Federated architecture for biomedical data integration

The last decades have been characterized by a continuous adoption of IT solutions in the healthcare sector, which resulted in the proliferation of tremendous amounts of data over heterogeneous systems. Distinct data types are currently generated, manipulated, and stored, in the several institutions where patients are treated. The data sharing and an integrated access to this information will allow extracting relevant knowledge that can lead to better diagnostics and treatments. This thesis proposes new integration models for gathering information and extracting knowledge from multiple and heterogeneous biomedical sources. The scenario complexity led us to split the integration problem according to the data type and to the usage specificity. The first contribution is a cloud-based architecture for exchanging medical imaging services. It offers a simplified registration mechanism for providers and services, promotes remote data access, and facilitates the integration of distributed data sources. Moreover, it is compliant with international standards, ensuring the platform interoperability with current medical imaging devices. The second proposal is a sensor-based architecture for integration of electronic health records. It follows a federated integration model and aims to provide a scalable solution to search and retrieve data from multiple information systems. The last contribution is an open architecture for gathering patient-level data from disperse and heterogeneous databases. All the proposed solutions were deployed and validated in real world use cases.

Security and Trust in Distributed Computation

We propose three research problems to explore the relations between trust and security in the setting of distributed computation. In the first problem, we study trust-based adversary detection in distributed consensus computation. The adversaries we consider behave arbitrarily disobeying the consensus protocol. We propose a trust-based consensus algorithm with local and global trust evaluations. The algorithm can be abstracted using a two-layer structure with the top layer running a trust-based consensus algorithm and the bottom layer as a subroutine executing a global trust update scheme. We utilize a set of pre-trusted nodes, headers, to propagate local trust opinions throughout the network. This two-layer framework is flexible in that it can be easily extensible to contain more complicated decision rules, and global trust schemes. The first problem assumes that normal nodes are homogeneous, i.e. it is guaranteed that a normal node always behaves as it is programmed. In the second and third problems however, we assume that nodes are heterogeneous, i.e, given a task, the probability that a node generates a correct answer varies from node to node. The adversaries considered in these two problems are workers from the open crowd who are either investing little efforts in the tasks assigned to them or intentionally give wrong answers to questions. In the second part of the thesis, we consider a typical crowdsourcing task that aggregates input from multiple workers as a problem in information fusion. To cope with the issue of noisy and sometimes malicious input from workers, trust is used to model workers' expertise. In a multi-domain knowledge learning task, however, using scalar-valued trust to model a worker's performance is not sufficient to reflect the worker's trustworthiness in each of the domains. To address this issue, we propose a probabilistic model to jointly infer multi-dimensional trust of workers, multi-domain properties of questions, and true labels of questions. Our model is very flexible and extensible to incorporate metadata associated with questions. To show that, we further propose two extended models, one of which handles input tasks with real-valued features and the other handles tasks with text features by incorporating topic models. Our models can effectively recover trust vectors of workers, which can be very useful in task assignment adaptive to workers' trust in the future. These results can be applied for fusion of information from multiple data sources like sensors, human input, machine learning results, or a hybrid of them. In the second subproblem, we address crowdsourcing with adversaries under logical constraints. We observe that questions are often not independent in real life applications. Instead, there are logical relations between them. Similarly, workers that provide answers are not independent of each other either. Answers given by workers with similar attributes tend to be correlated. Therefore, we propose a novel unified graphical model consisting of two layers. The top layer encodes domain knowledge which allows users to express logical relations using first-order logic rules and the bottom layer encodes a traditional crowdsourcing graphical model. Our model can be seen as a generalized probabilistic soft logic framework that encodes both logical relations and probabilistic dependencies. To solve the collective inference problem efficiently, we have devised a scalable joint inference algorithm based on the alternating direction method of multipliers. The third part of the thesis considers the problem of optimal assignment under budget constraints when workers are unreliable and sometimes malicious. In a real crowdsourcing market, each answer obtained from a worker incurs cost. The cost is associated with both the level of trustworthiness of workers and the difficulty of tasks. Typically, access to expert-level (more trustworthy) workers is more expensive than to average crowd and completion of a challenging task is more costly than a click-away question. In this problem, we address the problem of optimal assignment of heterogeneous tasks to workers of varying trust levels with budget constraints. Specifically, we design a trust-aware task allocation algorithm that takes as inputs the estimated trust of workers and pre-set budget, and outputs the optimal assignment of tasks to workers. We derive the bound of total error probability that relates to budget, trustworthiness of crowds, and costs of obtaining labels from crowds naturally. Higher budget, more trustworthy crowds, and less costly jobs result in a lower theoretical bound. Our allocation scheme does not depend on the specific design of the trust evaluation component. Therefore, it can be combined with generic trust evaluation algorithms.

