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1.
Säo Paulo med. j ; 138(6): 475-482, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1145137

ABSTRACT

ABSTRACT BACKGROUND: Cancer is a serious public issue problem worldwide. In Brazil, breast cancer is the most common type and cervical cancer is the third most frequent among women. OBJECTIVE: To analyze the temporal trend of coverage of mammography and cervical oncotic cytological testing, between 2007 and 2018. DESIGN AND SETTING: Time-series study conducted in the 26 Brazilian state capitals and in the Federal District. METHODS: A linear regression model was used to estimate trends in coverage of mammography and cervical oncotic cytological testing over the period. The data collection system for Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel) was used. RESULTS: A significant increase in mammography coverage was observed, from 71.1% in 2007 to 78.0% in 2018. There was a trend towards an increase among women with 0 to 8 years of schooling, in all regions of Brazil. Regarding cervical oncotic cytological testing coverage, there was a trend towards stability during the period analyzed, reaching 81.7% in 2018. On the other hand, there was a significant increase in the northern region. CONCLUSIONS: There was an improvement in the coverage of these screening examinations, especially regarding mammography. However, it is still necessary to expand their provision, quality and surveillance, aimed towards women's health.


Subject(s)
Humans , Female , Mammography/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Early Detection of Cancer/statistics & numerical data , Papanicolaou Test/statistics & numerical data , Socioeconomic Factors , Brazil , Breast Neoplasms/diagnosis , Uterine Cervical Neoplasms/diagnosis
2.
Rev. chil. pediatr ; 91(4): 507-511, ago. 2020. tab
Article in Spanish | LILACS | ID: biblio-1138664

ABSTRACT

INTRODUCCIÓN: En los últimos años se ha observado un aumento significativo de la tasa de hospitalización por asma en niños. En la actualidad se desconocen las tasas regionales y la tasa de mortalidad. OBJETIVO: Conocer las tasas regionales de hospitalización por asma en niños y determinar la mortalidad en este grupo etario. PACIENTES Y MÉTODO: Se calculó la tasa de hospitalización por asma en las 15 regiones del país existentes al momento de realizar el estudio, entre el año 2008 y 2014, en base al número de egresos hospitalarios por región y de las poblaciones expuestas al riesgo de hospitalización. La tasa de mor talidad se obtuvo calculando el cociente entre el número de defunciones por asma en niños de 5 a 15 años y la población expuesta. RESULTADOS: La tasa más alta de hospitalización la presentó la V región con 7,6 por 10.000 habitantes. La tasa media de hospitalización en las distintas regiones fue similar a la de la Región Metropolitana, con la excepción de 4 regiones. La tasa global de mortalidad por asma en niños de 5 a 15 años para el periodo analizado es de 0,37 por 100.000 habitantes. CONCLUSIONES: La mayoría de las regiones del país presentan tasas de hospitalización similares a la Región Metropolitana. La V Región presenta la tasa más alta de hospitalización. La tasa global de mortalidad por asma en niños de 5 a 15 años es de 0,37 por 100.000 habitantes.


INTRODUCTION: In recent years, there has been a significant increase in asthma hospitalization rates in children, however, regional and mortality rates are yet unknown. OBJECTIVE: To determine regional asth ma hospitalization rates in children and the global mortality rate in this age group. PATIENTS AND METHOD: We determined asthma hospitalization rates in the 15 regions of the country existing at the time of the study, between 2008 and 2014, based on the number of hospital discharges in each region and the population at risk of hospitalization. The mortality rate was obtained using the ratio between deaths due to asthma in children aged 5 to 15 and the exposed population. RESULTS: the 5th region presented the highest hospitalization rate (7.6 per 10,000 inhabitants). Except for 4 regions, the median hospitalization rates of the different regions were similar to those found in the Metropolitan Region. The overall mortality rate due to asthma in 5 to 15-year-old children was 0.37 per 100,000 inhabitants in the analyzed period. CONCLUSIONS: most regions of the country have similar hospitalization rates to the Metropolitan Region and the 5th region presents the highest hospitali zation rate due to asthma. The global mortality rate in children between 5 and 15 years old is 0.37 per 100,000 inhabitants.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Asthma/mortality , Health Status Disparities , Healthcare Disparities/statistics & numerical data , Hospitalization/statistics & numerical data , Asthma/therapy , Poisson Distribution , Chile/epidemiology , Registries
3.
Rev. chil. pediatr ; 91(2): 216-225, abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1098894

ABSTRACT

Resumen: Objetivo: describir las terapias utilizadas en lactantes con bronquiolitis aguda admitidos en 20 Uni dades de Cuidados Intensivos (UCI) pediátricos miembros de LARed en 5 países latinoamerica nos. Pacientes y Método: Estudio observacional retrospectivo, multicéntrico, de datos del Registro Latinoamericano de Falla Respiratoria Aguda Pediátrica. Se incluyeron niños menores de 2 años ingresados a UCI pediátrica por bronquiolitis aguda comunitaria entre mayo-septiembre 2017. Se recolectaron datos demográficos, clínicos, soporte respiratorio, terapias utilizadas y resultados clí nicos. Se realizó análisis de subgrupos según ubicación geográfica, tipo financiación y presencia de academia. Resultados: Ingresaron al registro 1155 pacientes con falla respiratoria aguda. Seis casos fueron excluidos por no tener formulario completo. De los 1147 pacientes, 908 eran menores de 2 años. De ellos, 467 tuvieron diagnóstico de bronquiolitis aguda, correspondiendo a la principal causa de ingreso a UCI pediátrica por falla respiratoria aguda (51,4%). Las características demográficas y de gravedad entre los centros fueron similares. El soporte máximo respiratorio más frecuente fue cánula nasal de alto flujo (47%), seguido por ventilación mecánica no invasiva (26%) y ventilación mecánica invasiva (17%), con un coeficiente de variación (CV) amplio entre los centros. Hubo una gran dispersión en uso de terapias, siendo frecuente el uso de broncodilatadores, antibióticos y corticoides, con CV hasta 400%. El análisis de subgrupos mostró diferencias significativas en soporte respiratorio y tratamientos utilizados. Un paciente falleció en esta cohorte. Conclusión: Detectamos gran variabilidad en el soporte respiratorio y tratamientos entre UCI pediátricas latinoamericanas. Esta variabilidad no es explicada por disparidades demográficas ni clínicas. Esta heterogeneidad de tratamientos debería promover iniciativas colaborativas para disminuir la brecha entre la evidencia científica y la práctica asistencial.


Abstract: The objective of this study was to describe the management of infants with acute bronchiolitis admit ted to 20 pediatric intensive care units (PICU) members of LARed in 5 Latin American countries. Pa tients and Method: Retrospective, multicenter, observational study of data from the Latin American Registry of Acute Pediatric Respiratory Failure. We included children under 2 years of age admitted to the PICU due to community-based acute bronchiolitis between May and September 2017. Demo graphic and clinical data, respiratory support, therapies used, and clinical results were collected. A subgroup analysis was carried out according to geographical location (Atlantic v/s Pacific), type of insurance (Public v/s Private), and Academic v/s non-Academic centers. Results: 1,155 patients were included in the registry which present acute respiratory failure and 6 were excluded due to the lack of information in their record form. Out of the 1,147 patients, 908 were under 2 years of age, and out of those, 467 (51.4%) were diagnosed with acute bronchiolitis, which was the main cause of admission to the PICU due to acute respiratory failure. The demographic and severity characteristics among the centers were similar. The most frequent maximum ventilatory support was the high-flow nasal can nula (47%), followed by non-invasive ventilation (26%) and invasive mechanical ventilation (17%), with a wide coefficient of variation (CV) between centers. There was a great dispersion in the use of treatments, where the use of bronchodilators, antibiotics, and corticosteroids, representing a CV up to 400%. There were significant differences in subgroup analysis regarding respiratory support and treatments used. One patient of this cohort passed away. Conclusion: we detected wide variability in respiratory support and treatments among Latin American PICUs. This variability was not explained by demographic or clinical differences. The heterogeneity of treatments should encourage collabora tive initiatives to reduce the gap between scientific evidence and practice.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Practice Patterns, Physicians'/statistics & numerical data , Bronchiolitis/therapy , Intensive Care Units, Pediatric/statistics & numerical data , Guideline Adherence/statistics & numerical data , Critical Care/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Bronchiolitis/diagnosis , Registries , Acute Disease , Retrospective Studies , Practice Guidelines as Topic , Critical Care/methods , Latin America
4.
Rev. bras. ter. intensiva ; 32(1): 72-80, jan.-mar. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138457

ABSTRACT

RESUMO Objetivo: Analisar a distribuição das unidades de terapia intensiva para adultos, segundo a região geográfica e o setor sanitário no Rio de Janeiro, e investigar a mortalidade por infecção respiratória aguda grave no setor público e sua associação com a capacidade de terapia intensiva no setor público. Métodos: Avaliamos a variação da disponibilidade de terapia intensiva e a mortalidade por infecção respiratória aguda grave no setor público em diferentes áreas da cidade em 2014. Utilizamos as bases de dados do Cadastro Nacional de Estabelecimentos de Saúde, do Instituto Brasileiro de Geografia e Estatística, do Sistema de Informações sobre Mortalidade e do Sistema de Informações Hospitalares do SUS. Resultados: Foi ampla a variação na disponibilidade de leitos em unidades de terapia intensiva per capita (desde 4,0 leitos de terapia intensiva por 100 mil habitantes em hospitais públicos na zona oeste até 133,6 leitos em unidades de terapia intensiva por 100 mil habitantes nos hospitais privados na zona central) na cidade do Rio de Janeiro. O setor privado respondeu pelo suprimento de quase 75% dos leitos em unidades de terapia intensiva. Uma análise espacial com base em mapas mostrou falta de leitos em unidades de terapia intensiva em vastas extensões territoriais nas regiões menos desenvolvidas da cidade. Houve correlação inversa (r = -0,829; IC95% -0,946 - -0,675) entre a quantidade de leitos públicos em unidade de terapia intensiva per capita em diferentes áreas de planejamento em saúde na cidade e a mortalidade por infecção respiratória aguda grave em hospitais públicos. Conclusão: Nossos resultados mostram disponibilidade desproporcional de leitos em unidades de terapia intensiva na cidade do Rio de Janeiro e a necessidade de uma distribuição racional da terapia intensiva.


ABSTRACT Objective: To analyze the distribution of adult intensive care units according to geographic region and health sector in Rio de Janeiro and to investigate severe acute respiratory infection mortality in the public sector and its association with critical care capacity in the public sector. Methods: We evaluated the variation in intensive care availability and severe acute respiratory infection mortality in the public sector across different areas of the city in 2014. We utilized databases from the National Registry of Health Establishments, the Brazilian Institute of Geography and Statistics, the National Mortality Information System and the Hospital Admission Information System. Results: There is a wide range of intensive care unit beds per capita (from 4.0 intensive care unit beds per 100,000 people in public hospitals in the West Zone to 133.6 intensive care unit beds per 100,000 people in private hospitals in the Center Zone) in the city of Rio de Janeiro. The private sector accounts for almost 75% of the intensive care unit bed supply. The more developed areas of the city concentrate most of the intensive care unit services. Map-based spatial analysis shows a lack of intensive care unit beds in vast territorial extensions in the less developed regions of the city. There is an inverse correlation (r = -0.829; 95%CI -0.946 to -0.675) between public intensive care unit beds per capita in different health planning areas of the city and severe acute respiratory infection mortality in public hospitals. Conclusion: Our results show a disproportionate intensive care unit bed provision across the city of Rio de Janeiro and the need for a rational distribution of intensive care.


Subject(s)
Humans , Adult , Respiratory Tract Infections/therapy , Critical Care/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Intensive Care Units/statistics & numerical data , Severity of Illness Index , Brazil , Urban Health , Delivery of Health Care/organization & administration , Spatial Analysis
5.
Rev. chil. pediatr ; 91(1): 46-50, feb. 2020. tab
Article in Spanish | LILACS | ID: biblio-1092786

ABSTRACT

Resumen: Introducción: La migraña abdominal (MA) es infrecuente y poco estudiada. Nuestro objetivo fue investigar el diagnóstico y tratamiento de niños y adolescentes con MA y compararlos entre gastroen terólogos y neurólogos pediatras. Pacientes y Método: Todos los cuadros de MA (1-18 años) de un hospital de EE. UU, con diagnóstico de MA o sus variantes (ICD-9 346.2 o IC-10 G43.D, G43.D0, G43.D1) entre 2011-2017 fueron revisados. La información sobre diagnóstico, intervalo desde inicio de síntomas, criterios diagnósticos, pruebas diagnósticas, tratamiento y resultado se analizaron. Re sultados: Sesenta y nueve historias médicas fueron identificadas. La edad media al diagnóstico fue 9,7 años. El 48% de los pacientes fueron del sexo femenino. Cincuenta (72,4%) pacientes fueron tratados solo por gastroenterólogos pediatras, y 10/69 (14,5%) por neurológos pediatras exclusivamente. 6/69 (8,7%) fueron inicialmente evaluados por gastroenterología y posteriormente referidos a neurología, y 2/69 (2,9%) fueron inicialmente evaluados por neurología y luego referidos a gastroenterología. 3/10 (30%) de las MA diagnosticadas por neurólogos no mencionaban que el paciente tuviera dolor abdominal, sin embargo, todos los diagnósticos realizados por gastroenterólogos presentaron dicho síntoma (p=0,0035). 5/50 (10%) de las historias médicas de gastroenterología y ninguna de las histo rias de neurología mencionaban los criterios de Roma. Conclusiones: La mayoría de los niños fueron diagnosticados por pediatras gastroenterólogos. Los gastroenterólogos rara vez utilizaron los criterios de Roma. Pacientes evaluados por neurología son frecuentemente diagnosticados con MA, incluso sin presentar dolor abdominal (criterio necesario para el diagnóstico). Se recomienda educación para el correcto y oportuno diagnóstico de la migraña abdominal.


Abstract: Introduction: Abdominal migraine (AM) is uncommon and understudied. Our objective was to investigate the diagnosis and treatment of children and adolescents with AM and compare with that of pediatric gastroenterologists and neurologists. Patients and Method: All AM cases (1-18 years) from a USA hospital with diagnosis of abdominal migraine or its variants (ICD-9 346.2 or IC-10 G43.D, G43.D0, G43.D1) between 2011 and 2017 were reviewed. Information on diagnosis, interval from onset of symptoms, diagnostic criteria, diagnostic tests, treatment, and outcome were analyzed. Results: 69 medical records were identified. The mean age at diagnosis was 9.7 years, and 48% of patients were female. 50/69 (72.4%) patients were exclusively treated by a pediatric gastroenterologist and 10/69 (14.5%) exclusively by a pediatric neurologist. 6/69 (8.7%) were initially evaluated by gas troenterology and referred to neurology, and 2/69 (2.9%) were initially evaluated by neurology and then referred to gastroenterology. 3/10 (30%) of the AM diagnosed by neurologists did no report ab dominal pain (AP), however, all diagnoses made by gastroenterologists did (p = 0.0035). 5/50 (10%) of the gastroenterology medical records and no neurology medical records mentioned Rome criteria. Conclusions: Most of the children were diagnosed by pediatric gastroenterologists. Gastroenterolo gists rarely use the Rome criteria. Patients evaluated by neurologists are frequently diagnosed with AM even without AP (a criterion that is required for its diagnosis). Education is recommended for the correct and timely diagnosis of AM.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Practice Patterns, Physicians'/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Gastroenterology , Migraine Disorders/diagnosis , Migraine Disorders/therapy , Neurology , Referral and Consultation , United States , Abdominal Pain/etiology , Follow-Up Studies , Practice Guidelines as Topic , Guideline Adherence/statistics & numerical data , Diagnosis, Differential , Diagnostic Errors , Migraine Disorders/complications
6.
Rev. saúde pública (Online) ; 54: 58, 2020. tab, graf
Article in English | LILACS, BBO | ID: biblio-1101875

ABSTRACT

ABSTRACT OBJECTIVE To describe the human resources for health and analyze the inequality in its distribution in Mexico. METHODS Cross-sectional study based on the National Occupation and Employment Survey (ENOE in Spanish) for the fourth quarter of 2018 in Mexico. Graduated physicians and nurses, and auxiliary/technician nurses with completed studies were considered as human resources for health. States were grouped by degree of marginalization. Densities of human resources for health per 1,000 inhabitants, Index of Dissimilarity (DI) and Concentration Indices (CI) were estimated as measures of unequal distribution. RESULTS The density of human resources for health was 4.6 per 1,000 inhabitants. We found heterogeneity among states with densities from 2.3 to 10.5 per 1,000 inhabitants. Inequality was higher in the states with a very low degree of marginalization (CI = 0.4) than those with high marginalization (CI = 0.1), and the inequality in the distribution of physicians (CI = 0.5) was greater than in graduated nurses (CI = 0.3) among states. In addition, 17 states showed a density above the threshold of 4.5 per 1,000 inhabitants proposed in the Global Strategy on Human Resources for Health. That implies a deficit of nearly 60,000 human resources for health among the 15 states below the threshold. For all states, to reach a density equal to the national density of 4.6, about 12.6% of human health resources would have to be distributed among states that were below national density. CONCLUSIONS In Mexico, there is inequality in the distribution of human resources for health, with state differences. Government mechanisms could support the balance in the labor market of physicians and nurses through a human resources policy.


RESUMEN OBJETIVO Describir los recursos humanos en salud y analizar la desigualdad en su distribución en México. MÉTODOS Estudio transversal basado en la Encuesta Nacional de Ocupación y Empleo del cuarto trimestre de 2018 en México. Se consideraron como recursos humanos en salud médicos y enfermeras con licenciatura, y personal de enfermería auxiliar/técnica con estudios concluidos. Se agrupó a los estados por grado de marginación y se estimó densidades de recursos humanos en salud por 1.000 habitantes, Índices de Disimilitud e Índices de Concentración (IC) como medidas de desigualdad en la distribución. RESULTADOS La densidad de recursos humanos en salud fue de 4,6 por 1.000 habitantes; se observó heterogeneidad entre los estados con que van 2,3 hasta 10,5 por 1.000 habitantes. La desigualdad fue mayor en los estados con muy bajo grado de marginación (IC = 0,4) que en los estados de muy alto grado (IC = 0,1), y fue mayor la desigualdad en la distribución de los médicos (IC = 0,5) que en las enfermeras profesionales (IC = 0,3) entre los estados. Para que todos los estados tuvieran una densidad igual a la nacional de 4,6, se tendrían que distribuir alrededor de 12,6% de los recursos humanos en salud entre los estados que estuvieron por debajo de la densidad nacional. Adicionalmente, 17 estados tuvieron una densidad superior al umbral de 4,5 por 1.000 habitantes propuesto en la Estrategia Global en Recursos Humanos para la Salud. Eso implica un déficit de casi 60 mil recursos humanos en salud entre los 15 estados por debajo del umbral. CONCLUSIONES En México existe desigualdad en la distribución de recursos humanos en salud, diferenciada en los estados. Mecanismos gubernamentales a través de una política de recursos humanos podrían incentivar el equilibrio en el mercado de laboral de los médicos y enfermeras.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Physicians/supply & distribution , Healthcare Disparities/statistics & numerical data , Health Workforce/statistics & numerical data , Nurses/supply & distribution , Socioeconomic Factors , Cross-Sectional Studies , Population Density , Age Distribution , Quality-Adjusted Life Years , Geography , Health Services Accessibility/statistics & numerical data , Mexico , Middle Aged
7.
Epidemiol. serv. saúde ; 29(1): e2018512, 2020. tab, graf, mapa
Article in Portuguese | LILACS | ID: biblio-1090255

ABSTRACT

Objetivo: descrever a distribuição dos transplantes de órgãos sólidos no Brasil, bem como informações da lista de espera (demanda) e origem dos pacientes transplantados, por tipo de órgão e Unidade da Federação, de 2001 a 2017. Métodos: estudo descritivo, com dados das Centrais Estaduais de Transplantes, da Associação Brasileira de Transplantes de Órgãos e do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Resultados: 153 centros de transplante foram identificados em 2017, apenas 11,8% deles localizados nas regiões Norte e Centro-Oeste; no período em estudo, foram realizados 99.805 transplantes, variando de 3.520 (2001) a 8.669 (2017); as regiões Sul e Sudeste concentraram o maior número de transplantes. Conclusão: existem desigualdades regionais na realização dos transplantes, possivelmente por não haver uniformidade na distribuição dos serviços.


Objetivo: describir la distribución de los trasplantes de órganos sólidos en Brasil, así como informaciones de la lista de espera (demanda) y origen de los pacientes trasplantados por tipo de órgano y unidad federativa, entre 2001 y 2017. Métodos: estudio descriptivo usando datos extraídos de Centrales Estatales de Trasplantes, Asociación Brasileña de Trasplantes de Órganos y Sistema de Informaciones Hospitalarias del Sistema Único Nacional de Salud (SIH/SUS). Resultados: 153 centros de trasplante identificados en 2017, solamente 11,8% están ubicados en las regiones Norte y Centro-Oeste; se realizaron 99.805 trasplantes, desde 3.520 (2001) hasta 8.669 (2017); Sur y Sudeste concentran el mayor número de trasplantes. Conclusión: hay desigualdad en el acceso a los trasplantes, posiblemente debido a la falta de uniformidad en la distribución de los servicios.


Objective: to describe the distribution of solid organ transplants in Brazil, as well as information about the waiting list (demand) and origin of transplant patients by organ type and Federative Unit, from 2001 to 2017. Methods: this was a descriptive study using data from State Transplantation Centers, the Brazilian Organ Transplant Association, and the Brazilian National Health System Hospital Information System (SIH/SUS). Results: 153 transplant units were identified in 2017, with only 11.8% located in the Northern and Midwest regions; within the study period, 99,805 transplants were performed, ranging from 3,520 (2001) to 8,669 (2017); the highest number of transplants was concentrated in the Southern and Southeastern regions. Conclusion: there are inequalities in transplantation access, possibly due to lack of uniformity in service distribution.


Subject(s)
Humans , Organ Transplantation/trends , Organ Transplantation/statistics & numerical data , Healthcare Disparities/trends , Healthcare Disparities/statistics & numerical data , Spatio-Temporal Analysis , Transplant Recipients/statistics & numerical data , Health Services Accessibility/trends , Socioeconomic Factors , Brazil/epidemiology , Retrospective Studies , Heart Transplantation/statistics & numerical data , Kidney Transplantation/statistics & numerical data , Liver Transplantation/statistics & numerical data , Lung Transplantation/statistics & numerical data , Pancreas Transplantation/statistics & numerical data
8.
Salud pública Méx ; 61(6): 726-733, nov.-dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1252161

ABSTRACT

Resumen: Objetivo: Estimar la desigualdad en acceso a servicios de salud en poblaciones de localidades menores de 100 000 habitantes en México. Material y métodos: Análisis de la Encuesta Nacional de Salud y Nutrición 100k 2018. Se estimó el acceso con base en la afiliación a un esquema de aseguramiento (acceso potencial) y la atención para el más reciente problema de salud (acceso a atención) mediante el índice de concentración, utilizando una imputación del ingreso per cápita. Resultados: La afiliación a algún esquema de aseguramiento en salud fue de 82.42% y el acceso a atención de 60.03%. Se identificaron desigualdades en ambos indicadores, marginales para acceso potencial y con mayor concentración entre la población de menor ingreso; para acceso a atención se encontró desigualdad con mayor concentración entre la población de mayor ingreso. Conclusión: En México prevalecen desigualdades en acceso a servicios de salud para la población en condiciones de pobreza. Es necesario desarrollar intervenciones públicas con mayor granularidad para incidir de forma efectiva en la desigualdad.


Abstract: Objective: To estimate inequalities in access to health services among Mexican population living in localities of 100 000 or less inhabitants. Materials and methods: Cross-sectional analysis using the National Health and Nutrition Survey 100k 2018 survey data. Access was estimated using health insurance and care for the last health condition. As inequality measure, we estimated the concentration index using an imputation of household per capita income. Results: Among studied population, health insurance was 82.42% and access to care 60.03%. We identified inequalities in both indicators; marginal and pro-poor for insurance and pro-rich for access to care. Conclusion: In Mexico, even within the population living in poverty there are inequalities in access to health care. More granular public interventions are needed to address inequalities in an effective way.


Subject(s)
Humans , Male , Female , Adult , Healthcare Disparities/statistics & numerical data , Health Policy , Health Services Accessibility/statistics & numerical data , Cross-Sectional Studies , Mexico
9.
Ciênc. Saúde Colet ; 24(7): 2745-2760, jul. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1011857

ABSTRACT

Resumo Este artigo busca discutir a evolução das desigualdades em saúde e no acesso aos serviços de saúde nas grandes regiões a partir de inquéritos domiciliares realizados de 1998 a 2013. As desigualdades sociais foram analisadas pelas razões de extremos de anos de escolaridade, considerando duas faixas etárias (18 a 59 anos e 60 anos ou mais). Nas condições de saúde, observa-se, nos dois grupos etários, uma pior avaliação do estado de saúde e um aumento da prevalência de diabetes e hipertensão, o que pode estar relacionado à expansão da atenção básica. Quanto à realização de consultas médicas no último ano, encontra-se, no geral, maior acesso, com manutenção de pequenas desigualdades. A maior utilização de consulta odontológica entre os de menor escolaridade provoca uma redução nas desigualdades, que ainda são significativas. As internações hospitalares, ao longo da série, são maiores entre os menos escolarizados, e há uma redução nas taxas nos dois grupos etários, em quase todas as regiões. Percebe-se um aumento na realização de mamografia por mulheres menos escolarizadas, com diminuição da desigualdade. Os resultados corroboram a necessidade da continuidade dos inquéritos domiciliares para o monitoramento das desigualdades regionais e sociais no acesso ao sistema de saúde.


Abstract This article discusses trends in health inequalities and access to health services across the regions of Brazil using data from household surveys conducted between 1998 and 2013. Social inequality was measured based on the ratio between the extremes of years of schooling considering two age groups (18 to 59 years and 60 years and over). The findings show a decline in health status and increase in prevalence of diabetes and hypertension in both age groups, which may be related to the expansion of primary healthcare. The findings regarding the percentage of people who had had a medical appointment in the last 12 months show that low levels of inequalities persist despite a general improvement in access. Despite an increase in the percentage of people with up to 3 years of schooling who had had a dental appointment in the last year, significant inequalities persist. The percentage of people who reported being admitted to hospital in the last 12 months was greater among people with up to 3 years of schooling throughout the study period. The hospitalization rate decreased in both age groups across almost all regions. The proportion of women aged between 50 and 69 years with up to 3 years of schooling who had had a mammogram increased, leading to a decrease in inequality. The findings show the need to ensure the continuity of household surveys to monitor inequalities in access to health care services by region and social group.


Subject(s)
Humans , Female , Adolescent , Adult , Aged , Young Adult , Health Status , Health Status Disparities , Health Services Accessibility , Primary Health Care/organization & administration , Social Class , Brazil , Mammography/statistics & numerical data , Surveys and Questionnaires , Age Factors , Delivery of Health Care/statistics & numerical data , Educational Status , Healthcare Disparities/statistics & numerical data , Hospitalization/statistics & numerical data , Middle Aged
10.
Rev. pesqui. cuid. fundam. (Online) ; 11(3): 816-822, abr.-maio 2019. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-987303

ABSTRACT

Objective: The study's goal has been to both know and analyze the aspects that the studies from national and international literatures can reveal about the profile of maternal mortality. Methods: It is an integrative literature review. The search was conducted in August 2017, through the Virtual Health Library (VHL), searching in the databases named Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) [Latin-American and Caribbean Literature in Health Sciences], Medical Literature Analysis and Retrieval System Online (MEDLINE), Nursing Database (ND); establishing inclusion and exclusion criteria, and then selecting nine studies. Results: The epidemiological profile of maternal deaths is influenced by social factors, which reflect the inequalities present in the world, the disparities in accessing health services, education and other factors that affect a vulnerable group at alarming rates. Conclusions: The studies suggest the need for greater efforts regarding the engagement of society, public agencies and health professionals, aiming to bigger commitment and co-responsibility in the struggle to reduce maternal mortality


Objetivo: Conhecer e analisar os aspectos que os estudos da literatura nacional e internacional revelam sobre o perfil da mortalidade materna. Métodos: Revisão da literatura, a busca foi realizada em agosto de 2017, por meio da Biblioteca Virtual em Saúde, nas bases de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online e, Base de dados da Enfermagem, estabelecendo-se critérios de inclusão e exclusão, sendo selecionados nove estudos. Resultados: O perfil epidemiológico dos óbitos maternos é influenciado por fatores sociais, os quais refletem as desigualdades que assolam o mundo, a disparidade nas formas de acesso aos serviços de saúde, a educação e demais fatores que repercutem num grupo vulnerável para índices alarmantes. Conclusões: Os estudos refletem a necessidade de maiores esforços com engajamento da sociedade, órgãos públicos, profissionais de saúde, com vista a maior comprometimento e co-resposabilização na luta pela redução da mortalidade materna


Objetivo: Investigar y analizarlos aspectos que elestudio de la literatura nacional e internacional revelan sobre el perfil de lamortalidad materna. Metodos: La revisión se realizóen agosto de 2017, a través de la Biblioteca Virtual enSalud, enlas bases de datos de la Literatura Latinoamericana y del Caribe enCiencias de laSalud, Medical LiteratureAnalysis and Retrieval System Online y, Base de datos de la literatura Enfermería, estableciéndosecriterios de inclusión y exclusión, siendo selecionado snueve estudios. Resultados: El perfil epidemiológico de lasmuertes maternas se ve influenciada por factores sociales, que reflejanlas desigualdades que aquejan al mundo, la disparidadenlas formas de acceso a losservicios de salud, educación y otrosfactores que afectan a un grupo vulnerable a niveles alarmantes. Conclusiones: Los estúdios reflejan la necesidad de mayores esfuerzos para involucrar a lasociedad, agencias gubernamentales, profesionales de lasalud, con miras a um mayor compromiso y co-resposabilizaçãoenla lucha por reducir la mortalidad materna


Subject(s)
Humans , Female , Pregnancy , Adult , Middle Aged , Maternal Mortality/trends , Women's Health/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Health Policy
11.
Ciênc. Saúde Colet ; 24(3): 1153-1164, mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-989582

ABSTRACT

Abstract This study maps and analyzes patient flows for breast cancer chemotherapy in order to identify the potential implications for organization of pharmaceutical services in the cancer care network. An ecological study design sought to correlate the place of residence with place of care for breast cancer patients. All chemotherapy procedures financed by Brazil's Unified Health System (SUS) and performed from January to December 2013 were included. Flows were mapped using TerraView® software. A total of 1 347 803 outpatient chemotherapy procedures were delivered by 243 cancer care units located in 156 municipalities. Seventeen cities concentrated approximately 50.0 % of the procedures. A total of 8 538 origin-destination flows were generated and 49.2% of procedures were performed in services located outside the municipality in which the patient resided. Context challenges, related to inequality of access to chemotherapy and hindrances in planning and management of pharmaceutical services, were discussed.


Resumo Este estudo mapeia e analisa os fluxos percorridos por pacientes em uso de quimioterapia para o tratamento do câncer de mama no Brasil, usando metodologia de redes, de forma a identificar potenciais implicações para a organização da assistência farmacêutica na rede de atenção oncológica. Realizou-se um estudo ecológico correlacionando o local de residência com o de atendimento de pacientes com câncer de mama. Incluiu-se todos os procedimentos de quimioterapia financiados pelo Sistema Único de Saúde (SUS), realizados no ano de 2013. O mapeamento dos fluxos foi efetuado no programa TerraView®. Foram realizados 1.347.803 procedimentos ambulatoriais de quimioterapia em 243 unidades habilitadas pelo SUS, sediadas em 156 municípios brasileiros. Dezessete cidades concentraram aproximadamente 50,0% dos atendimentos. Foram gerados 8.538 fluxos de origem-destino e 49,2% dos procedimentos foram realizados em serviços sediados fora do município de residência da mulher. Alguns aspectos da organização da assistência farmacêutica, relacionados a desigualdades no acesso à quimioterapia e dificuldades no planejamento de ações e serviços farmacêuticos foram problematizados frente ao contexto apresentado.


Subject(s)
Humans , Female , Pharmaceutical Services/statistics & numerical data , Breast Neoplasms/drug therapy , Health Services Accessibility , Antineoplastic Agents/administration & dosage , Brazil , Residence Characteristics/statistics & numerical data , Healthcare Disparities/statistics & numerical data , National Health Programs/statistics & numerical data
12.
Ciênc. Saúde Colet ; 24(3): 1223-1232, mar. 2019. tab
Article in Portuguese | LILACS | ID: biblio-989580

ABSTRACT

Resumo O objetivo deste estudo foi avaliar a adequação do cuidado pré-natal no Brasil associado a determinantes sociodemográficos. A pesquisa consistiu em uma análise dos dados da Pesquisa Nacional de Saúde realizada no Brasil em 2013. Foram avaliados dois desfechos sobre a adequação do pré-natal, o índice de Kessner modificado por Takeda que, além de levar em consideração esse índice, avaliou se houve aferição da pressão arterial e do peso em todas as consultas, realização de algum exame de sangue e urina e ultrassom. Ambos indicadores de qualidade foram avaliados para o Brasil e também pelas macrorregiões do país. De acordo com o desfecho 1, 80,6% das mulheres realizaram o pré-natal adequado. Ao adicionarmos a realização de exames (Desfecho 2) o percentual foi 71,4%. O pré-natal adequado foi mais frequente entre as mulheres de cor branca e que realizaram o pré-natal na rede privada. A região norte apresentou as menores frequências de pré-natal adequado, enquanto a região sudeste as maiores. Apesar da ampla cobertura, o pré-natal no Brasil ainda apresenta iniquidades e baixa qualidade no atendimento, especialmente entre mulheres das regiões mais pobre do país.


Abstract This study aimed to assess the adequacy of prenatal care in Brazil associated with sociodemographic determinants. The study included a data analysis from the National Health Research performed in Brazil in 2013. Two outcomes on the adequacy of prenatal care were assessed: the Kessner index modified by Takeda index that, in addition to the former, assessed whether blood pressure and weight were measured in all appointments, as well as the performance of blood and urine tests and ultrasound. Both quality indicators were assessed for Brazil and for its macro-regions. According to Outcome 1, 80.6% of women received adequate prenatal care. When adding the performance of tests (Outcome 2), the rate dropped to 71.4%. Adequate prenatal care was more frequent among white women who performed prenatal care in the private health sector. The northern region had the lowest rate of adequate prenatal care, while the southeast region showed the highest rates. Despite the extensive coverage, prenatal care in Brazil still presents inequities and low service quality, especially for women from the poorest regions of the country.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Prenatal Care/standards , Quality of Health Care , Healthcare Disparities/statistics & numerical data , Socioeconomic Factors , Brazil , Poverty Areas , Public Sector/statistics & numerical data , Private Sector/statistics & numerical data
13.
Rev. saúde pública (Online) ; 53: 40, jan. 2019. tab
Article in English | LILACS | ID: biblio-1004514

ABSTRACT

ABSTRACT OBJECTIVE To estimate coverage, examine trend and assess the disparity reduction regarding household income during prenatal care between mothers living in Rio Grande, state of Rio Grande do Sul, in 2007, 2010, 2013 and 2016. METHODS This study included all recent mothers living in this municipality, between 1/1 and 12/31 of those years, who had a child weighing more than 500 grams or 20 weeks of gestational age in one of the only two local maternity hospitals. Trained interviewers applied, still in the hospital and up to 48 hours after delivery, a unique and standardized questionnaire, seeking to investigate maternal demographic and reproductive characteristics, the socioeconomic conditions of the family and the assistance received during pregnancy and childbirth. To assess the adequacy of prenatal care, the criteria proposed by Takeda were used, which considers only the number of prenatal appointments and gestational age at initiation, and by Silveira et al., who in addition to these two variables, considers the achievement of some laboratory tests. Chi-square tests were used to compare proportions and assess the linear trend. RESULTS The total of 10,669 recent mothers were included in this survey (96.8% of the total). Prenatal coverage substantially increased between 2007 and 2016. According to Takeda, it rose from 69% to 80%, while for Silveira et al., it increased from 21% to 55%. This improvement occurred for all income groups (p < 0.01). The disparity between the extreme categories of income reduced, according to Takeda, and increased according to Silveira et al. CONCLUSIONS The provision of prenatal care, considering only the number of appointments and the early start, occurred in greater proportion among the poorest. However, only the richest recent mothers were contemplated with more elaborate care, such as laboratory tests, which increased the disparities in the provision of prenatal care.


RESUMO OBJETIVO Estimar a cobertura, examinar a tendência e avaliar se houve redução da disparidade em relação à renda familiar na realização de pré-natal adequado entre puérperas residentes em Rio Grande, RS, nos anos de 2007, 2010, 2013 e 2016. MÉTODOS Foram incluídas neste estudo todas as puérperas residentes nesse município que, entre 1/1 a 31/12 desses anos, tiveram filho com peso superior a 500 gramas ou 20 semanas de idade gestacional em alguma das duas únicas maternidades locais. Entrevistadoras treinadas aplicaram, ainda no hospital e em até 48 horas após o parto, questionário único e padronizado, buscando investigar as características demográficas e reprodutivas maternas, as condições socioeconômicas da família e a assistência recebida durante a gestação e parto. Para avaliação da adequação do pré-natal, foram utilizados os critérios propostos por Takeda, que considera apenas o número de consultas pré-natais e a idade gestacional de início, e de Silveira et al., que além dessas duas variáveis, leva em conta a realização de alguns testes laboratoriais. Foram utilizados os testes qui-quadrado para comparar proporções e avaliar tendência linear. RESULTADOS Foram incluídas neste inquérito 10.669 puérperas (96,8% do total). Verificou-se substancial aumento na cobertura de pré-natal adequado entre 2007 e 2016. Segundo Takeda, passou de 69% para 80%, enquanto para Silveira et al. aumentou de 21% para 55%. Essa melhora no período ocorreu para todos os grupos de renda (p < 0,01). Houve redução na disparidade entre as categorias extremas de renda segundo Takeda e aumento acentuado segundo Silveira et al. CONCLUSÕES A oferta de pré-natal, considerando apenas o número de consultas e o início precoce, ocorreu em maior proporção entre as mais pobres. No entanto, ao oferecer cuidados mais elaborados, como exames laboratoriais, estes alcançaram principalmente as puérperas mais ricas, aumentando assim as disparidades na oferta da assistência pré-natal.


Subject(s)
Humans , Female , Pregnancy , Child , Adolescent , Adult , Young Adult , Prenatal Care/trends , Prenatal Care/statistics & numerical data , Healthcare Disparities/trends , Healthcare Disparities/statistics & numerical data , Reference Values , Socioeconomic Factors , Time Factors , Brazil , Family Characteristics , Surveys and Questionnaires , Maternal Age
14.
Cad. Saúde Pública (Online) ; 35(supl.3): e00181318, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1019649

ABSTRACT

Resumo: Este estudo avalia a atenção pré-natal de mulheres indígenas com idades entre 14-49 anos, com filhos menores de 60 meses no Brasil. O Primeiro Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas avaliou 3.967 mulheres que atendiam a tais requisitos, sendo 41,3% da Região Norte; 21,2% do Centro-oeste; 22,2% do Nordeste; e 15% do Sul/Sudeste. O pré-natal foi ofertado a 3.437 (86,6%) delas. A Região Norte registrou a maior proporção de mulheres que não fizeram pré-natal. A cobertura alcançada foi de 90,4%, mas somente cerca de 30% iniciaram o pré-natal no 1º trimestre e apenas 60% das elegíveis foram vacinadas contra difteria e tétano. Somente 16% das gestantes indígenas realizaram 7 ou mais consultas de pré-natal. Ter acesso a pelo menos um cuidado clínico-obstétrico foi observado em cerca de 97% dos registros, exceto exame de mamas (63%). Foi baixa a solicitação de exames (glicemia 53,6%, urina 53%, hemograma 56,9%, citologia oncótica 12,9%, teste de sífilis 57,6%, sorologia para HIV 44,2%, hepatite B 53,6%, rubéola 21,4% e toxoplasmose 32,6%) e prescrição de sulfato ferroso (44,1%). No conjunto, a proporção de solicitações de exames laboratoriais preconizados não ultrapassou 53%. Os percentuais de realização das ações do pré-natal das indígenas são mais baixos que os encontrados para mulheres não indígenas no conjunto do território nacional, e até mesmo para as residentes em regiões de elevada vulnerabilidade social e baixa cobertura assistencial como a Amazônia Legal e o Nordeste. Os resultados reafirmam a persistência de desigualdades étnico-raciais que comprometem a saúde e o bem-estar de mães indígenas.


Abstract: This study assesses prenatal care for indigenous women 14-49 years of age with children under five years of age in Brazil. The First National Survey of Indigenous People's Health and Nutrition assessed 3,967 women who met these criteria, of whom 41.3% in the North, 21.2% in the Central, 22.2% in the Northeast, and 15% in the South/Southeast. Prenatal care was offered to 3,437 (86.6%) of these women. The North of Brazil showed the highest proportion of indigenous women who did not receive prenatal care. Coverage was 90.4%, but only some 30% began prenatal care in the first trimester, and only 60% of the eligible women were vaccinated for diphtheria and tetanus. Only 16% of indigenous pregnant women had seven or more prenatal visits. Access to at least one clinical-obstetric consultation was found in 97% of the records, except for breast examination (63%). Laboratory test rates were low (blood glucose 53.6%, urinalysis 53%, complete blood count 56.9%, Pap smear 12.9%, syphilis test 57.6%, HIV serology 44.2%, hepatitis B 53.6%, rubella 21.4%, and toxoplasmosis 32.6%), as was prescription of ferrous sulfate (44.1%). As a whole, the proportion of orders for recommended laboratory tests was only 53%. The percentages of prenatal care procedures for indigenous women are lower than for non-indigenous Brazilian women as a whole, and are even lower than among women in regions with high social vulnerability and low healthcare coverage, like the Legal Amazonia and the Northeast. The results confirm the persistence of ethnic-racial inequalities that compromise the health and well-being of indigenous mothers.


