Evangelina Xavier Gouveia de Oliveira

Acesso à internação hospitalar nos municípios brasileiros em 2000: territórios do Sistema Único de Saúde

This article investigates the effect of external factors on hospitalization patterns in Brazilian municipalities (or counties): supply, spatial configuration, socioeconomic aspects, and political context. Inpatient data from 2000 for individuals 15 years and over and most frequent hospital procedures, obtained from the National Hospital Information System (SIH-SUS), were aggregated by place of residence at the municipal level. Nested generalized additive mixed models were fitted using Bayesian inference. Probability of hospitalization is shown to increase with hospital bed supply and with primary care and local capacity, and to decrease with increasing distances and in larger and wealthier municipalities. Inclusion of random, State, and spatial patterns effects reveals regional differences in the probability of hospitalization and the main factors explaining such different patterns.

Condicionantes socioeconômicos e geográficos do acesso à mamografia no Brasil, 2003-2008

This study examined the effect of population characteristics and geographic location of residences and services on the odds of receiving a mammography in 2003 and 2008. Patterns of mammography use were analyzed using data from the Health Supplements of the National Household Sample Survey for women aged over 25, using prevalence ratios, and for women over 40 using multivariate logistic regression, correcting for complex sample design effects. In 2003, 54.6% of women of 50-69 years of age reported having had a mammography, in 2008, 71.5%. The odds are higher for those 50 to 69 years old, and increase with family income, education, being married, having consulted a doctor and having health insurance. Living in a metropolitan area trebles the chance of mammography. Compared to the Northern region, residents in all other regions have greater odds, greater distances decrease the odds. Coverage increased in the age range targeted by national policy, and inequalities due to income and education on access to mammography were reduced but regional convergence was not marked. Increased access seems to relate more to policies of income distribution and social inclusion, and to the availability of the examination in the Unified Health System, than to an increasing number of mammography units.

Acesso à assistência oncológica: mapeamento dos fluxos origem-destino das internações e dos atendimentos ambulatoriais. O caso do câncer de mama

This study analyzes the flow of patients with breast cancer treated in Brazils Unified National Health System (SUS) by type of treatment (surgery, radiotherapy, and chemotherapy). Hospital and outpatient services networks were identified based on data from the National Information System for Inpatient Care (SIH), and the National Information System for Outpatient Cancer Care, for 2005-2006, using TabWin and TerraView. Health services networks reach most of the country, and few municipalities are not connected to a network. However, treatment is highly concentrated in the largest cities, and even the latter show evidence of service shortages. Furthermore, a large proportion of patients live more than 150km from the respective service. Network identification is important for planning and improving services distribution, since geographic access is a relevant issue for treatment outcome. Reduction of morbidity and mortality requires early identification, and appropriate and prompt treatment can reduce the impacts of the disease.

Análise dos fatores socioeconômicos e geográficos do acesso à mamografia no Brasil, 2003-2008

This study examined the effect of population characteristics and geographic location of residences and services on the odds of receiving a mammography in 2003 and 2008. Patterns of mammography use were analyzed using data from the Health Supplements of the National Household Sample Survey for women aged over 25, using prevalence ratios, and for women over 40 using multivariate logistic regression, correcting for complex sample design effects. In 2003, 54.6% of women of 50-69 years of age reported having had a mammography, in 2008, 71.5%. The odds are higher for those 50 to 69 years old, and increase with family income, education, being married, having consulted a doctor and having health insurance. Living in a metropolitan area trebles the chance of mammography. Compared to the Northern region, residents in all other regions have greater odds, greater distances decrease the odds. Coverage increased in the age range targeted by national policy, and inequalities due to income and education on access to mammography were reduced but regional convergence was not marked. Increased access seems to relate more to policies of income distribution and social inclusion, and to the availability of the examination in the Unified Health System, than to an increasing number of mammography units.

Childhood cancer and pediatric oncologic care in Brazil: access and equity

Cancer in children and adolescents is rare and highly curable if treatment is started early, yet it is still the main cause of death from disease in this age group. The aim of this study is to discuss access to health services for cancer patients under 19 years of age in Brazil, mapping deaths and treatment modalities in the Brazilian Unified National Health System (SUS). Data from 2000 to 2007 were analyzed according to health regions. Maps of cancer mortality rates and cancer care indicators - hospitalizations, chemotherapy, and radiotherapy financed by the national health system - revealed inequality in access, based on the small number of procedures for children in poorer regions of the country. Even with the usual concentration of specialized services in more heavily populated areas, access begins with clinical suspicion in primary care, followed by referral to more complex levels, where the diagnosis is made and treatment begins. Training pediatricians in clinical suspicion of childhood cancer and definition of more streamlined patient flows could improve the situation, thereby increasing the odds of cure.

