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1.
Arq. ciências saúde UNIPAR ; 26(1): 57-64, Jan-Abr. 2022.
Artículo en Portugués | LILACS | ID: biblio-1362673

RESUMEN

Objetivou-se analisar o perfil epidemiológico e as causas da mortalidade neonatal e infantil, em uma Regional de Saúde, de janeiro/2018 a agosto/2020. Trata-se de pesquisa exploratória, descritiva, transversal, retrospectivo, com abordagem quantitativa. A coleta de dados ocorreu em agosto de 2020, por meio de questionário elaborado pelas pesquisadoras, com base nas declarações de óbito disponibilizadas no Sistema de Informações de Mortalidade. O instrumento abordou as variáveis, sexo, raça, cor, idade da criança, idade materna, escolaridade materna, via de parto, idade gestacional, peso ao nascer, causa do óbito. Os dados foram submetidos à análise estatística descritiva e distribuição de frequência, por meio do Statistical Package for the Social Sciences (SPSS), versão 25.0. Constatou-se o predomínio de óbitos no sexo masculino (56,5%), de raça branca (87,8%), com equivalência entre extremo baixo peso e adequado (31,3%), com a principal causa de óbito por septicemia (13,9%). Quanto aos dados maternos, prevaleceram idade entre 21 e 30 anos de idade (45,2%) com gestação única (85,21%) e parto cesariano (65,2 %). Desses, 47,87% ocorreram no ano de 2018. Analisar os aspectos da mortalidade neonatal e infantil possibilita o planejamento e a readequação de ações no atendimento à saúde da criança, durante o período mais vulnerável e mais crítico dela, contribuindo, assim, para redução do número de óbitos.


This study analyzed the epidemiological profile and the causes of neonatal and infant mortality in a Health Regional Area between January 2018 and August 2020. This is an exploratory, descriptive, cross-sectional, retrospective study with a quantitative approach. Data collection took place during August 2020 through a questionnaire prepared by the researchers, based on the death certificates available in the Mortality Information System. The instrument included the variables of sex, race, color, child's age, mother's age, maternal education, childbirth mode, gestational age, birth weight, cause of death. The data were submitted to descriptive statistical analysis and frequency distribution using the Statistical Package for the Social Sciences (SPSS) version 25.0. There was a predominance of deaths among boys (56.5%), Caucasian (87.8%), with equivalence between extreme low and adequate weight (31.3%), with the main cause of death being septicemia (13.9%). As for maternal data, age between 21 to 30 years old (45.2%) prevailed, and 85.21% had a single pregnancy, with C-section childbirth (65.2%). From these, 47.87% occurred in 2018. It can be concluded that analyzing the aspects of neonatal and child mortality enables the planning and adjustment of actions in child health care during its most vulnerable and most critical period, thus contributing to reducing the number of deaths.


Asunto(s)
Humanos , Recién Nacido , Adulto , Regionalización , Mortalidad Infantil , Mortalidad Neonatal Precoz , Peso al Nacer , Causas de Muerte , Muerte , Atención a la Salud , Sepsis Neonatal/mortalidad , Investigación sobre Servicios de Salud
2.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud, LIS-bvsms | ID: lis-48639

RESUMEN

A Resolução aprova as diretrizes para os processo de regionalização, planejamento regional integrado e governança das redes de atenção à saúde


Asunto(s)
Atención Integral de Salud , Legislación como Asunto , Regionalización , Políticas, Planificación y Administración en Salud , Gobernanza
3.
J Thorac Cardiovasc Surg ; 163(3): 769-777, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-33934900

RESUMEN

OBJECTIVE: Existing evidence demonstrates some benefit of regionalization on early postoperative outcomes following lung cancer resection, but data regarding the persistence of this effect in long-term mortality are lacking. We investigated whether previously reported improvements in short-term outcomes translated to long-term survival benefit. METHODS: We retrospectively reviewed patients undergoing major pulmonary resection (lobectomy, bilobectomy, or pneumonectomy) for cancer within our integrated health care system before (2011-2013; n = 782) and after (2015-2017; n = 845) thoracic surgery regionalization. Overall survival was compared by Kaplan-Meier analysis, and 1- and 3-year mortality was compared by the by χ2 or Fisher exact test. Multivariable Cox regression models evaluated the effect of regionalization on mortality adjusted for relevant factors. RESULTS: Kaplan-Meier curves showed that overall survival was better among patients undergoing surgery postregionalization (log-rank test, P < .0001). Both 1- and 3-year mortality were decreased after regionalization: to 5.7% from 11.1% (P < .0001) for 1 year and to 17.0% from 25.5% (P = .0002) for 3 years. The multivariable adjusted Cox regression analysis revealed that only regionalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.42-0.76), age (HR, 1.03; 95% CI, 1.02-1.04), cancer stage (HR, 1.72, 1.83, and 2.56 for stages II, III, and IV, respectively), and Charlson comorbidity index (HR, 1.80 for 1-2; 2.05 for ≥3) were independent predictors of mortality. CONCLUSIONS: We found that overall mortality as well as 1- and 3-year mortality for lung cancer resection were lower after thoracic surgery regionalization. The association between regionalization and reduced mortality was significant even after adjusting for other related factors in a multivariable Cox analysis. Notably, surgeon volume, facility volume, surgeon specialty, neoadjuvant treatment, and video-assisted thoracoscopic surgery approach did not significantly affect mortality in the adjusted model.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/cirugía , Servicios Centralizados de Hospital , Prestación Integrada de Atención de Salud , Neoplasias Pulmonares/cirugía , Neumonectomía , Regionalización , Anciano , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Neumonectomía/efectos adversos , Neumonectomía/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
4.
Esc. Anna Nery Rev. Enferm ; 26: e20210137, 2022. tab, graf
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1350740

