[General characteristics of medical education in Mexico. A look from medical schools]. / Características generales de la educación médica en México. Una mirada desde las escuelas de medicina.

OBJECTIVE: To know the characteristics of medical education and identify its strengths and weaknesses. MATERIALS AND METHODS: A transversal and quantitative study of the characteristics of medical education in 29 medical schools in Mexico was carried out, between April and September 2017. Questionnaire with Likert scale was applied to explore context, regulation, structure, process, results and impact of medical education. Bivariate analysis was performed with a Chi square test and the significance level was equal to or less than 0.05. RESULTS: The political context obtained 64%, economical context 10% and mechanisms of regulation 31%. The educational structure was 61% and the social impact was 93%. CONCLUSIONS: Public policies, regulatory mechanisms and public investment must be strengthened to improve the quality of medical education.

OBJETIVO: Conocer las características de la educación médica e identificar sus fortalezas y debilidades. MATERIAL Y MÉTODOS: Se realizó un estudio transversal y cuantitativo para conocer las características de la educación médica en 29 escuelas de medicina en México, entre abril y septiembre de 2017. Se utilizó un cuestionario con escala tipo Likert para explorar el contexto, la regulación, la estructura, el proceso, los resultados y el impacto de la educación médica. Se realizó un análisis bivariado con ji cuadrada y una significancia estadística de p igual o menor a 0.05. RESULTADOS: El contexto político obtuvo 64%, el contexto económico 10%, los mecanismos de regulación 31%, la estructura educativa 61% y el impacto social 93%. CONCLUSIONES: Se requiere fortalecer las políticas públicas, la regulación y la inversión pública, para mejorar la calidad de la educación médica.

Características generales de la educación médica en México. Una mirada desde las escuelas de medicina / General characteristics of medical education in Mexico. A look from medical schools

Resumen: Objetivo: Conocer las características de la educación médica e identificar sus fortalezas y debilidades. Material y métodos: Se realizó un estudio transversal y cuantitativo para conocer las características de la educación médica en 29 escuelas de medicina en México, entre abril y septiembre de 2017. Se utilizó un cuestionario con escala tipo Likert para explorar el contexto, la regulación, la estructura, el proceso, los resultados y el impacto de la educación médica. Se realizó un análisis bivariado con ji cuadrada y una significancia estadística depigual o menor a 0.05. Resultados: El contexto político obtuvo 64%, el contexto económico 10%, los mecanismos de regulación 31%, la estructura educativa 61% y el impacto social 93%. Conclusiones: Se requiere fortalecer las políticas públicas, la regulación y la inversión pública, para mejorar la calidad de la educación médica.

Abstract: Objective: To know the characteristics of medical education and identify its strengths and weaknesses. Materials and methods: A transversal and quantitative study of the characteristics of medical education in 29 medical schools in Mexico was carried out, between April and September 2017. Questionnaire with Likert scale was applied to explore context, regulation, structure, process, results and impact of medical education. Bivariate analysis was performed with a Chi square test and the significance level was equal to or less than 0.05. Results: The political context obtained 64%, economical context 10% and mechanisms of regulation 31%. The educational structure was 61% and the social impact was 93%. Conclusions: Public policies, regulatory mechanisms and public investment must be strengthened to improve the quality of medical education.

Knowledge and attitudes of theatre staff prior to the implementation of robotic-assisted surgery in the public sector.

BACKGROUND: The use of robotic-assisted surgery (RAS) is becoming increasingly prevalent across a range of surgical specialties within public hospitals around Australia. As a result, it is critical that organisations consider workplace factors such as staff knowledge, attitudes and behaviours prior to the implementation of such new technology. This study aimed to describe the knowledge and attitudes of operating theatre staff from a large public tertiary referral hospital prior to the commencement of an RAS program. METHODS: A cross-sectional survey of nursing, medical and support staff working in the operating theatre complex of a large public tertiary referral hospital was completed over a one-week period in June 2016. A 23-item questionnaire was utilised for data collection. RESULTS: 164 (66%) theatre staff returned the surveys and were included in this study. The majority of medical staff reported being knowledgeable about RAS, whilst the majority of nursing and support staff did not. Overall the theatre staff were neutral about the potential benefits of RAS to patients. The majority of medical staff believed the implementation of RAS will increase the value of staff roles and job satisfaction, while nursing and support staff were uncertain about these benefits. All three staff groups were concerned about the impact of an RAS program on Workplace Health and Safety, and care and handling. CONCLUSION: Operating theatre staff presented different knowledge and attitudes prior to the introduction of RAS. Whilst theatre staff were more favourable towards RAS than negative, they largely reserved their judgement about the new system prior to their own experiences. Collectively, these findings should be taken into consideration for training and support strategies prior to the implementation of a RAS program.

