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Rev. Hosp. Ital. B. Aires (2004) ; 43(1): 7-11, mar. 2023. ilus, tab
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1434097


Introducción: el NPS (Net Promoter Score) es un indicador que se utiliza en los programas de experiencia del cliente para medir la satisfacción de dicho público objetivo y su lealtad. Nuestra finalidad fue consolidar el NPS por primera vez en una prepaga de un hospital de alta complejidad de Buenos Aires (PS-HIBA) en busca de establecer un indicador objetivo desde la perspectiva del cliente. Métodos: se realizó un estudio observacional analítico, de corte transversal. Se incluyeron en el estudio los datos obtenidos a partir de las respuestas de los afiliados al PS-HIBA. Resultados: se consolidó el primer indicador NPS del PS-HIBA: 22 puntos. Se visualizaron los tres perfiles de clientes, obteniendo un 45,7% promotores, 22,3% detractores y 32% pasivos o neutros. Complementariamente se identificaron los motivos de dichas calificaciones; las tres principales fueron: la problemática de accesibilidad a los turnos, la atención y los profesionales valorados positivamente. Conclusión: este estudio aporta un indicador objetivo, que facilita un lenguaje común en la organización y una comparación con el mercado desde la mirada del cliente. El NPS, como sistema, busca impulsar la construcción de una cultura centrada en el cliente, con el fin de mejorar su lealtad y permitir una retroalimentación donde se logra tener presente la voz del cliente, e identificar, priorizar y abordar los problemas percibidos. Nos permite establecer los lineamientos de oportunidades de mejora desde la perspectiva de los pacientes. (AU)

Introduction: the NPS (Net Promoter Score) is an indicator used in customer experience programs to measure the satisfaction of said target audience and their loyalty. Our purpose was to send the survey and consolidate the NPS for the first time in a high complexity prepaid hospital in Buenos Aires (PS-HIBA) in search of an objective indicator from the customer's perspective. Methods: an analytical, cross-sectional observational study was carried out. Data obtained from members' responses to the PS-HIBA were included in the study. Results: the first NPS indicator of PS-HIBA was consolidated: 22 points. The three customer profiles were displayed, obtaining 45.7% promoters, 22.3% detractors and 32% passive or neutral. Complementarily, the reasons for these qualifications were identified, being the three main ones: the problem of accessibility to medical appointments, the medical attention and the professionals valued positively. Conclusion: this study provides an objective indicator which facilitates a common language in the organization and a comparison with the market from the customer's point of view.The NPS as a system seeks to promote the construction of a customer-focused culture, in order to improve their loyalty and allow feedback. Thus, it is possible to keep the customer's voice in mind, identify, prioritize and address the perceived problems. It allows us to establish the guidelines for opportunities to improve from the patients' perspective. (AU)

Humans , Health Services Coverage , Patient Satisfaction , Quality Indicators, Health Care , Health Facilities, Proprietary , Argentina , Cross-Sectional Studies , Surveys and Questionnaires , Benchmarking , Patient Reported Outcome Measures
Ethiop. j. health sci ; 33(1): 3-14, 2023. figures, tables
Article in English | AIM | ID: biblio-1426100


BACKGROUND: The Health Extension Program (HEP) was introduced in 2003 to extend primary health care services by institutionalizing the former volunteer-based village health services.However, this program is not comprehensively evaluated.MATERIALS AND METHODS: The 2019 comprehensive national assessment of HEP involved (1) assessment through quantitative and qualitative primary data, (2) a thorough systematic review of the HEP literature, and (3) a synthesis of evidence from the two sources. The assessment included household survey(n=7122), a survey of health extension workers (HEWs) (n=584)_, and an assessment of health posts (HPs)(n=343) and their supervising health centers (HCs)(n=179)from 62 randomly selected woredas. As part of the comprehensive assessment.OUTPUT AND RESULTS: The outputs were (a) full and abridged reports, (b) 40 posters, (c) seven published, three under review scientific papers and (d) seven papers in this special issue. During the one-year period preceding the study, 54.8% of women, 32.1% of men, and 21.9% of female youths had at least a one-time interaction with HEWs. HPs and HEWs were universally available. There were critical gaps in the skills and motivation of HEWs and fulfillment of HP standards: 57.3% of HEWs were certified, average satisfaction score of HEWs was 48.6%, and 5.4% of HPs fulfilled equipment standards. CONCLUSIONS: The findings informed policy and program decisions of the Ministry of Health, including the design of the HEP Optimization Roadmap 2020­2035 and the development Health Sector Transformation Plan II. It is also shared with global community through published papers

Health Services Coverage , Community Health Workers , Primary Health Care , Clinical Protocols
Ethiop. j. health sci ; 33(1): 49-62, 2023. tables
Article in English | AIM | ID: biblio-1426226


BACKGROUND: Training and work experience are critical inputs for delivering quality health services. However, no nationwide assessment has been conducted on the status of training and the competency of Health Extension Workers (HEWs). Therefore, this study aimed to assess HEWs' pre service training status and perceived competency in Ethiopia. METHODS: The study was conducted in all regions and all HEWs training institutions in Ethiopia. We used cross sectional study design with a mixed method approach that included 585 HEWs, 1,245 HEW trainees, 192 instructors, and 43 key informants. Descriptive statistics and thematic analysis were used to analyse quantitative and quantitative data respectively. RESULT: Twenty-six percent of the HEWs said that they were competent to deliver all the HEP activities, and 73% of the HEWs said that they could confidently deliver 75% of the HEP activities. Receiving in-service training and having level III/IV qualifications are positively associated with the competency of HEWs. Similarly, HEP trainees perceived themselves as highly competent in executing their professional work, except in using computer and mobile health technology. Both instructors and trainees rated the quality of the curriculum and course materials positively. However, basic services and facilities in most training institutions were perceived to be inadequate. Additionally, individual learning, problem-solving, case-analysis, and assessment methods such as project work and portfolios were rarely practiced. CONCLUSIONS: Although the perceived competence of HEW trainees is high, the HEWs' training is not provided as per the curriculum because of limited resources. All the necessary resources should be made available to produce competent HEWs

