Trends in cesarean section rates in Brazil by Robson classification group, 2014-2020.

OBJECTIVES: to evaluate the trends in cesarean sections from 2014 to 2020 across both public and private sectors, utilizing the Robson Classification. METHODS: this time series study analyzed the proportion of women who underwent cesarean sections between 2014 and 2020, considering both the Robson classification and the type of healthcare service. Trend analysis was conducted using the Prais-Winsten regression. RESULTS: higher proportions of cesarean sections were observed in all Robson groups within the private sector compared to the public sector. This was despite a decreasing trend in the private sector and an increasing trend in the public sector. Notably, elevated proportions of cesarean sections were recorded in groups that are typically favorable to normal childbirth (Robson 1, 4, and 5). CONCLUSIONS: although there was a decreasing trend in cesarean sections within the private sector, an increasing trend was observed in the public sector. Additionally, there was a high proportion of cesarean sections among women with conditions favorable to normal childbirth. It is crucial to continuously monitor these indicators to evaluate and implement interventions aimed at reducing unnecessary cesarean sections.

Impact of Lung Cancer on Health-Related Quality of Life, Financial Toxicity, and Household Economics in Patients From the Public and the Private Healthcare Sector in Argentina.

OBJECTIVES: Non-small cell lung cancer (NSCLC) is Argentina's first cause of cancer death. Most patients have an advanced stage at diagnosis, with poor expected survival. This study aimed to characterize the health-related quality of life (HRQOL) and economic impact of patients treated in the private healthcare sector and compare it with that of the public sector. METHODS: We undertook an observational cross-sectional study that extended a previous study to a referral private center in Argentina. Outcomes included the EuroQol EQ-5D-3L (to assess HRQOL), Comprehensive Score for Financial Toxicity (financial toxicity instrument), Work Productivity and Activity Impairment - General Health (to assess productivity loss), and out-of-pocket expenses in adults diagnosed of NSCLC. RESULTS: We included 30 consecutive patients from a private healthcare center (July 2021 to March 2022), totaling 131 patients (n = 101 from previous public study). The whole sample had low quality of life and relevant economic impact. Patients in the private healthcare sector showed lower disease severity and higher educational level and household income. In addition, private healthcare system patients showed higher utility (0.77 vs 0.73; P < .05) and lower impairment of daily activities (41% vs 59%; P = .01). Private health system patients also showed lower financial toxicity as measured by the Comprehensive Score for Financial Toxicity score (23.9 vs 20.14; P < .05) but showed no differences when financial toxicity was assessed as a dichotomic variable. CONCLUSIONS: Although patients with NSCLC treated in a private healthcare center in Argentina showed a relevant HRQOL and economic impact, this impact was smaller than the one observed in publicly funded hospitals.

Retirement, Pensions, and Depressive Symptoms Among Older Adults in China, England, Mexico, and the United States.

This study explores the associations of retirement, and of public and private pensions, with older adults' depressive symptoms by comparing differences between countries and age groups. Harmonized data were analyzed from the family of Health and Retirement Study in 2012-2013 from China, England, Mexico, and the United States (n = 97,978). Respondents were asked if they were retired and received public or private pensions. Depressive symptom was measured by the Center for Epidemiologic Studies Depression Scale. Retirement was significantly associated with higher depressive symptoms for the United States and with lower depressive symptoms for Mexico and England. Public pension was significantly associated with lower depressive symptoms for Mexico and with higher depressive symptoms for the United States and China. Private pension was significantly associated with lower depressive symptoms for the United States, China, and England. Our study shows that continuity theory demonstrates cross-national variation in explaining the association between retirement and depressive symptoms.

Cenário da educação superior à distância em saúde no Brasil: a situação da Enfermagem / Escenario de la educación superior a distancia en salud en Brasil: situación de la Enfermería / Scenario of distance higher education in health in Brazil: the situation of Nursing

Resumo Objetivo Analisar a oferta dos cursos de graduação em saúde na modalidade de Ensino a Distância no Brasil, destacando suas principais características para Enfermagem. Método Estudo transversal baseado em dados on line de cursos de graduação em saúde a distância, criados entre 2005 e 2020. Para doze graduações em saúde, destacaram-se características da criação e distribuição do ensino a distância, enfatizando-se a situação da Enfermagem. Realizaram-se testes de significância estatística (α=5%) e mapa. Resultados Verificaram-se 431 cursos de graduação em saúde, sendo a maioria deles criados entre 2017 e 2020 (≥61,4%). Para Enfermagem, o período de maior criação foi anterior (entre 2013 e 2016; 72,7%) (p=0,001). Todos os cursos eram vinculados a instituições privadas, que ofertavam 82.000 vagas, distribuídas em 1.363 Polos por todos os estados. Verificou-se predomínio em São Paulo (23,9%) e nas cidades localizadas no interior dos estados (64,3%) (p=0,001). Conclusão e implicações para prática Houve aumento significativo de cursos de graduação em saúde no ensino a distância no Brasil. Para Enfermagem, estes se caracterizaram por oferta privada e localizada no interior dos estados. Contudo, a distribuição regional ainda é desigual, concentrando Polos nas regiões mais ricas e centrais do país, e longe das áreas com maiores necessidades de saúde.