Assistencia ao cancer entre criancas e adolescentes: mapeamento dos fluxos origem-destino no Brasil

OBJETIVO: Analizar los flujos de viajes de ninos y adolescentes con cancer, entre locales de residencia y servicio de salud. METODOS: se analizaron los flujos de viajes de ninos y adolescentes con cancer entre los locales de residencia y el servicio de salud del Sistema Unico de Salud (SUS), de 2000 a 2007. La unidad de analisis fue la regional de salud. Se utilizo el sistema de informaciones geograficas y metodologia de redes por tipo de tratamiento recibido (quimioterapia y radioterapia) e internaciones hospitalarias. RESULTADOS: Se emitieron 465.289 autorizaciones de quimioterapia, 29.151 de radioterapia y 383.568 de internaciones hospitalarias de ninos y adolescentes con diagnostico de cancer para tratamiento en el SUS. El flujo dominante formo 48 redes para quimioterapia, 53 para radioterapia y 112 para internaciones hospitalarias. La mayor parte del volumen de asistencia ocurrio en las regionales de salud de las 12 mayores metropolis del pais con gran relacionamiento entre ellas y extensa area de influencia directa acompanando la estructura de la red urbana brasilena. CONCLUSIONES: La identificacion de las redes establecidas en el ambito del SUS para la atencion de ninos y adolescentes con cancer muestra que la mayoria de los pacientes esta contemplada por las redes estructuradas. Cerca de 10% de los viajes ocurren fuera del flujo dominante, indicando la necesidad de regionalizacion alternativa. Los resultados evidencian la importancia de la planificacion de la distribucion de los servicios de acuerdo con las necesidades de la poblacion usuaria.OBJECTIVE To analyze fl ows of travel between place of residence and health care services by children and adolescents with cancer. METHODS The flows of travel between place of residence and the health care service for children and adolescents receiving care in Brazils Unifi ed Health System (SUS) were monitored between 2000 and 2007. The unit of analysis was the health care district. The geographical information system data and network methodology, by type of treatment received (chemotherapy and radiotherapy) and hospital admissions were used. RESULTS The SUS made 465,289 authorizations for chemotherapy, 29,151 for radiotherapy and 383,568 for hospital admissions for the treatment of children and adolescents with a diagnosis of cancer. The dominant fl ow formed 48 networks for chemotherapy, 53 for radiotherapy and 112 for hospital admissions. Most of the volume of treatment occurred in the health districts of Brazils 12 largest cities (with strong links between them and each having an extensive area of direct infl uence accompanying the structure of the Brazilian urban system. CONCLUSIONS Identifying the networks formed by utilization of SUS facilities providing care for children and adolescents with cancer shows that overall most patients are covered by the existing networks. However, about 10% of travel occurs outside the dominant structure, indicating the need for alternative regionalization. These results show the importance of planning the distribution of services to meet the populations needs.

Asistencia al cancer de ninos y adolescentes: mapeamiento de los flujos origen-destino en Brasil