RESUMEN

Resumo Objetivo avaliar o tempo de atuação de médicos e enfermeiros na Atenção Primária à Saúde (APS) e qualidade das ações desenvolvidas para controle do câncer cervicouterino (CC). Métodos estudo transversal, conduzido de janeiro a março de 2019 em região de saúde compreendida em 19 municípios localizada no estado da Bahia, Brasil. A amostra foi de 241 médicos e enfermeiros da APS. Utilizou-se a linha de cuidado do CC como condição traçadora. Elegeram-se o desfecho tempo de atuação na APS no mesmo município, categorizado em < 2 anos e ≥ 2 anos, e indicadores representativos da qualidade da APS. Os testes χ2 de Pearson e exato de Fisher foram empregados. Resultados a prevalência de tempo de atuação na APS foi 43,57% (IC95%: 37,40%; 49,94%) para < 2 anos e 56,43% (IC95%: 50,06%; 62,60%) para ≥ 2 anos. Observaram-se maiores prevalências, com diferença estatística significativa, dos indicadores de qualidade para o maior tempo de atuação. Conclusões e implicações para a prática a rotatividade profissional parece afetar o cuidado longitudinal de mulheres na linha de cuidado eleita. Sugere-se a ampliação do número e do papel dos enfermeiros, especialmente nos serviços de APS, para maior resolutividade e eficiência do sistema de saúde.


Resumen Objetivo evaluar el tiempo de actuación de médicos y enfermeros en la Atención Primaria de Salud (APS) y la calidad de las acciones desarrolladas para el control del cáncer cérvicouterino (CC). Métodos estudio transversal realizado de enero a marzo de 2019, en una región sanitaria que comprende 19 municipios en el estado de Bahía, Brasil. La muestra fue de 241 médicos y enfermeros de APS. La línea de cuidados de CC fue la condición trazadora. Se eligió el resultado tiempo trabajando en APS en el mismo municipio, categorizado en < 2 años y ≥ 2 años e indicadores representativos de calidad de APS. Se utilizaron pruebas exactas de chi-cuadrado de Pearson y Fisher. Resultados la prevalencia del tiempo de actuación en APS fue del 43,57% (IC95%: 37,40%; 49,94%) para < 2 años y del 56,43% (IC95%: 50,06%; 62,60%) para ≥ 2 años, considerado incipiente. Se observó una mayor prevalencia, con diferencia estadísticamente significativa, de los indicadores de calidad para un mayor tiempo de actuación. Conclusiones e implicaciones para la práctica la rotación de profesionales parece afectar la atención longitudinal de las mujeres en la línea de cuidado elegida. Se sugiere la ampliación del número y el papel de enfermería, especialmente en los servicios de APS, para una mayor resolutividad y eficiencia del sistema sanitario.


Abstract Objective to assess the working length of physicians and nurses in Primary Health Care (PHC) and the quality of actions taken to control cervical cancer (CC). Methods this is a cross-sectional study, conducted from January to March 2019, in a health region comprised of 19 municipalities located in the state of Bahia, Brazil. The sample consisted of 241 PHC physicians and nurses. The CC care line was used as a tracer condition. The outcome experience length in PHC in the same municipality was chosen, categorized as < 2 years and ≥ 2 years and representative indicators of PHC quality. Pearson's χ2 and Fisher's exact tests were used. Results the prevalence of length of experience in PHC was 43.57% (95%CI: 37.40%; 49.94%) for < 2 years, and 56.43% (95%CI: 50.06%; 62.60%) for ≥ 2 years. There was a higher prevalence, with a statistically significant difference, of the quality indicators for the longest working length. Conclusions and implications for practice professional turnover seems to affect the longitudinal care of women in the chosen care line. It is suggested to expand the number and role of nurses, especially in PHC services, for greater resolution and efficiency of the health system.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Atención Primaria de Salud , Calidad de la Atención de Salud/estadística & datos numéricos , Evaluación en Salud/estadística & datos numéricos , Neoplasias del Cuello Uterino/prevención & control , Personal de Salud , Tamizaje Masivo , Estudios Transversales , Prueba de Papanicolaou
6.
Rev. baiana saúde pública ; 45(Especial 3): 7-27, 20213112.
Artículo en Portugués | LILACS | ID: biblio-1355131

RESUMEN

O tema da cooperação federativa tornou-se fundamental na agenda política e de pesquisa no Brasil. Isso ocorre porque a dicotomia centralização versus descentralização mostra-se cada vez mais desgastada como chave para entender a dinâmica do federalismo brasileiro. Parte importante dos estudos internacionais e nacionais realça a necessidade de construir mecanismos de coordenação e parceria entre os níveis de governo para resolver dilemas de ação coletiva e problemas das políticas públicas. A cooperação intergovernamental ganhou terreno a partir de formas de colaboração federativa. Uma delas foi estabelecida no âmbito do desenho das políticas públicas e teve como precursor o Sistema Único de Saúde, cujas bases colaborativas já estavam no texto constitucional por meio dos princípios de hierarquização e regionalização dos serviços. Trata-se de um modelo que supõe articulação federativa nacional, com importante papel coordenador, indutor e financiador da União, mas que mantém relevante autonomia nas mãos dos governos subnacionais. Fatores internos e externos provenientes da instabilidade política e econômica brasileira induzem mudanças na forma de execução de políticas públicas, notadamente na área da saúde. A atual conjuntura da política de saúde no Brasil toma uma condução desafiadora diante da pandemia: governos subnacionais atuando por meio da cooperação interfederativa, mediante ações já comprovadamente eficazes no combate à Covid-19, em contraponto ao governo federal, onde prevalecem ações baseadas na opinião e vontade do presidente da República, contrariando evidências científicas. Assim, o objetivo deste artigo é demonstrar a cooperação ocorrida entre o Governo do Estado da Bahia e a Prefeitura do Município de Salvador no combate à pandemia da Covid-19, por meio de ações conjuntas desenvolvidas. A natureza do método desta pesquisa foi classificada como descritiva, a partir de uma abordagem qualitativa, com análise de documentos e observação não participativa. Os resultados apresentaram os números sobre a Covid-19 no Brasil e na Bahia, o quadro dos leitos programados e habilitados para o enfrentamento da doença e as ações implementadas. Discutiu-se sobre as ações em diversas frentes, efeitos do isolamento social e medidas regionalizadas. A pesquisa conclui que a experiência da cooperação interfederativa entre o Governo da Bahia e o município de Salvador está bem alinhada com a literatura de administração pública, que indica o ganho potencial de arranjos de cooperação intergovernamental.


