Brazilian Health System Research Articles

Cohort cholecystectomies in the Brazilian public system: is access to laparoscopy universal after three decades?

videosurgery in Brazil started in 1990 with the performance of laparoscopic cholecystectomy, being included by the public health system in 2008. We evaluated the current situation of the use of this technology in the Unified Health System (SUS - Sistema Único de Saúde). from 2013 to 2019, 1,406,654 patients registered at the SUS Informatics Department (DATASUS) were analyzed to calculate the rate of laparoscopic cholecystectomies (LC) in relation to open cholecystectomies (OC). Patient characteristics, disease presentation and postoperative mortality were evaluated. the LC rate reached 41.5% (growth of 68%) with no decrease in the absolute number of OC. In University Hospitals (UH), the LC rate reached 91.96%. The open technique in emergencies was more associated with male patients, aged 60 years or older, with prolonged hospitalization and in the ICU. Those undergoing LC were less predisposed to postoperative death, both electively (OR 0.49; 95% CI 0.42 - 0.56; NNT=20) and urgently (OR 0.23; 95% CI 0.20 - 0.25; NNT ≅1), providing a protective effect. despite the increase in the indication of LC, the open technique during the years studied remained stable and the most used in the public health system in Brazil. The effectiveness of public health policies to shorten the complete implementation of videosurgery in SUS needs to be investigated in future epidemiological studies, as well as its impact on postoperative morbidity and mortality.

Assessment of staffing needs for registered nurses and licensed practical nurses at primary care units in Brazil using Workload Indicators of Staffing Need (WISN) method

BackgroundThe balance between supply and demand for primary health care (PHC) services is one of the main challenges to the health system in Brazil. In this context, the application of planning methods could benefit the decision-making process for human resources organizations. Hence, the objective of this study was to assess the staffing needs for registered nurses (RNs) and licensed practical nurses (LPNs) at PHC services using the WISN method.MethodsThe Workload Indicators of Staffing Need (WISN) methodology was applied at 13 Primary Care Units (PCU) located in the city of São Paulo, Brazil. It included 87 RNs and 174 LPNs, and used data from 2017 to 2019.ResultsThe WISN results found that RNs were under high workload pressure at 10 PCUs (77%) in 2017 and 2018, with a decrease to 8 PCUs (61%) in 2019. For LPNs, high workload pressure increased from 2 PCUs (15%) in 2017 to 13 PCUs (100%) in 2018, with a decrease to 11 (85%) in 2019.ConclusionThe assessment of staffing needs for RNs and LPNs at the PCUs included in the study identified a consistent deficit in the number of professionals, and high workload pressure in most services throughout the study period.

Impact of COVID-19 Pandemic Over Solid Organ Transplantation in Unified Health System in Brazil and it Reflects in Rejection Episodes

Impact of COVID-19 Pandemic Over Solid Organ Transplantation in Unified Health System in Brazil and it Reflects in Rejection Episodes

EFETIVAÇÃO DO DIREITO DE HABILITAÇÃO E REABILITAÇÃO DA PESSOA COM DEFICIÊNCIA INTELECTUAL PELO SUS

This study aims to discuss the habilitation and rehabilitation for People with Disabilities (PCD), specifically for people with intellectual disabilities, as it contributes to more means of information for users who need this treatment and follow-up, since the greater the sources of information, more people will have access to treatments, which will make a difference in their lives. The realization of the right to habilitation and rehabilitation of people with intellectual disabilities aims at knowledge about the Brazilian Law of Inclusion of Persons with Disabilities (Statute of Persons with Disabilities), aiming at the work of the Unified Health System (SUS), which is important for PCD in their qualification and rehabilitation process. Ensuring a dignified treatment in health is to bring the PWD to a better coexistence in civil society. Aiming at quality of life and guarantee of rights, public health is directed to Persons with Disabilities, being composed of a wide network of care. Specifically in this work, the main approach is related to intellectual disability (ID), always with the aim of verifying and intensifying its potential. Interventions are carried out by a multi-professional technical team, which will work with People with Intellectual Disabilities in an individualized way, seeking success within the context presented to each one. The mechanisms for the implementation of this public policy must be allied to the family, civil society and the networking articulation is essential. Thus, the work presents a brief context about the functioning of the unified health system in Brazil, which covers People with Disabilities.

