Antonio da Cruz Gouveia Mendes

Avaliação do sistema de informações hospitalares - SIH/SUS como fonte complementar na vigilância e monitoramento de doenças de notificação compulsória

The objective of this paper was to explore the potentialities of the Hospital Information System - SIH/SUS for epidemiologic surveillance and monitoring of Notifiable Diseases. The states and regions of Brazil constituted the study area. Data relative to hospital admittances for Notifiable Diseases, during the period from 1984 to 1998, was obtained from the SIH/SUS and data from the National Center of Epidemiology – CENEPI, during the period from 1980 to 1997. Data bases were linked by pathologies, hospital admittances and by place of occurrence - distributed for states and regions of the country. The results of the classification of the states according to the four larger absolute frequencies of admittances and reports and the comparison between the reports and the number of admittances according to the need of admittances for the pathologies, showed a high level of coherence between CENEPI and SIH data. It was concluded that SIH/SUS has a great agility in obtaining the data and shows a good capacity for monitoring the analyzed pathologies, being an important complementary source of information for surveillance of Notifiable Diseases.

Assistência pública de saúde no contexto da transição demográfica brasileira: exigências atuais e futuras

This paper assesses inpatient and outpatient care and their capacity to respond to changing demands in the context of the demographic transition in Brazil. The data were obtained from studies by the Brazilian Institute of Geography and Statistics (IBGE) and databases in the National Health System (CNES, SIH, and SIA). The reduction in birth, fertility, and infant mortality rates and the increase in life expectancy at birth are still driving population growth, while decreasing the dependency rate, thereby providing the opportunity to make necessary adjustments. The population increased by more than 27.5 million from 1999 to 2009, with a 26.7% reduction in hospital beds and 947,000 hospitalizations, with distortions in the distribution by specialty, but with increases in high-complexity outpatient and inpatient care. The results show that Brazil is undergoing a transition in the healthcare model, requiring greater capacity for future planning of a more complex system and revising the model to prepare for a larger elderly population in the coming decades.This paper assesses inpatient and outpatient care and their capacity to respond to changing demands in the context of the demographic transition in Brazil. The data were obtained from studies by the Brazilian Institute of Geography and Statistics (IBGE) and databases in the National Health System (CNES, SIH, and SIA). The reduction in birth, fertility, and infant mortality rates and the increase in life expectancy at birth are still driving population growth, while decreasing the dependency rate, thereby providing the opportunity to make necessary adjustments. The population increased by more than 27.5 million from 1999 to 2009, with a 26.7% reduction in hospital beds and 947,000 hospitalizations, with distortions in the distribution by specialty, but with increases in high-complexity outpatient and inpatient care. The results show that Brazil is undergoing a transition in the healthcare model, requiring greater capacity for future planning of a more complex system and revising the model to prepare for a larger elderly population in the coming decades.

Qualidade do atendimento nas Unidades de Saúde da Família no município de Recife: a percepção do usuários

This study seeks to assess user perception regarding the quality of care in Family Health Units in Recife. It is a descriptive cross-sectional study adopting a quantitative approach. The survey was conducted in Recife and 939 users were interviewed, being predominantly young adults, female, married, housewives with low levels of education. They have strong links with the units, taking it as a benchmark for their care. The results show care in accordance with scheduled demand and users manifest marked satisfaction with the work of the professionals and less satisfaction with the conditions offered at the units. The younger and more educated the users are, the less satisfied they are with the conditions offered. There is considerable dissatisfaction with delays in attendance, in accessibility and the lack of educational and community activities, the latter two dimensions being related to the core principles of this strategy. The marked satisfaction with clinical care, confidentiality and right to information, which are dimensions related to user-professional relationship are fundamental to the quality of care. This evaluation focused on each aspect of the service provided and makes an important contribution with the critical appraisal reported by users.

Diferenciais nos fatores de risco para a mortalidade infantil em cinco cidades brasileiras: um estudo de caso-controle com base no SIM e no SINASC

This study aimed to identify differences in risk factors for infant mortality in five cities, one from each region of Brazil. This was a case-control study with cases defined as deaths in infants less than one year of age in the Mortality Information System (SIM) and Information System on Live Births (SINASC) and controls as live born infants recorded in the SINASC database and who had not died in the first year. Risk factors were estimated by univariate and multivariate analysis, using hierarchical logistic models. The main determinants of infant mortality were biological factors (low Apgar score, low birth weight, prematurity, and congenital malformations) mediated by socioeconomic factors (education, marital status, and race/color) and prenatal care conditions (prenatal visits). Despite agreement on the determinants of infant mortality among the five cities, some regional differences were observed, expressing infant mortality associated with inequalities in socioeconomic conditions and access to health services.

