Baptista T.W.F.,Escola Nacional de Saude Publica Sergio Arouca
Cadernos de Saude Publica | Year: 2010
This article analyzes the submission of health pol-icy bills by the Legislative and Executive Branches in the Brazilian National Congress, since 1990. The study analyzes the health legislation passed by the National Congress from 1990 to 2006. The bills were analyzed by type, authorship, review time, and thematic content, considering the political and institutional context. The Executive Branch passed 89.8% of its health bills, submitted budget issues and modified the approved budget, and ensured review and passage of its own bills six times faster than bills submitted by the Legislative itself. In conclusion, the policy process is imbalanced, with power concentrated in the Executive, with the latter assuming the main role of filtering health policy demands, thus reflecting a persistently immature approach for institutions in the democratic process.
Rivera F.J.U.,Escola Nacional de Saude Publica Sergio Arouca
Cadernos de Saude Publica | Year: 2011
This study analyzes the process of producing a situational plan according to a benchmark from the philosophy of language and argumentation theory. The basic approach used in the analysis was developed by Carlos Matus. Specifically, the study seeks to identify the inherent argumentative structure and patterns in the situational explanation and regulatory design in a plan's operations, taking argumentative approaches from pragma-dialectics and informal logic as the analytical parameters. The explanation of a health problem is used to illustrate the study. Methodologically, the study is based on the existing literature on the subject and case analyses. The study concludes with the proposition that the use of the specific references means introducing greater rigor into both the analysis of the validity of causal arguments and the design of proposals for interventions, in order for them to be more conclusive in achieving a plan's objectives.
Martins M.,Escola Nacional de Saude Publica Sergio Arouca
Revista de Saude Publica | Year: 2010
Objective: To assess the use of comorbidity measures to predict the risk of death in Brazilian in-patients. Methods: Data from the Sistema de Informações Hospitalares do Sistema Único de Saúde (Unified Health System Hospital Information System) were used, which enables only one secondary diagnosis to be recorded. A total of 1,607,697 hospitalizations were selected, all of which occurred in Brazil, between 2003 and 2004, and whose main diagnoses were: ischemic heart disease, congestive cardiac failure, stroke and pneumonia. Charlson Index and Elixhauser comorbidities were the comorbidity measures used. In addition, the simple record of a certain secondary diagnosis was also used. Logistic regression was applied to assess the impact of comorbidity measures on the estimate of risk of death. The baseline model included the following variables: age, sex and main diagnosis. Models to predict death were assessed, based on C-statistic and Hosmer-Lemeshow test. Results: Hospital mortality rate was 10.4% and mean length of stay was 5.7 days. The majority (52%) of hospitalizations occurred among men and mean age was 62.6 years. Of all hospitalizations, 5.4% included a recorded secondary diagnosis, although the odds ratio between death and presence of comorbidity was 1.93. The baseline model showed a discriminatory capacity (C-statistic) of 0.685. The improvement in the models, attributed to the introduction of comorbidity indices, was poor, equivalent to zero when C-statistic with only two digits was considered. Conclusions: Although the introduction of three comorbidity measures in distinct models to predict death improved the predictive capacity of the baseline model, the values obtained are still considered insufficient. The accuracy of this type of measure is influenced by the completeness of the source of information. In this sense, high underreporting of secondary diagnosis, in addition to the well-known lack of space to note down this type of information in the Sistema de Informações Hospitalares, are the main explanatory factors for the results found.
Hospitalization for primary care-sensitive conditions in Campo Grande, Mato Grosso do Sul state, Brazil, 2000-2009 [Internações por condições sensíveis à atenção primária em Campo Grande, mato grosso do sul, Brasil, 2000 a 2009]
de Campos A.Z.,Secretaria Municipal de Saude Publica de Campo Grande |
Theme-Filha M.M.,Escola Nacional de Saude Publica Sergio Arouca
Cadernos de Saude Publica | Year: 2012
This study analyzed the correlation between evolution in coverage of the Family Health Strategy (FHS) and the hospital admissions rate for primary care-sensitive conditions (PCSC) in Campo Grande, Mato Grosso do Sul State, Brazil, from 2000 to 2009. This was an ecological study using data from the Hospital Information System (SIH), available from the Information System of the Brazilian Unified National Health System (DATASUS) and the Brazilian Institute of Geography and Statistics (IBGE). Statistical analysis used Pearson's linear correlation coefficient and its significance. Campo Grande showed an inverse correlation, following the trend for the country as a whole, with a reduction in such admissions. The analysis of categories of hospital admissions showed a direct correlation with pulmonary tuberculosis, angina pectoris, and conditions related to prenatal care and childbirth. The results suggest that increased coverage of the FHS has contributed to a reduction in hospitalization rates for PCSC.
Public policy and the social determinants of health: The challenge of the production and use of scientific evidence [Políticas públicas e determinantes sociais da saúde: O desafi o da produção e uso das evidencias científi cas]
Filho A.P.,Escola Nacional de Saude Publica Sergio Arouca
Cadernos de Saude Publica | Year: 2011
This article serves as an introduction to the others published in this thematic issue of the Cader-nos de Saúde Pública. The author makes a brief historical review of the concepts, approaches and methodologies used to study the relationships between social determinants and health outcomes. By analyzing the current global movement around social determinants of health he emphasizes that the distinctive feature of this movement is the explicit commitment to action through intersectoral public policies that are based on evidence and implemented with the support and participation of broad segments of society. As this special issue of the Cadernos de Saúde Pública is dedicated to presenting the results of research related to social determinants of health, the author focuses on an analysis of the difficulties in the production and use of scientific evidence that supports the definition, implementation and evaluation of policies to combat health inequities through action on social determinants of health. To conclude, he presents some recommendations for overcoming these difficulties.
Health and Gender Relations: A reflection on the challenges for the implementation of public policies for health care for indigenous women [Saúde e relações de gênero: Uma reflexão sobre os desafios para a implantação de políticas públicas de atenção à saúde da mulher indígena]
Ferreira L.O.,Escola Nacional de Saude Publica Sergio Arouca
Ciencia e Saude Coletiva | Year: 2013
This article presents some contrasts that exist between the discourses of public policies concerning women's health care, especially with respect to indigenous women, and the ethnological discourse which emphasizes the specificity of gender relations within indigenous societies. We worked on the assumption that the development of these public policies as well as the organization of health care services offered, which in fact are necessary, have a transforming effect on prevailing gender relations within Amerindian Societies. On the one hand, gender relations between indigenous people are associated with the domains of kinship and corporeality. On the other hand, the process of creating public policies, by means of biomedical intervention and the medicalization of the female body, constitutes a powerful tool for body modeling and the construction of subjectivities contributing to making women worthy of citizenship. The female gender is under discussion and its content is being negotiated.
Factors associated with gestational weight gain in pregnant women in Rio de Janeiro, Brazil, 2008 [Fatores associados ao ganho de peso gestacional entre gestantes do Município do Rio de Janeiro, Brasil, 2008]
Fraga A.C.S.A.,Institute Pesquisa Clinica Evandro Chagas |
Filha M.M.T.,Escola Nacional de Saude Publica Sergio Arouca
Cadernos de Saude Publica | Year: 2014
Inadequate weight gain during pregnancy is an important predictor of complications for the mother and infant. This cross-sectional study assessed factors associated with inadequate weight gain among women in the third trimester of pregnancy who received prenatal care under the Brazilian Unified National Health System (SUS) in the city of Rio de Janeiro, Brazil, from November 2007 to July 2008. A total of 1,079 pregnant women were interviewed, and adequacy of weight gain was obtained by calculating weight gain as recommended by the U.S. Institute of Medicine. Social, demographic, and obstetric factors were analyzed as independent variables. A multinomial logistic regression model was used, and pregnant women with weight gain below or above the recommended levels were compared to those with adequate weight gain. Low schooling was associated with insufficient weight gain, while excessive gain was observed in women with hypertension and pre-gestational underweight, overweight, and obesity. Nutritional assessment during prenatal care is essential, and interventions should target cases of inadequate weight gain in order to prevent complications for the mother and infant.
de Abranches C.D.,Instituto Fernandes Figueira |
de Assis S.G.,Escola Nacional de Saude Publica Sergio Arouca
Cadernos de Saude Publica | Year: 2011
Psychological family violence in childhood and adolescence is still poorly studied, due to difficulties in its definition and detection. This article aims to examine how psychological family violence reported by children and adolescents has been addressed in academic studies, using a literature review (LILACS, MEDLINE, SciELO, PubMed, CAPES Portal, PsycINFO, and SCOPUS databases). Among 51 epidemiological studies, 16 articles met the review's objectives; some of the articles reported a high prevalence of such violence. The study showed that the issue has been studied more in the international literature than in Brazil, which has significantly increased its visibility in the last decade but still faces difficulties involving definition, conceptualization, and operationalization. Eliminating the invisibility of psychological violence in the family could help promote prevention of such violence and protection of children and adolescents.
Networks, disease management programs, GP coordinator: Analysis of recent ambulatory reforms in Germany [Redes integradas, programas de gestão clínica e generalista coordenador: Análise das reformas recentes do setor ambulatorial na alemanha]
Giovanella L.,Escola Nacional de Saude Publica Sergio Arouca
Ciencia e Saude Coletiva | Year: 2011
Strengthening the role of the general practitioner in the conduction and coordination of specialized, inpatient and social care to ensure the continuity is a trend observed in recent health reforms in European countries. In Germany, from the second half of the 1990s, driven by economic pressures, a specific legislation and initiatives of the providers themselves have developed new organizational structures and care models for the purpose of the integration of the health care system and the coordination of health care in the form of: physicians networks, practitioner coordinator model, diseases management programs and integrated care. From a literature review, document analysis, visits to services and interviews with key informants, this paper analyzes the dynamics of these organizational changes in the German outpatient sector. The mechanisms of integration and coordination proposed are examined, and the potential impacts on the efficiency and quality of new organizational arrangements are discussed. Also it is analyzed the reasons and interests involved that point out the obstacles to the implementation. It was observed the process of an incremental reform with a tendency of diversification of the healthcare panorama in Germany with the presence of integrated models of care and strengthening the role of general practitioners in the coordination of patient care.
O'Dwyer G.,Escola Nacional de Saude Publica Sergio Arouca
Ciencia e Saude Coletiva | Year: 2010
Attention to the emergency care has been criticized, and since 2002 the Brazilian State has assumed the efforts to standardize the level of attention. It was proposed the analysis of documents and acts based on the Structuration Theory that considers the mobilization of allocative and authoritarian resources as dimensions of structure in interaction, which would justify the legitimacy exercised since the establishment of regulations. The National Emergency Plan (PNAU) had as guides: the federal funding, regionalization, professional education, management by urgency committees, and the expansion of the network. It was identified the density of the documental proposals as the facilitator trend of the structural resource, innovative due to the regionalization and responsibilization proposals presented by the several actors and by the alleged centrality of the user. The financing of SUS, despite its persistent state of embarrassment, had no coercive action on the technology investment. Under the current administration there was a vigorous expansion and structuring of the network, which was made by a strong inflow of federal funds. The management by committees should be investigated and points out how fragile the management of labor is.