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1.
Epidemiol Serv Saude ; 33: e20240057, 2024.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-39661821

RESUMEN

OBJECTIVE: To analyze the recommendations for exclusion of health technologies in the Brazilian National Health System (SUS), made by the National Commission for the Incorporation of Technologies in the Brazilian National Health System (CONITEC) from 2012 to 2023, and to identify the disinvestment criteria used. METHODS: Documentary, descriptive and retrospective analysis of CONITEC reports that assessed technology exclusion requests. RESULTS: We identified 24 reports on 74 technologies, whereby the requests predominantly involved medications (95.9%). CONITEC favorably recommended 95% of the exclusions, prioritizing the absence of registration with the National Health Surveillance Agency and the existence of therapeutic alternatives. CONCLUSION: Low demand for exclusions compared to incorporations reveals challenges in identifying obsolescence and resistance to exclusion of technologies. The sustainability of the SUS requires greater monitoring of incorporated technologies, to optimize resources and promote the efficiency of the health system. MAIN RESULTS: The study identified that demands for exclusion of technologies in the Brazilian National Health System (Sistema Único de Saúde - SUS) are significantly lower than demands for incorporation, highlighting the need to pay greater attention to the disinvestment process, in order to guarantee the sustainability of the health system. IMPLICATIONS FOR SERVICES: The findings of this study point to the importance of structuring disinvestment assessment methods, with the aim of improving monitoring of health technology obsolescence and promoting more efficient allocation of resources in the SUS. PERSPECTIVES: We suggest that criteria be established for the periodic re-assessment of incorporated technologies, in order to guarantee regular reviews and the fluidity of CONITEC's work in assessing health technologies.


Asunto(s)
Tecnología Biomédica , Atención a la Salud , Programas Nacionales de Salud , Evaluación de la Tecnología Biomédica , Brasil , Humanos , Evaluación de la Tecnología Biomédica/métodos , Programas Nacionales de Salud/organización & administración , Estudios Retrospectivos , Atención a la Salud/normas
2.
Epidemiol Serv Saude ; 33(spe1): e2024350, 2024.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-39699441

RESUMEN

OBJECTIVE: This article explores the complexities and challenges of healthcare access for transgender people in Minas Gerais. METHODS: : This study is based on a subsample from the Manas Survey, comprised of 15 semi-structured interviews with transgender people, conducted between May 2018 and May 2020, analyzed using the content analysis method and organized into a thematic network. RESULTS: : The results highlight the need for adequate structures, specific training for healthcare professionals, the influence of support networks and challenges in mental health. CONCLUSIONS: : Despite advances in transgender health policies, access barriers persist, underscoring the importance of training strategies, accurate record-keeping and the expansion of specialized services and the role of primary health care. The study makes progress by including the perceptions from residents of small and medium-sized cities across different regions of the state, aiming to improve access and care for the transgender population via the Brazilian National Health System in Minas Gerais. MAIN RESULTS: The findings underscore the need for adequate structures, specific training for healthcare professionals, the influence of support networks and challenges in mental health, in addition to including the perceptions of residents from small and medium-sized cities. IMPLICATIONS FOR SERVICES: Improving the use of social name and gender identity in records. There is a need for training healthcare professionals in gender identity, expanding transgender-specific services and the role of primary health care (PHC) in this topic. PERSPECTIVES: Expansion of specialized services and the role of PHC for this population, in order to improve access and care for the transgender population via the Brazilian National Health System in Minas Gerais state.


Asunto(s)
Personal de Salud , Accesibilidad a los Servicios de Salud , Entrevistas como Asunto , Programas Nacionales de Salud , Atención Primaria de Salud , Personas Transgénero , Humanos , Brasil , Masculino , Femenino , Atención Primaria de Salud/organización & administración , Programas Nacionales de Salud/organización & administración , Servicios de Salud para las Personas Transgénero/organización & administración , Investigación Cualitativa , Adulto , Política de Salud , Salud Mental , Transexualidad , Adulto Joven , Persona de Mediana Edad
3.
Rev Saude Publica ; 58: 53, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39699470

RESUMEN

To correlate the incidence of leptospirosis with sociodemographic data in the Brazilian Unified Health System from 2011 to 2022.This ecological study used national health and economic secondary data sources. Secondary analyses summarized the scenario of disease-related hospitalizations among federative units. In total, two analyses were conducted: variable description for relationship analysis and a secondary analysis with population health and sanitation indicators and economic indicators from the Instituto Brasileiro de Geografia e Estatística (IBGE - Brazilian Institute of Geography and Statistics). The statistical analysis following this framework summarized raw data by year-month-federative unit. A time series regression was conducted, comparing the time variable with other national-level variables. Then, several simple linear regressions were performed.Linear regressions show the relationship between the reduction in cases and improved access to treated water and sewage collection, whereas an increase in per capita income seems to be inversely related to leptospirosis incidence. Geospatial distribution shows higher incidence in the Brazilian South and Southeast. Disease lethality varied over time but without significant change during the period. The average treatment cost remained constant over the years, despite its complexity.Leptospirosis incidence in Brazil from 2011 to 2021 decreased and was associated with improvements in socioeconomic conditions despite no changes in lethality.


Asunto(s)
Leptospirosis , Factores Socioeconómicos , Brasil/epidemiología , Humanos , Leptospirosis/epidemiología , Incidencia , Costo de Enfermedad , Hospitalización/estadística & datos numéricos , Factores de Tiempo , Programas Nacionales de Salud/estadística & datos numéricos , Masculino
4.
Arq Bras Cir Dig ; 37: e1836, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39630837

RESUMEN

BACKGROUND: Obesity is a multifactorial disease affecting a significant portion of the population. Bariatric surgery emerges as a prominent approach in this context, representing an effective treatment both in the short and long term. The costs associated with bariatric surgery vary depending on the characteristics of the patients, current hospital practices, and available funding sources. AIMS: To analyze the costs of minimally invasive bariatric surgery for the treatment of obesity in a tertiary federal public hospital. METHODS: An observational and descriptive study aimed at assessing the costs associated with laparoscopic vertical gastrectomy (GV) and Roux-en-Y gastric bypass (RYGB) in a federal public tertiary service from 2018 to 2021. Data were obtained through the management of medical-hospital expenses related to surgical and anesthetic supplies, as well as the amount reimbursed by the funding source to the hospital. RESULTS: Over the analyzed period, a total of 177 minimally invasive bariatric surgeries were performed. In terms of the charges, since 2018, the hospital has been receiving an amount of R$ 6,145.00 for the "bariatric surgery by videolaparoscopy" procedure, which includes RYGB, and R$ 4,095.00 for "vertical gastrectomy." Regarding the average hospital cost of surgical supplies, RYGB incurred a total of R$ 9,907.54, while GV incurred a total of R$ 9,315.84. The average total cost of RYGB was R$ 10,799.23, and, for GV, it was R$ 10,207.53. These figures indicate that the hospital incurred a loss of approximately R$ 4,654.23 for performing RYGB and R$ 6,112.53 for GV. CONCLUSION: Despite the increasing number of eligible patients for surgical treatment of obesity and the consequent quantitative growth of these procedures funded by the Brazilian Unified Health System (SUS), the costs exceed the reimbursement from the funding source in federal public hospitals. There is a need for a precise assessment of financing in the fight against obesity.


Asunto(s)
Laparoscopía , Centros de Atención Terciaria , Humanos , Brasil , Laparoscopía/economía , Centros de Atención Terciaria/economía , Cirugía Bariátrica/economía , Cirugía Bariátrica/métodos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Costos de Hospital , Gastrectomía/economía , Gastrectomía/métodos , Programas Nacionales de Salud/economía , Hospitales Públicos/economía , Obesidad/cirugía , Obesidad/economía , Derivación Gástrica/economía , Derivación Gástrica/métodos , Obesidad Mórbida/cirugía , Obesidad Mórbida/economía
5.
Salud Colect ; 20: e4905, 2024 11 13.
Artículo en Español | MEDLINE | ID: mdl-39667958

RESUMEN

This article discusses the experience of a permanent health education initiative focused on institutional racism with health professionals from the Brazilian Unified Health System (SUS) holding management positions in a municipality in the interior of Bahia, in Northeastern Brazil. A workshop was held in September 2022, based on a problematizing methodology called the Maguerez Arc, conducted by residents of the Multiprofessional Family Health Program. Ten managers participated in the workshop, most of whom were women. Despite acknowledging the presence and impact of racism in health services, managers find it challenging to recognize and address racism in its institutional dimension. A recurring discourse aligned with the myth of racial democracy was notable, and a higher level of commitment among Black women was observed throughout the workshop. Permanent health education emerges as an essential strategy to combat racism, necessary to expand such discussions within health services.


El artículo relata la experiencia de una acción de educación permanente en salud sobre racismo institucional con profesionales de la salud del Sistema Único de Salud (SUS), que ocupan cargos de gestión en un municipio del interior de Bahía, región nordeste de Brasil. Se realizó un taller en septiembre de 2022, basado en una metodología problematizadora denominada Arco de Maguerez, llevada a cabo por residentes del Programa Multiprofesional en Salud Familiar. El taller contó con la participación de diez gestores, siendo la mayoría mujeres. Los gestores, a pesar de reconocer la presencia y el impacto del racismo en los servicios de salud, encuentran dificultades para visibilizar y combatir el racismo en su dimensión institucional. Fue notable el discurso recurrente alineado con el mito de la democracia racial, y se observó un mayor compromiso de las mujeres negras a lo largo del taller. La educación permanente en salud se muestra como una importante estrategia de combate al racismo, necesaria para ampliar los debates de este tipo dentro de los servicios de salud.


Asunto(s)
Educación en Salud , Racismo , Brasil , Humanos , Racismo/prevención & control , Femenino , Educación en Salud/métodos , Masculino , Programas Nacionales de Salud
6.
Artículo en Inglés | PAHO-IRIS | ID: phr-62663

RESUMEN

[ABSTRACT]. On September 29, 2023, the Republic of Ecuador convened a meeting to address surgical system strengthening and urge political leaders to invest in surgical infrastructure. The meeting included experts in health diplomacy, innovative financing, implementation strategy and national surgical plans. The event occurred in parallel with the Sixtieth Directing Council of the Pan American Health Organization, Seventy-fifth session of the World Health Organization Regional Committee for the Americas. The meeting centered around four major areas: (i) building surgical capacity as a means to develop universal health care and emergency preparedness; (ii) developing policies and strategies for strengthening surgical systems; (iii) developing models for financing, sustaining, and improving surgical systems in low- and middle-income countries; and (iv) evaluating implementation strategies for funding these endeavors. National surgical plans represent a critical opportunity to build resilient health care systems by establishing comprehensive and sustainable policies. This article highlights the key messages from the event, which focused on Latin America, to inform the broader global health community.


