The Burden of Stroke in the Southeast Region of Brazil in 2019: an Estimate Based on Secondary Data from the Brazilian United Health System

Abstract Background: Stroke is one of the main causes of morbidity and mortality in the Southeast Region of Brazil, and it is impacted by socioeconomic conditions and the age of the population in the region. Objectives: The objective of this study was to estimate the burden of stroke in the adult population, for both sexes, in different age groups, in the Southeast Region of Brazil, in the year 2019. Methods: This descriptive study was conducted with secondary data on stroke, obtained from the Department of Informatics of the Brazilian Unified Health System (DATASUS) and the Brazilian Institute of Geography and Statistics (IBGE), to calculate years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY). Results: In the year 2019, in the Southeast Region of Brazil, a total of 713,132 DALY were estimated, 80% from YLD and 20% from YLL. The highest values were from the state of São Paulo, as it is the most populous state; in the female sex, due to the greater number of female inhabitants; and in the age group between 40 and 59 years. However, when adjusted to a rate of 100,000 inhabitants, the greatest impact was for the male sex in the state of Minas Gerais, mainly in the age group between 70 and 79 years. Conclusions: YLD were more relevant in the composition of DALY, due to higher stroke morbidity than mortality, and high stroke DALY burdens impact the economically active population in this region.

Contribution of the Unified Health Care System to mammography screening in Brazil, 2013 / Contribuição do Sistema Único de Saúde no rastreamento mamográfico no Brasil, 2013

Abstract Objective: To estimate the coverage of opportunistic mammography screening performed via the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System), at the state and regional level, in 2013. Materials and Methods: This was an ecological study in which coverage was estimated by determining the ratio between the number of mammograms performed and the expected number of mammograms among the population of females between 50 and 69 years of age. The number of mammograms performed in the target population was obtained from the Outpatient Database of the Information Technology Department of the SUS. To calculate the expected number of mammograms, we considered 58.9% of the target population, the proportion that would be expected on the basis of the recommendations of the Brazilian National Cancer Institute. Results: In 2013, the estimated national coverage of mammography screening via the SUS was 24.8%. The mammography rate ranged from 12.0% in the northern region to 31.3% in the southern region. When stratified by state, coverage was lowest in the state of Pará and highest in the state of Santa Catarina (7.5% and 35.7%, respectively). Conclusion: The coverage of mammography screening performed via the SUS is low. There is a significant disparity among the Brazilian states (including the Federal District of Brasília) and among regions, being higher in the south/southeast and lower in the north/northeast.

Resumo Objetivo: Estimar a cobertura mamográfica em rastreamento oportunista realizado pelo Sistema Único de Saúde (SUS) no Brasil, nas suas regiões e nas Unidades da Federação, no ano de 2013. Materiais e Métodos: Estudo ecológico, em que a estimativa da cobertura foi a proporção entre o número de exames realizados e o número de exames esperados na população feminina na faixa etária de 50 a 69 anos. O número de exames realizados refere-se aos dados da produção mamográfica da população alvo, disponíveis no Sistema de Informações Ambulatoriais do Departamento de Informática do SUS. Para o cálculo do número de exames esperados considerou-se 58,9% da população alvo, tendo em vista as recomendações do Instituto Nacional de Câncer. Resultados: A estimativa da cobertura mamográfica no rastreamento realizado pelo SUS no Brasil, em 2013, foi 24,8%. A prevalência de mamografias variou de 12,0% na Região Norte a 31,3% na Região Sul. Ao estratificar por Unidades da Federação, a menor cobertura foi no Pará (7,5%) e a maior cobertura foi em Santa Catarina (35,7%). Conclusão: A cobertura mamográfica do SUS no Brasil é baixa. Existe uma desigualdade significativa entre as Unidades da Federação, sendo maior nas regiões Sul e Sudeste e menor nas regiões Norte e Nordeste do país.

