Brazilian National Health System Research Articles

Behind Prep Decisions: Understanding User Patterns and Discontinuation Factors in Real-World.

This study aimed to characterize the epidemiological aspects of PrEP use and barriers to accessing this prophylaxis. This cross-sectional study was conducted between January 2021 and April 2022, encompassing 140 PrEP users treated at the Testing and Counseling Center (CTA) in Campo Grande, Mato Grosso do Sul. Data on sociodemographic characteristics and factors associated with PrEP discontinuation were obtained using a standardized questionnaire. Most PrEP users were cisgender men (92.00%), predominantly white (51.00%), over 30years of age (56.50%), homosexual-oriented (76.50%), and had a minimum of 12years of education (77.50%). Approximately 60.00% admitted to inconsistent condom use in recent sexual encounters, primarily involving anal intercourse. Approximately 88.00% perceived themselves as at risk of contracting STIs in the upcoming year. Regarding new presentation forms, 54.00% indicated a willingness to use "on-demand PrEP," and 92.00% expressed interest in using "injectable PrEP." After 6months of follow-up, 43.60% (95.00% CI: 35.50-52.00) discontinued PrEP use, primarily due to changes in sexual behavior (38.30%) and difficulties accessing healthcare services (21.28%). This study underscores the need to involve diverse key populations and highlights the significance of PrEP as an ongoing monitoring strategy for HIV/STI prevention in addition to the importance of incorporating new formulations such as daily oral PrEP into the Brazilian National Health System (SUS).

Comparative effectiveness of clozapine and non-clozapine atypical antipsychotics provided by the Brazilian National Health System in adults with schizophrenia.

Currently, 21 million people live with the disease, mostly in low to middle-income countries. We aimed to assess the survival of patients with schizophrenia using clozapine compared with non-clozapine atypical antipsychotics provided by the Brazilian National Health System using real-world data. This is an open retrospective cohort study of patients diagnosed with schizophrenia to whom atypical antipsychotics were dispensed by the Brazilian National Health System between 2000 and 2015, based on deterministic-probabilistic pairing of administrative data records. The Kaplan-Meier method was used to estimate the cumulative probability of survival and the Cox proportional hazards model was adjusted to assess the risk factors for survival via the hazard ratio (HR). Participants were 375,352 adults with schizophrenia, with an overall survival rate of 76.0% (95%CI 75.0-76.0) at the end of the cohort. Multivariate analysis indicated a greater risk of death for men (HR=1.30; 95%CI 1.27-1.32), older adults (HR=17.05; 95%CI 16.52-17.60), and in the Southeast region of Brazil (HR=1.20; 95%CI 1.17-1.23). Patients who used non-clozapine atypical antipsychotics had a 21% greater risk of death when compared to those taking clozapine (HR=1.21; 95%CI 1.14-1.29). Additionally, a history of hospitalization for pneumonia (HR=2.17; 95%CI 2.11-2.23) was the main clinical variable associated with increased risk of death, followed by hospitalization for lung cancer (HR=1.82; 95%CI 1.58-2.08), cardiovascular diseases (HR=1.44; 95%CI 1.40-1.49) and any type of neoplasia (HR=1.29; 95%CI 1.19-1.40). This is the first published Brazilian cohort study that evaluated survival in people with schizophrenia, highlighting the impact of atypical antipsychotics. In this real-world analysis, the use of clozapine had a protective effect on survival when compared to olanzapine, risperidone, quetiapine, and ziprasidone.

The Development of the Municipal Registry of People with Diabetes in Porto Alegre, Brazil.

