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Santos EFDS, Louvison MCP, Oliveira ECT, Monteiro CN, Barros MBDA, Goldbaum M, Cesar CLG. Analysis of education level in access and use of health care services, ISA-Capital, São Paulo, Brazil, 2003 and 2015. CAD SAUDE PUBLICA 2023; 39:e00249122. [PMID: 37820229 PMCID: PMC10566551 DOI: 10.1590/0102-311xen249122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/03/2023] [Accepted: 06/02/2023] [Indexed: 10/13/2023] Open
Abstract
The great socioeconomic inequality that prevails in Brazil and the existence of a national health system with universal coverage places the need to monitor the evolution and social inequities regarding access to these services. This study aims to analyze the changes in the prevalence of health care use and the extent of social inequality in the demand, use and, access, resolution of health problems, satisfaction, and health care use of Brazilian Unified National Health System (SUS) according to education levels in the population living in the urban area of the Municipality of São Paulo, in 2003 and 2015. We analyzed data from two population-based household health surveys (Health Survey in São Paulo City - ISA-Capital) from 2003 and 2015. Dependent variables related to health care use in the two weeks preceding the survey and due to diseases included demand, access, satisfaction, problem resolution, and the public or private nature of the service. Prevalence was estimated using level of education and prevalence ratios (PR) by the Poisson regression. In the period, the demand for health care, access, resolution, and use of public health care increased from 2003 to 2015. Inequities in public health care use changed from 2003 to 2015 according to level of education. We found no social inequities in health care use in the municipality of São Paulo regarding demand, access, satisfaction, and resolution according to levels of education. Results show progress in the use and resolution of health care services, as well as the strong concentration of the use of SUS by the population with lower education. Results indicate the progress that SUS has made, but also show persistent challenges in the use and access to services.
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Affiliation(s)
| | | | - Elaine Cristina Tôrres Oliveira
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
- Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, Brasil
| | | | | | - Moisés Goldbaum
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
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Carvalho AG, Dias CLH, Blok DJ, Ignotti E, Luz JGG. Intra-urban differences underlying leprosy spatial distribution in central Brazil: geospatial techniques as potential tools for surveillance. GEOSPATIAL HEALTH 2023; 18. [PMID: 37902566 DOI: 10.4081/gh.2023.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023]
Abstract
This ecological study identified an aggregation of urban neighbourhoods spatial patterns in the cumulative new case detection rate (NCDR) of leprosy in the municipality of Rondonópolis, central Brazil, as well as intra-urban socioeconomic differences underlying this distribution. Scan statistics of all leprosy cases reported in the area from 2011 to 2017 were used to investigate spatial and spatiotemporal clusters of the disease at the neighbourhood level. The associations between the log of the smoothed NCDR and demographic, socioeconomic, and structural characteristics were explored by comparing multivariate models based on ordinary least squares (OLS) regression, spatial lag, spatial error, and geographically weighted regression (GWR). Leprosy cases were observed in 84.1% of the neighbourhoods of Rondonópolis, where 848 new cases of leprosy were reported corresponding to a cumulative NCDR of 57.9 cases/100,000 inhabitants. Spatial and spatiotemporal high-risk clusters were identified in western and northern neighbourhoods, whereas central and southern areas comprised low-risk areas. The GWR model was selected as the most appropriate modelling strategy (adjusted R²: 0.305; AIC: 242.85). By mapping the GWR coefficients, we identified that low literacy rate and low mean monthly nominal income per household were associated with a high NCDR of leprosy, especially in the neighbourhoods located within high-risk areas. In conclusion, leprosy presented a heterogeneous and peripheral spatial distribution at the neighbourhood level, which seems to have been shaped by intra-urban differences related to deprivation and poor living conditions. This information should be considered by decision-makers while implementing surveillance measures aimed at leprosy control.
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Affiliation(s)
- Amanda G Carvalho
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, Rondonópolis, Brazil; Post-Graduation Program in Health Sciences, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá.
| | - Carolina Lorraine H Dias
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, Rondonópolis.
| | - David J Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam.
| | - Eliane Ignotti
- Post-Graduation Program in Health Sciences, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Brazil; Post-Graduation Program in Environmental Sciences, School of Health Sciences, State University of Mato Grosso, Cáceres.
| | - João Gabriel G Luz
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, Rondonópolis.