Humans , Primary Health Care , Community Health Workers , Health Services Coverage , Developing Countries
Ethiop. j. health sci ; 33(1): 63-74, 2023. tables, figures
Article in English | AIM | ID: biblio-1426232


BACKGROUND: Depression and burnout are common among healthcare workers (HCWs) and negatively affect their well being and the quality of the service they provide. However, the burden of depression and burnout among health extension workers (HEWs) in Ethiopia and their relationship has not been documented well. The objective of this study was to estimate the prevalence of depression and burnout among HEWs in Ethiopia and to investigate the relationship between these conditions. MATERIALS AND METHODS: We used a cross-sectional study design and collected data from 584 rural and 581 urban HEWs in Ethiopia, as part of the 2019 national health extension program assessment. The Patient Health Questionnaire (PHQ-9) and Burnout Self-Test were used to screen HEWs for depression and burnout, respectively. We used descriptive statistics to estimate the magnitude of depression and burnout, and logistic regression to examine their relationship. RESULT: Based on PHQ-9 cutoff scores of 10, the prevalence of major depression was 16.5% among rural and 8.9% among urban HEWs, whereas burnout risk was 39.8% among rural and 12.6% among urban HEWs. The odds of having depression among HEWs with burnout risk was relatively higher compared to those without burnout risk [For rural HEWs, the adjusted odds ratio (AOR) is 11.88 at a 95% confidence interval (CI; 5.27, 26.80), and for urban HEWs, the AOR is 11.49 at a 95% CI (5.35, 24.63)]. CONCLUSION: The prevalence of depression and burnout is high among HEWs in Ethiopia, with a significant rural­urban difference, and burnout is a significant predictor of depression. Mental health interventions that enable prevention, early detection, and management are needed especially for rural HEWs who are in charge of preventive health service delivery for the disadvantaged rural communities

Health Services Coverage , Adjustment Disorders , Prevalence , Poverty , Burnout, Psychological
Ethiop. j. health sci ; 33(1): 75-84, 2023. figures, tables
Article in English | AIM | ID: biblio-1426238


BACKGROUND: Ethiopia has been implementing a health extension program (HEP) to respond to the high maternal and child mortality in rural communities. HEP has brought tremendous contributions to improved access and coverage of primary healthcare in the last 15 years. Despite its attributions, attention to HEP has declined in recent years due to several reasons. This study is designed to explore HEP's relevance to the current healthcare needs of the rural communities. METHODS: This study is a nested cross-sectional mixed method to the overall HEP's evaluation between March and May 2019. Descriptive statistics were used on qualitative and quantitative assessment. A literature review supplemented the assessment. A representative quantitative sample of 11,746 women, men, and young girls; a qualitative sample of 268 key informants from Kebele administrators, HEWs, program people in the health system and focus groups from community leaders, men and women from 185 Kebeles in 62 woredas were selected. A thematic approach was used for qualitative analysis. RESULTS: Rural communities and program managers asserted that HEP's service packages with the existing service delivery modalities were relevant. Eighty-two percent of men and women and 77% of young girls confirmed this relevance. Besides the existing packages, additional curative services for adults and children were recommended with emphasis on the pastoralist community. HEP's service uptake has declined as over 86% of targeted rural communities bypassed HPs due to unavailability of services and capacity problems of HEWs. CONCLUSION: The current HEP packages with the existing service delivery modalities are still relevant to the rural communities' health needs. However, on-going changes to address the evolving demands of the targeted rural communities are crucial

Humans , Clinical Relevance , Health Services Needs and Demand , Primary Health Care , Health Services Coverage
Femina ; 50(12): 762-768, dez. 31, 2022. tab
Article in Portuguese | LILACS | ID: biblio-1414431


Objetivo: Avaliar o acesso e a adesão da população feminina, atendida pelo Sistema Único de Saúde (SUS), à Diretriz Brasileira de Detecção Precoce do Câncer de Mama, em duas cidades de médio porte de uma região metropolitana do estado de São Paulo, Brasil. Métodos: Estudo transversal. Os dados foram coletados no Sistema de Informação do Câncer (Siscan) e nas Secretarias Municipais de Saúde no período de 01/01 a 31/12 de 2017. Resultados: Em Santa Bárbara d'Oeste, foram realizadas 3.106 mamografias: 2.931 (94,4%) BI-RADS® 1-2; 21 (0,7%) BI-RADS® 3; 12 (0,4%) BI-RADS® 4-5; 142 (4,5%) BI-RADS® 0. A maioria dos exames (1.855 ­ 59,7%) foi realizada em mulheres de 50 a 69 anos. A cobertura mamográfica na população de risco foi de 11,2%. O envelhecimento foi relacionado ao BI-RADS® 4-5 (p = 0,005). A idade jovem esteve relacionada ao maior número de BI-RADS® 0 (p = 0,03). Em Vinhedo, foram realizadas 1.996 mamografias: 1.835 (91,9%) BI-RADS® 1-2; 9 (0,45%) BI-RADS® 3; 7 (0,35%) BI-RADS® 4-5; 145 (7,3%) BI-RADS® 0. A maioria dos exames (975 ­ 48,8%) foi realizada em mulheres de 50-69 anos. A população coberta pela mamografia foi de 17%. Reunindo ambas as análises populacionais, evidenciou-se que o envelhecimento esteve relacionado ao maior número de casos suspeitos (p = 0,007). Conclusão: A maioria das mamografias foi realizada em mulheres de 50-69 anos. A cobertura mamográfica ficou aquém da encontrada no Brasil e recomendada pela Organização Mundial da Saúde.

