, frequency of ICU admission, 58.6% and 85.3%, and case fatality ratio, 5.9% and 10.9% respectively. Of the total expenditure, USD 240 million, 66.3% corresponded to hospitalizations with embolization procedure. Conclusion: Hospital admissions with embolization procedure for treatment of cerebral aneurysms within the SUS showed a shorter length of stay, less frequent use of ICU and lower case fatality ratio, but higher expenditure when compared to brain microsurgery.

Hospitalizations due to diseases associated with poor sanitation in the public health care network of the metropolitan region of Porto Alegre, Rio Grande do Sul State, Brazil, 2010-2014. / Internações por doenças relacionadas ao saneamento ambiental inadequado na rede pública de saúde da região metropolitana de Porto Alegre, Rio Grande do Sul, 2010-2014.

OBJECTIVE: to describe the occurrence, characteristics and expenditures of hospitalizations due to diseases associated with poor sanitation funded by the Brazilian National Health System (SUS) among residents of the metropolitan region of Porto Alegre-RS, Brazil, from 2010 to 2014. METHODS: descriptive study with data from SUS Hospital Information System (SIH/SUS). RESULTS: out of 13,929 hospitalizations for diseases associated with poor sanitation, 93.7% were related to fecal-oral transmission diseases and 20.4% were children from 1 to 4 years of age (28.1 hospitalizations/10,000 inhabitants/year); hospital fatality rate was of 2.2%, fecal-oral transmission diseases were the main causes of death; intensive care unit (ICU) was used in 2.0% of hospitalizations; total expenditures on hospitalizations was around BRL6.1 million. CONCLUSION: diseases associated with poor sanitation are still an important issue in the metropolitan region of Porto Alegre-RS, although this region presents good development indicators.

HOSPITALIZATIONS FOR CHOLECYSTITIS AND CHOLELITHIASIS IN THE STATE OF RIO GRANDE DO SUL, BRAZIL.

BACKGROUND: The cholelithiasis is disease of surgical resolution with about 60,000 hospitalizations per year in the Sistema Único de Saúde (SUS - Brazilian National Health System) of the Rio Grande do Sul state. AIM: To describe the profile of hospitalizations for cholecystitis and cholelithiasis performed by the SUS of Rio Grande do Sul state, 2011-2013. METHODS: Hospital Information System data from the National Health System through morbidity list for cholelithiasis and cholecystitis (ICD-10 K80-K81). Variables studied were sex, age, number of hospitalizations and approved Hospitalization Authorizations (AIH), total amount and value of hospital services generated, days and average length of stay, mortality, mortality and case fatality ratio, from health regions of the Rio Grande do Sul. RESULTS: During 2011-2013 there were 60,517 hospitalizations for cholecystitis and cholelithiasis, representing 18.86 hospitalizations per 10,000 inhabitants/year, most often in the age group from 60 to 69 years (41.34 admissions per 10,000 inhabitants/year) and female (27.72 hospitalizations per 10,000 inhabitants/year). The fatality rate presented an inverse characteristic: 13.52 deaths per 1,000 admissions/year for males, compared with 7.12 deaths per 1,000 admissions/year in females. The state had an average total amount spent and value of hospital services of R$ 16,244,050.60 and R$ 10,890,461.31, respectively. The health region "Capital/Gravataí Valley" exhibit the highest total expenditure and hospital services, and the largest number of deaths, and average length of stay. CONCLUSION: The hospitalization and lethality coefficients, the deaths, the length of stay and spending related to admissions increased from 50 years old. Females had a higher frequency and higher values ​​spent on hospitalization, while the male higher coefficient of mortality and mean hospital stay.

RACIONAL: A colelitíase é doença de resolução cirúrgica com cerca de 60.000 internações por ano no Sistema Único de Saúde no estado do Rio Grande do Sul. OBJETIVO: Descrever o perfil das internações por colecistite e colelitíase na rede pública do estado no triênio 2011-2013. MÉTODOS: Emprego de dados do Sistema de Informações Hospitalares do Sistema Único de Saúde, através da lista de morbidades para colelitíase e colecistite (CID-10 K80-K81). As variáveis estudadas foram: sexo, idade, número de internações e de Autorizações de Internação Hospitalar aprovadas, valor total e valor dos serviços hospitalares gerados, dias e média de permanência, óbitos, coeficiente de mortalidade e letalidade, a partir das regiões de saúde do estado. RESULTADOS: No triênio ocorreram 60.517 internações por colecistite e colelitíase, o que representou 18,86 internações por 10.000 habitantes/ano, mais frequente na faixa etária dos 60 aos 69 anos (41,34 internações por 10.000 habitantes/ano) e no sexo feminino (27,72 hospitalizações por 10.000 habitantes/ano). O coeficiente de letalidade apresentou característica inversa: 13,52 óbitos para 1.000 internações/ano para o sexo masculino, contra 7,12 óbitos para 1.000 internações/ano no sexo feminino. O estado apresentou médias de valor total gasto e de valor dos serviços hospitalares de R$16.244.050,60 e R$10.890.461,31, respectivamente. A região de saúde "Capital/Vale do Gravataí" apresentou o maior valor total gasto e de serviços hospitalares, e o maior número de óbitos, média e dias de permanência. CONCLUSÃO: Os coeficientes de internação e de letalidade, os óbitos, os dias de permanência e os gastos referentes às internações aumentam a partir dos 50 anos de idade. O sexo feminino apresentou maior frequência e maiores valores gastos com a internação, enquanto o masculino maior coeficiente de letalidade e média de permanência hospitalar.

