Secretary Of State For Health Research Articles

The Perception of Health Care Professionals and Managers about Resource Allocation in Primary Health Care in Minas Gerais State Municipalities

Abstract This study aimed to examine and describe the perceptions of health professionals and managers about the main phenomena that influence resource allocation in primary health care. Adopting a qualitative approach, the field research was carried out in ten municipalities in Minas Gerais and involved eleven focus groups, six interviews and two semi-structured questionnaires in 2014 and 2015, and nine focus groups and five interviews in 2018, in which participated a total of 133 health professionals and managers. Other sources of evidence were also included, such as non-participating observations, photographs and documents from the Minas Gerais State Health Secretariat and the Ministry of Health. Based on the content analysis, eight categories of phenomena that influence resource allocation in PHC were obtained, derived from daily interactions between the population and health professionals and managers. Our findings show that primary health care is in a process of institutional change, dependent on the validity of actors and institutions, at different institutional levels. Among the determining factors affecting resource allocation in PHC, the main ones are the agency of the actors involved, the health service flow, the private sector, the medical corporatism, the influence of politicians, the municipal management capability, the infrastructure and groups of specific individuals.

Residência médica de pediatria: Limites e possibilidades

A Pós-Graduação em Medicina é uma etapa peculiar na Educação Médica, tendo na Residência Médica sua forma de especialização de caráter regular e permanente, e considerada padrão ouro na formação do médico. O estado do Maranhão tem uma das médias mais baixas, no que tange à relação profissionais médicos para cada grupo de mil pessoas. Em 2016 foi implementada a residência em Pediatria na rede estadual de saúde e buscamos através deste trabalho compreender a percepção dos médicos, residentes em Pediatria e preceptores, acerca de sua experiência nesse Programa de Residência Médica. Trata-se de um estudo descritivo e analítico, com abordagem qualitativa, e utilizamos como método para coleta de dados a entrevista semiestruturada onde entrevistamos 7 residentes e 13 preceptores. A pesquisa foi realizada de maio de 2019 a março de 2020, em um hospital de referência em Pediatria da rede estadual. Os resultados reafirmam a importância da residência médica, bem como apontam para a necessidade de redimensionamento da política de preceptoria médica da Secretaria de Saúde do Estado, no que se refere principalmente a importância de protocolos clínicos nos hospitais da rede, educação continuada na formação de médicos preceptores, revisão de contratos com grupos médicos que incluam a responsabilidade quanto à preceptoria médica, implementação de processo de avaliação de preceptores e definição de suas competências pedagógicas e responsabilidades técnicas.

Terms of engagement

Terms of engagement

Perfil dos portadores de hepatite A no Estado do Rio de Janeiro, no período de 2010 a 2018

Objetivo: Este estudo busca caracterizar o perfil dos indivíduos com hepatite A, no Estado do Rio de Janeiro, no período de 2010 a 2018. Metodologia: Trata-se de uma pesquisa transversal desenvolvida na abordagem quantitativa. Foram utilizados dados secundários provenientes da Ficha de Notificação das Hepatites Virais do banco do Sistema de Informação de Agravos de Notificação, cedida pela Secretaria Estadual de Saúde do Rio de Janeiro. Resultados: Foram analisados 48672 notificações, sendo que 3734 foram notificações confirmadas de portadores exclusivo da hepatite A, 28719 referentes a outras hepatites, 614 de co-infecção por mais de uma hepatite viral e 15605 ignoradas. A maior prevalência da hepatite A foi encontrada nos indivíduos com 4 a 8 anos de estudo, da raça negra, faixa ≤ 24 anos e sendo água e alimentos contaminados a principal fonte de contágio. Conclusão: A notificação dos casos e o preenchimento adequado é importante para definições de ações sanitárias capazes de mitigar os danos à saúde pública.