In response to the decreasing deterioration of the dichotomy of centralization versus decentralization as a key to understanding the dynamics of Brazilian federalism, federative cooperation has become a fundamental theme in the political and research agenda in Brazil. A considerable number of studies in the national and international scenario highlights the need to build coordination mechanisms and partnership between different governmental levels to solve collective action and public policy problems. Intergovernmental cooperation gained ground from forms of federative cooperation, one of which was established in the scope of public policies design and had the Brazilian Unified Health System (SUS) as a precursor ­ whose collaborative bases were already established through the principles of services hierarchization and regionalization in the constitutional text. The model assumes national federative articulation with the role of coordinating, inducing, and funding the Union while maintaining relevant autonomy in relation to subnational governments. Internal and external factors arising from political and economic instability induce changes in the way public policies are addressed, especially regarding the health field. The COVID-19 pandemic poses challenges to the current health policy conjuncture in Brazil, whereby subnational governments implemented actions proven effective in the fight against the disease by means of an interfederative cooperation whereas the Federal Government proposed measures contrary to scientific evidence, relying solely on the opinion and will of the President. Thus, this article aims to demonstrate the cooperation established between the Government of the State of Bahia and the Municipality of Salvador in the fight against the pandemic. It consists of a descriptive study based on a qualitative approach with document analysis and non-participatory observation. The results indicate the numbers of COVID-19 cases in both in Brazil and Bahia, the panorama of hospital beds programmed and qualified to cope with the disease, the actions implemented on several fronts, and effects of social isolation and sanitary measures at the regional level. The interfederative cooperation between the Government of Bahia and the municipality of Salvador is aligned with the literature on public administration, thus indicating the potential gain of intergovernmental cooperation arrangements.


La cooperación federativa se ha convertido en un tema fundamental en la agenda política y de investigación en Brasil. Esto se debe a que la dicotomía centralización versus descentralización está cada vez más desgastada para comprender la dinámica del federalismo brasileño. Algunos estudios internacionales y nacionales ponen de relieve la necesidad de construir mecanismos de coordinación y asociación entre los niveles de gobierno para resolver dilemas de acción colectiva y problemas de política pública. La cooperación intergubernamental ganó terreno a partir de formas de colaboración federativa. Una de ellas se estableció en el ámbito del diseño de políticas públicas y tuvo como precursor el Sistema Único de Salud, cuyas bases de colaboración ya estaban en el texto constitucional por medio de los principios de jerarquización y regionalización de servicios. Es un modelo que asume la articulación federativa nacional, con un importante papel coordinador, inductor y financiador de la Unión, pero que mantiene la autonomía pertinente en manos de los gobiernos subnacionales. Los factores internos y externos derivados de la inestabilidad política y económica brasileña inducen cambios en la forma en que se abordan las políticas públicas, sobre todo en el área de la salud. La coyuntura actual de la política sanitaria en Brasil adopta un enfoque desafiante ante la pandemia: los gobiernos subnacionales que actuan a través de la cooperación interfederativa con acciones efectivamente ya probadas en la lucha contra el COVID-19, en contraste con el Gobierno Federal, en que prevalecen las acciones basadas en la opinión y la voluntad del Presidente de la República, contrariamente a la evidencia científica. Así, el objetivo de este artículo es demostrar la cooperación que se produjo entre el Gobierno del Estado de Bahía (Brasil) y la Municipalidad de Salvador en la lucha contra la pandemia del COVID-19, a través de acciones conjuntas desarrolladas. Esta investigación utilizó el método descriptivo, de enfoque cualitativo con análisis documental y observación no participativa. Los resultados exponen los números sobre el COVID-19 en Brasil y Bahía, el panorama de las camas programadas y calificadas para hacer frente a la enfermedad y las acciones implementadas. Se discutieron las acciones en varios frentes, los efectos del aislamiento social y las medidas regionalizadas. Se concluyó que la experiencia de cooperación interfederativa entre el Gobierno de Bahía y el municipio de Salvador está bien alineada con la literatura de la administración pública, lo que indica posible ganancia de los acuerdos de cooperación intergubernamental.


Asunto(s)
Política Pública , Sistema Único de Salud , COVID-19 , Política de Salud
7.
J Infect Dev Ctries ; 15(11): 1593-1596, 2021 11 30.
Artículo en Inglés | MEDLINE | ID: mdl-34898483

RESUMEN

COVID-19 outbreak has resulted in a substantial morbidity and mortality, and has put the health system under tremendous stress. A need for devising and adopting newer methods and techniques is being emphasized in the healthcare facilities to combat the effects of the SARS-CoV-2. Besides patient care, focus needs to be laid on the effective and dignified management of the deceased and medico-legal services provided by the hospitals and medical institutions during the COVID-19 pandemic. Considering the likelihood of forensic experts and autopsy personnel being exposed to SARS-CoV-2 inadvertently during the autopsy, it is recommended to resort to safer and minimally invasive techniques of postmortem examination of the dead. In this regard, employing radiological techniques for postmortem examination appears to be a promising option during the COVID-19 pandemic. An inherent advantage of postmortem radiography over conventional autopsies is the minimization of the risk of transmission of infection to the health care workers. Our correspondence highlights on the possibility of using radiological facilities as an effective replacement of high-risk conventional autopsy procedures during the COVID-19 pandemic.