Resumen: Este estudio evalúa la atención prenatal a mujeres indígenas con edades comprendidas entre los 14-49 años, con hijos menores de 60 meses en Brasil. La Primera Encuesta Nacional de Salud y Nutrición de los Pueblos Indígenas evaluó a 3.967 mujeres que reunían tales requisitos, procediendo un 41,3% de la Región Norte; un 21,2% del Centro-oeste; un 22,2% del Nordeste; y un 15% del Sur/Sudeste. El servicio prenatal se le ofreció a 3.437 (86,6%) de ellas. La Región Norte registró la mayor proporción de mujeres que no realizaron el seguimiento prenatal. La cobertura alcanzada fue de un 90,4%, pero solamente cerca de un 30% comenzaron el seguimiento prenatal durante el primer trimestre y sólo un 60% de las elegibles fueron vacunadas contra la difteria y tétanos. Solamente un 16% de las gestantes indígenas realizaron 7 o más consultas de prenatal. Alrededor de un 97% de los registros se observó que tuvieron acceso a por lo menos un cuidado clínico-obstétrico, excepto el examen de mamas (63%). Fue baja la solicitud de exámenes (glucemia 53,6%, orina 53%, hemograma 56,9%, citología oncológica 12,9%, test de sífilis 57,6%, serología para VIH 44,2%, hepatitis B 53,6%, rubeola 21,4% y toxoplasmosis un 32,6%) y la prescripción de sulfato ferroso (44,1%). En conjunto, la proporción de solicitudes de exámenes de laboratorio previstos no sobrepasó el 53%. Los porcentajes de realización de acciones del seguimiento prenatal por parte de las indígenas son más bajos que los encontrados en mujeres no indígenas, en el conjunto del territorio nacional, y hasta incluso en comparación con las residentes en regiones de elevada vulnerabilidad social y baja cobertura asistencial como la Amazonia Legal y el Nordeste. Los resultados reafirman la persistencia de desigualdades étnico-raciales que comprometen la salud y el bienestar de las madres indígenas.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Prenatal Care/statistics & numerical data , Program Evaluation/statistics & numerical data , Indians, South American/statistics & numerical data , Health Care Surveys/statistics & numerical data , Socioeconomic Factors , Brazil , Cross-Sectional Studies , Healthcare Disparities/ethnology , Healthcare Disparities/statistics & numerical data , Health Records, Personal , Middle Aged
15.
Cad. Saúde Pública (Online) ; 35(supl.3): e00001019, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1019643

ABSTRACT

Resumo: Internacionalmente, observa-se um incremento no uso das internações por condições sensíveis à atenção primária (ICSAP) como indicador de efetividade da atenção primária à saúde. Este artigo analisa as iniquidades étnico-raciais nas internações por causas em menores de cinco anos no Brasil e regiões, com ênfase nas ICSAP e nas infecções respiratórias agudas (IRA). Com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS), 2009-2014, calcularam-se proporções por causas, taxas e razões de taxas de ICSAP ajustadas por sexo e idade após a imputação múltipla de dados faltantes de cor/raça. As principais causas de internação foram doenças do aparelho respiratório (37,4%) e infecciosas e parasitárias (19,3%), sendo as crianças indígenas as mais acometidas. As taxas brutas de ICSAP (por 1.000) foram mais elevadas em indígenas (97,3; IC95%: 95,3-99,2), seguidas das pardas (40,0; IC95%: 39,8-40,1), e as menores foram nas amarelas (14,8; IC95%: 14,1-15,5). As maiores razões de taxas ajustadas de ICSAP foram registradas entre crianças de cor/raça indígena e branca - 5,7 (IC95%: 3,9-8,4) no país, atingindo 5,9 (IC95%: 5,0-7,1) e 18,5 (IC95%: 16,5-20,7) no Norte e Centro-oeste, respectivamente. As IRA permanecem como importantes causas de hospitalização em crianças no Brasil. Foram observadas alarmantes iniquidades étnico-raciais nas taxas de ICSAP, com situação de desvantagem para indígenas. São necessárias melhorias nas condições de vida, saneamento e subsistência, bem como garantia de acesso oportuno e qualificado à atenção primária à saúde das populações mais vulneráveis, com destaque para os indígenas no Norte e no Centro-oeste, a fim de minimizar iniquidades em saúde e fazer cumprir as diretrizes do SUS e da Constituição do Brasil.


Abstract: There has been a global increase in hospital admissions for primary care-sensitive conditions (PCSCs) as an indicator of effectiveness in primary health care. This article analyzes ethnic and racial inequalities in cause-related hospitalizations in under-five children in Brazil as a whole and the country's five major geographic regions, with an emphasis on PCSCs and acute respiratory infections (ARIs). Using data from the Hospital Information Systems of the Brazilian Unified National Health System (SIH/SUS), 2009-2014, the authors calculated proportions, rates, and rate ratios for PCSCs, adjusted by sex and age after multiple imputation of missing data on color/race. The principal causes of hospitalization were respiratory tract infections (37.4%) and infectious and parasitic diseases (19.3%), and indigenous children were proportionally the most affected. Crude PCSC rates (per 1,000) were highest in indigenous children (97.3; 95%CI: 95.3-99.2), followed by brown or mixed-raced children (40.0; 95%CI: 39.8-40.1), while the lowest rates were in Asiandescendant children (14.8; 95%CI: 14.1-15.5). The highest adjusted rate ratios for PCSCs were seen among indigenous children compared to white children - 5.7 (95%CI: 3.9-8.4) for Brazil as a whole, reaching 5.9 (95%CI: 5.0-7.1) and 18.5 (95%CI: 16.5-20.7) in the North and Central, respectively, compared to white children. ARIs remained as important causes of pediatric hospitalizations in Brazil. Alarming ethnic and racial inequalities were observed in PCSCs, with indigenous children at a disadvantage. Improvements are needed in living conditions, sanitation, and subsistence, as well as guaranteed timely access to high-quality primary health care in the more vulnerable population groups, especially the indigenous peoples of the North and Central, in order to mitigate the health inequalities and meet the guidelines of the SUS and the Brazilian Constitution.


Resumen: Internacionalmente, se observa un incremento en las hospitalizaciones por condiciones sensibles a la atención primaria (ICSAP), como un indicador de efectividad de la atención primaria a la salud. Este artículo analiza las inequidades étnico-raciales en las hospitalizaciones por causas evitables em menores de cinco años en Brasil y sus regiones, con énfasis en las ICSAP y en las infecciones respiratorias agudas (IRA). Con datos del Sistema de Informaciones Hospitalarias del Sistema Único de Salud (SIH/SUS), 2009-2014, se calcularon porcentajes por causas, tasas y razones de tasas de ICSAP ajustadas por sexo y edad, tras la imputación múltiple de datos faltantes de color/raza. Las principales causas de hospitalización fueron enfermedades del aparato respiratório (37,4%) e infecciosas y parasitarias (19,3%), siendo los niños indígenas los más afectados. Las tasas brutas de ICSAP (por 1.000) fueron más elevadas en indígenas (97,3; IC95%: 95,3-99,2), seguidas de las mulatos/mestizos (40,0; IC95%: 39,8-40,1), mientras que las menores fueron en las de origen asiática (14,8; IC95%: 14,1-15,5). Las mayores razones de tasas ajustadas de ICSAP fueron en los niños indígenas comparados a los niños de color/raza blanca - 5,7 (IC95%: 3,9-8,4) en el país, alcanzando 5,9 (IC95%: 5,0-7,1) y 18,5 (IC95%: 16,5-20,7) en el Norte y Centro-oeste, respectivamente, en comparación con El color/raza blanca. Las IRA permanecen como importantes causas de hospitalización en niños em Brasil. Se observaron alarmantes inequidades étnico-raciales en las tasas de ICSAP, con situación de desventaja para los indígenas. Se necesitan mejoras en las condiciones de vida, saneamiento y subsistencia, así como la garantía de un acceso oportuno y cualificado a la atención primaria a La salud de las poblaciones más vulnerables, destacando los indígenas en el Norte y Centro-oeste, a fin de minimizar inequidades en salud y hacer cumplir las directrices del SUS y de la Constitución de Brasil.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Primary Health Care/statistics & numerical data , Ethnic Groups/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Hospitalization/statistics & numerical data , Respiratory Tract Infections/ethnology , Respiratory Tract Infections/epidemiology , Socioeconomic Factors , Brazil/ethnology , Brazil/epidemiology , Indians, South American/statistics & numerical data , Residence Characteristics/statistics & numerical data , Morbidity , Healthcare Disparities/ethnology , Length of Stay/statistics & numerical data , National Health Programs
16.
Medwave ; 19(3): e7619, 2019.
Article in English, Spanish | LILACS | ID: biblio-994942

