Models Used by Nurse Case Managers in Different Autonomous Communities in Spain: A Scoping Review.

(1) Background: The role of the nurse case manager is unknown to the population. The main objective is to analyze the existing differences within the national territory in order to make known the situation in Spain with a view to the recognition of its functions and the creation of the professional profile in an equal manner. (2) Methods: A scoping review was conducted in order to achieve the main aim. Selected articles were subjected to a critical reading, and the levels of evidence and grades of recommendation of the Joanna Briggs Institute were verified. The search field was limited to the last ten years. (3) Results: Case management models are heterogeneous in different autonomous communities in Spain. Case nurse management is qualified for high-complexity patients, follow up on chronic patients, and coordinate health assistance. (4) Conclusions: It concludes that nursing's role is crucial in the field of case management, being required in the follow-up of chronic patients of high complexity. Despite the proven health benefits, efficacy, and efficiency of case management, there are many heterogeneous models that coexist in Spain. This involves a restriction in the development of a nursing career because of the lack of a definition of its functions and competences.

Evaluating the decentralisation of the Spanish healthcare system: a data envelopment analysis approach.

OBJECTIVES: The aim of the study was to answer whether the central government has been more efficient than the regional governments or vice versa. Likewise, through the analysis of the data, the aim was to shed light on whether decentralisation has had a positive impact on the efficiency of the hospital sector or not. DESIGN: In this paper, we have used data envelopment analysis to analyse the evolution of efficiency in the last 10 Autonomous Regions to receive healthcare competences at the end of 2001. PARTICIPANTS: For this study, we have taken into account the number of beds and full-time workers as inputs and the calculation of basic care units as outputs to measure the efficiency of the Spanish public sector, private sector and jointly in the years 2002, 2007, 2012 and 2017 for the last Autonomous Regions receiving healthcare competences. RESULTS: Of the Autonomous Regions that received the transfers at the end of 2001, the following stand out for their higher efficiency growth: the Balearic Islands (81.44% improvement), the Madrid Autonomous Region, which practically reached absolute efficiency levels (having increased by 63.77%), and La Rioja which, together with the Balearic Islands which started from very low values, improved notably (46.13%). CONCLUSION: In general, it can be observed that the transfer of responsibilities in the health sector has improved efficiency in the National Health Service. JEL CLASSIFICATION: C14; I18; H21.

Inter-regional patient mobility in decentralised Spain: Explaining regional budget imbalances.

Inter-regional patient mobility represents both a resource and a challenge for the organization and financing of health systems, particularly in decentralised countries. We use cross-sectional time series regression analysis to test the determinants of imbalances in regional funds to finance inter-regional patient mobility for the 17 Spanish regions for the period 2014-2020. The findings indicate that highly specialised health centres and bilateral agreements partly explain the budget imbalance from inter-regional patient referrals, while local tourism partly explains the budget imbalance from non-referred patient mobility. Developing effective national schemes to compensate net patient recipient regions would be fundamental to addressing territorial imbalances.

Integração ensino-serviço-comunidade: perspectivas do Comitê Gestor Local do Contrato Organizativo de Ação Pública Ensino-Saúde / Integración enseñanza-servicio-comunidad: perspectivas del Comité Gestor Local del Contrato Organizativo de Acción Pública Enseñanza-Salud / Teaching-service-community integration: perspectives of the Local Management Committee of the TeachingHealth Public Action Organizational Contract

Com o objetivo de compreender o desenvolvimento da integração ensino-serviço-comunidade (Iesc) no município de Bragança Paulista, São Paulo, por meio do Contrato Organizativo de Ação Pública Ensino-Saúde (Coapes), realizou-se um estudo de caso. Uma amostra intencional com dez integrantes do Comitê Gestor Local que participaram de entrevistas semiestruturadas, em ambiente virtual, gravadas e transcritas na íntegra. Os relatos passaram por análise de conteúdo na modalidade temática e os resultados indicaram que a condução da Iesc e do Coapes foi bem-sucedida. A sustentabilidade e os êxitos da contratualização estão relacionados a estratégias, como aproximação, diálogo institucional, igualdade de valor e transparência, provenientes de discussões técnicas, compreensão do processo, escolha do formato, sensibilização e engajamento dos atores. A combinação desses elementos, aliada a novos projetos e atitudes, aponta caminhos para a consolidação da Iesc no território, que apresenta desafios a serem superados.