Public financing versus private billing in a public hospital under management of a Social Health Organization.

to assess the efficiency of management by a Social Health Organization (Organização Social de Saúde - OSS) compared with the private sector; to verify if there are savings for the State Health Secretariat (SES) in management contracts for financing the production of a public hospital versus its production values billed by private methods; and to establish if the amounts billed by the Unified Health System (SUS) table would finance the same procedures. we compiled and tabulated all procedures performed and the materials and drugs dispensed in the Euryclides Jesus Zerbini Transplant Hospital (HTEJZ), managed by the OSS Associação Paulista Para o Desenvolvimento da Medicina (SPDM), in September, October, and November 2018, according to the Brasíndice® table for drugs, the Simpro® table for materials, the CBHPM® table for medical fees, and tables SIGTAP SUS and SIA SUS. We then compared the average values obtained in the private billing with the costing amount reimbursed by the State Health Secretariat and the billing calculated in the SIA-SUS. the average SUS revenue was R$ 2,774,086.91; the monthly reimbursement by the SES was R$ 13,055,700.00; and the average private revenue was R$ 25,084,440.31. the management by the OSS SPDM in the Euryclides de Jesus Zerbini Transplant Hospital was more efficient in the financing / production ratio than it would be to a private hospital. The economy of public funds was significant. The current SUS table reimbursement values would not meet the need for funding for an overly complex hospital.

Hospital-based health technology assessment in Brazil: current experiences and challenges

Abstract In Brazil, there is no consensus on the concept of hospital-based health technology assessment (HB-HTA). There is great variability in the existing models and difficulty in evaluating their results—whether in respect of clinical decisions, quality of care, and hospital policy and management or in respect of optimizing the use of resources. This study aims to discuss the experiences of HB-HTA, its integration into the regulatory system for the adoption of new technologies into the Brazilian public (SUS) (Unified Health System), and its main challenges. During a workshop, a panel of specialists in HTA and/or HB-HTA was formed, representative of four different perspectives: (i) Health services and health technology assessment units, (ii) Academia, (iii) Secretary of State for Health, and (iv) the Federal SUS sector. This was followed by discussion, a preliminary consensus, contributions from the audience, a plenary session, and a final consensus. HB-HTA is not institutionalized, nor is it part of the regulation system for the adoption of new technologies in the SUS. The main challenges are the difficulties in creating qualified teams, financial support, and sustainability. The work of these bodies in respect of the evaluation of new technologies deserves further studies analyzing the relationship between the pressure for adoption from the hospital team and industry professionals and legal rulings. It is necessary to strengthen HB-HTA culture and implement this policy in hospital management, making assessment bodies a part of managerial and decision-making processes in hospitals, and develop regional collaborative networks and a national network of HTA.

Vaccinal Coverage of the Viral Triple in Cases of Measles in the Period 2016 to 2019 in Brazil

Objectives: Describe vaccination coverage and measles incidence in Brazil from 2016 to 2019. Methods: Quantitative, descriptive and retrospective study of confirmed cases of measles and vaccination coverage in the last 04 years, in the regions of Brazil. The data were exported from epidemiological bulletins from all regions, made available by the Ministry of Health and State Health Secretariats. Immunization data were collected using Tabnet/DATASUS, and organized in Microsoft Office Excel® (2019). Results: During 2016-2017, Brazil did not report confirmed measles cases. In 2018, 10,322 cases were recorded, with a prevalence of 10.245 (99.25%) in the North, followed by the South 46 (0.44%) and Southeast 23 (0.22%). In 2019, 20,901 cases were recorded, with the Southeast region having the highest incidence, 18.426 (88.15%), followed by the South region with 1.468 (7.02%). Between 2016-2019, the vaccination average was 84.05%. In this period, the North region reached the lowest coverage, 75.79%, followed by the Northeast region, 80.31%. In 2018, the highest incidence of cases was observed in the North region, due to the lower vaccination coverage obtained in the last 4 years. In 2019, the majority of cases were in the Southeast region, because despite the satisfactory vaccination coverage, the disease spreads more easily in large urban centers. Conclusion: Despite the increase in vaccination campaigns, Brazil has not reached the minimum number of vaccinations, in the last 4 years, to obtain herd immunity, increasing the manifestation of the disease in the last 2 years.