Background/Objective: Diabetes registries that enhance surveillance and improve medical care are uncommon in low- and middle-income countries, where most of the diabetes burden lies. We aimed to describe the methodological and technical aspects adopted in the development of a municipal registry of people with diabetes using local and national Brazilian National Health System databases. Methods: We obtained data between July 2018 and June 2021 based on eight databases covering primary care, specialty and emergency consultations, medication dispensing, outpatient exam management, hospitalizations, and deaths. We identified diabetes using the International Classification of Disease (ICD), International Classification of Primary Care (ICPC), medications for diabetes, hospital codes for the treatment of diabetes complications, and exams for diabetes management. Results: After data processing and database merging using deterministic and probabilistic linkage, we identified 73,185 people with diabetes. Considering that 1.33 million people live in Porto Alegre, the registry captured 5.5% of the population. Conclusions: With additional data processing, the registry can reveal information on the treatment and outcomes of people with diabetes who are receiving publicly financed care in Porto Alegre. It will provide metrics for epidemiologic surveillance, such as the incidence, prevalence, rates, and trends of complications and causes of mortality; identify inadequacies; and provide information. It will enable healthcare providers to monitor the quality of care, identify inadequacies, and provide feedback as needed.

Impacts of mining disasters on the ambulatory care of the Brazilian national health system: the cases of Mariana and Brumadinho/Brazil

BackgroundDisasters are events that bring with them effects that contribute to the disruption of the normality of a population and thus highlight the vulnerabilities of the health system. In Mariana and Brumadinho, the collapse of the dam of ore tailings brought with it several impacts that were felt in the short term and will be felt in the medium and long term. And that by being intensely intertwined with issues of economic and productive nature, has as its meaning an uninterrupted result of its activities.MethodsThrough the DATASUS database, two specific variables were chosen to perform the analysis: the approved amount and the approved value. For this research, a methodological device, the segmented regression line, was used to observe the influences that the disasters that occurred in Mariana and Brumadinho had on the ambulatory health systems.ResultsThe results of the segmented regression line show that, with Mariana, the amount approved continued to grow throughout the period, which shows that there was no change because of the disaster. There was a reduction in spending. In Brumadinho, regarding the amount approved, there was an upward trend in the disaster’s month, which did not change immediately afterwards, and regarding expenditure, the growth pattern was maintained in all three periods. Corroborating this data, the relative and absolute base elements show an increase in the amount approved and in the number of services provided at various posts compared with Minas Gerais.ConclusionsBased on the findings, it was possible to understand that although disasters exert an influence that may have some effect on the health system, the lack of significance sometimes cannot be interpreted as a lack of impact on the disaster. The segmented regression line outlines some effects that are not conclusive but indicative of a numerical interpretation and a trend interpretation.

Bed demand and occupancy within the Brazilian National Health System for the most common types of cancer in Brazil, from 2018 to 2021: a cross-sectional study.

To analyze bed demand and occupancy within the Brazilian National Health System (Sistema Único de Saúde - SUS) for the main types of cancer in Brazil, from 2018 to 2021. This was a descriptive cross-sectional study, using data from the Hospital Information System. Queuing theory model was used for calculating average admission rate, average hospitalization rate, probability of overload, and average number of people in the queue. The Southeast and South regions showed the highest average hospitalization rates, while the North region showed the lowest rates. The Southeast region presented a high probability of surgical bed overload, especially in the states of São Paulo (99.0%), Minas Gerais (97.0%) and Rio de Janeiro (97.0%). São Paulo state showed an overload above 95.0% in all types of beds analyzed. There was a high probability of oncology bed occupancy within the Brazilian National Health System, especially surgical and medical beds, and regional disparities in bed overload. The study found a high demand for hospital admissions to oncological bed in the Southeast region and a high probability of system overload in the states of the Southeast and Northeast regions of Brazil, thus highlighting the inequities in access to healthcare services in the country. This study presents a methodology for the improved allocation of resources and management of surgical and medical bed flows in areas with the highest bed overload and regions with low service availability. It is necessary to promote public policies that ensure the equitable supply of beds for oncological treatment within the SUS, especially in states with bed overload and healthcare service gaps.

Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019.

To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019. This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression. A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend. The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend. From 2011 to 2019, the diabetes mellitus hospitalization rate was 6.77 per 10,000 inhabitants, with a falling trend. Total expenditure was US$420,692.23 and it showed a rising trend. The study warns of the increase in child and adolescent hospitalizations, which indicates the need to invest in preventive actions and early diagnosis. The increase in length of hospital stay and related costs indicates a worrying scenario for the Brazilian National Health System and emphasizes the need to improve access to and quality of care, with a focus on diabetes education, so as to avoid complications and hospitalizations.