Histology and Cytopathology Capacity in the Public Health Sector in Kenya.

PURPOSE: Histology and cytopathology services are necessary for cancer diagnosis and treatment. However, the current capacity of Kenya's pathology laboratories is unknown. A national survey was conducted among public sector pathology laboratories to assess their capacity to perform histology, fine-needle aspiration, and bone marrow aspiration. METHODS: Between April and June 2017, we identified all public hospitals that provide pathology services in Kenya. In total, two national and 13 county referral hospitals met the inclusion criteria and were sent a standardized, pretested, self-administered questionnaire. RESULTS: A total of 11 hospitals (73%) completed the survey. The reported total caseload of histology, fine-needle aspiration, and bone marrow aspiration for 2016 was 26,472. All of the facilities staffed a pathologist and were providing cancer-related diagnostic services. Nine (82%) of the hospitals maintain a register of diagnosed cancer cases, but only one (11%) of those uses an electronic system. Six (55%) of the surveyed hospitals were able to perform histology with a median turnaround time of 14 days. Six (55%) laboratories regularly referred some specimens elsewhere for interpretation, but three of these centers relied on patients for transportation of the specimen to the referral institution. No laboratories were accredited by an external organization; however, 10 (91%) of the laboratories were working toward achieving accreditation, but only for clinical pathology services. CONCLUSION: This study describes the current status of histology and cytopathology capacity in Kenya's public sector hospitals. It provides useful baseline information needed by the Ministry of Health to develop necessary capacity building and referral-strengthening interventions. A high proportion of hospitals are working to achieve accreditation points toward their commitment to providing quality services to the Kenyan public.

Medical perception of stroke care conditions in Brazil / Percepção médica sobre as condições para atendimento do AVC no Brasil

ABSTRACT Stroke is currently the second leading cause of death in Brazil. Neurologists' reports on the absence of adequate resources for stroke care are frequent; however, there are no objective data on this perception. Objective To assess the perception of neurologists of stroke care conditions in Brazil. Methods Neurologists from all over Brazil were surveyed by means of an anonymous questionnaire about the main shortcomings in stroke care, focusing particularly on physical structure and infrastructure (diagnostic methods, patient transport, availability of beds, multi-professional team). Results The main shortcomings are indicated: the worst conditions, among all items surveyed, were found in the public sector. In the private sector, conditions were better. Conclusions Care conditions are worse in the public sector with regard to both infrastructure and human resources. Future public health policies for the prevention and treatment of stroke should be formulated, taking into consideration neurologists' perceptions.

RESUMO O acidente vascular cerebral é atualmente a segunda causa de morte no Brasil. São frequentes os relatos de médicos neurologistas sobre a ausência de recursos adequados para o atendimento do AVC, no entanto, não existem dados objetivos sobre essa percepção. Objetivo Analisar a percepção de médicos neurologistas sobre as condições para o atendimento de AVC no Brasil. Métodos Neste estudo foi realizada pesquisa por questionário anônimo com médicos neurologistas de todo o Brasil, perguntando-se as principais deficiências para o atendimento, com foco na estrutura física, infraestrutura (métodos diagnósticos, transporte do doente, disponibilidade de leitos, equipe multiprofissional). Resultados As principais deficiências são apontadas; no setor público notou-se as piores condições, em todos os itens pesquisados. No setor privado, as condições são melhores. Conclusões As condições de atendimento são piores no setor público, tanto de infraestrutura quanto de recursos humanos. Futuras políticas de saúde pública para prevenção e tratamento do AVC deveriam ser elaboradas levando em consideração a percepção do neurologista.

Prevalence of anxious and depressive symptoms in college students of a public institution / Prevalencia de síntomas ansiosos y depresivos en universitarios de una institución pública / Prevalência de sintomas ansiosos e depressivos em universitários de uma instituição pública

ABSTRACT Objective: Identify the prevalence of anxious and depressive symptoms and their correlations with sociodemographic and occupational characteristics in university students. Method: This is census, cross-sectional and analytical study, developed with nursing students of a federal public university in the Northeast of Brazil in the months of September and October 2016. 205 university students of all the periods of the course attended the study. Beck's inventories for anxiety and depression were applied. Results: Most of the participants were female, single, native of the state capital and living with his parents. The prevalence of depression was 30.2% and of anxiety, 62.9%. Association between the level of depressive symptoms, work, sex and leisure was identified. Conclusion: The prevalence of symptoms of anxiety and depression was quite expressive, lacking, thus, more attention to the promotion of mental health of nursing students.