Objective: To evaluate the access and adherence of the female population, assisted by Health Unic System (SUS), to Brazilian Breast Cancer Early Detection Guideline in two medium-sized cities of a metropolitan region in the State of São Paulo, Brazil. Methods: Cross-sectional study. Data were collected from the Cancer Information System (Siscan) and from the Municipal Health Secretariats between 01/01 to 12/31, 2017. Results: In Santa Bárbara d'Oeste 3,106 mammograms were performed: 2,931 (94.4%) BI-RADS® 1-2; 21 (0.7%) BI-RADS® 3; 12 (0.4%) BI-RADS® 4-5; 142 (4.5%) BI-RADS® 0. Most of the exams (1,855 ­ 59.7%) among women aged 50-69 years. The mammographic coverage at risk population was 11.2%. Aging was related to BI-RADS® 4-5 (p = 0.005). The young age was related to the highest number of BI-RADS® 0 (p = 0.03). In Vinhedo 1,996 mammograms were performed: 1,835 (91.9%) BI-RADS® 1-2; 9 (0.45%) BI-RADS® 3; 7 (0.35%) BI-RADS® 4-5; 145 (7.3%) BI-RADS® 0. Most of the exams (975 ­ 48.8%) among women aged 50-69 years. The population covered by mammography was 17%. Gathering both population analysis, it was shown that aging was related to the highest number of suspected cases (p = 0.007). Conclusion: Most mammograms were performed between 50-69 years. Mammographic coverage fell short of that found in Brazil and recommended by the World Health Organization.

Humans , Female , Breast Neoplasms/mortality , Breast Neoplasms/epidemiology , Breast Neoplasms/diagnostic imaging , Mammography/statistics & numerical data , Unified Health System , Health Services Coverage , Brazil/epidemiology , Cross-Sectional Studies
Rev. direito sanit ; 22(1): e0005, 20220825.
Article in Portuguese | LILACS | ID: biblio-1419268


Este artigo sistematizou a legislação e as alterações da regulamentação das coberturas dos planos de saúde entre 1998 e 2020 e analisou 2.845 acórdãos do Tribunal de Justiça do Estado de São Paulo no ano de 2018, relacionados a negativas de coberturas reclamadas por consumidores de planos de saúde. As coberturas hospitalares, dentre as quais destacam-se as cirurgias e internações, foram o principal objeto das demandas, compondo 41% do total estudado. A maioria das coberturas hospitalares excluídas ou negadas não constavam no rol de procedimentos e eventos em saúde da Agência Nacional de Saúde Suplementar. A regulamentação dessa agência, com destaque para o rol de procedimentos e eventos em saúde, relaciona-se com a exclusão de coberturas hospitalares por planos de saúde, sendo utilizada como argumento para a defesa judicial da negativa de cobertura pelas operadoras de planos de saúde, em conjunto com as previsões contratuais. O Tribunal de Justiça do Estado de São Paulo, na maioria das vezes (80% dos casos estudados), garantiu a cobertura hospitalar demandada, fundamentando as decisões prioritariamente no Código de Defesa do Consumidor, na Jurisprudência do Tribunal de Justiça do Estado de São Paulo, nas súmulas do tribunal e na Lei n. 9.656/1998 (Lei dos Planos de Saúde). Conclui-se que o Poder Judiciário, quando provocado, tende a reconhecer o direito dos consumidores ao acesso às coberturas assistenciais, muitas vezes em contraposição à regulação setorial pela Agência Nacional de Saúde Suplementar.

This article revisited the legislation and changes in the sectorial regulation of healthcare coverage from 1998 to 2020, and analyzed 2,845 decisions issued by the São Paulo State Court of Justice in 2018 related to coverage denial against health insurance beneficiaries. Inpatient coverage, among which surgeries and hospitalizations stand out, was the main object of the claims, accounting for 41% of the analyzed decisions. Most of the denied inpatient coverage was not included on the list of health procedures and events of the Brazilian Regulatory Agency for Private Health Insurance and Plans. This agency's regulation, especially the List of Health Procedures and Events, is related to the exclusion of hospital coverage by private health insurance, and is used as an argument for the legal defense for coverage denial together with contractual provisions. The São Paulo State Court of Justice, in most cases (80%), guaranteed the inpatient coverage claims, basing such decisions on the Consumer Protection Code, on Jurisprudence, on the Court's precedents and on Law no. 9.656/1998 (Health Insurance Law). In conclusion, when upon, the Judiciary tends to recognize the right of consumers to access health care coverage, often in opposition to sectorial regulation by the Brazilian Regulatory Agency for Private Health Insurance and Plans.

