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1.
Rev Saude Publica ; 54: 32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32236383

RESUMO

OBJECTIVE: To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD: In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil's federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS: In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97-0.99), structural conditions (RR: 0.98; 95%CI: 0.97-0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97-0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02-1.48), it forms (RR: 1.01, 95%CI: 1.01-1.02), and more medications (RR: 1.02, 95%CI: 1.01-1.03). CONCLUSION: Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations.


Assuntos
Hospitalização/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Asma/epidemiologia , Asma/terapia , Brasil/epidemiologia , Pré-Escolar , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Diarreia/epidemiologia , Diarreia/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pneumonia/epidemiologia , Pneumonia/terapia , Fatores Socioeconômicos
2.
Rev. saúde pública (Online) ; 54: 32, 2020. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1094411

RESUMO

ABSTRACT OBJECTIVE To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil's federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97-0.99), structural conditions (RR: 0.98; 95%CI: 0.97-0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97-0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02-1.48), it forms (RR: 1.01, 95%CI: 1.01-1.02), and more medications (RR: 1.02, 95%CI: 1.01-1.03) CONCLUSION Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations.

3.
Parasite Epidemiol Control ; 7: e00117, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31485493

RESUMO

Waterborne outbreaks of human toxoplasmosis can have great magnitude due to the number of persons infected while smaller-scale outbreaks are also possible. This is a study based on a historical database investigating a toxoplasmosis outbreak occurred in 2006 in a residential community in São Luís, in the Brazilian state of Maranhão. Ninety of the 110 residents, employees and domestic helping persons had blood samples collected and tested. The diagnosis of toxoplasmosis was established by quantification of anti-Toxoplasma gondii immunoglobulin M and immunoglobulin G antibodies using enzyme immunoassay. The subjects were classified as past infection, acute/recent infection or seronegatives. The definition of acute infection was based on the presence of indicative symptoms and immunoglobulin M positivity. There were 33 cases of acute infection. The outbreak was concluded to be waterborne: consumption of faucet-mount filtered water was indicated as risk factor. We discuss the challenges of investigating waterborne toxoplasmosis outbreaks.

4.
Cad Saude Publica ; 35(6): e00159718, 2019 Jul 04.
Artigo em Português | MEDLINE | ID: mdl-31291430

RESUMO

The aim of this cross-sectional study nested in a cohort was to describe the targeting and coverage of the Family Income program in children 13 to 35 months of age. Data were obtained from the BRISA Birth Cohorts in Ribeirão Preto, São Paulo State, and São Luís, Maranhão State, Brazil. The cohorts started in 2010 with the inclusion of all the births in Ribeirão Preto (7,794) and 5,236 in São Luís, covering a random sample of one third. In the follow-up waves in 2011 and 2013, 3,805 children returned in Ribeirão Preto and 3,308 in São Luís. The data were used from the time of follow-up and were integrated with the information from the Single Registry (CadÚnico). Two eligibility criteria were considered for receiving the Family Income benefit: monthly per capita family income of BRL 140.00 or less (approximately USD 38.00) and economic classes D/E. The percentages of targeting and covering were estimated for Family Income. Weighting was performed for losses to follow-up. According to family income, the program's targeting was 33.8% in São Luís and 15.9% in Ribeirão Preto; according to economic class, it was 33.7% in São Luís and 15.3% in Ribeirão Preto. According to per capita family income, coverage was 82.1% in São Luís and 71.6% in Ribeirão Preto; and according to economic class it was 68.9% in São Luís and 46.8% in Ribeirão Preto. The program's targeting rates were low, while the coverage rates were better. Both indicators were higher in São Luís than in Ribeirão Preto.

5.
Rev Panam Salud Publica ; 43: e47, 2019.
Artigo em Português | MEDLINE | ID: mdl-31139211

RESUMO

Objective: To present a methodology for the empirical evaluation of primary health care (PHC) through the construction of digital representations of potential PHC coverage areas. Methods: In this methodological study, potential areas were constructed by combinatorial analysis between census tracts and the location of basic health units with working PHC teams in Brazil. Six rules were used to parameterize the algorithm for the construction of potential areas. Thus, six restrictions were applied to enable the model: the selection of census tracts near the basic health unit; contiguous sectors; mutually exclusive sectors; sectors located in the same municipality of basic health units; sum of 4 500 users per health team in each unit; and volume of population ascribed proportional to the number of PHC teams allocated to the unit. Based on 316 594 census tracts and 39 758 basic health units, a neighborhood matrix was developed. To that matrix, a graph algorithm was applied to test combinations of sectors that simultaneously met the stipulated rules. Results: A total of 1 901 114 arcs were defined, connecting 30 351 census tracts, allowing the construction of 26 907 potential areas. Based on these results, intra-municipal analyses can be performed to monitor PHC indicators. Customizable algorithm parameters can be adjusted to accommodate different sets of rules which may be adapted to different countries. Conclusions: The use of geoprocessing approaches creates conditions for the assessment of PHC impact, based on secondary databases at various levels, such as intra-municipal, basic health unit, and even at the team level.

