Hospitalizations for ambulatory care-sensitive conditions in Brazil and Portugal: a comparative study

ABSTRACT - Background: Ambulatory Care Sensitive Conditions (ACSC) are health conditions for which adequate management, treatment and interventions delivered in outpatient setting could avoid the need of hospital admission. Hospitalizations for ACSC have been used to assess access, quality, and performance of the Primary Health Care (PHC). Portugal and Brazil have carried out reforms in their PHC delivery system in the last years, with similar organizational characteristics and objectives. While inter-country comparison provides opportunities for cross-country learning, ACSC have limitations as an indicator for quality of care. The aim of this thesis was to analyze the dynamics of hospitalizations for Ambulatory Care Sensitive Conditions in Brazil and Portugal. Methods: Firstly, a literature review was conducted to identify the conceptual, methodological, contextual and policy dimensions and factors that need to be accounted for when comparing hospitalizations for ACSC across countries. Secondly, hospitalizations for ACSC in Brazil and Portugal were compared in the dimensions of occurrence, rates, causes, sociodemographic characteristics, costs of hospitalizations and economic impact, geographic distribution and variations, and identification of spatial clusters. The data for this comparison was obtained from administrative databases of all hospitalizations in public hospital in each country for the year 2015. ACSC were classified according to the methodology by the Agency for Healthcare Research and Quality. Thirdly, a longitudinal analysis was carried out to investigate if expansion of PHC reform in Brazil and Portugal (using coverage of Family Health Units as proxy) was associated to hospitalizations for ACSC. This analysis was conducted for the period 2007 and 2016 using the same administrative databases, and possible associations analyzed using Spearman’s correlation analysis, Kruskal-Wallis tests, and linear regressions. Results: The inter-country comparison of hospitalizations for ACSC can suggest health policy implications and potential points of improvements to reduce these events; however there are factors in the dimension of methods, population and health system that need to be accounted for. Hospitalizations for ACSC accounted for around 7 and 10% of all hospitalizations in Brazil and Portugal in 2015, respectively. Both countries have similarities in standardized rates and which conditions were more common, and differences in crude rates and age distribution. Each hospitalization for ACSC had an estimated cost of US$PPP 1,919 and 4,278 in Brazil and Portugal, respectively. Both countries presented expressive geographic variations in rates of hospitalizations for ACSC. These indicate room of ix improvement and efficiency gains in Brazil and Portugal. Rates of hospitalizations for ACSC between 2007 and 2016 decreased in Brazil and increased in Portugal; although there were indications that expansion of PHC reform may be associated to reductions in ACSC hospitalizations, these results only applied for specific conditions and geographic areas within each country, and for some conditions results were discordant between the two countries. Conclusions: It is important to reduce ACSC hospitalizations given the impact these events represent for health systems and for society. The existing literature on inter-country comparison of hospitalizations for ACSC agree that strengthening PHC and promoting access provides opportunities to reduce these events. There was no robust evidence of the association between expansion of PHC reforms in Brazil and Portugal and reduction of hospitalizations for ACSC, indicating that the PHC reforms did not produce the same results neither within or between countries and not for all conditions. Findings indicate that focused actions can be more effective to reduce such events, with examples in both countries serving as valuable clues for the learning process and improvement.RESUMO - Enquadramento: Ambulatory Care Sensitive Conditions (ACSC) [Condições sensíveis ao cuidado em ambulatório] são condições de saúde para as quais o cuidado, tratamento e intervenção adequados realizados em contexto ambulatorial poderiam evitar a necessidade de internamento hospitalar. Os internamentos por ACSC têm sido utilizados para avaliar o acesso, a qualidade e o desempenho dos Cuidados de Saúde Primários (CSP). Portugal e o Brasil realizaram reformas em seus CSP nos últimos anos, com características e objetivos organizacionais semelhantes. Embora a comparação entre países ofereça oportunidades de aprendizagem entre países, as ACSC têm limitações como indicador de qualidade do cuidado. O objetivo desta tese foi analisar a dinâmica dos internamentos por ACSC no Brasil e em Portugal. Métodos: Em primeiro lugar, foi realizada uma revisão da literatura para identificar as dimensões conceituais, metodológicas, contextuais e políticas e os fatores que precisam ser considerados ao comparar os internamentos por ACSC entre países. Em segundo lugar, os internamentos por ACSC no Brasil e em Portugal foram comparados nas dimensões de ocorrência, taxas, causas, características sociodemográficas, custos de internamento e impacto econômico, distribuição e variações geográficas e identificação de clusters espaciais. Os dados para essa comparação foram obtidos em bancos de dados administrativos de todas os internamentos em hospitais públicos de cada país para o ano de 2015. ACSC foram classificadas de acordo com a metodologia da Agency for Healthcare Research and Quality. Em terceiro lugar, uma análise longitudinal foi realizada para investigar se a expansão da reforma dos CSP no Brasil e em Portugal (utilizando a cobertura de Unidades de Saúde da Família como proxy) estava associada aos internamentos por ACSC. Esta análise foi realizada para o período de 2007 e 2016 usando os mesmos bancos de dados administrativos e as possíveis associações analisadas usando a análise de correlação de Spearman, testes de Kruskal-Wallis e regressões lineares. Resultados: A comparação de internamentos por ACSC entre países pode sugerir implicações para as políticas de saúde e pontos de melhorias potenciais para reduzir esses eventos; no entanto, existem fatores na dimensão dos métodos, população e sistema de saúde que precisam ser considerados. Os internamentos por ACSC representaram cerca de 7 e 10Ambos os países têm semelhanças nas taxas padronizadas e quais condições eram mais comuns, e diferenças nas taxas brutas e distribuição por idade. Cada internamento por ACSC teve um custo estimado de US$ PPP 1.919 e 4.278 no Brasil e em Portugal, respectivamente. Ambos os países apresentaram variações geográficas expressivas nas taxas de internamentos por ACSC. Estes resultados indicam espaço para melhorias e ganhos de eficiência no Brasil e em Portugal. As taxas de internamentos por ACSC entre 2007 e 2016 diminuíram no Brasil e aumentaram em Portugal; embora houvesse indícios de que a expansão da reforma dos CSP possa estar associada a reduções nas internações por ACSC, esses resultados se aplicam apenas a condições e áreas geográficas específicas de cada país, e para algumas condições os resultados foram discordantes entre os dois países. A redução dos internamentos por ACSC é importante devido ao impacto que esses eventos representam para os sistemas de saúde e para a sociedade. A literatura existente sobre a comparação de internamentos por ACSC entre países concorda que o fortalecimento dos CSP e a promoção do acesso oferecem oportunidades para reduzir esses eventos. Não houve evidência robusta da associação entre a expansão das reformas dos CSP no Brasil e em Portugal e a redução dos internamentos por ACSC, indicando que as reformas dos CSP não produziram os mesmos resultados nem dentro ou entre os países e nem para todas as condições. Os resultados indicam que as ações focadas podem ser mais eficazes para reduzir tais eventos, com exemplos em ambos os países servindo como pistas valiosas para o processo de aprendizagem e melhoria

