Hospitalizations for ambulatory care-sensitive conditions, Minas Gerais, Southeastern Brazil, 2000 and 2010

OBJECTIVE To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program. METHODS An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses. RESULTS The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD) = 10.42) in 2000 to 14.92/thousand inhabitants (SD = 10.04) in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly. CONCLUSIONS Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.

Toimintolaskentajärjestelmän kehittäminen, Case: Xyrofin Oy

Tutkielman tavoitteena on toimintolaskentajärjestelmän kehittäminen osaksi case-yrityksen johdon informaatiojärjestelmää. Tutkielman empiirisessä osassa selvitetään haastattelujen ja osallistuvan havainnoinnin avulla toimintolaskennan asema ja nykytila sekä sille asetettavat tavoitteet. Tutkimusmetodologia on konstruktiivinen ja metodi case-tutkimus. Case-yrityksessä käytettiin toimintolaskentaa yrityksen kehittämisprojektissa vuonna 1997. Sen hyväksikäyttö on muuten ollut vähäistä. Yrityksen omistussuhteissa tapahtuneet muutokset, siitä johtuva resurssipula sekä taulukkolaskennalla toteutetun laskentamallin kankeus ovat olleet siihen osittain syynä. Toimintolaskenta rinnakkaisena laskentajärjestelmänä on jäänyt toissijaiseksi. Yrityksen johtoryhmän jäsenet odottavat toimintolaskentajärjestelmältä tällä hetkellä ensisijaisesti tuotekoodi- ja asiakaskannattavuuksien selvittämistä. Yksinkertaistamalla mallia ja helpottamalla päivittämistä saadaan tuotekoodien kustannukset ja kannattavuudet nopeammin. Yhdistämällä ne muista tietojärjestelmistä saataviin tietoihin pystytään tarvittaessa laskemaan asiakaskannattavuudet. Johtoryhmä saa näin tarvitsemansa kannattavuustiedon tuotteista ja asiakkaista päätöstensä tueksi.

A importância do observatório de atividades industriais vis-à-vis tendências em ciência, tecnologia e inovação

Given that innovation is fundamental for competitiveness, and that it is intrinsically linked to knowledge, it has become essential to foster effective interaction between the Brazilian productive sector and universities and R&D centers. This interface should be created by means of the model used in developed countries: Observatory of Industrial Activities and Trends in Science, Technology and Innovation. The present work describes its main functions, using examples of activities undertaken by the Chemical Industry Information System of the Federal University of Rio de Janeiro related to production systems of primary and high-tech industries, examining the diffusion of knowledge to decision-makers.

Diabetes mellitus : magnitude das hospitalizações na rede pública do Brasil, 1999-2001

