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Ventura MWS, Lima FET, Brito PDS, Pascoal LM, de Albuquerque NLS, de Almeida PC. Social determinants and access to health services in patients with COVID-19: a cross-sectional study. Rev Esc Enferm USP 2024; 58:e20230324. [PMID: 38466908 PMCID: PMC10927267 DOI: 10.1590/1980-220x-reeusp-2023-0324en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/19/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE To verify the association between social determinants of health and access to health services for COVID-19 patients. METHOD Analytical, cross-sectional study, carried out in three states in the Northeast of Brazil (Ceará, Maranhão and Pernambuco), with 968 patients, using questionnaires with sociodemographic data, determinants and the Primary Care Assessment Tool, adapted to the reality of COVID-19, with 58 items, classified as high (score ≥ 6.6) and low (score < 6.6), whose high value reveals better standards of access to health services. The Chi-square test was used for comparative analysis. RESULTS There was a significant difference (p < 0.05) between the domains of the instrument and the following determinants: age, skin color, body mass index, origin, schooling, employment, services close to home, first service, income and means of transport. CONCLUSION Access to health services for people with COVID-19 was associated with various determinants, including individual, behavioural and social ones, correlated with the structural and organizational aspects of the health services offered by the three states of Northeastern Brazil.
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Affiliation(s)
- Maria Williany Silva Ventura
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de enfermagem, Fortaleza, CE, Brazil
| | | | | | - Lívia Maia Pascoal
- Universidade Federal do Maranhão, Departamento de Enfermagem, Imperatriz, MA, Brazil
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Alvares LTDEA, Rangel AG, Campos LN, Viana SW, Kim AWS, Sampaio NZ, Ferreira R, Silva JB, Mooney DP, Camargo CP. Expanding Global Surgery Education in Brazil: Perspectives after the 35th Brazilian Surgical Congress. Rev Col Bras Cir 2024; 51:e20243667. [PMID: 38324886 PMCID: PMC10826473 DOI: 10.1590/0100-6991e-20243667-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/15/2023] [Indexed: 02/09/2024] Open
Abstract
The 35th Brazilian Congress of Surgery marked a turning point for surgical education in the country. For the first time, the Brazilian College of Surgeons included Global Surgery on the main congressional agenda, providing a unique opportunity to rethink how surgical skills are taught from a public health perspective. This discussion prompts us to consider why and how Global Surgery education should be expanded in Brazil. Although Brazilian researchers and institutions have contributed to the fields expansion since 2015, Global Surgery education initiatives are still incipient in our country. Relying on successful strategies can be a starting point to promote the area among national surgical practitioners. In this editorial, we discuss potential strategies to expand Global Surgery education opportunities and propose a series of recommendations at the national level.
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Affiliation(s)
| | - Ayla Gerk Rangel
- - Harvard Medical School, Program in Global Surgery and Social Change - Boston - Massachusetts - Estados Unidos
| | | | | | | | | | - Roseanne Ferreira
- - McMaster University, Department of Health Research Methods, Evidence and, Impact - Hamilton - Ontario - Canadá
| | | | - David P Mooney
- - Boston Children's Hospital - Boston - Massachusetts - Estados Unidos
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Moterani VC, Abbade JF, Borges VTM, Fonseca CGF, Desiderio N, Moterani Junior NJW, Gonçalves Moterani LBB. [Guidelines for clinical trial protocols for interventions involving artificial intelligence: the SPIRIT-AI extensionDiretrizes para protocolos de ensaios clínicos com intervenções que utilizam inteligência artificial: a extensão SPIRIT-AI]. Rev Panam Salud Publica 2023; 47:e149. [PMID: 38361499 PMCID: PMC10868409 DOI: 10.26633/rpsp.2023.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/23/2020] [Indexed: 01/10/2024] Open
Abstract
The SPIRIT 2013 statement aims to improve the completeness of clinical trial protocol reporting by providing evidence-based recommendations for the minimum set of items to be addressed. This guidance has been instrumental in promoting transparent evaluation of new interventions. More recently, there has been a growing recognition that interventions involving artificial intelligence (AI) need to undergo rigorous, prospective evaluation to demonstrate their impact on health outcomes. The SPIRIT-AI (Standard Protocol Items: Recommendations for Interventional Trials-Artificial Intelligence) extension is a new reporting guideline for clinical trial protocols evaluating interventions with an AI component. It was developed in parallel with its companion statement for trial reports: CONSORT-AI (Consolidated Standards of Reporting Trials-Artificial Intelligence). Both guidelines were developed through a staged consensus process involving literature review and expert consultation