Núbia Cristina da Silva

Primary Health Care and Cervical Cancer Mortality Rates in Brazil: A Longitudinal Ecological Study

Cervical cancer is a common neoplasm that is responsible for nearly 230 000 deaths annually in Brazil. Despite this burden, cervical cancer is considered preventable with appropriate care. We conducted a longitudinal ecological study from 2002 to 2012 to examine the relationship between the delivery of preventive primary care and cervical cancer mortality rates in Brazil. Brazilian states and the federal district were the unit of analysis (N = 27). Results suggest that primary health care has contributed to reducing cervical cancer mortality rates in Brazil; however, the full potential of preventive care has yet to be realized.

Equidade na Atenção Primária à Saúde da Mulher: uma análise do Brasil e suas regiões

This study aims to measure equity in primary health care of women through the evaluation of four using services markers: mammography, Pap cervical cancer, clinical examination and palpation of breast and health self-stated. The markers are evaluated according to family income and geographic location. For the analysis we used secondary data from the National Household Sample Survey (PNAD) of 2008. That study supported the analysis of equity by graphical method by constructing concentration curves for Brazil and for the North, Northeast, Midwest, Southeast and South regions. The results highlight that in general the performance of the chosen markers showed a pattern of inequity by income, and by geographic distribution. However, for the North and Northeast regions, some markers exhibited a pattern of equitable distribution or favoring the lower-income population. Despite advances to seek improvements in the provision of health services dedicated to women, there is still a necessity to improve access to basic preventive services.

Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil

BackgroundUnequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges.MethodsThe present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals.ResultsThe analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people.ConclusionsThere is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access to emergency and surgical care. However more investments in are necessary to improve small hospitals capabilities to fill this gap.

Human Resource Management in Health and Performance of Work Process in the Primary Health Care—An Efficiency Analysis in a Brazilian Municipality:

The objective of this study was to analyze how management practices of human resources (HR) in health can be associated with efficiency in fulfilling the work process of family health teams in primary health care (PHC) strategy adopted in a Brazilian municipality. To do so, were analyzed indicators of HR vis-à-vis an efficiency score obtained from data envelopment analysis (DEA). The analysis model used was based on the dimensions of structure, process as sources of information about the quality of care delivery actions, considering Donabedian’s model of evaluation of health services. The results indicate that investment in training of professionals and fixation of doctors can contribute significantly to improve the efficiency indices obtained by the teams of the city. Despite the advances made in terms of human resource management (HRM) in health, still weigh several challenges for this strategy to be consolidated as a tool to make the Family Health Strategy (FHS) more effectively.

A equidade na cobertura da Estratégia Saúde da Família em Minas Gerais, Brasil

A Estrategia Saude da Familia (ESF) tem papel relevante na prevencao e no acompanhamento das familias no Sistema Unico de Saude. O presente estudo tem como objetivo analisar a equidade na cobertura desses servicos ofertados na area urbana de Minas Gerais, Brasil. A pesquisa analisa diversos marcadores considerando quatro grupos-alvo: mulheres, gestantes, criancas e idosos, sendo representativa por macrorregiao de saude. Foram investigados em 2012, 6.797 domicilios, sendo entrevistados 5.820 mulheres, 1.758 criancas e 3.629 idosos. Para analisar a equidade, foram construidas taxas de cobertura da ESF por classe de riqueza e estimados indices e curvas de concentracao. Os resultados revelam que a ESF e uma politica equitativa. Os indicadores mostram que os domicilios mais pobres apresentam maiores taxas de visitacao da ESF. Considerando a populacao residente nas areas adscritas as equipes de saude, o nivel de cobertura e bastante elevado: 88% da populacao investigada receberam pelo menos uma visita dos profissionais da ESF nos ultimos 12 meses, o que resulta em indices de concentracao perto de zero.The Family Health Strategy (FHS) plays an important role in prevention and in monitoring families in the Brazilian Unified National Health System. This study aims to analyze equity in the coverage of these services in the urban areas of Minas Gerais State, Brazil. The research is unprecedented and analyzes several markers for four target groups: women, pregnant women, children, and the elderly. The study is representative of the various health macro-regions. In 2012, 6,797 households were surveyed, with 5,820 women, 1,758 children, and 3,629 elderly. To analyze equity, FHS coverage rates were calculated according to family income, and concentration indices and curves were estimated. The results show that the FHS is an equitable policy. The indicators show that poorer households have higher visitation rates under the FHS. Coverage of the eligible population is quite high: 88% of households received at least one visit from FHS professionals in the previous 12 months, resulting in a concentration index near zero.