6.
Rev Soc Bras Med Trop ; 52: e20180230, 2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30652792

RESUMO

INTRODUCTION: Tuberculosis (TB) is an infectious and contagious disease caused by Mycobacterium tuberculosis. TB emerged in the 21st century as an unsolved public health problem. This study aimed to analyze the relationship between the characteristics of basic health units (BHUs) and the number of TB cases detected in Maranhão, Brazil. METHODS: An ecological, analytical study was conducted using the municipalities in the state of Maranhão as the unit of analysis. Data regarding the number of detected TB cases was obtained from the Sistema de Informação de Agravos de Notificação database, and the characteristics of the BHUs were obtained from the first cycle of data collection for the Program to Improve Access and Quality of Basic Care. The BHU structure was classified as adequate (80%-100%), partially adequate (60%-79%), poorly adequate (40%-59%), or inadequate (<40%) according to the presence of specified items. The number of BHUs per municipality in each adequacy category was estimated. Inflated Poisson regression analysis was performed to estimate the incidence density ratios (IDRs) and the 95% confidence intervals (95% CIs). RESULTS: Municipalities with a higher level of BHU adequacy had a higher number of detected TB cases (IDR = 1.61, 95% CI: 1.01-2.60). CONCLUSIONS: Better structured health services in primary care may be associated with better detection and/or notification of TB cases.


Assuntos
Pesquisa sobre Serviços de Saúde , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Tuberculose Pulmonar/diagnóstico , Brasil , Notificação de Doenças , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Fatores Socioeconômicos
7.
Cad. Saúde Pública (Online) ; 35(6): e00159718, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1011701

RESUMO

Estudo transversal aninhado a uma coorte, que teve como objetivo descrever foco e cobertura do programa Bolsa Família em crianças de 13-35 meses de idade. Fez-se uso de dados das coortes de nascimento BRISA, em Ribeirão Preto, São Paulo, e São Luís, Maranhão, Brasil. O início das coortes ocorreu em 2010, com a inclusão de todos os nascimentos em Ribeirão Preto (7.794) e 5.236 em São Luís, abrangendo amostra aleatória de um terço. No seguimento, realizado de 2011 a 2013, retornaram 3.805 crianças em Ribeirão Preto e 3.308 em São Luís. Foram utilizados dados do momento do seguimento, e estes foram integrados às informações do Cadastro Único (CadÚnico). Consideraram-se dois critérios de elegibilidade para o benefício do Bolsa Família: renda familiar per capita mensal de até R$ 140,00 e classe econômica D/E. Estimaram-se percentuais de foco e cobertura do Bolsa Família. Realizou-se ponderação para perdas de seguimento. O foco do Bolsa Família, segundo renda familiar per capita mensal, foi de 33,8% em São Luís e 15,9% em Ribeirão Preto, e de acordo com a classe econômica foi de 33,7% em São Luís e 15,3% em Ribeirão Preto. A cobertura do Bolsa Família, de acordo com o critério de renda familiar per capita mensal, foi de 82,1% em São Luís e 71,6% em Ribeirão Preto; e segundo classe econômica foi de 68,9% em São Luís e 46,8% em Ribeirão Preto. Foram baixos os percentuais de foco e melhores os de cobertura do Bolsa Família, com estimativas destes indicadores maiores para São Luís em relação a Ribeirão Preto.


The aim of this cross-sectional study nested in a cohort was to describe the targeting and coverage of the Family Income program in children 13 to 35 months of age. Data were obtained from the BRISA Birth Cohorts in Ribeirão Preto, São Paulo State, and São Luís, Maranhão State, Brazil. The cohorts started in 2010 with the inclusion of all the births in Ribeirão Preto (7,794) and 5,236 in São Luís, covering a random sample of one third. In the follow-up waves in 2011 and 2013, 3,805 children returned in Ribeirão Preto and 3,308 in São Luís. The data were used from the time of follow-up and were integrated with the information from the Single Registry (CadÚnico). Two eligibility criteria were considered for receiving the Family Income benefit: monthly per capita family income of BRL 140.00 or less (approximately USD 38.00) and economic classes D/E. The percentages of targeting and covering were estimated for Family Income. Weighting was performed for losses to follow-up. According to family income, the program's targeting was 33.8% in São Luís and 15.9% in Ribeirão Preto; according to economic class, it was 33.7% in São Luís and 15.3% in Ribeirão Preto. According to per capita family income, coverage was 82.1% in São Luís and 71.6% in Ribeirão Preto; and according to economic class it was 68.9% in São Luís and 46.8% in Ribeirão Preto. The program's targeting rates were low, while the coverage rates were better. Both indicators were higher in São Luís than in Ribeirão Preto.


