Recuento histórico de la cobertura salubrista en las áreas rurales cienfuegueras / Historical count of health coverage in rural areas of Cienfuegos

RESUMEN Se hace un breve resumen sobre la evolución de la cobertura salubrista en la zona montañosa de la provincia de Cienfuegos. Se tiene en cuenta la denuncia realizada por el Comandante en Jefe en el juicio por los hechos del cuartel Moncada y su alegato ¨La Historia me Absolverᨠdonde se aborda la situación precaria de la salud en nuestros campos y las soluciones dadas a partir del establecimiento del Programa del Servicio Médico Rural, la integración Docente Asistencial a través de los Asistenciales, del Contingente Piti Fajardo (6to año) y la creación por el propio Fidel del Programa de la Medicina Familiar y la especialidad de Medicina General Integral, con lo cual se logra la cobertura en salud. Se señala como colofón la graduación de los primeros especialistas en Medicina General Integral y Estomatología General Integral formados íntegramente en los Consultorios del macizo montañoso de nuestro Plan Turquino cienfueguero.

ABSTRACT A brief summary is made on the evolution of health coverage in the mountainous area of the province of Cienfuegos. It takes into account the complaint made by the Commander-in-Chief in the trial for the events of the Moncada barracks and his plea "History will absolve me" where the precarious situation of health in our fields is addressed and the solutions given from the establishment of the Rural Medical Service Program, the integration of Healthcare Teaching through Healthcare, the Piti Fajardo Contingent (6th year) and the creation by Fidel himself of the Family Medicine Program and the specialty of Comprehensive General Medicine, with which achieves health coverage. The graduation of the first specialists in Comprehensive General Medicine and Comprehensive General Stomatology trained entirely in the Clinics of the mountainous massif of our Cienfuegos Turquino Plan is noted as a colophon.

Análisis de las cesáreas en Uruguay por tipo de centro hospitalario / An analysis of caesarean sections in Uruguay by type of hospital

Objetivo: Analizar comparativamente la incidencia de las cesáreas en los subsistemas de salud de Uruguay y en relación con los estándares de la Organización Mundial de la Salud (OMS) considerando las características médico-obstétricas de los partos, en especial la clasificación de Robson. Método: Se emplean 190.847 nacimientos registrados en el Sistema Informático Perinatal de Uruguay entre 2009 y 2014 por tipo de subsector sanitario. Mediante modeloslogitse analiza la probabilidad de cesárea considerando la clasificación de Robson, otros factores de riesgo y las características de las madres. Se comparan las tasas de cesárea predichas por los distintos subsectores sanitarios para una población común. Asimismo, se contraponen las tasas de cesáreas observadas en cada subsistema con las que, hipotéticamente, se encontrarían si los hospitales siguiesen las pautas de la muestra de hospitales de referencia de la OMS. Resultados: El subsector privado, en términos generales, presenta una incidencia de cesáreas mucho más elevada que el público, incluso después de considerar las características médico-obstétricas de los nacimientos. Las tasas de cesáreas en Uruguay están más de un 75% por encima del valor que cabría esperar de acuerdo con el modelo de la OMS. Conclusiones: La incidencia de cesáreas en Uruguay es muy alta respecto a los estándares definidos por la OMS, en especial en el subsector privado. Este hecho no se explica por las características clínicas de los nacimientos

Objective: To analyse on a comparative basis the incidence of caesarean sections among the different health care systems in Uruguay and with respect to the World Health Organization's (WHO) standards, taking into account the medical-obstetric characteristics of the births, particularly, the Robson classification. Methods: We examine 190,847 births registered by the Perinatal Information System in Uruguay between 2009 and 2014 by type of health care system. Usinglogitmodels, we analyse the probability of caesarean section taking into account the Robson classification, other risk factors and the mothers’ characteristics. We compared the caesarean rates predicted by the different subsystems for a common population. Furthermore, we contrast the caesarean rates observed in each subsystem with the rates that resulted if the Uruguayan hospitals followed the guidelines of the sample of WHO reference hospitals. Results: Private health systems in Uruguay exhibit a much higher incidence of caesarean sections than public ones, even after considering the medical-obstetric characteristics of the births. Caesarean rates are more than 75% higher than those observed if the WHO standards are applied. Conclusions: Uruguay has a very high incidence of caesarean sections with respect to WHO standards, particularly, in the private sector. This fact is unrelated to the clinical characteristics of the births

The impact of Dependency Act benefits on employment / La creación de empleo derivada de las prestaciones de la Ley de Dependencia

