Thiago Augusto Hernandes Rocha

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.

Geospatial analysis of unmet pediatric surgical need in Uganda

BACKGROUND In low- and middle-income countries (LMICs), an estimated 85% of children do not have access to surgical care. The objective of the current study was to determine the geographic distribution of surgical conditions among children throughout Uganda. METHODS Using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey, we enumerated 2176 children in 2315 households throughout Uganda. At the district level, we determined the spatial autocorrelation of surgical need with geographic access to surgical centers variable. FINDINGS The highest average distance to a surgical center was found in the northern region at 14.97km (95% CI: 11.29km-16.89km). Younger children less than five years old had a higher prevalence of unmet surgical need in all four regions than their older counterparts. The spatial regression model showed that distance to surgical center and care availability were the main spatial predictors of unmet surgical need. INTERPRETATION We found differences in unmet surgical need by region and age group of the children, which could serve as priority areas for focused interventions to alleviate the burden. Future studies could be conducted in the northern regions to develop targeted interventions aimed at increasing pediatric surgical care in the areas of most need. LEVEL OF EVIDENCE Level III.

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.

Desempenho dos médicos na saúde da família - uma análise a partir dos princípios ordenadores em um município brasileiro

A partir de los principios ordenadores de la atencion primaria (AP) definido por Starfield, este articulo analiza el grado en que el desempeno de los medicos de la Estrategia Salud de la Familia (ESF) contribuye a la consolidacion de estos principios. Se trata de un estudio descriptivo en el que se utilizaron los indicadores de desempeno, desplegado a partir de seis principios ordenadores del ESF con el fin de medir el desempeno de estos profesionales en la ciudad de Belo Horizonte. Los resultados indican generalmente que el desempeno del medico de familia favorece el cumplimiento de los principios ordenadores. De acuerdo con la literatura, los resultados del analisis de regresion multiple mostraron que el rendimiento del equipo de salud influye en el desempeno del medico, lo que refuerza la importancia de la adopcion de modelos de evaluacion de desempeno medica considerando multiples factores determinantes.From the guiding principles of primary care (AP), defined by Starfield, this article analyzes the extent to which performance of the doctors of the Family Health Strategy (ESF) contributes to the consolidation of these principles. For this purpose, it was carried out a descriptive study in which performance indicators were used, deployed from six guiding principles of the ESF, in order to measure the performance of these professionals in the city of Belo Horizonte. The results generally indicated that the performance of the familys doctor underpins the achievement of the guiding principles. According to the literature, the results of multiple regression analysis showed that the health teams performance influences the doctors performance, which reinforces the importance of adopting medical performance evaluation models that consider multiple determinants.

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.

SAÚDE DA FAMÍLIA E RH: DIMENSÕES PARA EFETIVIDADE

O presente estudo abordou sobre a tematica de gestao de recursos humanos em saude na Estrategia Saude da Familia sob uma perspectiva dos gestores e dos profi ssionais de saude alocados na atencao clinica. Seu principal objetivo foi analisar as dimensoes criticas, relacionadas a gestao de Recursos Humanos na esfera da saude, avaliando, comparativamente, as distintas perspectivas de profi ssionais e gestores, visando a elucidar os pontos convergentes e os divergentes desta tematica. Para tanto, foi desenvolvida uma pesquisa qualitativa calcada na realizacao de grupos focais com profi ssionais e gestores da Estrategia de Saude da Familia. Os resultados acenam para uma convergencia entre as percepcoes de gestores e profi ssionais, no que tange aos desafi os de gestao de recursos humanos em saude, para a Saude da Familia. Os desafi os apontados surgem como elementos de discussao para assegurar a efetividade da Estrategia de Saude da Familia.

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.