Con el objetivo de comprender el desarrollo de la integración enseñanza-servicio-comunidad (IESC) en el municipio de Braganza Paulista (Estado de São Paulo), a partir del Contrato Organizativo de Acción Pública Enseñanza-Salud (Coapes), se realizó un estudio de caso. Una muestra intencional con diez integrantes del Comité Gestor Local participó en entrevistas semiestructuradas, realizadas en ambiente virtual, grabadas y transcritas integralmente. Los relatos pasaron por un análisis de contenido en la modalidad temática. Los resultados indicaron que la conducción de la IESC y del Coapes fue exitosa. La sostenibilidad y los éxitos de la contractualización están relacionados con estrategias tales como la aproximación, el diálogo institucional, la igualdad de valor y transparencia, provenientes de discusiones técnicas, comprensión del proceso, elección del formato, sensibilización y compromiso de los actores. La combinación de esos elementos, aliada a nuevos proyectos y actitudes, señala caminos para la consolidación de la IESC en el territorio que presenta desafíos que hay que superar.

To comprehend the evolution of education-service-community integration (ESCI) in the municipality of Bragança Paulista, SP, through the Teaching-Health Public Action Organizational Contract (Coapes), a case study was conducted. An intentional sample of ten members from the Local Management Committee participated in semi-structured interviews, conducted virtually, recorded, and transcribed in full. The narratives underwent thematic content analysis. The results indicated that the implementation of IESC and Coapes was successful. The sustainability and achievements in contractualization are related to strategies such as approaching, institutional dialogue, equal value, and transparency, resulting from technical discussions, understanding of the process, format selection, sensitization, and actor engagement. The combination of these elements, along with new projects and attitudes, points towards the consolidation of IESC in the territory, which presents challenges to be overcome.

Retos del Sistema Nacional de Salud en los tiempos pos-COVID / Challenges of the National Health System in post-COVID times

El Sistema Nacional de Salud de Cuba se fundó en el año 1961 y es una entidad dependiente del Ministerio de Salud Pública de Cuba. Este constituye una prioridad nacional, tiene carácter universal, gratuito y se basa en el modelo del médico de familia, con un enfoque clínico, epidemiológico y social de los problemas sanitarios. Se sustenta en siete principios que expresan el derecho del pueblo a la salud, con responsabilidad del Estado, y las prácticas de salud se sostienen sobre una base científica sólida con acciones preventivas. En el año 2019, una epidemia azotó a la mayoría de los países del mundo (la COVID-19), entre ellos, Cuba. Ello conllevó a que los profesionales de la salud asumieran retos importantes ante una situación de salud sin precedentes. Este trabajo se refiere a los retos asumidos, principalmente, después de la COVID-19.

The Cuban National Health System was founded in 1961 and is an entity dependent on the Cuban Ministry of Public Health. This constitutes a national priority, is universal, free and is based on the family doctor model, with a clinical, epidemiological and social approach to health problems. It is supported in seven principles that express the right of the people to health, with responsibility of the State and the health practices are sustained on a solid scientific basis with preventive actions. In 2019, an epidemic hit most of the countries in the world (COVID-19), including Cuba. This led health professionals to assume important challenges in order to face an unprecedented health situation. This work refers to the challenges assumed, mainly, after COVID-19.

Habitual physical activity minimizes healthcare costs resulting from comorbidities among adults with cardiovascular diseases.