Identifying health inequalities in individuals with major mental illness (MMI) using routine data

Abstract and Summary of Thesis: Background: Individuals with Major Mental Illness (such as schizophrenia and bipolar disorder) experience increased rates of physical health comorbidity compared to the general population. They also experience inequalities in access to certain aspects of healthcare. This ultimately leads to premature mortality. Studies detailing patterns of physical health comorbidity are limited by their definitions of comorbidity, single disease approach to comorbidity and by the study of heterogeneous groups. To date the investigation of possible sources of healthcare inequalities experienced by individuals with Major Mental Illness (MMI) is relatively limited. Moreover studies detailing the extent of premature mortality experienced by individuals with MMI vary both in terms of the measure of premature mortality reported and age of the cohort investigated, limiting their generalisability to the wider population. Therefore local and national data can be used to describe patterns of physical health comorbidity, investigate possible reasons for health inequalities and describe mortality rates. These findings will extend existing work in this area. Aims and Objectives: To review the relevant literature regarding: patterns of physical health comorbidity, evidence for inequalities in physical healthcare and evidence for premature mortality for individuals with MMI. To examine the rates of physical health comorbidity in a large primary care database and to assess for evidence for inequalities in access to healthcare using both routine primary care prescribing data and incentivised national Quality and Outcome Framework (QOF) data. Finally to examine the rates of premature mortality in a local context with a particular focus on cause of death across the lifespan and effect of International Classification of Disease Version 10 (ICD 10) diagnosis and socioeconomic status on rates and cause of death. Methods: A narrative review of the literature surrounding patterns of physical health comorbidity, the evidence for inequalities in physical healthcare and premature mortality in MMI was undertaken. Rates of physical health comorbidity and multimorbidity in schizophrenia and bipolar disorder were examined using a large primary care dataset (Scottish Programme for Improving Clinical Effectiveness in Primary Care (SPICE)). Possible inequalities in access to healthcare were investigated by comparing patterns of prescribing in individuals with MMI and comorbid physical health conditions with prescribing rates in individuals with physical health conditions without MMI using SPICE data. Potential inequalities in access to health promotion advice (in the form of smoking cessation) and prescribing of Nicotine Replacement Therapy (NRT) were also investigated using SPICE data. Possible inequalities in access to incentivised primary healthcare were investigated using National Quality and Outcome Framework (QOF) data. Finally a pre-existing case register (Glasgow Psychosis Clinical Information System (PsyCIS)) was linked to Scottish Mortality data (available from the Scottish Government Website) to investigate rates and primary cause of death in individuals with MMI. Rate and primary cause of death were compared to the local population and impact of age, socioeconomic status and ICD 10 diagnosis (schizophrenia vs. bipolar disorder) were investigated. Results: Analysis of the SPICE data found that sixteen out of the thirty two common physical comorbidities assessed, occurred significantly more frequently in individuals with schizophrenia. In individuals with bipolar disorder fourteen occurred more frequently. The most prevalent chronic physical health conditions in individuals with schizophrenia and bipolar disorder were: viral hepatitis (Odds Ratios (OR) 3.99 95% Confidence Interval (CI) 2.82-5.64 and OR 5.90 95% CI 3.16-11.03 respectively), constipation (OR 