Josué Laguardia

Os Suplementos Saúde na Pesquisa Nacional por Amostra de Domicílios (PNAD) no Brasil

As mudancas socioeconomicas, demograficas e tecnologicas e suas implicacoes nas politicas publicas demandam dos orgaos governamentais a producao de informacoes. As informacoes atualizadas de base populacional e de âmbito nacional sao essenciais ao processo de planejamento e ao acompanhamento pela sociedade do cumprimento dos principios constitucionais da saude, como direito ao acesso igualitario aos servicos de saude. A Pesquisa Nacional por Amostra de Domicilios (PNAD) e uma fonte de dados importante para o conhecimento e monitoramento de aspectos relevantes da situacao de saude da populacao brasileira e do acesso, utilizacao e financiamento de servicos de saude. Neste artigo, faz-se um breve historico da evolucao dos objetivos, da periodicidade e da abrangencia geografica ao longo de quatro decadas da PNAD no Brasil, enfatizando-se os principais aspectos incluidos nos suplementos de saude em 1981, 1986, 1998 e 2003. A producao de textos tecnicos e academicos, gerados a partir desses suplementos, tem permitido conhecer aspectos importantes da saude da populacao brasileira e monitorar, em diferentes recortes geograficos e socioeconomicos, as politicas voltadas para o acesso e uso de servicos de saude. Argumenta-se sobre a necessidade de iniciar uma discussao mais profunda sobre a continuidade da serie historica iniciada em 1998, frente a implantacao, em futuro proximo, do Sistema Integrado de Pesquisas Domiciliares (SIPD) pelo IBGE.

Avaliação de Desempenho de Sistemas de Saúde: um modelo de análise

This paper presents a review of the Dimension Matrix for Evaluation of the Brazilian Health System that was initially developed in 2003, as well as a conceptual update of some of the sub-dimensions for the evaluation of health service performance, namely effectiveness, access, efficiency and appropriateness of health care. It also describes the indicator selection process as well as the results obtained in each performance dimension. The behavior of the indicators used to assess the performance of health services in Brazil, with respect to each sub-dimension, was not uniform. Areas of marked improvement were found in indicators that are influenced by activities in the field of primary care. The most significant improvements were seen in the sub-dimensions of Effectiveness and Access. With respect to the Efficiency of health services, situations of high efficiency coexist with others with substandard performance. The performance of health services in the sub-dimension of Appropriateness of Health Care was the lowest of all indicators.

A segurança do paciente como dimensão da qualidade do cuidado de saúde - um olhar sobre a literatura

O cenario moderno e competitivo dos sistemas de prestacao de cuidados de saude contrapoe-se as suas demandas ascendentes e aos recursos nem sempre suficientes. A preocupacao com a seguranca do paciente, importante dimensao da qualidade do cuidado de saude, constitui atualmente tema de relevância crescente entre pesquisadores do todo o mundo. Os eventos adversos ocorrem em qualquer local onde se prestam cuidados de saude e na maioria das situacoes sao passiveis de medidas preventivas. O objetivo deste artigo e apresentar, por meio de uma revisao bibliografica, o discurso sobre a seguranca do paciente a partir do seculo XXI, enfocando sua relevância enquanto problema global de saude publica; discorrer sobre os desafios relacionados as lacunas e perspectivas em termos de pesquisa acerca do tema e sua abordagem na realidade brasileira. Verifica-se que a investigacao sobre a seguranca do paciente ainda nao possui o beneficio de ter suas abordagens bem estabelecidas; e ainda, que multiplas barreiras e desafios precisam ser enfrentados na concepcao de delineamentos de estudos e na utilizacao de tecnicas de pesquisa.

Psychometric evaluation of the SF-36 (v.2) questionnaire in a probability sample of Brazilian households: results of the survey Pesquisa Dimensões Sociais das Desigualdades (PDSD), Brazil, 2008.

BackgroundIn Brazil, despite the growing use of SF-36 in different research environments, most of the psychometric evaluation of the translated questionnaire was from studies with samples of patients. The purpose of this paper is to examine if the Brazilian version of SF-36 satisfies scaling assumptions, reliability and validity required for valid interpretation of the SF-36 summated ratings scales in the general population.Methods12,423 individuals and their spouses living in 8,048 households were selected from a stratified sample of all permanent households along the country to be interviewed using the Brazilian SF-36 (version 2). Psychometric tests were performed to evaluate the scaling assumptions based on IQOLA methodology.ResultsData quality was satisfactory with questionnaire completion rate of 100%. The ordering of the item means within scales clustered as hypothesized. All item-scale correlations exceeded the suggested criteria for reliability with success rate of 100% and low floor and ceiling effects. All scales reached the criteria for group comparison and factor analysis identified two principal components that jointly accounted for 67.5% of the total variance. Role emotional and vitality were strongly correlated with physical and mental components, respectively, while social functioning was moderately correlated with both components. Role physical and mental health scales were, respectively, the most valid measures of the physical and mental health component. In the comparisons between groups that differed by the presence or absence of depression, subjects who reported having the disease had lower mean scores in all scales and mental health scale discriminated best between the two groups. Among those healthy and with one, two or three and more chronic illness, the average scores were inverted related to the number of diseases. Body pain, general health and vitality were the most discriminating scales between healthy and diseased groups. Higher scores were associated with individuals of male sex, age below 40 years old and high schooling.ConclusionsThe Brazilian version of SF-36 performed well and the findings suggested that it is a reliable and valid measure of health related quality of life among the general population as well as a promising measure for research on health inequalities in Brazil.