Asunto(s)
Autopsia , COVID-19/prevención & control , Instituciones de Salud , Enfermedades Profesionales/prevención & control , Radiología , SARS-CoV-2 , COVID-19/epidemiología , Humanos , India/epidemiología , Enfermedades Profesionales/epidemiología , Pandemias , Regionalización
8.
Asian Pac J Cancer Prev ; 22(9): 2945-2950, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34582666

RESUMEN

The COVID-pandemic has shown significant impact on cancer care from early detection, management plan to clinical outcomes of cancer patients. The Asian National Cancer Centres Alliance (ANCCA) has put together the 9 "Ps" as guidelines for cancer programs to better prepare for the next pandemic. The 9 "Ps" are Priority, Protocols and Processes, Patients, People, Personal Protective Equipments (PPEs), Pharmaceuticals, Places, Preparedness, and Politics. Priority: to maintain cancer care as a key priority in the health system response even during a global infectious disease pandemic. Protocol and processes: to develop a set of Standard Operating Procedures (SOPs) and have relevant expertise to man the Disease Outbreak Response (DORS) Taskforce before an outbreak. Patients: to prioritize patient safety in the event of an outbreak and the need to reschedule cancer management plan, supported by tele-consultation and use of artificial intelligence technology. People: to have business continuity planning to support surge capacity. PPEs and Pharmaceuticals: to develop plan for stockpiles management, build local manufacturing capacity and disseminate information on proper use and reduce wastage. Places: to design and build cancer care facilities to cater for the need of triaging, infection control, isolation and segregation. Preparedness: to invest early on manpower building and technology innovations through multisectoral and international collaborations. Politics: to ensure leadership which bring trust, cohesion and solidarity for successful response to pandemic and mitigate negative impact on the healthcare system.


Asunto(s)
Instituciones Oncológicas/organización & administración , Planificación en Desastres/métodos , Control de Infecciones/métodos , Neoplasias/prevención & control , Pandemias/prevención & control , Regionalización/organización & administración , Telemedicina/métodos , Inteligencia Artificial , Asia/epidemiología , Atención a la Salud , Humanos , Neoplasias/epidemiología
9.
Cien Saude Colet ; 26(suppl 2): 3385-3396, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-34468636

RESUMEN

The scope of this study was to analyze, from the standpoint of managers, the conformity of the process of regionalization in health in Brazil, with emphasis on the main advances and challenges. A mixed exploratory and descriptive study was conducted. In the first stage, an electronic questionnaire was given to managers from all health regions of the country. In the second stage, focus groups were staged with managers in all macro regions. A semi-structured interview was used to encourage managers to speak about the advances and main challenges of the process of regionalization. The data was analyzed using Iramuteq software, more specifically the Descending Hierarchical Classification (DHC), resulting in three main themes: the first deals with the efforts made for the regional organization at the macro level of management, with emphasis on reducing inequalities, actions and services to users; the second demonstrates the regional organization and the difficulties for the organization of the local system; the third reveals difficulties in accessing health services, especially those with greater technological complexity. The research results point to advances and challenges, involving a risk for the structuring of the regionalization process, with bureaucratic and fragmentation implications.


Este estudo teve como objetivo analisar, à luz da percepção dos gestores, a conformação do processo de regionalização em saúde no Brasil, com ênfase nos principais avanços e desafios. Um estudo misto do tipo exploratório e descritivo. Na primeira etapa foi aplicado um questionário eletrônico aos gestores de todas as regiões de saúde do país. Na segunda foram realizados grupos focais com os gestores de todas as macrorregiões. Utilizou-se um roteiro semiestruturado para estimular os gestores a falarem livremente sobre o processo de regionalização, seus avanços e principais desafios. Os dados foram analisados no software Iramuteq, com classificação hierárquica descendente (CHD), o que resultou em três eixos temáticos: o primeiro trata dos esforços realizados para a organização regional no nível mais macro da gestão, com destaque para a redução das desigualdades e o provimento de ações e serviços aos usuários; o segundo mostra a organização regional e as dificuldades para a organização do sistema local; o terceiro evidencia as dificuldades de acesso aos serviços de saúde, sobretudo os de maior complexidade tecnológica. Os resultados da pesquisa apontam para avanços e desafios, envolvendo um risco para a estruturação do processo de regionalização, com nuances burocráticas e fragmentadas.


Asunto(s)
Regionalización , Brasil , Estados Unidos
10.
Med Care ; 59(Suppl 5): S420-S427, 2021 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-34524238

RESUMEN

BACKGROUND: As coronavirus disease 2019 (COVID-19) rapidly progressed throughout the United States, increased demand for health workers required health workforce data and tools to aid planning and response at local, state, and national levels. OBJECTIVE: We describe the development of 2 estimator tools designed to inform health workforce planning for COVID-19. RESEARCH DESIGN: We estimated supply and demand for intensivists, critical care nurses, hospitalists, respiratory therapists, and pharmacists, using Institute for Health Metrics and Evaluation projections for COVID-19 hospital care and National Plan and Provider Enumeration System, Provider Enrollment Chain and Ownership System, American Hospital Association, and Bureau of Labor Statistics Occupation Employment Statistics for workforce supply. We estimated contact tracing workforce needs using Johns Hopkins University COVID-19 case counts and workload parameters based on expert advice. RESULTS: The State Hospital Workforce Deficit Estimator estimated the sufficiency of state hospital-based clinicians to meet projected COVID-19 demand. The Contact Tracing Workforce Estimator calculated the workforce needed based on the 14-day COVID-19 caseload at county, state, and the national level, allowing users to adjust workload parameters to reflect local contexts. CONCLUSIONS: The 2 estimators illustrate the value of integrating health workforce data and analysis with pandemic response planning. The many unknowns associated with COVID-19 required tools to be flexible, allowing users to change assumptions on number of contacts and work capacity. Data limitations were a challenge for both estimators, highlighting the need to invest in health workforce data and data infrastructure as part of future emergency preparedness planning.


