Health self-assessment by hemodialysis patients in the Brazilian Unified Health System.

OBJECTIVE: To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS: In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS: The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01-1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34-0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37-0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29-2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33-3.62), and reporting some (OR = 2.17; 95%CI 1.66-2.84) or a lot of (OR = 2.74; 95%CI 2.04-3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42-0.84). CONCLUSIONS: We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.

Health self-assessment by hemodialysis patients in the Brazilian Unified Health System / Autoavaliação de saúde por pacientes em hemodiálise no Sistema Único de Saúde

ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01-1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34-0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37-0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29-2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33-3.62), and reporting some (OR = 2.17; 95%CI 1.66-2.84) or a lot of (OR = 2.74; 95%CI 2.04-3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42-0.84). CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.

RESUMO OBJETIVO Analisar se nível de complexidade de estrutura dos serviços e características sociodemográficas e clínicas de pacientes em hemodiálise estão associados à prevalência de autoavaliação de saúde ruim. MÉTODOS Neste estudo transversal, foram avaliados 1.621 pacientes com doença renal crônica terminal em hemodiálise acompanhados em 81 serviços de diálise no Sistema Único de Saúde, no ano de 2007. A amostragem foi realizada por conglomerado em dois estágios e um questionário estruturado foi aplicado aos participantes. Para análise dos dados, foi usada regressão logística múltipla multinível. RESULTADOS A prevalência de autoavaliação de saúde ruim foi de 54,5%, e na análise multivariada apresentou associação com as seguintes variáveis: aumento da idade (OR = 1,02; IC95% 1,01-1,02), estado civil separado ou divorciado (OR = 0,62; IC95% 0,34-0,88), ter doze anos ou mais de estudo (OR = 0,51; IC95% 0,37-0,71), gastar mais de 60 min no deslocamento entre a casa e o serviço de diálise (OR = 1.80; IC95% 1,29-2,51), apresentar três ou mais doenças autorreferidas (OR = 2,20; IC95% 1,33-3,62) e relatar alguma (OR = 2,17; IC95% 1,66-2,84) ou muita (OR = 2,74; IC95% 2,04-3,68) dificuldade para dormir. Indivíduos em tratamento nos serviços de diálise com maior nível de complexidade na estrutura apresentaram menor chance de autoavaliar sua saúde como ruim (OR = 0,59; IC95% 0,42-0,84). CONCLUSÕES Autoavaliação de saúde ruim mostrou-se associada à idade, anos de estudo, estado civil, tempo de deslocamento de casa até o serviço de diálise, número de doenças autorreferidas, relato de dificuldade para dormir e também ao nível de complexidade da estrutura dos serviços de saúde. O reconhecimento desses fatores pode contribuir para o desenvolvimento de estratégias para melhorar a saúde dos pacientes em hemodiálise no Sistema Único de Saúde.

O Sistema de Vigilância Alimentar e Nutricional como instrumento de monitoramento da Estratégia Nacional para Alimentação Complementar Saudável / The Food and Nutrition Surveillance System as a tool for monitoring the National Strategy for Healthy Complementary Nutrition

Analisar o Sistema de Vigilância Alimentar e Nutricional (Sisvan) como instrumento de monitoramento da Estratégia Nacional para Alimentação Complementar Saudável (ENPACS) nos 40 Municípios da Superintendência Regional de Saúde de Belo Horizonte (SRS-BH). MÉTODOS: realizou-se estudo descritivo envolvendo o total de crianças menores de dois anos acompanhadas pelo Sisvan Web nos anos de 2008 a 2011. A cobertura do Sisvan Web foi calculada dividindo-se o número de crianças menores de dois anos, acompanhadas pelo Sisvan Web, pela população na mesma faixa etária. Foi enviado questionário pertinente às referências técnicas do Sisvan dos municípios avaliados, para levantamento de informações sobre o funcionamento do Sisvan. RESULTADOS: a cobertura do Sisvan Web, na totalidade dos municípios, variou de 4,3 por cento (2008) a 10,7 por cento (2011). O questionário foi respondido por 38 Municípios da SRS-BH, sendo que desses, 31,6 por cento informaram utilizar os dados do Sisvan Web para estabelecer ações de intervenção nutricional. CONCLUSÕES: o estudo identificou baixas coberturas, pouca utilização dos dados e a necessidade de fortalecer o Sisvan, para que possa gerar informações consistentes sobre a situação alimentar e nutricional das crianças menores de dois anos, tornando-se, assim, adequado para o monitoramento da ENPACS...

To examine the Food and Nutrition Surveillance System (Sisvan) as a tool for monitoring the National Strategy for Healthy Complementary Nutrition (ENPACS) in the 40 municipalities overseen by the Belo Horizonte regional superintendent for health (SRS-BH). METHODS: a descriptive study was carried out involving all children aged under two being accompanied by the Sisvan Web between 2008 and 2011. The coverage of the Sisvan Web was calculated by dividing the number of children aged under two years accompanied by the Sisvan Web by the total population for the same age group. A questionnaire relating to the technical references of the Sisvan of the municipalities under investigation was sent to collect information on the functioning of the Sisvan. RESULTS: the coverage of the Sisvan Web, in all municipalities, varied from 4.3 percent (2008) to 10.7 percent (2011). The questionnaire was answered by 38 municipalities in the SRS-BH, 31.6 percent of whom reported using data from the Sisvan Web system as a basis for nutritional interventions. CONCLUSIONS: the study identified low coverage, poor utilization of data and the need to improve the Sisvan, in order to generate consistent information on nutrition and food among children aged under two years, thereby making it appropriate for monitoring of the ENPACS...