Assessment of initial SARS-CoV-2 seroprevalence in the most affected districts in the municipality of São Paulo, Brazil.

BACKGROUND: São Paulo city has been one of the regions most affected by the COVID-19 pandemic in Brazil. Frequent asymptomatic and oligosymptomatic infections and poor access to diagnostic tests make serosurveys crucial to monitor the magnitude of the epidemic and to inform public health policies, such as vaccination plans. OBJECTIVES: To estimate, early in the epidemic, the seroprevalence of antibodies to SARS-CoV-2 in adults living in the six most affected districts in São Paulo city, and to assess potential associated risk factors. METHODS: This was a cross-sectional population-based survey of 1,152 households randomly selected from 72 census tracts. During the period May 4-12, 2020, 463 participants completed a questionnaire on sociodemographic characteristics and history of symptoms in the past two weeks, and provided a blood sample. Prevalence of SARS-CoV-2 antibodies was the outcome of interest and was estimated based on results of two immunoassays, Maglumi SARS-CoV-2 chemiluminescence assay Immunoglobulin (Ig) M (IgM) and IgG, and Roche electrochemiluminescence assay total Ig. Serum samples reactive to either assay were considered positive. RESULTS: Weighted overall seroprevalence was 6% (95%CI 3.9-8.3%). No association was observed between seropositivity and sex, age group or education level. Participants who reported black and brown skin color showed a 2.7 fold higher prevalence than people with white skin (p = 0.007). Among the 30 seropositive individuals, 14 (46.6%) reported no COVID-19 compatible symptoms in the past two weeks. CONCLUSION: This study represents the first assessment of SARS-CoV-2 seroprevalence in the city of São Paulo and 6% is the baseline estimate of a series of population-based seroprevalence surveys. Serological screening using sound serological assays is the key tool to monitoring temporal and geographic changes in the spread of the virus through an important epicenter of the COVID-19 pandemic in Brazil. Ultimately, it may inform prevention and control efforts.

Encouraging physical fitness in Brazilian adolescents with excess weight: can they outperform their eutrophic peers in some activities?

BACKGROUND: There is the need to encourage physical activity (PA) among adolescents with overweight or obesity. OBJECTIVES: The present study aimed to assess the relationship between health-related physical fitness (PF) and nutritional status, and to identify those activities more suited to adolescents with excess weight. METHODS: This cross-sectional study included 3,062 in-school adolescents, aged 10-18 years. We collected information on sex, age, weight, height, skinfold thickness, trunk height and leg length, and calculated body mass index (BMI) z-score, fat mass percentage, and peak height velocity (PHV). Participants were tested for PF by the 20-m shuttle run test (cardiorespiratory fitness); medicine ball throw and standing long jump tests (musculoskeletal fitness) and sit and reach test (flexibility). We used generalized linear mixed models (GLMM) to analyze the relationship between nutritional status and performance in the fitness tests, controlled for maturity offset and fat mass percentage. RESULTS: 1,563 (51%) were boys, mean age 12.6 years (±1.8), 22.8% were overweight and 12.5% had obesity. In both sexes, adolescents with obesity did better in the upper body strength test than their eutrophic peers. Boys with obesity had worse cardiorespiratory fitness and lower body muscular strength than eutrophic boys. Girls with obesity had similar cardiorespiratory fitness and better lower body strength than eutrophic girls. CONCLUSION: In muscular strength fitness tests, adolescents with obesity performed similarly to, or better than, their eutrophic peers. Motivation to maintain regular PA is reinforced by positive experiences. Interventions that emphasize muscular strength PF should be developed for adolescents with obesity.

Medical students with performance difficulties need wide support: Initial results of an academic tutoring program.

BACKGROUND: Even students with previous academic success may face challenges that affect their academic performance. Many medical schools offer programs to students at the risk of academic failure, to ensure that they succeed in the course. OBJECTIVE AND METHODS: In this report we describe a pioneering academic tutoring program developed at a Brazilian medical school and discuss the initial results of the program based on the feedback from tutors and data regarding the progression of students in the medical course. RESULTS: In 2018, 33 students enrolled into the program. Students' performance difficulties were mainly associated with mental health problems and socioeconomic vulnerability. Of the 33 students, 27 (81.8%) were assisted by the Mental Health Support Service and 16 (48.5%) were assisted by the Social Assistance Service. In addition to the planning academic activity class load, tutors were able to assist students in solving socioeconomic issues, carrying out personal support interventions with the promotion of self-esteem, and presenting suggestions for behavioral changes in their routine. For most students (72%), the action plan proposed by the tutors was successful. Eight of the 14 (57%) students in the fourth year progressed to the final two years of in-hospital practical training (internship). CONCLUSIONS: The Academic Tutoring Program showed positive results for most of the students. Close monitoring and tutor intervention allowed students with poor academic performance to overcome the low performance cycle. These important tasks demand time and energy from tutors, and institutional recognition of these professionals is essential for the successful maintenance of the program.

Medical students with performance difficulties need wide support: Initial results of an academic tutoring program

BACKGROUND: Even students with previous academic success may face challenges that affect their academic performance. Many medical schools offer programs to students at the risk of academic failure, to ensure that they succeed in the course. OBJECTIVE AND METHODS: In this report we describe a pioneering academic tutoring program developed at a Brazilian medical school and discuss the initial results of the program based on the feedback from tutors and data regarding the progression of students in the medical course. RESULTS: In 2018, 33 students enrolled into the program. Students' performance difficulties were mainly associated with mental health problems and socioeconomic vulnerability. Of the 33 students, 27 (81.8%) were assisted by the Mental Health Support Service and 16 (48.5%) were assisted by the Social Assistance Service. In addition to the planning academic activity class load, tutors were able to assist students in solving socioeconomic issues, carrying out personal support interventions with the promotion of self-esteem, and presenting suggestions for behavioral changes in their routine. For most students (72%), the action plan proposed by the tutors was successful. Eight of the 14 (57%) students in the fourth year progressed to the final two years of in-hospital practical training (internship). CONCLUSIONS: The Academic Tutoring Program showed positive results for most of the students. Close monitoring and tutor intervention allowed students with poor academic performance to overcome the low performance cycle. These important tasks demand time and energy from tutors, and institutional recognition of these professionals is essential for the successful maintenance of the program.

Assessment of initial SARS-CoV-2 seroprevalence in the most affected districts in the municipality of São Paulo, Brazil

ABSTRACT Background: São Paulo city has been one of the regions most affected by the COVID-19 pandemic in Brazil. Frequent asymptomatic and oligosymptomatic infections and poor access to diagnostic tests make serosurveys crucial to monitor the magnitude of the epidemic and to inform public health policies, such as vaccination plans. Objectives: To estimate, early in the epidemic, the seroprevalence of antibodies to SARS-CoV-2 in adults living in the six most affected districts in São Paulo city, and to assess potential associated risk factors. Methods: This was a cross-sectional population-based survey of 1,152 households randomly selected from 72 census tracts. During the period May 4-12, 2020, 463 participants completed a questionnaire on sociodemographic characteristics and history of symptoms in the past two weeks, and provided a blood sample. Prevalence of SARS-CoV-2 antibodies was the outcome of interest and was estimated based on results of two immunoassays, Maglumi SARS-CoV-2 chemiluminescence assay Immunoglobulin (Ig) M (IgM) and IgG, and Roche electrochemiluminescence assay total Ig. Serum samples reactive to either assay were considered positive. Results: Weighted overall seroprevalence was 6% (95%CI 3.9-8.3%). No association was observed between seropositivity and sex, age group or education level. Participants who reported black and brown skin color showed a 2.7 fold higher prevalence than people with white skin (p = 0.007). Among the 30 seropositive individuals, 14 (46.6%) reported no COVID-19 compatible symptoms in the past two weeks. Conclusion: This study represents the first assessment of SARS-CoV-2 seroprevalence in the city of São Paulo and 6% is the baseline estimate of a series of population-based seroprevalence surveys. Serological screening using sound serological assays is the key tool to monitoring temporal and geographic changes in the spread of the virus through an important epicenter of the COVID-19 pandemic in Brazil. Ultimately, it may inform prevention and control efforts.

The Edmonton Obesity Staging System: assessing a potential tool to improve the management of obesity surgery in the Brazilian public health services.

BACKGROUND: Limited access to publicly funded, insurance-covered, and self-paid obesity surgery is a reality worldwide. Waiting lists for procedures are usually based on chronologic criteria and body mass index (BMI)-defined obesity categorization. Obesity classification systems assess overall health and have been proposed as an alternative. OBJECTIVE: To investigate the correlation between BMI-based classification and the Edmonton Obesity Staging System (EOSS) to support current evidence that the assessment of the clinical severity of obesity could be a helpful tool to maximize access to surgery. SETTING: University hospital, Brazil. METHODS: Retrospective analysis of all 2011 to 2014 adult patients who underwent obesity surgery under the public health system. Data on sex, age, presurgical BMI, and co-morbidities were extracted from hospital records. Spearman correlation coefficients were used to assess the strength and direction of the relationship between BMI classification and EOSS. RESULTS: Of 565 patients, 79% were female, mean age 44.1 ± 10.9 years and mean BMI 46.9 ± 6.2 kg/m2. The most common EOSS stage was 2 (86.5%), followed by stages 3 (8.5%) and 1 (4.9%). There was no correlation between the severity of obesity measured by BMI and EOSS (ρ = -.030, P = .475). Older patients had higher Edmonton scores (ρ = .308, P < .001). No difference was observed regarding sex. CONCLUSIONS: No correlation was found between EOSS and BMI and between these and sex. Age correlated with both obesity indicators. EOSS was reproducible in Brazilian surgical patients and may be an important tool from a health services perspective contributing to the more efficient use of limited resources for obesity surgery.

Fasting insulin resistance affects the prevalence of metabolically healthy obesity in Brazilian adolescents.

AIM: We aimed to assess the influence of fasting insulin resistance on metabolically healthy obesity (MHO) prevalence in adolescents and to identify associated factors. METHODS: This retrospective, registry-based, cross-sectional study included 418 (51.9% girls) 10- to 18-year-old adolescents with obesity from a tertiary outpatient clinic in Sao Paulo, Brazil, between 2009 and 2013. The prevalence of MHO was estimated according to two definitions: (i) no cardiometabolic risk factors (CMRF) by the International Diabetes Federation parameters and (ii) no CMRF and homeostatic model assessment for insulin resistance <3.16. Adjusted prevalence ratios and 95% confidence intervals (CI) evaluated the association of gender, age, pubertal stages, skin colour and degree of obesity with MHO. RESULTS: Metabolically healthy obesity prevalence was lower in definition II than definition I (12.7%; 95% CI 9.1-16.3% versus 43.1%; 95% CI 38.0-48.2%, respectively). Adjusted results showed negative association between severe obesity and MHO by both definitions (p ≤ 0.01). Male and later pubertal stages were also less likely to have MHO, but neither remained significant in definition II. CONCLUSION: Metabolically healthy obesity prevalence decreased when insulin resistance was part of the definition. Detecting pre-clinical insulin resistance may improve the management of treatment-seeking adolescents, especially when they present no CMRF.

Obese patients lose weight independently of nutritional follow-up after bariatric surgery.

OBJECTIVE: to examine the association between preoperative body weight, adherence to postsurgical nutritional follow-up, length of postoperative period, and weight loss during the first 18 months among adults who have undergone bariatric surgery. METHODS: a retrospective cohort study was conducted on 241 consecutive patients who underwent open Roux-en-Y gastric bypass (RYGBP) from January 2006 to December 2008, in a teaching hospital in São Paulo (Brazil). Data were collected through hospital records review and the variables analyzed included sex, age, immediate preoperative weight, adherence to postsurgical nutritional visits and length of postoperative period. Proportional body weight reductions during the 18-month follow-up period were examined using generalized estimating equations. RESULTS: 81% (n = 195) of participants were female, with overall mean age of 44.4 ± 11.6 years, mean preoperative weight of 123.1 ± 21.2 kg and mean preoperative body mass index of 47.2 ± 6.2 kg/m2. The overall adherence to postoperative follow- up schedule was 51% (95%CI: 44.5-57.5%). Preoperative body weight and adherence were not associated with proportional weight reduction (Wald's test p > 0.18). Weight loss leveled off at the end of the 18-month follow-up period for both compliant and non-compliant patients (Wald's test p = 0.00). CONCLUSIONS: our study showed that weight loss occurred steadily over the first 18 months after RYGBP, leveling off at around 40% weight reduction. It was associated with neither presurgical weight, nor nutritional follow-up and it may be primarily dependent on the surgical body alterations themselves. This finding may have implications for intervention strategies aimed at motivating patients to comply with early postsurgical and life-long follow-up.