BACKGROUND: Habitual physical activity (HPA) can be used as a non-pharmacological strategy to prevent and control chronic diseases, as well as playing a role in minimizing healthcare costs. OBJECTIVE: To verify the impact of HPA on healthcare costs at different levels of care, over 24 months, in an adult population with cardiovascular diseases (CVD), including individuals with or without comorbidities. METHODS: Two-hundred and seventy-eight adults with CVD, aged between 30 and 65 years, participated in the study. Information on healthcare costs was obtained from medical records and included primary, secondary, and tertiary levels. Comorbidities such as diabetes, dyslipidemia, arterial hypertension, and obesity were registered. HPA was measured using the Baecke questionnaire. Comparisons between groups were performed using Student's t (

Evolución histórica del Sistema Nacional de Salud venezolano(1909-2023) / Historical evolution of the Venezuelan National Health System (1909-2023)

Se hace un análisis de la Evolución Histórica del Sistema Nacional de Salud en Venezuela desde 1909 hasta el año 2023. Se realizó un desglose de seis etapas: etapa "A" o Gomecista (1905 ­ 1935), etapa "B" o de la Segunda Guerra Mundial (1936- 1945), etapa "C" o de la División de Hospitales(1946-1949), etapa "D" o Perezjimenista (1950 ­ 1958), etapa "E" o de inicio de la Democracia (1959 ­ 1963), etapa "F" de Modelo Curativo y de Expansión Hospitalaria (1963 ­ 1998),etapa "G" de la Revolución Bolivariana (1999 ­ 2023). Se analizó también el Plan Nacional de Salud 2019 ­ 2025(AU)

An analysis of the Historical Evolution of the National Health System in Venezuela is made from 1909 to the year 2023. A breakdown of six stages is made: stage "A" or Gomez (1905 - 1935), stage "B" or Second World War (1936-1945),stage "C" or the Hospital Division (1946-1949), stage "D" or Perezjimenista (1950-1958), stage "E" or the beginning of Democracy (1959-1963), stage "F" of the Curative Model and Hospital Expansion (1963-1998), stage "G" of the Bolivarian Revolution (1999 - 2023). The National Health Plan 2019 -2025 is also analyzed(AU)

A Closer Look Into Brazil's Healthcare System: What Can We Learn?

Brazil's healthcare system has made significant progress in recent years but still faces major challenges. In this editorial, we examine the greatest flaws and achievements of Brazil's healthcare system, focusing on population coverage, quality metrics, spending over the last ten years, and estimates of per capita spending over the next decade. We discuss the role of the government, private sector, and civil society in shaping Brazil's healthcare landscape and provide recommendations for improvement. Despite the challenges, Brazil has made impressive strides in healthcare, such as the implementation of the family health program, which has improved primary care access and reduced infant mortality rates. However, much work remains to be done, and Brazil must prioritize investment in healthcare infrastructure, workforce development, and the integration of digital technologies to ensure universal access to quality care for all.

Impact of pneumocystosis on the Spanish health care system, 1997-2020: Profile of HIV and non-HIV immunocompromised patients.

BACKGROUND: Pneumocystis jirovecii is an opportunistic fungus recognized for causing P. jirovecii pneumonia. The global prevalence is thought to be higher than 400,000 annual cases, although detailed information about epidemiological patterns is scarce. METHODOLOGY: A retrospective longitudinal descriptive study was performed among patients with diagnosis of pneumocystosis according to Classification of Diseases 9th edition, Clinical Modification (code 136.3 for the cases from 1997 to 2015; and 10th edition code B59.0 for cases from 2016 to 2020 in Spanish public hospitals from 1 January 1997-31 December 2020. RESULTS: A total of 25289 cases were diagnosed. The period incidence rate was 2.36 (95 % CI, 2.33-2.39) cases per 100,000 person-years. Infection was more frequent among men (72.2 %) than among women (27.8 %). Comorbidity was the main characteristic of this cohort. Up to 72.3 % of pneumocystis-infected patients (18293) had HIV coinfection. During the study period, there was a progressive decrease in the number of HIV coinfected cases as the group of patients without HIV infection increased, with the largest group in 2017. The lethality rate in the cohort was 16.7 %. The global cost was €229,234,805 and the average ( ± SD) cost per patient was €9065 ( ± 9315). CONCLUSIONS: The epidemiology of pneumocystosis in Spain has changed in the last two decades. We noted in our study the possibility of a reemergence among non-HIV immunocompromised patients as patients with hematological and nonhematological neoplasia and other risk groups. The lethality of pneumocystosis continues to be high, and the underlying diseases are the main variable associated with lethality.