Health Services Coverage
Rev. APS ; 25(Supl 1): 172-189, 2022-05-06.
Article in Portuguese | LILACS | ID: biblio-1371068


A Atenção Básicaé a principal porta de entrada do Sistema Único de Saúde. O acesso efetivo a esse serviço pode ser avaliado pela utilização de atendimentos, e não apenas pela disponibilidade. O conhecimento do perfil populacional permite identificar grupos vulneráveis ànão utilização, assim como conhecer as morbidades mais prevalentes para promover melhor organização da oferta e utilização do serviço. Este trabalho trata-se de um estudo transversal, cujas fontes de dados foram registros das fichas do e-SUS de 8.390 indivíduos, cadastrados numa Unidade de Saúde da Família (USF). Foi analisada a prevalência de utilização de atendimentos na USF, nos quais se incluíram consultas médicas e de enfermagem. Foram comparados os perfis sociodemográfico e de morbidade referida dos utilizadores e não utilizadores da USF em 2019. O percentual de utilização de consultas foi de 50,1% dos cadastrados, sendo a média de 2,3 consultas por habitante ao ano. A maioria dos utilizadores fez até cinco consultas ao ano, porém aproximadamente um terço das consultas se referiram aos hiperutilizadores. Ser do sexo feminino, ser pardo ou negro, ter baixa escolaridade, idade mais avançada e não possuir plano de saúde privado foram condições associadas à maior utilização de consulta.

Primary care is the main entry point into the Brazilian public health system. Effective access to this service can be assessed not only by the quality of the healthcare assistance but also by its availability. Knowledge of the population's profile makes it possible to identify groups that are vulnerable to non-use of the service as well as to the most prevalent morbidities, so theservice can be better offered and organized. This is a cross-sectional study whose data source was records of 8,390 e-SUS files registered in a Family Health Unit (USF, in Portuguese). The prevalence of use of services at the USF was analyzed, which included medical and nursing consultations. The sociodemographic and reported morbidity profiles of users and non-users of the USF in 2019 were compared. The percentage of consultations was 50.1% of registered ones, with an average of 2.3 consultations per inhabitant per year. Most users have up to five consultations per year, but approximately a third of those consultations are referred to as hyper-users. Being female, being mixed-race or black, having low-level education, being older, and not having a private health plan were associated with greater use of consultations.

Primary Health Care , Health Services Coverage , Health Centers , Public Health , Delivery of Health Care , Effective Access to Health Services
Hist. ciênc. saúde-Manguinhos ; 28(2): 437-454, abr.-jun. 2021.
Article in Spanish | LILACS | ID: biblio-1279141


Resumen El artículo se acerca a las iniciativas de salud impulsadas por la colonia española en la capital mexicana durante el Porfiriato. Primero, se explica la importancia que adquirió la Sociedad de Beneficencia Española (SBE) durante este periodo. Se ubica la SBE en el contexto de expansión y profesionalización de los servicios médicos por el Estado, y la red de relaciones sociales, políticas y económicas entre los individuos prominentes de la colonia y el gobierno de Porfirio Díaz. Posteriormente, se indaga en las insatisfacciones que generó la SBE, que dio lugar a la fundación de un efímero proyecto de características mutuales, protagonizado por dependientes de comercio españoles: la Quinta de Salud.

Financial Support , Health Services Coverage , Healthcare Financing , Health Facilities/history , Spain , Mexico
Rev. baiana enferm ; 35: e38463, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1279764


Objetivo avaliar a cobertura do exame citopatológico do colo do útero. Método estudo exploratório-descritivo com abordagem quantitativa, tendo como unidade de análise o Distrito Sanitário de Brotas da cidade de Salvador, Bahia. Foram estimadas as coberturas real e potencial do exame citopatológico do colo do útero realizado na Atenção Primária à Saúde, no ano de 2018. Para a estimativa das coberturas, o padrão foi estabelecido com base na recomendação do Ministério da Saúde. Os dados foram obtidos da Planilha de Monitoramento de Exame Citopatológico do Colo do Útero distrital disponibilizada pela Secretaria Municipal de Saúde. Resultados foram encontradas baixas coberturas no período analisado, com cobertura real de 11,76% e cobertura potencial de 46,11%. Conclusão a baixa cobertura do exame citopatológico do colo do útero pode estar relacionada com o pequeno crescimento da oferta do serviço devido à expansão insuficiente da Atenção Primária no município de Salvador.

Objetivo evaluar la cobertura del examen citopatológico del cuello uterino. Método estudio exploratorio-descriptivo con enfoque cuantitativo, teniendo como unidad de análisis el Distrito Sanitario de Brotas de la ciudad de Salvador, Bahía. Se estimó la cobertura real y potencial del examen citopatológico del cuello uterino realizado en Atención Primaria de Salud en 2018. Para la estimación de la cobertura, la norma se estableció sobre la base de la recomendación del Ministerio de Salud. Los datos fueron obtenidos de la Hoja de Seguimiento del Examen Citopatológico del Cuello Uterino del distrito proporcionada por la Secretaría de Salud Municipal. Resultados se encontró baja cobertura en el período analizado, con una cobertura real del 11,76% y una cobertura potencial del 46,11%. Conclusión la baja cobertura del examen citopatológico del cuello uterino puede estar relacionada con el pequeño crecimiento de la oferta de servicio debido a la insuficiente expansión de la Atención Primaria en la ciudad de Salvador.

Objective to evaluate the coverage of the cervical cytopathological test. Method exploratory-descriptive study with quantitative approach, whose unit of analysis was the Health District of Brotas of the city of Salvador, Bahia. The study estimated the actual and potential coverage of the cervical cytopathological test performed in Primary Health Care in 2018. To estimate the coverage, the standard was established based on the recommendation of the Ministry of Health. The data were obtained from the Monitoring Worksheet of Cervical Cytopathological Test of the district provided by the Municipal Health Department. Results there was low coverage in the analyzed period, with real coverage of 11.76% and potential coverage of 46.11%. Conclusion the low coverage of the cervical cytopathological test may be related to the small growth of the service offer due to the insufficient expansion of Primary Care in the city of Salvador.