3.24 95% CI 3.01-3.49 and OR 2.84 95% CI 2.47-3.26 respectively) and Parkinson’s disease (OR 3.07 95% CI 2.43-3.89 and OR 2.52 95% CI 1.60-3.97 respectively). Both groups had significantly increased rates of multimorbidity compared to controls: in the schizophrenia group OR for two comorbidities was 1.37 95% CI 1.29-1.45 and in the bipolar disorder group OR was 1.34 95% CI 1.20-1.49. In the studies investigating inequalities in access to healthcare there was evidence of: under-recording of cardiovascular-related conditions for example in individuals with schizophrenia: OR for Atrial Fibrillation (AF) was 0.62 95% CI 0.52 - 0.73, for hypertension 0.71 95% CI 0.67 - 0.76, for Coronary Heart Disease (CHD) 0.76 95% CI 0.69 - 0.83 and for peripheral vascular disease (PVD) 0.83 95% CI 0.72 - 0.97. Similarly in individuals with bipolar disorder OR for AF was 0.56 95% CI 0.41-0.78, for hypertension 0.69 95% CI 0.62 - 0.77 and for CHD 0.77 95% CI 0.66 - 0.91. There was also evidence of less intensive prescribing for individuals with schizophrenia and bipolar disorder who had comorbid hypertension and CHD compared to individuals with hypertension and CHD who did not have schizophrenia or bipolar disorder. Rate of prescribing of statins for individuals with schizophrenia and CHD occurred significantly less frequently than in individuals with CHD without MMI (OR 0.67 95% CI 0.56-0.80). Rates of prescribing of 2 or more anti-hypertensives were lower in individuals with CHD and schizophrenia and CHD and bipolar disorder compared to individuals with CHD without MMI (OR 0.66 95% CI 0.56-0.78 and OR 0.55 95% CI 0.46-0.67, respectively). Smoking was more common in individuals with MMI compared to individuals without MMI (OR 2.53 95% CI 2.44-2.63) and was particularly increased in men (OR 2.83 95% CI 2.68-2.98). Rates of ex-smoking and non-smoking were lower in individuals with MMI (OR 0.79 95% CI 0.75-0.83 and OR 0.50 95% CI 0.48-0.52 respectively). However recorded rates of smoking cessation advice in smokers with MMI were significantly lower than the recorded rates of smoking cessation advice in smokers with diabetes (88.7% vs. 98.0%, p<0.001), smokers with CHD (88.9% vs. 98.7%, p<0.001) and smokers with hypertension (88.3% vs. 98.5%, p<0.001) without MMI. The odds ratio of NRT prescription was also significantly lower in smokers with MMI without diabetes compared to smokers with diabetes without MMI (OR 0.75 95% CI 0.69-0.81). Similar findings were found for smokers with MMI without CHD compared to smokers with CHD without MMI (OR 0.34 95% CI 0.31-0.38) and smokers with MMI without hypertension compared to smokers with hypertension without MMI (OR 0.71 95% CI 0.66-0.76). At a national level, payment and population achievement rates for the recording of body mass index (BMI) in MMI was significantly lower than the payment and population achievement rates for BMI recording in diabetes throughout the whole of the UK combined: payment rate 92.7% (Inter Quartile Range (IQR) 89.3-95.8 vs. 95.5% IQR 93.3-97.2, p<0.001 and population achievement rate 84.0% IQR 76.3-90.0 vs. 92.5% IQR 89.7-94.9, p<0.001 and for each country individually: for example in Scotland payment rate was 94.0% IQR 91.4-97.2 vs. 96.3% IQR 94.3-97.8, p<0.001. Exception rate was significantly higher for the recording of BMI in MMI than the exception rate for BMI recording in diabetes for the UK combined: 7.4% IQR 3.3-15.9 vs. 2.3% IQR 0.9-4.7, p<0.001 and for each country individually. For example in Scotland exception rate in MMI was 11.8% IQR 5.4-19.3 compared to 3.5% IQR 1.9-6.1 in diabetes. Similar findings were found for Blood Pressure (BP) recording: across the whole of the UK payment and population achievement rates for BP recording in MMI were also significantly reduced compared to payment and population achievement rates for the recording of BP in chronic kidney disease (CKD): payment rate: 94.1% IQR 90.9-97.1 vs.97.8% IQR 96.3-98.9 and p<0.001 and population achievement rate 87.0% IQR 