Contexto: O diabetes mellitus (DM) é uma causa importante de morbimortalidade nas sociedades ocidentais devido à carga de sofrimento, incapacidade, perda de produtividade e morte prematura que provoca. No Brasil, seu impacto econômico é desconhecido. Objetivos: Dimensionar a participação do DM nas hospitalizações da rede pública brasileira (1999-2001), colaborando na avaliação dos custos diretos. Especificamente, analisar as hospitalizações (327.800) e os óbitos hospitalares (17.760) por DM como diagnóstico principal (CID-10 E10-E14 e procedimento realizado) e estimar as hospitalizações atribuíveis ao DM, incluindo as anteriores e aquelas por complicações crônicas (CC) e condições médicas gerais (CMG). Métodos: A partir de dados do Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS) (37 milhões de hospitalizações), foram calculados indicadores por região de residência do paciente e sexo (ajustados por idade pelo método direto, com intervalos de confiança de 95%), faixas etárias, médias de permanência e de gastos por internação e populacional em US$. Realizou-se regressão logística múltipla para o desfecho óbito. As prevalências de DM foram combinadas aos riscos relativos de hospitalização por CC e CMG (metodologia do risco atribuível) e somadas às internações por DM como diagnóstico principal. Utilizou-se análise de sensibilidade para diferentes prevalências e riscos relativos. Resultados: Os coeficientes de hospitalizações e de óbitos hospitalares e a letalidade por DM como diagnóstico principal atingiram respectivamente 6,4/104hab., 34,9/106hab. e 5,4%. As mulheres apresentaram os coeficientes mais elevados, porém os homens predominaram na letalidade em todas as regiões. O gasto médio (US$ 150,59) diferiu significativamente entre as internações com e sem óbito, mas a média de permanência (6,4 dias) foi semelhante. O gasto populacional equivaleu a US$ 969,09/104hab. As razões de chances de óbito foram maiores para homens, pacientes ≥75 anos, e habitantes das regiões Nordeste e Sudeste. As hospitalizações atribuíveis ao DM foram estimadas em 836,3 mil/ano (49,3/104hab.), atingindo US$ 243,9 milhões/ano (US$ 14,4 mil/104hab.). DM como diagnóstico principal (13,1%), CC (41,5%) e CMG (45,4%) responderam por 6,7%, 51,4% e 41,9% respectivamente dos gastos. O valor médio das internações atribuíveis (US$ 292) situou-se 36% acima das não-atribuíveis. As doenças vasculares periféricas apresentaram a maior diferença no valor médio entre hospitalizações atribuíveis e não-atribuíveis (24%), porém as cardiovasculares destacaram-se em quantidade (27%) e envolveram os maiores gastos (37%). Os homens internaram menos (48%) que as mulheres, porém com gasto total maior (53%). As internações de pacientes entre 45-64 anos constituíram o maior grupo (45%) e gastos (48%) enquanto os pacientes com ≥75, os maiores coeficientes de hospitalização (350/104hab.) e de despesa (US$ 93,4 mil/104hab.). As regiões mais desenvolvidas gastaram o dobro (/104hab.) em relação às demais. Considerações Finais e Recomendações: As configurações no consumo de serviços hospitalares foram semelhantes às de países mais desenvolvidos, com importantes desigualdades regionais e de sexo. O gasto governamental exclusivamente com hospitalizações atribuíveis ao DM foi expressivo (2,2% do orçamento do Ministério da Saúde). A ampliação de atividades preventivas poderia diminuir a incidência do DM, reduzir a necessidade de internações, minimizar as complicações e minorar a severidade de outras condições médicas mais gerais.

Terrenos de marinha: terras públicas com função social? um estudo da orla marítima de natal

This work has as its theme the social function of terrenos de marinha. Theresearch universe is the terrenos de marinha of Natal coastline, focusing on thefulfillment of its social function. Prescribed by law since the colonial period with thepurpose of protecting the coast and free movement of people and goods, theywere swathes of land not available to private use by individuals. With the transitionfrom the allotments system to the purchase and sale, regard to land access,crystallized with the creation of the Land Law in the nineteenth century, the land isheld as merchandise and terrenos de marinha, following this logic, also acquireexchange value and become capable of enjoyment by private individuals, with thecondition of tax payments to the state. This is seen until the twentieth century,when in 1988, primarily because of the Federal Constitution promulgation, begins anew cycle when is possible to use on terrenos de marinha the principle of thesocial function of property. From this perspective this study aims to identify thesocial function of terrenos de marinha in Natal, focusing on the public destinationand the use value of the city coastline. To this end, it was made a data collection inthe on-line information system of the Federal Heritage Department of Rio Grandedo Norte (SPU / RN) and in the terrenos de marinha areas, in order to find out ifthey had public or private use, or if they were empty lots, as well as if thepopulation access to the shore exist. Interviews with managers of the SPU weremade. The empirical study showed that the social function of terrenos de marinhain the city of Natal still didn´t happen, considering the constant existence of vacantlots in their areas, the lack of access in significant portions of the coastline and thereduced areas directed to common use along the coastline, minimizing its potentialof enjoyment by the population. It concludes by pointing to the existence of a newtransition phase on the terrenos de marinha, in witch, gradually, come up lawprovisions in the legal system and public policies to expand the purely taxcollection function attributed to this land for two centuries. In this direction, thesocial function of terrenos de marinha is embodied in concomitant adjustment ofthe tax collection function and the rescue of coastline use value, national heritageand a place for sociability and social relations development