[What determines public-private choice in Spanish healthcare?] / ¿Qué determina la elección público-privada en la sanidad española?

INTRODUCTION AND OBJECTIVES: The aim of the study was to analyze, which individual characteristics (sociodemographic, attitudinal and political factors) mediates in the choice in Spain in 2022, of a private versus public health care alternative for family doctor, doctor specialist, hospital admissions and emergencies. METHODS: Using the health barometers of the Centro de Investigaciones Sociológicas (CIS), we carried out four logistic regressions (then, average marginal effects [AMEs]) whose dependent variables are the preference for a private choice of family doctor versus a public one, the preference for a private choice of doctor specialist versus a public one; the preference for a private choice of hospital admission versus a public one and the preference for a private choice of emergency admission versus a public one. The dependent variables are binary (1=private; 0=public). The sample consisted of more than 4,500 individuals older than 18years old distributed representatively throughout Spain. RESULTS: The probability of choosing private rather than public is correlated with the age of the individual: those over 50years are less likely to opt for a private alternative (P<.01), as well as by ideology and satisfaction with the way that the national health system (NHS) works. Patients with a conservative ideology are more likely to choose private options (P<.01) and individuals with greater satisfaction with the NHS are less likely to choose private ones (P<.01). CONCLUSIONS: Satisfaction with the NHS and patient ideology are the most relevant factors for private versus public choice.

Estimación económica de una muestra de casos de enfermedad profesional confirmados por el Instituto Nacional de la Seguridad Social atendidos en el Parc de Salut Mar, 2014-2021 / Economic cost estimation of a sample of occupational disease cases accepted by the National Institute of Social Security and evaluated at Parc de Salut Mar, 2014-2021

La infranotificación de enfermedades profesionales (EEPP) es un problema social y económico, pues repercute en el bienestar del trabajador afectado, y en las estimaciones presupuestarias que se planifican anualmente para la gestión de los servicios sanitarios. Los costes asistenciales fueron evaluados en una muestra de 13 casos de EEPP con resolución positiva por el Instituto Nacional de la Seguridad Social atendidos en el Parc de Salut Mar (Barcelona) entre 2014 y 2021. El coste de la asistencia generada del total de casos fue de 474.859 €, con un coste medio de 36.528 € por paciente. Por grupo diagnóstico, el coste más alto lo originaron los casos de cánceres que supusieron el 79% del gasto total (375.068 €). Los hallazgos del estudio reflejan el impacto económico que supone la asistencia sanitaria prestada por un hospital público a pacientes con una EEPP reconocida en el INSS (AU)

Underreporting of occupational diseases (OD) is a social and economic problem, because it has negative consequences for both the welfare of the affected workers and its impact on budgetary planning for the management of health services. We evaluated the healthcare costs of a sample of 13 cases of OD treated at a public hospital in Barcelona between 2014 and 2021, and officially accepted by the National Institute of Social Security (INSS). The total cost of care was €474,859, with an average cost of €36,528 per patient. By diagnostic group, the highest costs were associated with cancer cases, accounting for 79% of the total (€375,068). The findings of this study reflect the economic impact of health care provided by a public hospital to patients with an OD recognized by the INSS (AU)

Out-of-pocket costs sustained in the last 12 months by cancer patients: an Italian survey-based study on individual expenses between 2017 and 2018.