Humans , Female , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Primary Health Care , Health Services Coverage , Women's Health , Papanicolaou Test/statistics & numerical data
Rev. panam. salud pública ; 45: e42, 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1252011


RESUMEN Objetivo. Relacionar la distribución etaria estandarizada de las defunciones por COVID-19 en 22 países americanos y europeos, con diferentes indicadores de las características de las poblaciones y de los sistemas de salud. Métodos. Las distribuciones de las defunciones por COVID-19 por grupo etario en 22 países americanos y europeos fueron estandarizadas sobre la pirámide de edades de la población mundial. Se calcularon las correlaciones entre la proporción estandarizada de personas de menos de 60 años dentro de las personas fallecidas y cada uno de los seis indicadores. Resultados. Se evidenció la existencia de diferencias importantes de distribución por grupo etario entre los países después de haber estandarizado sobre la pirámide de edades a nivel mundial, siendo la proporción de personas de menos de 60 años superior en América Latina y Estado Unidos que en Canadá o Europa occidental. La proporción estandarizada de personas de menos de 60 años dentro de las personas fallecidas por COVID-19 está fuertemente correlacionada con la universalidad de una cobertura médica de calidad (r=-0,92, p<0,01). Esta relación se mantuvo significativa después de haber ajustado sobre los otros indicadores analizados. Conclusión. Se propone que las debilidades de la cobertura médica de la población podrían haber creado una mayor letalidad en las poblaciones de menos de 60 años en América Latina y en los Estados Unidos.

ABSTRACT Objective. Relate standardized age distribution of COVID-19 deaths in 22 countries in the Americas and Europe to different indicators of population characteristics and health systems. Methods. Distributions of COVID-19 deaths by age group in 22 countries of the Americas and Europe were standardized based on the age pyramid of the world's population. Correlations were calculated between the standardized proportion of people aged <60 years among the deceased and each of six indicators. Results. Standardization based on the world age pyramid revealed considerable differences in age distribution among countries; the proportion of people aged <60 years was higher in Latin America and the United States than in Canada or Western Europe. The standardized proportion of people aged <60 years among persons who died of COVID-19 is strongly correlated to the existence of universal quality medical coverage (r=-0.92, p<0.01). This relationship remained significant after being adjusted for the other indicators. Conclusion. We propose that weaknesses in medical coverage of the population may have created higher case-fatality in populations aged <60 years in Latin America and the United States.

RESUMO Objetivo. Correlacionar a distribuição etária padronizada de mortes por COVID-19 em 22 países das Américas e da Europa com diversos indicadores das características das populações e dos sistemas de saúde. Métodos. As distribuições das mortes por COVID-19 por faixa etária em 22 países das Américas e da Europa foram padronizadas pela pirâmide etária da população mundial. Foram calculadas correlações entre a proporção padronizada de pessoas com menos de 60 anos entre as pessoas que morreram e cada um dos seis indicadores. Resultados. Foram evidenciadas diferenças importantes de distribuição etária entre os países estudados após a padronização pela pirâmide etária da população mundial, sendo maior a proporção de mortes de pessoas com menos de 60 anos na América Latina e nos Estados Unidos que no Canadá ou na Europa ocidental. A proporção padronizada de pessoas com menos de 60 anos entre as pessoas que morreram por COVID-19 está fortemente correlacionada com a universalidade de cobertura médica de qualidade (r=-0,92, p<0,01). Esta correlação se manteve significativa após o ajuste para outros indicadores analisados. Conclusão. O nosso estudo sugere que falhas na cobertura médica da população podem ter provocado maior letalidade nas pessoas com menos de 60 anos na América Latina e nos Estados Unidos.

Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , COVID-19/mortality , Health Services Coverage , Americas/epidemiology , Age Distribution , Europe/epidemiology
Rev. chil. salud pública ; 25(2): 163-173, 2021.
Article in Spanish | LILACS | ID: biblio-1369930


INTRODUCCIÓN. Las personas mayores en Chile tienen alta carga de morbilidad oral y de déficit funcional que afecta directamente su calidad de vida. El programa universal GES Salud Oral Integral del adulto de 60 años, implementado desde el 2007, permite a las personas de 60 años acceder a tratamiento odontológico integral, aunque a la fecha se tiene pocos antecedentes de sus resultados. El objetivo de este estudio es estimar la cobertura del programa GES 60 para el año 2019 de los beneficiarios FONASA y su variabilidad territorial desagregada por Servicio de Salud (SS), sexo y tipo de prestador (público o compra de servicios). MATERIALES Y MÉTODOS. Se realizó un estudio observacional ecológico, utilizando fuentes de datos secundarios de uso público (DEIS, FONASA). Se estimó la cobertura nacional total y por sexo, estratificada para cada SS. RESULTADOS. La cobertura del programa en el sector público de salud fue de un 22,8% el año 2019. La menor cobertura se observó en el SS Arica (5,3%) y la mayor en el SS Arauco (37,9%). La cobertura nacional fue significativamente mayor (valor p=0,001) en mujeres (27,1%) que en hombres (17,9%). La compra de servicios a proveedores externos totalizó el 12,2% de las altas dentales, siendo esta proporción heterogénea entre SS con relación inversa entre Compra de servicios y Cobertura. DISCUSIÓN. La cobertura para el año evaluado fue baja, siendo insuficiente para poder resolver la alta carga de morbilidad de las personas mayores chilenas. Existe una amplia variabilidad territorial de la cobertura, presentando diferencias por sexo y en la compra de servicios.