Resumen Objetivo Analizar la oferta de estudios superiores en salud bajo la modalidad de Educación a Distancia en Brasil, destacando sus principales características para Enfermería. Método Estudio transversal a partir de datos en línea de las carreras de grado en salud a distancia, creadas entre 2005 y 2020. Para doce titulaciones de salud se destacaron características de la creación y distribución de la educación a distancia, destacando la situación de Enfermería. Se realizaron pruebas de significación estadística (α = 5%) y mapa. Resultados Se detectaron 431 carreras de grado en salud, la mayoría de las cuales se crearon entre 2017 y 2020 (≥61,4%). Para Enfermería, el período de mayor creación fue anterior (entre 2013 y 2016; 72,7%) (p = 0,001). Todos los cursos estuvieron vinculados a instituciones privadas, que ofrecieron 82.000 plazas, distribuidas en 1.363 centros en todos los estados. Se registró predominio de cursos en São Paulo (23,9%) y en ciudades del interior de los estados (64,3%) (p = 0,001). Conclusión e implicaciones para la práctica Se advierte un aumento significativo en los cursos de pregrado en salud en educación a distancia en Brasil. Para Enfermería, estos se caracterizaron por una oferta privada ubicada en el interior de los estados. Sin embargo, la distribución regional sigue siendo desigual, concentrada en las regiones más ricas y céntricas del país, y lejos de las áreas con mayores necesidades de salud.

Abstract Objective To analyze the offer of undergraduate health courses in the Distance Learning modality in Brazil, highlighting its main characteristics for Nursing. Method This is a cross-sectional study based on distance health undergraduate courses online data, created between 2005 and 2020. For twelve health degrees, characteristics of the creation and distribution of distance learning were highlighted, emphasizing Nursing courses. Statistical significance tests (α = 5%) and mapping were performed. Results There were 43 undergraduate courses in health, most of which were created between 2017 and 2020 (≥61.4%). For Nursing, most courses were created in earlier years (2013 and 2016; 72.7%) (p = 0.001). The courses were linked to private institutions, which offered 82,000 seats and are distributed in 1,363 hubs across all states. Courses predominated in São Paulo (23.9%) and non-capital cities (64.3%) (p = 0.001). Conclusion and implications for the practice There has been a significant increase in distance education in Brazil's undergraduate health courses. For Nursing, the courses were characterized by private offers located in non-capital cities. However, the regional distribution is still uneven, concentrating hubs in the country's richest and most central regions and away from areas with the greatest health needs.

Insurance Type and Surgical-Patient Characteristics in the UPR-Affiliated Hospitals.

OBJECTIVE: The characteristics of surgical patients were examined according to type of health insurance to determine whether differences existed between these groups. METHODS: We evaluated the characteristics of cases in the UPR General Surgery Department's database (entered from January 1, 2018 through December 31, 2018) by insurance type. The variables examined included age, gender, inpatient/outpatient status, wound classification, type of surgery, American Society of Anesthesiology (ASA) scores and whether a given patient had diabetes, was a smoker, or suffered from hypertension. This database had no trauma cases. RESULTS: Information was available for 5,097 cases during the study period. The mean age of the group was 51 (±22) years. The gender distribution indicated that 56% were women and 44% were men. The insurance types were distributed as follows: government/no insurance, 40%; Medicare, 12%; and private insurance, 48%. The government-insured/uninsured patients were younger (mean age, 41 ±24) and had had emergency surgery more frequently (18%) than had privately insured patients (10%). Medicare patients were significantly older (mean age, 72 ±12), and had had higher incidences of diabetes (46%) and hypertension (81%), presenting with ASA scores greater than or equal to 3 in 73% of cases. More privately insured individuals than those in other groups had had elective surgery (90%); 48% had been outpatients when they had their surgery, 58% had had clean wounds, and 61% of the patients having elective surgery were women. CONCLUSION: There were significant differences (P<.05) in the characteristics of patients with different types of health insurance. The frequency of emergency surgery was found to be significantly higher in the government-insured/uninsured group than in the privately insured group.

COVID-19 - The Availability of ICU Beds in Brazil during the Onset of Pandemic.

Background: Brazil faces some challenges in the battle against the COVID-19 pandemic, including: the risks for cross-infection (community infection) increase in densely populated areas; low access to health services in areas where the number of beds in intensive care units (ICUs) is scarce and poorly distributed, mainly in states with low population density. Objective: To describe and intercorrelate epidemiology and geographic data from Brazil about the number of intensive care unit (ICU) beds at the onset of COVID-19 pandemic. Methods: The epidemiology and geographic data were correlated with the distribution of ICU beds (public and private health systems) and the number of beneficiaries of private health insurance using Pearson's Correlation Coefficient. The same data were correlated using partial correlation controlled by gross domestic product (GDP) and number of beneficiaries of private health insurance. Findings: Brazil has a large geographical area and diverse demographic and economic aspects. This diversity is also present in the states and the Federal District regarding the number of COVID-19 cases, deaths and case fatality rate. The effective management of severe COVID-19 patients requires ICU services, and the scenario was also dissimilar as for ICU beds and ICU beds/10,000 inhabitants for the public (SUS) and private health systems mainly at the onset of COVID-19 pandemic. The distribution of ICUs was uneven between public and private services, and most patients rely on SUS, which had the lowest number of ICU beds. In only a few states, the number of ICU beds at SUS was above 1 to 3 by 10,000 inhabitants, which is the number recommended by the World Health Organization (WHO). Conclusions: Brazil needed to improve the number of ICU beds units to deal with COVID-19 pandemic, mainly for the SUS showing a late involvement of government and health authorities to deal with the COVID-19 pandemic.

The COVID-19 pandemic in Brazil: analysis of supply and demand of hospital and ICU beds and mechanical ventilators under different scenarios. / Pandemia por COVID-19 no Brasil: análise da demanda e da oferta de leitos hospitalares e equipamentos de ventilação assistida segundo diferentes cenários.