81.3-91.7 vs. 97.1% IQR 95.5-98.4, p<0.001. Exception rates again were significantly higher for the recording of BP in MMI compared to CKD (6.4% IQR 3.0-13.1 vs. 0.3% IQR 0.0-1.0, p<0.001). There was also evidence of differences in rates of recording of BMI and BP in MMI across the UK. BMI and BP recording in MMI were significantly lower in Scotland compared to England (BMI:-1.5% 99% CI -2.7 to -0.3%, p<0.001 and BP: -1.8% 99% CI -2.7 to -0.9%, p<0.001). While rates of BMI and BP recording in diabetes and CKD were similar in Scotland compared to England (BMI: -0.5 99% CI -1.0 to 0.05, p=0.004 and BP: 0.02 99% CI -0.2 to 0.3, p=0.797). Data from the PsyCIS cohort showed an increase in Standardised Mortality Ratios (SMR) across the lifespan for individuals with MMI compared to the local Glasgow and wider Scottish populations (Glasgow SMR 1.8 95% CI 1.6-2.0 and Scotland SMR 2.7 95% CI 2.4-3.1). Increasing socioeconomic deprivation was associated with an increased overall rate of death in MMI (350.3 deaths/10,000 population/5 years in the least deprived quintile compared to 794.6 deaths/10,000 population/5 years in the most deprived quintile). No significant difference in rate of death for individuals with schizophrenia compared with bipolar disorder was reported (6.3% vs. 4.9%, p=0.086), but primary cause of death varied: with higher rates of suicide in individuals with bipolar disorder (22.4% vs. 11.7%, p=0.04). Discussion: Local and national datasets can be used for epidemiological study to inform local practice and complement existing national and international studies. While the strengths of this thesis include the large data sets used and therefore their likely representativeness to the wider population, some limitations largely associated with using secondary data sources are acknowledged. While this thesis has confirmed evidence of increased physical health comorbidity and multimorbidity in individuals with MMI, it is likely that these findings represent a significant under reporting and likely under recognition of physical health comorbidity in this population. This is likely due to a combination of patient, health professional and healthcare system factors and requires further investigation. Moreover, evidence of inequality in access to healthcare in terms of: physical health promotion (namely smoking cessation advice), recording of physical health indices (BMI and BP), prescribing of medications for the treatment of physical illness and prescribing of NRT has been found at a national level. While significant premature mortality in individuals with MMI within a Scottish setting has been confirmed, more work is required to further detail and investigate the impact of socioeconomic deprivation on cause and rate of death in this population. It is clear that further education and training is required for all healthcare staff to improve the recognition, diagnosis and treatment of physical health problems in this population with the aim of addressing the significant premature mortality that is seen. Conclusions: Future work lies in the challenge of designing strategies to reduce health inequalities and narrow the gap in premature mortality reported in individuals with MMI. Models of care that allow a much more integrated approach to diagnosing, monitoring and treating both the physical and mental health of individuals with MMI, particularly in areas of social and economic deprivation may be helpful. Strategies to engage this “hard to reach” population also need to be developed. While greater integration of psychiatric services with primary care and with specialist medical services is clearly vital the evidence on how best to achieve this is limited. While the National Health Service (NHS) is currently undergoing major reform, attention needs to be paid to designing better ways to improve the current disconnect between primary and secondary care. This should then help to improve physical, psychological and social outcomes for individuals with MMI.