INTRODUCTION. Elderly people in Chile have a high burden of oral morbidity and functional deficits that directly affect their quality of life. The universal GES program: "Comprehensive Oral Health for the 60-year-old adult", implemented since 2007, allows 60-year-olds to access comprehensive dental treatment, however there is limited evidence of its results to date.The aim of this study is to estimate the coverage of the program for the year 2019 of the public health insurance FONASA beneficiaries and their territorial variability disaggregated by Health Service (HS), sex and type of provider (public or purchase of services). MATERIALS AND METHODS. An observational ecological study was carried out, using secondary data from public sources (DEIS, FONASA). Total national coverage and by sex was estimated, stratified for each SS. Results. The coverage of the program in the public health sector was 22.8% in 2019. The lowest coverage was observed in Arica HS (5.3%) and the highest in Arauco HS (37.9%). National coverage was significantly higher (p-value = 0.001) in women (27.1%) than in men (17.9%). Purchase of services from external providers totaled 12.2% of the dental discharges, this pro-portion being heterogeneous between SS with an inverse relationship between "Purchase of services" and "Coverage". DISCUSSION. The coverage for the evaluated year was low, being insufficient to be able to solve the high burden of morbidity of Chilean elderly. There is a wide territorial variability of coverage, presenting differences by sex and in the purchase of services.

Humans , Male , Female , Middle Aged , Aged , Health Services Coverage , Oral Health , Dental Care for Aged/statistics & numerical data , Comprehensive Dental Care/statistics & numerical data , Chile , Public Sector , Sex Distribution , Ecological Studies , Universal Health Coverage , Health Policy , Health Services for the Aged/statistics & numerical data
Rev. Ciênc. Méd. Biol. (Impr.) ; 19(4): 565-571, dez 30, 2020. tab, ilus
Article in Portuguese | LILACS | ID: biblio-1355125


Introdução: a triagem auditiva neonatal (TAN) está disposta na Lei nº 12.303/2010, a qual, obriga a realização do teste da orelhinha em todos os hospitais e maternidades do Brasil. Porém, vários estados brasileiros ainda não atingiram o nível de cobertura satisfatória desse programa conforme preconizado. Objetivo: analisar a cobertura da triagem auditiva neonatal no período entre 2011 a 2018 nas macrorregiões do Estado da Bahia. Metodologia: estudo ecológico, quase-experimental, realizado por meio do tabulador genérico de domínio público desenvolvido pelo DATASUS. Resultados: a produção ambulatorial dos procedimentos da TAN no Estado da Bahia obteve crescimento considerável ao longo do período do estudo, porém os achados apontaram que as taxas de crescimentos anuais apresentaram um comportamento irregular no seu crescimento. Observou-se que a média das taxas de cobertura na Bahia é inferior à média nacional e muito discrepante quando comparada a média universal. Conclusão: os achados demonstraram que o Estado da Bahia segue com taxas de cobertura da TAN inferior ao preconizado pelo COMUSA (Comitê Multiprofissional de Saúde Auditiva), apresentando distribuição irregular na realização dos procedimentos, ausência de recursos tecnológicos em algumas macrorregiões, o que compromete o princípio da universalidade da TAN no Estado.

Introduction: the newborn hearing screening (NHS) is set out in Law Nº 12.303/2010, which requires the ear test to be performed in all hospitals and maternity hospitals in Brazil. However, several Brazilian states have not yet reached the level of satisfactory coverage of this program as recommended. Objective: to analyze the coverage of newborn hearing screening, between 2011 and 2018, in the macro-regions of the State of Bahia. Methodology: ecological, quasi-experimental study, carried out using the generic public domain tab developed by DATASUS. Results: the NHS procedures in the State of Bahia achieved considerable growth over the period of the study, however the findings pointed out that the annual growth rates showed an unstable behavior in their growth. It was observed that the average coverage rates in Bahia are lower than the national average and very different when compared to the universal average. Conclusion: the findings showed that the State of Bahia continues to have NHS coverage rates lower than recommended by COMUSA (Multiprofessional Hearing Health Committee), unstable distribution in the performance of procedures, there are no technological resources in some macro-regions, which compromises the principle of universality of NHS in the state.

Health Services Coverage , Infant, Newborn , Neonatal Screening , Health Care Quality, Access, and Evaluation , Otoacoustic Emissions, Spontaneous , Evoked Potentials, Auditory , Intervention Studies , Database , Ecological Studies
Medisur ; 18(4): 733-736, jul.-ago. 2020.
Article in Spanish | LILACS | ID: biblio-1125257


RESUMEN Se hace un breve resumen sobre la evolución de la cobertura salubrista en la zona montañosa de la provincia de Cienfuegos. Se tiene en cuenta la denuncia realizada por el Comandante en Jefe en el juicio por los hechos del cuartel Moncada y su alegato ¨La Historia me Absolverᨠdonde se aborda la situación precaria de la salud en nuestros campos y las soluciones dadas a partir del establecimiento del Programa del Servicio Médico Rural, la integración Docente Asistencial a través de los Asistenciales, del Contingente Piti Fajardo (6to año) y la creación por el propio Fidel del Programa de la Medicina Familiar y la especialidad de Medicina General Integral, con lo cual se logra la cobertura en salud. Se señala como colofón la graduación de los primeros especialistas en Medicina General Integral y Estomatología General Integral formados íntegramente en los Consultorios del macizo montañoso de nuestro Plan Turquino cienfueguero.