[RESUMEN]. El 29 de septiembre del 2023, República de Ecuador convocó una reunión para abordar el fortalecimiento del sistema quirúrgico e instar a las autoridades políticas a realizar inversiones en infraestructura quirúrgica. En la reunión participaron expertos en diplomacia de la salud, financiamiento innovador, estrategias de implementación y planes quirúrgicos nacionales. El evento se celebró en paralelo con el 60.o Consejo Directivo de la Organización Panamericana de la Salud y la 75.a Sesión del Comité Regional de la Organización Mundial de la Salud para las Américas La reunión se centró en cuatro áreas principales: i) el aumento de la capacidad quirúrgica como medio para avanzar en la atención universal de salud y la preparación para emergencias; ii) la formulación de políticas y estrategias para fortalecer los sistemas quirúrgicos; iii) la elaboración de modelos para financiar, sostener y mejorar los sistemas quirúrgicos en países de ingresos bajos y medianos; y iv) la evaluación de las estrategias de implementación para el financiamiento de estas iniciativas. Los planes quirúrgicos nacionales brindan una oportunidad crucial para la creación de sistemas de atención de salud resilientes mediante el establecimiento de políticas integrales y sostenibles. En este artículo se resaltan los mensajes más destacados del evento, que estuvo centrado en América Latina, a fin de proporcionar información a la comunidad de la salud más amplia a nivel mundial.


[RESUMO]. Em 29 de setembro de 2023, a República do Equador convocou uma reunião para tratar do fortalecimento do sistema de atenção cirúrgica e exortar as lideranças políticas a investir em infraestrutura. Participaram da reunião especialistas em diplomacia da saúde, financiamento inovador, estratégia de implementação e planos nacionais de atenção cirúrgica. O evento ocorreu em paralelo ao 60º Conselho Diretor da Organização Pan-Americana da Saúde, 75a Sessão do Comitê Regional da Organização Mundial da Saúde para as Américas. A reunião abordou quatro áreas centrais: (i) capacitação cirúrgica como forma de fazer avançar a atenção universal à saúde e a preparação para emergências; (ii) elaboração de políticas e estratégias para fortalecer os sistemas de atenção cirúrgica; (iii) criação de modelos para financiar, sustentar e melhorar os sistemas de atenção cirúrgica nos países de baixa e média renda; e (iv) avaliação de estratégias de implementação para financiar esses esforços. Ao estabelecer políticas integrais e sustentáveis, os planos nacionais de atenção cirúrgica representam uma oportunidade fundamental para criar sistemas de saúde resilientes. Este artigo destaca as principais mensagens desse evento voltado à América Latina, a fim de informar a comunidade mundial de saúde.


Asunto(s)
Cirugía General , Programas Nacionales de Salud , Resiliéncia de los Sistemas de la Salud , Organización Panamericana de la Salud , América Latina , Cirugía General , Programas Nacionales de Salud , Resiliéncia de los Sistemas de la Salud , Organización Panamericana de la Salud , América Latina , Cirugía General , Programas Nacionales de Salud , Resiliéncia de los Sistemas de la Salud , Organización Panamericana de la Salud
7.
Cad Saude Publica ; 40(10): e00088123, 2024.
Artículo en Portugués | MEDLINE | ID: mdl-39504059

RESUMEN

Hospitalization costs due to cardiovascular diseases are high. In 2019, for Bahia State, Brazil, alone, they exceeded BRL 153 million for the Brazilian Unified National Health System, surpassing the costs of cancer hospitalizations. This fact will show an upward trend with the increase in life expectancy in Brazil (7.3 years more by 2060). Introducing new technologies can mitigate the problem. This study analyzes the impact of telediagnostics in electrocardiogram on hospitalizations for cardiovascular diseases in 326 municipalities in Bahia from 2014 to 2020. Diff-in-diff estimator method was used for analysis of the periods before and after the implementation of telediagnostics in Bahia. Results show that the municipalities which introduced the new technology reduced cardiovascular diseases hospitalizations by 6 for each additional year. In the case of families benefiting from the Brazilian Income Transfer Program, the reduction was 3.26 hospitalizations, and 3.08 among municipalities with the specialized service. Hospitalization increase by 7.66 in the 30 to 59 age group and by 5.34 among men for each additional year. Results show a reduction of 1.15 hospitalizations for rheumatologic heart diseases and 1.39 among diabetic people. In terms of ethnicity/color, underreporting was identified in the conditions studied, resulting in more severe prognoses for blacks. Telediagnostics was effective in reducing this inequality by expanding access and reducing hospitalizations, playing a crucial role in public health and impacting mortality reduction. The theme, therefore, deserves further studies with different samples and sample periods.


Os gastos com internações por doenças do aparelho circulatório são elevados: em 2019, apenas para o Estado da Bahia, Brasil, excederam 153 milhões de reais para o Sistema Único de Saúde, superando os custos de internações por câncer. Esse fato tende a se acentuar com o aumento da expectativa de vida no Brasil (7,3 anos a mais até 2060). A introdução de novas tecnologias pode mitigar o problema. Este estudo analisa o impacto da utilização do telediagnóstico em eletrocardiograma nas internações por doenças cardiovasculares, em 326 municípios baianos durante o período de 2014 a 2020. O método de estimador diff-in-diff foi utilizado para a análise entre os períodos anterior e posterior à implantação do serviço no estado. Os resultados mostram que os municípios que introduziram a nova tecnologia reduziram em seis internações por doenças cardiovasculares a cada ano adicional. No caso das famílias beneficiadas pelo Bolsa Família, a redução foi de 3,26 internações, e de 3,08 entre os municípios com o serviço especializado. Verificou-se um aumento de 7,66 internações na faixa etária de 30 a 59 anos e um aumento de 5,34 entre homens, a cada ano adicional. Os resultados evidenciam uma redução de 1,15 internações por doenças cardíacas reumatológicas e de 1,39 entre as pessoas diabéticas. No quesito raça/cor, foi identificada subnotificação nas condições estudadas, resultando em prognósticos mais severos para a população preta. A tecnologia mostrou-se eficaz para reduzir essa desigualdade, ao expandir o acesso e reduzir as internações, tendo um papel crucial na saúde coletiva e impactando na redução da mortalidade. O tema, portanto, é merecedor de mais estudos, com amostras e períodos amostrais diferentes.