Espaço urbano e a mobilidade das pessoas como construções sociais: aspectos estatísticos dos acidentes de trânsito com vítimas na Rodovia Federal BR 316

O trânsito é caracterizado como uma questão de saúde pública pela Organização Mundial da Saúde. O grande número de acidentes de trânsito não retira deste fato o status calamitoso que o mesmo detém, o que acaba por corroborar a preocupação das Nações Unidas em relação ao aumento progressivo da violência no trânsito, o que a fez proclamar a Década de Ação pela Segurança no Trânsito 2011/2020 em consequência da gravidade da situação, que vem ceifando mais vidas do que nos períodos de guerra, o que é corroborado pela constatação do crescimento em 24% do número total de óbitos por acidentes com transporte, no período de 2002 a 2010 pelo Sistema de Informações de Mortalidade da Organização Mundial da Saúde, revelando a importância social desta dissertação, que tem como objetivo identificar os fatores potencializadores de acidentes de trânsito com vitimizações fatais ocorridos na rodovia BR 316 nos quilômetros 21 ao 278, no período de 2010 a 2012. Para tanto, lançou-se mão de uma metodologia baseada em explorações teóricas aliadas a análises de informações provenientes do banco de dados da Polícia Rodoviária Federal que foram tratados a partir da aplicação de técnicas estatísticas descritivas e multivariadas a fim de confirmar a hipótese suscitada. Diante disto, pode-se concluir que o ano de 2011 foi o período marcado pelo maior número de ocorrências, ocorrências estas que se tornaram mais frequentes nos meses de junho, julho e dezembro, respectivamente, os quais se concentraram no turno da tarde e causados, sobretudo, pela falta de atenção, a desobediência à sinalização e a falta de guarda da distância de segurança; saliente-se o fato de que nos turnos da madrugada e noite os acidentes mais frequentes foram causados por ultrapassagens indevidas, condutores dormindo ao volante, defeitos na via e a ingestão de álcool e ainda vale antecipar, que nos intervalos de quilômetros de 41 a 50, 91 a 100, 101 a 110, 121 a 130, 141 a 150, 151 a 160, 201 a 210, 231 a 240, 251 a 260 e 261 a 270 da BR 316, é frequente que dos acidentes que ocorrem resultem dois ou mais feridos graves, sendo que destes feridos graves, nos intervalos de quilômetros 91 a 100 e 121 a 130, 221 a 230, dois ou mais venham a falecer. Desta forma, conclui-se que nos intervalos quilômetros 91 a 100 e 121 a 130, os feridos graves inevitavelmente faleceram. Diante disto, pode-se observar que o efetivo sentido de cidadania que deve ser dado às relações que se configuram a partir da utilização consciente do trânsito está perdido em meio a uma crise moral de sentidos, especialmente, em relação à obediência às leis de trânsito, o que acaba por transformar a rodovia BR 316 em um cenário de perdas iminentes de vidas, sobretudo, quando se remete ao fato de que todo o acidente de trânsito é previsível e evitável.

Estudo do perfil epidemiológico do melanoma cutâneo na cidade de Jaú-SP através do registro de base populacional

Pós-graduação em Pesquisa e Desenvolvimento (Biotecnologia Médica) - FMB

Análise da relação entre a distribuição espacial das morbidades por obesidade e hipertensão arterial para o estado de São Paulo, Brasil, de 2000 a 2010

A expansão da obesidade em diversos países do mundo na última década tem resultado no aumento da morbidade e mortalidade por hipertensão arterial e suas complicações. O objetivo deste trabalho é analisar a distribuição espacial da obesidade e hipertensão arterial no estado de São Paulo no período de 2000 a 2010, a partir de registros hospitalares e internação do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH - SUS). Foram utilizados coeficientes de prevalência das doenças em cada município suavizadas pelo método bayesiano empírico, permitindo uma visualização do padrão espacial dessas morbidades no Estado. Foi explorada a dependência espacial destes padrões verificando a autocorrelação entre os indicadores por meio do cálculo do Índice de Autocorrelação Espacial de Moran. Além disso, estudou-se a correlação positiva (Pearson) entre obesidade e hipertensão. Os dados e os mapas mostraram clusters de 87 municípios onde há maior e menor prevalência de hipertensão e obesidade no espaço com forte autocorrelação entre os municípios vizinhos. O coeficiente correlação de Pearson encontrado para esses municípios foi de 0,404 e sugere associação entre as morbidades. As técnicas de análise espacial mostraram-se úteis para o planejamento de ações de saúde pública.

