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BACKGROUND: Tools for assessing a country's capacity in the face of public health emergencies must be reviewed, as they were not predictive of the COVID-19 pandemic. Social cohesion and risk communication, which are related to trust in government and trust in others, may have influenced adherence to government measures and mortality rates due to COVID-19. OBJECTIVE: To analyse the association between indicators of social cohesion and risk communication and COVID-19 outcomes in 213 countries. RESULTS: Social cohesion and risk communication, in their dimensions (public trust in politicians, trust in others, social safety nets, and equal distribution of resources index), were associated with lower excess mortality due to COVID-19. The number of COVID-19-related disorder events and government transparency were associated with higher excess mortality due to COVID-19. The lower the percentage of unemployed people, the higher the excess mortality due to COVID-19. Most of the social cohesion and risk communication variables were associated with better vaccination indicators, except for social capital and engaged society, which had no statistically significant association. The greater the gender equality, the better the vaccination indicators, such as the number of people who received all doses. CONCLUSION: Public trust in politicians, trust in others, equal distribution of resources and government that cares about the most vulnerable, starting with the implementation of programs, such as cash transfers and combating food insecurity, were factors that reduced the excess mortality due to COVID-19. Countries, especially those with limited resources and marked by social, economic, and health inequalities, must invest in strengthening social cohesion and risk communication, which are robust strategies to better cope with future pandemics.
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COVID-19 , Comunicação , Confiança , Humanos , COVID-19/mortalidade , COVID-19/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Saúde Global/estatística & dados numéricos , Pandemias , Mortalidade/tendênciasRESUMO
BACKGROUND: National governance may have influenced the response of institutions to the Covid-19 pandemic, being a key factor in preparing for the next pandemics. The objective was to analyze the association between excess mortality due to COVID-19 (daily and cumulative per 100 thousand people) and national governance indicators in 213 countries. METHOD: Multiple linear regression models using secondary data from large international datasets that are in the public domain were performed. Governance indicators corresponded to six dimensions: (i) Voice and Accountability; (ii) Political Stability and Absence of Violence/Terrorism; (iii) Government Effectiveness; (iv) Regulatory Quality; (v) Rule of Law and (vi) Control of Corruption. The statistical analysis consisted of adjusting a multiple linear regression model. Excess mortality due to COVID-19 was adjusted for potential confounding factors (demographic, environmental, health, economic, and ethnic variables). RESULTS: The indicators Control of Corruption, Government Effectiveness, Regulatory Quality and Rule of Law had a significant inverse association (p < 0.0001) with the estimated excess mortality in 2020, 2021 and 2022. Furthermore, the governance indicators had a direct significant association (p < 0.0001) with the vaccination variables (People_fully_vaccinated; Delivered population; The total number of vaccination doses administered per 100 people at the country level), except for the variables Vaccination policies and Administration of first dose, which were inversely associated. In countries with better governance, COVID-19 vaccination was initiated earlier. CONCLUSION: Better national governance indicators were associated with lower excess mortality due to COVID-19 and faster administration of the first dose of the COVID-19 vaccine.
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COVID-19 , Humanos , Vacinas contra COVID-19 , Pandemias , Estudos Retrospectivos , GovernoRESUMO
[This corrects the article DOI: 10.1371/journal.pone.0272006.].
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BACKGROUND AIMS: Advanced therapy medicinal products (ATMPs) are a class of biological products for human use that are based on gene, tissues or cells. ATMPs have peculiar characteristics when compared with traditional medicines. In this regard, long-term safety and efficacy follow-up systems of individuals treated with ATMPs have become necessary and may present unique challenges, because unlike conventional drugs and biologics, these products can exert their effects for years after administration. This work seeks to assess the requirements foreseen in the regulatory frameworks for the post-marketing authorization safety and efficacy surveillance for ATMPs in Brazil, European Union (EU), Japan and United States, which are some of the members of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use. METHODS: We reviewed the scientific literature and official documents of regulatory agencies (RAs) in Brazil, the EU, Japan and the United States. RESULTS AND CONCLUSIONS: RAs in the EU, US and Japan have developed regulatory guidelines for the post-marketing surveillance of ATMPs. These guidelines aim at implementing surveillance plans for monitoring adverse events, including late ones, after marketing authorization. All the ATMPs authorized by the RAs studied, submitted some type of post-marketing requirement to supplement safety and efficacy data, according to the regulations and terminology used by those jurisdictions.
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Produtos Biológicos , Marketing , Humanos , Produtos Biológicos/efeitos adversos , Brasil , União Europeia , Japão , Preparações Farmacêuticas , Estados UnidosRESUMO
INTRODUCTION: The aim of the study was to identify factors associated with the causes of in-hospital morbidity and mortality in an elderly Brazilian population due to osteoporotic hip fractures. METHOD: Retrospective cohort study involving a population over 60 years of age admitted to hospital due to osteoporotic hip fractures and followed up from hospitalization to outcome (discharge or mortality) from 2010 to 2018, in a public hospital in Brasília, the capital of Brazil. Multivariate analysis was performed using the Poisson regression model with a robust variance, observing the hierarchical model proposed and the receiver operating characteristic (ROC) curve to obtain the cutoff point for mortality incidence in relation the total length of hospital stay. Significance level was set as p < 0.05. The analyses were conducted using the SAS 9.4 software. RESULT: The mean hospital mortality rate among the 402 patients involved was 18.4%, and the associations made with the outcome mortality were per relevance: respiratory infection, age over 90 years, high preoperative cardiovascular risk, chronic obstructive pulmonary disease (COPD) as comorbidity, serum hemoglobin level ≤ 10 and other infections. Mortality also showed association with longer total length of hospital stay, as well as with prolonged postoperative period. CONCLUSION: Hip fractures in the elderly due to osteoporosis indicate a relationship between the sicker profile of the aging elderly population and the prevalence of chronic diseases strongly associated with in-hospital infections, contributing to increased mortality. There were fewer early interventions, and mortality was also associated with prolonged postoperative period. The aim of this study was not to compare independent variables with each other, but suggests the relationship between the presence of comorbidities, which predisposes to the development of infections, directly linked to mortality.
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Fraturas do Quadril , Fraturas por Osteoporose , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos de Coortes , Comorbidade , Fraturas do Quadril/cirurgia , Mortalidade Hospitalar , Humanos , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To evaluate the healing of venous ulcers in the lower limbs (VLU) using dressings with hydrocolloid gel associated with Syzygium cumini extract (SHG) compared to standard hydrocolloid gel dressings (HG). METHOD: This prospective, double-blind, randomized trial recruited 90 patients with VLU divided into: dressings with SHG (n = 44) and dressings with HG (n = 46). Primary endpoint was healing in the 14th visit. Secondary endpoints were healing rate, complete healing during follow-up, and improvement in the pain scale and in quality of life. RESULTS: There were no significant between-group differences in healing (p = 0.15). The wound area made healing difficult (p = 0.008). Age, body mass index, and wound time demonstrated a tendency to worsen the healing. Positive culture for Pseudomonas aeruginosa resulted in 88% reduction in the healing risk (p < 0.0001). CONCLUSION: There was no difference between the dressings evaluated. The presence of Pseudomonas aeruginosa significantly impaired wound healing.
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Syzygium , Úlcera Varicosa , Curativos Hidrocoloides , Coloides , Humanos , Extremidade Inferior , Curativos Oclusivos , Estudos Prospectivos , Qualidade de Vida , CicatrizaçãoRESUMO
BACKGROUND AIMS: Advanced therapy medicinal products (ATMPs) are a class of biological products for human use that are based on genes, cells and tissues. The first ATMP received marketing authorization in Europe in 2009, whereas Brazil granted the first authorization in 2020. The objective of this study was to compare the regulatory models adopted by Brazil, the USA, Japan and the European Union, which comprise the member countries of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, with regard to the marketing authorization of ATMPs. METHODS: The authors performed a review of the scientific literature and official documents of the regulatory agencies in the aforementioned countries. RESULTS: The legislation and regulatory guidelines adopted by the regulatory agencies exhibit similarities and differences. It was not possible to assess whether these differences can be translated into divergent final recommendations by regulatory authorities upon a request for marketing authorization. CONCLUSIONS: In the future, it will be appropriate to start a progressive process of harmonization between these agencies in terms of terminology, legal recommendations and characterization requirements. This is particularly important for emerging countries such as Brazil. In this sense, some measures can be taken to achieve alignment between regulators.
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Produtos Biológicos , Brasil , Europa (Continente) , União Europeia , Humanos , Japão , Estados UnidosRESUMO
OBJETIVO: apresentar um panorama sobre o processo de tomada de decisões ético-profissionais em situações de excepcionalidade no início da pandemia da Covid-19. MÉTODO: trata-se de uma revisão de escopo, incluindo documentos publicados entre dezembro/2019 a julho/2020 nas seguintes bases de dados: Google Acadêmico, PubMed, Scopus, Scielo, CINAHL e BVS. Adotou-se o PRISMA-ScR Checklist para apresentação da revisão. RESULTADOS: foram selecionados 28 documentos, organizados em cinco categorias: Requisito Técnico-Médico-Científico, Justiça e Equidade, Histórico de Saúde, Comissão para Tomada de Decisão Compartilhada e Quadro Respiratório Grave. CONCLUSÃO: os critérios indicados para priorizar o processo de atenção direcionado a pacientes graves com Covid-19 foram: parâmetros técnico-médico-científico, gravidade do quadro clínico, maior idade, ser profissional da saúde, presença de doenças de base incurável, realização de sorteio e pacientes com maior probabilidade de sobrevivência.