Se trata de un estudio transversal anidado en una cohorte, cuyo objetivo fue describir la atención y cobertura del programa Bolsa Familia (PBF), en niños de 13 a 35 meses de edad. Se usaron datos de las cohortes de nacimiento BRISA, en Ribeirão Preto, São Paulo, y São Luís, Maranhão, Brasil. El inicio de las cohortes fue 2010, con la inclusión de todos los nacimientos en Ribeirão Preto (7.794) y 5.236 en São Luís, abarcando un tercio de la muestra aleatoria. En el seguimiento, realizado de 2011 a 2013, regresaron 3.805 niños en Ribeirão Preto y 3.308 en São Luís. Se utilizaron los datos recogidos cuando se realizó el seguimiento y, posteriormente, se integraron en la información que proporciona el Registro Único (CadÚnico). Se consideraron dos criterios de elegibilidad para ser beneficiario del Bolsa Familia renta familiar per cápita mensual de hasta BRL 140,00 y clase económica D/E. Se estimaron porcentajes de atención y cobertura del Bolsa Familia. Se realizó una ponderación respecto a las pérdidas en el seguimiento. La atención del Bolsa Familia, según renta familiar per cápita mensual, alcanzó a un 33,8% en São Luís y un 15,9% en Ribeirão Preto; y según la clase económica, fue de un 33,7% en São Luís y un 15,3% en Ribeirão Preto. La cobertura del Bolsa Familia, de acuerdo con el criterio de renta familiar per cápita mensual, fue de un 82,1% en São Luís y un 71,6% en Ribeirão Preto; y según la clase económica fue de un 68,9% en São Luís y un 46,8% en Ribeirão Preto. Fueron bajos los porcentajes de atención y mejores los porcentajes de cobertura del Bolsa Familia, con estimaciones mayores de esos indicadores en São Luís, en comparación con los de Ribeirão Preto.


Assuntos
Humanos , Lactente , Pré-Escolar , Financiamento Governamental/estatística & dados numéricos , Política Pública , Fatores Socioeconômicos , População Urbana , Brasil , Estudos Transversais , Estudos de Coortes , Programas Governamentais/estatística & dados numéricos
8.
Rev. Soc. Bras. Med. Trop ; 52: e, 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-977119

RESUMO

Abstract INTRODUCTION Tuberculosis (TB) is an infectious and contagious disease caused by Mycobacterium tuberculosis. TB emerged in the 21st century as an unsolved public health problem. This study aimed to analyze the relationship between the characteristics of basic health units (BHUs) and the number of TB cases detected in Maranhão, Brazil. METHODS An ecological, analytical study was conducted using the municipalities in the state of Maranhão as the unit of analysis. Data regarding the number of detected TB cases was obtained from the Sistema de Informação de Agravos de Notificação database, and the characteristics of the BHUs were obtained from the first cycle of data collection for the Program to Improve Access and Quality of Basic Care. The BHU structure was classified as adequate (80%-100%), partially adequate (60%-79%), poorly adequate (40%-59%), or inadequate (<40%) according to the presence of specified items. The number of BHUs per municipality in each adequacy category was estimated. Inflated Poisson regression analysis was performed to estimate the incidence density ratios (IDRs) and the 95% confidence intervals (95% CIs). RESULTS Municipalities with a higher level of BHU adequacy had a higher number of detected TB cases (IDR = 1.61, 95% CI: 1.01-2.60). CONCLUSIONS Better structured health services in primary care may be associated with better detection and/or notification of TB cases.

9.
Epidemiol Serv Saude ; 27(4): e2017444, 2018 12 13.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30570033

RESUMO

OBJECTIVE: to describe a solution enabling geolocation of hospital admissions (AIH), processed on the Brazilian National Health System's Hospital Information System. METHODS: in order to spatialize AIHs an R language script was written, based on the microdatasus and CepR packages; the script was applied to identify all AIHs in Goiás state in the year 2015; after downloading and pre-processing the data, the procedure for AIH spatialization was detailed. RESULTS: of the 361,213 AIHs processed, we were able to retrieve 24,220 different ZIP codes (CEPs); from this set of ZIP codes, 23,910 (98.7%) were geolocated; these geolocated ZIP codes enabled spatialization of 97.7% of AIHs processed for the state of Goiás. CONCLUSION: it is possible to spatialize AIHs with a high success rate; the method detailed in this paper opens a new range of possibilities for the design of evaluation studies, formulation of policies and planning of health care actions.


Assuntos
Sistemas de Informação Geográfica , Sistemas de Informação Hospitalar/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Programas Nacionais de Saúde , Brasil , Humanos , Software
10.
Rev Inst Med Trop Sao Paulo ; 60: e62, 2018 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-30379229

RESUMO

Dengue fever, chikungunya fever, and zika virus infections are increasing public health problems in the world, the last two diseases having recently emerged in Brazil. This ecological study employed spatial analysis of probable cases of dengue fever, chikungunya fever, and zika virus infections reported to the National Mandatory Reporting System (SINAN) in Maranhao State from 2015 to 2016. The software GeoDa version 1.10 was used for calculating global and local Moran indices. The global Moran index identified a significant autocorrelation of incidence rates of dengue (I=0.10; p=0.009) and zika (I=0.07; p=0.03). The study found a positive spatial correlation between dengue and the population density (I=0.31; p<0.001) and a negative correlation with the Performance Index of Unified Health System (PIUHS) by basic care coverage (I=-0.08; p=0.01). Regarding chikungunya fever, there were positive spatial correlations with the population density (I=0.06; p=0.03) and the Municipal Human Development Index (MHDI) (I=0.10; p=0.002), and a negative correlation with the Gini index (I=-0.01; p<0.001) and the PIUHS by basic care coverage (I=-0.18; p<0.001). Lastly, we found positive spatial correlations between Zika virus infections and the population density (I=0.13; p=0.005) and the MHDI (I=0.12; p<0.001), as well as a negative correlation with the Gini index (I=-0.11; p<0.001) and the PIUHS by basic care coverage (I=-0.05; p=0.03). Our results suggest that several socio-demographic factors influenced the occurrence of dengue fever, chikungunya fever, and zika virus infections in Maranhao State.