Delay in death reporting affects timely monitoring and modeling of the COVID-19 pandemic.

This study describes the COVID-19 death reporting delay in the city of São Luís, Maranhão State, Brazil, and shows its impact on timely monitoring and modeling of the COVID-19 pandemic, while seeking to ascertain how nowcasting can improve death reporting delay. We analyzed COVID-19 death data reported daily in the Epidemiological Bulletin of the State Health Secretariat of Maranhão and calculated the reporting delay from March 23 to August 29, 2020. A semi-mechanistic Bayesian hierarchical model was fitted to illustrate the impact of death reporting delay and test the effectiveness of a Bayesian Nowcasting in improving data quality. Only 17.8% of deaths were reported without delay or the day after, while 40.5% were reported more than 30 days late. Following an initial underestimation due to reporting delay, 644 deaths were reported from June 7 to August 29, although only 116 deaths occurred during this period. Using the Bayesian nowcasting technique partially improved the quality of mortality data during the peak of the pandemic, providing estimates that better matched the observed scenario in the city, becoming unusable nearly two months after the peak. As delay in death reporting can directly interfere with assertive and timely decision-making regarding the COVID-19 pandemic, the Brazilian epidemiological surveillance system must be urgently revised and notifying the date of death must be mandatory. Nowcasting has proven somewhat effective in improving the quality of mortality data, but only at the peak of the pandemic.

Distance training for professionals in the Academia das Cidades and Academia de Saúde Programs in Pernambuco

The objective of this study was to describe the experience of the development of the upgrading course in strategic actions for professionals in the Academia das Cidades e Saúde Programs, conducted by the School of Government in Public Health, together with the technical team of the Programs at the State Health Secretariat and the Secretariat for Urban Development and Housing, both from Pernambuco. For this, the experience report format was used. The course was developed through distance learning, in three stages: planning, development and evaluation. The minutes of meetings, tutors’ reports, online course monitoring files and students’ evaluations were used to describe the experience. The course was offered in 2019, in the state’s first health macro-region. Of the 156 professionals enrolled in the course, and who worked in the Programs, 100 concluded it, and positively evaluated the course, mainly in terms of changes in their work practices.

Perfil sociodemográfico dos pacientes confirmados para Covid-19 residentes no Espírito Santo, Brasil

Introdução: No final de 2019 o mundo foi acometido com o surgimento de uma doença, a Covid-19, que é causada pelo novo coronavírus SARS-COV-2, sendo inicialmente detectada na China e posteriormente se tornado uma pandemia, pois a doença ultrapassou várias fronteiras. Estudos deixam evidente que gênero, classe e raça apresentam condições de vulnerabilidade em relação à exposição da Covid-19, e estudos contribuem para a identificação dos grupos vulneráveis. Diante do exposto, realizou-se um estudo transversal de todos os casos confirmados com o objetivo de analisar as características sociodemográficas e a distribuição dos casos confirmados de Covid-19 nos municípios do Espírito Santo (ES). Método: O estudo trata de uma pesquisa observacional transversal, que foi desenvolvida em duas etapas metodológicas. A primeira destina-se à obtenção da base de dados da Secretaria de Estado da Saúde do Espírito Santo (SESA) dos casos confirmados, realizada no dia 01/06/2020. A segunda etapa contemplou a recodificação, ordenação e distribuição das características sociodemográficas segundo região de saúde no Microsoft Excel e SPSS. Resultados: Até 31/05/2020 foram registrados 13.386 casos confirmados da Covid-19 de residentes no ES. O perfil sociodemográfico predominante entre os pacientes é de pessoas pardas e pretas (39,4%), com ensino médio completo (26,4%), entre 20 e 39 anos (39,7%) e do sexo feminino (54,1%). Conclusão: Com o passar dos três meses iniciais da pandemia de Covid-19, podemos constatar os impactos diferentes entre os grupos populacionais devido a vários fatores. Por tratar de uma doença que apresenta alta disseminação por contato, regiões populosas como a região metropolitana de Vitória-ES apresentam o maior número de casos dentro do ES.