Novas metodologias para vigilância epidemiológica: uso do Sistema de Informações Hospitalares - SIH/SUS

Apresentacao A vigilância epidemiologica das doencas de notificacao compulsoria tem como principal fonte de informacao os servicos de saude, sobretudo ambulatorial, atraves do preenchimento das fichas de notificacao e investigacao do Sistema de Informacao de Agravos de Notificacao SINAN. Os estabelecimentos de saude hospitalares, na sua maioria, em funcao de sua complexidade e outros determinantes, notificam pouco suas internacoes, atraves do SINAN, mesmo com relacao a doencas de notificacao compulsoria. Embora sem a implantacao desse sistema de informacao, todos os hospitais conveniados com o Sistema Unico de Saude, dispoem do Sistema de Informacoes Hospitalares SIH, possibilitando-lhes atuar como uma fonte de informacao complementar para subsidiar as acoes de vigilância epidemiologica. Na tentativa de incrementar acoes de vigilância epidemiologica, o Centro Nacional de Epidemiologia CENEPI vem estimulando estudos de novas metodologias. O uso do SIH para subsidiar acoes de vigilância epidemiologica tem se comportado como uma importante tecnologia, principalmente pela sua agilidade e facil acesso. Este manual tem como objetivo instrumentalizar os servicos de saude para a exploracao do SIH no enfoque da vigilância epidemiologica, iniciando com uma discussao mais teorica sobre aspectos conceituais da informacao e sua interface com a epidemiologia. Em seguida, aborda o Sistema de Informacoes Hospitalares quanto a descricao, objetivos, instrumentos, informatizacao, fluxo, limites e possibilidades. Visando oferecer subsidios para exploracao das bases de dados do SIH, realiza-se uma discussao sobre o processo de investigacao dos problemas de saude, a construcao de indicadores e uma introducao ao banco de dados, sua descricao e seu acesso. Por fim, este manual serve de apoio para iniciar o processo de exploracao dos arquivos gerados pelo SIH, trabalhando passo a passo para a obtencao de informacoes epidemiologicas das internacoes hospitalares por doencas de notificacao compulsoria.

Avaliação da satisfação dos usuários com a qualidade do atendimento nas grandes emergências do Recife, Pernambuco, Brasil

OBJETIVOS: avaliar a satisfacao dos usuarios em relacao a qualidade do atendimento nas grandes emergencias do Recife, Pernambuco, Brasil. METODOS: trata-se de um estudo descritivo de corte transversal, realizado nas tres maiores emergencias do municipio: Hospital da Restauracao, Hospital Getulio Vargas e Hospital Otavio de Freitas. Foram entrevistados 420 usuarios (5% dos atendimentos semanais), atraves da aplicacao de questionarios fechados, buscando-se uma relacao entre variaveis independentes e o grau de satisfacao do usuario. RESULTADOS: o perfil predominante dos usuarios foi de uma populacao adulta jovem (46,7%), do sexo feminino (59,8%), com baixa escolaridade (61,6%), dona de casa ou desempregada (62,3%) e moradora da regiao metropolitana (83%). A insatisfacao com as condicoes oferecidas esteve presente em 55,2% dos usuarios, sendo ainda maior entre aqueles de causa externas da emergencia da Restauracao (77,1%). As dimensoes da qualidade pior avaliadas foram o conforto oferecido, 56% de insatisfacao, e a priorizacao na assistencia ao usuario atraves dos tempos de espera, com 48,1%. CONCLUSAO: os resultados demonstraram uma avaliacao critica dos usuarios. Percebe-se uma nitida variacao de resultados entre as tres unidades. A avaliacao positiva em relacao ao trabalho dos profissionais traz um alento sobre as possibilidades, porem os demais resultados evidenciam que muito ha por fazer para qualificacao do atendimento de emergencia.