Meanings of the preposition “of” in the oral interlanguage of A2 and B2 Brazilian learners

Prepositions are challenging for non-native speakers because of the idiosyncratic behavior of such words which do not follow any predictable pattern in similar contexts (FELICE; PULMAN, 2008). In addition, prepositions are difficult to acquire because their usage is influenced by the speakers’ mother tongue (L1) (KOOSHA & JAFARPOUR, 2006; COWAN et al., 2003; TANIMURA et al., 2004). In order to verify how non-native English speakers use prepositions, this study aims to describe how prepositional profiling of the word “of” are represented in the spoken interlanguage of Brazilian English learners within the proficiency levels A2 and B2 and whether the nature of inappropriate representation is affected by the equivalents in L1. The preposition “of” has been selected as the object of analysis because it is highly frequent in English language corpora (CHODOROW et. al., 2010; DAVIES, 2008; LEECH et. al., 2001). As the corpus for this research, the BraSEL Corpus (Brazilian Spoken of English Learners Corpus) is divided by the learners’ proficiency level according to the Common European Framework of Reference for Languages (CEFR). The major finding was that, even though some errors occurred, the use of the preposition “of'” tended to be well-entrenched in the interviewed Brazilian learners’ grammar. Through this result, we may conclude that “of” and its semantic meanings are stable and acquired since the earlier stages of the learning process

