Psychometric evaluation of the SF-36 (v.2) questionnaire in a probability sample of Brazilian households: results of the survey Pesquisa Dimensões Sociais das Desigualdades (PDSD), Brazil, 2008.

BACKGROUND: In Brazil, despite the growing use of SF-36 in different research environments, most of the psychometric evaluation of the translated questionnaire was from studies with samples of patients. The purpose of this paper is to examine if the Brazilian version of SF-36 satisfies scaling assumptions, reliability and validity required for valid interpretation of the SF-36 summated ratings scales in the general population. METHODS: 12,423 individuals and their spouses living in 8,048 households were selected from a stratified sample of all permanent households along the country to be interviewed using the Brazilian SF-36 (version 2). Psychometric tests were performed to evaluate the scaling assumptions based on IQOLA methodology. RESULTS: Data quality was satisfactory with questionnaire completion rate of 100%. The ordering of the item means within scales clustered as hypothesized. All item-scale correlations exceeded the suggested criteria for reliability with success rate of 100% and low floor and ceiling effects. All scales reached the criteria for group comparison and factor analysis identified two principal components that jointly accounted for 67.5% of the total variance. Role emotional and vitality were strongly correlated with physical and mental components, respectively, while social functioning was moderately correlated with both components. Role physical and mental health scales were, respectively, the most valid measures of the physical and mental health component. In the comparisons between groups that differed by the presence or absence of depression, subjects who reported having the disease had lower mean scores in all scales and mental health scale discriminated best between the two groups. Among those healthy and with one, two or three and more chronic illness, the average scores were inverted related to the number of diseases. Body pain, general health and vitality were the most discriminating scales between healthy and diseased groups. Higher scores were associated with individuals of male sex, age below 40 years old and high schooling. CONCLUSIONS: The Brazilian version of SF-36 performed well and the findings suggested that it is a reliable and valid measure of health related quality of life among the general population as well as a promising measure for research on health inequalities in Brazil.

[Characterization of assistance among philanthropic hospitals in Brazil]. / Caracterização assistencial de hospitais filantrópicos no Brasil.

OBJECTIVE: To characterize the Brazilian philanthropic hospital network and its relation to the public and private sectors of the Sistema Unico de Saude (SUS) [Brazilian Unified Health System]. METHODS: This is a descriptive study that took into consideration the geographic distribution, number of beds, available biomedical equipment, health care complexity as well as the productive and consumer profiles of philanthropic hospitals. It is based on a sample of 175 hospitals, within a universe of 1,917, involving 102 distinct institutions. Among these, there were 66 Brazilian Unified Health System (SUS) inpatient care providers with less than 599 beds randomly included in this study. Twenty-six of the twenty-seven SUS inpatient care providers with at least 599 beds, as well as ten institutions which do not provide their services to SUS, were also included. This is a cross-sectional study and the data was obtained in 2001. Data collection was conducted by trained researchers, who applied a questionnaire in interviews with the hospital's managers. RESULTS: Within the random sample, 81.2% of the hospitals are located in cities outside of metropolitan areas, and 53.6% of these are the only hospitals within their municipalities. Basic clinical hospitals, without ICUs, predominate within the random sample (44.9%). Among the individual hospitals of the large philanthropic institutions and the special hospitals, the majority -- 53% and 60% respectively -- are level II general hospitals, a category of greater complexity. It was verified that complexity of care was associated to hospital size, being that hospitals with the greatest complexity are situated predominantly in the capitals. CONCLUSIONS: Given the importance of the philanthropic hospital sector within the SUS [Unified Health System] in Brazil, this paper identifies some ways of formulating appropriate health policies adjusted to the specificities of its different segments.

Caracterização assistencial de hospitais filantrópicos no Brasil / Characterization of assistance among philanthropic hospitals in Brazil

OBJETIVO: Caracterizar a rede hospitalar filantrópica no Brasil e suas relações com o Sistema Unico de Saúde e o mercado de saúde suplementar. MÉTODOS: Estudo do tipo descritivo que considerou a distribuição geográfica, porte de leitos, presença de equipamentos biomédicos, complexidade assistencial e perfil de produção e de clientela. Baseou-se em uma amostra de 175 hospitais de um universo de 1.917, constituindo 102 entidades distintas. Destas, incluíram-se 66 entidades prestadoras de serviços ao Sistema único de Saúde (SUS) com menos de 599 leitos selecionadas aleatoriamente, 26 das 27 entidades prestadoras de serviços ao SUS com pelo menos 599 leitos e 10 entidades não prestadoras de serviços ao SUS. O estudo é transversal, com dados obtidos em 2001. A coleta de dados foi feita por pesquisadores treinados, utilizando um questionário, em entrevistas com dirigentes dos hospitais. RESULTADOS: Da amostra aleatória, 81,2 por cento dos hospitais estão localizados em municípios do interior, sendo que 53,6 por cento desses se constituem nos únicos hospitais do município. Na amostra aleatória, predominaram os hospitais de clínicas básicas sem UTI (44,9 por cento). Entre os hospitais individuais das grandes entidades e os hospitais especiais, a maioria - respectivamente 53 por cento e 60 por cento - caracterizou-se como hospital geral nível II, categoria de maior complexidade. A complexidade assistencial mostrou-se associada ao porte do hospital, estando os hospitais mais complexos predominantemente situados em capitais. CONCLUSÕES: Dada a importância do setor hospitalar filantrópico para o Sistema de Saúde no Brasil, identificam-se possíveis caminhos para a formulação de políticas públicas adequadas às especificidades dos seus diferentes segmentos.