to generate 26 candidate items, which were consulted upon by an international multi-stakeholder group in a two-stage Delphi survey (103 stakeholders), agreed upon in a consensus meeting (31 stakeholders) and refined through a checklist pilot (34 participants). The SPIRIT-AI extension includes 15 new items that were considered sufficiently important for clinical trial protocols of AI interventions. These new items should be routinely reported in addition to the core SPIRIT 2013 items. SPIRIT-AI recommends that investigators provide clear descriptions of the AI intervention, including instructions and skills required for use, the setting in which the AI intervention will be integrated, considerations for the handling of input and output data, the human-AI interaction and analysis of error cases. SPIRIT-AI will help promote transparency and completeness for clinical trial protocols for AI interventions. Its use will assist editors and peer reviewers, as well as the general readership, to understand, interpret and critically appraise the design and risk of bias for a planned clinical trial.
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Affiliation(s)
- Vinicius Cesar Moterani
- Universidade Estadual Paulista “Júlio de Mesquita Filho,”BotucatuBrazilUniversidade Estadual Paulista “Júlio de Mesquita Filho,” Botucatu, Brazil
| | - Joelcio Francisco Abbade
- Universidade Estadual Paulista “Júlio de Mesquita Filho,”BotucatuBrazilUniversidade Estadual Paulista “Júlio de Mesquita Filho,” Botucatu, Brazil
| | - Vera Therezinha Medeiros Borges
- Universidade Estadual Paulista “Júlio de Mesquita Filho,”BotucatuBrazilUniversidade Estadual Paulista “Júlio de Mesquita Filho,” Botucatu, Brazil
| | - Cecilia Guimarães Ferreira Fonseca
- Universidade Estadual Paulista “Júlio de Mesquita Filho,”BotucatuBrazilUniversidade Estadual Paulista “Júlio de Mesquita Filho,” Botucatu, Brazil
| | - Nathalia Desiderio
- Marilia Medical SchoolMariliaBrazilMarilia Medical School, Marilia, Brazil
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Cardoso FS, Gomes DCK, Silva ASD. Racial inequality in health care of adults hospitalized with COVID-19. CAD SAUDE PUBLICA 2023; 39:e00215222. [PMID: 37971100 PMCID: PMC10645056 DOI: 10.1590/0102-311xpt215222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/02/2023] [Accepted: 07/03/2023] [Indexed: 11/19/2023] Open
Abstract
The objective was to analyze the association of race/skin color in health care, in adults hospitalized with severe acute respiratory syndrome (SARS)/COVID-19, between March 2020 and September 2022, with Brazil as the unit of analysis. This is a cross-sectional study that used the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) database and had a population composed of adults (≥ 18 years) and the final classification was SARS by COVID-19 or unspecified SARS. The direct effect of skin color on in-hospital mortality was estimated through logistic regression adjusted for age, gender, schooling level, health care system and period, stratified by vaccination status. This same model was also used to assess the effect of skin color on the variables related to access to health care services: intensive care unit (ICU), tomography, chest X-ray and ventilatory support. The results show that black, brown and indigenous people died more, regardless the schooling level and number of comorbidities, with 23%, 32% and 80% higher chances of death, respectively, when submitted to ventilatory support. Racial differences were observed in the use of health care services and in outcomes of death from COVID-19 or unspecified SARS, in which ethnic minorities had higher in-hospital mortality and lower use of hospital resources. These results suggest that black and indigenous populations have severe disadvantages compared to the white population, facing barriers to access health care services in the context of the COVID-19 pandemic.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fuentes Bermudez GP, De Arco Canoles ODC. Nursing Services in the First Level of Care in Colombia. Analysis of the Offer 2002-2020. Invest Educ Enferm 2023; 40:e04. [PMID: 36867777 PMCID: PMC10017136 DOI: 10.17533/udea.iee.v40n3e04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/03/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES This work sought to characterize the primary care nursing consultation services reported in the official systemsof health services records in Colombia between 2002 and 2020. METHODS This was a descriptive, cross-sectional, retrospective study. Node geographic analysis and descriptive statistics were performed for quantitative data from the Special Registry of Health Providers and the Ministry of Health and Social Protection. RESULTS The study identified 6079 nursing services of which 72% are outpatient, 95.05% are assigned to institutions providing health services, 99.75% are of low complexity, and 48.22% of the offer was created in the last five years. The nodes with the highest increase in the offer of services are Caribbean (n = 909) and Pacific (n = 499), while Amazon (n = 48) showed the lowest offer in the last five years. CONCLUSIONS Disparity is evident in the availability of services by region and node, in addition to a low liberal exercise to provide nursing care.