identifying and comparing critical areas through spatial analysis

BACKGROUND: Hospitalizations for ambulatory care sensitive conditions have been used to assess the performance of primary health care. Few studies have compared geographic variation in rates of avoidable hospitalizations and characteristics of high-risk areas within and between countries. The aim of this study was to identify and compare critical areas of avoidable hospitalizations in Brazil and Portugal, because these countries have reformed their primary health care systems in recent years and have similar organizational characteristics. METHODS: An ecological study on hospitalizations for ambulatory care sensitive conditions produced in Brazil and Portugal in 2015 was used. Geographic variation of rates were analyzed and compared at the municipal level. A spatial scan statistic was employed to identify clusters with higher risk of hospitalizations for acute and chronic conditions in each country separately. Socioeconomic and primary health care characteristics of critical areas were compared to non-critical areas. RESULTS: There were high variations in rates of avoidable hospitalizations within and between Brazil and Portugal, with higher variations found in Brazil. A more evident pattern of rates was found in Portugal. Rates and cluster distribution of acute and chronic conditions had significant agreement for both countries. The differences in primary health care and socioeconomic characteristics between areas identified as high risk clusters and non-clusters varied between category of conditions and between countries. CONCLUSION: Brazil and Portugal presented expressive regional differences with respect to rates of avoidable hospitalizations, indicating that there is room to improve by reducing such events in both countries. Different areas presented distinct interactions between primary health care, socioeconomic characteristics, and avoidable hospitalizations. Results indicate that the primary health care reforms, with similar organizational characteristics in different contexts, did not produce similar results either between or within countries. Possible actions to reduce these events should be defined at a local level.publishersversionpublishe

The supernaturality in modern versions of Beowulf: a lexical study

This paper aims to verify how supernatural characters and environments are described in modern versions of Beowulf and describe the root of the monsters’ characterization. Four modern versions of the poem were used as corpus: A.D. Wackerbarth (1849), James M. Garnett (1882), Francis B. Gummere (1910) and John McNamara (2005). This research departs from the Lexical Field Theory, in which words can be gathered according to their common semantic meaning or to the absence of it (ABBADE, 2011; LIPKA, 1980). As a result, the lexical occurrences that describe the supernatural were divided into five fields: Religion, War, Name and Kinship, Creatures, and Hatred. There is a greater number of religious words, corroborating the idea that there is a contrast between paganism and Christianity in modern versions, just as there is in the original version of the poem "Beowulf" (GREENFIELD, 1966). Furthermore, the five proposed lexical fields correspond to the sacredness scale made by Júnior (2011), contributing to the idea that people in the Middle Ages saw the world with a supernatural perspective (JUNIOR, 2011).KEYWORDS: Beowulf. Supernaturality. Lexicon. Lexical fields. DOI: https://doi.org/10.47295/mgren.v9i3.251

O Manifesto Desáiner : um manifesto político para quem tem pouca grana e estuda design no Brasil

Trabalho de Conclusão de Curso (graduação)—Universidade de Brasília, Instituto de Artes, Departamento de Design, Habilitação em Programação Visual e Projeto de Produto, 2019.Este relatório apresenta a pesquisa e o desenvolvimento do manifesto político chamado “O Manifesto Desáiner”, publicado em uma wiki, e que contém princípios e dicas de como alunos de design com pouca renda podem vivenciar melhor sua vida universitária. É um projeto acadêmico desenvolvido como Diplomação em Programação Visual, no curso de Design da Universidade de Brasília. O grande objetivo do projeto é mostrar como foi criado o documento, através de pesquisa bibliográfico, entrevistas e edições posteriores ao texto original. Toda a metodologia é separada em pesquisas de autores conhecidos, pesquisa de outros documentos no mesmo modelo, pesquisa com alunos que se encaixavam no público-alvo, criação do documento e divulgação do documento. No final, os resultados técnicos e políticos do projeto são apresentados como parciais, pois foi criado com o intuito de ser utilizado mesmo depois de sua apresentação