This study aims to analyze the pressure on the Brazilian health system from the additional demand created by COVID-19. The authors performed a series of simulations to estimate the demand for hospital beds (health micro-regions) as well as to ICU beds, and mechanical ventilators (health macro-regions) under different scenarios of intensity (infection rates equivalent to 0.01, 0.1, and 1 case por 100 inhabitants) and time horizons (1, 3, and 6 months). The results reveal a critical situation in the system for meeting this potential demand, with numerous health micro-regions and macro-regions operating beyond their capacity, compromising the care for patients, especially those with more severe symptoms. The study presents three relevant messages. First, it is necessary to slow the spread of COVID-19 in the Brazilian population, allowing more time for the reorganization of the supply and relieve the pressure on the health system. Second, the expansion of the number of available beds will be the key. Even if the private sector helps offset the deficit, the combined supply from the two sectors (public and private) would be insufficient in various macro-regions. The construction of field hospitals is important, both in places with a history of "hospital deserts" and in those already pressured by demand. The third message involves the regionalized organization of health services, whose design may be adequate in situations of routine demand, but which suffer additional challenges during pandemics, especially if patients have to travel long distances to receive care.

O objetivo deste estudo é analisar a pressão sobre o sistema de saúde no Brasil decorrente da demanda adicional gerada pela COVID-19. Para tanto, foi realizado um conjunto de simulações para estimar a demanda de leitos gerais (microrregiões de saúde), leitos de UTI e equipamentos de ventilação assistida (macrorregiões de saúde) em diferentes cenários, para intensidade (taxas de infecção equivalentes a 0,01, 0,1 e 1 caso por 100 habitantes) e horizontes temporais (1, 3 e 6 meses). Os resultados evidenciam uma situação crítica do sistema para atender essa demanda potencial, uma vez que diversas microrregiões e macrorregiões de saúde operariam além de sua capacidade, comprometendo o atendimento a pacientes principalmente aqueles com sintomas mais severos. O estudo apresenta três mensagens relevantes. Em primeiro lugar, é necessário reduzir a velocidade de propagação da COVID-19 na população brasileira, permitindo um tempo maior para a reorganização da oferta e aliviando a pressão sobre o sistema de saúde. Segundo, é necessário expandir o número de leitos disponíveis. Ainda que o setor privado contribua para amortecer o déficit de demanda, a oferta conjunta dos dois setores não seria suficiente em várias macrorregiões. A construção de hospitais de campanha é importante, tanto em locais onde historicamente há vazios assistenciais como também naqueles onde já se observa uma pressão do lado da demanda. A terceira mensagem diz respeito à organização regionalizada dos serviços de saúde que, apesar de adequada em situações de demanda usual, em momentos de pandemia este desenho implica desafios adicionais, especialmente se a distância que o paciente tiver de percorrer for muito grande.

El objetivo de este estudio es analizar la presión sobre el sistema de salud brasileño, ocasionada por la demanda adicional de camas hospitalarias y equipos de ventilación mecánica, generada por el COVID-19. Para tal fin, se realizó un conjunto de simulaciones, con el fin de estimar la demanda de camas generales (microrregiones de salud), camas de UTI y equipamientos de ventilación asistida (macrorregiones de salud) en diferentes escenarios, según la intensidad (tasas de infección equivalentes a 0,01, 0,1 y 1 caso por 100 habitantes) y horizontes temporales (1, 3 y 6 meses). Los resultados evidencian una situación crítica del sistema para atender esa demanda potencial, ya que diversas microrregiones y macrorregiones de salud operarían más allá de su capacidad, comprometiendo la atención a pacientes principalmente aquellos con los síntomas más graves. El estudio presenta tres mensajes relevantes. En primer lugar, es necesario reducir la velocidad de propagación del COVID-19 en la población brasileña, permitiendo un tiempo mayor para la reorganización de la oferta y aliviando la presión sobre el sistema de salud. En segundo lugar, es necesario expandir el número de camas disponibles. A pesar de que el sector privado contribuya a amortiguar el déficit de demanda, la oferta conjunta de los dos sectores no sería suficiente en varias macrorregiones. La construcción de hospitales de campaña es importante, tanto en lugares donde históricamente existen lagunas asistenciales, como también en aquellos donde ya se observa una presión por parte de la demanda. El tercer mensaje se refiere a la organización por regiones de los servicios de salud que, a pesar de ser adecuada en situaciones de demanda habitual, en momentos de pandemia, este diseño implica desafíos adicionales, especialmente si la distancia que el paciente tuviera que recorrer fuera muy lejana.

Assessment of psychological capital at work by physiotherapists.

OBJECTIVE: Describe how psychological capital in the workplace impacts job satisfaction and quality life among Brazilian physiotherapists. METHODS: Questionnaires were distributed to physiotherapists of the Brazilian Physical Therapists Association working in clinical or managerial positions in the public or private sector. The response rate was 12%, with 389 participants. RESULTS: Job satisfaction was associated with self-efficacy, hope, optimism, and resilience, showing a direct relationship between satisfaction and psychological capital in the workplace. The self-employed physiotherapists were more satisfied and had higher psychological capital in the workplace than the physical therapists employed by a company. CONCLUSION: It is relevant that managers in the physiotherapy field recognize the relevance of psychological capital in the workplace and use it in their management practices. Understanding the individual characteristics of each employee is essential in promoting the personal development of physical therapists. This finding contributes to a healthier and more challenging work environment for physiotherapists in addition to developing their careers in physical therapy units.

Quality Indicators of End-of-Life Care Among Privately Insured People With Cancer in Brazil.