Impact of HIV pre-exposure prophylaxis (PREP) on health-related quality of life (QOL) of patients followed up at a reference center in São Paulo, Brazil

BackgroundHIV Pre-Exposure Pophylaxis (PrEP) is provided free of charge by the Brazilian national health system. Though effective in preventing HIV infection, little is known about its impact on the health-related Quality of Life (QoL) of users. ObjectiveThe present study aimed at assessing the impact of PrEP on the QoL of its users. MethodsProspective cohort study with 114 HIV-negative participants aged 18 years or older. Participants' QoL was assessed before starting PrEP and after 7 months of use, using the self-responsive WHOQOL-bref questionnaire. Sociodemographic and behavioral aspects were described and the Wilcoxon signed-rank test with p ≤ 0.05 was considered statistically significant. ResultsImprovement was seen in QoL scores for the environment domain (p = 0.02), which addresses feeling of physical safety, access to information and health services, and participation in leisure activities. Furthermore, participants reported improved satisfaction with their sex life, when questioned about the social relationships domain. There was no statistically significant change in the global QoL score, in the global health score, in the physical and psychological domains, nor in the total score for the social relationships domain. As for their socio-demographic profile, most participants were white and highly educated young cisgender men who have sex with men. 76.3% had unprotected sex in the 3 months before starting PrEP. 60.5% had reported substance use: marijuana (42.1%), club drugs (35.1%), and poppers (20.2%). ConclusionsThis study unveiled that PrEP benefited our cohort beyond its effectiveness in preventing HIV infection, having improved environmental aspects of QoL and self-satisfaction with sex life.

ERRATUM: Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019

ERRATUM: Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019

Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life.

To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil. Marked racial inequalities were found in the obstacles to vaccination of children under 24 months in Brazil and to timely vaccination at 5 months and in the first year of life. Racial inequalities in the occurrence of vaccination shortcomings in health services, in the objective restrictions faced by families in taking their children to vaccination centers and in incomplete vaccination in a timely manner need to be addressed by the Brazilian National Health System. Equal public policies to address barriers to vaccination and qualification of health services need to be implemented. Studies need to deepen understanding of the structural determinants that lead to racial disparities.

Saúde Digital no Sistema Único de Saúde (SUS)

Saúde Digital no Sistema Único de Saúde (SUS)

Theoretical-methodological framework, functions, and effects of institutional support in health within the Brazilian National Health System (SUS)

Resumo Os arranjos de apoio institucional têm se destacado como um modo inovador de gestão. Este artigo objetivou sumarizar e analisar o arcabouço teórico-metodológico e os efeitos do apoio institucional no contexto do Sistema Único de Saúde (SUS) e sintetizar os conceitos, as funções e as habilidades do apoiador institucional. Uma revisão de escopo foi empreendida em diferentes bases científicas, resultando em 89 publicações, cuja análise indicou que os conceitos e métodos de apoio se ancoram no Método Paideia, que intenciona a democratização da gestão. Os apoiadores institucionais, com esse objetivo, atuam como articuladores dos diversos jeitos de gerir a micropolítica dos espaços coletivos, fornecendo suporte para o movimento de ampliação da descentralização do poder e para a geração de autonomia. Os efeitos de sua aplicação expressam processos de democratização institucional, que se traduzem como dilatação da autonomia dos sujeitos nos processos decisórios, da reflexão crítica e compreensão dos processos instituídos. Esses efeitos também expressam novos modos de produzir saúde, que buscam romper com as práticas de saúde repetitivas, cristalizadas e cronificadas. As evidências publicadas não nos permitiram refletir a respeito dos limites macro e microinstitucionais concretamente encontrados na implementação do apoio, colocando-nos o desafio de adentrarmos cientificamente nas práticas de socialização de recursos de poder operadas pela função apoio.