PURPOSE: Out of Pocket costs (OOP) sustained by cancer patients also in public NHS contribute to disease-related financial toxicity. Aim of the study was to investigate the amount and the types of OOP sustained by Italian cancer patients for care services. METHODS: A sample survey was conducted by FAVO in December 2017-June 2018, in 39 adhering hospitals and 1289 patients diagnosed from 1985 to 2018, by standardized questionnaire inquiring on: yearly expenditure by cancer service, age, year of diagnosis, disease phase, cancer site, sex, marital status, education, residence. Univariate and multivariable regression analyses were performed between OOP and each variable. Multilevel mixed-effects negative binomial regression was used to assess the combined effects of patients characteristics on the differences in acquiring health services. RESULTS: The yearly average OOP was 1841.81€, with the highest values for transports (359.34€) and for diagnostic examinations (259.82€). Significantly higher OOP were found in North and Centre than South and Islands (167.51 vs. 138.39). In the fully adjusted multivariable analysis, the variables significantly associated with higher than reference expenditure were: medium/high education (OR 1.22 [1.05-1.42], upper gastrointestinal tract cancer (OR 1.37 [1.06-1.77]), disease phase of treatments for cancer progression or pain therapy (OR 1.59 [1.30-1.93]). CONCLUSION: Italian cancer patients in 2018 sustained OOP quite similar to those measured in 2012 to supplement NHS services. The main component of the OOP costs were diagnostic examination and transportation. The NHS should pay attention to potentiate its ability to answer unmet needs of patients with advanced cancer who are the most fragile ones. IMPLICATIONS FOR CANCER SURVIVORS: Reinforcing the services where the main OOP expenses are located can help in promoting public health actions and reduce socio-economic needs that could compromise the receipt of optimal care along the whole disease course, from diagnosis to rehabilitation.

Reimagining India's national health system (NHS).

In the light of the poor performance of the National Health System as a whole, the article argues the case for the urgent re-imagination and recalibration of the roles of legally approved, health knowledge systems. The article suggests that the analysis of ten years' retrospective clinical data (around 100 million records) from the most reputed Allopathic and Ayurveda clinical establishments may serve as a reliable source of information on the actual performance of different knowledge systems. This strategy for evidence generation, argues the author, is perhaps more realistic than analysis of fragmented clinical and preclinical data from trials and experiments. The article also reviews the quality of evidence and societal performance of western medicine during the last 70 years. The plural health seeking behaviour of millions of citizens, suggest that in the 21st century, a creative, functional, reliable form of integrative healthcare is imperative.

A perspectiva de egressos e de outros atores envolvidos sobre uma formação em serviços farmacêuticos na Atenção Primária à Saúde / The perspective of graduates and other stakeholders on a training on pharmaceutical services in primary health care

Objetivou-se analisar as contribuições do curso Serviços Farmacêuticos na Atenção Primária em Saúde, oferecido no município do Rio de Janeiro, especialmente quanto às suas fortalezas e fragilidades para as práticas profissionais e na gestão do trabalho, considerando a perspectiva dos egressos e de outros atores de interesse. Os dados foram obtidos no período de 11 de dezembro de 2020 a 29 de janeiro de 2021, com reunião de grupo focal e por questionário eletrônico contendo perguntas estruturadas e semiestruturadas, autorrespondido por 109 (33,2%) egressos. Foram identificadas fortalezas, como a "ampliação do conhecimento" e "melhoria da atuação e/ou conduta profissional", bem como fragilidades, como a carga horária. Ainda que com baixa carga horária e sob o desafio da compatibilização da atividade de educação continuada com a carga laboral, pode-se concluir que o curso conseguiu promover o desenvolvimento de competências em seus aspectos de ser, saber e fazer.(AU)

El objetivo fue analizar las contribuciones del curso Servicios Farmacéuticos en la Atención Primaria de la Salud, ofrecido en el municipio de Río de Janeiro, especialmente con relación a sus puntos fuertes y débiles para las prácticas profesionales y en la gestión del trabajo, considerando la perspectiva de los egresados y otros actores de interés. Los datos se obtuvieron en el período del 11/12/2020 al 29/01/2021, con reunión de grupo focal y por cuestionario electrónico, que contenía preguntas estructuradas y semiestructuradas, auto-respondido por 109 (33,2%) egresados. Se identificaron puntos fuertes como la 'ampliación del conocimiento' y la 'mejora de la actuación y/o conducta profesional' así como fragilidades, como la carga horaria. Aunque con baja carga horaria y enfrentando el desafío de la compatibilización de la actividad de la educación continuada con la carga laboral, fue posible concluir que el curso consiguió promover el desarrollo de competencias en sus aspectos de ser, saber y hacer.(AU)