PURPOSE: To examine quality indicators of end-of-life (EOL) care among privately insured people with cancer in Brazil. METHODS: We evaluated medical records linked to health insurance databank to study consecutive patients who died of cancer. We collected information about demographics, cancer type, and quality indicators of EOL care including emergency department (ED) visits, intensive care unit (ICU) admissions, chemotherapy use, medical imaging utilization, blood transfusions, home care support, days of inpatient care, and hospital deaths. RESULTS: We included 865 patients in the study. In the last 30 days of life, 62% visited the ED, 33% were admitted to the ICU, 24% received blood transfusions, and 51% underwent medical imaging. Only 1% had home care support in the last 60 days of life, and 29% used chemotherapy in the last 14 days of life. Patients had an average of 8 days of inpatient care and 52% died in the hospital. Patients with advanced cancer who used chemotherapy were more likely to visit the ED (78% vs 59%; P < .001), undergo medical imaging (67% vs 51%; P < .001), and die in the hospital (73% vs 50%; P = .03) than patients who did not use chemotherapy. In the multivariate analysis, chemotherapy use near death and advanced cancer were associated with ED visits and ICU admissions, respectively (odds ratio >1). CONCLUSION: Our study suggests that privately insured people with cancer receive poor quality EOL care in Brazil. Further research is needed to assess the impact of improvements in palliative care provision in this population.

Mexico: Health System Review.

This analysis of the Mexican health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Mexican health system consists of three main components operating in parallel: 1) employment-based social insurance schemes, 2) public assistance services for the uninsured supported by a financial protection scheme, and 3) a private sector composed of service providers, insurers, and pharmaceutical and medical device manufacturers and distributors. The social insurance schemes are managed by highly centralized national institutions while coverage for the uninsured is operated by both state and federal authorities and providers. The largest social insurance institution - the Mexican Social Insurance Institute (IMSS) - is governed by a corporatist arrangement, which reflects the political realities of the 1940s rather than the needs of the 21st century. National health spending has grown in recent years but is lower than the Latin America and Caribbean average and considerably lower than the OECD average in 2015. Public spending accounts for 58% of total financing, with private contributions being mostly comprised of out-of-pocket spending. The private sector, while regulated by the government, mostly operates independently. Mexico's health system delivers a wide range of health care services; however, nearly 14% of the population lacks financial protection, while the insured are mostly enrolled in diverse public schemes which provide varying benefits packages. Private sector services are in high demand given insufficient resources among most public institutions and the lack of voice by the insured to ensure the fulfilment of entitlements. Furthermore, the system faces challenges with obesity, diabetes, violence, as well as with health inequity. Recognizing the inequities in access created by its segmented structure, both civil society and government are calling for greater integration of service delivery across public institutions, although no consensus yet exists as to how to bring this about.

Pandemia por COVID-19 no Brasil: análise da demanda e da oferta de leitos hospitalares e equipamentos de ventilação assistida segundo diferentes cenários / Pandemia por COVID-19 en Brasil: análisis de la demanda y oferta de camas hospitalarias, así como equipamientos de ventilación asistida, según diferentes escenarios / The COVID-19 pandemic in Brazil: analysis of supply and demand of hospital and ICU beds and mechanical ventilators under different scenarios

O objetivo deste estudo é analisar a pressão sobre o sistema de saúde no Brasil decorrente da demanda adicional gerada pela COVID-19. Para tanto, foi realizado um conjunto de simulações para estimar a demanda de leitos gerais (microrregiões de saúde), leitos de UTI e equipamentos de ventilação assistida (macrorregiões de saúde) em diferentes cenários, para intensidade (taxas de infecção equivalentes a 0,01, 0,1 e 1 caso por 100 habitantes) e horizontes temporais (1, 3 e 6 meses). Os resultados evidenciam uma situação crítica do sistema para atender essa demanda potencial, uma vez que diversas microrregiões e macrorregiões de saúde operariam além de sua capacidade, comprometendo o atendimento a pacientes principalmente aqueles com sintomas mais severos. O estudo apresenta três mensagens relevantes. Em primeiro lugar, é necessário reduzir a velocidade de propagação da COVID-19 na população brasileira, permitindo um tempo maior para a reorganização da oferta e aliviando a pressão sobre o sistema de saúde. Segundo, é necessário expandir o número de leitos disponíveis. Ainda que o setor privado contribua para amortecer o déficit de demanda, a oferta conjunta dos dois setores não seria suficiente em várias macrorregiões. A construção de hospitais de campanha é importante, tanto em locais onde historicamente há vazios assistenciais como também naqueles onde já se observa uma pressão do lado da demanda. A terceira mensagem diz respeito à organização regionalizada dos serviços de saúde que, apesar de adequada em situações de demanda usual, em momentos de pandemia este desenho implica desafios adicionais, especialmente se a distância que o paciente tiver de percorrer for muito grande.

El objetivo de este estudio es analizar la presión sobre el sistema de salud brasileño, ocasionada por la demanda adicional de camas hospitalarias y equipos de ventilación mecánica, generada por el COVID-19. Para tal fin, se realizó un conjunto de simulaciones, con el fin de estimar la demanda de camas generales (microrregiones de salud), camas de UTI y equipamientos de ventilación asistida (macrorregiones de salud) en diferentes escenarios, según la intensidad (tasas de infección equivalentes a 0,01, 0,1 y 1 caso por 100 habitantes) y horizontes temporales (1, 3 y 6 meses). Los resultados evidencian una situación crítica del sistema para atender esa demanda potencial, ya que diversas microrregiones y macrorregiones de salud operarían más allá de su capacidad, comprometiendo la atención a pacientes principalmente aquellos con los síntomas más graves. El estudio presenta tres mensajes relevantes. En primer lugar, es necesario reducir la velocidad de propagación del COVID-19 en la población brasileña, permitiendo un tiempo mayor para la reorganización de la oferta y aliviando la presión sobre el sistema de salud. En segundo lugar, es necesario expandir el número de camas disponibles. A pesar de que el sector privado contribuya a amortiguar el déficit de demanda, la oferta conjunta de los dos sectores no sería suficiente en varias macrorregiones. La construcción de hospitales de campaña es importante, tanto en lugares donde históricamente existen lagunas asistenciales, como también en aquellos donde ya se observa una presión por parte de la demanda. El tercer mensaje se refiere a la organización por regiones de los servicios de salud que, a pesar de ser adecuada en situaciones de demanda habitual, en momentos de pandemia, este diseño implica desafíos adicionales, especialmente si la distancia que el paciente tuviera que recorrer fuera muy lejana.

