Health surveys and use of maternal and child health care services in three municipalities within the Sao Paulo metropolitan area

Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the Sao Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes. Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the Sao Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions. Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of Sao Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance. Conclusions. The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.

Health in Brazil 6 Health conditions and health-policy innovations in Brazil: the way forward

Brazil is a large complex country that is undergoing rapid economic, social, and environmental change In this Series of six articles, we have reported important improvements in health status and life expectancy, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation. Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, reflecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes conflict and contradiction. The challenge is ultimately political, and we conclude with a call for action that requires continuous engagement by Brazilian society as a whole in securing the right to health for all Brazilian people.

Shared decision-making in mental health care : a user perspective on decisional needs in community-based services

BACKGROUND: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. OBJECTIVE: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. METHODS: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. RESULTS: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

Avalia����o de pol��ticas p��blicas: estudo do comportamento de indicadores relacionados com a sa��de em munic��pios do estado de Pernambuco ap��s a emenda Constitucional N�� 29

The Brazilian Public Health System (Sistema ��nico de Sa��de - SUS), defined by the Constitution of 1988, is almost 20 years old and is a landmark for health public policies. In these 20 years, the law was altered several times with the objective of prioritizing the investment of public money in such a needy area as health. Among these changes, it is important to single out the Constitutional Amendment number 29, issued on 13th September 2000, which determined the minimum investment in health. According to this amendment, as from the year 2000, the municipalities should invest in health services a minimum of 7% of the revenue from taxes and transferences from the Federal and State governments. This value was to rise gradually to 15% by 2004. Since every public policy should be systematically evaluated and considering the assumption that, according to the incrementalist theory, more money invested in health would tend to solve the crisis in the health system, this dissertation consists of a study of a set of health indicators in some municipalities of the State of Pernambuco after the Amendment 29. The evaluation period spanned 4 years, from 2002 to 2005 and the area chosen for the study was located in southern agreste region of the state. Ten health indicators were selected, all of which included in the Administrative Rule no 493, of the Health Ministry. It was found that in the chosen period the average investment in health was greater than 15% of the municipalities�� revenue since 2002. However, the value of the investment per capita, considering the municipality's share of it, which was half of the total investment, decreased from 2002 to 2004 and increased in 2005. It was also found that the municipalities with the lowest per capita income were the ones with the highest investment per capita in health. As regards children mortality in the region, it was on average 33 for every 1000 children born, which is classified as ��medium�� according to the above mentioned Administrative Rule no 493. No statistically significative correlation was found between the amount of money invested in health and children mortality.

Informatiza����o da opera����o e da gest��o de uma unidade de sa��de de alta complexidade do sistema ��nico de sa��de (SUS): estudo de caso do instituto de medicina integral Prof. Fernando Figueira (Imip) sob o enfoque do isomorfismo institucional

O trabalho buscou identificar e avaliar a escolha do Imip �� luz da teoria neoinstitucional, mediante os mecanismos isom��rficos que caracterizam o campo das organiza����es de sa��de. Trata-se de um estudo de caso, tendo o Imip como objeto de an��lise, voltado especificamente para dois modelos de informatiza����o da opera����o e da gest��o, a fim de verificar qual o mais adequado para as especificidades da institui����o, incluindo o aspecto financeiro, custo/benef��cio. O primeiro modelo se refere a um sistema pr��prio de informatiza����o; o segundo a um modelo de sistema de gest��o j�� existente, comercializado por empresa especializada nesta tecnologia. A metodologia abrangeu pesquisas bibliogr��ficas, documentais e de campo. O referencial te��rico foi a teoria neoinstitucional e o trabalho de campo constou de uma pesquisa incluindo observa����o simples, visando compor vari��veis dos dois modelos avaliados, e coleta de dados realizada por meio da aplica����o de dois question��rios: um question��rio aberto, com os dirigentes do Imip, e um question��rio misto, com cem colaboradores, utilizadores do sistema, escolhidos aleatoriamente, por sorteio. Entre os achados se identificou claras refer��ncias ao isomorfismo, principalmente o mim��tico, nas percep����es dos indiv��duos respondentes. Ao final da pesquisa, foi poss��vel concluir que a contrata����o de um sistema de gest��o hospitalar, j�� existente no mercado, concebido e comercializado por empresa de tecnologia especializada no segmento da sa��de, justificou-se como a melhor escolha para a organiza����o, pois, as semelhan��as existentes entre os processos do Instituto e aqueles contidos no sistema eram muito mais relevantes que suas particularidades. Outro fator relevante levou em considera����o os elevados custos para uma ��nica institui����o desenvolver e manter sozinha um sistema atualizado segundo as exig��ncias normativas e t��cnicas necess��rias ��s organiza����es de sa��de e os padr��es de qualidade da informa����o estabelecidos pelo SUS.

