Joyce Mendes de Andrade Schramm

Transição epidemiológica e o estudo de carga de doença no Brasil

No Brasil, a transicao epidemiologica nao tem ocorrido de acordo com o modelo experimentado pela maioria dos paises desenvolvidos. Velhos e novos problemas em saude coexistem, com predominância das doencas cronico-degenerativas, embora as doencas transmissiveis ainda desempenhem um papel importante. Neste estudo, os diferenciais, em relacao ao padrao epidemiologico, sao descritos para o Brasil e grandes regioes, para o indicador de saude dos estudos da carga de doenca, o DALY. Entre os principais resultados encontrados, para o Brasil, destaca-se que o grupo das doencas nao-transmissiveis, infecciosas/parasitarias/maternas/perinatais/nutricionais, e das causas externas representaram, respectivamente, 66,3%, 23,5% e 10,2% da carga total de doenca estimada. A utilizacao do indicador DALY propicia a identificacao de prioridades em funcao do perfil epidemiologico, facilitando a tomada de decisoes e destinacao adequada de recursos por parte dos gestores.

Revisão das dimensões de qualidade dos dados e métodos aplicados na avaliação dos sistemas de informação em saúde

In Brazil, quality monitoring of data from the various health information systems does not follow a regular evaluation plan. This paper reviews quality evaluation initiatives related to the Brazilian information systems, identifying the selected quality dimensions and the method employed. The SciELO and LILACS databases were searched, as were the bibliographical references from articles identified in the search. 375 articles were initially identified, leaving a final total of 78 after exclusions. The four most frequent dimensions in articles totaled approximately 90% of the analyses. The studies prioritized certain quality dimensions: reliability, validity, coverage, and completeness. Half of the studies were limited to data from Rio de Janeiro and Sao Paulo. The limited number of studies on some systems and their unequal distribution between regions of the country hinder a comprehensive quality assessment of Brazils health information systems. The importance of accurate information highlights the need to implement a data management policy for health information systems in Brazil.

Global burden of disease attributable to diabetes mellitus in Brazil

Type II diabetes mellitus accounts for 90% of all cases of diabetes, and its inclusion in health evaluation has shown that its complications have a considerable impact on the populations quality of life. The current article presents the results of the Global Burden of Disease Study in Brazil for the year 1998, with an emphasis on diabetes mellitus and its complications. The indicator used was disability-adjusted life years (DALY), using a discount rate of 3%. In Brazil, ischemic heart disease, stroke, and diabetes accounted for 14.7% of total lost DALYs. Brazil showed a higher proportion of years lived with disability (YLDs) among total DALYs for diabetes as compared to other countries. Retinopathy and neuropathy were the complications that contributed most to YLDs. According to forecasts, diabetes mellitus will have an increasing impact on years of life lost due to premature death and disability in the world, shifting from the 11th to 7th cause of death by 2030. It is thus urgent to implement effective measures for prevention, early diagnosis, counseling, and adequate follow-up of patients with diabetes mellitus.

Sistema hospitalar como fonte de informações para estimar a mortalidade neonatal e a natimortalidade