Estratégia de vacinação da BCG: unidade de saúde versus maternidade / BCG vaccination strategy: health unit versus maternity

Objetivo: comparar a estratégia atual de vacinação BCG em Unidade de Saúde com a alternativa de aplicação em maternidades/hospitais no município de Porto Alegre - Rio Grande do Sul. Metodologia: trata-se de um estudo de abordagem quantitativa, com base em dados de espelhos dos registros físicos das carteiras de vacinação e dados secundários de sistemas de informação de saúde, relativos ao período 2010 a 2014. Resultados: apenas 3,7% dos nascidos vivos foram vacinados nas primeiras 12 horas de vida, enquanto 50,1% o foram na primeira semana e 22,9% após os 15 dias de vida, aumentando o risco de exposição à tuberculose. Somente 22% das doses distribuídas às unidades de saúde foram aplicadas indicando elevado desperdício de doses e recursos financeiros. Conclusão: a estratégia de aplicação da BCG em Unidade de Saúde não corresponde à melhor alternativa de vacinação para o município sugerindo-se, portanto, a aplicação ainda na maternidade/hospital de nascimento.

Objective: To compare the current BCG vaccination strategy in Health Units with the alternative of application in maternity/hospitals in the city of Porto Alegre - Rio Grande do Sul. Methodology: This is a quantitative study based on mirror data from physical records of vaccination cards and secondary data from health information systems from 2010 to 2014. Results: Only 3.7% of live births were vaccinated in the first 12 hours of life, while 50.1% were in the first week, and 22.9% after 15 days of life, increasing the risk of exposure to tuberculosis. Only 22% of the doses distributed to the health units were applied, indicating high waste of doses and financial resources. Conclusion: The strategy of BCG application in Health Units does not correspond to the best vaccination alternative for the city, suggesting, therefore, the application still in the maternity/hospital of birth.

Percurso formativo na Rede de Atenção Psicossocial: inovação e transformação nas práticas em saúde mental / Training path in the Psychosocial Care Network: innovation and transformation in mental health practices / Recorrido formativo en la Red de Atención Psicosocial: innovación y transformación en las prácticas en salud mental

OBJETIVO: descrever as transformações decorrentes da participação de trabalhadores da Secretaria Municipal de Saúde de Guaíba/RS no projeto "Percursos Formativos na Rede de Atenção Psicossocial: Intercâmbio entre experiências", do Ministério da Saúde. MÉTODOS: estudo qualitativo, descritivo, em que foram realizadas entrevistas semiestruturadas individuais com 22 participantes e consultas a documentos pertinentes ao projeto. Utilizou-se análise de conteúdo de Bardin. RESULTADOS: apresentados em dois eixos: "Intercâmbio como estratégia inovadora na formação", "Ressignificação das práticas no campo da saúde mental". Identificaram-se mudanças nos processos de trabalho decorrentes do aumento da visibilidade do campo da saúde mental e melhorias na atenção aos usuários, com destaque para práticas alinhadas à humanização do cuidado. Detectou-se incremento na motivação dos trabalhadores e maior articulação entre os serviços da rede. O projeto apresentou características inovadoras de formação e sua execução foi decisiva nas transformações que já estavam em curso. A pesquisa evidenciou a relação entre experiências de formação e processos de cuidado mais afeitos a uma produção de saúde crítica, reflexiva, criativa e emancipatória. CONCLUSÃO: desvela-se desenvolvimento de forte e duradouro senso de crítica e de necessidade de inovação em saúde mental, que parecem ter emergido com mais vigor durante a realização do projeto.