an ecological study in Portugal

Funding Information: The present publication was funded by Fundação Ciênciae Tecnologia, IP national support through CHRC (UIDP/04923/2020) and NOVA National School of Public Health. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.Background: Hospitalisations for Ambulatory Care Sensitive Conditions (ACSC) cause harm to users and to health systems, as these events are potentially avoidable. In 2009, Portugal was hit by an economic and financial crisis and in 2011 it resorted to foreign assistance (“Memorandum of Understanding” (2011–2014)). The aim of this study was to analyse the association between the Troika intervention and hospitalisations for ACSC. Methods: We analysed inpatient data of all public NHS hospitals of mainland Portugal from 2007 to 2016, and identified hospitalisations for ACSC (pneumonia, chronic obstructive pulmonary disease, hearth failure, hypertensive heart disease, urinary tract infections, diabetes), according to the AHRQ methodology. Rates of hospitalisations for ACSC, the rate of enrollment in the employment center and average monthly earnings were compared among the pre-crisis, crisis and post-crisis periods to see if there were differences. A Spearman’s correlation between socioeconomic variables and hospitalisations was performed. Results: Among 8,160,762 admissions, 892,759 (10.94%) were classified as ACSC hospitalizations, for which 40% corresponded to pneumonia. The rates of total hospitalisations and hospitalisations for ACSC increased between 2007 and 2016, with the central and northern regions of the country presenting the highest rates. No correlations between socioeconomic variables and hospitalisation rates were found. Conclusions: During the period of economic and financial crisis based on Troika’s intervention, there was an increase in potentially preventable hospitalisations in Portugal, with disparities between the municipalities. The high use of resources from ACSC hospitalisations and the consequences of the measures taken during the crisis are factors that health management must take into account.publishersversionpublishe

what conditions make inter-country comparisons possible?

Hospitalizations for ambulatory care sensitive conditions have been extensively used in health services research to assess access, quality and performance of primary health care. Inter-country comparisons can assist policy-makers in pursuing better health outcomes by contrasting policy design, implementation and evaluation. The objective of this study is to identify the conceptual, methodological, contextual and policy dimensions and factors that need to be accounted for when comparing these types of hospitalizations across countries. A conceptual framework for inter-country comparisons was drawn based on a review of 18 studies with inter-country comparison of ambulatory care sensitive conditions hospitalizations. The dimensions include methodological choices; population's demographic, epidemiologic and socio-economic profiles and features of the health services and system. Main factors include access and quality of primary health care, availability of health workforce and health facilities, health interventions and inequalities. The proposed framework can assist in designing studies and interpreting findings of inter-country comparisons of ambulatory care sensitive conditions hospitalizations, accelerating learning and progress towards universal health coverage.publishersversionpublishe

Maconha e preconceito: representações sociais de uma droga

This article aims to analyze the construction of prejudice over marijuana and its user in Brazil and how it is reproduced in press nowadays. The theoretical basis are the Social Representations Theory, the psychosocial concept of attitude, as well as the concepts of culture, as developed by Geertz and of social constructionof meaning, as propposed by Berger & Luckman. It was made a qualiquantitative analysis of all texts from the newspaper Folha de S. Paulo which contained the word maconha, using the software Alceste. Thediscourse analysis showed different meanings assigned to cannabis, but it is still associated with the poorest strata of society society.Este artigo tem por objetivo analisar a construção do preconceito acerca da maconha e seus usuários no Brasil, e como isso se reflete atualmente na imprensa. Os marcos teóricos são a Teoria das Representações Sociais e o conceito psicossocial de atitude, além dos conceitos de cultura, conforme Geertz, e de constituição social de significados, segundo Berger & Luckman. Procedeu-se análise qualiquantitativa dos textos do jornal Folha de S. Paulo que continham a palavra maconha, utilizando-se o software Alceste. A análise do discurso evidenciou diferentes significados atribuídos Ã  maconha, mas ela continua sendo associada com as camadas mais pobres da população

Efeitos de práticas lúdicas e corporais na solução criativa de problemas : impactos na saúde mental e física