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Rossi CE, Pinho MGM, Corrêa EN, de Abreu ÂH, Rech CR, Ferreira JRDC, de Vasconcelos FDAG. Neighborhood Availability and Use of Food, Physical Activity, and Social Services Facilities in Relation to Overweight and Obesity in Children and Adolescents. Food Nutr Bull 2023; 44:12-26. [PMID: 36601667 DOI: 10.1177/03795721221146215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the association of a combined measure of availability and use of facilities from the food environment and overweight (including obesity) among schoolchildren, while taking into account the physical activity and social-assistance environments. METHODS Cross-sectional study with a probabilistic sample of schoolchildren aged 7 to 14 years living in a southern Brazilian city (n = 2026). Multilevel analyses were performed with overweight as outcome and the food environment as main exposure. Models were adjusted for the physical activity and social-assistance environments, as well as individual and other residential neighborhood characteristics. RESULTS Greater availability of restaurants around the home was associated with higher odds of overweight (odds ratio [OR] = 1.40; 95% CI = 1.06-1.85). Stronger associations were found for schoolchildren reporting to use restaurants (OR = 1.48; 95% CI = 1.15-1.90). This association remained significant after adjusting for the presence of other food retailers. Schoolchildren who had social-assistance facilities around their homes, but reported not to use them, showed consistently higher odds of being overweight (OR = 1.34; 95% CI = 1.01-1.78) as compared to schoolchildren who had these facilities near home and used them. The physical activity environment was not associated with the outcome. CONCLUSIONS Availability and use of the food and social-assistance environments were significantly associated with overweight (including obesity) among the schoolchildren. Future research should consider the use of environmental facilities in combination to their geographical availability. Our results highlight the need for policies that limit the access to obesogenic food outlets by children and adolescents.
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Affiliation(s)
| | - Maria Gabriela M Pinho
- Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands.,Upstream Team, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Elizabeth Nappi Corrêa
- Universidade Federal de Santa Catarina. Rua Engenheiro Agronômico Andrei Cristian Ferreira, s/n-Centro de Ciências da Saúde, Trindade, Florianópolis-Santa Catarina, Brazil
| | - Ângelo Horta de Abreu
- Gis Especialist. Imagem-Enterprise for Geographic Intelligence Solutions. Belo Horizonte-Minas Gerais, Brazil
| | - Cassiano Ricardo Rech
- Programa de Pós-Graduação em Educação Física (PPGEF), Campus Universitário Trindade, Florianópolis-Santa Catarina, Brazil
| | | | - Francisco de Assis Guedes de Vasconcelos
- Universidade Federal de Santa Catarina. Rua Engenheiro Agronômico Andrei Cristian Ferreira, s/n-Centro de Ciências da Saúde, Trindade, Florianópolis-Santa Catarina, Brazil
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Quadra MR, Shäfer AA, Meller FDO. Inequalities in the use of health services in a municipality in Southern Brazil in 2019: a cross-sectional study. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2023; 32:e2022437. [PMID: 36946830 PMCID: PMC10027051 DOI: 10.1590/s2237-96222023000100025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/07/2022] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE to assess inequalities in the use of health services in a municipality in Southern Brazil. METHODS This was a population-based cross-sectional study conducted with adults living in the urban area of the municipality of Criciúma, state of Santa Catarina, Brazil, between March and December 2019; the research outcomes were medical consultation, dental visit, nutritional counseling and the use of the Brazilian National Health System (Sistema Único de Saúde - SUS); the exposures were age, schooling and income; inequalities were analyzed using the Slope index of inequality and equiplots. RESULTS A total of 820 individuals were studied; medical consultation was higher (14.2 percentage points [p.p.]), and dental visit was lower (-29.5 p.p.), in older adults, when compared to young people; dental visit (41.1 p.p.) and nutritional counseling (18.0 p.p.) were higher in individuals with higher level of education, when compared to those with lower level of education; the use of SUS was higher in older adults (21.3 p.p.), with lower level of education (-61.2 p.p.) and lower income (-51.6 p.p.), when compared to their peers. CONCLUSION in order to develop public policies, these inequalities should be taken into consideration.