Los costos de las hospitalizaciones por enfermedades del sistema circulatorio son elevados: en el 2019, solo para el Estado de Bahía, Brasil, superaron los BRL 153 millones para el Sistema Único de Salud, superando los costos de las hospitalizaciones por cáncer. Este hecho tiende a acentuarse con el aumento de la esperanza de vida en Brasil (7,3 años más hasta el 2060). La introducción de nuevas tecnologías puede mitigar este problema. Este estudio analiza el impacto del uso del telediagnóstico por electrocardiograma en las hospitalizaciones por enfermedades cardiovasculares en 326 municipios de Bahía durante el período de 2014-2020. Para el análisis entre los períodos anterior y posterior a la implementación del servicio en el Estado, se utilizó el método de estimador diff-in-diff. Los resultados muestran que los municipios que introdujeron la nueva tecnología redujeron las hospitalizaciones por enfermedades cardiovasculares en 6 cada año adicional. En el caso de las familias beneficiarias del Bolsa Familia, la reducción fue de 3,26 hospitalizaciones y de 3,08 entre los municipios con servicio especializado. Se constató un aumento de 7,66 hospitalizaciones en el rango de edad de 30 a 59 años y un aumento de 5,34 entre hombres, por cada año adicional. Los resultados muestran una reducción de 1,15 hospitalizaciones por cardiopatías reumatológicas y de 1,39 entre personas diabéticas. En términos de raza/color, se identificó una infranotificación en las condiciones estudiadas, lo que resultó en pronósticos más severos para la población negra. La tecnología ha demostrado ser eficaz para reducir esta desigualdad, al ampliar el acceso y reducir las hospitalizaciones, desempeñando un papel crucial en la salud colectiva e impactando en la reducción de la mortalidad. El tema, por lo tanto, merece más estudios, con diferentes muestras y períodos muestrales.


Asunto(s)
Enfermedades Cardiovasculares , Hospitalización , Humanos , Brasil/epidemiología , Enfermedades Cardiovasculares/diagnóstico , Hospitalización/estadística & datos numéricos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Telemedicina/estadística & datos numéricos , Electrocardiografía , Factores Socioeconómicos , Anciano , Adulto Joven , Programas Nacionales de Salud , Ciudades
8.
Epidemiol Serv Saude ; 33(spe1): e2024133, 2024.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-39504075

RESUMEN

OBJECTIVE: To analyze the sociodemographic and access profile of trans men and transmasculine individuals linked to the Transgender Outpatient Clinic in Porto Alegre, capital city of the state of Rio Grande do Sul. METHODS: This was a descriptive cross-sectional study based on data from users registered with the service between 2019 and 2021. RESULTS: Of the 418 people included, 384 (91.2%) identified as trans men and 34 (8.8%) as transmasculine individuals. The majority were of White race/skin color (77.9%) and 16.4% had a right to name and gender rectification. Scheduled appointments were the predominant mode of access (84.0%). Among the trans men, 188 (49.0%) had utilized primary healthcare services prior to receiving care at the outpatient clinic. CONCLUSION: The users were predominantly young, White, with higher levels of education, and were minimally engaged in the formal labor market. The existence of a service staffed with qualified and sensitized professionals can enhance the access of this population to the Brazilian National Health System (Sistema Único de Saúde - SUS).


MAIN RESULTS: Less than half of trans men had used primary healthcare services prior to receiving care at the Transgender Outpatient Clinic. Users are predominantly young, White, with higher levels of education and are minimally engaged in the formal labor market. IMPLICATIONS FOR SERVICES: The results can serve as a basis for structuring and improving healthcare services and policies for trans men and transmasculine individuals within the SUS. It also shows that specialized and sensitized professionals can expand access to healthcare. PERSPECTIVES: It is essential to develop comprehensive studies (both qualitative and quantitative) that evaluate the barriers to accessing the SUS faced by trans men and transmasculine individuals, as well as feasible ways to reduce them.


Asunto(s)
Instituciones de Atención Ambulatoria , Accesibilidad a los Servicios de Salud , Personas Transgénero , Humanos , Brasil , Estudios Transversales , Personas Transgénero/estadística & datos numéricos , Masculino , Adulto , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Adulto Joven , Femenino , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Adolescente , Persona de Mediana Edad , Atención Primaria de Salud/estadística & datos numéricos , Programas Nacionales de Salud , Transexualidad , Factores Sociodemográficos
9.
Cad Saude Publica ; 40(9): e00156023, 2024.
Artículo en Portugués | MEDLINE | ID: mdl-39536224

RESUMEN

This article aims to analyze the performance of the Brazilian Unified National Health System (SUS, acronym in Portuguese) hospital network based on the national databases of the Brazilian Hospital Information System (SIH, acronym in Portuguese) and the Brazilian National Registry of Health Establishments (CNES, acronym in Portuguese). The research used a set of indicators covering the production of admissions, the profile, quality and performance of care, associated with hospital size and legal nature. For data analysis, the Analysis of Variance with Tukey-Kramer test was used to highlight the differences between public and private hospitals, the moderation analysis to verify the effect of hospital size and the Pabon Lasso model to integrate the results. The results show that the increase in the number of beds influences the performance of the indicators differently for public and private hospitals. Public hospitals showed higher gains in scale efficiency with the increase in beds, whereas private non-profit hospitals showed a higher performance in the set of indicators and a more balanced performance in the different sizes. The application of the Pabon Lasso model showed that small hospitals, both public and private, perform poorly. It also showed that from medium-sized onwards, public and private hospitals perform well. However, each category displays particularities in its performance profile, reflecting a diversity of practices and operational results. This study thus confirms previous findings that hospital performance tends to improve as the number of beds increases, but also reveals that it varies significantly depending on the legal nature of these institutions.