Mortalidade segundo sua causa de morte e seus determinantes: uma análise para as capitais brasileiras e municípios do nordeste do Brasil, 2000 e 2010

This dissertation considered the development of two papers, both related to mortality in Brazil. In the first article, "The context of mortality according to the three broad groups of causes of death in Brazilian capitals, 2000 and 2010", the objective was to analyze the mortality rate according to the three major groups of causes of death in Brazilian capitals. In the second article, "Typology and characteristics of mortality from external causes in the municipalities in the Northeast of Brazil, 2000 and 2010", it was built up a typology for the Northeastern municipalities taking into account information on mortality from external causes and a set of indicators related to socioeconomic, demographic, and infrastructure aspects of such municipalities, both articles for the years 2000 and 2010. Thus, we used data from the Mortality Information System of the Ministry of Health. Furthermore, it was used information from the Demographic Census for those years. The variables relating to socioeconomic and demographic conditions used in this study were those available on the home page of the United Nations Program for Development. The variables relating to socioeconomic and demographic conditions used in this study were those available on the home page of the United Nations Program for Development. Was used in Article 1 the pro-rata distribution method to accomplish the redistribution of ill-defined causes. Moreover, made use of the technique of cluster analysis with the aim of grouping the capital that had proportions of deaths from ill-defined causes similar to each other. Already in Section 2, we used the technique of Empirical Bayesian estimation; spatial statistics technique; and finally, the Grade of Membership method to find types of municipalities from information on mortality from external causes associated with socioeconomic, demographic and infrastructure variables. As the main results, it stands out in Article 1, in relation to data quality, we observed the formation of four groups of similar capital between themselves, as the proportion of illdefined causes. Regarding the behavior of mortality, according to the three major groups of causes of death, it was noted both for 2000 and for 2010 the prevalence of deaths from noncommunicable diseases for both sexes, although the reduction was identified rates in some of the capitals. Communicable diseases stood out as the second cause of death among women. Also, we found that deaths due to external causes are responsible for the second cause of death among men, as well as presenting an increase among women. As for the Article 2, stands out, in general, not just an extension of mortality from external causes in the municipalities, as well as an enlargement of the configurator stain existence of external cause deaths for the whole area of Northeast. Regarding the typology of municipalities, three vi extreme profiles were buit: the profile 1, which comprises municipalities with high rates of mortality from external causes and the best social indicators; the profile 2, that was composed of municipalities that are characterized by having low mortality rates from external causes and the lowest social indicators; and the profile 3, that brings together municipalities with intermediate mortality rates and median values considered in relation to social indicators. Although we have not seen changes in the characteristics of the profiles, we observed an increase in the proportion of municipalities that belong to the extreme profile 3, taking into account the mixed profiles.

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.

Terrenos de marinha: terras públicas com função social? um estudo da orla marítima de natal