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Araújo MDSD, Albuquerque ACD, Felisberto E, Samico I, Rodrigues ÁS. [Assessment of the implementation of an care teleregulation project in a Brazilian capital city]. CAD SAUDE PUBLICA 2023; 39:e00009623. [PMID: 37466552 PMCID: PMC10494686 DOI: 10.1590/0102-311xpt009623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 07/20/2023] Open
Abstract
This study evaluates the degree of implementation (DI) of the Regulates+ Brazil project and analyzes to what extent the variations in implementation influence the results observed in access to specialized appointments in Recife, Pernambuco, Brazil. This is an evaluative research of implementation analysis. A logic model and an analysis and judgment matrix with indicators for evaluating the degree of implementation and the results of the Project were developed and submitted to expert consensus. The data collection was conducted via a semi-structured questionnaire applied to key informants and secondary data extracted from the official documents from Regulates+ Brazil and Brazilian National Regulation System (SISREG), referring to the period from May/2020 to May/2021, which were consolidated and compared with values defined in the matrix. The degree of implementation of the Regulates+ Brazil project in Recife was considered to be implemented (83.7%), as well as the Structure (81.7%) and Methods (84.6%) dimensions. However, most effect indicators underperformed, which, when confronted, were consistent with bottlenecks observed in some components and subcomponents of the Project, such as the performance of professionals in basic health units, which was indicated as incipient, especially regarding follow-up of returned requests. The results suggest that any intervention in Telehealth requires, for its proper implementation, the adequacy of teams and work processes, practices of Continuing Education, as well as a continuous evaluation process, to achieve the expected results, or else it will become another bureaucratization and barrier to access.
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Affiliation(s)
| | | | | | - Isabella Samico
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brasil
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Talini C, Carvalho ARDAS, Viera CS. Elective pediatric surgery: profile description of children and late referral identification. Rev Col Bras Cir 2023; 50:e20233516. [PMID: 37341289 PMCID: PMC10508650 DOI: 10.1590/0100-6991e-20233516-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/02/2023] [Indexed: 06/22/2023] Open
Abstract
Pediatric surgery receives great demand for referrals from primary care services in order to evaluate the need for surgical intervention. However access to this specialized evaluation and in intervention does not always occur at the appropriate time. This study aims to characterize the profile of pediatric patients electively operated in the western Paraná state region, between 2018 and 2020, and identify those who were lately referred to surgical evaluation. This is a descriptive, cross-sectional and retrospective study through the review of electronic medical records. The variables evaluated were sociodemographic data, information on underlying diseases, referral data, specialist assessment and surgical procedure. During this period, 410 patients underwent an elective surgical procedure, of which 289 were included in the research. The sample was predominantly male (72.3%) with a mean age of 57.9 months at the surgeons assessment and 59 months at the date of surgery. Most of the patients came from primary care (75%) and the most common pathology was inguinal hernia (39.1%). The mean time interval between referral through primary care and surgery was 4.98 months, and between the surgeons assessment and surgery was 1.21 months. Of the total sample, 77 (26.6%) patients were identified as being referred late for the surgical procedure. Knowing the profile of patients and the problems experienced in this region in relation to the care provided in pediatric surgery provides subsidies to propose improvement strategies not only for the health system in this location, but for several inner regions of Brazil in a similar situation.