Assuntos
Febre de Chikungunya/epidemiologia , Dengue/epidemiologia , Infecção por Zika virus/epidemiologia , Brasil/epidemiologia , Humanos , Incidência , Fatores Socioeconômicos , Análise Espacial
11.
Cad Saude Publica ; 34(9): e00049817, 2018 09 06.
Artigo em Português | MEDLINE | ID: mdl-30208170

RESUMO

The study aimed to: (1) describe the work process in Brazil's oral health teams, based on the essential attributes of primary health care, according to geographic region, type of team, and the municipality's socioeconomic characteristics and (2) verify whether the data in the work process of the oral health teams in the Brazilian National Program to Improve Access and Quality in primary health (PMAQ-AB) were capable of measuring such attributes. This was a nationwide ecological study with data from cycle I of PMAQ-AB. The study included descriptive, exploratory factor, and confirmatory factor analyses (α = 5%). Constructs were analyzed in light of the essential attributes of primary health care (first contact, coordination of care, comprehensiveness, and continuity). The first three constructs and a fourth factor were formed, called dental prosthesis actions. However, the continuity attribute was not formed. The models' goodness-of-fit measures were satisfactory. Factor loads were greater than 0.5, except for the two variables in factor 3. The actions most frequently performed by the oral health teams (> 60%) were in first contact, and the least frequent were those in comprehensiveness, highlighting referrals to specialties (7.6%). There were differences in the work process in oral health teams between regions of the country, type of team, and certification strata (p < 0.05). In conclusion, data on the work process in oral health teams from cycle primary health care in the services' work routine. Further research is recommended on continuity of care. In addition, the oral health teams participating in cycle I of PMAQ-AB should make further progress in actions related to comprehensiveness and coordination of care.


Assuntos
Saúde Bucal/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , /estatística & dados numéricos , Brasil , Inquéritos de Saúde Bucal/estatística & dados numéricos , Análise Fatorial , Saúde da Família , Mão de Obra em Saúde/normas , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/estatística & dados numéricos , Saúde Bucal/normas , Equipe de Assistência ao Paciente/normas , Atenção Primária à Saúde/normas , Melhoria de Qualidade , Valores de Referência , Fatores Socioeconômicos
12.
Rev. enferm. UFPE on line ; 12(6): 1507-1513, jun. 2018. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-981861

RESUMO

Objetivo: descrever o perfil epidemiológico e clínico da hanseníase em capital hiperendêmica. Método: estudo quantitativo, descritivo, realizado em instituições de saúde que operacionalizam o PCH. Adaptou-se o instrumento para a coleta de dados com base nas informações contidas na ficha do Sistema de Informação de Agrafos de Notificação. O processamento e a análise dos dados foram realizados no programa Epi-Info, versão 7, e os resultados, apresentados em tabelas. Resultados: foram notificados 1.055 casos, dos quais 51,2% eram do sexo masculino, na faixa etária entre 21 a 40 anos (35,4%). Do total, 79,1% foram classificados como casos novos e 52,0%, detectados por demanda espontânea. A forma clínica predominante foi a dimorfa (58,8%) e, quanto à classificação operacional, 74,1% eram multibacilares. Conclusão: a ocorrência de hanseníase ainda é elevada, indica falha na qualidade das ações realizadas pelos profissionais de saúde, resulta no aumento da transmissibilidade da doença, na detecção tardia dos casos e no surgimento de incapacidades físicas. Várias medidas devem ser tomadas para o tratamento adequado. Essas contribuirão para o diagnóstico precoce, o tratamento adequado e a prevenção da doença.(AU)


Assuntos
Humanos , Masculino , Gravidez , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Perfil de Saúde , Diagnóstico da Situação de Saúde , Saúde Pública , Doenças Endêmicas , Hanseníase , Hanseníase/epidemiologia , Epidemiologia Descritiva , Sistemas de Informação em Saúde
13.
Cad Saude Publica ; 34(3): e00041717, 2018 03 12.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29538497

RESUMO

This study estimated the percentages of incomplete immunization with new vaccines and old vaccines and associated factors in children 13 to 35 months of age belonging to a birth cohort in São Luís, the capital of Maranhão State, Brazil. The sample was probabilistic, with 3,076 children born in 2010. Information on vaccination was obtained from the Child's Health Card. The new vaccines, namely those introduced in 2010, were meningococcal C and 10-valent pneumococcal, and the old vaccines, or those already on the childhood immunization schedule, were BCG, hepatitis B, human rotavirus, polio, tetravalent (diphtheria, tetanus, pertussis, Haemophilus influenzae b), yellow fever, and triple viral (measles, mumps, rubella). The study used hierarchical modeling and Poisson regression with robust variance. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated. Incomplete immunization was higher with new vaccines (51.1%) than with old vaccines (33.2%). Children 25 to 35 months of age (PR = 1.27; 95%CI: 1.14-1.41) and those in economic classes D/E (PR = 1.20; 95%CI: 1.06-1.35) were only significantly associated with new vaccines; low maternal schooling (PR = 1.58; 95%CI: 1.21-2.06), unavailability of outpatient and/or hospital care for the child (PR = 1.20; 95%CI: 1.04-1.38), and unavailability of the vaccine in health services (PR: 1.28; 95%CI: 1.12-1.46) were only associated with old vaccines. Immunization strategies should consider the vulnerability of older preschool-age children and those belonging to classes D and E, especially when new vaccines are introduced, as well as children of mothers with low schooling. Strategies should also address problems with the availability of health services and vaccines.