RESUMEN Objetivo: Identificar la prevalencia de síntomas ansiosos y depresivos y sus correlaciones con características sociodemográficas y ocupacionales en universitarios. Método: Se trata de un estudio censal, transversal, y analítico, desarrollado con estudiantes de enfermería de una universidad pública federal del Nordeste de Brasil en los meses de septiembre y octubre de 2016. Participaron 205 universitarios de todos los períodos del curso. Se aplicaron los inventarios de Beck para la ansiedad y la depresión. Resultados: La mayoría de los participantes era del género femenino, soltera, natural de la capital del estado y vivía con los padres. La prevalencia de depresión fue del 30,2%, y de ansiedad el 62,9%. Se identificó asociación entre el nivel de síntomas depresivos, trabajo, sexo y ocio. Conclusión: La prevalencia de los síntomas de ansiedad y depresión fue bastante expresiva, necesitando, por lo tanto, de más atención y promoción a la salud mental de los estudiantes de enfermería.

RESUMO Objetivo: Identificar a prevalência de sintomas ansiosos e depressivos e suas correlações com características sociodemográficas e ocupacionais em universitários. Método: Trata-se de estudo censitário, transversal, e analítico, desenvolvido com estudantes de enfermagem de uma universidade pública federal do Nordeste do Brasil nos meses de setembro e outubro de 2016. Participaram 205 universitários de todos os períodos do curso. Foram aplicados os inventários de Beck para ansiedade e depressão. Resultados: A maioria dos participantes era do sexo feminino, solteira, natural da capital do estado e morava com os pais. A prevalência de depressão foi de 30,2% e de ansiedade, 62,9%. Identificou-se associação entre o nível de sintomas depressivos, trabalho, sexo e lazer. Conclusão: A prevalência dos sintomas de ansiedade e depressão foi bastante expressiva, carecendo, portanto, de mais atenção e promoção à saúde mental dos estudantes de enfermagem.

Quality of the ophthalmological service to outpatients of the public and private healthcare systems.

PURPOSE: To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. METHODS: This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. RESULTS: Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. CONCLUSIONS: Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

Quality of the ophthalmological service to outpatients of the public and private healthcare systems / Qualidade do serviço oftalmológico prestado aos pacientes ambulatoriais dos sistemas de saúde público e privado

ABSTRACT Purpose: To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. Methods: This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Results: Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Conclusions: Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

RESUMO Objetivo: Comparar a percepção da qualidade dos serviços oftalmológicos prestado aos pacientes ambulatoriais do sistema público com a do sistema privado e detectar quais ações são percebidas como necessárias e prioritárias para melhorar a qualidade do atendimento. Métodos: Foi realizado estudo prospectivo observacional de 200 pacientes sendo 101 do sistema público de saúde e 99 do sistema privado submetidos a exame oftalmológico em Hospital Especializado em Oftalmologia (HEO) - Belo Horizonte - MG - Brasil. Realizaram-se entrevistas pessoais, mediante a aplicação de dois questionários estruturados adaptados da escala SERVQUAL modificada. Resultados: No geral, detectou-se que pacientes do sistema de saúde privado, estão significativamente mais insatisfeitos que aqueles do sistema público de saúde. Em ambos os sistemas a confiabilidade foi considerada o determinante de qualidade mais importante e o que apresentou o maior índice de insatisfação. No sistema público a satisfação foi significativamente superior à do sistema privado a nível dos determinantes da escala SERVQUAL: tangibilidade, confiabilidade, atendimento e segurança. Conclusões: A instituição deve planejar, executar, avaliar e monitorar ações que busquem melhorar a satisfação geral dos pacientes com a qualidade do serviço recebido, principalmente do sistema privado, com atenção especial à confiabilidade nos dois sistemas. A identificação e monitorização da qualidade dos serviços de saúde, empregando periodicamente a escala SERVQUAL, poderá fornecer informações à administração dos serviços de saúde para que possam detectar, planejar e monitorizar as ações necessárias e prioritárias, podendo funcionar como chave estratégica para o aprimoramento da qualidade dos serviços de saúde ambulatoriais públicos e privados.

