Revista de saude publica最新文献

{"title":"Ten years of the Citizen's Electronic Health Record e-SUS Primary Healthcare: in search of an electronic Unified Health System.","authors":"Ianka Cristina Celuppi, Eduarda Talita Bramorski Mohr, Mariano Felisberto, Thiago Serafim Rodrigues, Jades Fernando Hammes, Célio Luiz Cunha, Raul Sidnei Wazlawick, Eduardo Monguilhott Dalmarco","doi":"10.11606/s1518-8787.2024058005770","DOIUrl":"10.11606/s1518-8787.2024058005770","url":null,"abstract":"<p><strong>Objective: </strong>Contextualize the adherence to the Prontuário Eletrônico do Cidadão (PEC - Citizen's Electronic Health Record) by Brazilian municipalities and the evolution of the electronic strategy of the Unified Health System (e-SUS) for Primary Healthcare (PHC) during its 10 years.</p><p><strong>Methods: </strong>This descriptive study added information on adherence to the use of medical records extracted from the database of the Secretaria de Atenção Primária à Saúde (SAPS- Primary Healthcare Secretary) of the Federal Government between 2017 and 2022. We analized the number of computerized basic healthcare units that used some electronic medical records, the number of those that used simplified data collection (SDC), and those that implemented the citizen's electronic health record (PEC) in the same period. A descriptive synthesis of the functionalities and modules implemented in the system during its 10 years of development was also carried out.</p><p><strong>Results: </strong>The adherence of Brazilian municipalities to the PEC has grown exponentially in the last five years, going from 8,930 healthcare units in 2017 to 26,091 in 2022. As expected, while the main functionalities and improvements developed in this decade sought to implement new flows and modules of administrative, clinical care, and care management processes and health service administration, improving aspects of usability and technological infrastructure of the application architecture was also crucial for the success of the system.</p><p><strong>Conclusions: </strong>In 2023, the milestone of a decade will be celebrated since the beginning of health records implementation by Brazilian municipalities, marked by technological and infrastructure challenges and improvements and new functionalities that highlight the technological evolution of the e-SUS PHC system and strategy. Despite many other tools, the PEC is arguably Brazil's leading electronic medical record today, as it has always invested in evolution, updating itself in technological and usability opportunities.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"23"},"PeriodicalIF":2.1,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The resilience of the Brazilian Unified Health System is not (only) in responding to disasters.","authors":"Alessandro Jatobá, Paulo Victor Rodrigues de Carvalho","doi":"10.11606/s1518-8787.2024058005731","DOIUrl":"10.11606/s1518-8787.2024058005731","url":null,"abstract":"<p><p>Coping with the recent COVID-19 pandemic has shown that the Brazilian Unified Health System (SUS) needs to improve its resilience to handle the rapid spread of communicable diseases while ensuring the necessary care for an aging population with comorbidities and in a vulnerable situation. This article identifies, analyzes, and discusses critical aspects of the resilience of the SUS, calling into question the prevailing focus on the robustness and volume of resources mobilized during the outbreak of major disasters. Recent studies demonstrate that the skills that favor adaptation to unexpected situations emerge from the daily functioning of organizations. Restricting the discussion to the mobilization of structures to respond to adverse events has the effect of limiting their potential, inhibiting the emergence of the transformative, adaptive, anticipatory, and learning skills necessary for the sustainable development of resilience.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"22"},"PeriodicalIF":2.1,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"","doi":"10.11606/s1518-8787.2024058005484err","DOIUrl":"10.11606/s1518-8787.2024058005484err","url":null,"abstract":"<p><p>[This corrects the article doi: 10.11606/s1518-8787.2024058005484].</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"09err"},"PeriodicalIF":2.8,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11090613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality and years of life lost related to adverse drug events in Brazil.","authors":"Lunara Teles Silva, Ana Carolina Figueiredo Modesto, Rodrigo Alves de Oliveira, Rita Goreti Amaral, Flavio Marques Lopes","doi":"10.11606/s1518-8787.2024058005458","DOIUrl":"10.11606/s1518-8787.2024058005458","url":null,"abstract":"<p><strong>Objective: </strong>To assess regional and national mortality and years of life lost (YLL) related to adverse drug events in Brazil.