Asunto(s)
COVID-19/epidemiología , Planificación en Salud Comunitaria , Personal de Salud/estadística & datos numéricos , Fuerza Laboral en Salud/estadística & datos numéricos , Modelos Estadísticos , Regionalización , Trazado de Contacto , Humanos , Estados Unidos/epidemiología , Carga de Trabajo
11.
Rev. Ciênc. Plur ; 7(3): 121-136, set. 2021. tab, maps
Artículo en Portugués | LILACS, BBO - Odontología | ID: biblio-1337942

RESUMEN

Introdução:No ponto de vista organizativodo Sistema Único de Saúde, a descentralização e a regionalização visam ampliar a resolutividade em nível local, reduzindo a desigualdade na assistência à saúde da população. Em meio às dificuldades de financiar os serviços dos três níveis de complexidades assistenciais em todos os municípios, opta-se pela formação de Regiões de Saúde. No Rio Grande do Norte, seus167 municípiosdividem-se em oito Regiões de Saúde. Objetivo:Identificar os procedimentos obstétricos e Estado que mais frequentemente ocasionou as invasões territoriais na assistência à saúde na VIregião de saúde do Rio Grande do Norte em 2018. Metodologia:Estudo quantitativo, de caráter exploratório e descritivo realizado com dados secundários, referentes a 2018, captadosnoDepartamento de Informática do Sistema Único de Saúdee bancode dados da programação pactuada e produção hospitalar cedido pela Secretaria Estadual de SaúdePública do Rio Grande do Norte.Resultados:Indicaram a existência da invasão territorial na região de saúde, afirmando maior representatividade dessa invasãopelos Estados limítrofes. Conclusões:Ainvasão territorial se mostrapresente na região de saúdee no Estado,despertando olhares sobre tal questão e suas implicações, potencializando novas inquietações (AU).


Introduction:From the organizational point of view of the Unified Health System, decentralization and regionalization aim to expand resolvability at the local level, reducing inequality in healthcare for the population. In the midst of the difficulties of financing the services of the three levels of assistance complexities in all municipalities, the option is for the formation of Health Regions. In Rio Grande do Norte, its 167 municipalities aredivided into eight Health Regions. Objective:Identify the obstetric and State procedures that most often caused territorial invasions in health care in the VI health region of Rio Grande do Norte in 2018. Methodology:Quantitative, exploratory and descriptive study conducted with secondary data, referring to 2018, captured in the Informatics Department of the Unified Health Systemand database of the agreed schedule and hospital production provided by the State Secretariat of Public Health of Rio Grande do Norte. Results:They indicated the existence of territorial invasion in the health region, affirming the greater representativeness of this invasion by neighboring states. Conclusions:The territorial invasion appears to be present in the health region and in the State, awakening views on this issue and its implications, potentiating new concerns (AU).


Introducción: Desde el punto de vista organizativo del Sistema Único de Salud, la descentralización y la regionalización apuntan a ampliar la resolubilidad a nivel local, reduciendo la desigualdad en la atención de salud de la población. En medio de las dificultades para financiar los servicios de los tres niveles de complejidad asistencial en todos los municipios, la opción es por la formación de Regiones de Salud. En Rio Grande do Norte, sus 167 municipios se dividen en ocho Regiones de Salud. Objetivo: Identificar los procedimientos obstétricos y estatales que con mayor frecuencia causaron invasiones territoriales en la atención de la salud en la VI Región de Salud de Rio Grande do Norte en 2018. Metodología: Estudio cuantitativo, exploratorio y descriptivo realizado con datos secundarios,referidos a 2018, capturados en el Departamento de Informática del Sistema Único de Salud y base de datos del cronograma acordado y producción hospitalaria proporcionadapor la Secretaría de Estado de Salud Pública de Rio Grande do Norte.Resultados: Señalaron la existencia de invasión territorial en la región de la salud, afirmando la mayor representatividad de esta invasión por parte de los estados vecinos.Conclusiones: La invasión territorial parece estar presente en la región de la salud y en el Estado, despertando visiones sobre este tema y sus implicaciones, potencializando nuevas preocupaciones (AU).


Asunto(s)
Humanos , Femenino , Regionalización , Sistema Único de Salud , Brasil/epidemiología , Migración Humana , Obstetricia , Epidemiología Descriptiva , Atención a la Salud
12.
San Salvador; MINSAL; jul. 28, 2021. 32 p. ilus, tab.
No convencional en Español | LILACS, BISSAL | ID: biblio-1292939

RESUMEN

El presente Plan Estratégico Institucional (PEI) del Ministerio de Salud (MINSAL) constituye el mapa estratégico para la Secretaría de Estado, Direcciones Regionales de Salud, hospitales de segundo y tercer nivel de atención y establecimientos de salud del primer nivel de atención. Contiene los principales retos para el MINSAL en el marco de la recientemente aprobada Ley del Sistema Nacional Integrado de Salud (SNIS) en materia de rectoría y gobernanza, promoción de la salud, capacidad para entregar servicios de salud de calidad y el abordaje de la determinación social de la salud, teniendo como ejes trazadores la transformación digital y la mejora continua. Plantea alternativas para enfrentar los desafíos para, progresivamente y en comunión con el resto de las instituciones del SNIS, garantizar el derecho a la salud y mejorar la calidad de vida de la población, en ruta a la salud universal


This Institutional Strategic Plan (PEI) of the Ministry of Health (MINSAL) constitutes the strategic map for the Secretary of State, Regional Health Directorates, second and third level of care hospitals and first level of care health facilities. It contains the main challenges for the MINSAL within the framework of the recently approved Law of the National Integrated Health System (SNIS) in matters of stewardship and governance, health promotion, capacity to deliver quality health services and the approach to determination social health, having digital transformation and continuous improvement as tracing axes. It proposes alternatives to face the challenges to, progressively and in communion with the rest of the NHIS institutions, guarantee the right to health and improve the quality of life of the population, on the road to universal health