The outcomes of patients returned to general practitioner after being declined hip and knee replacement.

AIM: To determine the outcome of patients waitlisted for hip and knee replacement surgery who were returned to GP due to resource constraints. METHODS: Prospectively gathered data of all patients returned to GP was analysed, including demographics, clinical prioritisation scores and patient-reported scores. Subsequent outcome was collected from departmental records and the National Joint Registry. RESULTS: Between November 2013 and December 2015, 374 patients were returned to GP care. At minimum 12-month follow-up, 215 (57.5%) had undergone or had certainty for surgery, 36 patients (9.6%) had been re-referred and again declined surgery and 123 (32.9%) remained in GP care. The factors influencing the likelihood of a patient subsequently qualifying for surgery were need for hip rather than knee replacement, time from initial FSA and initial NZOA score. The mean waiting time for those patients who underwent publicly-funded surgery was 14.7 months. CONCLUSION: Returning patients to GP delays treatment rather than reducing the need for surgery. This delay results in waste, added costs to the patient, healthcare system and society, and may reduce the benefit of surgery. There needs to be a significant increase in capacity to meet this demand.

The first implementation of IMRT technique for head & neck and prostate cancer patients in public sector in Greece: feasibility, treatment planning and dose delivery verification using the delta(4PT) Pre-Treatment volumetric quality assurance system.

PURPOSE: Intensity Modulated Radiation Therapy (IMRT) is nowadays the treatment of choice, in terms of technique, for either head & neck or prostate cancer. With this paper, we are sharing our experience for the first inplementation of IMRT planning in the public sector in Greece, and especially in the Aretaieion University Hospital of Athens. METHODS: From May 2013 until January 2014 four prostate and four head & neck cancer patients were evaluated in the present study. We used the ONCENTRA IMRT treatment planning with a step and shoot technique in a SIEMENS ONCORE Linac. The dose verification method used was based on the delta4(PT) Pre-Treatment volumetric quality assurance system, by Scadidos. RESULTS: In all cases, the Relative Standard Deviation between the prescribed and the calculated average dose received by the target volume was less than 5%, while the γ-index was more than 90%. The acute toxicity was low and equivalent to published data with IMRT technique. CONCLUSION: In conclusion, the first implementation of IMRT technique in the Medical School of Athens was feasible and safe as well as in terms of dose verification. The IMRT technique is already in clinical use and further results with long term radiation induced toxicity will be reported.

Improving the public health sector in South Africa: eliciting public preferences using a discrete choice experiment.

BACKGROUND: The introduction of national health insurance (NHI), aimed at achieving universal coverage, is the most important issue currently on the South African health policy agenda. Improvement in public sector health-care provision is crucial for the successful implementation of NHI as, regardless of whether health-care services become more affordable and available, if the quality of the services provided is not acceptable, people will not use the services. Although there has been criticism of the quality of public sector health services, limited research is available to identify what communities regard as the greatest problems with the services. METHODS: A discrete choice experiment (DCE) was undertaken to elicit public preferences on key dimensions of quality of care when selecting public health facilities in South Africa. Qualitative methods were applied to establish attributes and levels for the DCE. To elicit preferences, interviews with community members were held in two South African provinces: 491 in Western Cape and 499 in Eastern Cape. RESULTS: The availability of necessary medicine at health facilities has the greatest impact on the probability of attending public health facilities. Other clinical quality attributes (i.e. provision of expert advice and provision of a thorough examination) are more valued than non-clinical quality of care attributes (i.e. staff attitude, treatment by doctors or nurses, and waiting time). Treatment by a doctor was less valued than all other attributes. CONCLUSION: Communities are prepared to tolerate public sector health service characteristics such as a long waiting time, poor staff attitudes and lack of direct access to doctors if they receive the medicine they need, a thorough examination and a clear explanation of the diagnosis and prescribed treatment from health professionals. These findings prioritize issues that the South African government must address in order to meet their commitment to improve public sector health-care service provision.

What encourages sun protection among outdoor workers from four industries?