</p><p><strong>Methods: </strong>This is an ecological study in which death records from 2009 to 2018 from the Mortality Information System were analyzed. Codes from the International Classification of Diseases 10th revision (ICD-10) that indicated drugs as the cause of death were identified. The number of deaths and the YLL due to adverse drug events were obtained. Crude, age- and gender-specific, and age-adjusted mortality rates and YLL rates per 100,000 inhabitants were formed by year, age group, gender, and Brazilian Federative Unit. Rate ratios were calculated by comparing rates from 2009 to 2018. A joinpoint regression model was applied for temporal analysis.</p><p><strong>Results: </strong>For the selected ICD-10 codes, a total of 95,231 deaths and 2,843,413 YLL were recorded. Mortality rates from adverse drug events increased by a mean of 2.5% per year, and YLL rates increased by 3.7%. Increases in rates were observed in almost all age groups for both genders. Variations in rates were found between Federative Units, with the highest age-adjusted mortality and YLL rates occurring in the Distrito Federal.</p><p><strong>Conclusions: </strong>The numbers and rates of deaths and YLL increased during the study period, and variations in rates of deaths and YLL were observed between Brazilian Federative Units. Information on multiple causes of death from death certificates can be useful for quantifying adverse drug events and analyzing them geographically, by age and by gender.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"20"},"PeriodicalIF":2.8,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11090614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking, mortality, access to diagnosis, and treatment of lung cancer in Brazil.","authors":"Mônica Rodrigues Campos, Jessica Muzy Rodrigues, Aline Pinto Marques, Lara Vinhal Faria, Tayná Sequeira Valerio, Mario Jorge Sobreira da Silva, Debora Castanheira Pires, Luisa Arueira Chaves, Carlos Henrique Dantas Cardoso, Silvio Rodrigues Campos, Isabel Cristina Martins Emmerick","doi":"10.11606/s1518-8787.2024058005704","DOIUrl":"10.11606/s1518-8787.2024058005704","url":null,"abstract":"<p><strong>Introduction: </strong>Lung cancer (LC) is a relevant public health problem in Brazil and worldwide, given its high incidence and mortality. Thus, the objective of this study is to analyze the distribution of smoking and smoking status according to sociodemographic characteristics and disparities in access, treatment, and mortality due to LC in Brazil in 2013 and 2019.</p><p><strong>Method: </strong>Retrospective study of triangulation of national data sources: a) analysis of the distribution of smoking, based on the National Survey of Health (PNS); b) investigation of LC records via Hospital-based Cancer Registry (HCR); and c) distribution of mortality due to LC in the Mortality Information System (SIM).</p><p><strong>Results: </strong>There was a decrease in the percentage of people who had never smoked from 2013 (68.5%) to 2019 (60.2%) and in smoking history (pack-years). This was observed to be greater in men, people of older age groups, and those with less education. Concerning patients registered in the HCR, entry into the healthcare service occurs at the age of 50, and only 19% have never smoked. While smokers in the population are mainly Mixed-race, patients in the HCR are primarily White. As for the initial stage (I and II), it is more common in White people and people who have never smoked. The mortality rate varied from 1.00 for people with higher education to 3.36 for people without education. Furthermore, White people have a mortality rate three times higher than that of Black and mixed-race people.</p><p><strong>Conclusion: </strong>This article highlighted relevant sociodemographic disparities in access to LC diagnosis, treatment, and mortality. Therefore, the recommendation is to strengthen the Population-Based Cancer Registry and develop and implement a nationwide LC screening strategy in Brazil since combined prevention and early diagnosis strategies work better in controlling mortality from the disease and continued investment in tobacco prevention and control policies.