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Affiliation(s)
- Carolina Talini
- - Universidade Estadual do Oeste do Paraná, Programa de Pós-graduação em Biociências & Saúde - Cascavel - PR - Brasil
| | | | - Claudia Silveira Viera
- - Universidade Estadual do Oeste do Paraná, Programa de Pós-graduação em Biociências & Saúde - Cascavel - PR - Brasil
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Guijarro S, Torres AL, Montero G, Garcia M, Sabay H, Iribarren S, Ocaña JA, Yánez P, Murgueytio P. Perspectives of health practitioners on the challenges to accessing sexual and reproductive health care services for Venezuelan migrant women during the COVID-19 pandemic in Quito, Ecuador. Rev Panam Salud Publica 2023; 47:e58. [PMID: 37008676 PMCID: PMC10065305 DOI: 10.26633/rpsp.2023.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/02/2022] [Indexed: 04/03/2023] Open
Abstract
Objectives. To describe the perspectives of health practitioners on the barriers, gaps, and opportunities that Venezuelan migrant women experienced to accessing sexual and reproductive health (SRH) services during the COVID-19 pandemic and how SRH services were affected in Quito, Ecuador. Methods. Health practitioners involved in SRH services at nine public health care facilities in three zones of Quito were surveyed. The Minimum Initial Service Package readiness assessment tool survey, available from the Inter-Agency Working Group on Reproductive Health in Crisis, was adapted for use and data collection in Ecuador. Results. Of 297 respondents, 227 were included in the analysis. Only 16% of the health practitioners agreed that discrimination against migrant Venezuelans women occurred in the health care system. Of those, only 2.3% described specific conditions associated with discrimination, including requiring identification documents (7.5%) and lack of empathy or responsiveness (6.6%). Most (65.2%) respondents reported that the COVID-19 pandemic affected the use of SRH services by women in the general population and by Venezuelan migrant women more so (56.3%) because of more limited access to SRH services, poverty, and vulnerability. There were no differences between perceptions by levels of health care facility, except with regard to the lack of supplies, awareness of discrimination, and the belief that Venezuelan migrant women were affected more negatively than the local population. Conclusion. The perception among health practitioners in Quito was that discrimination occurred infrequently during the COVID-19 pandemic despite affecting the health care system. However, some level of discrimination toward migrant Venezuelan migrant women seeking SRH services was acknowledged and may be underrepresented.
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Affiliation(s)
- Susana Guijarro
- Public Health InstituteSchool of MedicinePontifical Catholic University of EcuadorQuitoEcuadorPublic Health Institute, School of Medicine, Pontifical Catholic University of Ecuador, Quito, Ecuador.
- Susana Guijarro,
| | - Ana Lucia Torres
- Public Health InstituteSchool of MedicinePontifical Catholic University of EcuadorQuitoEcuadorPublic Health Institute, School of Medicine, Pontifical Catholic University of Ecuador, Quito, Ecuador.
| | - Gonzalo Montero
- Public Health InstituteSchool of MedicinePontifical Catholic University of EcuadorQuitoEcuadorPublic Health Institute, School of Medicine, Pontifical Catholic University of Ecuador, Quito, Ecuador.
| | - Mónica Garcia
- Graduate Program in Gynecology and ObstetricsSchool of MedicinePontifical Catholic University of EcuadorQuitoEcuadorGraduate Program in Gynecology and Obstetrics, School of Medicine, Pontifical Catholic University of Ecuador, Quito, Ecuador.
| | - Hernán Sabay
- Graduate Program in Gynecology and ObstetricsSchool of MedicinePontifical Catholic University of EcuadorQuitoEcuadorGraduate Program in Gynecology and Obstetrics, School of Medicine, Pontifical Catholic University of Ecuador, Quito, Ecuador.
| | - Sarah Iribarren
- University of WashingtonSeattleUnited States of AmericaUniversity of Washington, Seattle, United States of America.
| | - José Andrés Ocaña
- Public Health InstituteSchool of MedicinePontifical Catholic University of EcuadorQuitoEcuadorPublic Health Institute, School of Medicine, Pontifical Catholic University of Ecuador, Quito, Ecuador.
| | - Paula Yánez
- Public Health InstituteSchool of MedicinePontifical Catholic University of EcuadorQuitoEcuadorPublic Health Institute, School of Medicine, Pontifical Catholic University of Ecuador, Quito, Ecuador.
| | - Patricio Murgueytio
- Independent advisorGaithersburgUnited States of AmericaIndependent advisor, Gaithersburg, United States of America.
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Pachito DV, Finkelstein B, Albertini C, Gaspar A, Pereira C, Vaz P, Eckeli AL, Drager LF. Legal action for access to resources inefficiently made available in health care systems in Brazil: a case study on obstructive sleep apnea. J Bras Pneumol 2023; 49:e20220092. [PMID: 36820743 PMCID: PMC9970612 DOI: 10.36416/1806-3756/e20220092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 12/06/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a highly prevalent chronic disease, associated with morbidity and mortality. Although effective treatment for OSA is commercially available, their provision is not guaranteed by lines of care throughout Brazil, making legal action necessary. This study aimed at presenting data related to the volume of legal proceedings regarding the access to diagnosis and treatment of OSA in Brazil. METHODS This was a descriptive study of national scope, evaluating the period between January of 2016 and December of 2020. The number of lawsuits was analyzed according to the object of the demand (diagnosis or treatment). Projections of total expenses were carried out according to the number of lawsuits. RESULTS We identified 1,462 legal proceedings (17.6% and 82.4% related to diagnosis and treatment, respectively). The projection of expenditure for OSA diagnosis in the public and private spheres were R$575,227 and R$188,002, respectively. The projection of expenditure for OSA treatment in the public and private spheres were R$2,656,696 and R$253,050, respectively. There was a reduction in the number of lawsuits between 2017 and 2019. CONCLUSIONS Legal action as a strategy for accessing diagnostic and therapeutic resources related to OSA is a recurrent practice, resulting in inefficiency and inequity. The reduction in the number of lawsuits between 2017 and 2019 might be explained by the expansion of local health care policies or by barriers in the journey of patients with OSA, such as difficulties in being referred to specialized health care and low availability of diagnostic resources.
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Affiliation(s)
- Daniela V Pachito
- . Prossono - Centro de Diagnóstico e Medicina do Sono, Ribeirão Preto (SP) Brasil
| | | | | | | | | | - Paulo Vaz
- . Heads in Health, São Paulo (SP) Brasil
| | - Alan Luiz Eckeli
- . Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto (SP) Brasil
| | - Luciano F Drager
- . Unidades de Hipertensão, Instituto do Coração - InCor - e Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Centro de Cardiologia, Hospital Sírio-Libanês, São Paulo (SP) Brasil
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Rosa CT, Zonta MB, Lange MC, Zétola VDHF. Quality of life: predictors and outcomes after stroke in a Brazilian public hospital. Arq Neuropsiquiatr 2023; 81:2-8. [PMID: 36918001 PMCID: PMC10014206 DOI: 10.1055/s-0042-1758364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND Some scales are applied after stroke to measure functional independence but qualify of life (QoL) is sometimes neglected in this scenario. OBJECTIVE To analyze predictors and outcomes of QoL after stroke using a validated scale in our population. METHODS Our study included patients who had their first ischemic stroke and were followed in the outpatient clinic for at least 6 months from stroke index. Disability status was assessed using the modified Rankin scale (mRS), the Barthel index (BI), and the Lawton and Brody scale. Quality of life was assessed by a stroke-specific QoL (SSQoL) scale. Statistical significance was accepted for p < 0.05. The estimated measure of association was the odds ratio (OR) for which 95% confidence intervals (95%Cis) were presented. RESULTS Of 196 patients studied, the median age was 60.4 (±13.4) years, and 89 (45.40%) of the patients were female. In a stepwise model considering risk factors, basic activities of daily living scales, satisfaction with life, and outcomes, we found four independent variables related to a poor QoL after stroke, namely hypertension, non-regular rehabilitation, not returning to work, and medical complications. The National Institutes of Health stroke scale (NIHSS) score at admission ≥ 9 was also an independent clinical marker. Approximately 30% of all participants had a negative score under 147 points in the SSQoL. CONCLUSIONS Our results showed that QoL after stroke in a developing country did not seem to differ from those of other countries, although there is a gap in rehabilitation programs in our public system. The functional scales are important tools, but they have failed to predict QoL, in some patients, when compared with specific scales.