Acessibilidade aos serviços básicos de saúde: um caminho ainda a percorrer

This study seeks to evaluate accessibility to the Basic Units of the Family Health Strategy (ESF-UB) and Traditional Basic Units (BU-T) in the city of Recife in 2009. Data were collected through three instruments: a roadmap for systematic observation of the units and questionnaires for users and professional units. This is a descriptive cross-sectional study using a quantitative approach, and 1180 users, 61 doctors and 56 nurses were interviewed. The results showed good ties and recognition of users whereby primary healthcare is seen as the access portal to the health system. In the comparison between ESF-UB and UB-T, evaluations are always more favorable to the family healthcare strategy, though with relatively insignificant differences. The overall result revealed widespread dissatisfaction with the difficulty of obtaining drugs and taking tests, and also with the waiting times and access to specialized care. This showed the existence of organizational problems that may constitute barriers limiting accessibility to basic healthcare services for users.

Population aging in Brazil: current and future social challenges and consequences

Objective: To analyze the current and future challenges related to the planning of public policies and population aging. Method: A case study was conducted using quantitative and qualitative data from secondary data information systems and interviews with actors of social policy and the countrys health. Results: In 2010, there were 39 elderly persons for every 100 young people, while in 2040 there will be an estimated 153 elderly persons for every 100 young people. For those interviewed, Brazil is not prepared for the needs generated by such population aging, due to challenges such as the adequacy of the social security and health system. The growing number of elderly persons and increasing morbidity and mortality profiles worsen the heterogeneous epidemiological situation with disease, disability and sequelae that require the health system to be a continuous and multidisciplinary organization. The present study identified a reduction of beds and hospitalizations, which may reflect the improvement of primary care and quality of life, with a complexification of hospitalizations. Conclusion: With population aging and a lack of necessary support, society must be aware of the price that it must pay and the state must be prepared to provide specific policies to ensure comprehensive care, recognizing the characteristics of aging and preserving quality of life.

Microcephaly epidemic related to the Zika virus and living conditions in Recife, Northeast Brazil

BackgroundStarting in August 2015, there was an increase in the number of cases of neonatal microcephaly in Northeast Brazil. These findings were identified as being an epidemic of microcephaly related to Zika virus (ZIKV) infection. The present study aims to analyse the spatial distribution of microcephaly cases in Recife (2015–2016), which is in Northeast Brazil, and its association with the living conditions in this city.MethodsThis was an ecological study that used data from reported cases of microcephaly from the State Health Department of Pernambuco (August 2015 to July 2016). The basic spatial unit of analysis was the 94 districts of Recife. The case definition of microcephaly was: neonates with a head circumference of less than the cut-off point of −2 standard deviations below the mean value from the established Fenton growth curve. As an indicator of the living conditions of the 94 districts, the percentage of heads of households with an income of less than twice the minimum wage was calculated. The districts were classified into four homogeneous strata using the K-means clustering algorithm. We plotted the locations of each microcephaly case over a layer of living conditions.ResultsDuring the study period, 347 microcephaly cases were reported, of which 142 (40.9%) fulfilled the definition of a microcephaly case. Stratification of the 94 districts resulted in the identification of four strata. The highest stratum in relation to the living conditions presented the lowest prevalence rate of microcephaly, and the overall difference between this rate and the rates of the other strata was statistically significant. The results of the Kruskal-Wallis test demonstrated that there was a strong association between a higher prevalence of microcephaly and poor living conditions. After the first 6 months of the study period, there were no microcephaly cases recorded within the population living in the richest socio-economic strata.ConclusionThis study showed that those residing in areas with precarious living conditions had a higher prevalence of microcephaly compared with populations with better living conditions.

Autopercepção da saúde bucal entre adultos na região Nordeste do Brasil

OBJETIVO: Identificar la auto percepcion de la salud bucal por adultos y variables asociadas. METODOS: Estudio realizado con los datos del SBBrasil 2010 relativos a 2.456 adultos de 35 a 44 anos de la region Noreste. La variable dependiente fue la auto percepcion de la salud bucal. Las variables independientes fueron agrupadas en: demograficas, predisposicion/facilitacion, condicion de salud bucal y relacionadas a la auto percepcion de la necesidad de tratamiento. La prueba de Rao y Scott fue utilizada para evaluar la asociacion entre tales variables. El efecto de las variables independientes sobre el resultado fue evaluado por el modelo de regresion logistica mulninomial segun modelo jerarquizado, en dos etapas: analisis simple y analisis multiple jerarquizado. RESULTADOS: La auto percepcion positiva de la salud bucal fue observada en 37% de los participantes. En el modelo final, las caracteristicas directamente asociadas a esa auto percepcion fueron: ser blanco, tener renta familiar superior a R