This study aims to analyze the pressure on the Brazilian health system from the additional demand created by COVID-19. The authors performed a series of simulations to estimate the demand for hospital beds (health micro-regions) as well as to ICU beds, and mechanical ventilators (health macro-regions) under different scenarios of intensity (infection rates equivalent to 0.01, 0.1, and 1 case por 100 inhabitants) and time horizons (1, 3, and 6 months). The results reveal a critical situation in the system for meeting this potential demand, with numerous health micro-regions and macro-regions operating beyond their capacity, compromising the care for patients, especially those with more severe symptoms. The study presents three relevant messages. First, it is necessary to slow the spread of COVID-19 in the Brazilian population, allowing more time for the reorganization of the supply and relieve the pressure on the health system. Second, the expansion of the number of available beds will be the key. Even if the private sector helps offset the deficit, the combined supply from the two sectors (public and private) would be insufficient in various macro-regions. The construction of field hospitals is important, both in places with a history of "hospital deserts" and in those already pressured by demand. The third message involves the regionalized organization of health services, whose design may be adequate in situations of routine demand, but which suffer additional challenges during pandemics, especially if patients have to travel long distances to receive care.

A expansão da educação física no ensino superior brasileiro / The expansion of physical education in brazilian higher education

RESUMO Esta pesquisa documental objetivou apresentar considerações do cenário da expansão da Educação Física no contexto do ensino superior brasileiro, com foco em seus principaisdesdobramentos para a área. Para tanto, utilizamos dados das Sinopses Estatísticas do Censo de Ensino Superior, que foram interpretados à luz dos conceitos de Pierre Bourdieu e Ulrich Beck. Os resultados indicaram que, no lastro da expansão, ocorreu a criação e abertura de novos cursos de Educação Física, apresentando umincrementobastante considerável(874%), entre 1991-2015. A expansão se deu, especialmente, pelo setor privado, responsável pelo maior crescimento (1.381%). Isso traz à tona efeitos colaterais que têm implicado em um conjunto de desafios para a Educação Física no país.

ABSTRACT This documentary research aimed to present considerations on the scenario of the expansion of Physical Education in the context of Brazilian higher education, focusing, on its main developments for the area. For this, we used data from the Statistical Synopses of the Higher Education Census, which were interpreted in light of the concepts of Pierre Bourdieu and Ulrich Beck. The results indicated that, on the basis of the expansion, there was the creation and opening of new Physical Education courses, presenting a considerable increase (874%),between 1991-2015. The expansion was mainly due to the private sector, which accounted for the highest growth (1,381%). This brings up side effects that have implied a set of challenges forPhysical Education in the country.

[Acute coronary syndromes in public and non-public institutions of Argentina]. / Síndromes coronarios agudos en instituciones públicas y no públicas de Argentina.

Treatment of acute coronary syndrome (ACS) may differ according to the health system coverage. The objective of this study was to evaluate demographic characteristics of patients with ACS assisted in public sector institutions compared to the non-public sector of Argentina, as well as the therapeutic and its relationship with the resources of each sector. We analyzed patients hospitalized in institutions of a national, voluntary, prospective and multicenter registry. Between March 2006 and May 2016, 11 072 ACSs were registered in 64 institutions, 39% public (44% have hemodynamic laboratory) and 61% non-public (82% with hemodynamic). Public centers presented less structure and assisted a higher proportion of ST elevation acute coronary syndrome (STE-ACS). (52.5% vs. 36.1%, p < 0.001). Public sector patients were younger, more frequently men, smokers, and less dyslipemics. The proportion of patients reperfused in the STE-ACS was similar in both sectors. The use of coronary angiography in non-ST elevation acute coronary syndrome (NSTE-ACS) was higher in the public sector, whose patients presented more frequently electrocardiographic changes and biomarker elevation. Considering all ACS, 80.2% of patients in public and 90.1% in non-public institutions were incorporated by haemodynamic centers. The availability of hemodynamics was the variable most associated with reperfusion in NSTE-ACS, and invasive treatment in NSTE-ACS. This research demonstrates the complexity of a comparative analysis of health sectors, due to the relevance acquired by the level of resources installed and the demographic differences of the inpatient population, above the simple difference of belonging to the public or non-public system.

El tratamiento del síndrome coronario agudo (SCA) puede diferir según la cobertura de salud. El objetivo fue comparar características demográficas de pacientes con SCA atendidos en instituciones del sector público, o en el no-público de Argentina, las terapéuticas y su relación con los recursos de cada sector. Analizamos internaciones en instituciones de un registro nacional, voluntario, prospectivo y multicéntrico. Entre marzo 2006 y mayo 2016 ingresaron 11 072 SCA en 64 instituciones, 39% públicas (44% con laboratorio de hemodinamia) y 61% no públicas (82% con hemodinamia). Los centros públicos presentaron menos estructura y atendieron mayor proporción de SCA con elevación del segmento ST (SCACEST) (52.5% vs. 36.1%, p < 0.001). Los pacientes del sector público fueron más jóvenes, más frecuentemente hombres, fumadores, y menos dislipémicos. La proporción de reperfundidos entre SCA con elevación del ST (SCACEST) fue similar en ambos sectores. La utilización de coronariografía en SCA sin elevación del ST (SCASEST) fue mayor en el sector público, cuyos pacientes presentaron más frecuentemente cambios electrocardiográficos y biomarcadores elevados. Un 80.2% de los SCA en instituciones públicas y 90.1% en las no públicas fueron incorporados por centros con hemodinamia. La disponibilidad de hemodinamia fue la variable más asociada a reperfusión entre SCACEST y al tratamiento invasivo entre SCASEST. Se demuestra la complejidad del análisis comparativo de sectores de salud, por la relevancia que adquieren los recursos instalados y las diferencias demográficas de la población, por encima de la simple diferencia de pertenecer al sistema público o al no público.