O artigo tem como objetivo analisar o desempenho da rede hospitalar do Sistema Único de Saúde (SUS) com base nos bancos de dados nacionais do Sistema de Informações Hospitalares (SIH) e do Cadastro Nacional de Estabelecimentos de Saúde (CNES). A pesquisa utilizou um conjunto de indicadores abrangendo a produção de internações, o perfil de atendimentos, a qualidade e o desempenho, associados ao porte dos hospitais e à natureza jurídica. Para análise de dados, empregou-se: a análise da variância com teste de Tukey-Kramer para evidenciar as diferenças entre hospitais públicos e privados; a análise de moderação para verificar o efeito do porte hospitalar; e o modelo Pabon Lasso para integrar os resultados. Estes demonstram que o aumento no número de leitos influencia o desempenho dos indicadores de maneira distinta para hospitais públicos e privados. Hospitais públicos apresentaram ganhos de eficiência de escala superiores com o aumento de leitos e os privados sem fins lucrativos, um desempenho superior no conjunto de indicadores e mais equilibrado nos diferentes portes. A aplicação do modelo Pabon Lasso demonstrou que hospitais pequenos, tanto públicos quanto privados, apresentam baixo desempenho, e evidenciou também que, a partir do médio porte, os hospitais públicos e privados apresentam um bom desempenho. No entanto, cada categoria exibe particularidades em seu perfil de performance, refletindo uma diversidade de práticas e resultados operacionais. Desse modo, o estudo confirma achados anteriores de que o desempenho hospitalar tende a melhorar com o aumento do número de leitos, mas revela também que ele varia significativamente em função da natureza jurídica dessas instituições.


Este artículo tiene como objetivo analizar el desempeño de la red hospitalaria del Sistema Único de Salud brasileño (SUS, por sus siglas en portugués) a partir de las bases de datos nacionales del Sistema de Información Hospitalaria (SIH, por sus siglas en portugués) y del Registro Nacional de Establecimientos de Salud (CNES, por sus siglas en portugués). Para ello, se utilizó un conjunto de indicadores que cubren la producción de hospitalizaciones, el perfil de la atención, la calidad y el desempeño asociados con la capacidad de los hospitales y la naturaleza legal. El análisis de varianza con prueba de Tukey-Kramer se utilizó en el análisis de datos para identificar las diferencias entre los hospitales públicos y privados; el análisis de moderación para verificar el efecto de la capacidad del hospital; y el modelo Pabon Lasso para integrar los resultados. Los resultados mostraron que un aumento en la cantidad de camas influye en el desempeño de los indicadores de manera distinta tanto en los hospitales públicos como en los privados. Los hospitales públicos tuvieron mayor ganancia de eficiencia de escala con el aumento de camas, mientras que los hospitales privados sin fines de lucro mostraron un mejor desempeño en el conjunto de indicadores y más equilibrado en las diferentes capacidades. La aplicación del modelo Pabon Lasso demostró que los pequeños hospitales, tanto públicos como privados, tuvieron un bajo desempeño. También mostró que los hospitales públicos o privados de mediano tamaño tuvieron un buen desempeño. Sin embargo, cada categoría guarda particularidades en su perfil de desempeño, reflejando una diversidad de prácticas y resultados operativos. Por lo tanto, los resultados de este estudio confirman los hallazgos previos de que el desempeño hospitalario tiende a mejorar con el aumento del número de camas, pero también revela que hay una variación significativa dependiendo de la naturaleza legal de estas instituciones.


Asunto(s)
Hospitales Privados , Hospitales Públicos , Programas Nacionales de Salud , Brasil , Hospitales Privados/estadística & datos numéricos , Hospitales Privados/normas , Hospitales Públicos/estadística & datos numéricos , Hospitales Públicos/normas , Programas Nacionales de Salud/legislación & jurisprudencia , Humanos , Indicadores de Calidad de la Atención de Salud , Capacidad de Camas en Hospitales/estadística & datos numéricos , Calidad de la Atención de Salud
10.
Rev Saude Publica ; 58: 48, 2024.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-39607211

RESUMEN

OBJECTIVE: To analyze the investments made in medicines by the federated entities and the asymmetries in these investments from 2016 to 2020, which may have an impact on the supply of and access to these medicines in the SUS. METHODS: This is an exploratory, retrospective study to identify who are the main entities responsible for investment in Primary Care medicines in municipalities, the evolution, counterparts, and regional differences of this investment between 2016 and 2020. RESULTS: The amounts spent on medicines by Brazilian municipalities were higher than the contribution to the CBAF from the MS or the MS + State in all the years analyzed. The average percentages of federal funds transferred and municipal spending varied according to the region of Brazil. The average per capita amount invested in medicines by municipalities increased between 2016 and 2020 (deflation applied), with a greater impact for municipalities with lower MHDI. The Farmácia Popular program mainly reaches municipalities with the largest populations and the highest MHDI and is therefore not enough to address the inequalities in access pointed out. CONCLUSIONS: There has been a widening of inequalities in the capacity of municipalities to ensure access to medicines, especially among the most vulnerable municipalities, accumulating even more risks of illnesses and deaths from primary care-sensitive diseases.


