Gabriella Morais Duarte Miranda

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.

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.

Condições e motivações para o trabalho de enfermeiros e médicos em serviços de emergência de alta complexidade

This study aimed to evaluate the motivations and conditions offered to the work of nurses and doctors in three high complexity emergency services of the city of Recife, Pernambuco. It is a descriptive transversal type study. It was interviewed 42 nurses and 84 doctors, of a total population of 97 nurses and 469 doctors. It was used a questionnaire prepared for this survey and the Scale of Values Related to Work. On the motivation assessment it was found that Professional Realization was the major motivational factor, and Prestige the less important factor.This study aimed to evaluate the motivations and conditions offered to the work of nurses and doctors in three high complexity emergency services of the city of Recife, Pernambuco. It is a descriptive transversal type study. It was interviewed 42 nurses and 84 doctors, of a total population of 97 nurses and 469 doctors. It was used a questionnaire prepared for this survey and the Scale of Values Related to Work. On the motivation assessment it was found that Professional Realization was the major motivational factor, and Prestige the less important factor.

Desafios das políticas públicas no cenário de transição demográfica e mudanças sociais no Brasil

Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.

Evaluation of maternal and neonatal hospital care: quality index of completeness

OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System. METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country. RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country. CONCLUSIONS The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations.

Childbirth care in Brazil: a critical situation has not yet been overcome. 1999-2013

Objectives: to analyze the evolution of childbirth care in Brazil, between 1999-2013. Methods: a time-series ecological study, using data from Ministry of Health, Brazilian Institute of Geography and Statistics, and Interagency Network of Information for Health. 18 indicators were analyzed related to childbirth and mortality. Results: there was a reduction in rates of fertility, natality and the total number of births, with increased cesarean surgeries. Growth of prenatal consultation, intensive care beds and reduction of beds in obstetrics sector. The significant growth of caesarean deliveries, prenatal consultation coverage and concentration of births in hospitals occurred simultaneously with the growth: of preventable child deaths by adequate attention, management causes and appropriate delivery, prematurity; low weight; Downs syndrome; and the persistence of maternal deaths due to direct obstetric causes. Conclusions: persists hegemonic technocratic model of childbirth care without considering the observed changes in the profile of mothers and births, with slow reduction of perinatal and neonatal deaths and maintenance of high maternal mortality demonstrating that the critical situation of delivery care model in Brazil has not, yet, been overcome.

Public policies challenges on the background of demographic transition and social changes in Brazil

Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.

Desafíos de las políticas públicas en el escenario de transición demográfica y cambios sociales en Brasil

Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.