Uma avaliação da eficiência econômica das políticas públicas de saúde dos Estados brasileiros com o uso da análise envoltória de dados

The evaluation of public policies allowsidentifying the most efficient, effectiveand effective programs. The informationcoming from the evaluation processenables the Government to correcterrors and improve policies. When itcomes to health, one of the greatadvances in the decentralization processof Brazilian public health policies wasthe implementation of the UnifiedHealth System (SUS). However,budgetary constraints, coupled with theheterogeneity of geographic, economicand social characteristics of theBrazilian states, have limited theefficiency of SUS. This study sought toevaluate public health policies, focusingon the economic efficiency of totalexpenditure per capita, using for thispurpose the Data Envelopment Analysiswith constant returns of scale, orientedto the inputs. Six models were built. Inthe first one, only the discretionary input was used, and in the others thenon-discretionary inputs were inserted,that is, variables that are not under thecontrol of health managers, but that canchange the efficiency indicators. Theresults showed that States could beefficient with lower costs and identifieda greater frequency of States of theNortheast and North Regions at theefficiency frontier.La evaluación de políticas públicaspermite identificar los programas máseficientes, eficaces y efectivos. Lasinformaciones resultantes del procesode evaluación hacen posible, alGobierno, la corrección de errores y lamejora de las políticas. Cuando se tratade salud, uno de los grandes avances enel proceso de descentralización de laspolíticas públicas de salud brasileña fuela implantación del Sistema Único deSalud (SUS). Sin embargo, limitacionespresupuestarias, junto con la diversidadde las características geográficas,económicas y sociales de los Estadosbrasileños tienen limitado la eficienciadel SUS. Este estudio buscó evaluar laspolíticas públicas de salud, con el focoen la eficiencia económica del gastototal per cápita, haciendo uso delanálisis envolvente de datos conrendimientos constantes de escala,insumos orientados. Fueron construidosseis modelos. En un principio se utilizósolamente la entrada discrecional y losdemás se insertaron las entradas nodiscrecionales, es decir, variables queno están bajo el control de losadministradores de salud, pero quepuede cambiar los indicadores deeficiencia. Los resultados demostraronque los Estados podrían ser eficientescon costos más bajos y reportaron unamayor frecuencia de los Estados delnoreste y del norte en la fronteraeficiente.A avaliação de políticas públicas permite identificar os programas mais eficientes, eficazes e efetivos. As informações advindas do processo de avaliação possibilitam, ao Governo, a correção de erros e o aperfeiçoamento das políticas. Em se tratando de saúde, um dos grandes avanços no processo de descentralização das políticas públicas de saúde brasileira foi a implantação do Sistema Único de Saúde (SUS). Contudo, limitações orçamentárias, aliada à heterogeneidade das características geográficas, econômicas e sociais dos Estados brasileiros têm limitado a eficiência do SUS. Este trabalho buscou avaliar as políticas públicas de saúde, com o foco na eficiência alocativa dos recursos pelos Estados, utilizando para isso a análise envoltória de dados com retornos constantes de escala, orientada para os insumos. Foram construídos seis modelos. No primeiro foi usado apenas o insumo discricionário e nos demais foram inseridos os insumos não-discricionários, ou seja, variáveis que não estão sob  o controle dos gestores da saúde, mas que podem  alterar os indicadores de eficiência. Os resultados demonstraram que Estados poderiam ser eficientes com menores gastos e identificaram uma frequência maior de Estados das Regiões Nordeste e Norte na fronteira de eficiência

An evaluation of the economic efficiency of the public health policies of the Brazilian states with the use of data envelopment analysis

A avaliação de políticas públicas permite identificar os programas mais eficientes, eficazes e efetivos. As informações advindas do processo de avaliação possibilitam, ao Governo, a correção de erros e o aperfeiçoamento das políticas. Em se tratando de saúde, um dos grandes avanços no processo de descentralização das políticas públicas de saúde brasileira foi a implantação do Sistema Único de Saúde (SUS). Contudo, limitações orçamentárias, aliada à heterogeneidade das características geográficas, econômicas e sociais dos Estados brasileiros têm limitado a eficiência do SUS. Este trabalho buscou avaliar as políticas públicas de saúde, com o foco na eficiência alocativa dos recursos pelos Estados, utilizando para isso a análise envoltória de dados com retornos constantes de escala, orientada para os insumos. Foram construídos seis modelos. No primeiro foi usado apenas o insumo discricionário e nos demais foram inseridos os insumos não-discricionários, ou seja, variáveis que não estão sob o controle dos gestores da saúde, mas que podem alterar os indicadores de eficiência. Os resultados demonstraram que Estados poderiam ser eficientes com menores gastos e identificaram uma frequência maior de Estados das Regiões Nordeste e Norte na fronteira de eficiência.info:eu-repo/semantics/publishedVersio

A viagem científica de Neiva e Penna: roteiro para os estudos das doenças do sertão The scientific journey taken by Neiva and Penna: a blueprint for studies of diseases from the Brazilian hinterland

Analisa o relatório de Arthur Neiva e Belisario Penna , focalizando a contribuição dos autores ao estudo de uma das doenças endêmicas por eles encontrada ao longo de todo o trajeto percorrido, de longa data conhecida popularmente por 'mal de engasgo'. Observaram e descreveram com minúcia os sintomas apresentados pelos doentes e a associação frequente do mal de engasgo com outro mal endêmico conhecido por 'vexame' ou 'vexame do coração', que consistia em crises de palpitações. Os estudos epidemiológicos e clínicos de Neiva e Penna sobre o mal de engasgo muito contribuíram para o conhecimento dessa afecção e representaram um incentivo para todos os pesquisadores que se dedicaram ao seu estudo, especialmente quanto a sua relação com a doença de Chagas.<br>Analyze the report by Neiva and Penna, focusing on the contribution these authors made to the study of one of the endemic diseases encountered throughout their journey, which had been long known under the popular name of mal de engasgo (choking disease). They recorded their observations and detailed descriptions of the patients' symptoms and the association frequently encountered between mal de engasgo and another endemic disease, known as vexame or vexame do coração, characterized by bouts of palpitations. Neiva and Penna's epidemiological and clinical observations of mal de engasgo were crucial for all the researchers interested in the disease, especially its relationship with Chagas disease

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P &lt; 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study

Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion