Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 8 de 8
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Neurosurg Focus ; 47(5): E6, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675716

RESUMO

OBJECTIVE: The purpose of this study was to determine if patients with traumatic brain injury (TBI) in low- and middle-income countries who receive surgery have better outcomes than patients with TBI who do not receive surgery, and whether this differs with severity of injury. METHODS: The authors generated a series of Kaplan-Meier plots and performed multiple Cox proportional hazard models to assess the relationship between TBI surgery and TBI severity. The TBI severity was categorized using admission Glasgow Coma Scale scores: mild (14, 15), moderate (9-13), or severe (3-8). The authors investigated outcomes from admission to hospital day 14. The outcome considered was the Glasgow Outcome Scale-Extended, categorized as poor outcome (1-4) and good outcome (5-8). The authors used TBI registry data collected from 2013 to 2017 at a regional referral hospital in Tanzania. RESULTS: Of the final 2502 patients, 609 (24%) received surgery and 1893 (76%) did not receive surgery. There were significantly fewer road traffic injuries and more violent causes of injury in those receiving surgery. Those receiving surgery were also more likely to receive care in the ICU, to have a poor outcome, to have a moderate or severe TBI, and to stay in the hospital longer. The hazard ratio for patients with TBI who underwent operation versus those who did not was 0.17 (95% CI 0.06-0.49; p < 0.001) in patients with moderate TBI; 0.2 (95% CI 0.06-0.64; p = 0.01) for those with mild TBI, and 0.47 (95% CI 0.24-0.89; p = 0.02) for those with severe TBI. CONCLUSIONS: Those who received surgery for their TBI had a lower hazard for poor outcome than those who did not. Surgical intervention was associated with the greatest improvement in outcomes for moderate head injuries, followed by mild and severe injuries. The findings suggest a reprioritization of patients with moderate TBI-a drastic change to the traditional practice within low- and middle-income countries in which the most severely injured patients are prioritized for care.

2.
PLoS One ; 14(9): e0222668, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31557165

RESUMO

Microcephaly and Zika Virus infection (ZIKV) were declared Public Health Emergencies of International Concern by the World Health Organization in 2016. Brazil was considered the epicenter of the outbreak. However, the occurrence of both ZIKV and microcephaly in Brazil was not evenly distributed across the country. To better understand this phenomenon, we investigate regional characteristics at the municipal level that can be associated with the incidence of microcephaly, our response variable, and its relationship with ZIKV and other predictors. All epidemiological data in this study was provided by the Ministry of Health official database (DATASUS). Microcephaly was only confirmed after birth and the diagnostic was made regardless of the mother's ZIKV status. Using exploratory spatial data analysis and spatial autoregressive Tobit models, our results show that microcephaly incidence is significantly, at 95% confidence level, related not only to ZIKV, but also to access to primary care, population size, gross national product, mobility and environmental attributes of the municipalities. There is also a significant spatial autocorrelation of the dependent variable. The results indicate that municipalities that show a high incidence of microcephaly tend to be clustered in space and that incidence of microcephaly varies considerably across regions when correlated only with ZIKV, i.e. that ZIKV alone cannot explain the differences in microcephaly across regions and their correlation is mediated by regional attributes.

3.
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.

4.
Int J Equity Health ; 18(1): 5, 2019 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-30621709

RESUMO

BACKGROUND: Brazilian Primary Care Facilities (PCF) provide primary care and must offer dental services for diagnosis, prevention, and treatment of diseases. According to a logic of promoting equity, PCF should be better structured in less developed places and with higher need for oral health services. OBJECTIVE: To analyze the structure of dental caries services in the capitals of the Brazilian Federative Units and identify whether socioeconomic factors and caries (need) are predictors of the oral health services structure. METHODS: This is an ecological study with variables retrieved from different secondary databases, clustered for the level of the federative capitals. Descriptive thematic maps were prepared, and structural equations were analyzed to identify oral health service structure's predictors (Alpha = 5%). Four models with different outcomes related to dental caries treatment were tested: 1) % of PCF with a fully equipped office; 2) % of PCF with sufficient instruments, and 3) % of PCF with sufficient supplies; 4) % of PCF with total structure. RESULTS: 21.6% of the PCF of the Brazilian capitals had a fully equipped office; 46.9% had sufficient instruments, and 30.0% had sufficient supplies for caries prevention and treatment. The four models evidenced proper fit indexes. A correlation between socioeconomic factors and the structure of oral health services was only noted in model 3. The worse the socioeconomic conditions, the lower the availability of dental supplies (standard factor loading: 0.92, P = 0.012). Estimates of total, direct and indirect effects showed that dental caries experience observed in the Brazilian population by SB-Brasil in 2010 did not affect the outcomes investigated. CONCLUSION: Material resources are not equitably distributed according to the socioeconomic conditions and oral health needs of the population of the Brazilian capitals, thus contributing to persistent oral health inequities in the country.