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Affiliation(s)
- Micaela Rabelo Quadra
- Universidade do Extremo Sul Catarinense, Programa de Pós-Graduação
em Ciências da Saúde, Criciúma, SC, Brasil
| | - Antônio Augusto Shäfer
- Universidade do Extremo Sul Catarinense, Programa de Pós-Graduação
em Saúde Coletiva, Criciúma, SC, Brasil
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Tang S, Yao L, Ye C, Li Z, Yuan J, Tang K, Qian D. Can health service equity alleviate the health expenditure poverty of Chinese patients? Evidence from the CFPS and China health statistics yearbook. BMC Health Serv Res 2021; 21:718. [PMID: 34289849 PMCID: PMC8293547 DOI: 10.1186/s12913-021-06675-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To comprehend the relationship between various indicators of health service equity and patients’ health expenditure poverty in different regions of China, identify areas where equity in health service is lacking and provide ideas for improving patients’ health expenditure poverty. Method Data from China Family Panel Studies (CFPS) in 2018 and the HFGT index formula were used to calculate the health expenditure poverty index of each province. Moreover, Global Moran’s I and Local Moran’s I test are applied to measure whether there is spatial aggregation of health expenditure poverty. Finally, an elastic net regression model is established to analyze the impact of health service equity on health expenditure poverty, with the breadth of health expenditure poverty as the dependent variable and health service equity as the independent variable. Results In the developed eastern provinces of China, the breadth of health expenditure poverty is relatively low. There is a significant positive spatial agglomeration. “Primary medical and health institutions per 1,000 population”, “rural doctors and health workers per 1,000 population”, “beds in primary medical institutions per 1,000 population”, “proportion of government health expenditure” and “number of times to participate in medical insurance (be aided) per 1,000 population” have a positive impact on health expenditure poverty. “Number of health examinations per capita” and “total health expenditure per capita” have a negative impact on health expenditure poverty. Both effects passed the significance test. Conclusion To enhance the fairness of health resource allocation in China and to alleviate health expenditure poverty, China should rationally plan the allocation of health resources at the grassroots level, strengthen the implementation of hierarchical diagnosis and treatment and encourage the investment in business medical insurance industry. Meanwhile, it is necessary to increase the intensity of medical assistance and enrich financing methods. All medical expenses of the poorest should be covered by the government. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06675-y.
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Affiliation(s)
- Shaoliang Tang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China.
| | - Ling Yao
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chaoyu Ye
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhengjun Li
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jing Yuan
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Kean Tang
- Faculty of Science, Skane, Lund University, Lund, Sweden
| | - David Qian
- Swinburne Business School, Swinburne University of Technology, Melbourne, Australia
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Oliveira MAD, Boska GDA, Oliveira MAFD, Barbosa GC. Access to health care for people experiencing homelessness on Avenida Paulista: barriers and perceptions. Rev Esc Enferm USP 2021; 55:e03744. [PMID: 34259755 DOI: 10.1590/s1980-220x2020033903744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the perceptions of homeless people on Avenida Paulista in the city of São Paulo regarding access to health devices in the region. METHOD This is a qualitative research conducted with 10 people who were homeless on Avenida Paulista in January 2019. Data were collected through semi-structured interviews, and analysis of the findings was made using hermeneutics-dialectics. Two categories of results were created: Health services accessed in the region by homeless people; Barriers to health access faced by homeless people on Avenida Paulista, São Paulo. This study obtained ethical approval. RESULTS Seeking emergency services occurs as the main gateway for homeless people in the region, and among the barriers faced, prejudice is placed as the main phenomenon. CONCLUSION It is necessary to consider the specificities of this population, understand their conceptions of health-disease and their trajectories so that services can be improved and access to health for this vulnerable and growing group can be guaranteed.