OBJECTIVE: to present an overview of the ethical-professional decision-making process in exceptional situations at the beginning of the COVID-19 pandemic. METHOD: this is a scoping review, including documents published between December 2019 and July 2020 in the following databases: Google Scholar, PubMed, Scopus, SciELO, CINAHL and BVS. The PRISMA-ScR Checklist was adopted to present the review. RESULTS: a total of 28 documents were selected, organized into five categories: Technical-Medical-Scientific Requirement, Justice and Equality, Health History, Commission for Shared Decision-Making and Severe Respiratory Condition. CONCLUSION: the criteria indicated to prioritize the care process targeted at critically-ill patients with COVID-19 were as follows: technical-medical-scientific parameters; severity of the clinical condition; older age; being a health professional; presence of incurable underlying diseases; carrying out draws; and patients with a higher survival probability.
OBJETIVO: presentar un panorama del proceso de toma de decisiones ético-profesionales en situaciones excepcionales al comienzo de la pandemia de Covid-19. MÉTODO: se trata de una revisión de alcance, que incluye documentos publicados entre diciembre de 2019 y julio de 2020 en las siguientes bases de datos: Google Scholar, PubMed, Scopus, Scielo, CINAHL y BVS. Se adoptó la PRISMA-ScR Checklist para presentar la revisión. RESULTADOS: fueron seleccionados 28 documentos, organizados en cinco categorías: Requerimiento Médico Científico Técnico, Justicia y Equidad, Historial de Salud, Comisión para la Toma de Decisiones Compartidas y Cuadro Respiratorio Grave. CONCLUSIÓN: los criterios señalados para priorizar el proceso de atención dirigido a pacientes críticos con Covid-19 fueron: parámetros médicos científicos técnicos, gravedad del cuadro clínico, mayor edad, ser profesional de la salud, presencia de enfermedades de base incurables, realizar sorteos y pacientes con mayor probabilidad de supervivencia.
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Humanos , Ocupação de Leitos , Bioética , Pessoal de Saúde , Tomada de Decisão Clínica , COVID-19 , Unidades de Terapia Intensiva , Assistência Integral à Saúde , Gravidade do PacienteRESUMO
OBJECTIVE: The present study seeks to assess the impact of gestational hypertensive disorders on premature newborns below 34 weeks and to establish the main morbidities and mortality in the neonatal period and at 18 months. MATERIALS AND METHODS: A retrospective observational study was carried out with 695 premature newborns of gestational age (GA) between 24 and 33 weeks and 6 days, born alive in the Neonatal ICU of Brasília's Mother and Child Hospital (HMIB), in the period from January 1, 2014, to July 31, 2019. In total, 308 infants were born to hypertensive mothers (G1) and 387 to normotensive mothers (G2). Twin pregnancies and diabetic patients with severe malformations were excluded. Outcomes during hospitalization and outcomes of interest were evaluated: respiratory distress syndrome (RDS), brain ultrasonography, diagnosis of bronchopulmonary dysplasia (BPD), diagnosis of necrotizing enterocolitis, retinopathy of prematurity, breastfeeding rate at discharge, survival at discharge and at 18 months of chronological age and relationship between weight and gestational age. RESULTS: Newborns with hypertensive mothers had significantly lower measurements of birth weight and head circumference. The G1 group had a higher risk small for gestational age (OR 2.4; CI 95% 1.6-3.6; p <0.00), as well as a greater risk of being born with a weight less than 850 g (OR 2.4; 95% CI 1.2-3.5; p <0.00). Newborns of mothers with hypertension presented more necrotizing enterocolitis (OR 2.0; CI 95% 1.1-3.7); however, resuscitation in the delivery room and the need to use surfactant did not differ between groups, nor did the length of stay on mechanical ventilation, or dependence on oxygen at 36 weeks of gestational age. Survival was better in newborns of normotensive mothers, and this was a protective factor against death (OR 0.7; 95% CI 0.5-0.9; p <0.01). In the follow-up clinic, survival at 18 months of chronological age was similar between groups, with rates of 95.3% and 92.1% among hypertensive and normotensive mothers, respectively. Exclusive breastfeeding at discharge was 73.4% in the group of hypertensive women and 77.3% in the group of normotensive mothers. There were no significant differences between groups. CONCLUSION: Among the analyzed outcomes, arterial hypertension during pregnancy can increase the risk of low weight, small babies for gestational age (SGA), deaths in the neonatal period and enterocolitis, with no differences in weight and survival at 18 months of chronological age. Arterial hypertension presents a high risk of prematurity in the neonatal period, with no difference at 18 months of age.