OBJECTIVE: to identify and describe changes resulting from the participation of workers from the Municipal Health Department of Guaíba/RS in the project entitled "Training Path in the Psychosocial Care Network: Exchange between experiences", from the Ministry of Health. METHOD: a qualitative and descriptive study in which individual semi-structured interviews were conducted with 22 participants, as well as consultations to documents relevant to the project. Bardin content analysis was used. RESULTS: presented in two axes: "Exchange as an innovative training strategy" and "Resignifying the practices in the field of mental health". Changes in work processes were identified, as a result of increased visibility of mental health field and improvements in care, with emphasis on practices aligned with the humanization of care. There was an increase in the workers' motivation and articulation among the services of the network. The project presented innovative training characteristics and its execution was decisive in the transformations that were underway. The research showed the relation between training experiences and care processes more related to a critical, reflective, creative and emancipatory health production. CONCLUSION: the development of a strong sense of criticism and the need for innovation in mental health was revealed, which emerged with more vigor during the project.

OBJETIVO: identificar y describir las transformaciones provenientes de la participación de trabajadores de Guaíba/RS en el proyecto "Recorrido Formativo en la Red de Atención Psicosocial: Intercambio entre experiencias" del Ministerio de Salud. MÉTODOS: estudio cualitativo descriptivo. Se realizaron entrevistas semiestructuradas entre 22 participantes y consultas sobre documentos relevantes para el proyecto. Además, el análisis de contenido de Bardin orientó la reflexión. RESULTADOS: se presentaron dos ejes: "Intercambio como estrategia innovadora de formación", "Resignificación de las prácticas en el campo de salud mental". Se identificaron cambios en los procesos laborales provenientes del aumento de la visibilidad del campo de la salud mental y mejorías en la atención de usuarios con destaque para prácticas alineadas a la humanización del cuidado. Se detectó incremento en la motivación de trabajadores y mayor articulación entre los servicios de la red. El proyecto presentó características innovadoras de formación y su ejecución fue decisiva en la transformación de la Red que estaba en curso. La investigación evidenció la relación entre las experiencias de formación y los procesos de cuidado más vinculados a una producción de salud crítica, reflexiva, creativa y emancipadora. CONCLUSIÓN: se devela el desarrollo firme y duradero del sentido crítico como también de la necesidad de innovación en salud mental que parecen haber emergido con mayor vigor durante la realización del proyecto.

Desperdício de vacinas: uma revisão da literatura / Vaccine waste: a review of the literature / Residuos de vacunas: una revisión de la literatura

O presente artigo tem como objetivo sistematizar o que tem sido publicado sobre desperdício de vacinas multidoses e monodoses. Trata-se de uma revisão da literatura construída a partir da questão norteadora: O que a literatura tem publicado sobre o desperdício de vacinas? Os unitermos definidos foram: "vaccine", "waste", "vial wastage" e "multidose". Para a seleção dos artigos foram consultadas as bases de dados "PubMed", "Scielo", "Revista Vaccine", "Periódicos Capes", "Teses e Dissertações Capes". Optou-se em continuar a busca por mais estudos utilizando a técnica "schneeball". A amostra final foi constituída de 26 artigos e duas dissertações, sendo o texto mais antigo de 2002 e os mais recentes de 2017. A maioria teve sua publicação no idioma inglês e em periódicos internacionais. Concluímos que independentemente das causas de desperdício de vacinas, evidencia-se a importância do monitoramento desses desperdícios e de serem criadas estratégias para sua redução.

This literature review summarizes the recent research published on multi-dose and single-dose vaccine waste. Based on the research question "What has been published on vaccine waste?" papers were selected from the PubMed, Scielo, Vaccine Magazine, Periods Capes, and Thesis and Dissertation Capes databases using the following descriptors: "vaccine," "waste," "vial wastage," "multidose." A manual search was performed using the "schneeball" technique. The final sample comprised 26 papers and 2 dissertations, the oldest text being from 2002 and the most recent from 2017. Most articles were published in English and in international journals. In conclusion, regardless its causes, vaccine wastage must be monitored and strategies developed for its reduction.

El presente artículo tiene como objetivo sistematizar lo que se ha publicado sobre el desperdicio de vacunas multidosis y monodosis. Se trata de una revisión de la literatura construida a partir de la cuestión orientadora: ¿Qué ha publicado la literatura sobre el desperdicio de vacunas? Los términos definidos fueron: "vaccine", "waste", "vial wastage" y "multidose". Para la selección de los artículos fueron consultadas las bases de datos "PubMed", "SciELO", "Revista Vaccine", "Periódicos Capes" y "Teses e Dissertações Capes". Se optó por continuar la búsqueda de más estudios utilizando la técnica "schneeball". La muestra final constó de 26 artículos y dos disertaciones, en que el más antiguo fue de 2002 y los más recientes de 2017. La mayoría tuvo su publicación en el idioma inglés y en revistas internacionales. Se concluyó que, independiente de las causas de desperdicio de vacunas, se evidencia la importancia del monitoreo de esos desperdicios y de que se creen estrategias para su reducción.