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Affiliation(s)
| | | | | | - Guilherme Correa Barbosa
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Enfermagem, Botucatu, SP, Brasil
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Riley M, Swann A, Morris AJ, Martins SM, Adams R, Jordan RE. Knowledge, attitudes and practices of patients and healthcare professionals regarding oral health and COPD in São Paulo, Brazil: a qualitative study. NPJ Prim Care Respir Med 2021; 31:20. [PMID: 33947866 PMCID: PMC8096830 DOI: 10.1038/s41533-021-00235-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/29/2021] [Indexed: 12/02/2022] Open
Abstract
Poor oral health is associated with worse clinical outcomes in Chronic Obstructive Pulmonary Disease (COPD). This qualitative study aimed to investigate the knowledge, attitudes and practices of COPD patients and primary health care professionals (HCPs) in Brazil - where there are high rates of COPD and periodontal disease. Semi-structured interviews with COPD patients (n = 9) and three semi-structured focus groups with HCPs (n = 25) were conducted in São Paulo. Interviews were thematically analysed using The Framework Method. Despite a high prevalence of edentulism, patients viewed tooth loss and decay as a norm and neglected preventative oral health practices. HCPs blamed patients for avoiding preventative opportunities, whilst patients discussed significant barriers to oral healthcare. Knowledge of the relationship between oral health and COPD was lacking among HCPs and patients, but all participants were receptive to oral health education. Practitioners identified the need for a COPD primary care pathway that integrates oral health protocols. This study indicates that Brazil must incorporate preventative oral health into COPD management and expand public dental services to increase uptake.
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Affiliation(s)
- Matthew Riley
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Amber Swann
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Alexander J Morris
- School of Dentistry, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sonia M Martins
- Department of Community Health, Faculty of Medicine of ABC, São Bernardo do Campo, São Paulo, Brazil
- Respiratory Group, Brazilian Society of Family and Community Medicine, São Bernardo do Campo, São Paulo, Brazil
| | - Rachel Adams
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Rachel E Jordan
- Institute for Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
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Medeiros ADA, Galvão MHR, Barbosa IR, Oliveira AGRDC. Use of rehabilitation services by persons with disabilities in Brazil: A multivariate analysis from Andersen's behavioral model. PLoS One 2021; 16:e0250615. [PMID: 33914791 PMCID: PMC8084141 DOI: 10.1371/journal.pone.0250615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background For many years, discussions about health care for people with disabilities (PwD) in Brazil have not been treated as a priority; however, based on the advances made at the beginning of this century, new policies have been developed with the aim of improving access of these people to health services. Therefore, the aim of this study was to analyze how individual characteristics and contextual indicators are associated with access to rehabilitation services for PwD in Brazil. Methods A multivariate analysis was performed based on data from the National Health Survey 2013, considering access to rehabilitation services by PwD as the primary outcome and individual and contextual factors selected from Andersen’s behavioral model as independent variables. The contextual variables were reduced to two composite indicators (1-primary health care coverage and unfavorable socioeconomic conditions, and 2-economic inequality) from the analysis of the principal components. Poisson regression analysis with robust variance was performed to estimate the prevalence ratio (PR) and the respective 95% confidence interval (95%CI). Results Access to rehabilitation services by PwD was more prevalent in people aged 0 to 17 years (PR = 3.28; 95%CI 2.85–3.78), who are illiterate (PR = 1.24; 95%CI 1.09–1.40), whose socioeconomic level is A or B (PR = 1.60; 95%CI 1.35–1.88), who have health insurance (PR = 1.31; 95%CI 1.15–1.49), who have severe limitations (PR = 3.09; 95%CI 2.64–3.62), who live in states with a good offer of Specialized Rehabilitation Centers, both type II (PR = 1.20; CI95% 1.08; 1.33) and type IV (PR = 1.29; CI95% 1.15; 1.44), and who have greater coverage of primary health care, but unfavorable socioeconomic conditions (PR = 1.15; CI95% 1.03–1.28). Conclusion The results clarify the social inequities that exist regarding access to rehabilitation services for PwD in Brazil and highlight the need to formulate and implement public policies that guarantee the realization of the rights of these people.