A contracepção como um valor: histórias de jovens sobre desafios no uso e manejo dos métodos

Abstract This study presents the findings of the social anthropological research project “Jovens da era digital: Sexualidade, reprodução, redes sociais e prevenção às IST/HIV/AIDS” [Young people in the digital age: Sexuality, reproduction, social media, and prevention of STI/HIV/AIDS], which was conducted with interlocutors between the ages of 16 and 24 years old from six Brazilian cities. This study focuses on contraceptive management among heterosexual adolescents and young adults, with particular emphasis on women, given their prominent role in family planning within hierarchical gender contexts. We describe the typical script for youth contraception, which involves the use of condoms at the onset of sexual activity, followed by the incorporation of hormonal methods or the withdrawal method. We also find that adolescents frequently resort to the use of emergency contraception. Women frequently report experiencing side effects from hormonal contraceptives, which results in high rates of discontinuation and an increased interest in copper IUDs, which are scarce resources within the Brazilian National Health System. It can be concluded that, despite gender constraints and social, ethnic, and racial inequalities, the interviewees value contraception, offering insights for the review and improvement of public policies concerning young people.

Blows and clinches: scenes of a cartographic study between the Brazilian National Health System (SUS) and supplementary health

A pesquisa cartográfica se caracteriza pela imersão da pessoa pesquisadora no território afetivo-existencial a ser pesquisado. Este artigo põe em análise, por meio dessa proposta metodológica, as implicações e sobreimplicações de um pesquisador negro, bissexual e médico de Família e Comunidade em um contexto de trabalho e pesquisa entre uma Unidade Básica de Saúde (UBS) e uma clínica de atenção primária de um plano privado de saúde localizada no município de Natal, RN. Ele desvela, por meio da “escrevivência” de quatro cenas, a precarização do processo de trabalho, a deterioração de algumas ferramentas clínicas e a forte presença de um racismo estrutural e institucional.

Digital Health in the Brazilian National Health System (SUS)

Digital Health in the Brazilian National Health System (SUS)

Hospitalizations for mental and behavioral disorders due to alcohol and other psychoactive substance use among adolescents in Brazil, 2017-2022.

To assess the epidemiological profile and trend in hospitalizations for mental and behavioral disorders due to alcohol and other psychoactive substance use among Brazilian adolescents, between 2017 and 2022. This was a time-series study using data from the Hospital Information System of the Brazilian National Health System; the trend analysis was performed by estimating the annual percentage change (APC) of hospitalization rates per 100,000 inhabitants and respective confidence intervals (95%CI), using the Prais-Winsten method. A total of 29,991 hospitalizations were recorded in the study period, with a decreasing trend observed, from 16.18/100,000 inhabitants in 2017 to 13.72/100,000 inhab. in 2022 (percent change of -2.65%; 95%CI -4.47;-0.80), a greater decline was found in males (-3.48%; 95%CI -5.20;-1.72), in the age group of 15 to 19 years (-2.79%; 95%CI -4.49;-1.06), in the South (-3.29%; 95%CI -5.37;-1.16) and Midwest (-3.64%; 95%CI -5.75;-1.49) regions of the country. Hospitalizations showed a decreasing trend in the study period, with sociodemographic disparities.

Human Papillomavirus vaccination coverage among the female population living in the state of Goiás, Brazil, 2014-2020: a time series study.

To analyze the temporal trend of human papillomavirus (HPV) vaccination coverage among the female population aged 10 to 14 years, living in the state of Goiás, Brazil, between 2014 and 2022. This was an ecological time series study using data from the Brazilian National Health System Information Technology Department (Departamento de Informática do Sistema Único de Saúde - DATASUS); the annual vaccination coverage rate was calculated based on the number of second doses administered; the trend of the rates was analyzed using the Prais-Winsten model. A total of 407,217 second doses of the quadrivalent HPV vaccine were administered to the female population aged 10-14 years, with annual vaccination coverage rates ranging from 12.3% (2019) to 30.0% (2015), and an annual percentage change (APC) of 0.7% (95%CI 0.9; 0.2; p-value = 0.030). In Góias state, the quadrivalent HPV vaccine coverage rate was below the national target (80%), showing a stationary trend in the time series.

Validation study of obstetric hospitalization data held on the Brazilian National Health System Hospital Information System for maternal morbidity surveillance: Brazil, 2021-2022.