Assuntos
Programas de Imunização/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Brasil , Pré-Escolar , Feminino , Programas Governamentais , Necessidades e Demandas de Serviços de Saúde , Humanos , Lactente , Masculino , Estudos Prospectivos , Fatores Socioeconômicos , Cobertura Vacinal/classificação
14.
Cad. Saúde Pública (Online) ; 34(9): e00049817, 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-952464

RESUMO

Resumo: Os objetivos do estudo foram: (1) descrever o processo de trabalho das equipes de saúde bucal (ESB) do Brasil, com base nos atributos essenciais da atenção primária à saúde, segundo regiões, tipo de equipe e características socioeconômicas dos municípios; e (2) verificar se os dados do processo de trabalho das ESB do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) foram capazes de aferir tais atributos. Estudo ecológico, de abrangência nacional, com dados do ciclo I do PMAQ-AB. Foram feitas análises descritivas, fatoriais exploratória e confirmatória (α = 5%). Os construtos formados foram analisados à luz dos atributos essenciais da atenção primária à saúde (primeiro contato, coordenação do cuidado, integralidade e longitudinalidade). Formaram-se os três primeiros construtos e um quarto fator, denominado ações em prótese dentária. Porém, o atributo longitudinalidade não foi conformado. As medidas de ajuste dos modelos foram satisfatórias. As cargas fatoriais foram maiores que 0,5, exceto para duas variáveis do fator 3. As ações mais realizadas pelas ESB (> 60%) foram as do primeiro contato e as menos comuns foram as da integralidade, destacando-se ter referência para especialidades (7,6%). Houve diferenças no processo de trabalho das ESB entre as regiões, tipo de equipe e estrato de certificação (p < 0,05). Conclui-se que os dados de processo de trabalho das ESB do ciclo I do PMAQ-AB foram capazes de discriminar três dos quatro atributos essenciais da atenção primária à saúde na rotina dos serviços. Sugere-se aprofundar a avaliação da longitudinalidade. Ademais, as ESB participantes do ciclo I do PMAQ-AB precisam avançar nas ações relacionadas à integralidade e coordenação do cuidado.


Abstract: The study aimed to: (1) describe the work process in Brazil's oral health teams, based on the essential attributes of primary health care, according to geographic region, type of team, and the municipality's socioeconomic characteristics and (2) verify whether the data in the work process of the oral health teams in the Brazilian National Program to Improve Access and Quality in primary health (PMAQ-AB) were capable of measuring such attributes. This was a nationwide ecological study with data from cycle I of PMAQ-AB. The study included descriptive, exploratory factor, and confirmatory factor analyses (α = 5%). Constructs were analyzed in light of the essential attributes of primary health care (first contact, coordination of care, comprehensiveness, and continuity). The first three constructs and a fourth factor were formed, called dental prosthesis actions. However, the continuity attribute was not formed. The models' goodness-of-fit measures were satisfactory. Factor loads were greater than 0.5, except for the two variables in factor 3. The actions most frequently performed by the oral health teams (> 60%) were in first contact, and the least frequent were those in comprehensiveness, highlighting referrals to specialties (7.6%). There were differences in the work process in oral health teams between regions of the country, type of team, and certification strata (p < 0.05). In conclusion, data on the work process in oral health teams from cycle primary health care in the services' work routine. Further research is recommended on continuity of care. In addition, the oral health teams participating in cycle I of PMAQ-AB should make further progress in actions related to comprehensiveness and coordination of care.


Resumen: Los objetivos de este trabajo fueron: (1) describir el proceso de trabajo de los equipos de salud bucal (ESB) en Brasil, conforme los atributos esenciales de la atención primaria a la salud, según regiones, tipo de equipo y características socioeconómicas de los municipios; además de (2) verificar si los datos del proceso de trabajo de las ESB en el Programa Nacional de Mejora del Acceso y Calidad de la Atención Básica (PMAQ-AB) fueron capaces de evaluar tales atributos. Es un estudio ecológico, de cobertura nacional, con datos del ciclo I del PMAQ-AB. Se realizaron análisis descriptivos, factoriales exploratorios y confirmatorios (α = 5%). Los constructos creados se analizaron a la luz de los atributos esenciales de la atención primaria a la salud (primer contacto, coordinación del cuidado, integralidad y longitudinalidad). Se generaron los tres primeros constructos, y un cuarto factor, denominado acciones en prótesis dental. No obstante, el atributo longitudinalidad no se configuró. Las medidas de ajuste de los modelos fueron satisfactorias. Las cargas factoriales fueron mayores que 0,5, excepto en dos variables del factor 3. Las acciones más realizadas por las ESB (> 60%) fueron las de primer contacto, y las menos comunes fueron las de integralidad, destacándose contar con referencias para especialidades (7,6%). Hubo diferencias en el proceso de trabajo de las ESB entre las regiones, tipo de equipo y extracto de certificación (p < 0,05). Se concluye que los datos del proceso de trabajo de las ESB del ciclo I del PMAQ-AB fueron capaces de discriminar tres de los cuatro atributos esenciales de la atención primaria a la salud en la rutina de los servicios. Se sugiere profundizar en la evaluación de la longitudinalidad. Además, las ESB participantes del ciclo I del PMAQ-AB necesitan avanzar en acciones relacionadas con la integralidad y coordinación del cuidado.


