Marismary Horsth De Seta

Avaliação dos serviços hospitalares de emergência do programa QualiSUS

The aid lent by the emergency services is the object of this paper, which aims to assess the emergency service of the QualiSUS program. The study is descriptive with the application of a questionnaire to the responsible of the emergency services in eight hospitals. The emergency services were always overcrowded, and the causes pointed were the low resolutivity of basic attention and the precariousness of the hospital network. Contributing to this there is the primary care decreased resolutivity and the precariousness of the hospital network. Six hospitals do not manage the emergency service. The entrance system is not organized and only three hospitals work with risk classification. All of them refer difficulties with internal and external services. The hardest pathologies to refer to other services are the chronicles, neurological and social. The professionals do not have specific qualification and the precariousness job contracts do not contribute neither for the professionals fixation nor for his qualification. Clinical protocols are used by one service. It was noticed the influence of the QualiSUS in the hospitals. The failure of the health services network interferes with the emergency patients profile. The investment of the QualiSUS cannot be restrained to the hospital. Emergency should be more integrated to the system and hospital. The qualification of human resources is indispensable as well as the beds regulation.

Construção do Sistema Brasileiro de Vigilância Sanitária: argumentos para debate

This paper analyzes the Brazilian Sanitary Surveillance System as an arrangement aimed at regulating and reducing health risks associated with consumption of products, use of health services and the environment. Historical, political and tax aspects were considered and their development compared with the National Health Surveillance System, which has received strong international cooperation. The comparison was based on the trajectory of their national systems and related federal agencies, as well as on criteria adopted for decentralization. The central category of analysis is federative coordination and was based on the framework of federalism and intergovernmental relations. The institutional context of health and sanitary surveillance presents strong political competition, instability in the project and probable reduction of the ability of federal coordination after the Pact for Health. The National Sanitary Surveillance System due to its nature of public good and high externality in its field of action requires federal coordination for increasing the regional and local cooperation, also because of the structural heterogeneity of Brazilian municipalities.

Adverse events and other incidents in neonatal intensive care units

The occurrence of avoidable adverse events (AEs) represents a problem of quality of care that is responsible for the increase in monetary and social costs, causing suffering to the patient, their family members and the professional involved. This situation is aggravated when it involves newborns (NBs) with very low birth weights and shorter gestational ages, admitted to neonatal intensive care units (NICU). The scope of this study is to understand more about these incidents and adverse events in NICUs. The article aims to identify the occurrence of incidents, with and without injury that have occurred in NICUs in the literature and correlate this with the gestational age group of the NBs most affected. This is a systematic review of the available literature on incidents, particularly AEs as witnessed in NICUs. This study reveals that the types of incidents that occur in NICUs, with or without injury to the patient, are related to errors or failures in medication use, healthcare-associated infections (HAIs), skin injuries, mechanical ventilation and intravascular catheters. The cause of incidents and adverse events in NICUs are associated with human factors and the outcomes that are most damaging are due to HAIs. Furthermore, the study points out ways to mitigate these occurrences.

Evolution of mammographic image quality in the state of Rio de Janeiro

Objective To evaluate the evolution of mammographic image quality in the state of Rio de Janeiro on the basis of parameters measured and analyzed during health surveillance inspections in the period from 2006 to 2011. Materials and Methods Descriptive study analyzing parameters connected with imaging quality of 52 mammography apparatuses inspected at least twice with a one-year interval. Results Amongst the 16 analyzed parameters, 7 presented more than 70% of conformity, namely: compression paddle pressure intensity (85.1%), films development (72.7%), film response (72.7%), low contrast fine detail (92.2%), tumor mass visualization (76.5%), absence of image artifacts (94.1%), mammography-specific developers availability (88.2%). On the other hand, relevant parameters were below 50% conformity, namely: monthly image quality control testing (28.8%) and high contrast details with respect to microcalcifications visualization (47.1%). Conclusion The analysis revealed critical situations in terms of compliance with the health surveillance standards. Priority should be given to those mammography apparatuses that remained non-compliant at the second inspection performed within the one-year interval.

Cuidado nutricional em hospitais públicos de quatro estados brasileiros: contribuições da avaliação em saúde à vigilância sanitária de serviços

Considering the importance of nutritional care for the quality of care provided to hospitalized patients, the study aims to assess health care in eight public hospitals that have received support from QualiSUS in four Brazilian states. There were semi-structured interviews with nutritionists, direct observation and review of 219 records of patients admitted to the medical clinics. The findings suggest weaknesses in the hospital nutritional care, poor integration between the production of food and nutritional care in the surveyed hospitals, in addition to structural deficiencies. We highlight problems related to the nutritional care process, including its documentation. In 93% of the records there were no records on the nutritional status on admission, or nutritional assessment of patients in nutritional therapy. It was observed that the assessment made by the health surveillance in routine inspections, focusing on the verification of compliance and structural aspects, does not include the detection of a possible nutritional risk for the patient. We suggest the inclusion of other criteria and strategies for surveillance, among them a review of open medical records.