Adaptação transcultural da versão brasileira do Hospital Survey on Patient Safety Culture: etapa inicial

A avaliacao da cultura de seguranca do paciente permite aos hospitais identificar e gerir prospectivamente questoes relevantes de seguranca em suas rotinas de trabalho. Este artigo descreve a adaptacao transcultural do Hospital Survey on Patient Safety Culture (HSOPSC) para a Lingua Portuguesa e contexto brasileiro. Adotou-se abordagem universalista para avaliar a equivalencia conceitual, de itens e semântica. A metodologia incluiu os seguintes estagios: (1) traducao do questionario para o Portugues; (2) retraducao para o Ingles; (3) painel de especialistas para elaboracao da versao preliminar; (4) avaliacao da compreensao verbal pela populacao-alvo. O questionario foi traduzido para o Portugues e sua versao final incluiu 42 itens. A populacao-alvo avaliou todos os itens como de facil compreensao. O questionario encontra-se traduzido para o Portugues e adaptado para o contexto brasileiro, entretanto, faz-se necessario avaliar sua equivalencia de mensuracao, validade externa e reprodutibilidade.

Avaliação em ambientes virtuais de aprendizagem

The demand for evaluations of projects of virtual distance learning has required the use of concepts and methods that go beyond the strictly educational field, with emphasis on the multiplicity of theoretical frameworks and technical approaches employed in the assessment strategies of online learning. Despite the hegemony of quantitative methods in the evaluation of the technologies of information and communication, the use of qualitative methods in the assessment of virtual environments has increased throughout the last decades. The combination of qualitative-quantitative methods allows a better understanding of the phenomena underlying the use of technologies for online learning. Given that education in virtual environments relates to learning experiences that make use of hypermediatic resources within environments supported by an online communication technology, we have opted in the present article for focusing on topics associated to the evaluation of information and learning technologies in these environments, furthering the discussion concerning the methods relevant to the assessment both of the virtual learning environments and of the learning within this medium. This choice is due to the recognition of the specificities of the practices of distance learning, which stress the relationship between education and communication, made possible through the new information and communication technologies. It also recognizes the various roles, positive and negative, attributed to the information and communication technologies in education.

Brazilian normative data for the Short Form 36 questionnaire, version 2

METHODS The study Pesquisa Dimensões Sociais das Desigualdades (PDSD) (Social Dimensions of Inequalities) involves 12,423 randomly selected Brazilian men and women aged 18 years old or more from urban and rural areas of the five Brazilian regions, and the information collected included the SF-36 as a measure of health-related quality of life. This provided a unique opportunity to develop age and gender-adjusted normative data for the Brazilian population. RESULTS Brazilian men scored substantially higher than women on all eight domains and the two summary component scales of the SF-36. Brazilians scored less than their international counterparts on almost all of SF-36 domains and both summary component scales, except on general health status (US), pain (UK) and vitality (Australia, US and Canada). CONCLUSION The differences in the SF-36 scores between age groups, genders and countries confirm that these Brazilian norms are necessary for comparative purposes. The data will be useful for assessing the health status of the general population and of patient populations, and the effect of interventions on health-related quality of life.

Comparison between two race/skin color classifications in relation to health-related outcomes in Brazil

BackgroundThis paper aims to compare the classification of race/skin color based on the discrete categories used by the Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE) and a skin color scale with values ranging from 1 (lighter skin) to 10 (darker skin), examining whether choosing one alternative or the other can influence measures of self-evaluation of health status, health care service utilization and discrimination in the health services.MethodsThis is a cross-sectional study based on data from the World Health Survey carried out in Brazil in 2003 with a sample of 5000 individuals older than 18 years. Similarities between the two classifications were evaluated by means of correspondence analysis. The effect of the two classifications on health outcomes was tested through logistic regression models for each sex, using age, educational level and ownership of consumer goods as covariables.ResultsBoth measures of race/skin color represent the same race/skin color construct. The results show a tendency among Brazilians to classify their skin color in shades closer to the center of the color gradient. Women tend to classify their race/skin color as a little lighter than men in the skin color scale, an effect not observed when IBGE categories are used. With regard to health and health care utilization, race/skin color was not relevant in explaining any of them, regardless of the race/skin color classification. Lack of money and social class were the most prevalent reasons for discrimination in healthcare reported in the survey, suggesting that in Brazil the discussion about discrimination in the health care must not be restricted to racial discrimination and should also consider class-based discrimination. The study shows that the differences of the two classifications of race/skin color are small. However, the interval scale measure appeared to increase the freedom of choice of the respondent.

No fio da navalha: anemiafalciforme, raça e as implicaçõesno cuidado à saúde

As propostas de politicas de saude para a populacao negra tem uma historia recente no cenario politico brasileiro, com um destaque especial para o Programa Nacional de Anemia Falciforme (PAF). Esse programa e o resultado das acoes politicas do movimento negro em prol do reconhecimento da anemia falciforme como uma doenca prevalente na populacao negra brasileira. No seio dessa acao politica foram elaborados discursos sobre a anemia falciforme que ressaltam, a partir de pressupostos biologicos e epidemiologicos, o carater racial dessa doenca. O proposito deste artigo e criticar tais pressupostos, enfatizando as implicacoes eticas decorrentes da racializacao das doencas.

Raça e epidemiologia: as estratégias para construção de diferenças biológicas

In the current controversies about race and racial differences in health, epidemiology is seen as the authority that confirms or refutes the scientific truth of these differences. Pointing out the current discussions about the limitations of risk factor epidemiology, hegemonic branch of the epidemiological approaches, it is the aim of this article to highlight the ideological character of the causal assumptions and epistemological strategies that restate and reify the racial differences in health based on biological determinism and statistical reductionism. The objective of this work is to highlight the possibilities of contestation of some interpretations about epidemiological findings on racial differences in health, emphasizing the political and ideological aspects of science and providing the investigators with arguments that can help to overcome the racialism that permeates certain causal hypothesis about human diversity and disease.