Assuntos
Humanos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Avaliação de Processos em Cuidados de Saúde/estatística & dados numéricos , Equipe de Assistência ao Paciente/normas , Atenção Primária à Saúde/normas , Valores de Referência , Fatores Socioeconômicos , Brasil , Inquéritos de Saúde Bucal/estatística & dados numéricos , Saúde Bucal/normas , Saúde da Família , Análise Fatorial , Avaliação de Processos em Cuidados de Saúde/normas , Melhoria de Qualidade , Mão de Obra em Saúde/normas , Mão de Obra em Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/estatística & dados numéricos
15.
Cad. Saúde Pública (Online) ; 34(3): e00041717, 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-889896

RESUMO

Neste estudo, foram estimados percentuais de incompletude vacinal e fatores associados ao esquema vacinal para novas vacinas (EVNV) e esquema vacinal para antigas vacinas (EVAV) em crianças de 13 a 35 meses de idade de uma coorte de nascimento em São Luís, Maranhão, Brasil. A amostra foi probabilística, com 3.076 crianças nascidas em 2010. Informações sobre vacinação foram obtidas da Caderneta de Saúde da Criança. As vacinas consideradas para o EVNV foram meningocócica C e pneumocócica 10 valente, e para EVAV, vacinas BCG, hepatite B, rotavírus humano, poliomielite, tetravalente (vacina difteria, tétano, coqueluche e Haemophilus influenzae b), febre amarela, tríplice viral (vacina sarampo, caxumba, rubéola). Empregou-se modelagem hierarquizada e regressão de Poisson com variância robusta. Estimaram-se razões de prevalência (RP) e intervalos de 95% de confiança (IC95%). Incompletude vacinal foi maior para EVNV (51,1%) em relação ao EVAV (33,2%). Crianças com 25 a 35 meses de idade (RP = 1,27; IC95%: 1,14-1,41) e pertencer às classes D/E (RP = 1,20; IC95%: 1,06-1,35) se associaram somente ao EVNV; enquanto baixa escolaridade materna (RP = 1,58; IC95%: 1,21-2,06), indisponibilidade de atendimento ambulatorial e/ou hospitalar para a criança (RP = 1,20; IC95%: 1,04-1,38) e de vacina nos serviços de saúde (RP = 1,28; IC95%: 1,12-1,46), apenas ao EVAV. Faz-se importante considerar, nas estratégias de vacinação, a vulnerabilidade de crianças com mais idade e pertencentes às classes D e E, especialmente quando novas vacinas são introduzidas, e ainda de filhos de mães que possuem baixa escolaridade. Assim como, quando há menor disponibilidade de serviços de saúde para a criança e de vacina.


En este estudio se estimaron porcentajes de vacunación no completada y los factores asociados al esquema de vacunas para nuevas vacunas (EVNV) y al de antiguas vacunas (EVAV), en niños de 13 a 35 meses de edad de una cohorte de nacimiento en São Luís, Maranhão, Brasil. La muestra fue probabilística, con 3.076 niños nacidos en 2010. La información sobre la vacunación se obtuvo de la cartilla de salud del niño. Las vacunas consideradas para el EVNV fueron la meningocócica C y neumocócica 10 valente, y para EVAV, vacunas BCG, hepatitis B, rotavirus humano, poliomielitis, tetravalente (vacuna difteria, tétanos, tosferina y Haemophilus influenzae b), fiebre amarilla, triple viral (vacuna contra el sarampión, paperas, rubeola). Se empleó un modelo jerarquizado y la regresión de Poisson con variancia robusta. Se estimaron razones de prevalencia (RP) e intervalos de 95% de confianza (IC95%). La vacunación no completada fue mayor para EVNV (51,1%), en relación con el EVAV (33,2%). Ser niños de 25 a 35 meses de edad (RP = 1,27; IC95%: 1,14-1,41) y pertenecer a las clases D/E (RP = 1,20; IC95%: 1,06-1,35) se asociaron solamente al EVNV; mientras que la baja escolaridad materna (RP = 1,58; IC95%: 1,21-2,06), indisponibilidad de atención ambulatoria y/o hospitalaria para el niño (RP = 1,20; IC95%: 1,04-1,38) y de la vacuna en los servicios de salud (RP = 1,28; IC95%: 1,12-1,46), solamente al EVAV. Es importante considerar, en las estrategias de vacunación, la vulnerabilidad de los niños con más edad y pertenecientes a las clases D y E, especialmente cuando se introducen las nuevas vacunas, incluyendo también a los hijos de madres con baja escolaridad. También es problemática la existencia de una menor disponibilidad de servicios de salud para el niño y de la vacuna.