Obese patients lose weight independently of nutritional follow-up after bariatric surgery / Pacientes obesos perdem peso independentemente do seguimento nutricional pós-cirurgia bariátrica

Summary Objective: to examine the association between preoperative body weight, adherence to postsurgical nutritional follow-up, length of postoperative period, and weight loss during the first 18 months among adults who have undergone bariatric surgery. Methods: a retrospective cohort study was conducted on 241 consecutive patients who underwent open Roux-en-Y gastric bypass (RYGBP) from January 2006 to December 2008, in a teaching hospital in São Paulo (Brazil). Data were collected through hospital records review and the variables analyzed included sex, age, immediate preoperative weight, adherence to postsurgical nutritional visits and length of postoperative period. Proportional body weight reductions during the 18-month follow-up period were examined using generalized estimating equations. Results: 81% (n=195) of participants were female, with overall mean age of 44.4 ± 11.6 years, mean preoperative weight of 123.1± 21.2 kg and mean preoperative body mass index of 47.2± 6.2 kg/m2. The overall adherence to postoperative follow- up schedule was 51% (95%CI: 44.5-57.5%). Preoperative body weight and adherence were not associated with proportional weight reduction (Wald’s test p > 0.18). Weight loss leveled off at the end of the 18-month follow-up period for both compliant and non-compliant patients (Wald’s test p = 0.00). Conclusions: our study showed that weight loss occurred steadily over the first 18 months after RYGBP, leveling off at around 40% weight reduction. It was associated with neither presurgical weight, nor nutritional follow-up and it may be primarily dependent on the surgical body alterations themselves. This finding may have implications for intervention strategies aimed at motivating patients to comply with early postsurgical and life-long follow-up. .

Resumo Objetivo: examinar a perda de peso nos primeiros 18 meses em pacientes submetidos à cirurgia bariátrica. Métodos: um estudo de coorte retrospectiva foi realizado com 241 adultos submetidos à gastroplastia, entre janeiro/2006 e dezembro/2008, em um centro em São Paulo (Brasil). Foi feita a revisão dos prontuários e as variáveis analisadas foram sexo, idade, peso pré-cirúrgico imediato, adesão ao seguimento nutricional pós-operatório e duração do período pós-operatório. A proporção do peso inicial perdido durante os 18 primeiros meses pós-cirurgia foi analisada pela técnica de equações generalizadas de estimação. Resultados: 81% (n=195) eram mulheres; média de idade 44,4 ± 11,6 anos; média de peso pré-operatório 123,1± 21,2 kg; média do índice de massa corporal 47.2± 6.2 kg/m2. A prevalência de adesão ao seguimento nutricional pós-cirúrgico foi de 51% (IC95% = 44,5-57,5%). Peso pré-cirúrgico e adesão não se mostraram significativamente associados à redução da proporção do peso inicial (Teste de Wald p>0,18). A perda de peso tendeu a diminuir no final do período de 18 meses pós-cirúrgico nos grupos de pacientes aderentes e não aderentes (Teste de Wald p=0,00). Conclusão: nosso estudo mostrou que a perda de peso durante os primeiros 18 meses após a cirurgia chega a 40% do peso. O emagrecimento não foi associado ao peso pré-operatório, nem à adesão ao seguimento nutricional pós-cirúrgico e pode depender, principalmente, das alterações promovidas pelo procedimento cirúrgico em si. Esse achado poderá levar à proposição de intervenções para motivar os pacientes ao seguimento pós-operatório. .

Intersectorial health-related policies: the use of a legal and theoretical framework to propose a typology to a case study in a Brazilian municipality / Políticas Intersetoriais Relacionadas à Saúde: uso de marcos legais e teóricos para a proposição de uma tipologia aplicada a um estudo de caso em um município brasileiro

This article analyzes intersectorial health-related policies (IHRP) based on a case study performed in 2008-2009 that mapped the social policies of the city of Piracicaba, State of Sao Paulo, Brazil. The research strategy comprised quantitative and qualitative methodologies and converging information sources. Legal and theoretical conceptual frameworks were applied to the Piracicaba study results and served as the basis for proposing a typology of IHRP. Three types of IHRP were identified: health policies where the health sector is coordinator but needs non-health sectors to succeed; policies with a sector other than health as coordinator, but which needs health sector collaboration to succeed; and thirdly, genuine intersectorial policies, not led by any one sector but by a specifically-appointed intersectorial coordinator. The authors contend that political commitment of local authorities alone may not be enough to promote efficient intersectorial social policies. Comprehension of different types of IHRP and their interface mechanisms may contribute to greater efficiency and coverage of social policies that affect health equity and its social determinants positively. In the final analysis,, this will lead to more equitable health outcomes.