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Affiliation(s)
- Camila Thieime Rosa
- Universidade Federal do Paraná, Hospital de Clínicas, Unidade de AVC, Departamento de Clínica Médica, Curitiba PR, Brazil
| | - Marise Bueno Zonta
- Universidade Federal do Paraná, Hospital de Clínicas, Unidade de AVC, Departamento de Clínica Médica, Curitiba PR, Brazil
| | - Marcos Christiano Lange
- Universidade Federal do Paraná, Hospital de Clínicas, Unidade de AVC, Departamento de Clínica Médica, Curitiba PR, Brazil
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Oliveira VDAS, Chaves VB, Aboud AAN, Bunholli AM, Macedo RM, Pinto RM. Trends in bariatric surgeries in the Brazilian Federative Units, 2009-2019: a descriptive study. Rev Col Bras Cir 2022; 49:e20223335. [PMID: 36350881 PMCID: PMC10578865 DOI: 10.1590/0100-6991e-20223335-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE our objective is to describe the epidemiological distribution of hospitalizations and postoperative deaths, as well as the trends of bariatric surgeries performed by SUS in all Brazilian federative units (FUs) from an analysis of the period from 2009 to 2019. METHODS This is an observational, descriptive ecological time-series study with quantitative and descriptive analysis, based on secondary data. The period analyzed was from 2009 to 2019. We collected, from DATASUS, data from obese men and women who were hospitalized after undergoing bariatric surgery. Prais-Winsten regression was performed to identify the trends. RESULTS In the period, 83,829 bariatric surgeries were performed, of which 161 resulted in death, representing 0.19% of the procedures. We found an increasing trend in the number of surgeries for Brazil (β=0.04; p<0.001), but 11 FUs showed a stationary trend and three, decreasing ones (six UFs did not have enough data to enter the analysis). In the North and Northeast regions, stationary trends prevailed, while in the Center-West, the decreasing trends, and in the South and Southeast, the increasing ones. CONCLUSIONS we found an evident disparity between regions, suggesting deficiencies in access to health. By demonstrating which FUs and demographic characteristics have the lowest rates of surgeries, our study is able to direct public policies towards a more egalitarian Brazilian public health.
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Affiliation(s)
| | | | | | | | | | - Renata Machado Pinto
- - Universidade Federal de Goiás, Departamento de Pediatria - Goiânia - GO - Brasil
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de Barros RD, Costa EA, dos Santos DB, Souza GS, Álvares J, Guerra AA, Acurcio FDA, Guibu IA, Costa KS, Karnikowski MGDO, Soeiro OM, Leite SN. Access to medicines: relations with the institutionalization of pharmaceutical services. Rev Saude Publica 2017; 51:8s. [PMID: 29160462 PMCID: PMC5676401 DOI: 10.11606/s1518-8787.2017051007138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 02/08/2017] [Indexed: 11/25/2022] Open
Abstract
OBJETIVE To analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services 2015), a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis. RESULTS Full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: "management tools," "participation and social control," "financing," and "personnel structure," with significant associations in the bivariate analysis. The "pharmaceutical care" dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3); there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1); there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0); those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5); there is computerized system for pharmaceutical services management, OR = 4.3 (95%CI 2.4-7.5). CONCLUSIONS Aspects related to the institutionalization of pharmaceutical services have been strongly related to access to medicines. Our results indicate the need to prioritize its implementation, contributing to its consolidation in Brazil and to the effectiveness of health services regarding the purposes of pharmaceutical services policies.