Trabalho de Conclusão de Curso (graduação)—Universidade de Brasília, Faculdade de Educação Física, 2019.Saúde mental e física são aspectos fundamentais da saúde. Há um crescimento exponencial das demandas dentro dessas áreas hoje no mundo, como surgimento de altos índices de depressão e ansiedade, sedentarismo e obesidade, principalmente, em países subdesenvolvidos e em populações universitárias. Os resultados dos estudos continuam a apoiar uma literatura crescente, sugerindo que a Cultura Corporal e as intervenções de atividades físicas têm grande valor terapêutico, não se restringindo apenas aos ganhos físicos, reduzindo também, de forma significativa, os sintomas depressivos e ansiosos, promovendo maior auto realização e um ganho na eficiência da regulação emocional do indivíduo. Porém, para que promova a diminuição do estresse e a melhoria da qualidade de vida, a atividade física precisa ser interessante e motivadora. O jogo, além de divertido e motivador, possibilita um desenvolvimento físico, motor, cognitivo, afetivo e vários outros tipos de desenvolvimentos benéficos. No entanto, para que os jogos e brincadeiras sejam considerados ferramentas eficazes no ensino-aprendizagem é preciso uma planificação organizada. O objetivo deste estudo é avaliar os efeitos de uma dinâmica de jogos sobre aspectos relacionados ao humor de universitários de Brasília

Diferenciação racial de traficantes de drogas na mídia : um estudo de análise de discurso crítica

Monografia (graduação)—Universidade de Brasília, Instituto de Letras, Departamento de Linguística, Português e Línguas Clássicas, 2016.Este estudo situa-se na Análise de Discurso Crítica (ADC), tendo como marcos teóricos a metodologia de análise de Fairclough e os conceitos de poder, ideologia e comunicação de massa, segundo Fairclough, van Dijk e Thompson. Segundo a ADC, o discurso racista se mantém e se modifica ao longo do tempo através da difusão da ideologia dominante pela mídia de massa. Atualmente, no Brasil, o racismo se expressa na mídia de massa de formas sutis, e uma delas é a crença de que certos grupos sociais estão diretamente envolvidos com a criminalidade e com o tráfico de drogas, enquanto outros grupos não são vinculados ao crime e, quando citados, têm seu delito amenizado e são tratados como participantes em alguma organização criminosa invisível. Essa crença é reafirmada com diversos mecanismos linguísticos. A seleção do corpus de análise foi feita com buscador online, usandose os termos de busca "jovens de classe média são presos com maconha" e "traficante é preso com maconha", com vistas a selecionar notícias policiais de jornais de distribuição de massa que representassem a dicotomia jovens de classe média X traficante em notícias parecidas. Foram escolhidas duas notícias do portal G1. A análise de discurso evidenciou que a diferenciação racial dos criminosos se dá por procedimentos de passivização, personalização e nominalização, no caso dos jovens de classe média, e de apagamento do sujeito e estereotipação do traficante de classe baixa. No primeiro caso, os sujeitos têm nome e as circunstâncias da apreensão em geral são mais detalhadas. A passivização se dá pelo uso da voz passiva e também pela nominalização, isto é, a conversão de ações verbais em sintagmas nominais, como "envolvimento com tráfico", ao invés do ato de traficar. Já no segundo caso, o sujeito não é identificado e o fato em si é pouco detalhado. Ao invés da identificação explícita do criminoso, este é tratado enquanto classe e enquanto tipo criminal (traficante).This study resides in the Critical Discourse Analysis (CDA), having as theoretical framework the analysis methodology of Fairclough and the concepts of power, ideology and mass communication, according to Fairclough, van Dijk and Thompson. According to CDA, the racist discourse is maintained and modified through time due to the dissemination of the dominant ideology by mass media. Today, in Brazil, racism is expressed in mass media in subtle forms, one of them being the belief that certain social groups are directly involved with criminality and drug trafficking, whereas other groups are not linked to crime and, when cited, have their transgression softened and are depicted as participants in some invisible crime organization. This belief is reasserted with various linguistic machanisms. The selection of the analysis corpus was made with an online searcher, using the search terms "middle-class youngsters get arrested with marijuana" and "dealer gets arrested with marijuana", in order to select police news from massive newspapers which represented the dicotomy middle-class youngsters X dealer in similar news. There were chosen two news from G1 website. The discourse analysis highlighted that the racial differentiation of criminals is performed by passivization, personalization and nominalization, regarding the middle-class youngsters, and by obliteration of the subject stereotyping for the lower-class dealer. In the first case, the subjects have names and the circunstances of the arrest are more detailed. The passivization takes place in the use of passive voice and also in nominalization, that is, the conversion of verbal actions in nominal syntagms, such as "involvement with drugdealing", instead of the act of dealing. In the second case, the subject is not identified and the fact itself is poorly detailed. Instead of the explicit identification of the criminal, he is depicted as his class and as the criminal type (dealer)