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Hipertensão Induzida pela Gravidez/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Displasia Broncopulmonar , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/fisiopatologia , Feminino , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/fisiopatologia , Lactente , Mortalidade Infantil , Lactente Extremamente Prematuro/fisiologia , Recém-Nascido , Doenças do Recém-Nascido/fisiopatologia , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/fisiopatologia , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Recém-Nascido de muito Baixo Peso/fisiologia , Unidades de Terapia Intensiva Neonatal , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Respiração Artificial , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Estudos RetrospectivosRESUMO
BACKGROUND: Among the processes to be experienced by any organization during its establishment is the formation of an organizational identity. This process can be understood as the activity and event through which an organization becomes unique in the mind of its members. An organizational identity leads to an identification and both are directly associated with the success of an institution. This study is about a public higher education institution in health in its early years, with distinctive characteristics in the country where it is situated. In spite of having been successful in the graduation of its students it has fragile institutional bases, lack of autonomy and internal problems common to other institutions of this type. Thus, this study was conducted to understand how this institution defined itself among its own members, the elements of its identity and what justified its relative success despite its weaknesses. METHODS: A mixed-method approach was used to evaluate how a representative portion of this organization identifies with it. For the qualitative study two focus groups were conducted with transcripts submitted to content analysis proposed by Bardin, culminating in results from which a Likert scale-based questionnaire was elaborated and applied to 297 subjects. RESULTS: There were six central elements of the organizational identity made evident by the focus groups: political / ideological conflict; active teaching and learning methodologies; location / separation of campuses; time of existence; teaching career; political-administrative transformations. The quantitative analysis revealed in more detail the general impressions raised in the focus groups. Most results were able to demonstrate distinct identifications of the same identity with its exposed weaknesses. CONCLUSIONS: Lack of autonomy, administrative and structural shortcomings and ideological or political conflicts presented themselves as problems capable of destabilizing the identity of a public higher education institution. On the other hand, one way to combat such problems is through the development of the institution itself, particularly by becoming more active and useful to the community and seeking in a common interest to the higher administration agencies.
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Aprendizagem , Universidades , Grupos Focais , Humanos , Pesquisa QualitativaRESUMO
We assessed psychotropic prescribing patterns in the clinical treatment of agitation and aggressive behavior in patients with Alzheimer's disease (AD) treated at specialist outpatient clinics in the Federal District of Brazil. This was a naturalistic, observational, multicenter study of a convenience sample of patients with AD (according to DSM-5) who had behavioral symptoms of aggression and/or agitation at outpatient visits, as assessed by the Neuropsychiatric Inventory (NPI), and required pharmacologic intervention. Participants were recruited in 2018-2019 from 11 AD treatment centers. Sociodemographic and clinical data were collected during routine visits. The sample consisted of 369 older adults with a mean age of 82.3 (SD, 7.7) years. The medications most commonly used in patients with behavioral disorders were antidepressants (79.1%), antipsychotics (70.2%), benzodiazepines (10.6%), and mood stabilizers (9.5%). Quetiapine was the most frequently prescribed antipsychotic medication (48.5%), at a mean dose of 57.4 (SD, 40.7) mg. Citalopram was the most widely used antidepressant medication (32.0%), at a mean daily dose of 24.1 (SD, 8.1) mg. In this sample, two or more pharmacologic agents were frequently used together to control aggression and agitation. Benzodiazepine was not frequently used.
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Agressão/efeitos dos fármacos , Doença de Alzheimer/complicações , Agitação Psicomotora/tratamento farmacológico , Psicotrópicos/uso terapêutico , Fumarato de Quetiapina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Agressão/psicologia , Doença de Alzheimer/psicologia , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Brasil , Citalopram/uso terapêutico , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
OBJECTIVES: to identify the aspects related to professional training and autonomy of undergraduate nursing teachers of a public institution in Brasília, Federal District, in order to contribute to the course management and qualification. METHODS: mixed method study conducted with 77 teachers. A semi-structured questionnaire was applied, where quantitative items were evaluated through the Student's T and ANOVA (p<0.05%) parametric tests. The qualitative part underwent content analysis with use of the IRAMUTEQ software and descending hierarchical classification. RESULTS: the training of professionals was focused mostly (67.5%) on their initial area of expertise, and their mean values in autonomy-related factors were low and moderate. Two categories emerged in the qualitative analysis: "Identifying teacher autonomy" and "Applying teacher autonomy". CONCLUSIONS: understanding the meaning and degree of autonomy perceived by teachers can foster the reflection on the praxis and enhance their performance.
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Certificação/estatística & dados numéricos , Docentes de Enfermagem/classificação , Autonomia Profissional , Ensino/estatística & dados numéricos , Adulto , Bacharelado em Enfermagem/métodos , Docentes de Enfermagem/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Competência Profissional , Pesquisa Qualitativa , Inquéritos e Questionários , Ensino/normasRESUMO
BACKGROUND: Brazilian patients have legal right to access unlicensed medicines undergoing clinical research, if there is evidence of efficacy and safety. This study investigated the occurrence of serious adverse events related to very high-cost medicines from clinical studies, expanded access and compassionate use programs, obtained by patients though health litigation. METHODS: A descriptive study using secondary data investigated unlicensed medicines obtained through lawsuits from 2010 to 2017, costing more than 1 million Brazilian reais (BRL), adjusted by the Brazilian Consumer Index to July 2017. Data sources were the Brazilian Health Surveillance Agency Registry (DATAVISA) and Adverse Events in Clinical Studies (NotivisaEC) Databases. Medicines were categorized by the Anatomical Therapeutic Chemical classification to level 03 and events by the WHO Adverse Drug Reaction Terminology. The study received ethical approval by the University of Brasilia Institutional Research Board. RESULTS: In the period, 812 drugs were obtained through litigation, and of these, 78 exceeded cost of 1 million BRL; 44 of them presented reports of 1,248 serious adverse events. Total Brazilian Government expenditure with these drugs was 3.2 billion BRL. Class L04A (n=7) showed greater expenditures (over 1.8 billion BRL). One hundred ninety-six deaths occurred and L01X was the most involved category (49.5%). Most other serious events (n=419) and sequelae (n=10) were related to L01X. CONCLUSION: Very high-cost drugs paid for by the government and obtained through health litigation presented deaths and serious adverse events in expanded access and compassionate use programs in Brazil.
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OBJECTIVE: To evaluate the profile of femur fractures in older adults in Brazil between 2008 and 2018. METHODS: Population-based time series study with data from the Department of Informatics of the Unified Health System (Datasus), including 480,652 hospitalizations, of adults from 60 years and over, with hip fracture (ICD10-S72). RESULTS: There was an increase of 76.9% in the hospitalization register (mean 5.87%/year) and an average incidence rate of 19.46 fractures for every 10,000 older adults. In total, 68% of hospitalizations were female, 28% from São Paulo. The average length of stay was 8.9 days, being higher in the Northern Region (11.8) and in the Federal District (18.7). Average mortality rate was 5%, being higher in men (5.45%) and over 80 years old. Northeast Region had the lowest mortality rate (3.54%). Southeast Region had the highest rate (5.53%). Total cost of hospitalizations was R$ 1.1 billion, with an average of R$ 100 million/year. Average cost per hospitalization was higher in the Southern Region (R$ 2,491.00). CONCLUSION: Femoral fracture is an important cause of mortality among older adults, with a higher incidence in women but higher mortality in men, with high cost to the system and regional differences. Level of Evidence II, Economic and decision analyses - developing an economic or decision model.
OBJETIVO: Avaliar o perfil das fraturas de fêmur em idosos no Brasil no período de 2008 a 2018. MÉTODOS: Estudo de série temporal baseado em dados do Departamento de Informática do Sistema Único de Saúde (Datasus), incluindo 480.652 internações de pessoas com idade a partir de 60 anos e com fratura de quadril (ICD10-S72). RESULTADOS: Houve aumento de 76,9% no registro de hospitalização (média de 5,87% por ano) e taxa de incidência média de 19,46 fraturas para cada 10 mil idosos. O estado de São Paulo respondeu por 28% do total de registros, e as internações de pacientes do sexo feminino corresponderam a 68% do total. O tempo médio de permanência foi de 8,9 dias, com maiores índices na Região Norte (11,8) e no Distrito Federal (18,7). A taxa média de mortalidade foi de 5% e atingiu os maiores valores entre os homens (5,45%) e os pacientes com mais de 80 anos. A região Nordeste apresentou a menor taxa de mortalidade (3,54%) e a região Sudeste teve a maior (5,53%). O custo total das internações foi de R$ 1,1 bilhão, com média de R$ 100 milhões ao ano. O custo médio por hospitalização foi maior na região Sul (R$ 2.491,00). CONCLUSÃO: A fratura do fêmur é importante causa de mortalidade em idosos, com maior incidência em mulheres e maior mortalidade em homens, alto custo para o sistema e diferenças regionais. Nível de Evidência II, Análises econômicas e de decisão - desenvolvimento de modelo econômico ou de decisão.
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ABSTRACT Objective: To evaluate the profile of femur fractures in older adults in Brazil between 2008 and 2018. Methods: Population-based time series study with data from the Department of Informatics of the Unified Health System (Datasus), including 480,652 hospitalizations, of adults from 60 years and over, with hip fracture (ICD10-S72). Results: There was an increase of 76.9% in the hospitalization register (mean 5.87%/year) and an average incidence rate of 19.46 fractures for every 10,000 older adults. In total, 68% of hospitalizations were female, 28% from São Paulo. The average length of stay was 8.9 days, being higher in the Northern Region (11.8) and in the Federal District (18.7). Average mortality rate was 5%, being higher in men (5.45%) and over 80 years old. Northeast Region had the lowest mortality rate (3.54%). Southeast Region had the highest rate (5.53%). Total cost of hospitalizations was R$ 1.1 billion, with an average of R$ 100 million/year. Average cost per hospitalization was higher in the Southern Region (R$ 2,491.00). Conclusion: Femoral fracture is an important cause of mortality among older adults, with a higher incidence in women but higher mortality in men, with high cost to the system and regional differences. Level of Evidence II, Economic and decision analyses - developing an economic or decision model.