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"18"},"PeriodicalIF":2.8,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11090611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structure and process in primary health care for children and spatial distribution of infant mortality.","authors":"Alitéia Santiago Dilélio, Márcio Natividade, Luiz Augusto Facchini, Marcos Pereira, Elaine Tomasi","doi":"10.11606/s1518-8787.2024058005527","DOIUrl":"10.11606/s1518-8787.2024058005527","url":null,"abstract":"<p><strong>Objective: </strong>To identify the spatial patterns of the quality of the structure of primary health care services and the teams' work process and their effects on infant mortality in Brazil.</p><p><strong>Methods: </strong>An ecological study of spatial aggregates, using the 5,570 municipalities in Brazil as the unit of analysis. Secondary databases from the Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB - National Program for Improving Access and Quality of Primary Care), the Mortality Information System (SIM), and the Live Birth Information System (SINASC) were used. In 2018, the infant mortality rate was the outcome of the study, and the exposure variables were the proportion of basic health units (BHU) with adequate structure and work processes. Global and local Moran's indices were used to evaluate the degree of dependence and spatial autocorrelation. Spatial linear regression was used for data analysis.</p><p><strong>Results: </strong>In 2018, in Brazil, the infant mortality rate was 12.4/1,000 live births, ranging from 10.6/1,000 and 11.2/1,000 in the South and Southeast, respectively, to 14.1/1,000 and 14.5/1,000 in the Northeast and North regions, respectively. The proportion of teams with an adequate work process (β = -3.13) and the proportion of basic health units with an adequate structure (β = -0.34) were associated with a reduction in the infant mortality rate. Spatial autocorrelation was observed between smoothed mean infant mortality rates and indicators of the structure of primary health care services and the team's work process, with higher values in the North and Northeast of Brazil.</p><p><strong>Conclusions: </strong>There is a relationship between the structure of primary health care services and the teams' work process with the infant mortality rate. In this sense, investment in the qualification of health care within the scope of primary health care can have an impact on reducing the infant mortality rate and improving child health care.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"21"},"PeriodicalIF":2.8,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11090610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"","doi":"10.11606/s1518-8787.2024058005504err","DOIUrl":"10.11606/s1518-8787.2024058005504err","url":null,"abstract":"<p><p>[This corrects the article doi: 10.11606/s1518-8787.2024058005504].</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"08err"},"PeriodicalIF":2.8,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11090609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pesticide contamination of lactating mothers' milk in Latin America: a systematic review.","authors":"Thalyta Mota Figueiredo, Jerusa da Mota Santana, Fernando Henrique Basilio Granzotto, Bianca Sampaio Dos Anjos, Danilo Guerra Neto, Laylla Mirella Galvão Azevedo, Marcos Pereira","doi":"10.11606/s1518-8787.2024058005446","DOIUrl":"10.11606/s1518-8787.2024058005446","url":null,"abstract":"<p><strong>Objective: </strong>To identify the prevalence of contamination by pesticides and their metabolites in the milk of lactating mothers in Latin America.</p><p><strong>Methods: </strong>In this systematic review, the PubMed, LILACS, Embase, and Scopus databases were searched up to January 2022 to identify observational studies. The Mendeley software was used to manage these references. The risk of bias assessment was evaluated according to the checklist for prevalence studies and writing design, by the Prisma guidelines.</p><p><strong>Results: </strong>This study retrieved 1835 references and analyzed 49 studies. 69.38% of the analyzed studies found a 100% prevalence of breast milk contamination by pesticides among their sample. Main pesticides include dichlorodiphenyltrichloroethane (DDT) and its isomers (75.51%), followed by the metabolite dichlorodiphenyldichloroethylene (DDE) (69.38%) and hexachlorocyclohexane (HCH) (46.93%). This study categorized most (65.30%) studies as having a low risk of bias.</p><p><strong>Conclusions: </strong>This review shows a high prevalence of pesticide contamination in the breast milk of Latin American women. Further investigations should be carried out to assess contamination levels in breast milk and the possible effects of these substances on maternal and child health.