Asunto(s)
Regionalización , Salud Pública , Planes de Sistemas de Salud
13.
BMC Pregnancy Childbirth ; 21(1): 410, 2021 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-34078318

RESUMEN

INTRODUCTION: Cambodia has achieved significant progress in maternal health, yet remains in the group of countries with the highest maternal mortality ratio in South-East Asia. Extra efforts are needed to improve maternal health through assessing the coverage of maternal health services as a continuum of care (CoC) and identifying the gaps. Our study aims to explore the coverage level of the Optimal CoC by (1) measuring the continuity of optimal antenatal care (ANC), skilled birth attendance (SBA) and optimal post-natal care (PNC), (2) identifying the determinants of dropping out from one service to another and (3) of not achieving the complete CoC. METHOD: The study employed data from the Cambodia Demographic Health Survey 2014. We restricted our analysis to married women who had a live birth in the five years preceding the survey (n = 5678). Bi-variate and multivariate logistic regression were performed using STATA version 14. RESULTS: Almost 50% of women had achieved the complete optimal CoC, while the remaining have used only one or two of the services. The result shows that the level of women's education was positively associated with the use of optimal ANC, the continuation to using optimal PNC and achieving the complete CoC. More power of women in household decision making was also positively associated with receiving the complete CoC. The birth order was negatively associated with achieving the complete CoC, while exposure to the mass media and having health insurance increased the odds of achieving the complete CoC. Household wealth consequently emerged as an influential predictor of dropping out and not achieving the complete CoC. Receiving all different elements of ANC care improved the continuity of care from optimal ANC to SBA and from SBA to optimal ANC. CONCLUSION: The findings urge policy makers to approach maternal health care as a continuum of care with different determinants at each step. Household wealth was found to be the most influential factor, yet the study discovered also other barriers to optimal maternal health care which need to be addressed: future intervention should thus not only aim to increase wealth or health insurance coverage but also stimulate the education of women and empower women to claim power in household decision-making.


Asunto(s)
Continuidad de la Atención al Paciente/estadística & datos numéricos , Atención Prenatal/estadística & datos numéricos , Regionalización , Adolescente , Adulto , Cambodia , Demografía , Femenino , Humanos , Embarazo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
14.
Value Health ; 24(6): 795-803, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34119077

RESUMEN

OBJECTIVES: To experiment with new approaches of collaboration in healthcare delivery, local authorities implement new models of care. Regarding the local decision context of these models, multi-criteria decision analysis (MCDA) may be of added value to cost-utility analysis (CUA), because it covers a wider range of outcomes. This study compares the 2 methods using a side-by-side application. METHODS: A new Dutch model of care, Primary Care Plus (PC+), was used as a case study to compare the results of CUA and MCDA. Data of patients referred to PC+ or care-as-usual were retrieved by questionnaires and administrative databases with a 3-month follow-up. Propensity score matching together with generalized linear regression models was used to reduce confounding. Univariate and probabilistic sensitivity analyses were performed to explore uncertainty in the results. RESULTS: Although both methods indicated PC+ as the dominant alternative, complementary differences were observed. MCDA provided additional evidence that PC+ improved access to care (standardized performance score of 0.742 vs 0.670) and that improvement in health-related quality of life was driven by the psychological well-being component (standardized performance score of 0.710 vs 0.704). Furthermore, MCDA estimated the budget required for PC+ to be affordable in addition to preferable (€521.42 per patient). Additionally, MCDA was less sensitive to the utility measures used. CONCLUSIONS: MCDA may facilitate an auditable and transparent evaluation of new models of care by providing additional information on a wider range of outcomes and incorporating affordability. However, more effort is needed to increase the usability of MCDA among local decision makers.


Asunto(s)
Técnicas de Apoyo para la Decisión , Atención a la Salud/economía , Costos de la Atención en Salud , Modelos Económicos , Atención Primaria de Salud/economía , Regionalización/economía , Adulto , Anciano , Conducta de Elección , Investigación sobre la Eficacia Comparativa , Análisis Costo-Beneficio , Femenino , Accesibilidad a los Servicios de Salud/economía , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Países Bajos , Satisfacción del Paciente/economía , Estudios Prospectivos , Mejoramiento de la Calidad/economía , Indicadores de Calidad de la Atención de Salud/economía , Participación de los Interesados
15.
PLoS One ; 16(6): e0253334, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34185777

RESUMEN

By the time the etiologic agent of the COVID-19 was identified as a novel coronavirus, no country in the Americas Region had laboratory capacity for detecting this new virus. A strategic multilevel approach with specific reagent purchase and delivery, regional trainings, in-country missions, and the provision of technical support was established for timely preparedness of national reference laboratories for SARS-CoV-2 detection. All countries should be prepared to timely detect any potential pandemic emerging agent. The rapid SARS-CoV-2 molecular detection implementation throughout the Americas showed the importance of an efficient and coordinated laboratory response for preparedness. Here we present how in 25 days the Americas Region went from no SARS-CoV-2 diagnostic capacity, to molecular detection fully implemented in 28 Member States, under the coordinated strategy of the Pan American Health Organization and collaborative work at regional and country level with national authorities and public health laboratories.


