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Castanheira ERL, Duarte LS, Viana MMDO, Nunes LO, Zarili TFT, Mendonça CS, Sanine PR. Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System's guidelines. CAD SAUDE PUBLICA 2024; 40:PT099723. [PMID: 38422250 PMCID: PMC10896491 DOI: 10.1590/0102-311xpt099723] [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: 05/29/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 03/02/2024] Open
Abstract
This study analyzes the main organization patterns used by primary health care (PHC) services in municipal networks and evaluates them according to indicators of local management-administration interface. Evaluative research analyzed 461 municipalities in São Paulo, Brazil, that participated in the Primary Care Services Quality Assessment Survey (QualiAB) in 2017/2018, classified according to the organizational arrangements composition of 2,472 PHC services. Eight indicators of local management and administration were selected to evaluate the identified patterns. Results indicate two groups of municipalities: homogeneous, with services presenting the same arrangement (43.6%); and heterogeneous, with different arrangements (56.4%). These were subdivided into seven patterns that ranged from homogeneous-traditional, homogeneous-Family Health Strategy, homogeneous-mixed, and different combinations in the heterogeneous group. All indicators showed significant differences between groups (p < 0.001), especially the homogeneous-traditional group, which presented an organizational pattern far from the desired model of a comprehensive and problem-solving PHC. Those integrated with family health units (FHU) and basic health units with community health workers and/or family health teams (BHU/FHU) showed a pattern closer to a comprehensive model - with planning and evaluation actions committed to the local reality and qualification of care. Implementation of federal and state policies are essential for defining the PHC health care model adopted by municipalities.
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Affiliation(s)
| | | | | | - Luceime Olívia Nunes
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil
| | | | - Carolina Siqueira Mendonça
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil
| | - Patricia Rodrigues Sanine
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil
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Araújo MSM, Branco MDRFC, Costa SDSB, de Oliveira DC, Queiroz RCDS, de Oliveira BLCA, Pasklan ANP, dos Santos AM. [COVID-19 mortality in metropolitan areas vs. other regions of Brazil, 2020 to 2021Mortalidad por COVID-19 en las regiones metropolitanas y en el interior de Brasil, 2020-2021]. Rev Panam Salud Publica 2023; 47:e115. [PMID: 37489235 PMCID: PMC10361444 DOI: 10.26633/rpsp.2023.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/21/2023] [Indexed: 07/26/2023] Open
Abstract
Objective To compare hospital mortality rates (HMR) due to severe acute respiratory syndrome (SARS) associated with COVID-19 recorded in metropolitan areas and other regions (interior) of Brazil in 2020 and 2021. Method This ecological study used public data available on OpenDataSUS. The information was accessed in May 2022. The following variables were considered: age, sex, hospitalization, presence of a risk factor, ICU stay, use of ventilatory support, and final classification in the individual registration form of SARS cases due to COVID-19. Cases and deaths were stratified into five age groups (0-19 years, 20-39 years, 40-59 years, 60-79 years, and ≥80 years) and by place of residence (metropolitan area or interior). The HMR had as numerator the absolute number of deaths by SARS associated with covid-19; and, as a denominator, the absolute number of cases of SARS due to covid-19 according to the year of occurrence, area of residence, age bracket, sex, hospitalization, presence of a risk factor, ICU admission, and use of ventilatory support. Results There was a significant increase in HMR due to SARS associated with COVID-19 in 2021 in all age groups, except 0-19 years and ≥80 years, as well as among individuals admitted to an ICU and who used invasive ventilatory support, both in metropolitan areas as well as in the interior. Conclusions There was a worsening of the epidemiological scenario in 2021 with an increase in HMR. However, no differences were identified between the metropolitan regions and the interior of the country.
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Affiliation(s)
- Mayra Sharlenne Moraes Araújo
- Universidade Federal do Maranhão (UFMA)Programa de Pós-Graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-Graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Maria dos Remédios Freitas Carvalho Branco
- Universidade Federal do Maranhão (UFMA)Programa de Pós-Graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-Graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Silmery da Silva Brito Costa
- Universidade Federal do MaranhãoDepartamento de Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão, Departamento de Saúde Coletiva, São Luís (MA), Brasil.
| | - Daniel Cavalcante de Oliveira
- Universidade Federal do ABC (UFABC)Departamento de Engenharia BiomédicaSanto André (SP)BrasilUniversidade Federal do ABC (UFABC), Departamento de Engenharia Biomédica, Santo André (SP), Brasil.
| | - Rejane Christine de Sousa Queiroz
- Universidade Federal do Maranhão (UFMA)Programa de Pós-Graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-Graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Bruno Luciano Carneiro Alves de Oliveira
- Universidade Federal do Maranhão (UFMA)Programa de Pós-Graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-Graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Amanda Namíbia Pereira Pasklan
- Universidade Federal do MaranhãoDepartamento de MedicinaSão Luís (MA)BrasilUniversidade Federal do Maranhão, Departamento de Medicina, São Luís (MA), Brasil.
| | - Alcione Miranda dos Santos
- Universidade Federal do Maranhão (UFMA)Programa de Pós-Graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-Graduação em Saúde Coletiva, São Luís (MA), Brasil.