Objective: To assess the amount of employment generated from the effective development of the Dependency Act in 2012, by evaluating the number of jobs depending on whether in-kind services or cash benefits were applied. Methods: The level and total costs of dependency were obtained by using the Survey on Disability, Personal Autonomy and Dependency Situations of 2008. The consumption of dependent households was collected from the Household Budget Survey of 2012 carried out by the Spanish Statistics Institute. The impact on employment was estimated using an extended Input-Output model based on Symmetric Input-Output Tables and labour data from the Spanish National Accounts Base. Results: The total estimated costs of dependency in 2012 were 4,545 million Euros for in-kind services and 2,662 for cash benefits. One hundred and ninety-five thousand, six hundred and sixty-eight jobs were generated in 2012 from dependency costs, and132,997 were linked to in-kind services and 62,671 to cash benefits. Every million Euros allocated for dependency by the Government returned 53.33 jobs linked to in-kind services and 46.21 to cash benefits. Furthermore, 341,505 jobs would have been created if dependency benefits had been exclusively offered via in-kind services. Conclusions: Dependency benefits were equally distributed between in-kind services and cash benefits in 2012. Given that two out of three job positions generated from dependency benefits are linked to in-kind services, while the remaining third is generated by cash benefits, we conclude that around 146 thousand more jobs would have been generated if benefits had been offered as in-kind services instead of overusing cash benefits

Objetivo: Estimar la creación de empleo generada por la implantación de la Ley de Dependencia en 2012, evaluando el número de puestos de trabajo vinculados a servicios y a prestaciones económicas. Métodos: Los grados y los costes totales de la dependencia se han obtenido de la Encuesta sobre Discapacidades, Autonomía Personal y Situaciones de Dependencia de 2008. El consumo de los hogares dependientes proviene de la Encuesta de Presupuestos Familiares realizada por el Instituto Nacional de Estadística en 2012. La creación de empleo se ha estimado con un modelo ampliado input-output basado en las tablas simétricas input-output y en datos de empleo de la Contabilidad Nacional de España. Resultados: Los costes totales de dependencia estimados en 2012 fueron de 4545 millones de euros en servicios y 2662 millones de euros en prestaciones económicas. Se generaron 195.668 empleos vinculados a prestaciones de dependencia en 2012, 132.997 asociados a servicios y 62.671 a prestaciones económicas. Cada millón de euros asignados a prestaciones de dependencia por la Administración generó 53,33 empleos vinculados a servicios y 46,21 a prestaciones económicas. Además, se habrían creado 341.505 empleos si las prestaciones de dependencia hubieran sido asignadas únicamente como servicios. Conclusiones: Los costes de dependencia se distribuyeron por igual entre servicios y prestaciones económicas en 2012. Dado que dos de cada tres empleos generados por las prestaciones de dependencia están vinculados a servicios, mientras que el tercio restante a prestaciones económicas, se habrían generado 146.000 empleos más si todas las prestaciones hubieran sido asignadas como servicios en lugar de la masiva utilización de prestaciones económicas

Hacia el fortalecimiento de la atención primaria para alcanzar la cobertura sanitaria universal / Towards the strengthening of primary care to achieve universal health coverage

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eHealth: los pacientes ante la nueva realidad tecnológica en el ámbito sanitario / eHealth: patients in the face of the new technological reality in the health field

En la actualidad la tecnología, su comprensión y aplicabilidad en muchos escenarios de la vida diaria de las personas, así como la producción de transformaciones radicales en cuanto a la irrupción y asentamiento de nuevos modelos socio sanitarios, resulta un tema de profunda complejidad. Por ello, para entender dichas transformaciones y como son percibidas por la ciudadanía, resulta necesario incorporar sus voces, discursos y narrativas sobre eHealth

Nowadays, technology, its understanding and applicability in many daily arenas, as well as the production of radical transformations in terms of the emergence and establishment of new social and health models, is a matter of deep complexity. Therefore, to understand these transformations and how they are perceived by citizens, it is necessary to incorporate their voices, discourse and narratives about eHealth

The impact on training of the dynamic model for assessment and family intervention