Acesso e direito à saúde para migrantes bolivianos em uma metrópole brasileira

Abstract This paper analyzes the health care accessibility conditions afforded to Bolivian immigrants in the Brazilian health system and their perception of the right to health. This was a cross-sectional, quantitative and qualitative study carried out from 2013 to 2015. Data were collected by a questionnaire with closed questions answered by 633 Bolivian individuals; questions regarding access to health were answered by 472 immigrants over 18 years old. Semi-structured interviews conducted with 55 subjects (Bolivians, health professionals, representatives of Health Departments, Consulate of Bolivia, Public Defender’s Office, Federal Public Prosecutor’s Office and Non-Governmental Organizations) underwent content analysis. Most Bolivian immigrants know the Brazilian National Health System (SUS) and often use Primary Health Care; however, they described structural and systemic barriers to health accessibility, such as lack of documentation, working conditions, medium and high complexity procedures, language barriers, among others. The National Health Card (CNS) is an important gateway to access health care, playing a role of social integration. Interviewees recognize health as a social right, pointing it out as a human and solidary value. Ensuring this recognition, when not based on the consolidation of social policies aimed at strengthening universal social protection, is threatened.

Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018.

This study aimed to analyze the presence of adequate infrastructure and work process in primary health care for the diagnosis, management, and treatment of syphilis in Brazil in 2012, 2014, and 2018. This is a cross-sectional, nationwide study with data from the three cycles of the Program for Improvement of Access and Quality of Basic Healthcare (PMAQ-AB): 2012 (Cycle I), 2014 (Cycle II), and 2018 (Cycle III). Two outcomes were assessed: adequate infrastructure and work process. The independent variables were macroregion, municipality size, Municipal Human Development Index (HDI-M), and coverage of the Family Health Strategy (FHS). Variance-weighted least squares regression was used to estimate annual changes in percentage. In total, 13,842 primary basic health units (UBS) and 17,202 professional health care teams were assessed in Cycle I; 24,055 UBS and 29,778 teams in Cycle II, and 28,939 UBS and 37,350 teams in Cycle III. About 1.4% of UBS had adequate infrastructure in Cycle I; 17.5% had in Cycle II; and 42.7% had in Cycle III. Adequate work process also increased in the three cycles, ranging from 47.3% in Cycle I to 45.5% in Cycle II and 75.4% in Cycle III. However, inequities are observed, considering that richer regions and larger municipalities, with higher HDI-M and lower FHS coverage improved the most. The low prevalence of adequate infrastructure and work process for the care of patients with syphilis in Brazil reflects a significant weakness in the Brazilian health system.

Gliomas molecular markers: importance in treatment, prognosis and applicability in brazilian health system.

Gliomas represent 80% of all primary malignant brain tumors in adults. In view of this public health problem, the early detection through sensitive and specific molecular tumor markers analysis can help to improve gliomas diagnosis and prognosis as well as their staging, assessment of therapeutic response and detection of recurrence. Therefore, this review focuses in current gliomas tumor markers, IDH-1/2, 1p/19q, MGMT, ATRX, TERT, H3, EGFR, BRAF and Ki67 used in clinic worldwide and their importance to early detection, glioma histological and molecular classification as well as in predicting patient's therapeutic response. In addition, we present what are the steps in the requesting process for this type of examination in the Brazilian Public Health System (SUS) scope, which attends most of the Brazilian population. Thereby, this article is useful in demonstrating which markers are used in the clinical practice for glioma patients and can be performed in the SUS through partnerships/agreements between specialized health centers and clinical analysis laboratories. It is hoped that this work clarifies, the necessary subsidies to carry out the research of tumor markers in all institutions that serve SUS users, providing a service with equal conditions.