Asunto(s)
Financiación Gubernamental , Accesibilidad a los Servicios de Salud , Programas Nacionales de Salud , Atención Primaria de Salud , Brasil , Humanos , Estudios Retrospectivos , Financiación Gubernamental/estadística & datos numéricos , Programas Nacionales de Salud/economía , Accesibilidad a los Servicios de Salud/economía , Atención Primaria de Salud/economía , Ciudades , Gastos en Salud/estadística & datos numéricos , Medicamentos Esenciales/economía , Medicamentos Esenciales/provisión & distribución , Preparaciones Farmacéuticas/economía , Preparaciones Farmacéuticas/provisión & distribución
11.
BMC Oral Health ; 24(1): 1375, 2024 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-39543622

RESUMEN

BACKGROUND: Although malocclusion is the third most prevalent oral health condition, orthodontics is not part of the minimum list of mandatory specialties to be offered in the Dental Specialty Centers of the Brazilian public health system, but rather as optional. Since the acknowledgment of this field as a part of the Brazilian Unified Health System (SUS), access to orthodontic procedures has become optional by municipal governments. Therefore, this study analyzed the evolution of orthodontic procedure provision within SUS from 2011 to 2022. METHODOLOGY: We conducted a retrospective observational study of time series analysis trends on the number of orthodontic procedures and municipalities offering them. The presentation of findings followed the recommendations of the Reporting of Studies Conducted using Observational Routinely Collected Data. Secondary data from 2011 to 2022 were collected from the SUS Department of Informatics. Orthodontic procedures were organized by year, region, state, and municipality. The study applied descriptive analyses, and the Prais-Winsten generalized linear regressions for time series analysis. RESULTS: The quantity of municipalities offering orthodontic procedures have shown a small increasing during period analyzed (from 128 to 157). Northeast and South macro-regions have increased consistently the municipalities with orthodontic offering. All regions showed stable trends for each procedure, except for the South, which exhibited increasing rates of space maintainer placement (Annual Percentage Change (APC): 72.95; 95% CI: 31.6, 127.3) and maintenance sessions (APC: 15.40; 95% CI: 4.5, 27.5). The study showed decreasing trends for appliance removal in the South (APC: -38.07; 95% CI: -47.1, -27.5) and Northeast (APC: -25.19; 95% CI: -36.5, -11.9) regions. CONCLUSION: From 2011 to 2022, there was a small increase in number of municipalities offering orthodontic procedures in the Brazilian public health system, in addition to a stationary trend for almost all types of procedures.


Asunto(s)
Ortodoncia , Brasil , Humanos , Estudios Retrospectivos , Ortodoncia/estadística & datos numéricos , Ortodoncia/tendencias , Programas Nacionales de Salud/estadística & datos numéricos , Maloclusión/epidemiología , Maloclusión/terapia
12.
Washington, D.C.; OPS; 2024-11-12.
en Español | PAHO-IRIS | ID: phr-62078

RESUMEN

Estas herramientas ayudarán a los directores o asociados de los programas de control de las enfermedades infecciosas desatendidas a colaborar con la comunidad de WASH, guiándoles en la creación de alianzas, en la movilización de recursos y en el diseño, la aplicación y la evaluación de las intervenciones.


Asunto(s)
Medicina Tropical , Enfermedades Desatendidas , Saneamiento , Programas Nacionales de Salud , Conservación de los Recursos Naturales
13.
BMC Health Serv Res ; 24(1): 1171, 2024 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-39363165

RESUMEN

BACKGROUND: After the establishment of the public health emergency of international concern in 2020, health systems worldwide and in Brazil observed the need to apply more extraordinary logistical efforts and possibly resources to combat the imminent pandemic. METHODS: Using the historical series of public expenditures of the National Health Fund (FNS), 2015 to 2021, the number of confirmed cases of COVID-19, and a seasonal ARIMAX model, we sought to assess how the increase in the new virus infections affected the systematic financing of the SUS in Brazil. RESULTS: There were signs of seasonality and an increasing trend in the expenditure variable, which in practical terms, only indicated that the resource contributions followed an increasing trajectory already underway before the advent of the pandemic. The 1% increase in COVID-19 cases, with a one-month lag, contributes to the 0.062% increase in the variation in FNS expenditures but a decrease of 0.058% with a two-month lag. CONCLUSION: The tests showed no evidence to confirm a positive shift on FNS spending growth trajectory due to the increase of COVID-19 cases, only observing a significant increase one month after the occurrence of COVID cases, probably due to their worsening after this period, which was followed by a similar and comparable decrease in percentage of growth in the following month.


Asunto(s)
COVID-19 , Gastos en Salud , COVID-19/epidemiología , COVID-19/economía , Humanos , Brasil/epidemiología , Gastos en Salud/estadística & datos numéricos , Pandemias/economía , SARS-CoV-2 , Programas Nacionales de Salud/economía , Financiación de la Atención de la Salud , Financiación Gubernamental
15.
Rev Saude Publica ; 58: 44, 2024.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-39442119

RESUMEN

OBJECTIVE: To propose a method for detecting and analyzing under-registration and highlight its potential financial effect in view of the implementation of the Previne Brasil Program. METHODS: An ecological study was carried out to analyze cytopathological exams in programmatic area 3.1 in the municipality of Rio de Janeiro. The data was collected from the Departamento de Informática do Sistema Único de Saúde (DATASUS - Department of Informatics of the Unified Health System) database, including information on reports from outsourced cytopathology laboratories and those available in the Sistema de Informação em Saúde para a Atenção Básica (SISAB - Health Information System for Primary Care) and the Sistema de Informação do Câncer do Colo do Útero (SISCOLO - Cervical Cancer Information System) of DATASUS/Ministry of Health. RESULTS: The estimated under-registrations per health unit totaled 108,511 exams in the last two years in the programmatic area 3.1 area, which corresponds to an estimated total of R$ 435,129.00 that would have been foregone if the Previne Brasil Program had been in place during the period studied. CONCLUSION: The article's main contribution lies in the presentation of empirical evidence of the potential effects of under-registration on Primary Health Care financing. In addition, there are two other significant findings - firstly, it highlights weaknesses in the process of recording health information inherent to vulnerable regions; secondly, it indicates a vicious circle potentially fueled by sudden changes in Primary Health Care funding conditions, in addition to potential consequences for other levels of care.