Introduction: The Dynamic Model for Assessment and Family Intervention (MDAIF), as an operative theoretical referential underlying the assessment and family inter-vention practices, was adopted for the family nursing specialty, in Portugal. Objective: To assess the impact of the professional practice of MDAIF on the as-sessment and family intervention practices of Primary Healthcare Nurses. Methods: A study descriptive case. Forty-nine nurses were invited to participate in the pre-training moment and forty-three in the post-training. Participants were as-ked to sign a written informed consent and were delivered an open-question form applied in the two moments. The data retrieved were submitted to content analysis with a posteriori categorization. Results and discussion: In the pre-training moment, the most common family as-sessment practices were: "Areas of attention MDAIF", "Evaluative data of the MDAIF"; "Attention Individual areas"; and for the most common family intervention practices", "action"; "client"; "health programmes"; "prevention levels".After the training: "MDAIF dimensions"; and "individual areas of attention", with occasional incidence. In the family intervention, the categories identified were: "MDAIF areas of attention" and "action". It is well known that knowledge transfer into practice in family health nursing is a challenge and that only a relatively small percentage of the training is effectively applied, however, in this study it is possible to observe that training had a positive impact in practice changes. The actions focused on care provided to each member of the family changed to care targeted at the family as a client. Conclusion: Training has enabled knowledge transfer to professional performance

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Acceso a la salud (cobertura e internación) y autopercepción del estado de salud de la población en la Ciudad de Buenos Aires: EAH 2016

La Encuesta Anual de Hogares (EAH) se propone brindar información sobre la situación socioeconómica de la población de la Ciudad de Buenos Aires, sus hogares y viviendas. El operativo de campo se realiza, desde el año 2002, entre octubre y diciembre de cada año. Los aspectos de salud indagados por la EAH 2016 refieren a cobertura de salud, a la autopercepción del estado de salud y a la internación de la población. En este informe se analiza, por un lado, la cobertura de salud de la población residente en la Ciudad según edad, condición de actividad, nivel de ingreso y comuna de residencia. Por otro lado, se presenta información sobre la autopercepción del estado general de salud de la población encuestada. Por último, se muestra algunos datos de la población internada en los últimos meses según sexo y edad. (AU)

Cobertura de atención de enfermería y su impacto en la mortalidad por enfermedades crónicas no transmisibles en México, 2013 / Nursing care coverage and its impact on mortality from chronic non communicable diseases in Mexico, 2013

Introducción: el análisis de los índices, cobertura de enfermería y mortalidad por enfermedades crónicas no transmisibles aporta a los tomadores de decisiones información basada en evidencia. Objetivo: identificar el impacto que tiene la cobertura de atención de enfermería en la mortalidad por enfermedades crónicas no trasmisibles en México. Metodología: Estudio transversal analítico que utilizó información oficial de 2013 del Sistema Nacional de Salud sobre recursos humanos y daños a la salud. Resultados: se encontró que existe significancia estadística entre el índice de cobertura y la mortalidad, interpretándose que por cada punto porcentual que se incrementa la cobertura de enfermería disminuye la mortalidad en -.472. Conclusiones: el ejercicio de regresión lineal simple a nivel nacional demostró que existe significancia estadística entre cobertura y mortalidad ya que cuando se incrementa el primero, disminuye el segundo

Introduction: the analysis of the rates, nursing coverage and mortality from chronic non communicable diseases gives decision makers evidence-based information. Objective: to identify the impact of nursing care coverage in mortality from chronic non-communicable diseases in Mexico. Methodology: cross-sectional study using official data from the National Health System of human resources and damage to health of 2013. Results: it was found that there is statistical significance between the coverage ratio and mortality, interpreted that for every percentage point that nursing coverage increases mortality reduces in -.472. Conclusions: the simple linear regression exercise nationwide showed that there is statistical significance between coverage and mortality because when the first increases, the second diminishes

Tendencias recientes y características de la fecundidad adolescente en la Ciudad de Buenos Aires / Recent trends and characteristics of adolescent fertility in the City of Buenos Aires

El presente informe tiene como objetivo analizar las tendencias de fecundidad adolescente en la Ciudad de Buenos Aires en las últimas décadas y su comparación con lo acontecido en el total del país y el resto de las jurisdicciones. También se aborda, sobre la base de los datos del último año disponible, algunos de los principales aspectos relacionados −tales como el peso al nacer, el tiempo de gestación, el lugar de ocurrencia del parto, el nivel educativo, la cobertura médica y la situación de convivencia de la madre− que ayudan a una mejor caracterización actual del fenómeno. Para ello, se contemplan las diferencias que se expresan en su territorio, focalizando el análisis a nivel de las divisiones político-administrativas que lo componen, como son las Comunas. (AU)

Diferencias en el uso de servicios sanitarios en la población española adulta / Differencias in the use of health esrvices in the spanish adult population

