Análise de custos da assistência à saúde aos portadores de diabetes melito e hipertensão arterial em uma unidade de saúde pública de referência em Recife - Brasil = Analysis of health care costs of patients with diabetes mellitus and hypertension in a public health reference unit in Recife - Brazil

Objective: To analyze health care costs of patients with diabetes mellitus and hypertension, and to estimate the cost of medium complexity outpatient procedures, compared with the standard reimbursement values used in Brazil. Materials and methods: We analyzed direct health costs in a public health reference unit in Recife/PE, in 2007. Costs were determined and allocated using the techniques of absorption costing and apportionment. Results: Direct costs and the amount reimbursed by the SUS totaled R$4,855,291.82 and R$ 2.118.893,56, respectively. The greatest groups of expenditure were medications, with R$1,762,424.42 (36.3$ 996,637.82 (20.5%); and personnel, with R$ 978,096.10 (20.1%). All procedures had higher estimated costs than what is reimbursed by the SUS. Conclusions: Drugs were associated with the highest health care costs, a considerable difference was observed between estimated costs and the amount reimbursed by the SUS. Arq Bras Endocrinol Metab. 2011;55(6):406-1

Risk factor control in hypertensive and diabetic subjects attended by the Family Health Strategy in the State of Pernambuco, Brazil : the SERVIDIAH study = Controle dos fatores de risco em hipertensos e diabéticos acompanhados pela Estratégia Saúde da Família no Estado de Pernambuco, Brasil : estudo SERVIDIAH

The SERVIDIAH study (Evaluation of Health Services for Diabetic and Hypertensive Subjects) was conducted in 2010 in the State of Pernambuco, Brazil. A multi-stage random sample of 785 hypertensive and 823 diabetic patients was drawn from 208 Family Health Strategy (FHS) units selected throughout 35 municipalities. Patients underwent a structured interview and weight, height, blood pressure and HbA1c levels (for diabetic patients) were measured. Mean age was approximately 60 years, and women were overrepresented in the sample (70%). 43.7% of hypertensive subjects and 25.8% of diabetic subjects achieved adequate blood pressure control and 30.5% of diabetic subjects had HbA1c levels below 7%. Despite 70% of the patients being overweight or obese, few had adhered to a weight-loss diet. The study of this representative sample of hypertensive and diabetic patients attended by the FHS in the State of Pernambuco shows that improvements in the management of hypertension and diabetes are needed in order to prevent the occurrence of serious and costly complications, especially given the context of increasing incidence of these two conditions

Predicting Rice Yield Under Salinity Stress Using K/Na Ratio Variable in Plant Tissue

Estimation of yield reduction in crop caused by the salinity stress is mostly based on variations of soil electrical conductivity and the severity of water stress. Crop response curves to salinity were developed without considering ion toxicity and nutritional imbalance in the plant. The objective of this study was to explore the possibility of using the ratio of the concentration of potassium by sodium in rice leaf (leaf-K/Na) to predict yield under the salinity stress. The rice (Oryza sativa L.) yield under fresh and saline condition and the leaf-K/Na related database was created. Data were collected from consecutive three seasons of a field experiment in the Africa Rice Center experimental farm in Senegal (16° 11ʹ N, 16° 15ʹW). We studied the relationship between the relative yield (Yr), a ratio of yield under the salinity stress to the potential yield and the leaf-K/Na (x). Furthermore, we did regression analyses and F-test to determine the best fitting function. Results indicate that the exponential function [i.e. Yr = 100 exp (-b x)] was the best fitting model with the lowest root mean square error (9.683) and the highest R2 value (0.90). Example applications on independent data from published papers showed relatively good predictions, suggesting that the model can be used to predict rice yield in saline soils

Perfil de indicadores da atenção primária à saúde no estado de São Paulo: retrospectiva de 10 anos

Há mais de 20 anos da criação do Sistema Único de Saúde (SUS) e após longo período de incremento da atenção primária à saúde (APS) no Estado de São Paulo, Brasil, uma das mais importantes tarefas é avaliar seus processos e resultados. O objetivo deste estudo é analisar o perfil de indicadores relacionados à APS no Estado de São Paulo, de 2000 a 2009. Foram selecionados 14 indicadores de estrutura, desempenho do SUS e de condições de saúde, relacionados à APS. Esses indicadores foram analisados considerando o Estado de São Paulo como um todo e por grupos de municípios segundo portes populacionais (pequeno: menos de 20 mil habitantes; médio: entre 20 e 100 mil; grande: acima de 100 mil) e "riqueza" (alta; baixa). Quase todos dos 14 indicadores tiveram incremento favorável no período. Os indicadores de estrutura da APS apresentaram incremento, sendo que os grupos dos pequenos municípios apresentaram melhores níveis no período. Os indicadores de desempenho mostraram diferenças entre grupos de municípios. O grupo dos grandes municípios obteve taxas mais baixas de internações nas condições sensíveis à APS. No entanto, esse grupo obteve as piores taxas de exames citopatológicos de colo uterino. O grupo dos municípios pequenos e ricos apresentou melhor evolução dos indicadores de condições de saúde. O grupo dos grandes municípios apresentou as maiores taxas de mortalidade por câncer de colo uterino e por doença do aparelho circulatório. Concluindo, verificou-se uma clara melhora na APS, em termos de estrutura, desempenho da atenção e do estado de saúde.More than 20 years after the creation of Sistema Único de Saúde (SUS - Brazil's National Health System) and after a long period of improvements in primary health care (PHC) in the State of São Paulo, Brazil, one of the most important tasks is to evaluate their processes and their health outcomes. The aim of this study is to analyze the profile of indicators related to PHC in the State of São Paulo during the last decade (2000 to 2009). Fourteen indicators related to PHC structure, SUS performance and to health conditions were selected. These indicators were analyzed considering the entire State of São Paulo and by groups of municipalities defined by their population (small: less than 20 thousand inhabitants; medium: between 20 and 100 thousand inhabitants; large: more than 100 thousand inhabitants) and by their wealth (low; high). Almost all the 14 selected indicators improved along the period. The PHC structure-related indicators had a global improvement, and the groups of small municipalities showed better levels along the entire period. The SUS performance-related indicators showed differences among groups of municipalities. The group of large municipalities obtained lower hospitalization rates in conditions preventable by PHC. Nevertheless, this same group had the lowest rates of pap smear tests. The group of small and high wealth municipalities presented better trends in health condition indicators. The group of large municipalities presented the highest rates of mortality caused by cervical cancer and cardiovascular disease. In conclusion, there is a clear improvement in PHC in terms of structure, health care performance and health conditions

(Mal)nutrition and the new epidemiological trend in a context of development and inequalities

The current context of intense social, economic and political transformations has contributed to changes in the health profile of the population and generated discussions about the impact of these changes on the reorganization of society. At the present moment, the increase in non-communicable illnesses and diseases raises major concerns about the paradox of malnutrition and obesity. Based on an in-depth reading and interpretation of texts, documents and databases, this article discusses issues related to nutrition, considering the dimensions of shortages and excesses, the evolution of nutrition over time, and the connection with the new epidemiological trend. We begin with a conceptual characterization, the historical background and the anthropological connections with the guiding theme of the article. We then describe the prevalence, distribution and secular trend of malnutrition and obesity, as well as the temporal relationship with the new epidemiological trend in Brazil within a context of development and inequalities. Finally, we reflect on the issue of (mal) nutrition in post-modernity, the new interests at stake in the health-disease process, as well as international experiences and strategies of partnerships designed to overcome these problems. We conclude by discussing some current advances and challenges in relation to the complexity and speed of contemporary changes

(Mal)nutrition and the new epidemiological trend in a context of development and inequalities

The current context of intense social, economic and political transformations has contributed to changes in the health profile of the population and generated discussions about the impact of these changes on the reorganization of society. At the present moment, the increase in non-communicable illnesses and diseases raises major concerns about the paradox of malnutrition and obesity. Based on an in-depth reading and interpretation of texts, documents and databases, this article discusses issues related to nutrition, considering the dimensions of shortages and excesses, the evolution of nutrition over time, and the connection with the new epidemiological trend. We begin with a conceptual characterization, the historical background and the anthropological connections with the guiding theme of the article. We then describe the prevalence, distribution and secular trend of malnutrition and obesity, as well as the temporal relationship with the new epidemiological trend in Brazil within a context of development and inequalities. Finally, we reflect on the issue of (mal) nutrition in post-modernity, the new interests at stake in the health-disease process, as well as international experiences and strategies of partnerships designed to overcome these problems. We conclude by discussing some current advances and challenges in relation to the complexity and speed of contemporary changes