Disponibilidad de servicios de mamografía en Colombia / Availability of mammography services in Colombia

Objetivos: Determinar la disponibilidad de servicios de mamografía a nivel nacional para mujeres colombianas entre los 50 y 69 años. Adicionalmente, describir la disponibilidad del servicio de mamografía dentro y fuera del departamento de residencia. Métodos: Se elige Sistema Integral de Información de la Protección Social (SISPRO) como la fuente de información adecuada para desarrollar la investigación. Se calculó la tasa de lugar de prestación de servicio de mamografía por 10.000 mujeres entre los 50 y 69 años. Se dispuso esta información en mapas, y se calculó la proporción de mujeres que recibieron el servicio según el lugar de residencia. Resultados: A nivel nacional se observó una tasa de lugar de prestación promedio de 5,4 por 10.000 mujeres entre los 50 y 69 años, con un máximo de 9,6 y un mínimo de 0. El 23% de las mujeres colombianas entre los 50 y 69 años deben salir de su departamento de residencia para recibir el servicio de mamografía, con un mínimo de 3% y un máximo de 100%. Conclusiones: Existe una distribución heterogénea de los lugares de prestación del servicio de mamografía. En algunos departamentos no existe prestación del servicio y el total de la población reportada en estos lugares debe salir de su departamento de residencia para recibir la prestación. Determinar la disponibilidad de los servicios de mamografía permitió conocer la situación de la oferta para enfocar los recursos y mejorar la disponibilidad de estos, pues tienen un impacto directo en los resultados de cáncer de mama en el país.

Objective: To determine the availability of mammography services at national level targeted at women between 50 and 69 years, as well as to report on the availability of these services within and outside the area of residence. Methods: The Integrated Information System on Social Protection (SISPRO, in its abbreviation in Spanish) was chosen as the source of information to develop an appropriate research study. The rate of places providing mammography services per 10,000 women aged 50 to 69 years was calculated. This information was then displayed on maps. Finally, an estimation of was made of the proportion of women who received the service related to the place of residence. Results: Nationally, an average rate of 5.4 centers providing mammography services per 10,000 women aged 50 to 69 years was observed, with a maximum of 9.6 and a minimum of 0 services per 10,000 women aged 50 to 69 years. It was observed that around 23% of Colombian women had to travel from their department of residence to use the mammography service, with a maximum of 100% and a minimum of 3%. Conclusions: There is a heterogeneous distribution of mammography service delivery. Some departments completely lack mammography service facilities. The population reported in those departments had to travel from their department of residence to receive the service. Determining the availability of mammography services has the aim of finding out the status of the mammogram services offered, and to focus resources to improve access to mammography services, which have a direct impact on health outcomes.

Factors associated to the imposition of types of violence against women informed in sentry services / Factores asociados a la sobreposicion de tipos de violencia contra la mujer notificada en servicios centinela

OBJECTIVE: to identify the prevalence and the factors associated to the imposition of the different types of violence against women informed in sentry services. METHOD: transversal study accomplished through 939 notification forms of cases of violence against women, referring to the three years from 2006 to 2008 in Fortaleza, Ceará. Univariate and multiple analyses by logistic regression were realized. RESULT: the results showed a positive association between the imposition of types of violence against women with a schooling varying from illiterate to basic education and the aggression which had occurred other times. CONCLUSION: this knowledge contributes to the delineation of specific actions that aim at facing this problem, as well as generates subsidies for adequate attendance proposals and guidance for the victims who call on health services. .

OBJETIVO: identificar la prevalencia y los factores asociados a la sobreposición de los diferentes tipos de violencia contra la mujer notificados en servicios centinela. MÉTODO: estudio transversal realizado con 939 fichas de notificación de casos de violencia contra la mujer, referentes al trienio de 2006 a 2008, en Fortaleza, Ceará. Fueron realizados el análisis univariado y el múltiple por regresión logística. RESULTADOS: los resultados mostraron asociación positiva entre la sobreposición de tipos de violencia contra la mujer, con la escolaridad variando de analfabeta a enseñanza fundamental y la agresión haber ocurrido otras veces. CONCLUSIÓN: este conocimiento contribuye para el delineamiento de acciones específicas que tengan por objetivo enfrentar esta problemática, así como generar subsidios para elaborar una propuesta adecuada de atención y encaminamiento de las víctimas que buscan los servicios de salud. .