Assuntos
Assistência Odontológica/organização & administração , Assistência Odontológica/estatística & dados numéricos , Cárie Dentária/epidemiologia , Cárie Dentária/terapia , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Brasil/epidemiologia , Cidades/estatística & dados numéricos , Geografia , Humanos , Fatores Socioeconômicos
5.
Rev Panam Salud Publica ; 42: e185, 2018.
Artigo em Português | MEDLINE | ID: mdl-31093213

RESUMO

Despite the 40 years elapsed since the Alma-Ata principles were first launched, a series of challenges still persists for the consolidation of primary health care (PHC) as the backbone of health care systems around the world. Among these challenges, especially noteworthy are the issues associated with the inequality in the allocation of human resources. The experience of the More Doctors Program (Programa Mais Médicos, PMM) in Brazil is an example of initiatives that tackle this inconclusive Alma-Ata agenda. By changing key aspects of physician training, provision, and allocation, PMM was shown to be a feasible alternative to minimize the challenge of physician shortage. Assessments of PMM, even though preliminary, have produced positive evidence showing increase in access and improvement of PHC quality in Brazil, a middle income country. Nevertheless, the generation of more robust evidence regarding the impact of PMM on PHC performance indicators is urgent. The discussion proposed in the present article emphasizes the need to prioritize quasi-experimental studies to measure the impact of PMM on population health. The article thus introduces a set of guidelines that may become a useful model to approach challenges associated with the shortage of health care professionals in low and middle income countries.

6.
BMC Cancer ; 17(1): 706, 2017 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-29084516

RESUMO

BACKGROUND: Oral cancer is a potentially fatal disease, especially when diagnosed in advanced stages. In Brazil, the primary health care (PHC) system is responsible for promoting oral health in order to prevent oral diseases. However, there is insufficient evidence to assess whether actions of the PHC system have some effect on the morbidity and mortality from oral cancer. The purpose of this study was to analyze the effect of PHC structure and work processes on the incidence and mortality rates of oral cancer after adjusting for contextual variables. METHODS: An ecological, longitudinal and analytical study was carried out. Data were obtained from different secondary data sources, including three surveys that were nationally representative of Brazilian PHC and carried out over the course of 10 years (2002-2012). Data were aggregated at the state level at different times. Oral cancer incidence and mortality rates, standardized by age and gender, served as the dependent variables. Covariables (sociodemographic, structure of basic health units, and work process in oral health) were entered in the regression models using a hierarchical approach based on a theoretical model. Analysis of mixed effects with random intercept model was also conducted (alpha = 5%). RESULTS: The oral cancer incidence rate was positively association with the proportion of of adults over 60 years (ß = 0.59; p = 0.010) and adult smokers (ß = 0.29; p = 0.010). The oral cancer related mortality rate was positively associated with the proportion of of adults over 60 years (ß = 0.24; p < 0.001) and the performance of preventative and diagnostic actions for oral cancer (ß = 0.02; p = 0.002). Mortality was inversely associated with the coverage of primary care teams (ß = -0.01; p < 0.006) and PHC financing (ß = -0.52-9; p = 0.014). CONCLUSIONS: In Brazil, the PHC structure and work processes have been shown to help reduce the mortality rate of oral cancer, but not the incidence rate of the disease. We recommend expanding investments in PHC in order to prevent oral cancer related deaths.


Assuntos
Promoção da Saúde/métodos , Neoplasias Bucais/epidemiologia , Saúde Bucal/normas , Atenção Primária à Saúde/normas , Adulto , Idoso , Brasil/epidemiologia , Feminino , Geografia , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/mortalidade , Análise Multivariada , Saúde Bucal/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Fatores de Risco , Fumantes/estatística & dados numéricos , Taxa de Sobrevida
7.
Int J Equity Health ; 16(1): 149, 2017 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-28830521

RESUMO

BACKGROUND: Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. METHODS: The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. RESULTS: The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. CONCLUSIONS: There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access to emergency and surgical care. However more investments in are necessary to improve small hospitals capabilities to fill this gap.


Assuntos
Serviços Médicos de Emergência , Disparidades em Assistência à Saúde , Hospitais/estatística & dados numéricos , Brasil , Análise por Conglomerados , Estudos Transversais , Humanos , Análise Espacial
8.
s.l; s.n; s.f. 16 p. tab.
Monografia em Português | Repositório RHS | ID: biblio-981962

RESUMO

A gestão de recursos humanos, envolta em um debate que, de um lado privilegia sua posição estratégica nas organizações e, de outro, se atém à multifacetada composição de suas variáveis ditas operacionais, normalmente expressas nos clássicos subsistemas organizacionais, encontra no campo da saúde um espaço privilegiado de discussão e aplicabilidade. No caso brasileiro, a complexidade do Sistema Único de Saúde, que tem na Atenção Primária à Saúde sua estratégia central e na Saúde da Família sua expressão mais visível de atuação, aumenta sua relevância, considerando o perfil do atendimento priorizado e a necessidade de se alinhar ações públicas àquelas voltadas à prática cotidiana de gerenciamento de pessoas. Nesta perspectiva, o presente ensaio, de natureza teórica, procura ampliar o olhar da gestão de recursos humanos na saúde, expandindo o debate para além de estereótipos usuais neste campo associados a dimensões como capacitação e quantidade de profissionais. Para tanto, foi feita uma reflexão que procura aproximar gestão de recursos humanos e saúde, o que permitiu a sistematização de múltiplos indicadores que servem como elementos de análise e atuação que podem ampliar o entendimento deste campo do conhecimento em suas especificidades dadas pelo contexto da saúde. (AU)


Assuntos
Humanos , Administração de Recursos Humanos , Mão de Obra em Saúde/tendências , Atenção Primária à Saúde , Sistema Único de Saúde , Brasil , Saúde da Família , Capacitação de Recursos Humanos em Saúde
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA