Gasto com a internação de idosos em unidades de terapia intensiva

Introduction: Population aging in Brazil underscores the need to discuss the proper management of the budget allocated in health field, especially in the sectors of high complexity, where coexist costly procedures, limited resources and the need for cost containment. In the other hand, demand is growing in a way directly proportional to the increase in the number of elderly in country. Objective: In this way, this research had as main objective to analyze the costs resulting from the admission of elderly in intensive care units (ICU) and its associated factors. Methods: This is a cross-sectional study with a quantitative approach and featured as a descriptive and exploratory research. Data were collected from medical records of elderly hospitalized in ICU from a brazilian city called Natal-RN, between november first, 2013 and january, 31 of 2014. The variables collected relate to the socio demographic profile, morbidity framework and characterization of hospitalization. The dependent variable was categorized by quartile 75 in high and low expense of hospitalization and submitted to chi-square test with the independent variables of the survey. Associations with p value <0.20 in the bivariate analysis were submitted to the technique of multiple logistic regression. We opted for the construction of three regression models from the above algorithm: general regression model, composed by all 493 hospitalizations in the study, other made with 181 individuals admitted in health public system (SUS) and a third one related to 312 cases from private service in health area. Results: In the general regression model, the variables respiratory diseases, hospitalizations in the private system, disoriented patient and previous stroke were associated with greater probability of high spending in the ICU. In the other hand, in SUS kind of hospitalizations, this probability was associated with disoriented patient, 80 years old or more, sepsis and admission for clinical reason. In the cases from the private network health, the high expenditure was associated with respiratory disease, mechanical ventilation, hospitalization for clinical reason and disoriented patients. Conclusion: The increased expenditure on hospitalization of elderly in intensive care depends on the clinical conditions of individuals. This highlights the importance of avoiding hospitalizations due to diseases sensitive to primary care by health preventive actions and providing comprehensive care to the elderly. In addition, obtaining different explanatory models, according to kind hospital funding, demonstrates the importance of the organization in health services related to composition of costs of hospitalization among the elderly. Another question founded was the need that to improve the funding, we must use rationally the available resources by avoiding unnecessary hospitalizations of elderly people in the extremes of severity. On this kind of precarious funding, ICU hospitalization of elderly non-critical or in a terminal state can compromise the quality of services provided to those who really need intensive care.

Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.

Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.

Avaliação multidimensional da qualidade de vida em idosos: um estudo no Curimataú ocidental paraibano

The fast growth of the elderly population is a reality throughout the world and has become one of the greatest challenges for contemporary public health. When considering the increased life expectancy and the aging as a multidimensional phenomenon, one should highlight the need to investigate if the increase of longevity is associated with satisfactory levels of Quality of Life (QOL). This study has the objective of assessing the QOL of elderly people from the Paraíba’s Western Curimataú microregion, explained by its health and living conditions. This is a cross-sectional and observational study with quantitative design held with 444 elderly people from five cities: Barra de Santa Rosa, Cuité, Nova Floresta, Remígio e Sossego. In order to obtain information, the following instruments were used: I) Questionnaire for collection data related to the elderly population, for sociodemographic, clinical and behavioral characteristics; and II) WHOQOL-Old questionnaire, with a view to measuring and assessing QOL. Data were processed on the IBM-SPSS Statistics 20.0 software by means of the ANOVA (one-way), Student’s t, Mann-Whitney, Kruskal-Wallis and Pearson’s correlation tests, with p-values<0,05 accepted as being statistically significant. The results indicate a good global QOL (ETT=65,69%), with better assessment by elderly men, aged between 60 and 74 years, married, living with partner and children, without caregiver, physical activity practitioners, with up to one health problem before an aspect of multimorbidity and with very good and/or good assessment of basic needs. The self-reported stress showed a negative significant correlation before the global QOL, where the greater the perception of stress, the worse the assessment of QOL. In the faceted assessment of QOL, the Sensory Operation showed the best performance (ETF= 68,86%) and the Social Participation (SP) the worst (ETF=60,37%). In the multiple linear regression model, SP is singly responsible for 51,8% (R2=0,518) of explanation of the global QOL. In the intercorrelation among the WHOQOL-Old facets, only Death and Dying did not reveal significance. The harmony highlighted among the facets raises the need to ensure a comprehensive health care for the elderly population, especially in understanding the social participation as an intrinsic part of the QOL and that it requires the re-discussion and reconstruction of individual and collective, family and community, political and government actions. Hence, guaranteeing an active, healthy and participatory aging, with QOL, is the major challenge.

Avaliação multidimensional da qualidade de vida em idosos: um estudo no Curimataú ocidental paraibano

The fast growth of the elderly population is a reality throughout the world and has become one of the greatest challenges for contemporary public health. When considering the increased life expectancy and the aging as a multidimensional phenomenon, one should highlight the need to investigate if the increase of longevity is associated with satisfactory levels of Quality of Life (QOL). This study has the objective of assessing the QOL of elderly people from the Paraíba’s Western Curimataú microregion, explained by its health and living conditions. This is a cross-sectional and observational study with quantitative design held with 444 elderly people from five cities: Barra de Santa Rosa, Cuité, Nova Floresta, Remígio e Sossego. In order to obtain information, the following instruments were used: I) Questionnaire for collection data related to the elderly population, for sociodemographic, clinical and behavioral characteristics; and II) WHOQOL-Old questionnaire, with a view to measuring and assessing QOL. Data were processed on the IBM-SPSS Statistics 20.0 software by means of the ANOVA (one-way), Student’s t, Mann-Whitney, Kruskal-Wallis and Pearson’s correlation tests, with p-values<0,05 accepted as being statistically significant. The results indicate a good global QOL (ETT=65,69%), with better assessment by elderly men, aged between 60 and 74 years, married, living with partner and children, without caregiver, physical activity practitioners, with up to one health problem before an aspect of multimorbidity and with very good and/or good assessment of basic needs. The self-reported stress showed a negative significant correlation before the global QOL, where the greater the perception of stress, the worse the assessment of QOL. In the faceted assessment of QOL, the Sensory Operation showed the best performance (ETF= 68,86%) and the Social Participation (SP) the worst (ETF=60,37%). In the multiple linear regression model, SP is singly responsible for 51,8% (R2=0,518) of explanation of the global QOL. In the intercorrelation among the WHOQOL-Old facets, only Death and Dying did not reveal significance. The harmony highlighted among the facets raises the need to ensure a comprehensive health care for the elderly population, especially in understanding the social participation as an intrinsic part of the QOL and that it requires the re-discussion and reconstruction of individual and collective, family and community, political and government actions. Hence, guaranteeing an active, healthy and participatory aging, with QOL, is the major challenge.

Efeito de diferentes divisões territoriais na flutuação aleatória de indicadores socioeconômicos relacionados à determinação social da saúde

This research aimed to analyse the effect of different territorial divisions in the random fluctuation of socio-economic indicators related to social determinants of health. This is an ecological study resulting from a combination of statistical methods including individuated and aggregate data analysis, using five databases derived from the database of the Brazilian demographic census 2010: overall results of the sample by weighting area. These data were grouped into the following levels: households; weighting areas; cities; Immediate Urban Associated Regions and Intermediate Urban Associated Regions. A theoretical model related to social determinants of health was used, with the dependent variable Household with death and as independent variables: Black race; Income; Childcare and school no attendance; Illiteracy; and Low schooling. The data was analysed in a model related to social determinants of health, using Poisson regression in individual basis, multilevel Poisson regression and multiple linear regression in light of the theoretical framework of the area. It was identified a greater proportion of households with deaths among those with at least one black resident, lower-income, illiterate, who do not attend or attended school or day-care and less educated. The analysis of the adjusted model showed that most adjusted prevalence ratio was related to Income, where there is a risk value of 1.33 for households with at least one resident with lower average personal income to R$ 655,00 (Brazilian current). The multilevel analysis demonstrated that there was a context effect when the variables were subjected to the effects of areas, insofar as the random effects were significant for all models and with different prevalence rates being higher in the areas with smaller dimensions - Weighting areas with coefficient of 0.035 and Cities with coefficient of 0.024. The ecological analyses have shown that the variable Income and Low schooling presented explanatory potential for the outcome on all models, having income greater power to determine the household deaths, especially in models related to Immediate Urban Associated Regions with a standardized coefficient of -0.616 and regions intermediate urban associated regions with a standardized coefficient of -0.618. It was concluded that there was a context effect on the random fluctuation of the socioeconomic indicators related to social determinants of health. This effect was explained by the characteristics of territorial divisions and individuals who live or work there. Context effects were better identified in the areas with smaller dimensions, which are more favourable to explain phenomena related to social determinants of health, especially in studies of societies marked by social inequalities. The composition effects were better identified in the Regions of Urban Articulation, shaped through mechanisms similar to the phenomenon under study.

A utilização de serviços odontológicos entre crianças e fatores associados em Sobral, Ceará, Brasil

NORO, L. R. A. et al. A utilização de serviços odontológicos entre crianças e fatores associados em Sobral, Ceará, Brasil. Cad. Saúde Pública, v. 24, n. 7, p. 1509-1516. 2008. ISSN 0102-311X.