OBJECTIVES: We aimed to identify current practice of sun protection and factors associated with effective use in four outdoor worker industries in Queensland, Australia. METHODS: Workplaces in four industries with a high proportion of outdoor workers (building/construction, rural/farming, local government, and public sector industries) were identified using an online telephone directory, screened for eligibility, and invited to participant via mail (n=15, recruitment rate 37%). A convenience sample of workers were recruited within each workplace (n=162). Workplaces' sun protective policies and procedures were identified using interviews and policy analysis with workplace representatives, and discussion groups and computer-assisted telephone interviews with workers. Personal characteristics and sun protection knowledge, attitudes and behaviors were collated and analysed. RESULTS: Just over half the workplaces had an existing policy which referred to sun protection (58%), and most provided at least some personal protective equipment (PPE), but few scheduled work outside peak sun hours (43%) or provided skin checks (21%). Several worker and workplace characteristics were associated with greater sun protection behaviour among workers, including having received education on the use of PPE (p<0.001), being concerned about being in the sun (p=0.002); and working in a smaller workplace (p=0.035). CONCLUSIONS: Uptake of sun protection by outdoor workers is affected by a complex interplay of both workplace and personal factors, and there is a need for effective strategies targeting both the workplace environment and workers' knowledge, attitudes and behaviors to decrease harmful sun exposure further.

Comparison of adherence to chlamydia screening guidelines among Title X providers and non-Title X providers in the California Family Planning, Access, Care, and Treatment Program.

BACKGROUND: Annual chlamydia screening is recommended for adolescent and young adult females and targeted screening is recommended for women ≥26 years based on risk. Although screening levels have increased over time, adherence to these guidelines varies, with high levels of adherence among Title X family planning providers. However, previous studies of provider variation in screening rates have not adjusted for differences in clinic and client population characteristics. METHODS: Administrative claims from the California Family Planning, Access, Care, and Treatment (Family PACT) program were used to (1) examine clinic and client sociodemographic characteristics by provider group-Title X-funded public sector, non-Title X public sector, and private sector providers, and (2) estimate age-specific screening and differences in rates by provider group during 2009. RESULTS: Among 833 providers, Title X providers were more likely than non-Title X public sector providers and private sector providers to serve a higher client volume, a higher proportion of clients aged ≤25 years, and a higher proportion of African American clients. Non-Title X public providers were more likely to be located in rural areas, compared with Title X grantees and private sector providers. Title X providers had the largest absolute difference in screening rates for young females vs. older females (10.9%). Unadjusted screening rates for young clients were lower among non-Title X public sector providers (54%) compared with private sector and Title X providers (64% each). After controlling for provider group, urban location, client volume, and percent African American, private sector providers had higher screening rates than Title X and non-Title X public providers. CONCLUSIONS: Screening rates for females were higher among private providers compared with Title X and non-Title X public providers. However, only Title X providers were more likely to adhere to screening guidelines through high screening rates for young females and low screening rates for older females.

Evaluation of health workforce competence in maternal and neonatal issues in public health sector of Pakistan: an Assessment of their training needs.

BACKGROUND: More than 450 newborns die every hour worldwide, before they reach the age of four weeks (neonatal period) and over 500,000 women die from complications related to childbirth. The major direct causes of neonatal death are infections (36%), Prematurity (28%) and Asphyxia (23%). Pakistan has one of the highest perinatal and neonatal mortality rates in the region and contributes significantly to global neonatal mortality. The high mortality rates are partially attributable to scarcity of trained skilled birth attendants and paucity of resources. Empowerment of health care providers with adequate knowledge and skills can serve as instrument of change. METHODS: We carried out training needs assessment analysis in the public health sector of Pakistan to recognize gaps in the processes and quality of MNCH care provided. An assessment of Knowledge, Attitude, and Practices of Health Care Providers on key aspects was evaluated through a standardized pragmatic approach. Meticulously designed tools were tested on three tiers of health care personnel providing MNCH in the community and across the public health care system. The Lady Health Workers (LHWs) form the first tier of trained cadre that provides MNCH at primary care level (BHU) and in the community. The Lady Health Visitor (LHVs), Nurses, midwives) cadre follow next and provide facility based MNCH care at secondary and tertiary level (RHCs, Taluka/Tehsil, and DHQ Hospitals). The physician/doctor is the specialized cadre that forms the third tier of health care providers positioned in secondary and tertiary care hospitals (Taluka/Tehsil and DHQ Hospitals). The evaluation tools were designed to provide quantitative estimates across various domains of knowledge and skills. A priori thresholds were established for performance rating. RESULTS: The performance of LHWs in knowledge of MNCH was good with 30% scoring more than 70%. The Medical officers (MOs), in comparison, performed poorly in their knowledge of MNCH with only 6% scoring more than 70%. All three cadres of health care providers performed poorly in the resuscitation skill and only 50% were able to demonstrate steps of immediate newborn care. The MOs performed far better in counselling skills compare to the LHWs. Only 50 per cent of LHWs could secure competency scale in this critical component of skills assessment. CONCLUSIONS: All three cadres of health care providers performed well below competency levels for MNCH knowledge and skills. Standardized training and counselling modules, tailored to the needs and resources at district level need to be developed and implemented. This evaluation highlighted the need for periodic assessment of health worker training and skills to address gaps and develop targeted continuing education modules. To achieve MDG4 and 5 goals, it is imperative that such deficiencies are identified and addressed.