Objetivo. Conocer las diferencias de utilización de servicios sanitarios según la modalidad de seguro sanitario, en la población española adulta. Métodos. Se realizó un estudio descriptivo transversal, empleando los datos de la Encuesta Nacional de Salud de España de 2011-2012, con entrevista a 21 007 personas. Entre los individuos que tenían alguna cobertura sanitaria, se han diferenciado los que tenían servicios sanitarios públicos, privados, o mixtos. Se realizó un estudio univariante y bivariante para conocer las diferencias de utilización de servicios según el tipo de cobertura. Resultados. El 83.5 % de la población manifiesta disponer exclusivamente de cobertura pública, el 2.5 % cuenta con seguro únicamente privado y el 14 % está afiliado a ambas modalidades. Los individuos con cobertura exclusivamente pública acuden más al facultativo general (81.9 %), mientras que las personas con seguro únicamente privado han sido quienes consultan en mayor proporción al especialista (65.6 %). Los sujetos con cobertura exclusivamente pública describen los mayores tiempos de espera, tanto para el ingreso programado como para recibir atención médica. En general, las personas con doble cobertura tuvieron una mayor participación en actividades preventivas. Conclusiones. La sanidad pública es la principal cobertura de la población española. Se evidencian perfiles diferentes de utilización de los recursos sanitarios distintos, según la cobertura asistencial correspondiente (AU)

Objective. To explore the use of health services in the Spanish population, according health insurance. Methods. A cross-sectional study using data from the Spanish National Health Survey 2011-2012 was conducted. 21 007 people were included. Among individuals with health coverage, three groups were differentiated: people with public, private and mixed insurance. Univariate and bivariate analyses were developed to know health services use differences by health insurance. Results. 83.5 % of the population reported only a public coverage, 2.5 % has only private insurance and 14 % was enrolled in both forms. Individuals with public coverage visited with higher frequency the general physician (81.9 %), while those with only private insurance visited a specialist in the highest proportion (65.6 %). Individuals with only public health coverage presented the longest waiting times, for both programmed hospitalization and medical attention. In general terms, people with double coverage showed the greatest participation in preventive activities. Conclusions. Public coverage is the most important coverage of the Spanish population. Different use of health resources were observed according to health insurance (AU)

Estrategias para mejorar la cobertura de la vacunación antigripal en Atención Primaria / Strategies to improve influenza vaccination coverage in Primary Health Care

Introducción. En adultos, las coberturas vacunales alcanzadas son insuficientes, por lo que son precisas nuevas estrategias. Objetivo: comparar estrategias para mejorar la cobertura de la vacuna antigripal en los mayores de 64 años. Pacientes y método. En nuestro centro de salud, en la campaña 2013-2014 hemos introducido nuevas estrategias: además de vacunar en el centro de salud se ha vacunado en los centros de mayores. Hemos comparado las coberturas de los 4 últimos años de 3 consultas de Medicina de Familia: C1, El médico de familia ha vacunado a los pacientes mayores de 64 años que acudían a consulta; C2, El médico de familia insistía en la vacunación sistemáticamente a los pacientes mayores, remitiéndolos a solicitar fecha, y C3: el médico de familia no insistía. Resultados. Estas consultas atienden 278 pacientes mayores de 64 años el C1, 320 el C2, y 294 el C3. Coberturas global/C1/C2/C3 en 2010: 51,2/51,4/55/46,9% (p = NS); en 2011: 52,4/52,9/53,8/50,3% (p = NS); en 2012: 51,9/52,5/55,3/47,6% (p = NS), y en 2013: 63,5/79,1/59,7/52,7% (p = 0,000 C1 respecto a C2 y C3; p = NS entre C2 y C3). Se compararon las coberturas 2012-2013 dentro de cada consulta: C1 (p = 0,000), C2 (p = 0,045), y C3 (p = 0,018). En la C2 y C3 la totalidad de las vacunaciones las ha realizado enfermería en el horario preestablecido. En la C1, el 55% fueron vacunados por enfermería, el 24,1% por el médico, el 9,7% han rechazado la vacuna y el resto no han pasado por la consulta en el periodo vacunal (octubre 2013-febrero 2014). Conclusiones. La estrategia de utilizar los centros de mayores ha mejorado un 5% la cobertura en cada consulta. La estrategia «aquí te pillo, aquí te vacuno» de la C1 ha mejorado en un 22% la cobertura vacunal (AU)