Asunto(s)
COVID-19/diagnóstico , Laboratorios/estadística & datos numéricos , COVID-19/virología , América Central , Humanos , Laboratorios/normas , Regionalización , SARS-CoV-2/aislamiento & purificación , América del Sur
16.
J Stroke Cerebrovasc Dis ; 30(8): 105843, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34000607

RESUMEN

OBJECTIVES: There are regional disparities in implementation rates of endovascular thrombectomy due to time and resource constraints such as endovascular thrombectomy specialists. In Hokkaido, Japan, Drive and Retrieve System (DRS), where endovascular thrombectomy specialists perform early endovascular thrombectomies by traveling from the facilities where they normally work to facilities closer to the patient. This study analyzed the cost-effectiveness of allocating a endovascular thrombectomy specialist for DRS to treat stroke patients. MATERIALS AND METHODS: he number of ischemic stroke patients expected to receive endovascular thrombectomy in Hokkaido in 2015 was estimated. It was assumed that an additional neutointerventionist was allocated for DRS. The analysis was performed from the government's perspective, which includes medical and nursing-care costs, and the personnel cost for endovascular thrombectomy specialist. The analysis was conducted comparing the current scenario, where patients received endovascular thrombectomy in facilities where endovascular thrombectomy specialists normally work, with the scenario with DRS within 60 min drive distance. Patient transport time was analyzed using geographic information system, and patient severity was estimated from the transport time. The primary outcome was incremental cost-effectiveness ratio (ICER) in each medical area which was calculated from the incremental costs and the incremental quality-adjusted life years (QALYs), estimated from patient severity using published literature. The entire process was repeated 100 times. RESULTS: DRS was most cost-effective in Kamikawachubu area, where the ICER was $14,173±16,802/QALY, significantly lower than the threshold that the Japanese guideline suggested. CONCLUSIONS: Since DRS was cost-effective in Kamikawachubu area, the area should be prioritized when a endovascular thrombectomy specialist for DRS is allocated as a policy.


Asunto(s)
Conducción de Automóvil , Accidente Cerebrovascular Embólico/economía , Accidente Cerebrovascular Embólico/terapia , Procedimientos Endovasculares/economía , Sistemas de Información Geográfica/economía , Costos de la Atención en Salud , Neurólogos/economía , Trombectomía/economía , Áreas de Influencia de Salud/economía , Simulación por Computador , Análisis Costo-Beneficio , Prestación Integrada de Atención de Salud/economía , Accidente Cerebrovascular Embólico/diagnóstico , Accidente Cerebrovascular Embólico/fisiopatología , Humanos , Evaluación de Programas y Proyectos de Salud , Años de Vida Ajustados por Calidad de Vida , Regionalización/economía , Factores de Tiempo , Resultado del Tratamiento
17.
Epidemiol Infect ; 149: e98, 2021 04 14.
Artículo en Inglés | MEDLINE | ID: mdl-33849676

RESUMEN

Monitoring and evaluation (M&E) is an essential component of public health emergency response. In the WHO African region (WHO AFRO), over 100 events are detected and responded to annually. Here we discuss the development of the M&E for COVID-19 that established a set of regional and country indicators for tracking the COVID-19 pandemic and response measures. An interdisciplinary task force used the 11 pillars of strategic preparedness and response to define a set of inputs, outputs, outcomes and impact indicators that were used to closely monitor and evaluate progress in the evolving COVID-19 response, with each pillar tailored to specific country needs. M&E data were submitted electronically and informed country profiles, detailed epidemiological reports, and situation reports. Further, 10 selected key performance indicators were tracked to monitor country progress through a bi-weekly progress scoring tool used to identify priority countries in need of additional support from WHO AFRO. Investment in M&E of health emergencies should be an integral part of efforts to strengthen national, regional and global capacities for early detection and response to threats to public health security. The development of an adaptable M&E framework for health emergencies must draw from the lessons learned throughout the COVID-19 response.


Asunto(s)
COVID-19/prevención & control , Organización Mundial de la Salud/organización & administración , África/epidemiología , COVID-19/epidemiología , Urgencias Médicas , Humanos , Vigilancia en Salud Pública , Regionalización , SARS-CoV-2
18.
Epidemiol Serv Saude ; 30(1): e2020576, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33852697

RESUMEN

Health status indicators are an important tool for monitoring the performance of public health actions, identifying trends and priority regions for resource allocation. An R package was developed in order to increase the feasibility of handling and analyzing health status indicator data. The rtabnetsp package requests data from TabNet servers on the São Paulo State Department of Health website, retrieving and preprocessing the data for user manipulation. This article presents the rtabnetsp package and its functions, installation and use; as well as providing examples of its functionalities, which involve listing and searching among available indicators, selecting desired content and obtaining data aggregated according to regionalization level held on the data matrix, enabling greater agility in tasks regarding public health management in the state of São Paulo.


Indicadores de saúde representam uma importante ferramenta de acompanhamento de desempenho de ações em Saúde Pública, permitindo a avaliação de intervenções realizadas, bem como a identificação de tendências e regiões prioritárias para alocação de recursos. Com o objetivo de aumentar a praticidade nas tarefas de análise e manipulação de dados desses indicadores, foi criado um pacote R. O pacote rtabnetsp realiza requisições aos servidores TabNet da página eletrônica da Secretaria de Estado da Saúde de São Paulo, recuperando e tratando tais dados para utilização do usuário. Este artigo apresenta o pacote rtabnetsp e suas funções, modo de instalação e uso; traz também exemplos de suas funcionalidades, que permitem a visualização, busca e seleção, entre uma lista de indicadores, do conteúdo desejado, além da obtenção dos dados agregados pelo nível de regionalização disponível na matriz de dados, conferindo maior agilidade a tarefas de gestão em saúde do estado de São Paulo.


Indicadores de salud son una herramienta importante para monitorear el desempeño de las acciones de salud pública, permitiendo la evaluación de las intervenciones hechas, así como la identificación de tendencias y regiones prioritarias para la asignación de recursos. En la búsqueda de aumentar la practicidad en las tareas de análisis y manipulación de datos de estos indicadores, se creó un paquete R. El paquete rtabnetsp realiza solicitudes a los servidores TabNet del Departamento de Salud del Estado de São Paulo, recogiendo y procesando dichos datos para el usuario. Este artículo presenta el paquete, sus funciones, instalación y uso, así como ejemplos de sus funcionalidades, que permiten visualizar y buscar desde un listado de indicadores, seleccionar el contenido deseado y obtener los datos agregados por el nivel de regionalización disponible en la matriz de datos, alcanzando más agilidad en las tareas de gestión de la salud en el estado de São Paulo.