RESUMO Objetivo: Avaliar o perfil das fraturas de fêmur em idosos no Brasil no período de 2008 a 2018. Métodos: Estudo de série temporal baseado em dados do Departamento de Informática do Sistema Único de Saúde (Datasus), incluindo 480.652 internações de pessoas com idade a partir de 60 anos e com fratura de quadril (ICD10-S72). Resultados: Houve aumento de 76,9% no registro de hospitalização (média de 5,87% por ano) e taxa de incidência média de 19,46 fraturas para cada 10 mil idosos. O estado de São Paulo respondeu por 28% do total de registros, e as internações de pacientes do sexo feminino corresponderam a 68% do total. O tempo médio de permanência foi de 8,9 dias, com maiores índices na Região Norte (11,8) e no Distrito Federal (18,7). A taxa média de mortalidade foi de 5% e atingiu os maiores valores entre os homens (5,45%) e os pacientes com mais de 80 anos. A região Nordeste apresentou a menor taxa de mortalidade (3,54%) e a região Sudeste teve a maior (5,53%). O custo total das internações foi de R$ 1,1 bilhão, com média de R$ 100 milhões ao ano. O custo médio por hospitalização foi maior na região Sul (R$ 2.491,00). Conclusão: A fratura do fêmur é importante causa de mortalidade em idosos, com maior incidência em mulheres e maior mortalidade em homens, alto custo para o sistema e diferenças regionais. Nível de Evidência II, Análises econômicas e de decisão - desenvolvimento de modelo econômico ou de decisão.
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OBJECTIVE: To know the positions and practices adopted by nursing students in scientific initiation programs about the principles of scientific integrity in the different stages of the process of doing science. METHOD: An exploratory study of a quantitative nature, in which nursing student participants of the Scientific Initiation Program from the Federal District were interviewed. RESULTS: Fifty (50) nursing students participated in the study. Most of the interviewed participants presented good notions about the process of conducting research in its different stages. Nevertheless, it was found that even though they were familiar with good scientific practices, students did not always behave in the most responsible manner. It was observed that the knowledge on topics related to the ethics of the scientific process was predominantly obtained through formal education, consisting of classes and courses. Nonetheless, the importance of complementary spaces such as research and research groups is recognized. Conclusion: Research experiences are important educational and vocational training spaces for students. Therefore, good research practices need to be included early in the academic curriculum.
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Educação em Enfermagem/métodos , Pesquisa em Enfermagem/educação , Estudantes de Enfermagem/psicologia , Adulto , Estudos Transversais , Currículo , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa em Enfermagem/ética , Adulto JovemRESUMO
ABSTRACT Objectives: to identify the aspects related to professional training and autonomy of undergraduate nursing teachers of a public institution in Brasília, Federal District, in order to contribute to the course management and qualification. Methods: mixed method study conducted with 77 teachers. A semi-structured questionnaire was applied, where quantitative items were evaluated through the Student's T and ANOVA (p<0.05%) parametric tests. The qualitative part underwent content analysis with use of the IRAMUTEQ software and descending hierarchical classification. Results: the training of professionals was focused mostly (67.5%) on their initial area of expertise, and their mean values in autonomy-related factors were low and moderate. Two categories emerged in the qualitative analysis: "Identifying teacher autonomy" and "Applying teacher autonomy". Conclusions: understanding the meaning and degree of autonomy perceived by teachers can foster the reflection on the praxis and enhance their performance.
RESUMEN Objetivos: identificar aspectos relacionados con la formación profesional y la autonomía de los docentes universitarios de enfermería de una institución pública en Brasilia, Distrito Federal, para contribuir a la gestión y calificación del curso. Métodos: investigación de método mixto realizada con 77 docentes. Se aplicó un cuestionario semiestructurado, donde los ítems cuantitativos se evaluaron mediante las pruebas paramétricas T de Student y ANOVA (p<0.05%). La parte cualitativa se sometió a análisis de contenido con el uso del software IRAMUTEQ y clasificación jerárquica descendente. Resultados: con la formación enfocada principalmente (67.5%) en su área inicial de experiencia, los profesionales expresaron promedios bajos y moderados en factores relacionados con la autonomía. En el análisis cualitativo surgieron dos categorías: "Identificar la autonomía del docente" y "Aplicar la autonomía del docente". Conclusiones: comprender el significado y el grado de autonomía percibido por los docentes puede fomentar la reflexión de la praxis y mejorar su desempeño.