Asunto(s)
Atención Primaria de Salud , Reembolso de Incentivo , Humanos , Atención Primaria de Salud/economía , Brasil , Reembolso de Incentivo/economía , Femenino , Programas Nacionales de Salud/economía
16.
Epidemiol Serv Saude ; 33(spe2): e20231309, 2024.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-39442145

RESUMEN

OBJECTIVE: To analyze the reliability of records held on the National Immunization Program Information System (SI-PNI) in a subsample of children included in the national vaccination coverage survey in Brazilian state capitals and Federal District in 2020. METHODS: This was a study of agreement between data recorded on vaccination cards (doses and dates) and on the SI-PNI for 4050 children with full coverage at 24 months. RESULTS: Data on 3587 children were held on the SI-PNI, with losses of 11% (95%CI: 10;12). Total agreement between doses and dates in the two sources was 86% (95%CI: 86;87), however taking each dose and vaccine individually, variation was greater, with 32% of data in only one source. CONCLUSION: Part of the information was not recorded, but the discrepancy can be considered small. Nonetheless, underrecording of doses and children can compromise vaccination coverage estimates, altering the numerator and denominator data. MAIN RESULTS: Subsample of 4,050 children, among those completing the full schedule at 24 months studied in the national survey, 11% had not been recorded on the SI-PNI, 32% had unrecorded doses (doses or dates) and there was 8% disagreement between vaccination cards and SI-PNI records. IMPLICATIONS FOR SERVICES: Recognizing the difficulties faced by the SI-PNI and the discrepancies between sources is essential for adopting initiatives to improve data quality, so as to avoid inaccurate estimates of childhood vaccination coverage. PERSPECTIVES: This study is expected to contribute to improving the quality of records and the usability of data for monitoring vaccination coverage of the immunization program from the local to the national level.


Asunto(s)
Programas de Inmunización , Sistemas de Información , Cobertura de Vacunación , Vacunación , Humanos , Programas de Inmunización/estadística & datos numéricos , Brasil , Cobertura de Vacunación/estadística & datos numéricos , Reproducibilidad de los Resultados , Sistemas de Información/estadística & datos numéricos , Sistemas de Información/normas , Lactante , Vacunación/estadística & datos numéricos , Preescolar , Programas Nacionales de Salud , Masculino , Femenino , Esquemas de Inmunización , Vacunas/administración & dosificación
17.
Arch Endocrinol Metab ; 68: e230311, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39420893

RESUMEN

Objective: The aim of this study was to estimate the budget impact of adding cabergoline to the Brazilian Unified Health System (SUS) formulary for the treatment of patients with Cushing's disease (CD) who do not achieve disease control after transsphenoidal surgery. Materials and methods: We conducted a budget impact analysis (BIA) from the perspective of the Brazilian SUS over a 5-year time horizon. We compared two scenarios: ketoconazole (Scenario 1) versus including cabergoline as a treatment option (Scenario 2). All analyses were conducted using Microsoft Excel. Uncertainty was explored in univariate sensitivity analyses. Results: The total costs were BRL $25,596,729 for Scenario 1 and BRL $32,469,169 for Scenario 2. The budget impact of adding cabergoline to the formulary for CD treatment within the SUS would be BRL $6,091,036 over 5 years. On univariate analyses, variations in the rates of surgical failure and CD recurrence had the greatest potential to affect the final costs associated with cabergoline. Conclusions: The estimated budget impact of adding cabergoline to the formulary for CD treatment within the Brazilian SUS would be about BRL $6 million. While cost savings cannot be expected, the budget impact of adding cabergoline would be lower than that of adding other treatment options for CD.


Asunto(s)
Presupuestos , Cabergolina , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT) , Cabergolina/uso terapéutico , Cabergolina/economía , Humanos , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/tratamiento farmacológico , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/economía , Brasil , Cetoconazol/uso terapéutico , Cetoconazol/economía , Análisis Costo-Beneficio , Programas Nacionales de Salud/economía , Ergolinas/uso terapéutico , Ergolinas/economía , Costos de los Medicamentos/estadística & datos numéricos
18.
BMC Health Serv Res ; 24(1): 1125, 2024 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-39334045

RESUMEN

OBJECTIVE: To evaluate the variation in COVID-19 inpatient care mortality among hospitals reimbursed by the Unified Health System (SUS) in the first two years of the pandemic in São Paulo state and make performance comparisons within periods and over time. METHODS: Observational study based on secondary data from the Hospital Information System. The study universe consisted of 289,005 adult hospitalizations whose primary diagnosis was COVID-19 in five periods from 2020 to 2022. A multilevel regression model was applied, and the death predictive variables were sex, age, Charlson Index, obesity, type of admission, Brazilian Deprivation Index (BrazDep), the month of admission, and hospital size. Then, the total observed deaths and total deaths predicted by the model's fixed effect component were aggregated by each hospital, estimating the Standardized Mortality Ratio (SMR) in each period. Funnel plots with limits of two standard deviations were employed to classify hospitals by performance (higher-than-expected, as expected, and lower-than-expected) and determine whether there was a change in category over the periods. RESULTS: A positive association was observed between hospital mortality and size (number of beds). There was greater variation in the percentage of hospitals with as-expected performance (39.5 to 76.1%) and those with lower-than-expected performance (6.6 to 32.3%). The hospitals with higher-than-expected performance remained at around 30% of the total, except in the fifth period. In the first period, 64 hospitals (18.3%) had lower-than-expected performance, with standardized mortality ratios ranging from 1.2 to 4.4, while in the last period, only 23 (6.6%) hospitals were similarly classified, with ratios ranging from 1.3 to 2.8. A trend of homogenization and adjustment to expected performance was observed over time. CONCLUSION: Despite the study's limitations, the results suggest an improvement in the COVID-19 inpatient care performance of hospitals reimbursed by the SUS in São Paulo over the period studied, measured by the standardized mortality ratio for hospitalizations due to COVID-19. Moreover, the methodological approach adapted to the Brazilian context provides an applicable tool to follow-up hospital's performance in caring all or specific-cause hospitalizations, in regular or exceptional emergency situations.