OBJETIVO: Apesar da reconhecida importância em acompanhar a evolucao temporal da mortalidade infantil precoce, a deficiencia das estatisticas vitais no Brasil ainda permanece na agenda atual dos problemas que impedem o seu acompanhamento espaco-temporal. Realizou-se estudo com o objetivo de investigar o Sistema de Informacoes Hospitalares (SIH/SUS) como fonte de informacoes, para estimar a natimortalidade e a mortalidade neonatal. METODOS: Propoe-se um metodo para estimar a natimortalidade e a mortalidade neonatal, o qual foi aplicado para todos os Estados das regioes Nordeste, Sul e Sudeste e para o Para, no ano de 1995. Para fins comparativos, o Sistema de Informacoes sobre Mortalidade (SIM/MS) foi utilizado para estimar as taxas sob estudo, apos a correcao do numero de nascidos vivos por um metodo demografico. RESULTADOS: O SIH/SUS forneceu mais obitos fetais e neonatais precoces do que o SIM/MS em grande parte das unidades federadas da regiao Nordeste. Adicionalmente para os Estados localizados nas regioes Sul e Sudeste, que apresentam, em geral, boa cobertura do registro de obitos, as taxas calculadas pelos dois sistemas de informacao tiveram valores semelhantes. CONCLUSOES: Considerando a cobertura incompleta das estatisticas vitais no Brasil e a agilidade do SIH/SUS em disponibilizar as informacoes em meio magnetico, conclui-se que o uso do SIH/SUS podera trazer inumeras contribuicoes para analise do comportamento espaco-temporal do componente neonatal da mortalidade infantil no territorio brasileiro, em anos recentes.OBJECTIVE Studies on the evolution of infant mortality rate are very relevant. Nevertheless, lack of vital statistics in Brazil limits the temporal and spatial analysis of this indicator. This study aims to investigate the possible use of the Brazilian Hospital Information System as an alternative information source for stillbirth and neonatal mortality rates by age group. METHODS A new method to estimate the stillbirth and neonatal mortality rates is proposed. It was applied in a set of selected Brazilian states in the year of 1995. For comparative purposes, the Brazilian Death Information System was assessed to estimate the mortality rates under study, after adjusting the registered number of live births by using a demographic tool. RESULTS By assessing the Hospital Information System a larger number of fetal and early neonatal deaths were observed when compared to data given by the death information system of the Northeastern states. Besides, in the Southern and Southeastern states, where death records are more thorough, the mortality rates calculated using both information sources were very similar. CONCLUSIONS The results suggest that the proposed methodology could greatly contribute to the analysis of the spatial-time evolution of stillbirth and neonatal death rates in recent years in Brazil, as data on death registration in the majority of the Brazilian states are less thorough than those from the hospital information system.

Evaluation of antenatal peregrination in a sample of postpartum women in Rio de Janeiro, Brazil, 1999/2001

The access to obstetric care in the city of Rio de Janeiro, Brazil, was evaluated in this study. The aim of this article was to determine the social, demographic and obstetric factors associated with the antenatal search for health services, in a sample of 6,652 postpartum women. It was observed that 1/3 of patients have to search for services in more than one hospital, not uncommonly in 3 or more. It is important to consider that only 1/5 of these patients are transferred by ambulance. The factors associated with this peregrination were: place of residence, birth weight, age, skin color, marital status and residence in places where garbage is not picked up. There was no association with schooling; Kotelchuck modified index, obstetric risk, water source and residence in slums.

Algoritmo para a composição de dados por internação a partir do sistema de informações hospitalares do sistema único de saúde (SIH/SUS) - Composição de dados por internação a partir do SIH/SUS

The authorization form for hospital admittance (AIH), an observation unit under the Hospital Information System of the Unified Health System (SIH/SUS), may represent a short-term hospital admittance or a longer hospital stay. This study presents an algorithm for composing admittance data based on the AIH forms, allowing for a proper assessment of hospital mortality, costs under the Unified Health System (SUS), and longer hospital stays, typical of chronic, terminal, and psychiatric patients.

Comparação das informações sobre as prevalências de doenças crônicas obtidas pelo suplemento saúde da PNAD/98 e as estimadas pelo estudo Carga de Doença no Brasil

In this study, prevalence estimates of five chronic disease cirrhosis, depression, diabetes, chronic rhenal insufficiency and tuberculosis based on the 1998 PNAD Health Supplement were compared to those obtained by the Brazilian Global Burden of Disease Project. These estimates were based on systematic literature review as well as on available data set of morbidities. The results show that PNAD presented higher number of cases for depression and Chronic rhenal insufficiency while the prevalence rates estimated by Brazilian Global Burden of Disease Project were higher for cirrhosis, diabetes and tuberculosis.