This study estimated the percentages of incomplete immunization with new vaccines and old vaccines and associated factors in children 13 to 35 months of age belonging to a birth cohort in São Luís, the capital of Maranhão State, Brazil. The sample was probabilistic, with 3,076 children born in 2010. Information on vaccination was obtained from the Child's Health Card. The new vaccines, namely those introduced in 2010, were meningococcal C and 10-valent pneumococcal, and the old vaccines, or those already on the childhood immunization schedule, were BCG, hepatitis B, human rotavirus, polio, tetravalent (diphtheria, tetanus, pertussis, Haemophilus influenzae b), yellow fever, and triple viral (measles, mumps, rubella). The study used hierarchical modeling and Poisson regression with robust variance. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated. Incomplete immunization was higher with new vaccines (51.1%) than with old vaccines (33.2%). Children 25 to 35 months of age (PR = 1.27; 95%CI: 1.14-1.41) and those in economic classes D/E (PR = 1.20; 95%CI: 1.06-1.35) were only significantly associated with new vaccines; low maternal schooling (PR = 1.58; 95%CI: 1.21-2.06), unavailability of outpatient and/or hospital care for the child (PR = 1.20; 95%CI: 1.04-1.38), and unavailability of the vaccine in health services (PR: 1.28; 95%CI: 1.12-1.46) were only associated with old vaccines. Immunization strategies should consider the vulnerability of older preschool-age children and those belonging to classes D and E, especially when new vaccines are introduced, as well as children of mothers with low schooling. Strategies should also address problems with the availability of health services and vaccines.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Adolescente , Adulto , Programas de Imunização/estatística & dados numéricos , Cobertura Vacinal/classificação , Cobertura Vacinal/estatística & dados numéricos , Fatores Socioeconômicos , Brasil , Estudos Prospectivos , Fatores Etários , Programas Governamentais , Necessidades e Demandas de Serviços de Saúde
16.
Rev Inst Med Trop Sao Paulo ; 59: e71, 2017 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-29116291

RESUMO

Severe dengue cases have increased in Brazil since 2001, with the first records in Maranhão dating back to 2002. The aim of this study was to determine the prevalence of severe dengue cases by age group and the possible risk factors. This was a study of secondary data on dengue in residents of São Luís, Maranhão, Brazil, using probable cases notified to the National Mandatory Reporting System (SINAN) from 2002 to 2011. The diagnosis and classification of dengue were based on the Brazilian Ministry of Health criteria: dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue fever with complications (DWC). DHF and DWC were considered severe dengue, and DF was classified as non-severe dengue. A logistic regression analysis was performed with severe dengue as the outcome. During the study period, 1,229 cases of severe dengue were reported; of these, 812 in patients under the age of 15 (66%). Among the risk factors evaluated, age under 15 years old (OR = 3.10, 95% CI = 2.69-3.57, p-value = 0.001) was associated with severe dengue. The prevalence of severe dengue in children under the age of 15 was higher, and only this age group was associated with the occurrence of severe dengue.


Assuntos
Dengue Grave/epidemiologia , Adolescente , Brasil/epidemiologia , Notificação de Doenças , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Índice de Gravidade de Doença
17.
Rev Saude Publica ; 51: 75, 2017 Aug 17.
Artigo em Inglês, Português | MEDLINE | ID: mdl-28832757