UK’s COVID-19 mass-screening program under fire

Matt Hancock’s optimism was running at full throttle as he addressed lawmakers in the UK’s House of Commons Sept. 10. Hancock, the government’s secretary of state for health and social care , waxed...

DINÂMICA DE CONTÁGIO DA COVID-19 EM CIDADES MÉDIAS DA AMAZÔNIA LEGAL: ARAGUAÍNA (TO), IMPERATRIZ (MA) E MARABÁ (PA)

This work aims to demonstrate that three medium sized cities - Araguaina (TO), Imperatriz (MA) and Maraba (PA), located in the Legal Amazon, suffered a significant impact from the pandemic due to the spread of the virus following the flow of capital in the country. This impact was probably due to the characteristics of economic development linked to the production of commodities, which interconnect them with large national and international producing centers and consumers, independently of their capitals. To demonstrate the dynamics of dissemination, the occurrences of Acute Respiratory Syndrome for the three states (TO, MA and PA) as well as confirmed cases of COVID-19 were quantitatively analyzed for the cities studied and their respective capitals. The data made available by the Oswaldo Cruz Foundation and the Epidemiological Bulletins released by the State Health Secretariats and City Halls were collected. As a result, it was observed that the disease growth rates are higher in three cities, as they behave in a similar fashion with respect to the pandemic and differentiate to each other by the incidence of COVID-19 in their respective cities. It is argued that in a post-COVID-19 period, the characteristics of interconnection between the three cities must be valued, through public policies that promote the development of the region with a focus on reorganizing the city for its people.

Birth registration: ‘coherent and certain’ or ‘an occasion for exquisite embarrassment and confusion’?

R (McConnell And YY) v Registrar General And Secretary Of State For Health And Social Care And Others [2020] EWCA Civ 559 revealed the different priorities of the Court of Appeal and the President ...

Perfil dos óbitos por coronaví­rus (COVID-19) em Mato Grosso: Reflexos da flexibilização no estado

Objetivo: Analisar o perfil epidemiológico os óbitos por COVID-19 em Mato Grosso, de abril a junho de 2020, segundo variáveis demográficas e decretos de abertura as atividades comerciais. Métodos: Trata-se de um estudo transversal e ecológico com dados dos Boletins Informativos da Secretária do Estado de Saúde de Mato Grosso. Consideraram-se os óbitos, número, sexo, faixa etária. para a construção de mapas temáticos utilizou-se os municí­pios de residência dos óbitos. Resultados: Dos casos confirmados, 3,8% foram a óbitos (661 óbitos), destes, 61,0% eram homens, 46,8% tinha entre 61 a 80 anos. A maior taxa de mortalidade ocorreu no municí­pio de Ponte Branca (63,5/100 mil hab.), e em Nova Xavantina (57,1%). Conclusão: Foi observada maior frequência dos óbitos por COVID-19 nos homens, idosos, nas regiões Centro-Sul e Sudoeste do estado, com aumento de óbitos 500%.

Perfil epidemiológico dos óbitos por Coronaví­rus (COVID -19) em Mato Grosso

Objetivo: Analisar o perfil epidemiológico os óbitos por COVID-19 em Mato Grosso, de abril a junho de 2020, segundo variáveis demográficas e de doenças pré-existentes (DPE). Métodos: Trata-se de um estudo transversal e ecológico com dados dos Boletins Informativos da Secretária do Estado de Saúde de Mato Grosso. Consideraram-se os óbitos, número e tipo de doença pré-existente, taxa de mortalidade e letalidade para a construção de mapas temáticos. Resultados: Dos casos confirmados, 3,8% (661 óbitos) morreram, destes, 61,0% eram homens, 63,3% tinha 61 anos ou mais, e 72,9% apresentavam doença pré-existente, sendo 39,3% hipertensão, 27,9% diabetes e 12,1% patologias do aparelho circulatório. A maior taxa de mortalidade ocorreu no municí­pio de Ponte Branca (63,5/100 mil hab.), e em Nova Xavantina (57,1%) a maior letalidade. Conclusão: Foi observada maior frequência dos óbitos por COVID-19 nos homens, idosos e com doença pré-existente, nas regiões Centro-Sul e Sudoeste do estado.