Data warehouse para el Centro de Documentación Regional "Juan Bautista Vázquez"

El proceso de toma de decisiones en las bibliotecas universitarias es de suma importancia, sin embargo, se encuentra complicaciones como la gran cantidad de fuentes de datos y los grandes volúmenes de datos a analizar. Las bibliotecas universitarias están acostumbradas a producir y recopilar una gran cantidad de información sobre sus datos y servicios. Las fuentes de datos comunes son el resultado de sistemas internos, portales y catálogos en línea, evaluaciones de calidad y encuestas. Desafortunadamente estas fuentes de datos sólo se utilizan parcialmente para la toma de decisiones debido a la amplia variedad de formatos y estándares, así como la falta de métodos eficientes y herramientas de integración. Este proyecto de tesis presenta el análisis, diseño e implementación del Data Warehouse, que es un sistema integrado de toma de decisiones para el Centro de Documentación Juan Bautista Vázquez. En primer lugar se presenta los requerimientos y el análisis de los datos en base a una metodología, esta metodología incorpora elementos claves incluyendo el análisis de procesos, la calidad estimada, la información relevante y la interacción con el usuario que influyen en una decisión bibliotecaria. A continuación, se propone la arquitectura y el diseño del Data Warehouse y su respectiva implementación la misma que soporta la integración, procesamiento y el almacenamiento de datos. Finalmente los datos almacenados se analizan a través de herramientas de procesamiento analítico y la aplicación de técnicas de Bibliomining ayudando a los administradores del centro de documentación a tomar decisiones óptimas sobre sus recursos y servicios.

APPLICATION OF AN IMPUTATION METHOD FOR GEOSPATIAL INVENTORY OF FOREST STRUCTURAL ATTRIBUTES ACROSS MULTIPLE SPATIAL SCALES IN THE LAKE STATES, U.S.A.

Credible spatial information characterizing the structure and site quality of forests is critical to sustainable forest management and planning, especially given the increasing demands and threats to forest products and services. Forest managers and planners are required to evaluate forest conditions over a broad range of scales, contingent on operational or reporting requirements. Traditionally, forest inventory estimates are generated via a design-based approach that involves generalizing sample plot measurements to characterize an unknown population across a larger area of interest. However, field plot measurements are costly and as a consequence spatial coverage is limited. Remote sensing technologies have shown remarkable success in augmenting limited sample plot data to generate stand- and landscape-level spatial predictions of forest inventory attributes. Further enhancement of forest inventory approaches that couple field measurements with cutting edge remotely sensed and geospatial datasets are essential to sustainable forest management. We evaluated a novel Random Forest based k Nearest Neighbors (RF-kNN) imputation approach to couple remote sensing and geospatial data with field inventory collected by different sampling methods to generate forest inventory information across large spatial extents. The forest inventory data collected by the FIA program of US Forest Service was integrated with optical remote sensing and other geospatial datasets to produce biomass distribution maps for a part of the Lake States and species-specific site index maps for the entire Lake State. Targeting small-area application of the state-of-art remote sensing, LiDAR (light detection and ranging) data was integrated with the field data collected by an inexpensive method, called variable plot sampling, in the Ford Forest of Michigan Tech to derive standing volume map in a cost-effective way. The outputs of the RF-kNN imputation were compared with independent validation datasets and extant map products based on different sampling and modeling strategies. The RF-kNN modeling approach was found to be very effective, especially for large-area estimation, and produced results statistically equivalent to the field observations or the estimates derived from secondary data sources. The models are useful to resource managers for operational and strategic purposes.