RESUMO Objetivos: identificar aspectos relativos à formação profissional e à autonomia dos docentes de graduação em Enfermagem de uma instituição pública de Brasília, Distrito Federal, de forma a contribuir na gestão e na qualificação do curso. Métodos: estudo misto, realizado com 77 docentes. Aplicou-se questionário semiestruturado, onde os itens quantitativos foram avaliados por testes paramétricos: Teste t-student e ANOVA (p<0,05%). A parte qualitativa passou por análise de conteúdo com subsídio do software IRAMUTEQ, e foi empregada a Classificação Hierárquica Descendente. Resultados: com formação voltada majoritariamente (67,5%) à sua área de atuação inicial, os profissionais expressaram médias baixas e moderadas nos fatores relacionados à autonomia. Na análise qualitativa emergiram duas categorias: "Identificando a autonomia docente" e "Aplicando a autonomia docente". Conclusões: entender o significado e o grau de autonomia percebido pelo docente pode fomentar a reflexão da práxis e potencializar sua atuação.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensino/estatística & dados numéricos , Certificação/estatística & dados numéricos , Autonomia Profissional , Docentes de Enfermagem/classificação , Competência Profissional , Ensino/normas , Inquéritos e Questionários , Pesquisa Qualitativa , Bacharelado em Enfermagem/métodos , Docentes de Enfermagem/estatística & dados numéricosRESUMO
Abstract Objective: To know the positions and practices adopted by nursing students in scientific initiation programs about the principles of scientific integrity in the different stages of the process of doing science. Method: An exploratory study of a quantitative nature, in which nursing student participants of the Scientific Initiation Program from the Federal District were interviewed. Results: Fifty (50) nursing students participated in the study. Most of the interviewed participants presented good notions about the process of conducting research in its different stages. Nevertheless, it was found that even though they were familiar with good scientific practices, students did not always behave in the most responsible manner. It was observed that the knowledge on topics related to the ethics of the scientific process was predominantly obtained through formal education, consisting of classes and courses. Nonetheless, the importance of complementary spaces such as research and research groups is recognized. Conclusion: Research experiences are important educational and vocational training spaces for students. Therefore, good research practices need to be included early in the academic curriculum.
Resumen Objetivo: Conocer planteamientos y prácticas adoptados por alumnos de enfermería incluidos en programas de iniciación científica acerca de los principios de integridad científica en las distintas etapas del proceso de hacer ciencia. Método: Estudio exploratorio, de naturaleza cuantitativa, en que fueron entrevistados estudiantes de enfermería del Distrito Federal, participantes en el Programa de Iniciación Científica. Resultados: Participaron en el estudio 50 estudiantes de enfermería. La mayoría de los entrevistados presentaron buenas nociones acerca del proceso de conducción de la investigación, en sus distintas etapas. Pese a ello, se verificó que, aun teniendo familiaridad con buenas prácticas científicas, no siempre los estudiantes se portaban de modo más responsable. Se observó que los conocimientos acerca de los temas relacionados con la etnicidad del proceso científico fueron obtenidos predominantemente mediante enseñanza formal, constituida de clases y asignaturas. Sin embargo, se reconoce la importancia de espacios complementarios, como la investigación y los grupos de investigación. Conclusión: Las experiencias en investigación son importantes espacios educativos y de formación profesional para los estudiantes. Por lo que las buenas prácticas en investigación necesitan incluirse precozmente en el currículo académico.
Resumo Objetivo: Conhecer posicionamentos e práticas adotados por alunos de enfermagem inseridos em programas de iniciação científica acerca dos princípios de integridade científica nas diferentes etapas do processo de fazer ciência. Método: Estudo exploratório, de natureza quantitativa, em que foram entrevistados estudantes de enfermagem do Distrito Federal, participantes do Programa de Iniciação Científica. Resultados: Participaram do estudo 50 estudantes de enfermagem. A maioria dos entrevistados apresentou boas noções sobre o processo de condução de pesquisa, em suas diferentes etapas. Apesar disso, verificou-se que, mesmo possuindo familiaridade com boas práticas científicas, nem sempre os estudantes se comportavam de maneira mais responsável. Observou-se que os conhecimentos sobre temas relacionados à eticidade do processo científico foram obtidos predominantemente por meio de ensino formal, constituído por aulas e disciplinas. Apesar disso, reconhece-se a importância de espaços complementares, como a pesquisa e grupos de pesquisa. Conclusão: As experiências em pesquisa são importantes espaços educativos e de formação profissional para os estudantes. Por isso, boas práticas em pesquisa precisam ser incluídas precocemente no currículo acadêmico.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estudantes de Enfermagem , Má Conduta Científica , Ética em Pesquisa , Revisão Ética , Princípios MoraisRESUMO
This article analyzes the profile of research conducted in the Federal District of Brazil funded through public calls for proposals issued by the Research for the SUS Program: shared health management/Federal District (PPSUS/DF) and a research support program run by the Superior School of Health Sciences, maintained by the Health Sciences Teaching and Research Foundation (ESCS/FEPECS, acronym in Portuguese). A document analysis was undertaken of all research funded by the PPSUS/DF and ESCS/FEPECS's Research Support Program between 2008 and 2017 using the following variables: year, title, research themes of the National Agenda for Health Research Priorities (ANPPS, acronym in Portuguese), implementing organization, area of application of research, and amount of funding. PPSUS/DF funded 73 projects with a total investment of approximately R$8 million, while ESCS/FEPECS funded 85 projects with a total investment of R$2.3 million. This study provides a critical analysis of the research themes supported by ESCS/FEPECS and PPSUS/DF between 2008 and 2017. It is recommended that future calls for proposals should prioritize the three leading causes of death in the Federal District and the organization and evaluation of healthcare services.