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Affiliation(s)
- Arthur de Almeida Medeiros
- Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Graduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- * E-mail:
| | | | - Isabelle Ribeiro Barbosa
- Graduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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de Moraes Bernal H, de Abreu LC, Pinheiro Bezerra IM, Adami F, Takasu JM, Ji Young Suh JV, de Lira Ribeiro S, de Sousa Santos EF. Incidence of hospitalization and mortality due to stroke in young adults, residents of developed regions in Brazil, 2008-2018. PLoS One 2020; 15:e0242248. [PMID: 33196650 PMCID: PMC7668581 DOI: 10.1371/journal.pone.0242248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 10/29/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction We evaluated trends in hospitalization incidence and mortality due to hemorrhagic and ischemic stroke in young adults, according to gender and developed regions in Brazil. Methods Between 2008–2018, we performed a population-based time-series study using official hospitalization and death data due to stroke, in individuals aged 10–49 years, from Southeast and South, Brazil. Data were based on reports from the Unified Health System of Hospital Information System and Mortality Information System. Stroke was defined by the International Classification of Diseases, 10th revision (I60–I63). A Prais-Winsten regression model was performed and the Annual Percentage Change was calculated. Results In total, 78,123 hospitalizations of individuals aged 10–49 years were recorded, of which 59,448 (76%) resulted from hemorrhagic stroke (HS). The hospitalizations for HS was significantly decreased (- 4.37%) among men and women in both regions. The hospitalizations for ischemic stroke (IS) was flat, except between 2011 and 2018, when IS hospitalization rates increased. In the analysis by states, HS hospitalizations declined across all states, except for Espírito Santo, where it remained unchanged (p > 0.05). IS flat hospitalizations were observed in all states, except Espírito Santo, where it increased by 24.93%. In terms of mortality, 28,625 deaths were recorded, of which 26,548 (92.7%) resulted from HS. HS mortality decreased significantly by -3.48%and IS mortality by -3.84%. Decreases also occurred in all Southeast and South states (p < 0.05). IS remained unchanged across all states, except Minas Gerais, where it decreased by -14.95%. Conclusions We identified a decline in the hospitalizations and mortality of HS and a flat trend for IS in developed regions of Brazil. The recent period (2011–2018) demonstrated increasing rates in the hospitalizations of IS in both regions and genders. The mortality rates for HS and IS decreased between 2008–2018 in Southeast and South Brazil for both genders.
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Affiliation(s)
- Henrique de Moraes Bernal
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
- * E-mail:
| | - Luiz Carlos de Abreu
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
- Programa de Mestrado em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia, Vitória, Brazil
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Italla Maria Pinheiro Bezerra
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
- Programa de Mestrado em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia, Vitória, Brazil
| | - Fernando Adami
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
| | - Jessica Miwa Takasu
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
| | - João Victor Ji Young Suh
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
| | - Silmara de Lira Ribeiro
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
| | - Edige Felipe de Sousa Santos
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
- Faculdade de Saúde Pública, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
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Bariatric Surgery Offer in Brazil: a Macroeconomic Analysis of the Health system's Inequalities. Obes Surg 2020; 29:1874-1880. [PMID: 30739302 DOI: 10.1007/s11695-019-03761-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Brazil currently holds the second place in the worldwide ranking of the largest number of bariatric surgical procedures performed. The offer of bariatric surgery in the public health system is not sufficient for its demand; it remains to be determined whether the recent economic downturn affected this offer. OBJECTIVE To analyze the proportion of bariatric surgeries performed by the public system in Brazil and assess the influence of macroeconomic variables over time. METHODS This is a nationwide analysis which correlated the estimated number of bariatric surgeries in Brazil in both public and private health-providing systems from 2003 through 2017 with the main macroeconomic variables of Brazil during the evaluated period (gross domestic product [GDP], inflation rate, and unemployment rate), and both overall and public healthcare expenditures. RESULTS The proportion of surgeries performed in the public system varied from 7.1% in 2014 to 10.4% in 2004. There was a significant positive correlation between the public proportion of surgeries with the unemployment rate (R = 0.55666; P = 0.03868). There were significant negative correlations between the proportion of public surgeries with the public health expenditure per capita (R = - 0.88811; P = 0.00011) and with the public percentage of healthcare expenditure per capita (R = - 0.67133; P = 0.01683). CONCLUSION There were direct correlations between the number of public bariatric procedures and the unemployment rate, as well as with the public healthcare expenditure per capita. Despite the increase in the number of public procedures, its proportion reveals an insufficiency of the current offer of bariatric surgery provided by the public system.