ABSTRACT

INTRODUCCIÓN La insuficiencia renal crónica es una enfermedad que se encuentra en un estado de constante crecimiento. La discapacidad que genera esta enfermedad debe considerar efectos físicos y sociales, dada la falta de atención y a las condiciones socioeconómicas que la generan. Por lo tanto, el acceso a los servicios para tratar la insuficiencia renal crónica está condicionado a factores de tipo social y de tipo biológico. OBJETIVO Analizar el efecto de los componentes sociales en la insuficiencia renal crónica en un sector de la población de México que padece la enfermedad, en particular para el caso de la mujer. MÉTODOS Se aplicó el modelo lineal generalizado de Poisson, seleccionando las variables relacionadas con la equidad en la aplicación de los servicios de salud. Se tomaron datos estadísticos reportados en mujeres por el Instituto Nacional de Estadística y Geografía de México en el periodo 2009-2015. Las variables consideradas fueron grado de escolaridad, ocupación, acceso a la salud, región geográfica y zona habitable, así como le etapa de vida. RESULTADOS La mayor tasa de incidencia para la insuficiencia renal crónica corresponde a la mujer adulta intermedia, que trabaja en servicios informales excluidos legalmente de la cobertura institucional de salud, tiene baja escolaridad y vive en un área rural de la zona centro; mientras que la mujer adulta joven que vive en una metrópoli urbana de la zona norte presenta el perfil de menor incidencia. CONCLUSIONES Los determinantes económicos derivados de la actividad de las personas, así como la edad, el nivel educativo y el entorno en el que habitan, influyen tanto en el padecimiento de la enfermedad como en las posibilidades de enfrentarla con éxito.


INTRODUCTION Kidney chronic disease patients are being increasingly identified. The disability generated by this disease must consider physical and social effects given the lack of attention and the socioeconomic conditions that generate it. Therefore, access to services to treat kidney chronic disease is determined by social and biological factors. OBJECTIVE To analyze the effect of the social components on kidney chronic disease in a sector of the Mexican population that suffers from the disease, particularly in the case of women. METHODS The Poisson generalized linear model was applied, selecting the variables related to equity in the administration of health services. Statistical data reported by the National Institute of Statistics and Geography of Mexico in the period 2009-2015 in women was taken. The variables considered were the level of schooling, occupation, access to health, geographical region and habitable zone, as well as stage of life. RESULTS The highest incidence rate for kidney chronic disease is attributed to the intermediate adult woman, who works in informal services legally excluded from institutional health coverage, has low schooling and lives in a rural area of the Center zone, while the young adult woman that lives in an urban metropolis in the North zone presents lowest incidence profile. CONCLUSION The economic determinants derived from people's activities, as well as their age, the educational level and the environment in which they live influence both the acquisition of the disease and the possibilities of managing it successfully.


Subject(s)
Humans , Male , Female , Adult , Healthcare Disparities/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Kidney Failure, Chronic/therapy , Sex Factors , Incidence , Risk Factors , Educational Status , Kidney Failure, Chronic/epidemiology , Mexico
17.
Cad. Saúde Pública (Online) ; 35(6): e00099817, 2019. tab, graf
Article in English | LILACS | ID: biblio-1011692

ABSTRACT

Abstract: Our objectives with this study were to describe the spatial distribution of mammographic screening coverage across small geographical areas (micro-regions) in Brazil, and to analyze whether the observed differences were associated with spatial inequities in socioeconomic conditions, provision of health care, and healthcare services utilization. We performed an area-based ecological study on mammographic screening coverage in the period of 2010-2011 regarding socioeconomic and healthcare variables. The units of analysis were the 438 health micro-regions in Brazil. Spatial regression models were used to study these relationships. There was marked variability in mammographic coverage across micro-regions (median = 21.6%; interquartile range: 8.1%-37.9%). Multivariable analyses identified high household income inequality, low number of radiologists/100,000 inhabitants, low number of mammography machines/10,000 inhabitants, and low number of mammograms performed by each machine as independent correlates of poor mammographic coverage at the micro-region level. There was evidence of strong spatial dependence of these associations, with changes in one micro-region affecting neighboring micro-regions, and also of geographical heterogeneities. There were substantial inequities in access to mammographic screening across micro-regions in Brazil, in 2010-2011, with coverage being higher in those with smaller wealth inequities and better access to health care.


Resumo: O estudo teve como objetivos descrever a distribuição espacial do rastreamento por mamografia entre áreas geográficas pequenas (microrregiões) no Brasil, além de investigar se as diferenças observadas estavam associadas a inequidades espaciais nas condições socioeconômicas, na prestação de assistência à saúde e no uso de serviços de saúde. Este foi um estudo ecológico de base territorial, comparando a cobertura do rastreamento por mamografia em 2010-2011 com fatores socioeconômicos e de cuidados de saúde. O estudo usou 438 microrregiões sanitárias brasileiras como as unidades analíticas. Foram utilizados modelos de regressão espacial para estudar as associações. Houve uma importante variabilidade na cobertura por mamografia entre microrregiões (mediana = 21,6%; variação interquartil: 8,1%-37,9%). A análise multivariada identificou: forte desigualdade na renda familiar, número baixo de radiologistas/100 mil habitantes, número baixo de aparelhos de mamografia/10 mil habitantes e número baixo de mamografias realizadas com cada aparelho enquanto correlatos independentes da baixa cobertura mamográfica no nível microrregional. Houve evidência de forte dependência espacial nessas associações, em que as mudanças em uma microrregião afetavam as microrregiões vizinhas, além de heterogeneidade geográfica. O estudo revelou importantes inequidades no acesso ao exame de mamografia entre microrregiões brasileiras em 2010-2011, com cobertura mais alta nas microrregiões com menor desigualdade de renda e melhor acesso geral aos cuidados de saúde.


Resumen: Los objetivos de este estudio fueron describir la distribución espacial de la cobertura del cribado mamográfico, a través de pequeñas áreas geográficas (microrregiones) en Brasil, y examinar si las diferencias observadas estuvieron asociadas con inequidades espaciales, en términos de condiciones socioeconómicas, sistema de atención de salud, y utilización de servicios de salud. Se trata de un estudio ecológico, basado en áreas incluidas en la cobertura de cribado mamográfico durante 2010-2011 y relacionadas con variables socioeconómicas y de salud. Las unidades de análisis fueron 438 microrregiones de salud en Brasil. Se utilizaron modelos de regresión espacial para estudiar estas relaciones existentes. Hubo una variabilidad marcada en relación con la cobertura mamográfica a través de las microrregiones (media = 21.6%; rango intercuartílico: 8,1%-37,9%). Los análisis multivariables identificaron una alta inequidad en los ingresos por hogar, bajo número de radiólogos/100,000 habitantes, bajo número de máquinas de mamografía/10.000 habitantes, y un bajo número de mamografías realizadas por cada máquina, lo que está independiente correlacionado con la baja cobertura de mamografías en el nivel de microrregión. Hubo evidencias de una dependencia espacial fuerte de estas asociaciones, con cambios en una microrregión afectando a microrregiones vecinas, y también de heterogeneidades geográficas. Hubo inequidades sustanciales en el acceso al cribado mamográfico a través de las microrregiones en Brasil, en 2010-2011, con una cobertura superior en aquellas con pequeñas inequidades respecto a la riqueza y mejor acceso a los servicios de salud.