ABSTRACT A brief summary is made on the evolution of health coverage in the mountainous area of the province of Cienfuegos. It takes into account the complaint made by the Commander-in-Chief in the trial for the events of the Moncada barracks and his plea "History will absolve me" where the precarious situation of health in our fields is addressed and the solutions given from the establishment of the Rural Medical Service Program, the integration of Healthcare Teaching through Healthcare, the Piti Fajardo Contingent (6th year) and the creation by Fidel himself of the Family Medicine Program and the specialty of Comprehensive General Medicine, with which achieves health coverage. The graduation of the first specialists in Comprehensive General Medicine and Comprehensive General Stomatology trained entirely in the Clinics of the mountainous massif of our Cienfuegos Turquino Plan is noted as a colophon.

Humans , Health Services Coverage/trends , Cuba , Family Practice , History
Acta bioeth ; 26(1): 73-80, mayo 2020.
Article in Spanish | LILACS | ID: biblio-1114600


Las experiencias tempranas de vida impactan de manera significativa en la arquitectura del cerebro del infante, pudiendo fortalecerla o debilitarla permanentemente. La sintomatología psicológica presente en la infancia no es transitoria, por lo que la intervención temprana supone beneficios directos, tanto sociales como económicos. El presente trabajo propone fundamentar, con base en los hallazgos de la literatura más reciente, la incorporación en Chile de nuevas Garantías Explícitas en Salud, destinadas específicamente a tratar patologías mentales de la infancia. Se argumenta que se trata de una política pública altamente eficiente, capaz de aportar significativamente en la disminución tanto de los costes asociados a Salud Mental como de las brechas de equidad en salud.

Early life experiences can make an important impact in the architecture of the infant's brain, which can strengthen or weaken it permanently. The childhood psychological symptomatology is not fleeting, so early intervention involves direct social and economic benefits. This paper offers, based on the most recent findings, the addition of new Health Care Guarantees specifically aimed to treating mental pathologies in childhood. This public policy has been shown to be highly efficient and capable to make a real contribution to the reduction of both, the costs associated with Mental Health and the equity gaps in child health care.

As experiências iniciais da vida afetam significativamente a arquitetura do cérebro da criança, que pode fortalecê-lo ou enfraquecê-lo permanentemente. A sintomatologia psicológica presente na infância não é transitória, portanto a intervenção precoce envolve benefícios sociais e econômicos diretos. O presente trabalho propõe basear, com base nos achados da literatura mais recente, a incorporação no Chile de novas Garantias Explícitas de Saúde especificamente voltadas ao tratamento de patologias mentais da infância. Argumenta-se que se trata de uma política pública altamente eficiente, capaz de contribuir significativamente para a redução tanto dos custos associados à Saúde Mental quanto das disparidades de equidade em saúde.

Humans , Child , Health Services Coverage , Mental Health Services/economics , Mental Health Services/supply & distribution , Anxiety , Attention Deficit Disorder with Hyperactivity , Stress Disorders, Post-Traumatic , Chile , Child Health , Delivery of Health Care , Depression
Rev. enferm. UFSM ; 10: 14, 2020.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1118032


Objetivo: discutir e refletir sobre as Redes de Atenção à Saúde, seus conceitos teóricos e marcos legais nas políticas de saúde. Método: estudo teórico reflexivo, baseado na literatura científica sobre conceitos teóricos e marcos legais das Redes de Atenção à Saúde. Resultados: a integração dos serviços de saúde é uma resposta à fragmentação do cuidado e possui multiplicidade de conceitos, princípios e dimensões. As Redes de Atenção à Saúde revelam-se como uma estratégia para integração dos serviços e são uma alternativa na qualificação do cuidado. Experiências nacionais e internacionais indicam que o cuidado em rede, garante maior eficácia das ações de saúde com cuidados múltiplos pautados em uma integração sistêmica. Conclusões: a conformação de Redes de Atenção à Saúde colabora para superação do modelo verticalizado. A estruturação é pautada com base no perfil epidemiológico e colabora para melhoria da atenção prestada, com superação de lacunas assistenciais e redução de custos.

Objective: to discuss and reflect on Health Care Networks, their theoretical concepts and legal frameworks in health policies. Method: a reflective theoretical study, based on the scientific literature on theoretical concepts and legal frameworks of Health Care Networks. Results: the integration of health services is a response to the fragmentation of care, and has a multiplicity of concepts, principles and dimensions. Health Care Networks are revealed as a strategy for the integration of services and are an alternative in the qualification of care. National and international experiences indicate that networked care ensures greater effectiveness of health actions with multiple care based on a systemic integration. Conclusions: the conformation of Health Care Networks contributes to overcoming the vertical model. The structuring is based on the epidemiological profile and contributes to improving the care provided, overcoming care gaps and reducing costs.

Objetivo: discutir y reflexionar sobre las Redes de Atención de Salud, sus conceptos teóricos y los marcos legales en las políticas de salud. Método: estudio teórico reflexivo, basado en literatura científica sobre conceptos teóricos y marcos legales. Resultados: la integración de los servicios de salud es una respuesta a la fragmentación de la atención y tiene una multiplicidad de conceptos, principios y dimensiones. Las Redes de Atención de Salud son una estrategia para integrar servicios y son una alternativa en la calificación de la atención. Las experiencias nacionales e internacionales indican que la atención en red garantiza una mayor efectividad de las acciones de salud con atención múltiple basada en una integración sistémica. Conclusiones: la conformación de Redes de Atención de Salud contribuye a superar el modelo vertical. La estructura se basa en el perfil epidemiológico y contribuye a mejorar la atención brindada, superar las brechas de atención y reducir los costos.

