Eduarda Ângela Pessoa Cesse

Tendência da mortalidade por doenças do aparelho circulatório no Brasil: 1950 a 2000

BACKGROUND The circulatory system diseases (CAD), one of the most important current health problems, have started to show a declining trend in mortality in several countries, although they are still proportionally the number one regarding the statistics of morbimortality. OBJECTIVE To analyze the mortality trend due to CAD in Brazilian capital cities, during the period of 1950 to 2000. METHODS Temporal series study, of Standardized Mortality Ratios by CAD. We used secondary data on death from the statistical annual reports from IBGE (the Brazilian Institute of Geography and Statistics) and from the Mortality Information System. We carried out a linear trend analysis of the Standardized Mortality Ratios due to CAD in the Brazilian capital cities that presented complete mortality series, considering the census years during the study period (1950 to 2000). RESULTS Although proportionally the CAD represent the main cause of death in the Brazilian population, as well as presenting a proportional increase during the period of analysis of this study, the risk of death, represented by the Standardized Mortality Ratios, have been decreasing, particularly from the eighties onward. It is noteworthy the fact that Fortaleza, Salvador, Belo Horizonte, Rio de Janeiro and São Paulo presented elevated Standardized Mortality Ratios, however with a decreasing trend (p<0.05 and p<0.10), since the start of the analyzed period. CONCLUSION The behavior of the risk of death due to CAD suggests that this group of diseases is the first to be established, following the increase in industrialization observed from the thirties onward and after the Second World War in Brazil, as it occurred in Sao Paulo and Rio de Janeiro, cities that historically experienced a process of development and urbanization earlier and at a higher extent, when compared to the other capital cities.FUNDAMENTO: As doencas do aparelho circulatorio (DAC), um dos mais importantes problemas de saude da atualidade, apesar de proporcionalmente ainda liderarem as estatisticas de morbi-mortalidade, comecam a apresentar tendencia declinante da mortalidade em diversos paises. OBJETIVO: Analisar a tendencia da mortalidade por DAC nas capitais brasileiras, no periodo de 1950 a 2000. METODOS: Estudo de serie temporal das razoes de mortalidade padronizadas por DAC. Utilizamos dados secundarios de obitos dos anuarios estatisticos do IBGE e do Sistema de Informacao de Mortalidade. Realizamos analise de tendencia linear das razoes de mortalidade padronizadas por DAC nas capitais brasileiras que apresentaram series completas de mortalidade, considerando os anos censitarios do periodo do estudo (1950 a 2000). RESULTADOS: Apesar de proporcionalmente as DAC representarem a primeira causa de obito na populacao brasileira, bem como apresentarem crescimento proporcional no periodo de analise deste estudo, o risco de obito, representado pelas razoes de mortalidade padronizadas, apresenta-se em decrescimo, particularmente a partir da decada de 80. Destacam-se as cidades de Fortaleza, Salvador, Belo Horizonte, Rio de Janeiro e Sao Paulo, que apresentam razoes de mortalidade padronizadas elevadas, porem em decrescimo (p < 0,05 e p < 0,10) desde o inicio do periodo analisado. CONCLUSAO: O comportamento do risco de obito por DAC sugere que esse grupo de enfermidades e o que primeiro se estabelece, acompanhando o aumento da industrializacao no Brasil, verificado a partir da decada de 1930 e apos a Segunda Guerra Mundial, Como ocorreu em Sao Paulo e Rio de Janeiro, que historicamente experimentaram um processo de desenvolvimento e urbanizacao anterior e diferenciado em relacao as outras capitais.

Óbito por dengue como evento sentinela para avaliação da qualidade da assistência: estudo de caso em dois municípios da Região Nordeste, Brasil, 2008

Despite the existing resources for adequate dengue patient care in the Brazilian healthcare system, the case-fatality rate for the disease is still high in the country. In order to identify factors associated with dengue-related death, this study evaluated quality of care according to the degree of implementation of specific measures, the technical and scientific quality of care, and access to health services in two municipalities (counties) in Northeast Brazil. An evaluative study of the implementation analysis type was performed, with death from dengue as the sentinel event for quality of care. To assess the degree of implementation and quality of care, the study scored the interview criteria and patient chart analysis; access was evaluated by thematic analysis. As for structure and process, the health services were found to be partially adequate (70%). No geographic or economic barriers were found to explain the occurrence of deaths. Technical and scientific quality failed to achieve adequate levels in the municipalities (46% and 30%) or in the specific services, and clinical management of dengue by the health services proved insufficient.