Subject(s)
Humans , Female , Middle Aged , Aged , Breast Neoplasms/diagnostic imaging , Mammography/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Socioeconomic Factors , Brazil , Mammography/economics , Residence Characteristics , Healthcare Disparities/economics , Healthcare Disparities/statistics & numerical data , Early Detection of Cancer , Spatial Analysis , Health Services Accessibility/economics , Health Services Needs and Demand/statistics & numerical data
18.
Rev. bras. epidemiol ; 22(supl.2): E190015.SUPL.2, 2019. tab
Article in English | LILACS | ID: biblio-1042223

ABSTRACT

ABSTRACT: Introduction: Despite the improvement in oral health conditions observed in the Brazilian population, there are still high social inequalities that must be monitored. Objective: To evaluate income inequality in oral hygiene practices, oral health status and the use of dental services in the adult and senior Brazilian population. Methods: Data from the National Health Survey conducted in 2013 (Pesquisa Nacional de Saúde - PNS 2013) were used for the population aged 18 years old or older. Results: Inequalities were found among the income strata in most of the oral health indicators evaluated. The greatest inequalities were observed in the use of dental floss, in hygiene practices (PR = 2.85 in adults and PR = 2.45 in seniors), and in total tooth loss (PR = 6.74 in adults and PR = 2.24 in seniors) and difficulty in chewing (PR = 4.49 in adults and PR = 2.67 in seniors) among oral condition indicators. The magnitude of inequalities was high in both groups in most oral condition indicators. Income was a factor that persisted in limiting access to dental services, and even the lower income segments had high percentages that paid for dental consultations. Conclusion: Based on data from the first PNS, the findings of this study enabled the identification of oral health and dental care aspects more compromised by income differentials, thus, contributing to the planning of dental care in Brazil and to stimulate the monitoring of these disparities with data from future surveys.


RESUMO: Introdução: Apesar da melhora das condições de saúde bucal constatada na população brasileira, persistem elevadas desigualdades sociais que precisam ser monitoradas. Objetivo: Avaliar a desigualdade de renda nas práticas de higiene bucal, nas condições bucais e no uso de serviços odontológicos na população brasileira de adultos e idosos. Métodos: Foram utilizados dados da Pesquisa Nacional de Saúde realizada em 2013 (PNS 2013) referentes à população de 18 anos ou mais. Resultados: Detectaram-se desigualdades entre os estratos de renda na maioria dos indicadores de saúde bucal avaliados. As desigualdades de maior magnitude foram verificadas no uso de fio dental, nas práticas de higiene (RP = 2,85 nos adultos e RP = 2,45 nos idosos), e na perda de todos os dentes (RP = 6,74 nos adultos e RP = 2,24 nos idosos) e dificuldade de mastigar (RP = 4,49 nos adultos e RP = 2,67 nos idosos) entre os indicadores de condições bucais. Na maioria dos indicadores de condições bucais a magnitude das desigualdades foi elevada em ambos os grupos. A renda mostrou-se um fator que persiste limitando o acesso aos serviços odontológicos e, mesmo os segmentos de menor renda apresentaram elevados percentuais que pagam por consulta odontológica. Conclusão: Por meio dos dados da primeira PNS, os achados do estudo permitiram identificar aspectos de saúde e de atenção bucais mais comprometidos pelos diferenciais de renda, podendo, nesse sentido, contribuir para o planejamento da assistência odontológica no país e para estimular o monitoramento destas disparidades com dados das próximas pesquisas.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Social Class , Dental Health Surveys/methods , Oral Health/statistics & numerical data , Dental Health Services/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Income/statistics & numerical data , Oral Hygiene , Socioeconomic Factors , Brazil/epidemiology , Dental Health Surveys/statistics & numerical data , Prevalence , Regression Analysis , Health Status Disparities , Healthcare Disparities/statistics & numerical data , Middle Aged
19.
Arq. neuropsiquiatr ; 76(7): 444-451, July 2018. tab
Article in English | LILACS | ID: biblio-950566

ABSTRACT

ABSTRACT In light of the high cost of dementia treatment, there is legislation authorizing free distribution of cholinesterase inhibitors to those suffering from Alzheimer's disease in Brazil. However, the existence of this free distribution does not guarantee adequate distribution. Objectives The present study aimed to investigate the trends of prescriptions and the coverage of Alzheimer's disease treatment using cholinesterase inhibitors from public pharmacies dispensing high-cost drugs in Brazil. Methods This was a retrospective study that collected data from the Brazilian public Unified Health System. All cholinesterase inhibitors distributed at no cost to Brazilians during the year 2014, as well as the estimated number and percentages of patients who used these medications, were evaluated and compared to data from the year 2008. Results Our estimates indicated that 9.7% of the population having dementia syndromes used cholinesterase inhibitors, as well as 16.1% of those with Alzheimer's disease in Brazil. A clear disparity was noted between the use and distribution of cholinesterase inhibitors, depending on the region in which they were found. Over time, an increase in the distribution of cholinesterase inhibitors has been noted. In 2008, that use was 12.0% whereas, in 2014, it was 16.1%, an increase of 34% in six years. Conclusion It was estimated that 16.1% of patients with Alzheimer's disease in Brazil use cholinesterase inhibitors. These values have increased and, in spite of not being satisfactory, they indicate a potential for improvement. However, there is still a significant disparity among the regions.


RESUMO Devido ao custo alto de tratamento, existe uma legislação autorizando a distribuição sem custo de anticolinesterásicos para pacientes com doença de Alzheimer no Brasil. Entretanto, a existência dessa distribuição gratuita nem sempre garante uma distribuição adequada. Objetivos O presente estudo objetiva investigar a distribuição e desigualdades no uso de anticolinesterásicos (AChE) dispensados pelo Sistema de Saúde Público do Brasil. Métodos Estudo retrospectivo que coletou dados do Sistema Único de Saúde brasileiro. Foram avaliados todos os anticolinesterásicos distribuídos sem custo no Brasil durante o ano de 2014, assim como o número estimado e a porcentagem de pacientes que usavam essa medicação. Esses dados foram comparados com o ano de 2008. Resultados Estima-se que 9,7% da população que possui síndromes demenciais usa anticolinesterásicos, assim como 16,1% dos pacientes com doença de Alzheimer. Uma clara desigualdade entre o uso e a distribuição dos anticolinesterásicos foi encontrada, variando de acordo com a região. Houve um aumento na distribuição de anticolinesterásicos ao longo do tempo. Em 2008, o uso era de 12% e, em 2014, foi de 16,1%, resultando em um aumento de 34% em 6 anos. Conclusão Estima-se que 16,1% dos pacientes com doença de Alzheimer no Brasil usam anticolinesterásicos. Esses valores tiveram um aumento e, embora ainda não sejam satisfatórios, eles indicam um potencial de melhora. Entretanto, ainda foi evidenciada uma significante desigualdade entre as regiões.


Subject(s)
Humans , Cholinesterase Inhibitors/therapeutic use , Healthcare Disparities/statistics & numerical data , Alzheimer Disease/drug therapy , Medication Systems/statistics & numerical data , Brazil , Public Health , Retrospective Studies
20.
Salud colect ; 14(1): 5-17, mar. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-962398

ABSTRACT

RESUMEN Una de las tareas de la atención primaria de la salud es alcanzar una cobertura adecuada para el tratamiento de pacientes con hipertensión arterial. El objetivo de este estudio es analizar la variación espacial de la cobertura del tratamiento de hipertensión arterial en el municipio de Santiago de Chile, en el año de 2014, evaluando su relación con la distancia hacia los establecimientos de atención primaria y con factores socioeconómicos del lugar, utilizando técnicas de georreferenciamiento, modelos de regresión de Poisson global y geográficamente ponderada. Los resultados mostraron que la cobertura del tratamiento de hipertensión arterial presentaba dependencia espacial, dado que su relación con la presencia de adultos mayores, la proporción de inscritos, el nivel socioeconómico y la distancia hacia los establecimientos de salud varía en el espacio. Se concluye que para mejorar la cobertura de hipertensión arterial es necesario contemplar las diferentes realidades locales, lo que puede ser facilitado mediante la aplicación de técnicas de análisis espacial.


ABSTRACT One of the tasks of primary health care is to achieve adequate treatment coverage for patients with arterial hypertension. The aim of this study was to analyze the spatial variation of hypertension treatment coverage in the municipality of Santiago de Chile in 2014, evaluating its relationship with the distance to primary health care establishments and socioeconomic factors using georeferencing techniques and global and geographically weighted Poisson regression models. According to the results, arterial hypertension treatment coverage shows spatial dependence, given that its relationship with the presence of older adults, the proportion of population enrolled, socioeconomic status and the distance to primary health care establishments varied spatially. It is concluded that in order to improve hypertension coverage it is necessary to consider different local realities, a process that can be facilitated by the application of spatial analysis techniques.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Healthcare Disparities/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Hypertension/therapy , Socioeconomic Factors , Chile , Urban Health , Geographic Information Systems , Spatial Analysis
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