Accountability: já podemos traduzi-la para o português? / Accountability: can we now translate it into Portuguese?

O objetivo principal deste artigo é verificar se as alterações políticas, sociais e institucionais (ocorridas no Brasil) contribuíram para que a tradução da palavra accountability germinasse no solo brasileiro, tendo transcorrido duas décadas desde a publicação do instigante artigo de Anna Maria Campos sobre a ausência desse conceito no Brasil. Trata-se de estudo de natureza exploratória, analítica e descritiva, numa abordagem essencialmente qualitativa, em que se procurou, além de compreender o significado da palavra accountability nos dicionários e nos trabalhos sucessivos ao de Campos, analisar, por meio da literatura especializada, as principais mudanças processadas no cenário brasileiro, especialmente quanto à organização da sociedade, descentralização e transparência governamental e quanto à emergência de novos valores sociais em substituição aos tradicionais. Reconhecendo que avanços têm sido realizados nessa direção, admite-se ser difícil dar uma resposta conclusiva à questão formulada. Considera-se que estamos mais perto da resposta do que quando Campos se defrontou com o problema, mas ainda muito longe de construir uma verdadeira cultura de accountability.

Controle glicêmico de pacientes diabéticos tipo 2 nos serviços público e privado de Saúde / Glycemic control in type 2 diabetic patients in public and private Healthcare service

OBJETIVO: Comparar o tratamento de pacientes diabéticos tipo 2 provenientes de uma clínica privada aos pacientes atendidos no sistema público de Saúde. MÉTODOS: Foi desenhado um estudo de coorte retrospectivo, incluindo 80 pacientes atendidos no Ambulatório Central da Universidade de Caxias do Sul (AMCE), vinculado ao Sistema Único de Saúde, e 277 pacientes atendidos em uma clínica privada, que foram consultados nestes serviços no período entre maio de 2001 e outubro de 2007. RESULTADOS: Os pacientes atendidos no AMCE mostraram pior controle metabólico, embora somente os valores de A1c e colesterol total tenham alcançado significância estatística. Ambos os grupos apresentaram melhora de quase todos os parâmetros metabólicos. O uso de insulina no final do acompanhamento (B = 4,66; IC95 por cento = 2,18 - 9,89; p < 0,001) e a A1c inicial (B = 1,42; IC95 por cento = 1,16 - 1,74; p = 0,001) foram determinantes de pior controle glicêmico. A frequência de consultas foi determinante de melhor controle (B = 0,72; IC95 por cento = 0,55 - 0,93; p = 0,01). CONCLUSÕES: As variáveis como a A1c inicial e a frequência de consultas, que podem ser consideradas como indicadores do acesso dos pacientes ao sistema de saúde, têm maior impacto no controle do diabetes do que o local no qual os pacientes são tratados.

OBJECTIVE: To compare the treatment of type 2 diabetic patients from a private clinic with those of a public health service. METHODS: It was designed a retrospective cohort study, including 80 patients attended at the Central Clinic of Universidade de Caxias do Sul (AMCE), which is related to the Single Health System, and 277 patients attended at a private clinic, whom consult between May 2001 and October 2007. RESULTS: Patients attended at AMCE showed a worse metabolic control, although only the values of A1c and total cholesterol have reached statistical significance. Both groups had an improvement in almost all the metabolic parameters. The use of insulin at the end of follow-up (B = 4,66; CI95 percent = 2,18 - 9,89; p < 0,001) and initial A1c (B = 1,42; CI95 percent = 1,16 - 1,74; p = 0,001) were determinant of a worse glycemic control. The frequency of visits was determinant of a better control (B = 0,72; CI 95 percent = 0,55 - 0,93; p = 0,01). CONCLUSIONS: The variables such as the initial A1c and the frequency of visits, which may be considered as indicators of patients' access to the heath system, have greater impact on the control of diabetes than the place where the patients are treated.