Proadi-SUS: analysis of financial resources in the three-year periods 2009-2011, 2012-2014 and 2015-2017 / Proadi-SUS: análise dos recursos financeiros nos triênios 2009-2011, 2012-2014 e 2015-2017

ABSTRACT OBJECTIVE To characterize the tax exemption resources used in the Support Program for Institutional Development of the Unified Health System (Proadi-SUS) in the 3-year periods 2009-2011, 2012-2014, 2015-2017, considering the total volume of resources linked to the debate on tax expenditures on health and the constitution of a "new form of philanthropy" in the sector. METHODS To understand the philanthropic sector, tax expenditures between 2001 and 2017 were analyzed. To evaluate the resources used in the program, the values of projects and areas of activity were examined. RESULTS A real increase in the values of general tax expenses and tax expenses referring to the philanthropic sector was found. There was also a real increase in the program's resources. A total of 407 projects were carried out, amounting to R$ 3.4 billion for the period. An analysis of the average value of the projects shows an increase in values for all hospitals included in the program, with the exception of one of the institutions. In the 2009-2011 and 2012-2014 periods, the area with the highest number of projects and the most resources was "Management techniques and operation in health services". In the 3-year period 2015-2017, however, the sector that received the most investments and the largest number of projects developed was "Human Resources Training". CONCLUSION The program characterizes a different expression of the public-private partnership in the health sector linked to the principles of the new public management. As a development for future investigations, a qualitative characterization of the projects developed and the actions' impact on the public sector demands is necessary.

RESUMO OBJETIVO Caracterizar os recursos de isenção fiscal usufruídos no Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (Proadi-SUS) nos triênios 2009-2011, 2012-2014, 2015-2017, considerando o volume total dos recursos atrelado ao debate dos gastos tributários em saúde e a constituição de uma "nova modalidade de filantropia" no setor. MÉTODOS Para compreender o setor filantrópico, analisaram-se os gastos tributários no período de 2001 e 2017. Para avaliar os recursos utilizados no programa, foram examinados os valores dos projetos e das áreas de atuação. RESULTADOS Foi constatado um crescimento real dos valores dos gastos tributários gerais e dos gastos tributários referentes ao setor filantrópico. Constatou-se, também, um aumento real dos recursos do programa. Foram realizados 407 projetos, totalizando um valor de R$ 3,4 bilhões para o período. Ao se analisar o valor médio dos projetos, explicita-se ampliação dos valores para todos os hospitais inseridos no programa, com exceção de uma das instituições. Nos triênios 2009-2011 e 2012-2014, a área de atuação com maior número de projetos e mais recursos foi a "Área de técnicas e operação de gestão em serviços de saúde". Já no triênio 2015-2017, o setor que contou com mais investimentos e maior número de projetos desenvolvidos foi o de "Capacitação de recursos humanos". CONCLUSÃO O programa caracteriza outro patamar na relação do setor público com o setor privado/empresariado da saúde, atrelado aos princípios da nova gestão pública. Faz-se necessária, como desdobramento para futuras investigações, uma caracterização qualitativa dos projetos desenvolvidos e do impacto das ações diante das demandas do setor público.

Effects of a physiotherapeutic protocol in cardiorespiratory, muscle strength, aerobic capacity and quality of life after hematopoietic stem cell transplantation