Determinantes da Estrutura de Capital de Companhias Abertas Brasileiras Não-Financeiras: Um Estudo Empírico com Dados em Painel

When a company desires to invest in a project, it must obtain resources needed to make the investment. The alternatives are using firm s internal resources or obtain external resources through contracts of debt and issuance of shares. Decisions involving the composition of internal resources, debt and shares in the total resources used to finance the activities of a company related to the choice of its capital structure. Although there are studies in the area of finance on the debt determinants of firms, the issue of capital structure is still controversial. This work sought to identify the predominant factors that determine the capital structure of Brazilian share capital, non-financial firms. This work was used a quantitative approach, with application of the statistical technique of multiple linear regression on data in panel. Estimates were made by the method of ordinary least squares with model of fixed effects. About 116 companies were selected to participate in this research. The period considered is from 2003 to 2007. The variables and hypotheses tested in this study were built based on theories of capital structure and in empirical researches. Results indicate that the variables, such as risk, size, and composition of assets and firms growth influence their indebtedness. The profitability variable was not relevant to the composition of indebtedness of the companies analyzed. However, analyzing only the long-term debt, comes to the conclusion that the relevant variables are the size of firms and, especially, the composition of its assets (tangibility).This sense, the smaller the size of the undertaking or the greater the representation of fixed assets in total assets, the greater its propensity to long-term debt. Furthermore, this research could not identify a predominant theory to explain the capital structure of Brazilian

Fatores que influenciam a aceitação de práticas avançadas de gestão de segurança da informação: um estudo com gestores públicos estaduais no Brasil

This study examines the factors that influence public managers in the adoption of advanced practices related to Information Security Management. This research used, as the basis of assertions, Security Standard ISO 27001:2005 and theoretical model based on TAM (Technology Acceptance Model) from Venkatesh and Davis (2000). The method adopted was field research of national scope with participation of eighty public administrators from states of Brazil, all of them managers and planners of state governments. The approach was quantitative and research methods were descriptive statistics, factor analysis and multiple linear regression for data analysis. The survey results showed correlation between the constructs of the TAM model (ease of use, perceptions of value, attitude and intention to use) and agreement with the assertions made in accordance with ISO 27001, showing that these factors influence the managers in adoption of such practices. On the other independent variables of the model (organizational profile, demographic profile and managers behavior) no significant correlation was identified with the assertions of the same standard, witch means the need for expansion researches using such constructs. It is hoped that this study may contribute positively to the progress on discussions about Information Security Management, Adoption of Safety Standards and Technology Acceptance Model

Fatores que influenciam a intenção de compra online: aplicação de um modelo adaptado de aceitação da tecnologia para o comércio eletrônico

This research aims to understand the factors that influence intention to online purchase of consumers, and to identify between these factors those that influence the users and the nonusers of electronic commerce. Thus, it is an applied, exploratory and descriptive research, developed in a quantitative model. Data collection was done through a questionnaire administered to a sample of 194 graduate students from the Centre for Applied Social Sciences of UFRN and data analysis was performed using descriptive statistics, confirmatory factorial analysis and simple and multiple linear regression analysis. The results of descriptive statistics revealed that respondents in general and users of electronic commerce have positive perceptions of ease of use, usefulness and social influence about buying online, and intend to make purchases on Internet over the next six months. As for the non-users of electronic commerce, they do not trust the Internet to transact business, have negative perceptions of risk and social influence over purchasing online, and does not intend to make purchases on Internet over the next six months. Through confirmatory factorial analysis six factors were set up: behavioral intention, perceived ease of use, perceived usefulness, perceived risk, trust and social influence. Through multiple regression analysis, was observed that all these factors influence online purchase intentions of respondents in general, that only the social influence does not influence the intention to continue buying on the Internet from users of electronic commerce, and that only trust and social influence affect the intention to purchase online from non-users of electronic commerce. Through simple regression analysis, was found that trust influences perceptions of ease of use, usefulness and risk of respondents in general and users of electronic commerce, and that trust does not influence the perceptions of risk of non-users of electronic commerce. Finally, it was also found that the perceived ease of use influences perceived usefulness of the three groups. Given this scenario, it was concluded that it is extremely important that organizations that work with online sales know the factors that influence consumers purchasing intentions in order to gain space in their market

Sistema inteligente para estimar a porosidade em sedimentos a partir da análise de sinais GPR

This Thesis presents the elaboration of a methodological propose for the development of an intelligent system, able to automatically achieve the effective porosity, in sedimentary layers, from a data bank built with information from the Ground Penetrating Radar GPR. The intelligent system was built to model the relation between the porosity (response variable) and the electromagnetic attribute from the GPR (explicative variables). Using it, the porosity was estimated using the artificial neural network (Multilayer Perceptron MLP) and the multiple linear regression. The data from the response variable and from the explicative variables were achieved in laboratory and in GPR surveys outlined in controlled sites, on site and in laboratory. The proposed intelligent system has the capacity of estimating the porosity from any available data bank, which has the same variables used in this Thesis. The architecture of the neural network used can be modified according to the existing necessity, adapting to the available data bank. The use of the multiple linear regression model allowed the identification and quantification of the influence (level of effect) from each explicative variable in the estimation of the porosity. The proposed methodology can revolutionize the use of the GPR, not only for the imaging of the sedimentary geometry and faces, but mainly for the automatically achievement of the porosity one of the most important parameters for the characterization of reservoir rocks (from petroleum or water)