The objective was to analyze the contributions of the course on Primary Health Care Services offered in the municipality of Rio de Janeiro, especially regarding strengths and weaknesses for professional practices and work management, considering the perspective of graduates and other stakeholders. Data were obtained between 12/11/2020 and 01/29/2021 from focus group meetings and electronic questionnaires containing self-reported structured and semi-structured questions, answered by 109 (33,2%) graduates. Strengths were identified, such as 'expanded knowledge' and 'improved professional performance and/or conduct', as well as weaknesses, such as the workload. Although with a low hourly workload and under the challenge of making continuing education activity compatible with the workload, it can be concluded that the course managed to promote the development of competencies in its aspects of being, knowing and doing.(AU)

Avaliação de indicadores de monitoramento do rastreamento do câncer de mama na população do sexo feminino atendida no Sistema Único de Saúde, Brasil, 2018-2019: estudo descritivo / Evaluación de indicadores del tamizaje de cáncer de mama en la población femenina atendida en el Sistema Único de Salud, Brasil, 2018-2019: estudio descriptivo / Evaluation of breast cancer screening indicators in the female population using the National Health System, Brazil, 2018-2019: a descriptive study

Objetivo: analisar indicadores de monitoramento do rastreamento do câncer de mama na população feminina usuária do Sistema Único de Saúde, Brasil, no período 2018-2019. Métodos: estudo descritivo, a partir do Sistema de Informação do Câncer; foram calculados indicadores de rastreamento após relacionamento determinístico das bases de dados de mamografia e histopatologia. Resultados: em 2018, 807.430 mulheres na faixa etária de 50-69 anos foram rastreadas, e dessas, 91% apresentaram resultado benigno, 1,8% provavelmente benigno, 6,7% inconclusivo e 0,5% sugestivo de câncer; a taxa de mamografia positiva foi de 9,0%; estimou- -se indicação de biópsia para 1,6% das mulheres, resultado maligno para 33,9% delas, e taxa de confirmação de câncer de 5,4 por 1 mil mulheres. Conclusão: identificou-se elevada perda de seguimento das lesões benignas; a taxa de mamografias positivas foi inferior ao parâmetro internacional; contudo, a taxa de detecção de câncer foi adequada, e o percentual de mamografias inconclusivas, aceitável.

Objetivo: analizar indicadores del tamizaje de cáncer de mama en población femenina atendida por Sistema Único de Salud Brasileño, de 2018-2019. Métodos: estudio descriptivo basado en Sistema de Información del Cáncer (Siscan). Los indicadores de detección se calcularon después de vinculación determinista de bases de datos de mamografía e histopatología. Resultados: en 2018, 807.430 mujeres de 50-69 años examinaram cáncer de mama. De estos, 91% tuvo resultado benigno, 1,8% probablemente benigno, 6,7% resultado no concluyente y 0,5% sugestivo de cáncer. La tasa de mamografías positivas fue 9,0%. Se estimó indicación de biopsia en 1,6% de las mujeres, resultado maligno en 33,9% y tasa de confirmación de cáncer de 5,4 por 1.000 mujeres. Conclusión: se identificó alta pérdida de seguimiento de las lesiones benignas. La tasa de mamografías positivas fue inferior al parámetro internacional, pero la tasa de detección de cáncer fue adecuada y el porcentaje de mamografías no concluyentes aceptable.

Objetive: to analyze breast cancer screening monitoring indicators in the female population using the Brazilian National Health System, from 2018 to 2019. Methods: this was a descriptive study based on Cancer Information System (SISCAN) data; screening indicators were calculated following deterministic linkage of the mammography and histopathology databases. Results: in 2018, 807,430 women aged 50 to 69 years were screened for breast cancer, 91% of whom had a benign result, 1.8% probably benign, 6.7% inconclusive results and 0.5% results suggestive of cancer; the positive mammogram rate was 9.0%; biopsy was estimated to be indicated for 1.6% of the women, 33.9% of whom had a malignant result, and the cancer confirmation rate was 5.4 per 1,000 women. Conclusion: high benign lesion loss to follow-up was identified; the positive mammogram rate was lower than the international parameter, but the cancer detection rate was adequate and the percentage of inconclusive mammograms was acceptable.