Assessing the role of the private sector in surveillance for malaria elimination in Haiti and the Dominican Republic: a qualitative study.

BACKGROUND: Haiti and the Dominican Republic (DR) are targeting malaria elimination by 2022. The private health sector has been relatively unengaged in these efforts, even though most primary health care in Haiti is provided by non-state actors, and many people use traditional medicine. Data on private health sector participation in malaria elimination efforts are lacking, as are data on care-seeking behaviour of patients in the private health sector. This study sought to describe the role of private health sector providers, care-seeking behaviour of individuals at high risk of malaria, and possible means of engaging the private health sector in Hispaniola's malaria elimination efforts. METHODS: In-depth interviews with 26 key informants (e.g. government officials), 62 private providers, and 63 patients of private providers, as well as 12 focus group discussions (FGDs) with community members, were conducted within seven study sites in Haiti and the DR. FGDs focused on local definitions of the private health sector and identified private providers for interview recruitment, while interviews focused on private health sector participation in malaria elimination activities and treatment-seeking behaviour of febrile individuals. RESULTS: Interviews revealed that self-medication is the most common first step in the trajectory of care for fevers in both Haiti and the DR. Traditional medicine is more commonly used in Haiti than in the DR, with many patients seeking care from traditional healers before, during, and/or after care in the formal health sector. Private providers were interested in participating in malaria elimination efforts but emphasized the need for ongoing support and training. Key informants agreed that the private health sector needs to be engaged, especially traditional healers in Haiti. The Haitian migrant population was reported to be one of the most at-risk groups by participants from both countries. CONCLUSION: Malaria elimination efforts across Hispaniola could be enhanced by engaging traditional healers in Haiti and other private providers with ongoing support and trainings; directing educational messaging to encourage proper treatment-seeking behaviour; and refining cross-border strategies for surveillance of the high-risk migrant population. Increasing distribution of rapid diagnostic tests (RDTs) and bi-therapy to select private health sector facilities, accompanied by adopting regulatory policies, could help increase numbers of reported and correctly treated malaria cases.

Síndromes coronarios agudos en instituciones póblicas y no póblicas de Argentina / Acute coronary syndromes in public and non-public institutions of Argentina

El tratamiento del síndrome coronario agudo (SCA) puede diferir segó;ºn la cobertura de salud. El objetivo fue comparar características demográficas de pacientes con SCA atendidos en instituciones del sector pó;ºblico, o en el no-pó;ºblico de Argentina, las terapó;©uticas y su relació;n con los recursos de cada sector. Analizamos internaciones en instituciones de un registro nacional, voluntario, prospectivo y multicó;©ntrico. Entre marzo 2006 y mayo 2016 ingresaron 11 072 SCA en 64 instituciones, 39% pó;ºblicas (44% con laboratorio de hemodinamia) y 61% no pó;ºblicas (82% con hemodinamia). Los centros pó;ºblicos presentaron menos estructura y atendieron mayor proporció;n de SCA con elevació;n del segmento ST (SCACEST) (52.5% vs. 36.1%, p < 0.001). Los pacientes del sector pó;ºblico fueron más jó;venes, más frecuentemente hombres, fumadores, y menos dislipó;©micos. La proporció;n de reperfundidos entre SCA con elevació;n del ST (SCACEST) fue similar en ambos sectores. La utilizació;n de coronariografía en SCA sin elevació;n del ST (SCASEST) fue mayor en el sector pó;ºblico, cuyos pacientes presentaron más frecuentemente cambios electrocardiográficos y biomarcadores elevados. Un 80.2% de los SCA en instituciones pó;ºblicas y 90.1% en las no pó;ºblicas fueron incorporados por centros con hemodinamia. La disponibilidad de hemodinamia fue la variable más asociada a reperfusió;n entre SCACEST y al tratamiento invasivo entre SCASEST. Se demuestra la complejidad del análisis comparativo de sectores de salud, por la relevancia que adquieren los recursos instalados y las diferencias demográficas de la població;n, por encima de la simple diferencia de pertenecer al sistema pó;ºblico o al no pó;ºblico.

Treatment of acute coronary syndrome (ACS) may differ according to the health system coverage. The objective of this study was to evaluate demographic characteristics of patients with ACS assisted in public sector institutions compared to the non-public sector of Argentina, as well as the therapeutic and its relationship with the resources of each sector. We analyzed patients hospitalized in institutions of a national, voluntary, prospective and multicenter registry. Between March 2006 and May 2016, 11 072 ACSs were registered in 64 institutions, 39% public (44% have hemodynamic laboratory) and 61% non-public (82% with hemodynamic). Public centers presented less structure and assisted a higher proportion of ST elevation acute coronary syndrome (STE-ACS). (52.5% vs. 36.1%, p < 0.001). Public sector patients were younger, more frequently men, smokers, and less dyslipemics. The proportion of patients reperfused in the STE-ACS was similar in both sectors. The use of coronary angiography in non-ST elevation acute coronary syndrome (NSTE-ACS) was higher in the public sector, whose patients presented more frequently electrocardiographic changes and biomarker elevation. Considering all ACS, 80.2% of patients in public and 90.1% in non-public institutions were incorporated by haemodynamic centers. The availability of hemodynamics was the variable most associated with reperfusion in NSTE-ACS, and invasive treatment in NSTE-ACS. This research demonstrates the complexity of a comparative analysis of health sectors, due to the relevance acquired by the level of resources installed and the demographic differences of the inpatient population, above the simple difference of belonging to the public or non-public system.