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Rodrigues AMAM, Cavalcanti AL, Pereira JLDSH, Araújo CLCD, Bernardino ÍDM, Soares RL, Freire DEWG, Soares RDSC. Uso dos serviços de saúde segundo determinantes sociais, comportamentos em saúde e qualidade de vida entre diabéticos. CIENCIA & SAUDE COLETIVA 2020; 25:845-858. [PMID: 32159655 DOI: 10.1590/1413-81232020253.19532018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/19/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo investigou a utilização dos serviços de saúde segundo determinantes sociais, comportamentos em saúde e qualidade de vida entre diabéticos. A amostra foi composta por 416 diabéticos cadastrados na Estratégia Saúde da Família de um município do Nordeste do Brasil. A análise dos dados incluiu estatísticas descritivas, bivariadas e multivariada por meio da modelagem de Árvore de Decisão usando o algoritmo Chi-squared Automatic Interaction Detector (CHAID). Evidenciou-se expressiva utilização dos serviços públicos de saúde (80,7%). A utilização do serviço público de saúde com regularidade envolveu indivíduos com escolaridade baixa ou média (p < 0,001), empregados ou aposentados e/ou pensionistas (p = 0,019), com alto impacto do diabetes na qualidade de vida (p = 0,032), e que realizavam a quantidade recomendada de exames de glicemia em jejum ao ano (p < 0,001). A utilização dos serviços de saúde pôde ser explicada por diferenças relacionadas aos determinantes sociais, aos comportamentos em saúde e ao impacto do diabetes na qualidade de vida dos usuários.
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Leal MDC, Esteves-Pereira AP, Viellas EF, Domingues RMSM, Gama SGND. Prenatal care in the Brazilian public health services. Rev Saude Publica 2020; 54:08. [PMID: 31967277 PMCID: PMC6961968 DOI: 10.11606/s1518-8787.2020054001458] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/22/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To verify regional inequalities regarding access and quality of prenatal and birth care in Brazilian public health services and associated perinatal outcomes. METHODS Birth in Brazil was a national hospital-based survey conducted between 2011 and 2012, which included 19,117 women with public-funded births. Regional differences in socio-demographic and obstetric characteristics, as well as differences in access and quality of prenatal and birth care were tested by the χ2 test. The following outcomes were assessed: spontaneous preterm birth, provider-initiated preterm birth, low birth weight, intrauterine growth restriction, Apgar in the 5th min < 8, neonatal and maternal near miss. Multiple and non-conditional logistic regressions were used for the analysis of the associated perinatal outcomes, with the results expressed in adjusted odds ratio and 95% confidence interval. RESULTS Regional inequalities regarding access and quality of prenatal and birth care among users of public services are still evident in Brazil. Pilgrimage for birth associated with all perinatal outcomes studied, except for intrauterine growth restriction. The odds ratios ranged between 1.48 (95%CI 1.23-1.78) for neonatal near miss and 1.62 (95%CI 1.27-2.06) for provider-initiated preterm birth. Among women with clinical or obstetric complications, pilgrimage for birth associated with provider-initiated preterm birth and with Apgar in the 5th min < 8, odds ratio of 1.98 (95%CI 1.49-2.65) and 2.19 (95%CI 1.31-3.68), respectively. Inadequacy of prenatal care associated with spontaneous preterm birth in both groups of women, with or without clinical or obstetric complications. CONCLUSION Improvements in the quality of prenatal care, appropriate coordination and comprehensive care at the time of birth have a potential to reduce prematurity rates and, consequently, infant morbidity and mortality rates in the country.