Elementos para uma Política Nacional e Integrada de Pessoal para o Sistema Único de Saúde / Elements for a National na Integrated Policy of Workforce for the Brazilian National Health System

Resumo Este ensaio desenvolve argumentos e propostas a fim de fornecer elementos para a construção e implementação de uma nova política e gestão de pessoal para o Sistema Único de Saúde (SUS). Trata-se de um trabalho voltado tanto para auxiliar pesquisadores e especialistas em saúde coletiva, quanto para apoiar movimentos sociais criados para assegurar a sustentabilidade do SUS e condições adequadas de trabalho aos profissionais.

Abstract This essay develops arguments and proposals to provide elements to construct and implement a new workforce policy and management for the Brazilian National Health System (SUS). This is a work focused both in helping collective health researchers and specialists and in supporting social movements created to assure the sustainability of the SUS and the adequate working conditions to professionals.

Fortalecimento das ações de cuidado às pessoas com obesidade no contexto da pandemia de COVID-19: o caso do Brasil / Enhancing care measures for people with obesity in the context of the COVID-19 pandemic: the case of Brazil

Resumo O presente estudo ecológico descritivo objetivou analisar o papel indutor de um incentivo financeiro federal repassado aos municípios brasileiros em 2020, em meio à pandemia de COVID-19, no aumento do número de atendimentos individuais para a condição de obesidade na atenção primária à saúde (APS). Utilizaram-se dados secundários, obtidos no Sistema de Informação em Saúde para a Atenção Básica e no Sistema de Vigilância Alimentar e Nutricional (SISVAN). Em 2021, 74,8% dos 5.504 municípios que receberam o incentivo financeiro apresentaram aumento no número de atendimentos individuais para a condição avaliada como obesidade na APS, em relação a 2020. O número de pessoas identificadas com obesidade e o número de atendimentos individuais para esta condição foram maiores em 2021 do que nos demais anos analisados (2017 a 2020). Na comparação de 2021 com 2020 (ano de recebimento do incentivo financeiro), observou-se que o percentual de aumento de atendimentos individuais foi superior ao percentual de aumento de pessoas com obesidade registradas no SISVAN (77,6% vs. 39,1%). Em conclusão, incentivos financeiros federais, canalizados para o fortalecimento do cuidado às pessoas com obesidade no âmbito da APS, figuram como importantes mecanismos de indução de ações em nível local.

Abstract This descriptive ecological study sought to analyze the inductive role of a federal financial incentive passed on to Brazilian municipalities in 2020, during the COVID-19 pandemic, in increasing the number of individual consultations for the condition of obesity in primary health care (PHC). Secondary data obtained from the Health Information System for Primary Care and from the Food and Nutrition Surveillance System (SISVAN) were used. In 2021, 74.8% of the 5,504 municipalities that received the financial incentive, showed an increase in the number of individual obesity consultations in PHC, compared to 2020. The number of people identified with obesity and the number of individual visits for this condition were higher in 2021 than in the other years analyzed (2017 to 2020). Comparing 2021 with 2020 (year of receipt of the financial incentive), it was observed that the percentage of increase in the number of individual consultations for the condition of obesity was higher than the increase in the number of people identified with obesity in the SISVAN (77.6 % vs. 39.1%). In conclusion, federal financial incentives for municipalities, channeled to enhance care for people with obesity within the scope of PHC, are important mechanisms for inducing actions at the local level.

Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019 / Tendencia temporal y costos de las hospitalizaciones con el diagnóstico principal de diabetes mellitus en el Sistema Único de Salud de Brasil, de 2011 a 2019 / Tendência temporal e gastos das internações com diagnóstico principal por diabetes mellitus no Sistema Único de Saúde do Brasil, 2011 a 2019

ABSTRACT Objective To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019. Methods This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression. Results A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend. Conclusion The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend.