Este artigo analisa as Políticas Intersetoriais Relacionadas à Saúde (PIRS), com base em um estudo de caso realizado em 2008 e 2009 que mapeou as políticas sociais do município de Piracicaba, São Paulo, Brasil. A estratégia de pesquisa compreendeu metodologias qualitativa e quantitativa. Marcos legais e teóricos foram aplicados aos resultados do estudo de Piracicaba, servindo de base para a proposição de três tipos de PIRS: políticas de saúde coordenadas pelo setor saúde e que necessitam de outros para serem bem sucedidas; políticas coordenadas por outro setor, diferente do da saúde, mas que necessitam da participação deste para serem efetivas; e as políticas intersetoriais genuínas, que não são lideradas por um único setor mas sim por um órgão intersetorial criado especificamente para sua coordenação. Os autores sustentam que somente a vontade política do gestor pode não ser suficiente para a promoção de políticas intersetoriais eficientes, e que a compreensão dos tipos de PIRS, e seus diferentes mecanismos de articulação, podem contribuir para o aprimoramento e a cobertura das políticas sociais que afetam positivamente a equidade em saúde e os determinantes sociais. No final, isto irá conduzir a resultados com maior equidade em saúde.

Intersectorial health-related policies: the use of a legal and theoretical framework to propose a typology to a case study in a Brazilian municipality.

This article analyzes intersectorial health-related policies (IHRP) based on a case study performed in 2008-2009 that mapped the social policies of the city of Piracicaba, State of Sao Paulo, Brazil. The research strategy comprised quantitative and qualitative methodologies and converging information sources. Legal and theoretical conceptual frameworks were applied to the Piracicaba study results and served as the basis for proposing a typology of IHRP. Three types of IHRP were identified: health policies where the health sector is coordinator but needs non-health sectors to succeed; policies with a sector other than health as coordinator, but which needs health sector collaboration to succeed; and thirdly, genuine intersectorial policies, not led by any one sector but by a specifically-appointed intersectorial coordinator. The authors contend that political commitment of local authorities alone may not be enough to promote efficient intersectorial social policies. Comprehension of different types of IHRP and their interface mechanisms may contribute to greater efficiency and coverage of social policies that affect health equity and its social determinants positively. In the final analysis,, this will lead to more equitable health outcomes.

Profissionais da Estratégia Saúde da Família diante de demandas médico-sociais: dificuldades e estratégias de enfrentamento / Family Health Strategy professionals facing medical social needs: difficulties and coping strategies

Os profissionais da Estratégia Saúde da Família (ESF) atuam em comunidades onde a complexidade de problemáticas médico-sociais pode levá-los a sofrer psicologicamente, com prejuízos ao atendimento aos usuários e à consolidação da ESF como modelo de reorganização da atenção básica no Brasil. Esse estudo investigou as dificuldades e as formas de enfrentamento referidas por profissionais de equipes da ESF frente às demandas médico-sociais apresentadas pelos usuários em seu cotidiano de trabalho. Grupos focais e entrevistas semiestruturadas foram realizados com 68 profissionais de três Unidades de Saúde da Família da cidade de São Paulo. Tráfico e uso de drogas ilícitas, alcoolismo, depressão e violência doméstica são as demandas mais significativas para o grupo estudado. Frente a elas, os profissionais referem formação profissional e capacitação técnica insuficientes, sobrecarga e condições desfavoráveis de trabalho, com sentimentos de impotência e frustração. No enfrentamento das dificuldades, destacam-se as estratégias coletivas, especialmente as reuniões de equipe e apoio matricial, nas quais há troca de experiências, conhecimentos e apoio compartilhado. Os resultados indicam que as dificuldades referidas podem deixar os profissionais da ESF em situação de vulnerabilidade, tal como os usuários por eles atendidos. O investimento no desenvolvimento de competências, o fortalecimento de estratégias de enfrentamento coletivas, assim como maior articulação com as redes de serviços e as lideranças locais, mostram-se necessários para que os profissionais de saúde atuem com menor estresse frente às complexas demandas médico-sociais presentes em seu cotidiano de trabalho, e assim contribuam na consolidação da ESF.