Asunto(s)
Atención a la Salud , Indicadores de Salud , Brasil , Humanos
19.
Health Secur ; 19(4): 364-369, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33794098

RESUMEN

The COVID-19 pandemic has stretched limited public health resources beyond measures, particularly at the local level. What started as an interesting report of pneumonia of unknown etiology in late December 2019 in Wuhan, China, bloomed into an international crisis by mid-January 2020. However, it was not until late January, when the first case was reported in the United States, that a new reality took shape for US public health agencies. After all, severe acute respiratory syndrome never made it to this country, and the only 2 cases of Middle East respiratory syndrome here were imported and never spread. Local public health agencies are notoriously short-staffed and underfunded. Therefore, when a crisis looms, personnel from a multitude of areas within the agencies are called upon to help out. Under its innovative and forward-thinking leadership, the St. Louis County Department of Health internally implemented the Incident Command System, a component of the National Incident Management System. While reassignment of individuals to new responsibilities under a new and temporary reporting structure did not always go perfectly, Incident Command System kept its promise to be adaptable to a fast-evolving situation, to clearly outline needed areas of responsibility, and to provide scaffolding that kept the Department of Health functional in chaotic times. It was able to be implemented quickly within hours of the first confirmed COVID-19 case in St. Louis County and enhanced the quality and timeliness of the public health response. This experience is being shared to provide a model of how organizations with limited personnel can use the Incident Command System to reorganize and meet unexpected challenges with increased success.


Asunto(s)
COVID-19 , Comunicación , Planificación en Desastres/organización & administración , Gobierno Local , Salud Pública , Humanos , Missouri , Regionalización , Factores de Tiempo
20.
Palmas, TO; Secretaria da Saúde; 23 março 2021. 48 p. ilus.
Monografía en Portugués | Coleciona SUS, LILACS, Coleciona SUS, CONASS, SES-TO | ID: biblio-1151469

RESUMEN

Trata de parâmetros da Educação Permanente em Saúde e a humanização sob a perspectiva do apoio institucional na escola de Saúde pública do Tocantins (Etsus-TO). Trata ainda a organização do coletivo EPS/Humanização no contexto da pandemia da covid-19, as competências da GEPSUS e objetivos da assessoria de humanização, o apoio institucional, a produção de coletivos e de redes, os caminhos e pistas metodológicas para a estruturação do PMA bem como seus objetivos e arranjo de gestão além da modalidade e dinâmica do trabalho no contexto da pandemia da covid-19 e da matriz de planejamento 2021. Traz o diagnostico de estratégias de planejamento, monitoramento e avaliação, o percurso proposto para o PMA na dinâmica dos coletivos do plano de 2020 e a indissociabilidade entre planejamento, monitoramento e avaliação para o plano 2021. Mostra ainda os instrumentos de monitoramento e avaliação e as reflexões acerca do trabalho colaborativo.


It deals with parameters of Permanent Education in Health and humanization from the perspective of institutional support in the public health school of Tocantins (Etsus-TO). It also deals with the organization of the EPS / Humanization collective in the context of the covid-19 pandemic, the skills of GEPSUS and objectives of humanization assistance, institutional support, the production of collectives and networks, the methodological paths and tracks for structuring the PMA as well as its objectives and management arrangement in addition to the modality and dynamics of work in the context of the pandemic of the covid-19 and the planning matrix 2021. It brings the diagnosis of planning, monitoring and evaluation strategies, the proposed route for the PMA in the dynamics of the 2020 plan collectives and the inseparability between planning, monitoring and evaluation for the 2021 plan. It also shows the monitoring and evaluation instruments and reflections on collaborative work.


Se trata de parámetros de Educación Permanente en Salud y humanización desde la perspectiva del apoyo institucional en la escuela de salud pública de Tocantins (Etsus-TO). También se ocupa de la organización del colectivo EPS / Humanización en el contexto de la pandemia del covid-19, las competencias del GEPSUS y los objetivos de la humanización asistencial, el apoyo institucional, la producción de colectivos y redes, los caminos y pistas metodológicas para estructurar PMA así como sus objetivos y arreglo de gestión además de la modalidad y dinámica de trabajo en el contexto de la pandemia del covid-19 y la matriz de planificación 2021. Trae el diagnóstico de estrategias de planificación, seguimiento y evaluación, la ruta propuesta para el PMA en la dinámica de los colectivos del plan 2020 y la inseparabilidad entre planificación, seguimiento y evaluación para el plan 2021. También muestra los instrumentos de seguimiento y evaluación y reflexiones sobre el trabajo colaborativo.


Il traite des paramètres de l'Education Permanente à la Santé et à l'humanisation dans la perspective de l'appui institutionnel à l'école de santé publique de Tocantins (Etsus-TO). Il traite également de l'organisation du collectif EPS / Humanisation dans le cadre de la pandémie de covid-19, des compétences de GEPSUS et des objectifs d'aide à l'humanisation, de soutien institutionnel, de la production de collectifs et de réseaux, des pistes méthodologiques et des pistes de structuration du PMA ainsi que ses objectifs et son dispositif de gestion en plus de la modalité et de la dynamique de travail dans le cadre de la pandémie du covid-19 et de la matrice de planification 2021. Il apporte le diagnostic des stratégies de planification, de suivi et d'évaluation, le tracé proposé pour le PMA dans la dynamique des collectifs du plan 2020 et l'inséparabilité entre planification, suivi et évaluation pour le plan 2021. Il montre également les instruments de suivi-évaluation et les réflexions sur le travail collaboratif.


Asunto(s)
Humanos , Regionalización/organización & administración , Informe Anual , Educación Continua , Evaluación Educacional , Humanización de la Atención
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