Cristina Maria Rabelais Duarte

Eqüidade na legislação: um princípio do sistema de saúde brasileiro?

Este artigo procura delinear a concepcao inerente a legislacao brasileira e apontar possiveis consequencias da reforma do setor proposta pelo atual governo. Apos uma abordagem conceitual do termo equidade, os textos da Constituicao Federal e Leis Complementares sao avaliados. Em seguida, assumindo que os mecanismos de repasse de verbas do governo federal para os municipios funcionam como instrumentos de redistribuicao - ou nao - de recursos, sao analisados aqueles implementados pelas Normas Operacionais Basicas, considerando sua capacidade de promocao de equidade. Uma visao panorâmica das propostas de reforma do sistema de saude atualmente em debate e do papel desempenhado pelo setor privado de assistencia e proporcionada, procurando-se enfatizar suas implicacoes sobre a equidade. A guisa de conclusao, resgata-se que as profundas desigualdades sociais existentes no Brasil exigem politicas pautadas em principios de solidariedade e equidade. Neste sentido, a Constituicao e Leis Orgânicas sao avancadas e a normatizacao atual, embora ainda distante de concretizar os ditames constitucionais, apresenta progressos nesta direcao.

Regionalização e desenvolvimento humano: uma proposta de tipologia de Regiões de Saúde no Brasil

This article aimed to present a proposal for characterizing health regions in Brazil based on human development, contributing to the identification of comparable geographic areas for observation, analysis, and monitoring of performance in regionalized health systems. The dimensions of the Municipal Human Development Index were calculated for the health regions by aggregating data from municipalities, weighted by population size. The grouping of health regions in 5 groups, based on combinations of life expectancy, income, and schooling, was determined by the K-Means method. Approximately half of Brazils health regions were classified as type 1 and the other half as types 3 to 5. The typology provides a clustering model for homogeneous health regions, consistent with the theoretical assumptions of PROADESS. The choice of well-established indicators and aggregation methods tends to facilitate their comprehension and use by the actors involved in the administration of the Brazilian Unified National Health System (SUS).O objetivo do trabalho foi apresentar uma proposta de diferenciacao das Regioes de Saude no Brasil, baseada no desenvolvimento humano, contribuindo para a identificacao de espacos geograficos comparaveis para observacao, analise e acompanhamento do desempenho dos sistemas regionalizados de saude. Os valores das dimensoes do Indice de Desenvolvimento Humano Municipal foram calculados para as Regioes de Saude pela agregacao dos dados dos municipios, ponderados pelo seu tamanho populacional. O agrupamento das Regioes de Saude em 5 grupos, segundo combinacoes de longevidade, riqueza e escolaridade, foi determinado pelo metodo K-Medias. Metade das Regioes de Saude brasileiras foi classificada em grupos do tipo 1 e 2 e a outra metade em grupos dos tipos 3 a 5. A tipologia apresentada oferece um modelo de agrupamento de Regioes de Saude homogeneas, coerente com os pressupostos teoricos do PROADESS. A opcao por indicadores e metodos de agregacao bem estabelecidos tende a favorecer a sua compreensao e utilizacao pelos atores ligados a gestao do Sistema Unico de Saude (SUS).

UNIMED: história e características da cooperativa de trabalho médico no Brasil

This article describes the organizational characteristics of the UNIMED medical cooperative in Brazil. After an overview of UNIMEDs share in the current health plan market, the author analyzes its organizational structure, historical evolution, and contractual regimen with member physicians, including the formula used to calculate the payment schedule for physician services. The plan currently includes 367 local member cooperatives, operating in over 80% of Brazils counties, with 41% of existing physicians to serve 7% of the population. The organizations history began with local cooperatives and subsequently federations, the confederation, and other companies in the group. The organizational design and dynamics favor a high degree of decentralization and autonomy, subordination of all components in the system to the physician cooperative command, and the occurrence of internal disputes and conflicts between individual interests and those of the organization.