Adesão ao seguimento nutricional ambulatorial pós-cirurgia bariátrica e fatores associados / Adherence to outpatient nutritional follow-up after bariatric surgery and associated factors

OBJETIVO: Estimar a prevalência da adesão ao seguimento nutricional ambulatorial pós-cirúrgico e avaliar sua associação com fatores selecionados em indivíduos submetidos à cirurgia bariátrica. MÉTODOS: Estudo de coorte retrospectiva com base na revisão de dados pós-operatórios de 241 prontuários de adultos submetidos à gastroplastia redutora com derivação em Y de Roux entre 2006 e 2008. Considerou-se aderente o indivíduo que compareceu a quatro ou mais consultas nutricionais nos 12 primeiros meses após a cirurgia. Para investigar a associação entre adesão ao seguimento nutricional e idade, sexo, estado conjugal, escolaridade, situação empregatícia, distância entre a residência e o hospital, estratégias para perda de peso no período pré-operatório, índice de massa corporal no pré-cirúrgico imediato, presença de comorbidades e duração da internação pós-operatória, foram calculadas razões de prevalência e utilizou-se regressão múltipla de Poisson. RESULTADOS: A prevalência de adesão foi de 56% (IC95%=49,7-62,3) nessa população predominantemente feminina (80,9%), com média de idade de 44,4 anos (DP=11,6) e de IMC pré-operatório de 47,2kg/m² (DP=6,2). Dos fatores estudados, somente a duração da internação pós-operatória igual ou superior a 6 dias mostrou-se significativamente associada à adesão após análise ajustada por sexo e idade (RP=1,46; IC95%=1,15-1,86). CONCLUSÃO: A prevalência de adesão encontrada foi semelhante às de estudos internacionais, mas baixa considerando-se 75% como referência. A maior adesão observada nos indivíduos com internação pós-operatória prolongada pode sugerir que o maior contato com a equipe multiprofissional aumente a percepção da necessidade de cuidados com a saúde em longo prazo.

OBJECTIVE: This study estimated the prevalence of adherence to outpatient postoperative nutritional follow-up after bariatric surgery and analyzed the association between adherence and selected factors. METHODS: A total of 241 records of female and male adults who underwent Roux-en-Y gastric bypass between 2006 and 2008 were reviewed for this retrospective cohort study. The data included the preoperative and postoperative periods. Individuals were considered compliant when they attended four or more nutritional appointments in the first 12 months after surgery. Prevalence ratios were calculated for estimating the association between adherence to postoperative nutritional follow-up and factors such as age, gender, marital status, education level, employment status, distance between home and hospital, weight loss strategies used during the preoperative period, body mass index immediately before surgery, presence of comorbidities and duration of hospital stay after surgery, and the Poisson multiple regression was used for adjusted analysis. RESULTS: Adherence prevalence was 56.0% (CI95% 49.7-62.3). Women composed 80.9% of the population; the mean age of the sample was 44.4 years (SD=11.6) and mean preoperative body mass index was 47.2kg/m² (SD=6.2). Among the study factors, only duration of postoperative hospital stay was significantly associated with adherence after adjustment for age and gender (PR=1.46 CI95% 1.15-1.86). CONCLUSION: The adherence prevalence of this population was similar to those of foreign studies, but below the minimum prevalence of 75% considered reference. The greater adherence of individuals with longer postoperative hospital stays may have stemmed from their prolonged interaction with the multidisciplinary team, which may have increased their awareness of disease severity and need of long-term health care.

Assessing the scientific research productivity of a Brazilian healthcare institution: a case study at the Heart Institute of São Paulo, Brazil.