Introduction. Vaccination coverage reached in adults is insufficient, and there is a real need for new strategies. Objective. To compare strategies for improving influenza vaccination coverage in persons older than 64 years. Patients and methods. New strategies were introduced in our health care centre during 2013-2014 influenza vaccination campaign, which included vaccinating patients in homes for the aged as well as in the health care centre. A comparison was made on vaccination coverage over the last 4 years in 3 practices of our health care centre: P1, the general physician vaccinated patients older than 64 that came to the practice; P2, the general physician systematically insisted in vaccination in elderly patients, strongly advising to book appointments, and P3, the general physician did not insist. Results. These practices looked after P1: 278; P2: 320; P3: 294 patients older than 64 years. Overall/P1/P2/P3 coverages in 2010: 51.2/51.4/55/46.9% (P = NS), in 2011: 52.4/52.9/53.8/50.3% (P = NS), in 2012: 51.9/52.5/55.3/47.6% (P = NS), and in 2013: 63.5/79.1/59.7/52.7 (P = .000, P1 versus P2 and P3; P = NS between P2 and P3). Comparing the coverages in 2012-2013 within each practice P1 (P = .000); P2 (P = .045); P3 (P = .018). In P2 and P3 all vaccinations were given by the nurses as previously scheduled. In P3, 55% of the vaccinations were given by the nurses, 24.1% by the GP, 9.7% rejected vaccination, and the remainder did not come to the practice during the vaccination period (October 2013-February 2014). Conclusions. The strategy of vaccinating in the homes for the aged improved the vaccination coverage by 5% in each practice. The strategy of "I've got you here, I jab you here" in P1 improved the vaccination coverage by 22% (AU)

Cobertura sanitaria en población española adulta: diferencias sociodemográficas y del estado de salud / Healthcare coverage in the adult spanish population: sociodemographical and health status differences

OBJETIVO: conocer las diferencias sociodemográficas y del estado de salud según la modalidad de seguro sanitario en población española adulta. MÉTODO: se realizó un estudio descriptivo transversal, empleándolos datos de la Encuesta Nacional de Salud española 2011-2012.Entre los individuos que tenían alguna cobertura sanitaria, se han diferenciado los que tenían servicios sanitarios públicos, privados o doble cobertura. Se desarrolló un estudio bivariante para conocer las diferencias sociodemográficas y de salud según el tipo de cobertura. Se aplicó un modelo de análisis multivariable de regresión logística para determinar el perfil del usuario con cobertura pública. RESULTADOS: el estudio se desarrolló a partir de una muestra de21.007 individuos residentes en el territorio español mayores de 15años. Tras eliminar a los sujetos que no contaban con ningún tipo de cobertura sanitaria (62 personas) y los que no contestaron (132 personas), se incluyeron 20.813 individuos en el análisis. Un 83,5% de la población dispone exclusivamente de cobertura pública, caracterizada por ser joven, con nivel de estudios bajo, desempleada, con peor estado de salud percibido, y sin padecer enfermedades crónicas. Un 14% de población cuenta además con cobertura privada. CONCLUSIONES: la sanidad pública es la principal cobertura de la población española. Los individuos más mayores, con una renta familia relevada, en situación de empleo, con un nivel académico más elevado, un buen estado de salud percibido y con alguna enfermedad crónica, son el perfil del usuario que opta por un aseguramiento privado

OBJECTIVE: to understand the sociodemographic and health status differences according to the healthcare insurance model in the adult Spanish population. METHOD: a transversal descriptive study was conducted, using data from the 2011-2012 Spanish National Healthcare Survey. Those individuals with some type of healthcare coverage were divided into those who had public healthcare insurance, private healthcare insurance, or double coverage. A bivariate study was conducted in order to understand the sociodemographical and health differences according to type of coverage. A multivariable logistic regression analysis model was applied in order to determine the profile of the user with public coverage. RESULTS: the study was conducted in a sample of 21,007 persons over 15 years of age residing in the Spanish territory. After removing those subjects who had no type of healthcare coverage (62 persons)and those who did not answer (132 persons), the analysis included20,813 individuals. A 83.5% of the population has public coverage exclusively; this group is mostly young, with a low level of education, unemployed, with a worse perception of their health status, and without any chronic diseases. A 14% of this population has also private coverage. CONCLUSIONS: public health is the main coverage for the Spanish population. Older individuals, with a high family income, who are working and have a higher academic level, a good perception of their health status, and some chronic disease, represent the profile of the user who chooses private insurance

Sistema de autodeclaración de acontecimientos adversos y cobertura de vacunación antigripal en profesionales sanitarios en un hospital universitario de tercer nivel / Adverse events self-declaration system and influenza vaccination coverage of healthcare workers in a tertiary hospital