O objetivo deste trabalho foi analisar o perfil das pesquisas científicas financiadas no Distrito Federal provenientes das chamadas públicas do Programa Pesquisa para o SUS: Gestão Compartilhada em Saúde (PPSUS/DF) e Programa de Fomento a Pesquisa Científica da ESCS/FEPECS, no período de 2008 a 2017. O estudo é analítico e documental, abrangendo o universo das pesquisas financiadas nesses dois Programas. As variáveis foram: ano, título, tema de pesquisa da Agenda Nacional de Prioridades de Pesquisas em Saúde (ANPPS), setor de aplicação, instituição e valor financiado. No período de 2008 a 2017, 73 projetos foram financiados pelos cinco editais do PPSUS/DF. O valor total foi de aproximadamente oito milhões de reais. Em relação à ESCS/FEPECS, entre 2008 a 2017, foram financiados 85 projetos pelos dez editais lançados. O valor total foi de 2,3 milhões de reais. Concluiu-se que o perfil das pesquisas científicas permitiu uma análise crítica das temáticas dos projetos. Recomenda-se que os próximos editais adotem como prioridade de pesquisa as três principais causas de óbitos, o processo de organização e avaliação de linhas de cuidados, serviços de saúde e redes de atenção.
Assuntos
Tecnologia Biomédica/economia , Pesquisa sobre Serviços de Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Brasil , Pesquisa sobre Serviços de Saúde/economia , Humanos , Invenções/economia , Programas Nacionais de Saúde/economia , Apoio à Pesquisa como AssuntoRESUMO
Resumo O objetivo deste trabalho foi analisar o perfil das pesquisas científicas financiadas no Distrito Federal provenientes das chamadas públicas do Programa Pesquisa para o SUS: Gestão Compartilhada em Saúde (PPSUS/DF) e Programa de Fomento a Pesquisa Científica da ESCS/FEPECS, no período de 2008 a 2017. O estudo é analítico e documental, abrangendo o universo das pesquisas financiadas nesses dois Programas. As variáveis foram: ano, título, tema de pesquisa da Agenda Nacional de Prioridades de Pesquisas em Saúde (ANPPS), setor de aplicação, instituição e valor financiado. No período de 2008 a 2017, 73 projetos foram financiados pelos cinco editais do PPSUS/DF. O valor total foi de aproximadamente oito milhões de reais. Em relação à ESCS/FEPECS, entre 2008 a 2017, foram financiados 85 projetos pelos dez editais lançados. O valor total foi de 2,3 milhões de reais. Concluiu-se que o perfil das pesquisas científicas permitiu uma análise crítica das temáticas dos projetos. Recomenda-se que os próximos editais adotem como prioridade de pesquisa as três principais causas de óbitos, o processo de organização e avaliação de linhas de cuidados, serviços de saúde e redes de atenção.
Abstract This article analyzes the profile of research conducted in the Federal District of Brazil funded through public calls for proposals issued by the Research for the SUS Program: shared health management/Federal District (PPSUS/DF) and a research support program run by the Superior School of Health Sciences, maintained by the Health Sciences Teaching and Research Foundation (ESCS/FEPECS, acronym in Portuguese). A document analysis was undertaken of all research funded by the PPSUS/DF and ESCS/FEPECS's Research Support Program between 2008 and 2017 using the following variables: year, title, research themes of the National Agenda for Health Research Priorities (ANPPS, acronym in Portuguese), implementing organization, area of application of research, and amount of funding. PPSUS/DF funded 73 projects with a total investment of approximately R$8 million, while ESCS/FEPECS funded 85 projects with a total investment of R$2.3 million. This study provides a critical analysis of the research themes supported by ESCS/FEPECS and PPSUS/DF between 2008 and 2017. It is recommended that future calls for proposals should prioritize the three leading causes of death in the Federal District and the organization and evaluation of healthcare services.