Impacto da reforma de financiamento de hospitais de ensino no Brasil / Impacto de la reforma del financiamiento de hospitales de enseñanza en Brasil / Impact of the funding reform of teaching hospitals in Brazil

OBJETIVO: Avaliar o impacto da reforma de financiamento na produtividade de hospitais de ensino. MÉTODOS: A partir do Sistema de Informações dos Hospitais Universitários Federais, foram construídas fronteiras de eficiência e produtividade em 2003 e 2006 com técnicas de programação linear, por meio de análise envoltória de dados, considerando retornos variáveis de escala e orientação a input. Calculou-se o Índice de Malmquist para identificar mudanças de desempenho ao longo dos anos quanto à eficiência técnica (razão entre os escores de eficiência em tempos distintos) e eficiência tecnológica (deslocamento da fronteira no período considerado). RESULTADOS: Houve aumento do aporte financeiro em 51% e da eficiência técnica dos hospitais de ensino (de 11, passaram a ser 17 na fronteira empírica de eficiência), o mesmo não ocorrendo com a fronteira tecnológica. O uso de análise envoltória de dados estabeleceu os benchmarks para as unidades ineficientes (antes e depois da reforma) e os escores de eficiência mostraram uma possível correlação entre a eficiência técnica encontrada e a intensidade e dedicação de ensino. CONCLUSÕES: A reforma permitiu o desenvolvimento de melhorias gerenciais, mas é necessário maior tempo de acompanhamento para observar mudanças mais efetivas do modelo de financiamento.

OBJECTIVE: To assess the impact of funding reform on the productivity of teaching hospitals. METHODS: Based on the Information System of Federal University Hospitals of Brazil, 2003 and 2006 efficiency and productivity were measured using frontier methods with a linear programming technique, data envelopment analysis, and input-oriented variable returns to scale model. The Malmquist index was calculated to detect changes during the study period: "technical efficiency change," or the relative variation of the efficiency of each unit; and "technological change" after frontier shift. RESULTS: There was 51% mean budget increase and improvement of technical efficiency of teaching hospitals (previously 11, 17 hospitals reached the empirical efficiency frontier) but the same was not seen for the technology frontier. Data envelopment analysis set benchmark scores for each inefficient unit (before and after reform) and there was a positive correlation between technical efficiency and teaching intensity and dedication. CONCLUSIONS: The reform promoted management improvements but there is a need of further follow-up to assess the effectiveness of funding changes.

OBJETIVO: Evaluar el impacto de la reforma de financiamiento en la productividad de hospitales de enseñanza. MÉTODOS: A partir del Sistema de Informaciones de los Hospitales Universitarios Federales de Brasil, se construyeron fronteras de eficiencia y productividad en 2003 y 2006 con técnicas de programación linear, por medio de análisis envoltorio de datos, considerando retornos variables de escala y orientación a input. Se calculó el Índice de Malmquist para identificar cambios de desempeño a lo largo de los años con relación a la eficiencia técnica (cociente entre los puntajes de eficiencia en tiempos distintos) y eficiencia tecnológica (desplazamiento de la frontera en el período considerado). RESULTADOS: Hubo aumento del aporte financiero en 51% y de la eficiencia técnica de los hospitales de enseñanza (de 11, pasaron a ser 17 en la frontera empírica de eficiencia), no ocurriendo el mismo con la frontera tecnológica. El uso del análisis envoltorio de datos estableció los benchmarks para las unidades ineficientes (antes y después de la reforma) y los puntajes de eficiencia mostraron una posible correlación entre la eficiencia técnica encontrada y la intensidad y dedicación de enseñanza. CONCLUSIONES: La reforma permitió el desarrollo de mejoras gerenciales, pero es necesario mayor tiempo de acompañamiento para observar cambios más efectivos del modelo de financiamiento.

[Impact of the funding reform of teaching hospitals in Brazil]. / Impacto da reforma de financiamento de hospitais de ensino no Brasil.