Inequality of income and poverty persistence in the Municipality of Bologna: a cross-sectional and longitudinal analysis through administrative data

This work is part of a project promoted by Emilia-Romagna that aims at encouraging research activities in order to support the innovation strategies of the regional economic system through the exploitation of new data sources. To gain this scope, a database containing administrative data is provided by the Municipality of Bologna. This is achieved by linking data from the Register Office of the Municipality and fiscal data coming from the tax returns submitted to the Revenue Agency and released by the Ministry of Economy and Finance for the period 2002-2017. The main purpose of the project is the analysis of the medium term financial and distributional trends of income of the citizens residing in the Municipality of Bologna. Exploiting this innovative source of data allow us to analyse the dynamics of income at municipal level, overcoming the lack of information in official survey-based statistic. We investigate these trends by building inequality indicators and by examining the persistence of in-work poverty. Our results represent an important informative element to improve the effectiveness and equity of welfare policies at the local level, and to guide the distribution of economic and social support and urban redevelopment interventions in different areas of the Municipality.

Machine learning as a service for high energy physics (MLaaS4HEP): a service for ML-based data analyses

With the CERN LHC program underway, there has been an acceleration of data growth in the High Energy Physics (HEP) field and the usage of Machine Learning (ML) in HEP will be critical during the HL-LHC program when the data that will be produced will reach the exascale. ML techniques have been successfully used in many areas of HEP nevertheless, the development of a ML project and its implementation for production use is a highly time-consuming task and requires specific skills. Complicating this scenario is the fact that HEP data is stored in ROOT data format, which is mostly unknown outside of the HEP community. The work presented in this thesis is focused on the development of a ML as a Service (MLaaS) solution for HEP, aiming to provide a cloud service that allows HEP users to run ML pipelines via HTTP calls. These pipelines are executed by using the MLaaS4HEP framework, which allows reading data, processing data, and training ML models directly using ROOT files of arbitrary size from local or distributed data sources. Such a solution provides HEP users non-expert in ML with a tool that allows them to apply ML techniques in their analyses in a streamlined manner. Over the years the MLaaS4HEP framework has been developed, validated, and tested and new features have been added. A first MLaaS solution has been developed by automatizing the deployment of a platform equipped with the MLaaS4HEP framework. Then, a service with APIs has been developed, so that a user after being authenticated and authorized can submit MLaaS4HEP workflows producing trained ML models ready for the inference phase. A working prototype of this service is currently running on a virtual machine of INFN-Cloud and is compliant to be added to the INFN Cloud portfolio of services.

Data analysis and hydrological modelling of rainfall and discharge extremes along the Tione River: implications for the design of water structures

There are many natural events that can negatively affect the urban ecosystem, but weather-climate variations are certainly among the most significant. The history of settlements has been characterized by extreme events like earthquakes and floods, which repeat themselves at different times, causing extensive damage to the built heritage on a structural and urban scale. Changes in climate also alter various climatic subsystems, changing rainfall regimes and hydrological cycles, increasing the frequency and intensity of extreme precipitation events (heavy rainfall).  From an hydrological risk perspective, it is crucial to understand future events that could occur and their magnitude in order to design safer infrastructures. Unfortunately, it is not easy to understand future scenarios as the complexity of climate is enormous.  For this thesis, precipitation and discharge extremes were primarily used as data sources. It is important to underline that the two data sets are not separated: changes in rainfall regime, due to climate change, could significantly affect overflows into receiving water bodies. It is imperative that we understand and model climate change effects on water structures to support the development of adaptation strategies.   The main purpose of this thesis is to search for suitable water structures for a road located along the Tione River. Therefore, through the analysis of the area from a hydrological point of view, we aim to guarantee the safety of the infrastructure over time.   The observations made have the purpose to underline how models such as a stochastic one can improve the quality of an analysis for design purposes, and influence choices.

Variação na cobertura vegetal nativa em São Paulo: um panorama do conhecimento atual

Studies in several countries have shown the occurrence of forest transition, when forest cover increase overcomes the loss by deforestation. In Brazil, although deforestation is still higher than afforestation, this relationship may be inverse in some regions. Recent assessments suggest the tendency of the state of São Paulo towards forest transition. Aiming to analyze forest transition evidence and facilitate the use of existing information, we review data on native vegetation cover variation in São Paulo from four data sources (Instituto Florestal, SOS MataAtlântica/INPE, IBGE and CATI/IEA). Our results indicate that discrepancies among these assessments may be accounted by differences in methodologies and objectives. We highlight their common grounds and discuss possibilities to harmonize their information.