OBJETIVO: Analizar los flujos de viajes de ninos y adolescentes con cancer, entre locales de residencia y servicio de salud. METODOS: se analizaron los flujos de viajes de ninos y adolescentes con cancer entre los locales de residencia y el servicio de salud del Sistema Unico de Salud (SUS), de 2000 a 2007. La unidad de analisis fue la regional de salud. Se utilizo el sistema de informaciones geograficas y metodologia de redes por tipo de tratamiento recibido (quimioterapia y radioterapia) e internaciones hospitalarias. RESULTADOS: Se emitieron 465.289 autorizaciones de quimioterapia, 29.151 de radioterapia y 383.568 de internaciones hospitalarias de ninos y adolescentes con diagnostico de cancer para tratamiento en el SUS. El flujo dominante formo 48 redes para quimioterapia, 53 para radioterapia y 112 para internaciones hospitalarias. La mayor parte del volumen de asistencia ocurrio en las regionales de salud de las 12 mayores metropolis del pais con gran relacionamiento entre ellas y extensa area de influencia directa acompanando la estructura de la red urbana brasilena. CONCLUSIONES: La identificacion de las redes establecidas en el ambito del SUS para la atencion de ninos y adolescentes con cancer muestra que la mayoria de los pacientes esta contemplada por las redes estructuradas. Cerca de 10% de los viajes ocurren fuera del flujo dominante, indicando la necesidad de regionalizacion alternativa. Los resultados evidencian la importancia de la planificacion de la distribucion de los servicios de acuerdo con las necesidades de la poblacion usuaria.OBJECTIVE To analyze fl ows of travel between place of residence and health care services by children and adolescents with cancer. METHODS The flows of travel between place of residence and the health care service for children and adolescents receiving care in Brazils Unifi ed Health System (SUS) were monitored between 2000 and 2007. The unit of analysis was the health care district. The geographical information system data and network methodology, by type of treatment received (chemotherapy and radiotherapy) and hospital admissions were used. RESULTS The SUS made 465,289 authorizations for chemotherapy, 29,151 for radiotherapy and 383,568 for hospital admissions for the treatment of children and adolescents with a diagnosis of cancer. The dominant fl ow formed 48 networks for chemotherapy, 53 for radiotherapy and 112 for hospital admissions. Most of the volume of treatment occurred in the health districts of Brazils 12 largest cities (with strong links between them and each having an extensive area of direct infl uence accompanying the structure of the Brazilian urban system. CONCLUSIONS Identifying the networks formed by utilization of SUS facilities providing care for children and adolescents with cancer shows that overall most patients are covered by the existing networks. However, about 10% of travel occurs outside the dominant structure, indicating the need for alternative regionalization. These results show the importance of planning the distribution of services to meet the populations needs.

Access to pediatric cancer care in Brazil: mapping origin-destination flows

OBJETIVO: Analizar los flujos de viajes de ninos y adolescentes con cancer, entre locales de residencia y servicio de salud. METODOS: se analizaron los flujos de viajes de ninos y adolescentes con cancer entre los locales de residencia y el servicio de salud del Sistema Unico de Salud (SUS), de 2000 a 2007. La unidad de analisis fue la regional de salud. Se utilizo el sistema de informaciones geograficas y metodologia de redes por tipo de tratamiento recibido (quimioterapia y radioterapia) e internaciones hospitalarias. RESULTADOS: Se emitieron 465.289 autorizaciones de quimioterapia, 29.151 de radioterapia y 383.568 de internaciones hospitalarias de ninos y adolescentes con diagnostico de cancer para tratamiento en el SUS. El flujo dominante formo 48 redes para quimioterapia, 53 para radioterapia y 112 para internaciones hospitalarias. La mayor parte del volumen de asistencia ocurrio en las regionales de salud de las 12 mayores metropolis del pais con gran relacionamiento entre ellas y extensa area de influencia directa acompanando la estructura de la red urbana brasilena. CONCLUSIONES: La identificacion de las redes establecidas en el ambito del SUS para la atencion de ninos y adolescentes con cancer muestra que la mayoria de los pacientes esta contemplada por las redes estructuradas. Cerca de 10% de los viajes ocurren fuera del flujo dominante, indicando la necesidad de regionalizacion alternativa. Los resultados evidencian la importancia de la planificacion de la distribucion de los servicios de acuerdo con las necesidades de la poblacion usuaria.OBJECTIVE To analyze fl ows of travel between place of residence and health care services by children and adolescents with cancer. METHODS The flows of travel between place of residence and the health care service for children and adolescents receiving care in Brazils Unifi ed Health System (SUS) were monitored between 2000 and 2007. The unit of analysis was the health care district. The geographical information system data and network methodology, by type of treatment received (chemotherapy and radiotherapy) and hospital admissions were used. RESULTS The SUS made 465,289 authorizations for chemotherapy, 29,151 for radiotherapy and 383,568 for hospital admissions for the treatment of children and adolescents with a diagnosis of cancer. The dominant fl ow formed 48 networks for chemotherapy, 53 for radiotherapy and 112 for hospital admissions. Most of the volume of treatment occurred in the health districts of Brazils 12 largest cities (with strong links between them and each having an extensive area of direct infl uence accompanying the structure of the Brazilian urban system. CONCLUSIONS Identifying the networks formed by utilization of SUS facilities providing care for children and adolescents with cancer shows that overall most patients are covered by the existing networks. However, about 10% of travel occurs outside the dominant structure, indicating the need for alternative regionalization. These results show the importance of planning the distribution of services to meet the populations needs.