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Affiliation(s)
| | - Ediná Alves Costa
- Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
| | | | | | - Juliana Álvares
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Augusto Afonso Guerra
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Ione Aquemi Guibu
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Santa Casa de São Paulo. São Paulo, SP, Brasil
| | - Karen Sarmento Costa
- Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva. Faculdade de Medicina. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | | | - Orlando Mario Soeiro
- Faculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de Campinas. Campinas, SP, Brasil
| | - Silvana Nair Leite
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
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Stopa SR, Malta DC, Monteiro CN, Szwarcwald CL, Goldbaum M, Cesar CLG. Use of and access to health services in Brazil, 2013 National Health Survey. Rev Saude Publica 2017; 51:3s. [PMID: 28591351 PMCID: PMC5676359 DOI: 10.1590/s1518-8787.2017051000074] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/01/2016] [Indexed: 11/13/2023] Open
Abstract
OBJECTIVE To analyze the use of health services in the Brazilian population by sociodemographic factors, according to data from the 2013 Brazilian National Health Survey. METHODS The study analyzed data from 205,000 Brazilian citizens in all age groups who participated in the Brazilian National Health Survey, a cross-sectional study carried out in 2013. Prevalence and confidence intervals were estimated for indicators related to access to and use of health services according to age group, level of education of head of household, and Brazilian macroregions. RESULTS Among individuals who sought health services in the two weeks prior to the survey, 95.3% (95%CI 94.9-95.8) received care in their first visit. Percentages were higher in the following groups: 60 years of age and over; head of household with complete tertiary education; living in the South and Southeast regions. In addition, 82.5% (95%CI 81.2-83.7) of individuals who received health care and prescriptions were able to obtain all the necessary medicines, 1/3 of them from SUS. Less than half the Brazilian population (44.4%; 95%CI 43.8-45.1) visited a dentist in the 12 months prior to the survey, with smaller percentages among the following groups: 60 years of age or older; head of household with no education or up to incomplete elementary; living in the North region of Brazil. CONCLUSIONS People living in the South and Southeast regions still have greater access to health services, as do those whose head of household has a higher level of education. The (re)formulation of health policies to reduce disparities should consider differences encountered between regions and social levels. OBJETIVO Descrever o uso de serviços de saúde na população brasileira segundo fatores sociodemográficos, de acordo com dados da Pesquisa Nacional de Saúde, 2013. MÉTODOS Foram analisados dados referentes a 205 mil brasileiros, de todas as faixas etárias, que participaram da Pesquisa Nacional de Saúde, estudo transversal conduzido em 2013. Calcularam-se as prevalências e seus intervalos de confiança para indicadores referentes ao acesso e a utilização dos serviços de saúde, segundo grupos de idade, nível de instrução do chefe da família e macrorregiões do país. RESULTADOS Dentre os indivíduos que procuraram o serviço de saúde nas duas semanas prévias à pesquisa, 95,3% (IC95% 94,9-95,8) conseguiu usá-lo na primeira vez que procurou. As proporções foram maiores: no grupo de 60 anos ou mais; cujo chefe da família tinha nível superior completo; e nas regiões Sul e Sudeste. Ainda, dos indivíduos atendidos e que tiveram medicamentos receitados, 82,5% (IC95% 81,2-83,7) conseguiram obter todos os medicamentos, sendo 1/3 pelo SUS. Menos da metade da população brasileira (44,4%; IC95% 43,8-45,1) consultou um dentista nos 12 meses anteriores à pesquisa, com proporções menores entre: indivíduos com 60 anos ou mais; cujo chefe da família não possuía nível de instrução ou tinha até o fundamental incompleto; e indivíduos que residiam na região Norte do país. CONCLUSÕES Pessoas que residem nas regiões Sul e Sudeste ainda possuem maior acesso aos serviços de saúde, bem como aquelas cujo chefe da família tem maior nível de instrução. A (re)formulação de políticas de saúde no intuito de reduzir disparidades deve considerar as diferenças regionais e entre níveis sociais encontradas.
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Affiliation(s)
- Sheila Rizzato Stopa
- Programa de Pós-Graduação em Saúde Pública. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública. Escola de Enfermagem. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Camila Nascimento Monteiro
- Núcleo de Indicadores e Sistemas de Informação. Hospital Israelita Albert Einstein. São Paulo, SP, Brasil
| | - Célia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Moisés Goldbaum
- Departamento de Medicina Preventiva. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Chester Luiz Galvão Cesar
- Departamento de Epidemiologia. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
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