Distribuição espacial da COVID-19 no estado da Paraí­ba: uma associação com a densidade demográfica

Objetivo: Analisar e descrever a distribuição espacial dos dados epidemiológicos dos casos da COVID-19 no Estado da Paraí­ba. Método: Foi realizado um estudo ecológico descritivo, com base nas informações da COVID-19 na Paraí­ba, de acesso aberto do dashboard da Secretaria Estadual de Saúde, através dos dados de casos e óbitos confirmados. Após análise dos dados obtidos, foram transformados em taxas, a fim de compará-las com a densidade demográfica da região estudada. Resultados: Dentre os 223 municí­pios do Estado da Paraí­ba, aqueles com uma maior densidade demográfica lideraram as taxas de morbidade, incidência e letalidade da COVID-19 no Estado, durante o perí­odo estudado. Conclusão: Pôde-se observar a contribuição das grandes cidades como fonte de propagação da doença, por sua alta densidade demográfica, reafirmando assim, a necessidade e a importância das medidas preventivas de saúde pública a serem adotadas, a fim de garantir um baixo ní­vel de disseminação do ví­rus.

Is the National Health Service a Religion?

During the COVID-19 lockdown the initial British Government mantra of ‘Stay home. Protect the NHS. Save lives’, the ritualistic weekly public clapping for the National Health Service (NHS) and the overall tone of the media coverage led several commentators to raise the question of whether the NHS had become a religion. This question is legally significant. The question of whether the lockdown breached Article 9 has already been the subject of litigation. R (on the application of Hussain) v Secretary of State for Health [2020] EWHC 1392 (Admin) concerned the then prohibition on private prayer in places of worship. Swift J refused an application for interim relief to allow Friday prayers at Barkerend Road Mosque. Lockdown did infringe the claimant's Article 9 rights but this interference was only with one aspect of religious observance and the interference had a finite duration. The legitimate difference of opinion between the claimant and the British Board of Scholars and Imams was relevant to the question of justification. There was no real prospect that the claimant would succeed at obtaining a permanent injunction at trial because the pandemic presented ‘truly exceptional circumstances’ that meant that the interference would be justified on grounds of public health. Swift J was satisfied that there was a sufficiently arguable case to grant permission to apply for judicial review but he did not order that the claim be expedited. In Dolan, Monks and AB v Secretary of State for Health [2020] EWHC 1786 (Admin), an application of a judicial review of the lockdown regulations and schools closure was refused. However, in relation to Article 9, Lewis J adjourned consideration of this discrete issue because regulations had just been made that allowed communal worship which may have made the argument academic. English law provides the right to manifest religion or belief under the Human Rights Act 1998 and the right not to be discriminated against on grounds of religion or belief in relation to employment and the provision of goods and services under the Equality Act 2010. This raises the point: during the lifting of lockdown, when authorities require people to go back to their workplace or send their children to school, could individuals who refuse say they were legally entitled to decline on the basis that such a requirement breached their belief in protecting the NHS?