Analysis of financial statements from companies in the Brazilian health sector (2009-2015): concentration, centralization of capital, and expressions of financialization

The Brazilian health system is characterized by major participation by the private sector. In the current decade, companies working in health-related sectors have stood out in the corporate world due to the results and size of their financial operations. The study analyzed the companies' trajectory from the perspective of financialization, defined as the dissemination of a pattern of accumulation, characteristic of contemporary capitalism. The article aimed to to analyze the expressions of financialization in the accounting-financial dimension of companies and corporate groups in the Brazilian health sector. The study describes the trajectory of accounting items and indicators from 2009 to 2015, based on an examination of financial statements from 43 companies in 5 subsectors (health plans, hospitals, retail pharmacies, pharmaceutical industry, and diagnostic and therapeutic support services). The results are analyzed in four categories: size, performance, indebtedness, and relevance of financial operations. The results were compared to the overall results for large and open-capital corporations in Brazil. The study reveals central aspects of financialization such as the sector's growth, the expansion of leading companies, and capital centralization, corroborating hypotheses concerning the concentration and centralization of capital. Other hypotheses, such as the relevant impacts of financial operations on revenues, were not confirmed. Finally, the evidence provided by a strictly accounting-based analysis suggest the need to incorporate other dimensions, especially such strategies as mergers, acquisitions, and other equity operations.

Clozapine prescription trends in Brazil in the last decade.

Clozapine is a second-generation antipsychotic indicated for treatment-resistant schizophrenia. Studies in several countries have shown a low rate of clozapine use despite the fact that approximately 30% of schizophrenia cases are treatment-resistant. In Brazil, few studies have addressed the frequency and variety of antipsychotic use in individuals diagnosed with schizophrenia (ICD F20). The objective of this study was to measure the rates of clozapine use in this population in the last decade using Brazilian Ministry of Health data. Prescriptions made between 2010 and 2020 in all 26 states and the Federal District registered at the Outpatient Information System Database from the Brazilian Health System (SIASUS) were evaluated. A total of 25,143,524 prescriptions were recorded in this period, with clozapine representing 8.86% of all antipsychotics. The most frequently prescribed antipsychotic for patients with schizophrenia was olanzapine (35.8%), followed by quetiapine (27.5%). From 2010 to 2020, the rate of clozapine prescriptions in Brazil increased from 7.2% to 10.9%. Despite a slight increase in prescriptions in the last decade, clozapine is still underutilized in Brazil.

Reply to the commentary on the article The Dynamics of Financialized Capitalism and the Brazilian Health System: Reflections in the Shadows of the COVID-19 Pandemic

Reply to the commentary on the article The Dynamics of Financialized Capitalism and the Brazilian Health System: Reflections in the Shadows of the COVID-19 Pandemic

Notes on the text The Dynamic of Financialized Capitalism and the Brazilian Health System: Reflections in the Shadows of the COVID-19 Pandemic

Notes on the text The Dynamic of Financialized Capitalism and the Brazilian Health System: Reflections in the Shadows of the COVID-19 Pandemic

Economic crisis and disparities in spending, supply, and use of public and private health services in Brazil from 2011 to 2019

This study sought to analyze the repercussions of the economic crisis on the public and private sectors of the Brazilian health system and perform a trend analysis of economic and care indicators, based on secondary data from official public sources related to spending, the economic performance of health plans and insurance, and the supply and use of services. The results showed stagnation of public spending on health, as well as reduction of per capita public spending and of access to public health services. On the contrary, in a context of falling income and employment, health plans retained customers, increased revenues, profits, and their care production. The positive performance of companies, before and after the crisis, can be explained by the trend of maintaining public subsidies for the private sector and by financialized business strategies. We conclude that the actions of the Brazilian government during the crisis deepened the restriction of resources to the public sector and favored the expansion of private services, which thus contributed to increase the discrepancy in access to public and private health services in the country.