Abstract Objective To analyze the effects of hospital cardiorespiratory physical therapy protocol on the functional capacity and quality of life of patients submitted to hematopoietic stem cell transplantation (HSCT). Methods From January to December 2019, bilateral dynamometry, Manovacuometry and Ventilometry, peak expiratory flow "Peak Flow", 6-min walk test (6MWT), SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS) were applied in patients who have undergone an allogeneic or autologous hematopoietic stem cell transplantation (HSCT), pre-conditioning (initial evaluation) and pre-discharge (final evaluation). The patients were submitted to an intervention protocol, consisting of aerobic training, muscle strengthening and respiratory muscle training, between the two assessments. Results 29 patients were enrolled in the study and 24 (83%) completed all procedure. Myeloablative and reduced intensity conditioning were performed in 89.6% and 10.4%, respectively; 17 (58%) patients have undergone an autologous HSCT; 10 (35%) identical related allogeneic HSCT, and 2 (7%) haploidentical allogeneic HSCT. The median number of interventions per patient was 3 (1-9). A decreasing in the right and left dynamometry (p ≤ 0.0001 and 0.002, respectively) and, also in the distance covered in the 6MWT (p = 0.004), was observed after HSCT. There was no significant difference in respiratory muscle strength, quality of life and fatigue sensation. Conclusion Cardiorespiratory rehabilitation can preserve functional capacity and quality of life.

Teste de caminhada de seis minutos como ferramenta para avaliar a qualidade de vida em pacientes submetidos à cirurgia de revascularização miocárdica / Six-minute walk test as a tool for assessing the quality of life in patients undergoing coronary artery bypass grafting surgery

OBJETIVO: Avaliar a utilidade do teste de caminhada de seis minutos como indicador prognóstico de qualidade de vida em pacientes submetidos a revascularização do miocárdio. MÉTODO: Estudo prospectivo observacional em pacientes submetidos a operação de revascularização do miocárdio. Foram avaliadas as características clínicas, teste de caminhada de seis minutos (TC6) e questionário para avaliação de qualidade de vida, o questionário SF-36. Os pacientes foram avaliados no pré-operatório e divididos em dois grupos, conforme a distância percorrida no TC6: grupo que caminhou mais de 350 metros e grupo que caminhou menos de 350 metros. RESULTADOS: Foram incluídos no estudo 87 pacientes. A idade média semelhante em ambos os grupos (59 ± 9,5 anos vs. 61 ± 9,3 anos; P = 0,24). Os pacientes do grupo > 350 metros caminharam mais no TC6 após dois meses de operação (436 ± 78 metros vs. 348 ± 87 metros; P<0,01) quando comparado ao grupo < 350 metros. Observamos que a qualidade de vida era inferior no grupo < 350 metros em relação ao grupo > 350 metros, no período pré-operatório, nos domínios: capacidade funcional, aspectos físicos, estado geral de saúde, vitalidade e aspectos sociais. A qualidade de vida melhorou após dois meses, em ambos os grupos. CONCLUSÕES: O TC6 no pré-operatório tem correlação com a qualidade de vida após dois meses de revascularização do miocárdio. A qualidade de vida melhorou de forma geral em todos pacientes, sendo maior a melhora da qualidade de vida naqueles que caminharam menos que 350 metros no pré-operatório.

OBJECTIVE: To assess the quality of life in patients undergoing myocardial revascularization using the six-minute walk test. METHODS: Prospective observational study with patients who undergoing CABG. The clinical variables, the sixminute walk test, and the SF-36 test were recorded. The patients were assessed at the preoperative time and at 2 months of postoperative period. According their six-minute walk test results, the patients were divided into two groups: group walked more than 350 meters (> 350 meters Group) and the group walked less than 350 meters (< 350 meters Group) at the preoperative time. RESULTS: Eight-seven patients were included. Age was comparable in both groups (59 ± 9.5 years vs. 61 ± 9.3 years; respectively, P = 0.24). The group walked > 350 meters distance was higher than the < 350 meters group after 2 months of operation (436 ± 78 meters vs. 348 ± 87 meters; P <0.01). The quality of life was lower in the < 350 meters group compared to the > 350 meters group in the preoperative period in the following domains: functional capabilities, limitations due to physical aspects, overall health feelings, vitality, and social aspects. Quality of life improved after two months in both groups. CONCLUSIONS: The six-minute walk test at the preoperative time is associated with the quality of life after two months of coronary artery bypass grafting. In overall, quality of life has improved in all patients. The improvement in the quality of life was greater in those patients who walked distances lower than 350 meters at the preoperative time.