Mexican ENARM: performance comparison of public vs. private medical schools, geographic and socioeconomic regions.

OBJECTIVE: This study aimed to compare the performance in the National Assessment for Applicants for Medical Resi- dency (ENARM in spanish) of private versus public medical schools, geographic regions and socioeconomic levels by using three different statistical methods (summary measurements, the rate of change and the area under the receiver operator characteristics [AUROC]). These methods have not been previously used for the ENARM; however, some variations of the summary measurements have been reported in some USA assessments of medical school graduates. MATERIALS AND METHODS: Cross-sectional study based on historical data (2001-2017). We use summary measures and colourfilled map. The statistical analysis included Mann-Whitney U, Kruskal-Wallis, Spearman correlation coefficient (Rs), and linear regression. RESULTS: A total of 113 medical schools were included in our analysis; 60 were public and 53 private. We found difference in the median of total scores for type of schools, MD= 54.07 vs. MD= 57.36, p= 0.011. There were also significant differences among geographic and socioeconomic regions (p<0.05). CONCLUSIONS: Differences exist in the total scores and percentage of selected test-takers between type of schools, geographic and socioeconomic regions. Higher scores are prevalent in the Northeast and Norwest regions. Additional research is required to identify factors that contribute to these differences. Unsuspected differences in examination scores can be unveiled using summary measures.

OBJETIVO: Comparar el desempeño en el Examen Nacional de Aspirantes a Residencias Médicas (ENARM) de escuelas de medicina privadas y públicas, regiones geográficas y niveles socioeconómicos mediante el uso de tres métodos estadísti- cos diferentes (medidas de resumen, tasa de cambio y el área bajo las características del operador receptor [AUROC en inglés]). Estos métodos no han sido utilizados previamente para el ENARM; sin embargo, se han informado algunas variaciones de las mediciones de resumen en algunas evaluaciones de graduados de medicina de Estados Unidos. MATERIAL Y MÉTODOS: Estudio transversal basado en datos históricos (2001-2017). Se usaron medidas de resumen y un mapa lleno de color. El análisis estadístico incluyó Mann Whitney U, Kruskal-Wallis y coeficiente de correlación de Spearman (Rs). RESULTADOS: Se incluyeron 113 escuelas de medicina en el análisis; 60 eran públicas y 53 privadas. Se encontraron diferencias en la mediana de las puntuaciones totales para el tipo de escuelas, MD= 54.07 vs. MD= 57.36, p= 0.011. También hubo diferencias significativas entre las regiones geográficas y socioeconómicas (p<0.05). CONCLUSIONES: Existen diferencias en los puntajes totales y el porcentaje de examinados seleccionados entre el tipo de escuelas, regiones geográficas y socioeconómicas. Las puntuaciones más altas prevalecen en las regiones noreste y noroeste. Se requieren investigaciones adicionales para identificar los factores que contribuyen a estas diferencias. Las diferencias insospechadas en los puntajes de los exámenes se pueden revelar usando medidas de resumen.

Mexican ENARM: performance comparison of public vs. private medical schools, geographic and socioeconomic regions / ENARM: comparación del desempeño de escuelas de medicina públicas y privadas, regiones geográficas y socioeconómicas

Abstract: Objectives: This study aimed to compare the performance in the National Assessment for Applicants for Medical Residency (ENARM in spanish) of private versus public medical schools, geographic regions and socioeconomic levels by using three different statistical methods (summary measurements, the rate of change and the area under the receiver operator characteristics [AUROC]). These methods have not been previously used for the ENARM; however, some variations of the summary measurements have been reported in some USA assessments of medical school graduates. Materials and methods: Cross-sectional study based on historical data (2001-2017). We use summary measures and colour-filled map. The statistical analysis included Mann-Whitney U, Kruskal-Wallis, Spearman correlation coefficient (Rs), and linear regression. Results: A total of 113 medical schools were included in our analysis; 60 were public and 53 private. We found difference in the median of total scores for type of schools, MD= 54.07 vs. MD= 57.36,p= 0.011. There were also significant differences among geographic and socioeconomic regions (p<0.05). Conclusions: Differences exist in the total scores and percentage of selected test-takers between type of schools, geographic and socioeconomic regions. Higher scores are prevalent in the Northeast and Norwest regions. Additional research is required to identify factors that contribute to these differences. Unsuspected differences in examination scores can be unveiled using summary measures.

Resumen: Objetivo: Comparar el desempeño en el Examen Nacional de Aspirantes a Residencias Médicas (ENARM) de escuelas de medicina privadas y públicas, regiones geográficas y niveles socioeconómicos mediante el uso de tres métodos estadísticos diferentes (medidas de resumen, tasa de cambio y el área bajo las características del operador receptor [AUROC en inglés]). Estos métodos no han sido utilizados previamente para el ENARM; sin embargo, se han informado algunas variaciones de las mediciones de resumen en algunas evaluaciones de graduados de medicina de Estados Unidos. Material y métodos: Estudio transversal basado en datos históricos (2001-2017). Se usaron medidas de resumen y un mapa lleno de color. El análisis estadístico incluyó Mann Whitney U, Kruskal-Wallis y coeficiente de correlación de Spearman (Rs). Resultados: Se incluyeron 113 escuelas de medicina en el análisis; 60 eran públicas y 53 privadas. Se encontraron diferencias en la mediana de las puntuaciones totales para el tipo de escuelas, MD= 54.07 vs. MD= 57.36,p= 0.011. También hubo diferencias significativas entre las regiones geográficas y socioeconómicas (p<0.05). Conclusiones: Existen diferencias en los puntajes totales y el porcentaje de examinados seleccionados entre el tipo de escuelas, regiones geográficas y socioeconómicas. Las puntuaciones más altas prevalecen en las regiones noreste y noroeste. Se requieren investigaciones adicionales para identificar los factores que contribuyen a estas diferencias. Las diferencias insospechadas en los puntajes de los exámenes se pueden revelar usando medidas de resumen.