Universal health system based on Primary Care and advanced practice nursing.

To reflect on advanced practice nursing in Primary Health Care considering the complexity of the Brazilian health system. Reflective study, based on the document "Expanding the role of nurses in Primary Health Care" and anchored in the literature and critical analysis of the authors. Due to the complexity of the Unified Health System - in terms of infrastructure, human resources, funding - it is important for Brazil to carry out its own systematic process of discussion on the implementation of advanced practice nursing, considering the context of the current health care model, to define the role of this practice according to the characteristics of a universal health system and not a universal health coverage. Final considerations: The expansion of the workforce and the insertion of advanced practice nursing in Brazilian Primary Health Care needs to happen with greater recognition and incentives for the actions performed at this level of care. For example, they must occur through integration between professionals and the community in health promotion actions, with the availability of appropriate technologies for the work, in order to guarantee the quality and resolution of Primary Health Care.

Integrated health practices: Scenarios for interprofessional experiences in the Brazilian health system.

Integrated health practices: Scenarios for interprofessional experiences in the Brazilian health system.

Clinical Homeopathic Study in the Homeopathic Ambulatory at UNIRIO University Hospital, Brazil

Background: In 1966, the Gaffrée and Guinle University Hospital – GGUH was incorporated into the Federal University of the State of Rio de Janeiro – UNIRIO. Since then the Homeopathy clinic has had it's service there. Since the creation of medical residency in Homeopathy in 2004, there has been a significant increase of treatment in the number of patients and also a significant increase in the inter-relationship with other specialists and hospital services. A wide variety of patients have been treated at the GGUH on a daily basis. Many patients have been examined and treated with homeopathy alone, while others were also examined in other specialties, making homeopathic treatment an adjunct to classical therapy and vice versa. Given the expressive number of medical consultations (around 2500/year), this outstanding result in our clinical and academic practice has created the relevance and need for the verification of the epidemiological profile of these patients. Epidemiological studies are needed to clearly show the population included in this hospital, which is considered to be a reference in the Brazilian Health System (SUS).
 
 Aims: To demonstrate the epidemiological and clinical homeopathic profile in the ambulatory of homeopathy at the Gaffrée and Guinle University Hospital (GGUH) of the Federal University of the Staate of Rio de Janeiro - UNIRIO, Brazil.
 
 Methodology: Cross-sectional study of 140 medical records randomly selected from the ambulatory of homeopathy at GGUH. The sample represents 50% of the monthly average of the clinical service from January to October 2009. The medical records incorrectly completed for the data analysis were excluded. Microsoft Office Excel 2007 used to data collection and analysis.
 
 Results and Discussion: A total of 100 records were selected for analysis (71.4%). Average age: 50 years old, 69% being between 41 and 80 years old. Gender: 79% women and 21% men. Marital status: 46% married, 36% single, 10% divorced and 8% widowed. Color: 61% white, 31% colored and 8% black. Education: Only 12% obtained an undergratuadion degree. Groups of diseases: Group-01 (48%) high prevalence: 19% respiratory, 15% osteoarticular and 14% psychiatric; Group-02 (45%) medium prevalence: 11% gastrointestinal, 9% cardiovascular, 8% genitourinary, 6% neurological, 6% dermatologic and 5% endocrine; Group-03 (7%) low prevalence: 3% otological, 2% immunological, 1% oncological and 1% ophtalmological. 82% of the patients were treated solely with homeopathy and 18% with homeopathy and allopathy. Clinical-homeopathic diagnosis: 53% functional, 38% lesional; 9% sensorial. Constitutional diagnoses: 31% sulfuric, 25% phosphoric, 22% carbonic, 22% mixed. Miasmatic / diathesic diagnosis: 47% sycotic, 28% psoric, 12.5% mixed, 9.5% tuberculinic, 3% syphilinic.
 