Risk factor control in hypertensive and diabetic subjects attended by the Family Health Strategy in the State of Pernambuco, Brazil: the SERVIDIAH study

The SERVIDIAH study (Evaluation of Health Services for Diabetic and Hypertensive Subjects) was conducted in 2010 in the State of Pernambuco, Brazil. A multi-stage random sample of 785 hypertensive and 823 diabetic patients was drawn from 208 Family Health Strategy (FHS) units selected throughout 35 municipalities. Patients underwent a structured interview and weight, height, blood pressure and HbA1c levels (for diabetic patients) were measured. Mean age was approximately 60 years, and women were overrepresented in the sample (70%). 43.7% of hypertensive subjects and 25.8% of diabetic subjects achieved adequate blood pressure control and 30.5% of diabetic subjects had HbA1c levels below 7%. Despite 70% of the patients being overweight or obese, few had adhered to a weight-loss diet. The study of this representative sample of hypertensive and diabetic patients attended by the FHS in the State of Pernambuco shows that improvements in the management of hypertension and diabetes are needed in order to prevent the occurrence of serious and costly complications, especially given the context of increasing incidence of these two conditions.

Monitoramento do desempenho da gestão da vigilância em saúde: instrumento e estratégias de uso

Propoe-se um instrumento para monitorar o desempenho da Vigilância em Saude no âmbito estadual e estrategias para ampliar seu uso. Advoga-se o emprego de metodologias participativas em todas as etapas do monitoramento, desde a elaboracao do instrumento ate a analise e interpretacao dos indicadores, como forma de envolver os interessados e (co)responsabiliza-los nas decisoes tomadas, aumentando sua utilizacao. O instrumento de monitoramento foi construido apos o delineamento do modelo logico da gestao da vigilância em saude e os indicadores representativos de cada componente da gestao passaram por processo de validacao. Alem de subsidiar a tomada de decisao, o monitoramento e entendido enquanto pratica reflexiva capaz de promover o aprendizado pessoal e institucional, melhoria continua dos processos de gestao, maior transparencia e responsabilizacao.This work is a survey of information gathered from waste pickers in the south, southeast and northeast of Brazil in order to provide input for the development of a waste collection vehicle and a support system to define waste collection routes. Thus, the research sought to establish the profile of waste pickers, diagnose their working conditions and identify the physical and operational structure of the organizations to which they are linked. To achieve these objectives it was necessary to apply questionnaires to waste pickers from organizations who performed the collection of recyclable materials using human- and animal-drawn vehicles and the waste picking organizations themselves. These results were subsequently used for the development of the proposed technologies. It can be concluded that the profession of waste picker still suffers from numerous forms of deprivation, resulting in marginalization, prejudice and exclusion of individuals who make their livings from it. It is therefore indispensable to promote activities that contribute to the full productive inclusion of waste pickers.

Tendência da mortalidade por diabetes melito no Brasil: 1950 a 2000

OBJECTIVE: To analyze mortality trend by diabetes mellitus in Brazilian capitals. METHODS: It was analyzed mortality temporal trend by diabetes mellitus in Brazilian capitals, from the death data of the statistic directory of IBGE and the System of Mortality Information of the Ministry of Health, in the period from 1950 to 2000. RESULTS: It was observed the growth of proportional mortality and the Standard Mortality Ratio by diabetes in most of the capitals. Sao Paulo (SP) outstood for presenting expressive and constant proportional mortalities along the series, particularly from 1960. As to the Standard Mortality Ratio in this capital, as well as in Belo Horizonte (MG), where it was noticed the oscillation of these indicators tending to decrease in the last years, it was not observed significant trends. CONCLUSIONS: Mortality trend by diabetes is increasing in most of the capitals, with the exception of Sao Paulo and Belo Horizonte, which have shown different patterns from the other capitals.

Análise de custos da assistência à saúde aos portadores de diabetes melito e hipertensão arterial em uma unidade de saúde pública de referência em Recife - Brasil

Objective: To analyze health care costs of patients with diabetes mellitus and hypertension, and to estimate the cost of medium complexity outpatient procedures, compared with the standard reimbursement values used in Brazil. Materials and methods: We analyzed direct health costs in a public health reference unit in Recife/PE, in 2007. Costs were determined and allocated using the techniques of absorption costing and apportionment. Results: Direct costs and the amount reimbursed by the SUS totaled R

Análise da implantação de um programa com vistas à institucionalização da avaliação em uma Secretaria Estadual de Saúde

4,855,291.82 and R

Consensos sobre o papel do gestor estadual na regionalização da assistência à saúde no Sistema Único de Saúde (SUS)

2.118.893,56, respectively. The greatest groups of expenditure were medications, with R

Analysis of access to hypertensive and diabetic drugs in the Family Health Strategy, State of Pernambuco, Brazil

1,762,424.42 (36.3%), outsourced services, with R

Social determinants of death among the elderly: a systematic literature review

996,637.82 (20.5%); and personnel, with R