Uso de los establecimientos de salud del Ministerio de Salud del Perú, 2009 - 2011 / Use of health facilities of the Ministry Of Health of Peru, 2009-2011

Objetivo. Describir el uso de los servicios de salud y los factores asociados a este en los establecimientos de salud del Ministerio de Salud del Perú (MINSA). Materiales y método. Se realizó un estudio ecológico con información de los atendidos en los centros de salud a nivel nacional, durante años 2009 a 2011, empleando el sistema de información de salud HIS del MINSA. El uso de los servicios de salud fue definido por la proporción de atendidos y el total de la población. Esta variable se comparó por sexo, grupo de edad, zona geográfica y año calendario. Se realizó la prueba de chi cuadrado para comparar proporciones entre los diferentes estratos y regresión lineal para determinar los factores asociados. Resultados. Entre los años 2009-2011 hubo un incremento en el número de centros de salud y cobertura de seguros de salud, pero el uso de los servicios de salud disminuyó de 43,3% (2009) a 40,3% (2011). Se encontró un mayor uso por pobladores del sexo femenino, en el grupo de edades de 0 a 29 años y los residentes en la zona sur del país. En el análisis multivariado los factores asociados con uso de los sistemas de salud fueron zona geográfica y año calendario. Conclusiones. El uso de los servicios de salud no está asociada con el incremento en el número de centros de salud ni al acceso a los seguros de salud, sino a factores individuales o del sistema de salud que deben ser evaluados en estudios posteriores.

Objective. To describe the use of health services and associated factors in health care centers of the Ministry of Health of Peru (MINSA). Materials and methods. An ecological study was conducted with information from outpatients placed in all health centers from all Regions at the national level from 2009-2011. The use of health services was defined by the proportion of outpatient and the total population. This variable was compared by gender, age group, geographic area, and calendar year. Chi-square test was performed to compare proportions between the different layers. In addition, linear regression was performed to determine factors associated. Results. In this period of time there was an increased number of health care centers and health insurance coverage, but the use of health services decreased from 43.3% (2009) to 40.3% (2011). An increased use by female residents, age group of 0-29 years old and residents from the southern region was found. A multivariate analysis was conducted and factors associated with use of health systems were geographic area, and calendar year. Conclusions. Use of health services is not associated to the increased number of health centers nor the access to health insurance, but it is associated to individual factors or health system-related factors that should be evaluated in future studies.

Comportamiento de indicadores hospitalarios durante el decenio 1990-1999

Se realiza un estudio de tipo serie cronológica, con el objetivo de precisar el comportamiento de indicadores hospitalarios seleccionados, durante el decenio 1990-1999, para lo cual se determinó la tendencia lineal por el método de los semipromedios. Se observó una ligera tendencia al incremento de las consultas realizadas y del promedio de casos vistos por consulta, asimismo la tendencia del número total de casos vistos en consulta mostró un franco incremento, fundamentalmente por el aumento de los casos atendidos en consultas de especialidades quirúrgicas y consultas multidisciplinarias. Se constató una franca tendencia decreciente del número de ingresos en la institución, del índice ocupacional y de la estadía; la tendencia decreciente del número de fallecidos y de la tasa de mortalidad neta fue más discreta. También se evidenció una franca tendencia al incremento del número de operaciones ambulatorias. Como conclusión se verificó un comportamiento favorable durante los últimos 10 años de casi todos los indicadores hospitalarios seleccionados para análisis, posiblemente relacionado con los cambios organizativos efectuados en la institución durante la segunda mitad de la década estudiada.

A chronological study was conducted aimed at knowing the behavior of selected hospital indicators during 1990-1999, for which the lineal trend was determined by the semiaverages method. It was observed a light trend towards the increase of the consultations made and of the average of cases seen at the physician’s office. The trend of the total number of patients that received attention at the physician’s office showed a high increase due mainly to the rise of cases attended by different surgery specialists and multidisciplinary teams. It was observed a decreasing trend of the number of hospital admissions, of the bed occupancy rate and of hospital stay. The trend towards the reduction of deaths and of the net mortality rate was more discrete. A trend towards the increase of the number of ambulatory operations was also observed. A favorable behavior of almost all the hospital indicators selected to be analyzed was confirmed during the last 10 years due possibly to the organizational changes that occurred during the second half of the studied decade.