Asunto(s)
COVID-19 , Mortalidad Hospitalaria , Humanos , COVID-19/mortalidad , Brasil/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , SARS-CoV-2 , Programas Nacionales de Salud , Pandemias , Hospitalización/estadística & datos numéricos
19.
Cien Saude Colet ; 29(10): e02512024, 2024 Oct.
Artículo en Portugués | MEDLINE | ID: mdl-39292031

RESUMEN

This article analyzes the films produced and broadcast between 1976 and 1978 by the National Agency and the Public Relations Office (ARP) for the campaign to publicize the mandatory vaccination that was instituted by the National Immunization Plan (PNI), created in 1975 and regulated by Decree No. 78,231 of August 12, 1976. The objective is to understand the narrative constructed through images and speeches aimed at convincing the population to make vaccination a culturally accepted practice. To achieve this, we examine the legislation on the subject during the period under analysis, namely the civil-military dictatorship. The dictatorial regime is approached based on the conceptual aspects that guide the analysis of the appropriation of health campaigns as propaganda and investments in a private and curative health model. We can therefore conclude that the initiative to create the PNI is a hiatus in this process of privatizing health, since it is not an action guided by the dictatorship's responsibility for the health of the population, but an action that involved the management of multiple actors in the health field, and which was embraced by the regime because it was a process directly linked to interests connected to the country's conservative modernization project.


Este artigo analisa os filmes produzidos e veiculados, entre 1976 e 1978, pela Agência Nacional e pela Assessoria de Relações Públicas (ARP) para a campanha de divulgação da vacinação obrigatória que foi instituída pelo Plano Nacional de Imunizações (PNI), criado em 1975, e regulamentado pelo Decreto nº 78.231, de 12 de agosto de 1976. O objetivo é compreender a narrativa construída através de imagens e discursos visando tornar a vacina uma prática culturalmente aceita. Para isso, recorre-se à legislação que versa sobre o tema no período analisado, qual seja na ditadura civil-militar. O regime ditatorial é abordado a partir dos aspectos conceituais que orientam as análises sobre a apropriação das campanhas de saúde como propaganda e dos investimentos em um modelo de saúde privada e curativista. Conclui-se, assim, que a iniciativa de criação do PNI trata-se de um hiato nesse processo de privatização da saúde, já que não é uma ação orientada pela responsabilidade da ditadura para com a saúde da população, mas sim, uma ação que envolveu a gerência de múltiplos atores do campo da saúde, e que foi encampada pelo regime por se tratar de um processo diretamente atrelado a interesses ligados ao projeto de modernização conservadora do país.


Asunto(s)
Promoción de la Salud , Programas de Inmunización , Medios de Comunicación de Masas , Vacunación , Humanos , Programas de Inmunización/organización & administración , Vacunación/legislación & jurisprudencia , Promoción de la Salud/métodos , Brasil , Propaganda , Programas Nacionales de Salud/organización & administración , Programas Obligatorios , Historia del Siglo XX , Vacunación Obligatoria
20.
Cien Saude Colet ; 29(10): e03462023, 2024 Oct.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-39292034

RESUMEN

Primary healthcare is the main gateway and priority for healthcare management in Brazil. However, there are significant challenges in the quality of care, particularly for those most vulnerable, especially maternal and infant healthcare. This fact is exacerbated by regional inequalities, which have historically left the North and Northeast regions at a relative disadvantage. The study involves an analysis of the resources available for maternal and infant healthcare in the state of Roraima, the North region, and Brazil as a whole in 2012, 2014, and 2017, using data from Module I of the National Program for the Improvement of Access and Quality of Primary Care (PMAQ-AB). There was a significant improvement in physical infrastructure indicators (e.g., ventilation and air conditioning) as well as improvement in the distribution of supplies and equipment needed for maternal and infant care between 2014 and 2017. However, the availability of medicines and the number of human resources and hours worked diminished. The study offers a crucial longitudinal analysis, comparing the situation in Roraima and Brazil, whose findings could contribute to the development of programs and public policymaking for reproductive rights and maternal and infant health.


A atenção primária à saúde é a principal porta de entrada e prioridade na gestão de saúde no Brasil. Contudo, existem desafios importantes na qualidade da atenção, em particular aos mais vulneráveis, especificamente na rede de saúde materna-infantil (RASMI). Esse fato é agravado pelas já conhecidas desigualdades regionais, que historicamente afetam mais as regiões Norte e Nordeste. O objetivo é avaliar no espaço-tempo a estrutura da RASMI em Roraima, na região Norte e no Brasil nos anos de 2012, 2014 e 2017. Para isso, a fonte de dados será o Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB), Módulo I. Observou-se melhoria significativa nos indicadores de infraestrutura física, como ambiência/climatização; e na distribuição de insumos/equipamentos necessários à assistência materno-infantil, percebeu-se um crescimento progressivo entre 2014 e 2017. Por outro lado, notou-se piora na disponibilidade de medicamentos e diminuição de quantidade/carga-horária de recursos humanos. O estudo configurou uma importante análise longitudinal, comparativa entre a realidade estadual e nacional, que contribui para a formulação de políticas e programas relativos aos direitos reprodutivos e à assistência materno-infantil.


Asunto(s)
Accesibilidad a los Servicios de Salud , Servicios de Salud Materna , Atención Primaria de Salud , Brasil , Humanos , Lactante , Atención Primaria de Salud/organización & administración , Femenino , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/normas , Salud del Lactante , Calidad de la Atención de Salud , Embarazo , Recién Nacido , Programas Nacionales de Salud/organización & administración , Disparidades en Atención de Salud
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