Aten����o �� sa��de da pessoa idosa na estrat��gia sa��de da fam��lia no munic��pio de Santo Ant��nio/RN: um estudo de caso

According to demographic estimates, by the year 2025 Brazil will be the sixth country in the world in number of elderly. For this reason, it is a purpose of public policies to help people to reach that age being healthier. The current health care model of health surveillance through the Family Health Strategy (EFS, in portuguese) is configured as a gateway into the care of the elderly in the Unified Health System (SUS, in portuguese). It is also an area of development of practices to promote health, prevention and control of chronic nondegenerative diseases. The aim of this study was to analyze the health care of the elderly provided by ESF professionals for the achievement of a full care. The study is descriptive case study with a quantitative approach, performed in the city of Santo Ant��nio/RN. The population included all health professionals, who are FHS members of the city that agreed to participate of the survey, a total of 80 professionals. Data were collected using a structured questionnaire, having mostly closed questions and divided into two parts: one containing sociodemographic information of health professionals and vocational training and the other, the activities carried on by the professionals in senior care, being analyzed from a database tabulated in a spreadsheet and discussed according to the descriptive statistics in tables, graphs and charts using frequencies, medians and values of central tendency. It was verified a predominance of professionals who finished highschool, mostly female, aged from 30 to 34 years old, with training completed in the last 10 years, without being graduated in the field of geriatrics or gerontology and mostly without training in gerontology. Family members and caregivers were the components of the social support network most identified by the professionals (66.3%).The elderly access to the Family Health Basic Unit was considered by83.8% of professionals as the most important factor that interferes in the activities of health care of the elderly. Considering the inclusion of the family in care: 98.8% of professionals consider the family as one of the goals of care, but 82.5% assist the family to know their role and participate in the care of the elderly, emphasizing that no professional makes use of tools for evaluating the functionality of the family. Regarding the actions taken to assist the elderly, 91.25% have home visits program to the elderly, 88.75% use the host program; 77.5% know the habits of life, cultural, ethical and religious values of the elderly, their families and their community ;51.25% complement the activities through intersectoral actions, 50%participate in groups of living with the elderly; 33.75% keeps track and maintain updated the health information of the elderly; 11.25% of the professionals perform the Single Therapy Planning (PTS, in portuguese) and few implement the actions to promote health according to PTS; there is a deficit in the number of professional categories in the identification and monitoring of the frail older people in their households. It is concluded that the health care of the elderly developed by ESF professionals differs among the professional categories. It was identified weaknesses in the promotion of an active and healthy aging and also in the establishment of an integrated and full care of the elderly. It is recommended the adoption of permanent educational activities by the City Management, initially for ESF professionals in the the perspective of the guidelines of the National Policy of Health Care for the Elderly and later to the other professionals that are part of the health care network of the elderly, at all levels of care in the city for the development of strategies and practices that promote the improvement of the quality of healthcare for the elderly, expecting concrete and effective results in terms of promoting health within Brazilian reality

Health surveys and use of maternal and child health care services in three municipalities within the S��o Paulo metropolitan area

Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the S��o Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes.Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the S��o Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions.Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of S��o Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance.Conclusions. The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.

Fatores associados a n��o realiza����o da mamografia e do exame cl��nico das mamas: um estudo de base populacional em Campinas, S��o Paulo, Brasil

Funda����o de Amparo �� Pesquisa do Estado de S��o Paulo (FAPESP)

Avalia����o da alimenta����o de idosos de munic��pio paulista: aplica����o do ��ndice de Alimenta����o Saud��vel

OBJETIVO: avaliar a qualidade da dieta da popula����o idosa do munic��pio de Avar�� (SP) atrav��s do ��ndice de Alimenta����o Saud��vel (IAS) M��TODOS: trata-se de um estudo de corte transversal de base populacional realizado por meio de entrevista domiciliar. A amostra constou de 73 indiv��duos, sorteados aleatoriamente dos idosos integrados ao Sistema P��blico de Sa��de do Munic��pio. O consumo alimentar foi medido por meio de 3 Recordat��rios de 24 horas. Para avalia����o, foi aplicado o IAS adaptado para a popula����o brasileira. Parte-se do princ��pio que o presente estudo constitui o primeiro no Brasil a aplicar o IAS utilizando 3 inqu��ritos do tipo recordat��rio de 24 horas em popula����o idosa. Optou-se por esta metodologia, pois como descrito na literatura, um ��nico dia n��o representa a ingest��o habitual de um indiv��duo devido �� elevada variabilidade intrapessoal do consumo. RESULTADOS: Foram encontrados 32,9% de idosos com uma dieta de m�� qualidade; 60,3% necessitando de melhorias e 6,8% com uma dieta de boa qualidade. CONCLUS��O: Pode-se concluir que os idosos estudados precisam de melhorias na alimenta����o, o que ressalta a import��ncia de pol��tica de incentivo voltado �� alimenta����o saud��vel na terceira idade.

Harmonic content identification based on neural method for single phase power systems

An alternative method is presented in this paper to identify the harmonic components of non-linear loads in single phase power systems based on artificial neural networks. The components are identified by analyzing the single phase current waveform in time domain in half-cycle of the ac voltage source. The proposed method is compared to the fast Fourier transform. Simulation and experimental results are presented to validate the proposed approach.

Health benefits guarantees in Latin America: equity and quasi market restructuring at the beginning of the millennium

Includes bibliography

Modernization and foreign trade in the health services

Includes bibliography

Potential and limits of health management reform in Chile

Includes bibliography

Perfil demogr��fico, s��cio-econ��mico e morbidade referida na popula����o do munic��pio de Prat��nia, SP

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior (CAPES)

Sofrimento ps��quico dos trabalhadores de uma equipe do Programa Sa��de da Fam��lia na organiza����o do trabalho

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior (CAPES)