Psicologia do esporte : discussões sobre o cenario brasileiro

Universidade Estadual de Campinas . Faculdade de Educação Física

Malária autóctone notificada no Estado de São Paulo: aspectos clínicos e epidemiológicos de 1980 a 2007

INTRODUÇÃO: A malária autóctone no Estado de São Paulo caracteriza-se por surtos esporádicos na região oeste e transmissão persistente na região leste onde ocorrem casos oligossintomáticos com baixa parasitemia pelo Plasmodium vivax. Os objetivos deste estudo foram: analisar a completitude das fichas de notificação de malária autóctone; estimar a tendência da incidência de casos autóctones no ESP de 1980 a 2007; analisar o comportamento clínico e epidemiológico dos casos em duas regiões de autoctonia neste período. MÉTODOS: Foi realizado um estudo descritivo com 18 variáveis das FIN de malária do ESP, analisadas em duas regiões e em dois períodos (1980-1993 e 1994-2007). Fontes de dados: SUCEN/SES/SP, SINAN/CVE/SES/SP e DATASUS. RESULTADOS: A completitude foi superior a 85% em 11 variáveis. A tendência da incidência foi decrescente. Foram notificados 821 casos autóctones, 91,6% na região leste, predominando Plasmodium vivax. A infecção assintomática teve maior porcentagem no segundo período (p<0,001). CONCLUSÕES: A completitude das informações foi considerada satisfatória. As diferenças clínicas encontradas merecem atenção da vigilância epidemiológica que deve lidar com o desafio da infecção assintomática por Plasmodium.

Avaliação das declarações de nascido vivo como fonte de informação sobre defeitos congênitos

OBJETIVO: Estimar a prevalência de defeitos congênitos (DC) em uma coorte de nascidos vivos (NV) vinculando-se os bancos de dados do Sistema de Informação de Mortalidade (SIM) e do Sistema de Informação sobre Nascidos Vivos (SINASC). MÉTODOS: Estudo descritivo para avaliar as declarações de nascido vivo como fonte de informação sobre DC. A população de estudo é uma coorte de NV hospitalares do 1º semestre de 2006 de mães residentes e ocorridos no Município de São Paulo no período de 01/01/2006 a 30/06/2006, obtida por meio da vinculação dos bancos de dados das declarações de nascido vivo e óbitos neonatais provenientes da coorte. RESULTADOS: Os DC mais prevalentes segundo o SINASC foram: malformações congênitas (MC) e deformidades do aparelho osteomuscular (44,7%), MC do sistema nervoso (10,0%) e anomalias cromossômicas (8,6%). Após a vinculação, houve uma recuperação de 80,0% de indivíduos portadores de DC do aparelho circulatório, 73,3% de DC do aparelho respiratório e 62,5% de DC do aparelho digestivo. O SINASC fez 55,2% das notificações de DC e o SIM notificou 44,8%, mostrando-se importante para a recuperação de informações de DC. Segundo o SINASC, a taxa de prevalência de DC na coorte foi de 75,4%00 NV; com os dados vinculados com o SIM, essa taxa passou para 86,2%00 NV. CONCLUSÕES: A complementação de dados obtida pela vinculação SIM/SINASC fornece um perfil mais real da prevalência de DC do que aquele registrado pelo SINASC, que identifica os DC mais visíveis, enquanto o SIM identifica os mais letais, mostrando a importância do uso conjunto das duas fontes de dados.