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Affiliation(s)
- Maria do Carmo Leal
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública (ENSP/Fiocruz). Departamento de Epidemiologia e Métodos Quantitativos em Saúde (DEMQS). Rio de Janeiro, RJ, Brasil
| | - Ana Paula Esteves-Pereira
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública (ENSP/Fiocruz). Departamento de Epidemiologia e Métodos Quantitativos em Saúde (DEMQS). Rio de Janeiro, RJ, Brasil
| | - Elaine Fernandes Viellas
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública (ENSP/Fiocruz). Departamento de Epidemiologia e Métodos Quantitativos em Saúde (DEMQS). Rio de Janeiro, RJ, Brasil
| | - Rosa Maria Soares Madeira Domingues
- Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em HIV/Aids (INI/Fiocruz). Rio de Janeiro, RJ, Brasil
| | - Silvana Granado Nogueira da Gama
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública (ENSP/Fiocruz). Departamento de Epidemiologia e Métodos Quantitativos em Saúde (DEMQS). Rio de Janeiro, RJ, Brasil
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Chávez GM, Viegas SMDF, Roquini GR, Santos TR. Acesso, acessibilidade e demanda na estratégia saúde da família. ESCOLA ANNA NERY 2020. [DOI: 10.1590/2177-9465-ean-2019-0331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo compreender demanda, acesso e acessibilidade perante as necessidades de saúde, sob a ótica de profissionais e usuários da Estratégia Saúde da Família (ESF). Método utilizou-se a Teoria Fundamentada nos Dados, ancorada no Interacionismo Simbólico, com 34 participantes, usuários e profissionais da ESF de município de grande porte. Resultados as demandas cotidianas na ESF e as limitações do acesso evidenciam as dificuldades enfrentadas pelas equipes pela baixa cobertura populacional, elevado número de pessoas cadastradas, baixa resolutividade, falta de profissionais, ineficácia da gestão e escassez de ações programadas. As concepções de acesso, acessibilidade e resolutividade são contextualizadas no acolhimento e humanização, na precisão de ampliar a cobertura populacional e o acesso, além de os usuários e profissionais expressarem seus sentimentos de frustração, angústia e insatisfação perante a baixa resolutividade e insuficiência de recursos. Conclusões e implicações para prática a ESF ainda trabalha a lógica da atenção curativa, cujas atividades são realizadas dentro do consultório, com recursos insuficientes, elevada demanda reprimida e muitos desafios. Apresenta subsídios para que os profissionais de saúde, usuários e gestores busquem, de forma colaborativa, estratégias de enfrentamento da elevada demanda espontânea e dificuldades de acesso.
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Ehteshami A, Saghaeiannejad-Isfahani S, Samadbeik M, Falah K. Formulating Telemedicine Strategies in Isfahan University of Medical Sciences. Acta Inform Med 2018; 26:169-174. [PMID: 30515007 PMCID: PMC6195393 DOI: 10.5455/aim.2018.26.169-174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 07/20/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The use of telemedicine technology can lead to an equitable distribution of specialized care. There are numerous influencing factors which should be identified for successful implementation and efficacy of telemedicine. The aim of this study was to evaluate current situation and internal and external environment of Isfahan University of Medical Sciences (IUMS) and prepare telemedicine development strategies for IUMS. METHODS This study was an applied cross-sectional mixed method study which was conducted between July 2014 to November 2016 and in five phases in IUMS. a) Evaluating Internal and external factors (IFE & EFE); b) Formulating goals; c) Identifying and prioritizing strategic problems; d) Setting objectives; and e) formulating the strategies to develop telemedicine in IUMS. The research sample included 147 of IUMS inner customers and stakeholders in the first phase (census) and 14 in the second phase (Purposive sampling based on more work experience). In the first phase, to analyze obtained data of two researcher-made questionnaires, measures of central tendency and dispersion (frequency, percent and mean) were calculated using SPSS. To evaluate internal and external factors and formulating strategies was used TOWS matrix. And finally, to select optimal strategies for telemedicine developing quantitative strategic planning matrix was used. RESULTS The final score of internal and external factors evaluation was 2.67 and 2.68, respectively. According to the strategic position and action evaluation (SPACE), telemedicine strategic planning in IUMS was in aggressive posture. Because the numbers were closer to 2.5 can be concluded that based on internal factors the organization was in moderate to strong and based on external factors was in a moderate level and neither have a serious positive feature for use the opportunities outside the organization and suffered a serious threat from the outside of organization. Finally, we formulated 14 strategies to develop telemedicine in IUMS as followings: 5 SO, 2 ST, 5 WO, and 2 WT strategies. CONCLUSION Telemedicine development in IUMS is located in poor aggressive posture. Therefore, IUMS can develop telemedicine and subsequently, in this study, strategies were developed to preserve and retain healthcare workers, practical studies, data confidentiality and security programs, and other issues.
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Affiliation(s)
- Asghar Ehteshami
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mahnaz Samadbeik
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Khdijeh Falah
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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