Introducción: Durante la campaña de vacunación antigripal 2011-2012 establecimos un sistema de autodeclaración de acontecimientos adversos (AA) en el personal sanitario (PS). El objetivo de este estudio es describir la población vacunada y analizar la cobertura de vacunación y los AA autodeclarados tras la vacunación voluntaria del PS frente a la gripe en un hospital universitario de tercer nivel en Barcelona. Métodos: Estudio observacional. Para el cálculo de la cobertura de vacunación se utilizó el registro de vacunación de profesionales sanitarios del hospital. Los AA se recogieron mediante una encuesta voluntaria, anónima y autoadministrada durante la campaña de vacunación antigripal 2011-2012, y se analizaron mediante regresión logística. Se construyó un modelo de regresión logística para determinar los factores que predisponen a declarar AA. Resultados: La campaña alcanzó una cobertura de vacunación antigripal del 30,5% (n = 1.507/4.944) del PS. De los vacunados, el 23,8% (n = 358) respondieron la encuesta de AA autodeclarados. El 52,0% (n = 186) de los que respondieron a la encuesta declaró haber presentado algún tipo de AA. De estos, el 75,3% (n = 140) refirió signos y síntomas locales tras la vacunación, el 9,7% (n = 18), signos y síntomas sistémicos, y el 15,1% (n = 28), síntomas tanto locales como sistémicos. No se declaró ningún AA grave. Ser mujer y tener menos de 35 años se asoció a declarar algún tipo de AA. Conclusiones: El sistema de autodeclaración no registró AA graves en el PS, suponiendo una oportunidad para aumentar la confianza del PS en la vacuna antigripal (AU)

Introduction: During the influenza vaccination campaign 2011-2012 we established a self-declaration system of adverse events (AEs) in healthcare workers (HCW). The aim of this study is to describe the vaccinated population and analyse vaccination coverage and self-declared AEs after the voluntary flu vaccination in a university hospital in Barcelona. Methods: Observational study. We used the HCW immunization record to calculate the vaccination coverage. We collected AEs using a voluntary, anonymous, self-administered survey during the 2011-2012 flu vaccination campaign. We performed a logistic regression model to determine the associated factors to declare AEs. Results: The influenza vaccination coverage in HCW was 30.5% (n = 1,507/4,944). We received completed surveys from 358 vaccinated HCW (23.8% of all vaccinated). We registered AEs in 186 respondents to the survey (52.0% of all respondents). Of these, 75.3% (n = 140) reported local symptoms after the flu vaccination, 9.7% (n = 18) reported systemic symptoms and 15.1% (n = 28) both local and systemic symptoms. No serious AEs were self-reported. Female sex and aged under 35 were both factors associated with declaring AEs. Conclusions: Our self-reporting system did not register serious AEs in HCW, resulting in an opportunity to improve HCW trust in flu vaccination (AU)

Informe sobre la introducción de la vacuna antineumocócica conjugada 13valente (VNC13) para la prevención de la enfermedad neumocócica y neumonía en la cohorte de 60 años en la Comunidad de Madrid / No disponible

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Estratégia saúde da família e sua relação com as internações por condições sensíveis à atenção primária em Pernambuco, no período de 2000-2014

O presente estudo teve por objetivo analisar a relação entre a cobertura da ESF e as internações por condições sensíveis em Pernambuco. Estudo descritivo e analítico, quantitativo, com dados dos municípios de Pernambuco, de 2000-2014, agregados segundo porte populacional e região de saúde, além de abordagens considerando sexo, faixa etária e causa de internação. A análise dos dados ocorreu pela construção de séries históricas dos indicadores, análise de tendência e análise de correlação. Percebeu-se redução das taxas de internações sensíveis maior que nas não sensíveis, bem como maior amplitude das variações no período de 2000-2008, coincidindo com o período de maior expansão da ESF. As maiores taxas de internações sensíveis ocorreram nos menores de 1 ano e nos idosos com 60 e mais anos, sendo estes últimos detentores da maior redução do período. Houve taxas mais elevadas no sexo feminino e redução mais relevante no masculino. As gastroenterites infecciosas foram as principais responsáveis pelas internações sensíveis à APS. Os gastos com Icsap, em geral, sofreram redução. Concluiu-se que: após período certa estabilidade na cobertura da ESF, houve nova aceleração do crescimento em 2013 e 2014, fato que pode estar relacionado ao Programa Mais Médicos; há forte relação inversamente proporcional entre a cobertura da ESF e as internações por condições sensíveis; a redução ocorrida nos menores de 1 ano foi relevante, porém inferior ao esperado, tendo em vista a ênfase dada pela atenção primária a essa população; pelo mesmo motivo, não seria esperada a presença das doenças imunopreveníveis e as relacionadas ao pré-natal e parto entre os grupos de causas que sofreram elevações.

