Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

OBJECTIVES: Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). STUDY DESIGN: Cross-sectional ecological study. METHODS: Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. RESULTS: More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. CONCLUSION: Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances.

Inserção do lúdico como facilitador da hospitalização na infância: percepção dos pais / Insertion of play as facilitator of hospitalization in childhood: parental perception

Objetivo: conhecer a percepção dos pais quanto a inserção de atividades lúdicas durante a internaçãohospitalar da criança. Métodos: estudo qualitativo, descritivo e exploratório, realizado de outubro adezembro de 2012 em um hospital no Brasil. Foram entrevistados seis pais de crianças internadas. Aentrevista ocorreu em duas etapas: inicialmente, as crianças foram abordadas de forma lúdicadurante os cuidados de enfermagem. Após foram realizadas entrevistas semiestruturadas com os pais.O estudo foi aprovado pelo Comitê de Ética e Pesquisa sob o número 083/2012. Resultados: da análisesurgiram dois eixos temáticos: as dificuldades encontradas pelas crianças durante o período deinternação hospitalar, e, os benefícios da inserção de atividades lúdicas durante a hospitalização.Considerações finais: com a utilização de atividades lúdicas, conclui-se que essas são capazes detornar o ambiente hospitalar menos ameaçador, possibilitando resgatar sorrisos e alegria de sercriança.

Objective: to know the perception of the parents regarding the insertion of play activities duringthe hospitalization of the child. Methods: qualitative, descriptive and exploratory study, carried outfrom October to December 2012 in a hospital in Brazil. Parents of six hospitalized children wereinterviewed. The interview was made in two stages: first, the children were raised in a playful,during nursing care. After, semi-structured interviews with the parents were conducted. The studywas approved by the Research Ethics Committee with number 083/2012. Results: two theme fromthe analysis emerged: the difficulties faced by children during the hospitalization, and the benefitsof inclusion of recreational activities during hospitalization. Final considerations: with the use ofrecreational activities, we can conclude that they are able to make the hospital environment leastthreatening, enabling rescue smiles and the joy of being a child.