Résumé
Abstract Objective To evaluate the hospital cost of newborn infants diagnosed with sepsis from the perspective of the Brazilian Public Health System over 11 years. Method Cross-sectional study that analyzed secondary data from the databases of the Hospital Information System of the Brazilian Public Health System. Infants hospitalized between 0‒29 days after birth with a diagnosis of sepsis from 2008 to 2018 were included. The diagnosis used in the study was the one that the hospital considered the main diagnosis at admission. Costs were analyzed in US dollars and reflected the amount paid by the Brazilian Public Health System to the hospitals for the informed diagnosis upon admission. The costs were evaluated as the total per admission, and they were compared among Brazilian geographic regions, among etiologic agents, and between neonates with the diagnosis of sepsis that survived or died. Results From 2008 to 2018, 47,554 newborns were hospitalized with sepsis (148.04 cases per 100,000 live births), with an average cost of US$ 3345.59 per hospitalization, ranging from US$ 2970.60 in the North region to US$ 4305.03 in the Midwest. Among sepsis with identified agents, the highest mean cost was related to Gram-negative agents, and the lowest to Streptococcus agalactiae sepsis. Patients with sepsis who died had a higher cost than the survivors (t-test; p= 0.046). Conclusions The evaluation of costs related to neonatal sepsis in the country during an 11-year period shows the economic impact of morbidity that may be avoided by improving the quality of neonatal care.
Résumé
ABSTRACT Objective To analyze the COVID-19 pandemic in Brazil, a continental-sized country, considered as an emerging economy but with several regional nuances, focusing on the availability of human resources, especially for intensive care units. Methods The database of the National Registry of Health Facilities was accessed. Healthcare professionals in the care of COVID-19 were georeferenced. We correlated the number of professionals with the parameters used by the World Health Organization. According to the Brazilian Intensive Care Medicine Association, we correlated the data for adult intensive care unit beds in each state with the number of professionals for each ten intensive care unit beds. The number of professionals, beds, and cases were then organized by state. Results The number of physicians per 100 thousand inhabitants followed the World Health Organization recommendations; however, the number of nurses did not. The number of intensivists, registered nurses, nurse technicians specialized in intensive care, and respiratory therapists, necessary for every ten intensive care beds, was not enough for any of these professional categories. A complete team of critical care specialists was available for 10% of intensive care unit beds in Brazil. Conclusion There is a shortage of professionals for intensive care unit, as we demonstrated for Brazil. Intensive care physical resources to be efficiently used require extremely specialized human resources; therefore, planning human resources is just as crucial as planning physical and structural resources.
RESUMO Objetivo Analisar a pandemia da COVID-19 no Brasil, um país de dimensões continentais, considerado uma economia emergente, mas com inúmeras diferenças regionais, abordando a disponibilidade de recursos humanos, especialmente para unidades de terapia intensiva. Métodos Foi acessado o banco de dados do Cadastro Nacional de Estabelecimentos de Saúde. Os profissionais de saúde que atuavam nos cuidados para COVID-19 foram georreferenciados. O número de profissionais foi correlacionado com os parâmetros utilizados pela Organização Mundial da Saúde. De acordo com a Associação de Medicina Intensiva Brasileira, correlacionaram-se os dados de leitos de terapia intensiva adulta em cada unidade federativa com o número de profissionais para cada dez leitos de terapia intensiva. Os números de profissionais, leitos e casos foram, então, organizados por unidade federativa. Resultados O número de médicos por 100 mil habitantes seguiu as recomendações da Organização Mundial da Saúde; mas não o número de enfermeiras. O número de intensivistas, enfermeiros, técnicos de enfermagem especializados em terapia intensiva e fisioterapeutas respiratórios, necessário a cada dez leitos de terapia intensiva, não foi suficiente para nenhuma dessas categorias profissionais. Uma equipe completa desses especialistas esteve disponível para 10% dos leitos de terapia intensiva do Brasil. Conclusão Há carência de profissionais para unidade de terapia intensiva, como demonstrado no Brasil. Os recursos físicos da terapia intensiva, para serem usados de forma eficiente, precisam de recursos humanos extremamente especializados; portanto, o planejamento de recursos humanos é tão crucial quanto o planejamento de recursos físicos e estruturais.