Certificación de establecimientos de atención médica en México: análisis de los incentivos para su continuidad / Certification of medical care facilities in Mexico: analysis of the incentives for its continuity

Resumen: Objetivo: Analizar el posible efecto de los modelos de certificación y de los incentivos implementados en la participación de establecimientos de atención médica (EAM) en la certificación del Consejo de Salubridad General entre 1999-2017. Material y métodos: Se colectaron documentos oficiales, impresos y en línea, sobre la certificación de EAM y se solicitó información a diversas instancias relacionadas mediante mecanismos de transparencia. Se analizó la participación de EAM en los períodos político-administrativos entre 1999-2017. Resultados: El promedio anual de participación entre 1999-2000 fue de 259.5 EAM; entre 2013-2016, de 72.5. La participación de EAM públicos es decreciente. En 2017, los EAM certificados eran <1%. Conclusiones: No se identificaron efectos positivos ni sostenidos de ajustes al modelo, ni de los incentivos implementados. Se observa disminución de la participación en los distintos periodos político-administrativos. Debe evaluarse profundamente el Sistema Nacional de Certificación de EAM y su posible efecto en la calidad clínica.

Abstract: Objective: To analyze the possible effect of certification models and healthcare organizations' (HOs) participation incentives in the General Health Council certification process in the 1999-2017 period. Materials and methods: Official printed and online documents about HOs' certification were collected. Information from instances related to the process was requested through transparency mechanisms. Health organizations' participation in political-administrative periods between 1997-2017 was analyzed. Results: The annual average participation in the certification process during the 1999-2000 period was 259.5 HOs; during the 2013-2016 period, the average was 72.5. Public units' participation in this process has been decreasing. In 2017, certified HO were <1%. Conclusions: No positive effects of adjustments to the certification model or the incentives applied were identified. Conversely, there is decreasing participation in the different political-administrative periods. The National HO Certification System and its possible effect on clinical quality must be thoroughly evaluated.

Prevalence of juvenile idiopathic arthritis in schoolchildren from the city of São Paulo, the largest city in Latin America.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that affects children and adolescents. Its prevalence varies greatly from one study to another according to the population and methodology. Some tools may be helpful in screening for suspected cases. The aim of this study is determine the prevalence of JIA in children and adolescent students in the city of São Paulo, Brazil. METHODS: This cross-sectional study was conducted from March 2016 to November 2017. It was based on a populational study envolving school children and adolescents from São Paulo, the largest city of Brazil. We randomly selected students under 16 years old from private schools with more than 1000 students who were evaluated through a specific questionnaire for screening suspected cases of chronic arthropathy (Early Diagnosis of Chronic Arthritis - 12 items - EDA-12) and subsequent anamnesis and rheumatologic physical examination for diagnostic confirmation. RESULTS: We contacted all 79 schools in the universe, of which 12(15, 18%) agreed to participate in the study. A total of 21,119 questionnaires were handed out to the parents. We obtained a response of 5,710 (27%). In 108 cases the EDA-12 score was considered positive (≥ 5). We examined all these 108 "suspicious" children. In 10 cases, the rheumatologic evaluation confirmed the diagnosis of arthritis, since the subjects presented a history and physical examination compatible with JIA. The prevalence of JIA in children and adolescents was 0.196% (95% CI = 0.104-0.371%). CONCLUSION: In this first Brazilian population study to evaluate the prevalence of JIA, we observed that the disease is relatively prevalent in our country (196 / 100.000 children), which is similar to that observed in other studies involving children from urban centers.

[Certification of medical care facilities in Mexico: analysis of the incentives for its continuity.] / Certificación de establecimientos de atención médica en México: análisis de los incentivos para su continuidad.

OBJECTIVE: To analyze the possible effect of certification models and healthcare organizations' (HOs) participation incentives in the General Health Council certification process in the 1999-2017 period. MATERIALS AND METHODS: Official printed and online documents about HOs' certification were collected. Information from instances related to the process was requested through transparency mechanisms. Health organizations' participation in political-administrative periods between 1997-2017 was analyzed. RESULTS: The annual average participation in the certification process during the 1999-2000 period was 259.5 HOs; during the 2013-2016 period, the average was 72.5. Public units' participation in this process has been decreasing. In 2017, certified HO were <1%. CONCLUSIONS: No positive effects of adjustments to the certification model or the incentives applied were identified. Conversely, there is decreasing participation in the different political-administrative periods. The National HO Certification System and its possible effect on clinical quality must be thoroughly evaluated.

OBJECTIVE: Analizar el posible efecto de los modelos de certificación y de los incentivos implementados en la participación de establecimientos de atención médica (EAM) en la certificación del Consejo de Salubridad General entre 1999-2017. MATERIALS AND METHODS: Se colectaron documentos oficiales, impresos y en línea, sobre la certificación de EAM y se solicitó información a diversas instancias relacionadas mediante mecanismos de transparencia. Se analizó la participación de EAM en los períodos político-administrativos entre 1999-2017. RESULTS: El promedio anual de participación entre 1999-2000 fue de 259.5 EAM; entre 2013-2016, de 72.5. La participación de EAM públicos es decreciente. En 2017, los EAM certificados eran <1%. CONCLUSIONS: No se identificaron efectos positivos ni sostenidos de ajustes al modelo, ni de los incentivos implementados. Se observa disminución de la participación en los distintos periodos político-administrativos. Debe evaluarse profundamente el Sistema Nacional de Certificación de EAM y su posible efecto en la calidad clínica.