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Romero DE, Maia L, Muzy J, Andrade N, Souza Junior PRBD. Factors associated with worsening in the self-rated health status of Brazilian women who lived with dependent elderly people during the first wave of COVID-19. CIENCIA & SAUDE COLETIVA 2023; 28:2051-2064. [PMID: 37436318 DOI: 10.1590/1413-81232023287.13702022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 07/13/2023] Open
Abstract
The objective is to analyze the factors associated with the worsening of the self-rated health (SRH) of Brazilian women who live with elderly people with functional dependence (EFD) during the first wave of COVID-19. ConVid - Behavior Research was used as a data source. For the analysis, the group of women who lived with EFD was compared with those who lived with the elderly without any dependence. Hierarchical prevalence ratio (PR) models were estimated to test the associations between sociodemographic characteristics, changes in income, routine activities and health in the pandemic, with the outcome of worsening SRH. This worsening was more frequent in the group of women living with EFD. After adjusting for hierarchical factors, being black (PR=0.76; 95%CI 0.60-0.96) and having a per capita income lower than minimum wage (PR=0.78; 95%CI 0.64- 0.96) were shown to be protective factors for SRH worsening among EFD co-residents. Indisposition, emergence/worsening of back problems, affected sleep, poor SRH, feeling loneliness and difficulty in carrying out routine activities during the pandemic were positively associated factors. The study demonstrates that living with EFD was associated with a worsening in the health status of Brazilian women during the pandemic, especially among those of higher social status.
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Affiliation(s)
- Dalia Elena Romero
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. Rio de Janeiro RJ Brasil.
| | - Leo Maia
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. Rio de Janeiro RJ Brasil.
| | - Jessica Muzy
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. Rio de Janeiro RJ Brasil.
| | - Nathália Andrade
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. Rio de Janeiro RJ Brasil.
| | - Paulo Roberto Borges de Souza Junior
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4.365, Pavilhão Haity Moussatché, Manguinhos. Rio de Janeiro RJ Brasil.
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Santos LPDS, Lima AMFDS, Chaves SCL, Vilela DMOC, Valente APPC, Rossi TRA. Oral Health Policy in Brazil: changes and ruptures during the period 2018-2021. CIENCIA & SAUDE COLETIVA 2023; 28:1575-1587. [PMID: 37194888 DOI: 10.1590/1413-81232023285.14002022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/04/2022] [Indexed: 05/18/2023] Open
Abstract
This study analyzed the implementation of Brazil's National Oral Health Policy during the period 2018-2021, covering institutional actions, implementation of public dental services, results achieved, and federal funding. We conducted a retrospective descriptive study using documentary analysis and secondary data obtained from institutional websites, government information systems, and reports published by dental organizations. The findings show a significant reduction in funding between 2020 and 2021 and declining performance against indicators since 2018, such as coverage of first dental appointments and group supervised tooth brushing, which stood at 1.8% and 0.02%, respectively, in 2021. Federal funding dropped in 2018 and 2019 (8.45%), followed by an increase in 2020 (59.53%) and decrease in 2021 (-5.18%). The study period was marked by economic and political crises aggravated by the COVID-19 pandemic. This context influenced the functioning of health services in Brazil. There was a sharp reduction in performance against oral health indicators, while performance in primary health care and specialized care services remained stable.
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Affiliation(s)
- Lília Paula de Souza Santos
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. R. Basílio da Gama s/n, Canela. 40110-040 Salvador BA Brasil.
| | | | - Sônia Cristina Lima Chaves
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. R. Basílio da Gama s/n, Canela. 40110-040 Salvador BA Brasil.
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Almeida PFD, Casotti E, Silvério RFL. Care trajectories of COVID-19 patients: from preventive measures to rehabilitation. CAD SAUDE PUBLICA 2023; 39:e00163222. [PMID: 36820728 DOI: 10.1590/0102-311xpt163222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/09/2023] [Indexed: 02/19/2023] Open
Abstract
This study aims to analyze the care trajectories of patients diagnosed with COVID-19 who were hospitalized and are currently undergoing rehabilitation regarding their use of and access to the healthcare network (HN). An evaluative, qualitative study was carried out based on interviews with patients in the city of Niterói, Rio de Janeiro State, Brazil. The care trajectories were reconstructed at three different occasions that express their experiences with the healthcare and support network during the pandemic: prevention, support and diagnosis measures; hospitalization; post-COVID-19 care, rehabilitation and support. The results indicate that the main source of information about COVID-19 was TV newscasts. Preventive hygiene measures were the most widely adopted. The family was the main support network. There was no waiting time for admission to the municipal referral hospital. Hospitalization was very well evaluated in terms of user embracement, multidisciplinary care, virtual visits and daily contact between doctor and family members. A post-discharge "care vacuum" was identified, with no follow-up by primary health care (PHC) and other public services. Low-cost health insurance plans and private specialized post-COVID-19 services were frequently and spontaneously sought until the implementation of the rehabilitation service. In summary, solitary and discontinuous care trajectories of individuals and families shed light on several challenges to the health system, including guaranteed access to coordinated PHC and expanded offer of specialized public services and rehabilitation, aligned with the principles of humanized care, in addition to the maintenance of social support measures.