To validate the Brazilian National Health System Hospital Information System (SIH/SUS) for maternal morbidity surveillance. This was a cross-sectional study conducted in 2021/2022, taking as its reference a national study on maternal morbidity (MMG) conducted in 50 public and 28 private hospitals; we compared SIH/SUS and MMG data for hospitalization frequency, reason and type of discharge and calculated sensitivity, specificity, positive and negative likelihood ratios for seven diagnoses and four procedures. Hospitalizations identified on SIH/SUS (32,212) corresponded to 95.1% of hospitalizations assessed by MMG (33,867), with lower recording on SIH/SUS (85.5%) for private hospitals [10,036 (SIH/SUS)]; 11,742 (MMG)]; compared to MMG, SIH/SUS had a lower proportion of hospitalizations due to "complications during pregnancy" (9.7% versus 16.5%) as well as under-recording of all diagnoses and procedures assessed, except "ectopic pregnancy". Better recording of diagnoses and procedures on SIH/SUS is essential for its use in maternal morbidity surveillance.

Training for the Brazilian National Health System (SUS) in health residency programs: an analysis of policy effects in a state context

Este artigo analisa o contexto dos efeitos da política de residência em área profissional da saúde no estado de Pernambuco, Brasil, por meio do referencial teórico-analítico da Abordagem do Ciclo de Políticas. Trata-se de um estudo qualitativo que utilizou entrevista semiestruturada com nove atores-chave e pesquisa documental, explorada pela análise de conteúdo temática. Como resultados da política, observaram-se: fortalecimento do papel do Sistema Único de Saúde (SUS) na regulação da formação, elevada qualificação dos profissionais de saúde, qualidade do cuidado e ampliação do acesso. O investimento na implementação da política, enquanto lócus privilegiado de articulação entre ensino, serviço e comunidade, potencializa o alcance da integralidade da atenção ao mesmo tempo que contribui para avançar as mudanças necessárias na formação superior em Saúde e nas práticas de cuidado, ainda que persistam limites.

Descoordenação a serviço do racismo institucional: considerações sobre o acesso de indígenas à política de saúde

Abstract The Brazilian policy for indigenous health has its efficacy conditioned by the promotion of intergovernmental coordination between the Special Secretariat for Indigenous Health (SESAI), municipal, and regional health services. This coordination should be done both in the policy formulation and in its implementation-which should occur between medium and street-level bureaucrats. Based on the literature that discusses federalism and intergovernmental coordination mechanisms, this article investigates the mechanisms and difficulties of cooperation in the frontline of health services offered to Indigenous peoples. A total of six semi-structured interviews were carried out with professionals of the SESAI in the Mato Grosso do Sul DSEI. It was identified that the difficulties are related mainly to institutional racism, the overload of the Brazilian National Health System (SUS), the unaccountability of municipal services, and the weak communication between SESAI and hospitals. The cooperation mechanisms are personal relations, situated agency of SESAI professionals, and a monetary incentive. In conclusion, there is a need for more intergovernmental collaboration mechanisms that consider these difficulties in integrating the implementation of these services.

Avaliação do conhecimento da equipe de enfermagem sobre doença periodontal e suas associações com alterações sistêmicas

Abstract Introduction The maintenance of oral health in inpatients is essential, particularly to avoid complications arising from periodontal disease, which not only affect oral health but can also exacerbate systemic issues during hospitalization. Objective: This study aimed to assess nursing staff’s knowledge regarding the management of periodontal disease and its association with systemic diseases. Material and method This cross-sectional observational study was conducted in a general referral hospital of the Brazilian National Health System (SUS). A total of 504 nursing professionals completed a self-administered 24-item questionnaire on relating to oral care procedures and the importance of oral health in hospitalized patients. Data were analyzed using descriptive analysis and the chi-squared test (α = 0.05). Result Most respondents (97.8%) believed that oral infections can affect a patient's general health and that oral hygiene is important during hospitalization. However, knowledge deficits were identified. The oral effect of periodontal disease was considered moderate by 49.3% of the participants, and 74.6% believed that sugar was the most common cause of periodontal disease. Conclusion Nursing professionals are aware of the importance of maintaining oral hygiene and the relationship between periodontal and systemic diseases. However, their dental hygiene practice knowledge is limited. A training program on oral healthcare for inpatients and the inclusion of oral hygiene topics in the curricula of nursing professionals are recommended.