Humans , Primary Health Care , Health Services Coverage , Systems Integration , Delivery of Health Care, Integrated , Health Services
Epidemiol. serv. saúde ; 29(2): e2019377, 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1101129


Objetivo: analisar a tendência temporal da cobertura do Sistema de Vigilância Alimentar e Nutricional Web (Sisvan Web) em menores de 5 anos de idade da região Norte brasileira, no período de 2008 a 2017. Métodos: estudo ecológico de séries temporais, com dados do Sisvan Web; a variação percentual anual (VPA) da cobertura do sistema foi estimada pelo modelo de regressão de Prais-Winsten. Resultados: na região Norte, as coberturas do SISVAN Web em 2008 e 2017 foram de 12,2% e 37,9%, respectivamente, com tendência crescente (VPA=14,2% - IC95% 10,9;17,6); os estados da região e respectivas regionais de saúde apresentaram tendências semelhantes; o Acre foi o estado que apresentou maior VPA (17,3% - IC95% 13,6;21,1). Conclusão: houve tendência crescente da cobertura do Sisvan Web na região Norte do país, assim como em todos os seus estados e regionais de saúde.

Objetivo: analizar la tendencia temporal de la cobertura del Sistema de Vigilancia Alimentaria y Nutricional (SISVAN Web) en niños menores de 5 años en la Región Norte de Brasil entre 2008-2017. Métodos: estudio ecológico de series temporales con datos del SISVAN Web; el porcentaje de variación anual (PVA) de cobertura se estimó mediante el modelo de regresión de Prais-Winsten. Resultados: en la Región Norte, la cobertura del SISVAN Web en 2008 y 2017 fue de 12,2% y 37,9%, respectivamente, con una tendencia creciente (PVA=14,2% - IC95% 10,9;17,6); los Estados y las Regionales de Salud presentaron resultados similares; Acre fue el Estado con el PVA más alto (17,3% - IC95% 13,6;21,1). Conclusión: hubo una tendencia creciente en la cobertura del SISVAN Web en todos los Estados y Regionales de Salud de la Región Norte entre 2008 y 2017.

Objective: to analyze the temporal trend of Web Food and Nutrition Surveillance System (SISVAN Web) coverage of children under 5 years old in the Northern Region of Brazil between 2008-2017. Methods: this was an ecological time series study with data from SISVAN Web; coverage annual percentage change (APC) was estimated using the Prais-Winsten regression model. Results: SISVAN Web coverage in the Northern Region in 2008 and 2017 was 12.2% and 37.9%, respectively, with a rising trend (APC=14.2% - 95%CI 10.9;17.6); the states and health regions showed similar trends; Acre was the state with the highest APC (17.3% - 95%CI 13.6;21.1). Conclusion: there was a rising trend in SISVAN Web coverage in the Northern Region as a whole, in all its states and in all its health regions.

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Food and Nutritional Surveillance/methods , Health Services Coverage , Body Weights and Measures/methods , Nutrition Surveys/statistics & numerical data , Brazil/epidemiology , Time Series Studies , Nutritional Status , Health Information Systems
Rev. salud pública ; 21(5): e281275, sep.-oct. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1127216


RESUMEN Objetivo Estimar la cobertura de mamografías de tamización en Colombia durante el año 2014; así como el rendimiento en horas a emplear por equipo y el número de equipos requeridos, para alcanzar la meta de cobertura del 70% de mamografía de tamización antes del año 2021. Materiales y Métodos Se realizó un estudio descriptivo para la caracterización de equipos de mamografía existentes en el país. Para ello, se requirió la información del Registro Especial de Prestadores de Salud (REPS) y la información de licencias de funcionamiento de equipos de mamografía tramitados ante los entes territoriales; la información fue procesada, validada y analizada a través de tablas de distribución de frecuencias, en el programa Microsoft Office Excel®. Resultados La estimación de cobertura de mamografía de tamización para el país, con base en el censo de mamógrafos, es de 27.6%; para alcanzar la meta de cobertura de mamografías de tamización del 70% a nivel país, un mamógrafo requiere emplear semanalmente 38.2 horas para tamización, el 56,3% de su tiempo total para mamografías de tamización y adquirir aproximadamente 69 equipos adicionales a los censados en el año 2014. Se muestran marcadas diferencias en estos datos a nivel departamental y regional. Conclusión A nivel país, la estimación de cobertura de mamografía de tamización no es óptima; y se requiere mejorar el rendimiento de los equipos de mamografía, así como adquirir equipos adicionales para algunas regiones, acompañado de estrategias programáticas eficaces en detección temprana de cáncer de mama.(AU)

ABSTRACT Objective Estimate the coverage of screening mammograms in Colombia during 2014, as well as the performance in hours of equipment by the team and the number of teams required, to reach the goal of 70% coverage of screening mammography before the year 2021. Materials and Methods A descriptive census study was carried out to characterize existing mammography equipment in the country. To this end, information was required from the Special Registry of Health Providers (REPS) and the operating licenses of mammography equipment processed before the territorial entities; the information was processed, validated and analyzed through frequency distribution tables in the Microsoft Office Excel® program. Results The estimation of screening mammography coverage for the country based on the census of mammographers is 27.6%; To reach the screening goal of screening mammography of 70% at the country level, a mammograph requires weekly 38.2 hours for screening, use 56.3% of total time for screening mammograms and acquire approximately 69 additional equipment to those screened in 2014. There are marked differences in these data at the department and regional level. Conclusion At the country level, the estimation of screening mammography coverage is not good, it is necessary to improve the performance of mammography equipment, as well as acquire additional equipment for some regions; accompanied by effective programmatic strategies in early detection of breast cancer.(AU)

Humans , Health Services Coverage , Breast Neoplasms/prevention & control , Mammography/instrumentation , Mass Screening/methods , Epidemiology, Descriptive , Cross-Sectional Studies/instrumentation , Colombia/epidemiology