This study aimed to analyze the relationship between Family Health Strategy (FHS) coverage and hospitalizations for sensitive conditions in Pernambuco. Descriptive and analytical study, quantitative with data of counties of Pernambuco, from 2000-2014, aggregated by population size and health region, besides approaches taking into consideration gender, age and cause of hospitalization. The data analysis occured by the construction of historical series of indicators, trend analysis and correlation analysis. It was noticed a reduction in the rates of sensitive hospitalizations greater than in non-sensitive causes, as well as a greater amplitude of variations in the period 2000-2008, coinciding with the period of greatest expansion of the FHS. The highest sensitive hospitalization rates occurred in children under 1 year and elderly with 60 years or more, the latter holding the greatest reduction of the period. There were higher rates in female sex and more relevant reduction in male sex. Infectious gastroenteritis were the main responsible for hospitalizations sensitive to Primary Health Care. ICSAP spending, in general, were reduced. It was concluded that: after a certain period of stability in FHS coverage, there was a new acceleration of growth in 2013 and 2014, which may be related to the More Doctors Program; there is a strong inversely proportional relationship between FHS coverage and hospitalizations for sensitive conditions; the reduction that occurred in children under 1 year was relevant, but lower than expected, bearing in mind the emphasis given to primary care to this population; for the same reason, it wouldn´t be expected the presence of vaccine-preventable diseases and the ones related to prenatal and childbirth among the groups of causes that have experienced highs.

Población potencialmente excluida de cobertura sanitaria con el Real Decreto 16/2012 y sus repercusiones sanitarias: la experiencia desde la Cataluña Central / Potentially excluded population from health coverage and health impact since Royal Decree 16/2012: The Central Catalonia experience

OBJETIVO: Conocer la proporción de población potencialmente excluida de cobertura sanitaria a partir del Real Decreto-Ley 16/2012. Describir el uso de servicios sanitarios, la distribución de patología crónica e infecciosa y el gasto farmacéutico en 2012 de las personas excluidas respecto a las que mantendrían su cobertura. Diseño y emplazamiento: Estudio observacional analítico transversal de base poblacional en atención primaria. Gerencia Territorial de la Cataluña Central del Institut Català de la Salut. Participantes y MEDICIONES PRINCIPALES: Se seleccionaron las personas potencialmente excluidas a partir de la aplicación del Real Decreto-Ley 16/2012 y se compararon con las personas que mantendrían su cobertura sanitaria apareadas de forma aleatoria por edad, sexo y servicio de atención primaria. La información obtenida incluyó el uso de servicios sanitarios, la distribución de patologías crónicas e infecciosas y el gasto farmacéutico durante el año 2012. RESULTADOS: Se identificaron 1.699 personas, el 0,53% del total de la población (51,4% hombres), con una mediana de edad de 34 años (rango intercuartílico, 28-43) potencialmente excluidas de cobertura sanitaria. El uso de servicios sanitarios, la morbilidad crónica registrada y el gasto farmacéutico durante el año 2012 de los excluidos fueron inferiores a los de los no excluidos (p < 0,001). En cambio, la morbilidad infecciosa fue superior en los excluidos (p < 0,001). CONCLUSIONES: Los resultados del estudio llevan a pensar que esta medida legislativa no parece justificada por razones médicas ni económicas. Además, podría provocar problemas de salud pública y contribuir al riesgo de fractura social

OBJECTIVE: To assess the proportion of population potentially excluded from healthcare coverage since the Royal Decree-Law 16/2012. To describe the use of health services, the distribution of chronic and infectious diseases, and the pharmaceutical costs in 2012 of the persons potentially excluded compared to the those who maintain their coverage. Design and SETTING: An observational analytical cross-sectional study was designed and conducted on a Primary Care based population in the Central Catalonia Management Area of the Institut Català de la Salut Participants and MAIN MEASUREMENTS: Individuals potentially excluded since the application of the Royal Decree-Law 16/2012 were selected and compared with individuals who maintained their healthcare coverage, randomly matched by sex, age and Primary Care service. The information obtained included the use of health services, the distribution of chronic and infectious diseases, and the pharmaceutical costs during the year 2012. RESULTS: A total of 1,699 individuals were identified as potentially excluded from healthcare coverage, 0.53% of the total of population (51.4% men), with a median of age of 34 years (interquartile range, 28-43). The use of healthcare services, the chronic morbidity recorded, and the pharmaceutical costs during the year 2012 of the excluded individuals was lower than those of the non-excluded ones (P < .001). On the other hand, the infectious morbidity was higher in the excluded individuals (P < .001). CONCLUSIONS: The results of the study suggests that this legislative measure does not seem to be justified for medical or economic reasons. It could also cause public health problems and contribute to the risk of social fracture