RESUMO

OBJECTIVE: The objective of this study is to investigate whether the characteristics of the structure of primary health units and the work process of primary care teams are associated with the number of hospitalizations for primary care sensitive conditions. METHODS: In this ecological study, we have analyzed data of Brazilian municipalities related to sociodemographic characteristics, coverage of care programs, structure of primary health units, and work process of primary care teams. We have obtained the data from the first cycle of the Brazilian Program for Improving Access and Quality of the Primary Care, of the Department of Information Technology of the Brazilian Unified Health System, the Brazilian Institute of Geography and Statistics, and the United Nations Development Programme. The associations have been estimated using negative binomial regression coefficients (ß) and respective 95% confidence intervals, with a hierarchical approach in three levels (alpha = 5%). RESULTS: In the adjusted analysis for the outcome in 2013, in the distal level, the coverage of the Bolsa Família Program (ß = -0.001) and private insurance (ß = -0.01) had a negative association, and the human development index (ß = 1.13), the proportion of older adults (ß = 0.05) and children under the age of five (ß = 0.05), and the coverage of the Community Health Agent Strategy (ß = 0.002) showed positive association with hospitalizations for primary care sensitive conditions. In the intermediate level, minimum hours (ß = -0.14) and availability of vaccines (ß = -0.16) showed a negative association, and availability of medications showed a positive association (ß = 0.16). In the proximal level, only the variable of matrix support (ß = 0.10) showed a positive association. The variables in the adjusted analysis of the number of hospitalizations for primary care sensitive conditions in 2014 presented the same association as in 2013. CONCLUSIONS: The characteristics of the structure of primary health units and the work process of the primary care teams impact the number of hospitalizations for primary care sensitive conditions in Brazilian municipalities. OBJETIVO: Investigar se características da estrutura das unidades básicas de saúde e do processo de trabalho das equipes de atenção básica estão associadas ao número de internações por condições sensíveis à atenção primária. MÉTODOS: Neste estudo ecológico, foram analisados dados de municípios brasileiros relativos a características sociodemográficas, de cobertura de programas assistenciais, de estrutura das unidades básicas de saúde e processo de trabalho das equipes de atenção básica. Os dados foram obtidos do primeiro ciclo do Programa de Melhoria do Acesso e Qualidade da Atenção Básica, do Departamento de Informática do Sistema Único de Saúde, do Instituto Brasileiro de Geografia e Estatística e do Programa das Nações Unidas. Estimaram-se as associações por meio de coeficientes de regressão binomial negativa (ß) e respectivos intervalos de confiança a 95%, com abordagem hierarquizada em três blocos (alpha = 5%). RESULTADOS: Na análise ajustada, para o desfecho em 2013, no bloco distal, a cobertura do Programa Bolsa Família (ß = -0,001) e de plano privado (ß = -0,01) apresentaram associação negativa; e o índice de desenvolvimento humano (ß = 1,13), a proporção de pessoa idosa (ß = 0,05) e de menor de cinco anos (ß = 0,05) e a cobertura da Estratégia de Agentes Comunitários de Saúde (ß = 0,002) mostraram associação positiva com internações por condições sensíveis à atenção primária. No bloco intermediário, apresentaram associação negativa o horário mínimo (ß = -0,14) e a disponibilidade de vacina (ß = -0,16); e associação positiva, a disponibilidade de medicamentos (ß = 0,16). No bloco proximal, apenas a variável apoio matricial (ß = 0,10) mostrou associação positiva. Na análise ajustada do número de internações por condições sensíveis à atenção primária em 2014, as variáveis apresentaram o mesmo sentido de associação de 2013. CONCLUSÕES: Características da estrutura das unidades básicas de saúde e do processo de trabalho das equipes de atenção básica impactam no número de internações por condições sensíveis à atenção primária nos municípios brasileiros.


Assuntos
Hospitalização/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Populações Vulneráveis/estatística & dados numéricos , Brasil , Pré-Escolar , Demografia/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos
18.
J Ambul Care Manage ; 40 Suppl 2 Supplement, The Brazilian National Program for Improving Primary Care Access and Quality (PMAQ): S24-S34, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28252500

RESUMO

Cervical cancer is a common neoplasm that is responsible for nearly 230 000 deaths annually in Brazil. Despite this burden, cervical cancer is considered preventable with appropriate care. We conducted a longitudinal ecological study from 2002 to 2012 to examine the relationship between the delivery of preventive primary care and cervical cancer mortality rates in Brazil. Brazilian states and the federal district were the unit of analysis (N = 27). Results suggest that primary health care has contributed to reducing cervical cancer mortality rates in Brazil; however, the full potential of preventive care has yet to be realized.


Assuntos
Mortalidade/tendências , Atenção Primária à Saúde , Neoplasias do Colo do Útero/mortalidade , Brasil/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Programas de Rastreamento , Medicina Preventiva , Qualidade da Assistência à Saúde
19.
Rev Soc Bras Med Trop ; 50(1): 104-109, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28327810

RESUMO

INTRODUCTION: Currently, dengue fever, chikungunya fever, and zika virus represent serious public health issues in Brazil, despite efforts to control the vector, the Aedes aegypti mosquito. METHODS: : This was a descriptive and ecological study of dengue deaths occurring from 2002 to 2013 in São Luis, Maranhão, Brazil. Geoprocessing software was used to draw maps, linking the geo-referenced deaths with urban/social data at census tract level. RESULTS:: There were 74 deaths, concentrated in areas of social vulnerability. CONCLUSIONS:: The use of geo-technology tools pointed to a concentration of dengue deaths in specific intra-urban areas.


Assuntos
Vírus da Dengue/genética , Dengue/mortalidade , Surtos de Doenças , Populações Vulneráveis , Aedes/virologia , Animais , Brasil/epidemiologia , Dengue/virologia , Feminino , Humanos , Insetos Vetores/virologia , Masculino , Análise Espaço-Temporal , População Urbana
20.
Rev. Soc. Bras. Med. Trop ; 50(1): 104-109, Jan.-Feb. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1041395

RESUMO

Abstract: INTRODUCTION Currently, dengue fever, chikungunya fever, and zika virus represent serious public health issues in Brazil, despite efforts to control the vector, the Aedes aegypti mosquito. METHODS: This was a descriptive and ecological study of dengue deaths occurring from 2002 to 2013 in São Luis, Maranhão, Brazil. Geoprocessing software was used to draw maps, linking the geo-referenced deaths with urban/social data at census tract level. RESULTS: There were 74 deaths, concentrated in areas of social vulnerability. CONCLUSIONS: The use of geo-technology tools pointed to a concentration of dengue deaths in specific intra-urban areas.

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