Lifestyle and blood pressure control in the Family Health Strategy Program, Pernambuco, Brazil = Estilo de vida e controle da pressão arterial na Estratégia Saúde da Família em Pernambuco, Brasil

Blood pressure (BP) control - below 140 mmHg for systolic BP and 90 mmHg for diastolic BP, according to the Brazilian Society of Hypertension - reduces the risk of complications of hypertension. However, this control remains unsatisfactory in many hypertensive patients. In order to assess the size of the problem and the associated factors, blood pressure control and its association with socioeconomic, demographic, lifestyle and professional orientation characteristics were analyzed in a random sample of 784 hypertensive patients followed by the Family Health Strategy (FHS) in the state of Pernambuco. The dependent variable was BP control; the independent variables were age, gender, education, monthly family income, occupation, physical activity, adhering to a weight-reduction diet, smoking, frequency of alcohol consumption, and having been asked and/or advised by a FHS professional about: physical activity, necessity of losing weight, smoking and alcohol consumption habits. Chi-square and Student's t tests were used for statistical analyzes. BP was controlled in 43.1% of the hypertensive patients. Control was more observed in women (p <0.001), younger subjects (p = 0.003), with higher education (p <0.001) who had been asked and/or advised about physical activity (p = 0.017) or the necessity of losing weight (p = 0.045).There was no association between BP control and lifestyle characteristics. These results point to the need for investment in actions that qualify the performance of the FHS professionals for greater control of hypertension in patients

Correlates of physical activity counseling by health providers to patients with diabetes and hypertension attended by the Family Health Strategy in the state of Pernambuco, Brazil

Aims: The aim of this study was to determine correlates of physical activity (PA) counselingby health providers of the Brazilian primary care delivery system, for hypertensive and diabetic subjects, as well as correlates of actual leisure-time PA of these subjects. Methods: This was a cross-sectional study conducted in random samples of 785 hypertensive and 822 diabetic subjects, in the State of Pernambuco, Brazil. Relationships between PA counseling and leisure-time PA and explanatory variables were sought through multiple logistic regressions. Results: PA counseling had been received by 59.4% of the diabetic and 53.0% of the hypertensive subjects; around 30% of the diabetic and the hypertensive subjects declared having leisure-time PA. After adjustment, factors associated with PA counseling for diabetic subjects were: female gender, formal schooling, hypertension, obesity; for hypertensive subjects: being on a weight-loss diet, age between 60 and 74 and over 75. For both subject groups, leisure-time PA was more frequent when they lived in a medium-sized municipality, were female, aged between 60 and 75, and on a weight-loss diet. Conclusion: PA counseling appeared restricted to subjects with excess weight and/or cardiovascular risk factors when it should be directed to all subjects with hypertension or diabetes

The impact of an intervention to improve diabetes management in primary healthcare professionals' practices in Brazil

Aims: To evaluate the results of a structured intervention in primary healthcare to improve type 2 diabetes management. Methods: The intervention was implemented in 2011-2012 in two cities in the State of Pernambuco, Brazil, and evaluated in 2013 by interviewing healthcare professionals about their practices in all primary care facilities of these two cities (intervention group), and of two paired control cities (control group). Comparisons between the intervention and control groups were made using standard parametric tests. Results: The percentage of professionals who measured adherence to treatment, developed educational actions to control high-risk situations or prevent complications, or declared that they "explained" the disease to the patients, was higher in the control group (p < 0.05). Multidisciplinary involvement, requests for electrocardiograms and referrals to specialists were also more frequent in the control group (p < 0.01). The only differences favoring the intervention group were the higher proportion of nurses (p < 0.05) and community health workers (p < 0.01) trained for diabetes management and a greater frequency of discussing the cases of diabetic patients at team meetings (p < 0.01). Conclusions: These negative results raise questions about the effectiveness of actions aiming to improve diabetes management in primary care, and reinforce the need for careful evaluation of their impact