A regionalização intramunicipal do Sistema Único de Saúde (SUS): um estudo de caso do município de São Paulo-SP, Brasil

A regionalização tem sido apontada como um dos principais desafios para viabilizar a equidade e a integralidade do SUS. Este artigo tem como objetivo avaliar o processo de implementação de um projeto de organização de regiões de saúde no município de São Paulo. Para tanto, foi realizado um estudo de caso em uma região selecionada desse município, a partir do referencial da análise de implantação, utilizando-se como fonte de dados documentos da gestão e entrevistas semiestruturadas com informantes-chave da gestão municipal 2005-2008. A análise temática evidenciou que o projeto de regionalização idealizado no início da gestão não foi efetivamente implementado. Dentre os fatores que interferiram nesse insucesso, destacam-se: a) a Secretaria Municipal de Saúde (SMS), além de seu caráter centralizador, manteve estruturas político-administrativas independentes para a gestão da atenção básica e da assistência hospitalar; b) a SMS não assumiu a gestão, de fato, de ambulatórios e hospitais estaduais; c) o poder institucional e a resistência dos hospitais em se integrar ao sistema de saúde. Discute-se, ainda, a necessidade de avançar na descentralização intramunicipal do SUS e buscar novas estratégias para a construção de pactos que consigam superar as resistências e articular instituições historicamente consolidadas, visando uma regionalização cooperativa e solidária.

O difícil acesso a serviços de média complexidade do SUS: o caso da cidade de São Paulo, Brasil

O acesso aos serviços de média complexidade tem sido apontado, por gestores e pesquisadores, como um dos entraves para a efetivação da integralidade do SUS. Este artigo teve o objetivo de avaliar mecanismos utilizados pela gestão do SUS, no município de São Paulo, para garantir acesso à assistência de média complexidade, durante o período de 2005 a 2008. Optou-se pela estratégia de estudo de caso, utilizando as seguintes fontes de evidência: entrevistas com gestores; grupo focal com usuários e observação participante. Utilizouas técnica de análise temática, a partir do referencial teórico da integralidade da assistência, na dimensão da organização de serviços. Buscou-se descrever os caminhos percorridos pelos usuários para acessar os serviços da média complexidade, a partir da visão dos gestores e dos próprios usuários. A média complexidade foi identificada, pelos gestores, como o "gargalo" do SUS e um dos principais obstáculos para a construção da integralidade. Para enfrentar essa situação, o gestor municipal investiu na informatização dos serviços, como medida isolada e, ainda, sem considerar a necessidade dos usuários. Sendo assim, essa incorporação tecnológica teve pouco impacto na melhoria do acesso, o que se confirmou no relato dos usuários. Discute-se que para o enfrentamento de um problema tão complexo são necessárias ações articuladas, tanto no âmbito da política de saúde, quanto da organização dos serviços, bem como a (re)organização do processo de trabalho em todos os níveis do sistema de saúde.

O difícil acesso a serviços de média complexidade do SUS

O acesso aos serviços de média complexidade tem sido apontado, por gestores e pesquisadores, como um dos entraves para a efetivação da integralidade do SUS. Este artigo teve o objetivo de avaliar mecanismos utilizados pela gestão do SUS, no município de São Paulo, para garantir acesso à assistência de média complexidade, durante o período de 2005 a 2008. Optou-se pela estratégia de estudo de caso, utilizando as seguintes fontes de evidência: entrevistas com gestores; grupo focal com usuários e observação participante. Utilizouas técnica de análise temática, a partir do referencial teórico da integralidade da assistência, na dimensão da organização de serviços. Buscou-se descrever os caminhos percorridos pelos usuários para acessar os serviços da média complexidade, a partir da visão dos gestores e dos próprios usuários. A média complexidade foi identificada, pelos gestores, como o "gargalo" do SUS e um dos principais obstáculos para a construção da integralidade. Para enfrentar essa situação, o gestor municipal investiu na informatização dos serviços, como medida isolada e, ainda, sem considerar a necessidade dos usuários. Sendo assim, essa incorporação tecnológica teve pouco impacto na melhoria do acesso, o que se confirmou no relato dos usuários. Discute-se que para o enfrentamento de um problema tão complexo são necessárias ações articuladas, tanto no âmbito da política de saúde, quanto da organização dos serviços, bem como a (re)organização do processo de trabalho em todos os níveis do sistema de saúde