Perfil do gestor e práticas de gestão municipal no Sistema Único de Saúde (SUS) de acordo com porte populacional nos municípios do estado do Rio Grande do Sul / Manager profile and practices of county health management in the Unified Health System (SUS) according to population size in the municipalities of the Rio Grande do Sul state

Resumo O estudo buscou conhecer quem são os gestores municipais de saúde e práticas realizadas no âmbito de gestão. Possuiu delineamento transversal. A metodologia contou com o envio de um questionário eletrônico às secretarias de saúde dos 497 municípios do estado do Rio Grande do Sul (RS). Destes, 297 retornaram (59,75%). Contudo, foram considerados na análise estatística apenas os questionários com mais de 50% de respostas válidas (n = 264). A análise contou com o cálculo da distribuição das variáveis e com testes de qui-quadrado, onde o porte populacional foi considerado variável independente. A maioria foi composta por mulheres, com escolaridade alta e distintas formações, média de idade de 43,76 anos, cor branca. A média de gastos com saúde foi de ≈20% das receitas. Houve consenso quanto na insuficiência dos recursos. Quanto ao porte populacional, 79,92% possuíam ≤ 20.000 habitantes. Diferenças significativas foram observadas na gestão de municípios de distintos portes, tanto nas prioridades, quanto nas dificuldades. O estudo permitiu conhecer parcialmente a realidade da gestão municipal. Além disso, os resultados sugeriram a necessidade de novas pesquisas sobre a feminilização da gestão, avaliação de processos de trabalho e impactos da política de austeridade.

Abstract This study intended to gather who are the county health managers and the practices performed in management. It is based on a cross-sectional design. The methodology involved the use of electronic questionnaire, which was sent to the health departments of the 497 municipalities of the state of Rio Grande do Sul (RS). Of these, 297 were answered (59.75%). However, only those with more than 50% of valid answers (n = 264) were included in the statistical analysis. The analysis included the calculation of the distribution of variables and chi-square testes, taking population size as an independent variable. Most managers were women; graduated; from different professional backgrounds; average age of 43.76 years-old, and white. The average health expenditure in the municipalities was ≈ 20% of revenues. There was a consensus on the insufficiency of resources. With regards to population size, 79.92% presented with ≤ 20,000 inhabitants. Statistically significant differences were found in the management of municipalities of different sizes, both in terms of priorities and difficulties. The study allowed to partially understanding the reality of municipal management. These results indicate the need to further investigate the feminization of health management, working process assessment, and the impacts of economical austerity policy.

CONASS Documenta nº 30 O Direito Sanitário como instrumento de fortalecimento do SUS: ênfase na educação permanente em saúde / CONASS Documenta No. 30 El Derecho Sanitario como instrumento para fortalecer el SUS: énfasis en la educación permanente en salu / CONASS Documenta No. 30 Health Law as an instrument for strengthening SUS: emphasis on permanent health educatio

O Caderno Conass Documenta nº 30 apresenta a experiência do desenvolvimento de uma estratégia de ensino na saúde com o desenvolvimento ensino-aprendizado de aproximadamente 160 profissionais, de diferentes áreas das Secretarias Estaduais de Saúde (SES) e das procuradorias dos estados, buscando propiciar a observação e a compreensão dos indicadores de saúde, percorrer todo o arcabouço legislativo e normativo do SUS e fortalecer a política pública de saúde mediante o percurso desenvolvido desde a construção do curso de especialização proposto pelo Conass, com o Programa de Direito Sanitário (Prodisa) da Fiocruz Brasília, e da Universidade Aberta do SUS (UnaSUS) até a entrega dos Projetos de Intervenção desenvolvidos em cada estado brasileiro.

El Cuaderno de Documentación Conass No. 30 presenta la experiencia de desarrollar una estrategia de enseñanza en salud con el desarrollo de la enseñanza-aprendizaje de aproximadamente 160 profesionales de diferentes áreas de las Secretarías de Salud del Estado (SES) y fiscales estatales, que buscan proporcionar observación y la comprensión de los indicadores de salud, cubriendo todo el marco legislativo y normativo del SUS y fortaleciendo la política de salud pública a través del curso desarrollado desde la construcción del curso de especialización propuesto por Conass, con el Programa de Derecho Sanitario (Prodisa) de Fiocruz Brasilia, y la Universidad Abierta del SUS (UnaSUS) hasta la entrega de Proyectos de Intervención desarrollados en cada estado brasileño.

The Conass Documenta No. 30 presents the experience of developing a teaching strategy in health with the teaching-learning development of approximately 160 professionals from different areas of the State Health Secretariats (SES) and state prosecutors, seeking to provide observation and the understanding of health indicators, covering the entire legislative and normative framework of the SUS and strengthening public health policy through the course developed since the construction of the specialization course proposed by Conass, with Fiocruz's Sanitary Law Program (Prodisa) in Brasília, and the Open University of SUS (UnaSUS) until the delivery of Intervention Projects developed in each Brazilian state.