Carga de doença no Brasil e suas regiões, 2008

The current study estimated DALY (disability-adjusted life years), an indicator of burden of disease, for Brazil in 2008. The North and Northeast regions showed higher burden of disease. Chronic noncommunicable diseases predominated in all regions of the country, especially cardiovascular diseases, mental disorders (particularly depression), diabetes, and chronic obstructive pulmonary disease. The study also showed a high burden of homicides and traffic accidents. Brazils epidemiological profile appears even more complex when one considers the non-negligible burden of communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. The analyses allowed a more detailed understanding of the Brazilians populations health status, underscoring the need for crosscutting actions beyond specific health sector policies and greater attention to the quality of information on morbidity and mortality.En este estudio, se estimo DALY (anos de vida ajustados por discapacidad), un indicador de estudios de carga de enfermedad, para Brasil durante 2008. Entre los principales resultados se observan la mayor carga de enfermedad en las regiones Norte y Noreste y la preponderancia de las enfermedades cronicas no transmisibles en todas las regiones del pais; en particular, las enfermedades cardiovasculares, los trastornos mentales, destacandose la depresion, la diabetes y la enfermedad pulmonar obstructiva cronica. Llama tambien la atencion la elevada carga de homicidios y accidentes de trafico. El perfil epidemiologico se revela mas complejo cuando se considera la no despreciable carga de enfermedades transmisibles, condiciones maternas, perinatales y deficiencias nutricionales. Los analisis efectuados hicieron posible conocer el status de salud de la poblacion, lo que pone en evidencia la demanda de acciones que van mas alla de politicas especificas para el area de la salud, asi como la necesidad de ampliar la preocupacion con la calidad de las informaciones sobre morbimortalidad en Brasil.

Financiamento público em saúde e confiabilidade dos bancos de dados nacionais. Um estudo dos anos de 2001 e 2002

Created in 1999, the Information System on Government Health Budgets (SIOPS) provides information on health revenues and expenditures at the three government levels: Municipal, State, and Federal. The lack of other databases with nationwide coverage and detailed information on municipal expenditures makes SIOPS the main source of data for such studies or estimates. The current study aims to compare the revenues declared in SIOPS by the municipalities and the National Health Fund records in order to assess the reliability of the two databases and identify which variables are most discordant. It also compares the data on Municipal expenditures with those from National Treasury records. The Intra-Class Correlation Coefficient (CCIC) was used for this analysis, complemented by a scatterplot of the mean values for the two databases and their differences. The 2002 data showed better quality. The recognition that SIOPS provides reliable data should stimulate new studies including financial aspects in the analysis of population health.

Burden of disease in Brazil and its regions, 2008

The current study estimated DALY (disability-adjusted life years), an indicator of burden of disease, for Brazil in 2008. The North and Northeast regions showed higher burden of disease. Chronic noncommunicable diseases predominated in all regions of the country, especially cardiovascular diseases, mental disorders (particularly depression), diabetes, and chronic obstructive pulmonary disease. The study also showed a high burden of homicides and traffic accidents. Brazils epidemiological profile appears even more complex when one considers the non-negligible burden of communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. The analyses allowed a more detailed understanding of the Brazilians populations health status, underscoring the need for crosscutting actions beyond specific health sector policies and greater attention to the quality of information on morbidity and mortality.En este estudio, se estimo DALY (anos de vida ajustados por discapacidad), un indicador de estudios de carga de enfermedad, para Brasil durante 2008. Entre los principales resultados se observan la mayor carga de enfermedad en las regiones Norte y Noreste y la preponderancia de las enfermedades cronicas no transmisibles en todas las regiones del pais; en particular, las enfermedades cardiovasculares, los trastornos mentales, destacandose la depresion, la diabetes y la enfermedad pulmonar obstructiva cronica. Llama tambien la atencion la elevada carga de homicidios y accidentes de trafico. El perfil epidemiologico se revela mas complejo cuando se considera la no despreciable carga de enfermedades transmisibles, condiciones maternas, perinatales y deficiencias nutricionales. Los analisis efectuados hicieron posible conocer el status de salud de la poblacion, lo que pone en evidencia la demanda de acciones que van mas alla de politicas especificas para el area de la salud, asi como la necesidad de ampliar la preocupacion con la calidad de las informaciones sobre morbimortalidad en Brasil.