Vigilância em Saúde em tempos de pandemia: análise dos planos de contingência dos estados do Nordeste

Introduction: The COVID-19 pandemic revealed a number of challenges for health systems, requiring rapid decision making and integrated actions for its contingency. Health Surveillance is one of the key elements in developing responses to the pandemic. Objective: To analyze how the Health Surveillance has been thought by the state management structures in the Northeast of Brazil, considering the proposal of contingency measures for the confrontation to COVID-19. Method: It is a descriptive study, documental-based, analytical-reflexive, which took as an object the official publications of state health secretariats of the northeastern states, produced from the elaboration of government responses to the COVID-19 pandemic. The analysis process, anchored in theoretical-methodological assumptions of content analysis, considered the following components: (1) formal organization and structure; (2) defined objectives, general and specific and; (3) defined proposals for Health Surveillance. Results: The analysis led to the constitution of two categories: 1) political-managerial aspects of Health Surveillance; 2) organizational articulations of Health Surveillance. The first category discusses the relationship between state and municipal Health Surveillance, based on the capacity of institutionalization of government management. The second category focuses on the interface of the Health Surveillance with other health sectors and, in intersectoriality. Conclusions: In the northeastern context, challenges are posed to the organization of Health Surveillance responses in the management of the COVID-19 pandemic response, highlighting the intergovernmental articulation capacity of states and municipalities and the Health Surveillance interface with other health and social sectors.

EPIDEMIOLOGICAL INVESTIGATION OF COVID-19 IN THE STATE OF ALAGOAS, BRAZIL

Introdução: A evolução dos casos da COVID-19 no Brasil se apresentou de forma complexa, com muitas diferenças entre as regiões do país. O estudo objetiva traçar o perfil epidemiológico da doença no estado de Alagoas, Brasil. Delineamento:Trata-se de uma pesquisa observacional, descritiva, retrospectiva e com abordagem quantitativa, realizado no estado de Alagoas, Brasil. A coleta foi realizada diante dos informes publicados pela Secretaria Estadual de Saúde de Alagoas (SESAU/AL) com a inclusão dos dados de até 30/07/2020. Investigou-se sexo, faixa etária (em anos), raça, comorbidades, além da frequência de casos confirmados cumulativamente e óbitos segundo semana epidemiológica de confirmação. Os dados foram agrupados no Microsoft Excel® a partir de uma análise descritiva. Resultados: Foram registrados 58.979 casos confirmados e 1.554 óbitos. Os óbitos ocorreram em maior concentração na semana 31, em pessoas pardas, idosos, sexo masculino e com comorbidades. Implicações: o conhecimento do perfil epidemiológico da COVID-19 no estado de Alagoas evidencia a necessidade de constante monitoramento dos casos, fortalecimento da vigilância em saúde, aumento das medidas de contenção ao vírus, além de implementação de estratégias que levem em consideração os grupos mais vulneráveis à infecção.

Análise da dinâmica de transmissão da COVID-19 em Minas Gerais: Modelagem e Simulação

O entendimento da propagação e prevenção do novo coronavírus (SARS-CoV-2) tem se tornado um desafio para infectologistas, pesquisadores e gestores. O objetivo deste trabalho foi simular e analisar o modelo matemático do tipo SEIR (Suscetível-Exposto-Infectado-Recuperado) para dinâmica de transmissão da COVID-19 em Minas Gerais – Brasil. Adicionalmente, foi realizada a projeção da transmissão para 30 dias, bem como o impacto de diferentes taxas de isolamento social no achatamento da curva epidemiológica. Para a simulação do modelo matemático do tipo SEIR, foi utilizado o software Scilab®. Os parâmetros foram adequados a partir dos dados reais disponibilizados pela Secretaria de Saúde do Estado (SES). Os resultados mostraram que o modelo representou de forma adequada os casos confirmados (R2=0,994) e óbitos (R2=0,991). A projeção do modelo indica que o pico da doença no estado ocorrerá próximo ao dia 20/08/2020. O cenário sem isolamento social estima 10.060 óbitos até o dia 04/12/2020. O modelo projeta uma redução de 987 vítimas com 50% de isolamento (9.073 óbitos); 1.991 vítimas com 70% de isolamento (8.069 óbitos) e 6.770 vítimas com lockdown (3.290 óbitos). Pode-se afirmar que as medidas de isolamento são eficazes no achatamento da curva de contaminação da COVID-19. Os modelos matemáticos podem contribuir na escolha das estratégias de intervenção e revelar aspectos importantes sobre a disseminação da doença.