Equity in coverage by the Family Health Strategy in Minas Gerais State, Brazil

A Estrategia Saude da Familia (ESF) tem papel relevante na prevencao e no acompanhamento das familias no Sistema Unico de Saude. O presente estudo tem como objetivo analisar a equidade na cobertura desses servicos ofertados na area urbana de Minas Gerais, Brasil. A pesquisa analisa diversos marcadores considerando quatro grupos-alvo: mulheres, gestantes, criancas e idosos, sendo representativa por macrorregiao de saude. Foram investigados em 2012, 6.797 domicilios, sendo entrevistados 5.820 mulheres, 1.758 criancas e 3.629 idosos. Para analisar a equidade, foram construidas taxas de cobertura da ESF por classe de riqueza e estimados indices e curvas de concentracao. Os resultados revelam que a ESF e uma politica equitativa. Os indicadores mostram que os domicilios mais pobres apresentam maiores taxas de visitacao da ESF. Considerando a populacao residente nas areas adscritas as equipes de saude, o nivel de cobertura e bastante elevado: 88% da populacao investigada receberam pelo menos uma visita dos profissionais da ESF nos ultimos 12 meses, o que resulta em indices de concentracao perto de zero.The Family Health Strategy (FHS) plays an important role in prevention and in monitoring families in the Brazilian Unified National Health System. This study aims to analyze equity in the coverage of these services in the urban areas of Minas Gerais State, Brazil. The research is unprecedented and analyzes several markers for four target groups: women, pregnant women, children, and the elderly. The study is representative of the various health macro-regions. In 2012, 6,797 households were surveyed, with 5,820 women, 1,758 children, and 3,629 elderly. To analyze equity, FHS coverage rates were calculated according to family income, and concentration indices and curves were estimated. The results show that the FHS is an equitable policy. The indicators show that poorer households have higher visitation rates under the FHS. Coverage of the eligible population is quite high: 88% of households received at least one visit from FHS professionals in the previous 12 months, resulting in a concentration index near zero.

mHealth: Smart Wearable Devices and the Challenges of a Refractory Context

The development of smart wearable devices has strengthened a new area: mHealth. This is characterized by the use of mobile technologies for the diagnosis, monitoring, and intervention of health conditions. When inserted into the wider universe comprising the Internet of Things, mHealth solutions emerge with real-world applications. The myriad of mHealth-based applications already draws a scenario in which these new technologies will be responsible for changing the current logic of healthcare delivery. Nevertheless, there are numerous challenges for mHealth before its full potential can be realized. The Brazilian context is marked by peculiarities regarding the challenges for the dissemination of mHealth. There are few professionals, resistance to adopting new health technologies, an inexistent regulatory framework, regional inequalities, the absence of guidelines for protecting personal data, and difficulty associated with communication networks. Such aspects are discussed throughout this work together with components relating to the current status of development linked to mHealth.

Zika virus infection and microcephaly: Evidence regarding geospatial associations

Background Although the Zika virus (ZIKV) epidemic ceased to be a public health emergency by the end of 2016, studies to improve knowledge about this emerging disease are still needed, especially those investigating a causal relationship between ZIKV in pregnant women and microcephaly in neonates. However, there are still many challenges in describing the relationship between ZIKV and microcephaly. The few studies focusing on the epidemiological profile of ZIKV and its changes over time are largely limited to systematic reviews of case reports and dispersal mapping of ZIKV spread over time without quantitative methods to analyze patterns and their covariates. Since Brazil has been at the epicenter of the ZIKV epidemic, this study examines the geospatial association between ZIKV and microcephaly in Brazil. Methods Our study is categorized as a retrospective, ecological study based on secondary databases. Data were obtained from January to December 2016, from the following data sources: Brazilian System for Epidemiological Surveillance, Disease Notification System, System for Specialized Management Support, and Brazilian Institute of Geography and Statistics. Data were aggregated by municipality. Incidence rates were estimated per 100,000 inhabitants. Analyses consisted of mapping the aggregated incidence rates of ZIKV and microcephaly, followed by a Getis-Ord-Gi spatial cluster analysis and a Bivariate Local Moran’s I analysis. Results The incidence of ZIKV cases is changing the virus’s spatial pattern, shifting from Brazil’s Northeast region to the Midwest and North regions. The number of municipalities in clusters of microcephaly incidence is also shifting from the Northeast region to the Midwest and North, after a time lag is considered. Our findings suggest an increase in microcephaly incidence in the Midwest and North regions, associated with high levels of ZIKV infection months before. Conclusion The greatest burden of microcephaly shifted from the Northeast to other Brazilian regions at the beginning of 2016. Brazil’s Midwest region experienced an increase in microcephaly incidence associated with ZIKV incidence. This finding highlights an association between an increase in ZIKV infection with a rise in microcephaly cases after approximately three months.

Cadastro Nacional de Estabelecimentos de Saúde: evidências sobre a confiabilidade dos dados

This study compared the reliability of a data group registered in the secondary databases of the National Registry of Health Facilities. A survey was conducted in 2,777 with hospitals to achieve this objective. Visited hospitals provided information on equipment, geographic location, operating status and number of beds. Regarding matching data between visited hospitals and the National Registry, it can be noted that the operating status was updated in 89% of cases, the number of beds in 44%, 82% had the correct amount of equipment and 63% had accurate geographic coordinates. These findings point to a good reliability of information from the National Registry of Health Facilities, regarding the compared categories, excepting for data on the number of registered beds and for some equipment. As a further development of this work, we stress the need to discuss strategies and incentives to improve the reliability of data that still have inconsistencies, in order to improve the instruments used to formulate public policies.

Estrutura e processo de trabalho na atenção primária e internações por condições sensíveis

OBJETIVO Investigar se caracteristicas da estrutura das unidades basicas de saude e do processo de trabalho das equipes de atencao basica estao associadas ao numero de internacoes por condicoes sensiveis a atencao primaria. METODOS Neste estudo ecologico, foram analisados dados de municipios brasileiros relativos a caracteristicas sociodemograficas, de cobertura de programas assistenciais, de estrutura das […]ABSTRACT OBJECTIVE The objective of this study is to investigate whether the characteristics of the structure of primary health units and the work process of primary care teams are associated with the number of hospitalizations for primary care sensitive conditions. METHODS In this ecological study, we have analyzed data of Brazilian municipalities related to sociodemographic characteristics, coverage of care programs, structure of primary health units, and work process of primary care teams. We have obtained the data from the first cycle of the Brazilian Program for Improving Access and Quality of the Primary Care, of the Department of Information Technology of the Brazilian Unified Health System, the Brazilian Institute of Geography and Statistics, and the United Nations Development Programme. The associations have been estimated using negative binomial regression coefficients (β) and respective 95% confidence intervals, with a hierarchical approach in three levels (alpha = 5%). RESULTS In the adjusted analysis for the outcome in 2013, in the distal level, the coverage of the Bolsa Família Program (β = -0.001) and private insurance (β = -0.01) had a negative association, and the human development index (β = 1.13), the proportion of older adults (β = 0.05) and children under the age of five (β = 0.05), and the coverage of the Community Health Agent Strategy (β = 0.002) showed positive association with hospitalizations for primary care sensitive conditions. In the intermediate level, minimum hours (β = -0.14) and availability of vaccines (β = -0.16) showed a negative association, and availability of medications showed a positive association (β = 0.16). In the proximal level, only the variable of matrix support (β = 0.10) showed a positive association. The variables in the adjusted analysis of the number of hospitalizations for primary care sensitive conditions in 2014 presented the same association as in 2013. CONCLUSIONS The characteristics of the structure of primary health units and the work process of the primary care teams impact the number of hospitalizations for primary care sensitive conditions in Brazilian municipalities.