Avaliação do SISVAN na gestão de ações de alimentação e nutrição em Minas Gerais, Brasil

RESUMO O Núcleo de Apoio à Saúde da Família (Nasf) foi criado em 2008 visando aumentar a resolutividade e o escopo das ações da Atenção Básica (AB). Composto por uma equipe multiprofissional deve desenvolver atividades conjuntas com as equipes AB, seguindo a lógica do apoio matricial e das ações técnico-pedagógicas ou clínico-assistenciais, pretendendo a integralidade do cuidado. O objetivo deste estudo foi analisar o trabalho do Nasf no território brasileiro, considerando a integração entre as equipes Nasf e AB, a partir de dados provenientes da avaliação externa do Programa Nacional para Melhoria do Acesso e da Qualidade (PMAQ) segundo ciclo. Os resultados encontrados apontam adequação quanto à infraestrutura, às atividades de apoio matricial e às atividades integradas com as equipes AB. Contudo, o monitoramento e análise de indicadores, a formação inicial e a educação permanente carecem de maior desenvolvimento.

Objective To study the profile of hospitalizations due to COVID-19 in the Unified Health System (SUS) in Brazil and to identify factors associated with in-hospital mortality related to the disease. Methods Cross-sectional study, based on secondary data on COVID-19 hospitalizations that occurred in the SUS between late February through June. Patients aged 18 years or older with primary or secondary diagnoses indicative of COVID-19 were included. Bivariate analyses were performed and generalized linear mixed models (GLMM) were estimated with random effects intercept. The modeling followed three steps, including: attributes of the patients; elements of the care process; and characteristics of the hospital and place of hospitalization. Results 89,405 hospitalizations were observed, of which 24.4% resulted in death. COVID-19 patients hospitalized in the SUS were predominantly male (56.5%) with a mean age of 58.9 years. The length of stay ranged from less than 24 hours to 114 days, with a mean of 6.9 (±6.5) days. Of the total number of hospitalizations, 22.6% reported ICU use. The odds on in-hospital death were 16.8% higher among men than among women and increased with age. Black individuals had a higher likelihood of death. The behavior of the Charlson and Elixhauser indices was consistent with the hypothesis of a higher risk of death among patients with comorbidities, and obesity had an independent effect on increasing this risk. Some states, such as Amazonas and Rio de Janeiro, had a higher risk of in-hospital death from COVID-19. The odds on in-hospital death were 72.1% higher in municipalities with at least 100,000 inhabitants, though being hospitalized in the municipality of residence was a protective factor. Conclusion There was broad variation in COVID-19 in-hospital mortality in the SUS, associated with demographic and clinical factors, social inequality, and differences in the structure of services and quality of health care.

OBJECTIVE:To describe the implantation and the effects of directly-observed treatment short course (DOTS) in primary health care units. METHODS:Interviews were held with the staff of nine municipal health care units (MHU) that provided DOTS in Rio de Janeiro City, Southeastern Brazil, in 2004-2005. A dataset with records of all tuberculosis treatments beginning in 2004 in all municipal health care units was collected. Bivariate analyses and a multinomial model were applied to identify associations between treatment outcomes and demographic and treatment process variables, including being in DOTS or self-administered therapy (SAT). RESULTS:From 4,598 tuberculosis cases treated in public health units administrated by the municipality, 1,118 (24.3%) were with DOTS and 3,480 (75.7%) with SAT. The odds of DOTS were higher among patients with age under 50 years, tuberculosis relapse and prior history of default or treatment failure. The odds of death were 52.0% higher among patients on DOTS as compared to SAT. DOTS modality including community health workers (CHWs) showed the highest treatment success rate. A reduction of 21.0% was observed in the odds of default (vs. cure) among patients on DOTS as compared to patients on SAT, and a reduction of 64.0% among patients on DOTS with CHWs as compared to those without CHWs. CONCLUSIONS:Patients with a "low compliance profi le" were more likely to be included in DOTS. This strategy improves the quality of care provided to tuberculosis patients, although the proposed goals were not achieved.