Proteção à saúde no Brasil: o Sistema Nacional de Vigilância Sanitária

This essay presents the singular arrangement named Health Surveillance in Brazil and the specificities of its components: public Health Surveillance, Workers Surveillance, Environmental Surveillance, Sanitary Surveillance, as well as the constitutional determination to carry out the actions of sanitary and epidemiological surveillance and Workers Surveillance. The two national systems of protection and promote health are also presented - National Public Health Surveillance System and National Sanitary Surveillance System, with an emphasis on the regulatory issues in health made by the latter and some constraints to its action by the Legislative Branch. It reaffirms the Brazilian States constitutional duty to protect health, and to provide the means for adequate functioning of the two systems, bearing in mind that defense of the public interest in health products and services means confronting oligopolies of transnational economic interests. This paper states the opinion that the financial constraints facing the Brazilian State from time to time cannot be allowed to prevail over the rights of citizenship, independently of the public underfunding of health in Brazil.Resumo Neste ensaio se apresenta o singular arranjo denominado Vigilância em Saude no Brasil e as especificidades das vigilâncias que o compoem: Vigilância Sanitaria, Vigilância Epidemiologica Ampliada, Vigilância em Saude do Trabalhador e Vigilância Ambiental em Saude, bem como a determinacao constitucional de realizacao das acoes de Vigilância Sanitaria e Epidemiologica e de Saude do Trabalhador. Sao discutidos os dois sistemas nacionais de protecao da saude - Sistema Nacional de Vigilância em Saude e Sistema Nacional de Vigilância Sanitaria, ressaltando-se a regulacao sanitaria efetuada por este ultimo e alguns constrangimentos a sua acao pelo Poder Legislativo. Reafirma-se o dever constitucional do Estado brasileiro na protecao da saude, provendo meios para o adequado funcionamento dos dois sistemas, tendo em vista que a defesa dos interesses sanitarios representa o enfrentamento de interesses economicos transnacionais oligopolizados. O argumento da crise financeira do Estado brasileiro nao pode prevalecer sobre direitos da cidadania, na vigencia do subfinanciamento publico da saude no Brasil.

Financiamento federal da Vigilância Sanitária no Brasil de 2005 a 2012: análise da distribuição dos recursos

Resumo A Vigilância Sanitaria realiza um conjunto de acoes de prevencao de riscos a saude relacionados ao consumo de produtos e a prestacao de servicos no âmbito do Sistema Unico de Saude. A realizacao das acoes de Vigilância Sanitaria depende fortemente da politica de financiamento federal, que e indutora da sua descentralizacao. O objetivo deste texto e analisar o financiamento federal da Vigilância Sanitaria para estados e municipios, a partir dos repasses programados, no periodo entre 2005-2012. Entre os principais resultados estao o aumento nos valores per capita, com manutencao em torno do valor medio de R

Eventos adversos e incidentes sem dano em recém-nascidos notificados no Brasil, nos anos 2007 a 2013

1,25/hab/ano; o aumento no numero de municipios que pactuaram a realizacao de acoes estrategicas; e uma tendencia de estabilizacao nos percentuais atinentes a cada ente federado em torno de 50% aos Municipios, 25% aos entes federados Estado e 20% aos Laboratorios Centrais de Saude Publica. Os resultados evidenciam que a adocao de valores per capita unificados para todo o pais provocou distorcoes que indicam iniquidade entre territorios estaduais, apontando a necessidade de tornar mais preciso o conceito de equidade no financiamento no âmbito do Sistema Nacional de Vigilância Sanitaria e de ampliar a discussao sobre os criterios de alocacao atualmente utilizados.Health Surveillance carries out a set of actions to prevent health risks related to the consumption of products and the provision of services under the Unified Health System (SUS). The implementation of Health Surveillance actions relies heavily on the federal funding policy, which induces its decentralization. This text aims to analyze the federal funding of Health Surveillance to States and Municipalities from the scheduled onlendings in the period 2005-2012. Among the main results are the increase of per capita values, steady at around the mean value of R

Distribución de los mamógrafos y las mamografías en el estado de Rio de Janeiro, 2012/2013

1.25/inhabitant/year; the increased number of municipalities that agreed to carry out strategic actions; and a stable trend in the proportions of each federated entity at around 50% to Municipalities, 25% to state federated entities and 20% to the Central Public Health Laboratories (LACENs). Results show that the adoption of unified nationwide per capita values caused distortions that indicate inequity among state territories, pointing to the need to clarify the concept of equity in financing under the National Health Surveillance System and to broaden the discussion on the currently used allocation criteria.

Distribution of mammography equipment and mammographies in Rio de Janeiro State, Brazil, 2012 and 2013

This study aimed to analyze adverse events and near misses in newborns up to 28 days of life, reported to the Brazilian National Notification System for Sanitary Surveillance (NOTIVISA) system from 2007 to 2013. This was a quantitative, descriptive, retrospective study with analysis of secondary data. A total of 355 incidents were reported: 118 (33.3%) related to medical devices, 4 (1.1%) medical equipment, and 233 (65.6%) medicines. Silver nitrate and antibiotics were the most frequently reported medicines, and among medical devices and equipment, phlebitis associated with IV lines was the most frequently reported adverse event. The study unveils the reporting of adverse events and near misses, fostering discussion on what actually constitutes harm according to the person that reports the event. The challenge for NOTIVISA is to improve the system, and as with other information systems, this results from its use, critical analysis, and interaction with users - incident reporters and interested parties like teaching and research institutions.