 Conclusion: This study demonstrated a higher prevalence of women over 50 years old with respiratory, osteoarticular and psychiatric diseases. Most of them had a sulfuric constitution and presented functional diseases of sycotic origin. Homeopathy was the most adopted treatment during the period studied. This knowledge led to the creation of the “Homeopathic Clinical Identification Summary” which is used in the GGUH ambulatory. Epidemiological and clinical data were extracted from this summary with the objective to construct clinical trials.

Development of cervical intraepithelial lesions and cervical cancer is not influenced by SOD2 RS4880 polymorhism

Some of the more than 200 known HPV types are essential for cervical cancer development, the third type of cancer most incident in the female population. However, for the malignant transformation occur, some cofactors are needed, as the reactive oxygen species (ROS), which can be neutralized by the antioxidant system. The SOD2 enzyme, encoded by the same name gene, is found in mitochondria and is part of the first line of defense against oxidative stress damage. Genetic polymorphisms can act by altering the efficiency of the enzyme, among which the most studied is the rs4880. Thus, the purpose of the present study was to evaluate the association of this polymorphism with HPV infection and the development of low and high grade squamous intraepithelial lesions (LSIL and HSIL) and cervical cancer, in 407 women attended by the public health system in Brazil. HPV detection in cervical secretion samples was carried out by polymerase chain reaction (PCR) and blood samples were used for polymorphism genotyping through PCR followed by restriction fragment length polymorphism (RFLP). PCR and restriction products were subjected to 10% polyacrylamide gel electrophoresis. HPV negative group (control) included 158 women and the HPV positive group (case) 249 women. The infected group was divided into No Lesion (n = 90), LSIL (n = 20), HSIL (n = 67) and cervical cancer (n = 72). The data found on socio-epidemiological characteristics and habits corroborated with data found in the literature. The distribution of genotypes in the control group was 51.9% women TC, 29.8% TT and 18.3% CC. In the case group, the distribution was 55.0% women TC, 26.1% TT and 18.9% CC. This is the first study evaluating the influence of SOD2 rs4880 polymorphism on HPV infection, the development of cervical intraepithelial lesions and cervical cancer in a Brazilian population, although additional studies are needed to corroborate the results.

The role of health literacy as a factor associated with tooth loss.

ABSTRACTOBJECTIVE The objective was to analyze the role of health literacy (HL) as a factor associated with tooth loss among users of the Brazilian Health System with chronic non-communicable diseases.METHODS The cross-sectional analytical study was conducted with adult and elderly users chosen at ten Family Health Clinics in a draw in the town of Piracicaba, São Paulo State, Brazil. A questionnaire was applied with sociodemographic data (sex, age, skin color and education), behavioral data (brushing and flossing), determinants in health (type of dental health services and how often) and clinical data (pain). Mouth conditions were collected by intraoral examination of visible dental biofilm and community Pediodontal Index. The systemic clinical conditions (blood glucose, glycated hemoglobin and blood pressure) were extracted from the medical records. The explanatory variable was HL (low, medium and high), measured with the Health Literacy Scale (HLS-14).RESULTS The outcome was tooth loss measured by the index of decayed, missing and filled teeth. Logistic regression was performed using a conceptual model for HL (p < 0.05). For the 238 subjects, the mean age was 62.7 years (± 10.55). Tooth loss was associated with HL in regression models adjusted by type of dental service, dental frequency, and dental floss. In the final model, the factors associated with tooth loss are older age (OR = 1,12; 95%CI: 1,07–1,17), a lower education (OR = 3,43; 95%CI: 1,17–10,10), irregular use of dental floss (OR = 4,58; 95%CI: 1.75 in–7,31), irregular use of dental services (n = 2,60; 95% 1,32–5,12), periodontal pocket (> 4 mm) (n = 0,31; 95%CI: 0,01–0,08), having visible dental biofilm (OR = 7,23; 95%CI: 3,19–16,41) and a higher level of blood sugar (glucose) (n = 1,98; 95%CI: 1.00–3,92).CONCLUSIONS tooth loss was associated with HL when adjusted by health behaviors; when sociodemographic variables and clinical conditions were included, it was less significant. In the final model, behaviors, determinants in health and clinical conditions were risk indicators of tooth loss, showing the multifactorial nature of this phenomenon.