Parametrização de procedimentos e de cobertura nas áreas de endodontia, periodontia e exodontia para as populações adolescente, adulta e idosa de Minas Gerais / Parameterization of procedures and coverage in endodontics, periodontics and surgery in adolescents, adults and elderly people in Minas Gerais, Brazil

A melhoria nas condições econômicas e sociais alcançadas nestes últimos anos no Brasil e a implantação do Programa Brasil Sorridente trouxeram um avanço significativo das condições de saúde bucal em todas as faixas etárias da população brasileira. Entretanto os agravos em saúde bucal continuam com prevalência acima do preconizado pela Organização Mundial da Saúde. Para um constante avanço da saúde bucal é necessário o conhecimento da realidade epidemiológica localmente para subsidiar o planejamento e melhorar a vigilância em saúde. O emprego de indicadores e parâmetros é fundamental para alcançarmos as metas propostas, o aperfeiçoamento do processo de gestão e consequentemente a melhoria na prestação dos serviços em saúde bucal. O processo de pactuação de metas e os parâmetros propostos são frágeis e de pouca confiabilidade. Necessitando de serem revistos e redimensionados, tanto na atenção básica quanto na atenção especializada. Este estudo propõe o redimensionamento dos parâmetros de cobertura e produção nas áreas de endodontia, periodontia e exodontia nas faixas etárias de 15 a 19, 35 a 44 e 65 a 74 anos da população do Estado de Minas Gerais. Trata-se de um estudo exploratório, quantitativo e descritivo. Os parâmetros foram calculados tendo como base as necessidades da população encontradas no levantamento epidemiológico SB-Minas Gerais e os dados de produtividade encontrados no SIA/SUS, entre os anos de 2010 e 2013. Este estudo identificou que os parâmetros de cobertura e produtividade mais altos foram identificados para as exodontias, exceto entre os adolescentes para os quais os parâmetros de endodontia obtiveram valores mais altos. Menores valores dos parâmetros foram identificados entre idosos nas áreas de endodontia e exodontias. Portanto o presente estudo vem reafirmar a importância de se ter como referência, dados epidemiológicos de origem local, como forma de se conferir maior adequação a este processo de parametrização

The improvement in economic and social conditions achieved in recent years in Brazil and the Smiling Brazil Program deployment, there was a significant advance oral health conditions in all age groups of the population. However the aggravations in oral health continue with high prevalence and with targets above the recommended by the World Health Organization. For a constant advancement of oral health knowledge is required of the epidemiological reality locally to support the planning and improve health surveillance. The use of indicators and parameters is essential to achieve the proposed goals, to improve the management process and consequently the improvement in the provision of oral health services. The process of determining goals and parameters proposed are fragile and unreliable. Need to be reviewed and resized, both in the basic attention and specialized attention. This study proposes the resizing of the parameters and production in the fields of Endodontics, Periodontics and dental extraction in the age group of 15 to 19, 35 to 44 and 65 to 74 years the population of the State of Minas Gerais. It is a exploratory study, quantitative and descriptive. The parameters were calculated based on the needs of production and coverage found in the epidemiological survey SB-Minas Gerais and productivity data found in the SIA/SUS, between 2010 and 2013. This study identified that the parameters of coverage and higher productivity were identified for the dental extractions, except among teenagers for which the parameters of Endodontics have obtained higher values. Smaller values of the parameters were identified among the elderly in the areas of Endodontics and dental extractions. Therefore this study comes to reaffirm the importance of having as a reference, epidemiological data of local origin, as a way to confer greater fitness for this parameterization process

El acceso a la salud en la Ciudad de Buenos Aires: EAH 2012

A partir de los datos de la Encuesta Anual de Hogares (eah), en este informe se presenta información sobre el acceso al sistema de salud de la población residente en la Ciudad de Buenos Aires. Los aspectos de salud indagados por la EAH 2012 refieren a la autopercepción del estado de salud, a la cobertura de salud y a la utilización de los diferentes servicios de salud. (AU)