RESUMEN Objetivo Analizar la tendencia temporal y los costos de las internaciones por diabetes mellitus (DM) en Brasil, por región, Unidades Federativas (UF) y características poblacionales, de 2011 a 2019. Métodos Estudio ecológico con datos del Sistema de Información Hospitalaria, analizando la tendencia anual de las tasas de hospitalización (TH) por DM según sexo, edad, raza/color y región/UF mediante regresión de Prais-Winsten. Resultados Se registraron 1.239.574 hospitalizaciones por DM en el país y la TH fue de 6,77/10 mil habitantes en el período. La tendencia de TH por DM fue decreciente en ambos sexos y en la mayoría de las regiones y creciente en la población más joven y en la duración de la estancia. El gasto total fue de 420.692.238 dólares y fue creciente. Conclusión La tendencia temporal de TH por DM fue decreciente, con diferencias según región/UF y grupo de edad. La duración media de la estancia y los gastos mostraron una tendencia creciente.

RESUMO Objetivo Analisar a tendência temporal e gastos das internações por diabetes mellitus (DM) no Brasil, por região, Unidades da Federação (UFs) e características populacionais, de 2011 a 2019. Métodos Estudo ecológico com dados do Sistema de Informações Hospitalares, analisando a tendência anual das taxas de internação (TIs) por DM segundo sexo, idade, raça/cor e região/UF pela regressão linear generalizada de Prais-Winsten. Resultados Foram registradas 1.239.574 internações por DM no país e a TI foi de 6,77/10 mil habitantes, no período. A tendência das TIs por DM foi decrescente nos dois sexos e na maioria das regiões, e crescente na população mais jovem e no tempo de internação (média de 6,17 dias). O gasto total foi de US$ 420.692,23 e apresentou tendência crescente. Conclusão A tendência temporal da TI por DM foi decrescente, com diferenças segundo região/UF e grupo etário. O tempo médio de internação e os gastos apresentaram tendência de aumento.

A prática terapêutica do Tai Chi Chuan em um serviço de referência em práticas integrativas e complementares / The therapeutic practice of Tai Chi Chuan in a reference service for integrative and complementary practices

Resumo O Tai Chi Chuan (TCC) está entre as Práticas Integrativas e Complementares (PICS) mais utilizadas e apresenta, segundo a literatura científica, evidências clínicas para tratamento de diversos problemas de saúde. Entretanto, pouco se sabe sobre o desenvolvimento dessa modalidade no contexto do Sistema Único de Saúde (SUS). Neste sentido, o objetivo do artigo foi compreender a prática terapêutica do TCC em um serviço de referência em PICS no SUS, a partir de um estudo de caso qualitativo com observação participante e entrevistas semiestruturadas com usuários e terapeutas. Observou-se dessemelhanças entre a prática terapêutica do Tai Chi Chuan e as práticas corporais biomédicas, assim como a presença de diretrizes norteadoras de cuidado do SUS, como o acolhimento, a escuta qualificada, o vínculo terapêutico e a integralidade da atenção. Também foi identificada a prevalência de sofrimento mental como motivo de procura pela prática, necessidade de maior apoio financeiro ao serviço e resistência ao uso da Medicina Tradicional Chinesa por parte da rede de apoio de algumas usuárias.

Abstract Tai Chi Chuan (TCC) is among the most used Integrative and Complementary Health Practices (PICS) and, according to the scientific literature, presents clinical evidence for the treatment of various health problems. However, little is known about the development of this practice in the context of the Brazilian National Health System (SUS). In this sense, the objective of the article was to understand the therapeutic practice of TCC in a reference service in PICS in SUS, from a qualitative case study with participant observation and semi-structured interviews with users and therapists. Dissimilarities were observed between the therapeutic practice of TCC and biomedical body practices, as well as the presence of guidelines for SUS care, such as welcoming, qualified listening, therapeutic connection, and comprehensive care. The prevalence of mental distress was also identified as a reason for seeking the practice, as well as the need for greater financial support for the service, and the resistance to the use of Traditional Chinese Medicine by some female users' support network.