Prediction of indicators through machine learning and anomaly detection: a case study in the supplementary health system in Brazil

The research aimed to investigate the stages of a Machine Learning model process creation in order to predict the indicator over the number of medical appointments per day done in the area of ​​supplementary health in the region of Porto Alegre / RS - Brazil and to propose a metric for anomalies detection. Literature review and applied case study was used as a methodology in this paper, besides was used the statistical software called R, in order to prepare the data and create the model. The stages of the case study was: database extraction, division of the base in training and testing, creation of functions and feature engineering, variables selection and correlation analysis, choice of the algorithms with cross-validation and tuning, training of models, application of the models in the test data, selection of the best model and proposal of the metric for anomalies detection. At the end of these stages, it was possible to select the best model in terms of MAE (Mean Absolute Error), the Random Forest, which was the algorithm with better performance when compared to Linear Regression and Neural Network. It also makes possible to identified nine anomaly points and thirty-eight warning points using the standard deviation metric. It was concluded, through the proposed methodology and the results obtained, that the steps of feature engineering and variables selection were essential for the creation and selection of the model, in addition, the proposed metric achieved the objective of generates alerts in the indicator, showing cases with possible problems or opportunities.

Telemedicine Versus Face-to-Face Care in Ophthalmology: Costs and Utility Measures in a Real-World Setting

ObjectivesAdvances in telemedicine offer a unique opportunity to expand access to the health system. Nevertheless, few studies have described the impact of telediagnosis implementation on health and economic outcomes. MethodsAn ophthalmology telediagnosis service (TeleOftalmo) was compared with traditional face-to-face care provided by the Brazilian public health system. For both groups, utility data were collected at 2 time points using the Visual Function Questionnaire–Utility Index instrument from interviews with 536 patients. The cost per patient encounter was analyzed according to the time-driven activity-based costing. Value analyses were conducted to ascertain whether and how telemedicine service has the potential to generate cost savings for the health system. ResultsVisual function–related quality of life did not differ significantly between TeleOftalmo and face-to-face care groups. Using the current model, the telemedicine service assisted an average of 1159 patients per month at a median cost per telediagnosis of Int$97 (interquartile range, Int$82-Int$119) versus Int$77 (interquartile range, Int$75-Int$80) for face-to-face care. If the telemedicine service was redesigned, considering the opportunities for improvement identified, it could operate at a cost of Int$53 per telediagnosis (a 31% cost savings) and could serve 3882 patients per month. ConclusionsThis study demonstrates the potential value of a telemedicine service. There was no difference in patient-perceived utility between a telediagnostic ophthalmology service and face-to-face care by an eye specialist. TeleOftalmo has the potential to be a cost-saving strategy for the Brazilian health system and could be a template for implementation of telediagnostic services in other regions.

Regulation and Use of Health Information Systems in Brazil and Abroad: Integrative Review.

There is increasing debate about the importance of using information and communication technologies to strengthen health systems. Information systems are one of the most widespread technologies for this end in different healthcare contexts. The primary objective of this study was to highlight and discuss the main characteristics of the regulation and use of health information systems in Brazil and abroad. As a secondary objective, the main characteristics identified in Brazil were compared with the findings for other countries. A robust search strategy incorporated five electronic databases. The research question was defined using the SPIDER strategy, and thematic content analysis was applied. Fourteen articles composed the final sample, and three analytic categories were identified: "Use in the Context of Health Systems"; "Implications for Health Management"; and "Communication and Interoperability." The regulation and use of health information systems in different countries was directly related to their socioeconomic context. In Latin America and Africa, policy strengthening and implementation possibilities for health management were discussed. In the United States, Europe, and Asia, the discussions on interoperability between different services was emphasized. The complexity of the Brazilian health system leads to similarities in the data analysis with several countries from different regions and with distinct political configurations.