OBJECTIVE: To assess the impact of funding reform on the productivity of teaching hospitals. METHODS: Based on the Information System of Federal University Hospitals of Brazil, 2003 and 2006 efficiency and productivity were measured using frontier methods with a linear programming technique, data envelopment analysis, and input-oriented variable returns to scale model. The Malmquist index was calculated to detect changes during the study period: 'technical efficiency change,' or the relative variation of the efficiency of each unit; and 'technological change' after frontier shift. RESULTS: There was 51% mean budget increase and improvement of technical efficiency of teaching hospitals (previously 11, 17 hospitals reached the empirical efficiency frontier) but the same was not seen for the technology frontier. Data envelopment analysis set benchmark scores for each inefficient unit (before and after reform) and there was a positive correlation between technical efficiency and teaching intensity and dedication. CONCLUSIONS: The reform promoted management improvements but there is a need of further follow-up to assess the effectiveness of funding changes.

Clinical and diagnostic aspects of intestinal microsporidiosis in HIV-infected patients with chronic diarrhea in Rio de Janeiro, Brazil.

The objectives of this study were to determine both the prevalence of microsporidial intestinal infection and the clinical outcome of the disease in a cohort of 40 HIV-infected patients presenting with chronic diarrhea in Rio de Janeiro, Brazil. Each patient, after clinical evaluation, had stools and intestinal fragments examined for viral, bacterial and parasitic pathogens. Microsporidia were found in 11 patients (27.5%) either in stools or in duodenal or ileal biopsies. Microsporidial spores were found more frequently in stools than in biopsy fragments. Samples examined using transmission electron microscopy (n=3) or polymerase chain reaction (n=6) confirmed Enterocytozoon bieneusi as the causative agent. Microsporidia were the only potential enteric pathogens found in 5 of the 11 patients. Other pathogens were also detected in the intestinal tract of 21 patients, but diarrhea remained unexplained in 8. We concluded that microsporidial infection is frequently found in HIV infected persons in Rio de Janeiro, and it seems to be a marker of advanced stage of AIDS.

Sun tanning-related burns--a 3-year experience.

A retrospective study has analyzed 562 sun-related burns out of 19,643 patients treated at our institution from 1 March 1988 to 28 February 1991. These patients were analysed according to sex, age, burn area, mode and length of treatment and outcome. Females, mainly adults, represented 60.8 per cent of all patients presenting burned due to sun bathing. There is a marked seasonal incidence, proportionally constant throughout these 3 years. The main causes of injury were sun only (36.7 per cent), sun plus fig leaf 'tea' tanning lotion (17.7 per cent) and lemon juice (17.7 per cent). Healing to normal skin appearance was achieved in 99.1 per cent, 0.7 per cent healed with scarring and one patient died due to massive sepsis. The effect of sunlight on skin and the process of 'sunburn' when using homemade plant-derived tanning lotions containing substances which can induce a photodermatitis reaction is also discussed.

Two years in burn care, an analysis of 12,423 cases.

This is a retrospective study analysing 12,423 patients treated at our institution from 1 July 1988 to 30 June 1990. Burn incidence and mode of treatment were classified according to age and sex, as well as causative agent, place of the accident, length of treatment and outcome. 96.6 per cent of the patients were surgically treated, about 41 per cent of the patients were under 14 years of age. The most frequent cause of injury was related to meal preparation, with more than two-thirds of the accidents occurring at home. Only large or complicated burns (1094-8.8 per cent) were admitted, with 49 deaths occurring during this period. We conclude that children and younger adults are at greater risk of being burned and preventative measures should be oriented towards the prevention of such accidents.

Estudo comparativo da eficácia de cinco medicamentos tópicos no tratamento de queimaduras / Efficacy of five topical agents in burn treatment: a comparative study

Os autores realizaram um estudo comparativo de cinco preparados para uso tópico no tratamento de queimaduras. Foram tratadas 125 (cento e vinte e cinco) pacientes, divididos aleatoriamente em cinco grupos de 25 (vinte e cinco) pacientes cada. Os medicamentos empregados foram o merbromino a 2(pôr cento), salicilato de sódio, sulfadiazinato de zinco e a combinaçäo de colagenase com clorafenicol. No grupo IV foi feita uma associaçäo do salicilato de sódio e sulfadiazinato de zinco. A análise estatística dos resultados mostrou näo haver diferença significativa entre os diversos grupos, quando se toma em consideraçäo o tempo necessário para a completa epitelizaçäo das lesÆes