This work has as its theme the social function of terrenos de marinha. Theresearch universe is the terrenos de marinha of Natal coastline, focusing on thefulfillment of its social function. Prescribed by law since the colonial period with thepurpose of protecting the coast and free movement of people and goods, theywere swathes of land not available to private use by individuals. With the transitionfrom the allotments system to the purchase and sale, regard to land access,crystallized with the creation of the Land Law in the nineteenth century, the land isheld as merchandise and terrenos de marinha, following this logic, also acquireexchange value and become capable of enjoyment by private individuals, with thecondition of tax payments to the state. This is seen until the twentieth century,when in 1988, primarily because of the Federal Constitution promulgation, begins anew cycle when is possible to use on terrenos de marinha the principle of thesocial function of property. From this perspective this study aims to identify thesocial function of terrenos de marinha in Natal, focusing on the public destinationand the use value of the city coastline. To this end, it was made a data collection inthe on-line information system of the Federal Heritage Department of Rio Grandedo Norte (SPU / RN) and in the terrenos de marinha areas, in order to find out ifthey had public or private use, or if they were empty lots, as well as if thepopulation access to the shore exist. Interviews with managers of the SPU weremade. The empirical study showed that the social function of terrenos de marinhain the city of Natal still didn´t happen, considering the constant existence of vacantlots in their areas, the lack of access in significant portions of the coastline and thereduced areas directed to common use along the coastline, minimizing its potentialof enjoyment by the population. It concludes by pointing to the existence of a newtransition phase on the terrenos de marinha, in witch, gradually, come up lawprovisions in the legal system and public policies to expand the purely taxcollection function attributed to this land for two centuries. In this direction, thesocial function of terrenos de marinha is embodied in concomitant adjustment ofthe tax collection function and the rescue of coastline use value, national heritageand a place for sociability and social relations development

UTILIZACIÓN DEL CATÁLOGO EN LÍNEA DEL SISTEMA DE INFORMACIÓN DOCUMENTAL DE LA UNIVERSIDAD NACIONAL POR LOS USUARIOS DE LA BIBLIOTECA “JOAQUÍN GARCÍA MONGE”: GRADO DE CONOCIMIENTO

¿Qué grado de conocimiento y éxito en la localización de la información tienen los usuarios de la Biblioteca “Joaquín García Monge” en la utilización del catálogo en línea del Sistema de Información Documental de la Universidad Nacional (SIDUNA), Heredia, Costa Rica?. 

Análise das mudanças espaciais e temporais nos padrões de paisagem na região do oeste da Bahia sobre a formação do grupo urucuia (1988-2011) e suas implicações para a conservação do Cerrado

Tese (doutorado)—Universidade de Brasília, Instituto de Ciências Humanas, Departamento de Geografia, Programa de Pós Graduação em Geografia, 2015.

Terrenos de marinha: terras públicas com função social? um estudo da orla marítima de natal

This work has as its theme the social function of terrenos de marinha. Theresearch universe is the terrenos de marinha of Natal coastline, focusing on thefulfillment of its social function. Prescribed by law since the colonial period with thepurpose of protecting the coast and free movement of people and goods, theywere swathes of land not available to private use by individuals. With the transitionfrom the allotments system to the purchase and sale, regard to land access,crystallized with the creation of the Land Law in the nineteenth century, the land isheld as merchandise and terrenos de marinha, following this logic, also acquireexchange value and become capable of enjoyment by private individuals, with thecondition of tax payments to the state. This is seen until the twentieth century,when in 1988, primarily because of the Federal Constitution promulgation, begins anew cycle when is possible to use on terrenos de marinha the principle of thesocial function of property. From this perspective this study aims to identify thesocial function of terrenos de marinha in Natal, focusing on the public destinationand the use value of the city coastline. To this end, it was made a data collection inthe on-line information system of the Federal Heritage Department of Rio Grandedo Norte (SPU / RN) and in the terrenos de marinha areas, in order to find out ifthey had public or private use, or if they were empty lots, as well as if thepopulation access to the shore exist. Interviews with managers of the SPU weremade. The empirical study showed that the social function of terrenos de marinhain the city of Natal still didn´t happen, considering the constant existence of vacantlots in their areas, the lack of access in significant portions of the coastline and thereduced areas directed to common use along the coastline, minimizing its potentialof enjoyment by the population. It concludes by pointing to the existence of a newtransition phase on the terrenos de marinha, in witch, gradually, come up lawprovisions in the legal system and public policies to expand the purely taxcollection function attributed to this land for two centuries. In this direction, thesocial function of terrenos de marinha is embodied in concomitant adjustment ofthe tax collection function and the rescue of coastline use value, national heritageand a place for sociability and social relations development