Proteção social e pessoa com deficiência no Brasil

The article analyzes the social protection policy for people with disabilities in Brazil. It describes the patterns of demand and eligibility for Continued Benefit of Social Assistance (Benefício de Prestação Continuada - BPC) in the 1996-2014 period. The article argues that BPC is a direct result of the social pact achieved by the Brazilian Federal Constitution of 1988. BPC is a social assistance benefit consisting in an unconditional and monthly transference of the equivalent of a minimum wage, to poor people with deficiency and elders with more than 65 years. Disabled person eligibility depends on means-test, and social and medical evaluation by public bureaucracy. The research strategy was based on time series, and cross-sectional data collection and analysis. Dummy qualitative variables were also used to describe the pattern of demand and eligibility. The article demonstrates that BPC has provided income to disabled and elder people. However, systematic barriers were identified to disabled peoples access to BPC. The work suggests that the pattern of refusal could be associated to a means testing application by street-level-bureaucracy. In this sense, the work draws attention to the necessary revision of street-level-bureaucracy tools and procedures to increase BPC positive discrimination.

Cross-sectional study of anxiety symptoms and self-report of awake and sleep bruxism in female TMD patients

Abstract Aims: The aim of this study was to assess the relationship between levels of anxiety symptoms and prevalence of self-report of awake and sleep bruxism in patients with temporomandibular disorders (TMD). Method: One hundred and eighty-one female patients, aged 19–77 years, were consecutively evaluated. The patients were selected from among those who sought treatment at the TMD and Orofacial Pain Outpatient Clinic of the Petrópolis School of Medicine. All patients completed the questionnaire and underwent clinical examination, both components of the RDC/TMD, in addition to answering questions pertaining to the assessment of levels of anxiety symptoms, taken from the Symptom Check List 90 self-report instrument. The subjects were classified according to the presence of self-reported only awake bruxism, only sleep bruxism, both, or none. A logistic regression procedure was performed to evaluate the possible association through odds ratio between anxiety symptoms and self-reported awake or sleep bruxism. The cofactors for each outcome were age, self-reported bruxism during the circadian period other than the one being evaluated, and the use of selective serotonin reuptake inhibitors. Results: It was possible to demonstrate the presence of a positive and statistically significant relationship between anxiety levels and self-reported awake bruxism. This finding was not observed in those subjects who reported sleep bruxism. Conclusions: A positive relationship was found between self-reported awake bruxism and levels of anxiety symptoms, but not between sleep bruxism and anxiety.

Proteção social e política pública para populações vulneráveis: uma avaliação do Benefício de Prestação Continuada da Assistência Social - BPC no Brasil

This paper describes the historical development and profile of Continuous Cash Benefit (BPC) applicants, intended for poor elderly and people with disabilities, which, since 2009, uses eligibility criteria based on the International Classification of Functioning, Disability and Health (ICF) of the WHO and is aligned with the UN Convention on the Rights of Persons with Disabilities. The behavior of benefits was determined from the analysis the coefficients of the general and non-judicial grants between 1998 and 2014. The profile was established for the years 2010 and 2014 according to situation of acceptance, age, gender and ICF components. The average annual growth of the coefficient was higher from 2000 to 2010, prior to the adoption of the biopsychosocial eligibility model, and the coefficient of non-judicial grants increased until 2010, falling thereafter. The deferrals acceptance /rejections ratio was higher among children and among those facing severe or total environmental barriers, limitations, constraints and bodily changes. The implementation of the biopsychosocial evaluation model did not cause an increased rate of grants and results evidence the need for flexibility in the eligibility criteria.This paper describes the historical development and profile of Continuous Cash Benefit (BPC) applicants, intended for poor elderly and people with disabilities, which, since 2009, uses eligibility criteria based on the International Classification of Functioning, Disability and Health (ICF) of the WHO and is aligned with the UN Convention on the Rights of Persons with Disabilities. The behavior of benefits was determined from the analysis the coefficients of the general and non-judicial grants between 1998 and 2014. The profile was established for the years 2010 and 2014 according to situation of acceptance, age, gender and ICF components. The average annual growth of the coefficient was higher from 2000 to 2010, prior to the adoption of the biopsychosocial eligibility model, and the coefficient of non-judicial grants increased until 2010, falling thereafter. The deferrals acceptance /rejections ratio was higher among children and among those facing severe or total environmental barriers, limitations, constraints and bodily changes. The implementation of the biopsychosocial evaluation model did not cause an increased rate of grants and results evidence the need for flexibility in the eligibility criteria.