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"19"},"PeriodicalIF":2.8,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11090615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial analysis of American cutaneous leishmaniasis in the state of Amazonas.","authors":"Mirely Ferreira Dos Santos, Camila Lorenz, Francisco Chiaravalotti-Neto, Tamara Nunes Lima-Camara","doi":"10.11606/s1518-8787.2024058005662","DOIUrl":"https://doi.org/10.11606/s1518-8787.2024058005662","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate, using spatial analysis, the occurrence of American Cutaneous Leishmaniasis (ACL) and analyze its association with the municipal human development index (MHDI) and deforestation in the state of Amazonas, Brazil, from 2016 to 2020.</p><p><strong>Methods: </strong>This ecological study, carried out from January 2016 to December 2020, included the 62 municipalities of the state of Amazonas. The incidence rate of ACL was determined in space and time. Using Multiple Linear Regression by Ordinary Least Squares (OLS) and Spatial Autoregressive Regression (SAR) models, the relationship between incidence rates and Human Development Index (HDI) and deforestation was analyzed., The high- and low-risk clusters were identified by employing the Getis-Ord Gi* statistic.</p><p><strong>Results: </strong>A total of 7,499 cases of ACL were registered in all 62 municipalities in the state. Most cases were in male (n=5,924; 79.24%), with the greatest frequency in the population aged from 20 to 39 years (n=3,356; 44.7%). The incidence rate in the state of Amazonas was 7.34 cases per 100,000 inhabitants-year, with the municipalities of Rio Preto da Eva and Presidente Figueiredo showing the highest rates (1,377.5 and 817.5 cases per 100,000 population-year, respectively). The ACL cases were clustered into specific areas related to those municipalities with the highest incidence rates. The SAR model revealed a positive relationship between ACL and deforestation.</p><p><strong>Conclusions: </strong>The occurrence of ACL was evident in a variety of patterns in the state of Amazonas; the high incidence rates and persistence of this disease in this state were linked to deforestation. The temporal distribution showed variations in the incidence rates during each year. Our results can help optimize the measures needed to prevent and control this disease in the state.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"11"},"PeriodicalIF":2.8,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11037905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precarious work and methodological challenges to study hard-to-reach populations.","authors":"Rita de Cássia P Fernandes, Janaína Santos de Siqueira, Matheus F Dos Santos, Paulo G L Pena, Guilherme L Werneck, Alex Burdorf","doi":"10.11606/s1518-8787.2024058005470","DOIUrl":"https://doi.org/10.11606/s1518-8787.2024058005470","url":null,"abstract":"<p><strong>Objective: </strong>To describe the methodological challenges and strategies of a web survey on the working conditions and health among delivery workers.</p><p><strong>Methods: </strong>The study population consisted of Brazilian delivery workers operating in the national territory. Procedures include building solid and ongoing collaboration with worker representatives and conducting a four-month data collection from February to May 2022, sharing the link to the online questionnaire on social media such as social networks (Facebook, Instagram) and messaging apps (WhatsApp, Telegram).</p><p><strong>Results: </strong>The recruitment of 41 leaders or influencers of delivery workers increased the dissemination of the study, some of whom participated in the consensual validation of the questionnaire; the production of content for social media for the dissemination of the questionnaire link on social networks and applications, and the in-person dissemination of the study at the delivery workers' meeting points during the workday played a fundamental role, totaling around 132 hours in 45 shifts. The strategies adopted for data collection with a hybrid approach to dissemination made it possible to carry out the web survey. After four months of the web survey, 564 delivery workers, 543 men and 18 women, responded to the online questionnaire.</p><p><strong>Conclusion: </strong>The web survey presented methodological strategies to overcome the challenge of reaching workers, including hybrid work, to increase the participation of workers, on whom epidemiological research is still scarce.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"58 ","pages":"12"},"PeriodicalIF":2.8,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11037901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}