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Affiliation(s)
| | - Elisete Casotti
- Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Brasil
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Almeida PFD, Casotti E, Silvério RFL. Care trajectories of COVID-19 patients: from preventive measures to rehabilitation. CAD SAUDE PUBLICA 2023. [DOI: 10.1590/0102-311xen163222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
This study aims to analyze the care trajectories of patients diagnosed with COVID-19 who were hospitalized and are currently undergoing rehabilitation regarding their use of and access to the healthcare network (HN). An evaluative, qualitative study was carried out based on interviews with patients in the city of Niterói, Rio de Janeiro State, Brazil. The care trajectories were reconstructed at three different occasions that express their experiences with the healthcare and support network during the pandemic: prevention, support and diagnosis measures; hospitalization; post-COVID-19 care, rehabilitation and support. The results indicate that the main source of information about COVID-19 was TV newscasts. Preventive hygiene measures were the most widely adopted. The family was the main support network. There was no waiting time for admission to the municipal referral hospital. Hospitalization was very well evaluated in terms of user embracement, multidisciplinary care, virtual visits and daily contact between doctor and family members. A post-discharge “care vacuum” was identified, with no follow-up by primary health care (PHC) and other public services. Low-cost health insurance plans and private specialized post-COVID-19 services were frequently and spontaneously sought until the implementation of the rehabilitation service. In summary, solitary and discontinuous care trajectories of individuals and families shed light on several challenges to the health system, including guaranteed access to coordinated PHC and expanded offer of specialized public services and rehabilitation, aligned with the principles of humanized care, in addition to the maintenance of social support measures.
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Silva GAE, Alcantara LLDM, Tomazelli JG, Ribeiro CM, Girianelli VR, Santos ÉC, Claro IB, Almeida PFD, Lima LDD. [Evaluation of cervical cancer control actions within Brazil and its regions based on data recorded in the Brazilian Unified National Health System]. CAD SAUDE PUBLICA 2022; 38:e00041722. [PMID: 35894365 DOI: 10.1590/0102-311xpt041722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/06/2022] [Indexed: 11/22/2022] Open
Abstract
This study analyzes the performance of screening and diagnosis tests for cervical cancer among women aged 25 to 64 years, as well as the delay for the initiation of treatment within Brazil and in its geographic regions, from 2013 to 2020. Information on populational procedures and estimates was obtained from the information systems of the Brazilian Unified National Health System and the Brazilian National Supplementary Health Agency. We calculated the coverage indicators of the Pap smear, the percentages of altered cytopathological and histopathological tests, and the percentage of women diagnosed with cervical cancer with over 60 days of treatment. There was great variation in the coverage of the Pap smear test among the Brazilian regions with a downward trend from 2013, which was aggravated from 2019 to 2020. The number of altered cytopathological tests was 40% lower than estimated, and the difference between the recorded number of cancer diagnoses and the estimated number of patients was below 50%. The percentage of women diagnosed with invasive cervical cancer, who started treatment after 60 days, ranged from 50% in the South to 70% in the North Region with a decrease from 2018. In 2020, there was a decrease in the number of screening and follow-up tests, reducing the proportion of women delayed in starting treatment in the North, Southeast, and South regions. The decline in screening coverage and inadequate follow-up of women with altered results indicate the need to improve early detection strategies for the disease and establish mechanisms for constant evaluation and monitoring of actions.
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Affiliation(s)
- Gulnar Azevedo E Silva
- Instituto de Medicina Social Hesio Cordeiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | | | - Vania Reis Girianelli
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Édnei Cesar Santos
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Itamar Bento Claro
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
| | | | - Luciana Dias de Lima
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Parente RCM. [Reality of primary care in Brazil: there were never as many resources as in the Bolsonaro government]. CAD SAUDE PUBLICA 2022; 38:e00100622. [PMID: 35830086 DOI: 10.1590/0102-311xpt100622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
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Ramos AN. Persistence of syphilis as a challenge for the Brazilian public health: the solution is to strengthen SUS in defense of democracy and life. CAD SAUDE PUBLICA 2022; 38:PT069022. [PMID: 35584431 DOI: 10.1590/0102-311xpt069022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alberto Novaes Ramos
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Ceará, Fortaleza, Brasil.,Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Brasil
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Almeida PFD, Santos AMD. Primary health care in CSP. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311xen133622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Almeida PFD, Santos AMD. Atención primaria de salud en CSP. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311xes133622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Almeida PFD, Santos AMD. Atenção primária à saúde em CSP. CAD SAUDE PUBLICA 2022; 38:e00133622. [DOI: 10.1590/0102-311xpt133622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 12/23/2022] Open
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Ramos Jr. AN. Persistencia de la sífilis como desafío para la salud pública en Brasil: el camino es fortalecer el SUS, en defensa de la democracia y de la vida. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311xes069022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ramos Jr. AN. Persistence of syphilis as a challenge for the Brazilian public health: the solution is to strengthen SUS in defense of democracy and life. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311xen069022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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