Cross-cultural adaptation to Portuguese of the Research Diagnostic Criteria for Temporomandibular Disorders for adolescents: A semantic evaluation

Purpose: To describe the process of cross-cultural adaptation and present the Portuguese version of the instrument Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for use in adolescents. Methods: The RDC/TMD adapted for adolescents was fully translated into Portuguese by a translator and then back translated into English by a second translator who was blind to the original text. The back translation was compared with the original by the author and the final version defined by consensus. Part I of the instrument was administered to 186 students aged 12 to 17 years in the town of Tres Rios/Rio de Janeiro State, Brazil, to assess comprehensibility. Results: One question was considered inaccurate in the back translation. The young respondents struggled with five of other questions. The original version of the instrument in English and the final version in Portuguese were presented. Conclusion: The process of translation and back translation ensured the semantic equivalence of the original version relative to the translated version. The application of the questionnaire met wide acceptance and contributed to the final version of the instrument.

Regionalization and human development: a typology of health regions in Brazil

This article aimed to present a proposal for characterizing health regions in Brazil based on human development, contributing to the identification of comparable geographic areas for observation, analysis, and monitoring of performance in regionalized health systems. The dimensions of the Municipal Human Development Index were calculated for the health regions by aggregating data from municipalities, weighted by population size. The grouping of health regions in 5 groups, based on combinations of life expectancy, income, and schooling, was determined by the K-Means method. Approximately half of Brazils health regions were classified as type 1 and the other half as types 3 to 5. The typology provides a clustering model for homogeneous health regions, consistent with the theoretical assumptions of PROADESS. The choice of well-established indicators and aggregation methods tends to facilitate their comprehension and use by the actors involved in the administration of the Brazilian Unified National Health System (SUS).O objetivo do trabalho foi apresentar uma proposta de diferenciacao das Regioes de Saude no Brasil, baseada no desenvolvimento humano, contribuindo para a identificacao de espacos geograficos comparaveis para observacao, analise e acompanhamento do desempenho dos sistemas regionalizados de saude. Os valores das dimensoes do Indice de Desenvolvimento Humano Municipal foram calculados para as Regioes de Saude pela agregacao dos dados dos municipios, ponderados pelo seu tamanho populacional. O agrupamento das Regioes de Saude em 5 grupos, segundo combinacoes de longevidade, riqueza e escolaridade, foi determinado pelo metodo K-Medias. Metade das Regioes de Saude brasileiras foi classificada em grupos do tipo 1 e 2 e a outra metade em grupos dos tipos 3 a 5. A tipologia apresentada oferece um modelo de agrupamento de Regioes de Saude homogeneas, coerente com os pressupostos teoricos do PROADESS. A opcao por indicadores e metodos de agregacao bem estabelecidos tende a favorecer a sua compreensao e utilizacao pelos atores ligados a gestao do Sistema Unico de Saude (SUS).

Regionalización y desarrollo humano: una clasificación para las regiones de salud brasileñas

This article aimed to present a proposal for characterizing health regions in Brazil based on human development, contributing to the identification of comparable geographic areas for observation, analysis, and monitoring of performance in regionalized health systems. The dimensions of the Municipal Human Development Index were calculated for the health regions by aggregating data from municipalities, weighted by population size. The grouping of health regions in 5 groups, based on combinations of life expectancy, income, and schooling, was determined by the K-Means method. Approximately half of Brazils health regions were classified as type 1 and the other half as types 3 to 5. The typology provides a clustering model for homogeneous health regions, consistent with the theoretical assumptions of PROADESS. The choice of well-established indicators and aggregation methods tends to facilitate their comprehension and use by the actors involved in the administration of the Brazilian Unified National Health System (SUS).O objetivo do trabalho foi apresentar uma proposta de diferenciacao das Regioes de Saude no Brasil, baseada no desenvolvimento humano, contribuindo para a identificacao de espacos geograficos comparaveis para observacao, analise e acompanhamento do desempenho dos sistemas regionalizados de saude. Os valores das dimensoes do Indice de Desenvolvimento Humano Municipal foram calculados para as Regioes de Saude pela agregacao dos dados dos municipios, ponderados pelo seu tamanho populacional. O agrupamento das Regioes de Saude em 5 grupos, segundo combinacoes de longevidade, riqueza e escolaridade, foi determinado pelo metodo K-Medias. Metade das Regioes de Saude brasileiras foi classificada em grupos do tipo 1 e 2 e a outra metade em grupos dos tipos 3 a 5. A tipologia apresentada oferece um modelo de agrupamento de Regioes de Saude homogeneas, coerente com os pressupostos teoricos do PROADESS. A opcao por indicadores e metodos de agregacao bem estabelecidos tende a favorecer a sua compreensao e utilizacao pelos atores ligados a gestao do Sistema Unico de Saude (SUS).