INTRODUCTION: The present study was motivated by the need to systematically assess the research productivity of the Heart Institute (InCor), Medical School of the University of São Paulo, Brazil. OBJECTIVE: To explore methodology for the assessment of institutional scientific research productivity. MATERIALS AND METHODS: Bibliometric indicators based on searches for author affiliation of original scientific articles or reviews published in journals indexed in the databases Web of Science, MEDLINE, EMBASE, LILACS and SciELO from January 2000 to December 2003 were used in this study. The retrieved records were analyzed according to the index parameters of the journals and modes of access. The number of citations was used to calculate the institutional impact factor. RESULTS: Out of 1253 records retrieved from the five databases, 604 original articles and reviews were analyzed; of these, 246 (41%) articles were published in national journals and 221 (90%) of those were in journals with free online access through SciELO or their own websites. Of the 358 articles published in international journals, 333 (93%) had controlled online access and 223 (67%) were available through the Capes Portal of Journals. The average impact of each article for InCor was 2.224 in the period studied. CONCLUSION: A simple and practical methodology to evaluate the scientific production of health research institutions includes searches in the LILACS database for national journals and in MEDLINE and the Web of Science for international journals. The institutional impact factor of articles indexed in the Web of Science may serve as a measure by which to assess and review the scientific productivity of a research institution.

Assessing the scientific research productivity of a Brazilian healthcare institution: a case study at the heart institute of São Paulo, Brazil

INTRODUCTION: The present study was motivated by the need to systematically assess the research productivity of the Heart Institute (InCor), Medical School of the University of São Paulo, Brazil.OBJECTIVE: To explore methodology for the assessment of institutional scientific research productivity. MATERIALS AND METHODS: Bibliometric indicators based on searches for author affiliation of original scientific articles or reviews published in journals indexed in the databases Web of Science, MEDLINE, EMBASE, LILACS and SciELO from January 2000 to December 2003 were used in this study. The retrieved records were analyzed according to the index parameters of the journals and modes of access. The number of citations was used to calculate the institutional impact factor. RESULTS: Out of 1253 records retrieved from the five databases, 604 original articles and reviews were analyzed; of these, 246 (41%) articles were published in national journals and 221 (90%) of those were in journals with free online access through SciELO or their own websites. Of the 358 articles published in international journals, 333 (93%) had controlled online access and 223 (67%) were available through the Capes Portal of Journals. The average impact of each article for InCor was 2.224 in the period studied. CONCLUSION: A simple and practical methodology to evaluate the scientific production of health research institutions includes searches in the LILACS database for national journals and in MEDLINE and the Web of Science for international journals. The institutional impact factor of articles indexed in the Web of Science may serve as a measure by which to assess and review the scientific productivity of a research institution.

Ciência, tecnologia e inovação em saúde: desafios / Science, technology and innovation in health: challenges

Quais são os entraves e desafios para que se instale no país um ciclo virtuoso de produção e aplicação dos resultados das atividades de Ciência, Tecnologia e Inovação (CT&I) de maneira a beneficiar diretamente a população? Essa é a pergunta que se procurou enfrentar. Os sistemas de saúde e de CT&I são complexos e contam com muitos atores. De um lado, um sistema de saúde híbrido, com predomínio do sistema público (Sistema Único de Saúde e sua rede de instituições conveniadas), mas com expressiva participação do setor privado (medicina de grupo, seguradoras, cooperativas médicas e provedores particulares). De outro lado, os atores do sistema CT&I: os formuladores governamentais de políticas, a comunidade científica, as agências de fomento de atividades de CT&I públicas e privadas, os órgãos reguladores, as instituições gerenciadoras de informações em saúde e os componentes do setor produtivo (indústrias farmacêuticas, de insumos imuno-biológicos e de equipamentos médico-hospitalares e odontológicos). Os gestores e usuários do sistema de saúde são os grandes demandantes dos produtos, processos e serviços criados a partir de atividades científicas e tecnológicas. A fragilidade das estratégias de articulação e integração entre esses dois sistemas, a descontinuidade administrativa e política das instâncias gestoras e a insipiência de políticas explícitas de longo prazo e com o foco em resultados e avaliações, são alguns dos entraves para o pleno desenvolvimento científico e tecnológico no setor da saúde. O planejamento integrado, internamente nos dois sistemas e entre eles, a construção de parcerias estáveis e sólidas entre instituições componentes dos sistemas e o financiamento estável com maior participação do setor produtivo são algumas das medidas necessárias para que esse cenário possa mudar definitivamente e tornar-se mais favorável e produtivo, levando em última instância, a resultados que contribuam para a melhoria dos indicadores de saúde.