Contexto: O diabetes mellitus (DM) é uma causa importante de morbimortalidade nas sociedades ocidentais devido à carga de sofrimento, incapacidade, perda de produtividade e morte prematura que provoca. No Brasil, seu impacto econômico é desconhecido. Objetivos: Dimensionar a participação do DM nas hospitalizações da rede pública brasileira (1999-2001), colaborando na avaliação dos custos diretos. Especificamente, analisar as hospitalizações (327.800) e os óbitos hospitalares (17.760) por DM como diagnóstico principal (CID-10 E10-E14 e procedimento realizado) e estimar as hospitalizações atribuíveis ao DM, incluindo as anteriores e aquelas por complicações crônicas (CC) e condições médicas gerais (CMG). Métodos: A partir de dados do Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS) (37 milhões de hospitalizações), foram calculados indicadores por região de residência do paciente e sexo (ajustados por idade pelo método direto, com intervalos de confiança de 95%), faixas etárias, médias de permanência e de gastos por internação e populacional em US$. Realizou-se regressão logística múltipla para o desfecho óbito. As prevalências de DM foram combinadas aos riscos relativos de hospitalização por CC e CMG (metodologia do risco atribuível) e somadas às internações por DM como diagnóstico principal. Utilizou-se análise de sensibilidade para diferentes prevalências e riscos relativos. Resultados: Os coeficientes de hospitalizações e de óbitos hospitalares e a letalidade por DM como diagnóstico principal atingiram respectivamente 6,4/104hab., 34,9/106hab. e 5,4%. As mulheres apresentaram os coeficientes mais elevados, porém os homens predominaram na letalidade em todas as regiões. O gasto médio (US$ 150,59) diferiu significativamente entre as internações com e sem óbito, mas a média de permanência (6,4 dias) foi semelhante. O gasto populacional equivaleu a US$ 969,09/104hab. As razões de chances de óbito foram maiores para homens, pacientes ≥75 anos, e habitantes das regiões Nordeste e Sudeste. As hospitalizações atribuíveis ao DM foram estimadas em 836,3 mil/ano (49,3/104hab.), atingindo US$ 243,9 milhões/ano (US$ 14,4 mil/104hab.). DM como diagnóstico principal (13,1%), CC (41,5%) e CMG (45,4%) responderam por 6,7%, 51,4% e 41,9% respectivamente dos gastos. O valor médio das internações atribuíveis (US$ 292) situou-se 36% acima das não-atribuíveis. As doenças vasculares periféricas apresentaram a maior diferença no valor médio entre hospitalizações atribuíveis e não-atribuíveis (24%), porém as cardiovasculares destacaram-se em quantidade (27%) e envolveram os maiores gastos (37%). Os homens internaram menos (48%) que as mulheres, porém com gasto total maior (53%). As internações de pacientes entre 45-64 anos constituíram o maior grupo (45%) e gastos (48%) enquanto os pacientes com ≥75, os maiores coeficientes de hospitalização (350/104hab.) e de despesa (US$ 93,4 mil/104hab.). As regiões mais desenvolvidas gastaram o dobro (/104hab.) em relação às demais. Considerações Finais e Recomendações: As configurações no consumo de serviços hospitalares foram semelhantes às de países mais desenvolvidos, com importantes desigualdades regionais e de sexo. O gasto governamental exclusivamente com hospitalizações atribuíveis ao DM foi expressivo (2,2% do orçamento do Ministério da Saúde). A ampliação de atividades preventivas poderia diminuir a incidência do DM, reduzir a necessidade de internações, minimizar as complicações e minorar a severidade de outras condições médicas mais gerais. / Background: Diabetes mellitus (DM) is one of the main causes of morbi/mortality in western societies due to the burden of suffering, disabilities, loss of productivity and premature death that encompasses. Its economic impact is unknown in Brazil. Objectives: To dimension the share of DM hospitalizations on the Brazilian national health system (1999-2001), helping on evaluating direct costs. Specifically, to analyze hospitalizations (327.800) and hospitalization deaths (17.760) caused by DM as first-listed diagnosis (ICD-10 E10-E14 and procedure done) and to estimate the magnitude of DM attributable hospitalizations, including DM itself, chronic complications (CC) and general medical conditions (GMC). Methods: Data from the Hospital Information System of the National Health System (SIH/SUS) (37 millions of hospitalizations). Indicators were calculated by residence region of the patients and sex (adjusted by direct method for age with 95% confidence intervals), age intervals, average length of stay and expenditure by admission and population in US$. Multiple logistic regression was performed for death as outcome. Combinations of DM prevalence and hospitalization relative risks for CC and GMC were added to DM first-listed hospitalizations (attributable risk methodology). Sensitivity analyze was used for different prevalences and relative risks. Results: Hospitalizations and hospitalization deaths coefficients and lethality by DM as first-listed diagnosis were 6.4/104inhab., 34.9/106inhab. and 5.4% respectively. Coefficients were higher for women, although lethality was for men in every five region. Average expenditure (US$150,59) differed significantly between those with/without death but presented equal average length of stay (6.4). Population expenditure was US$ 969.09/104inhab. Odds-ratio for dying were larger for men, patients 75 yrs, and inhabitants of northeast and southeast. Hospitalizations attributable to DM were estimated at 836.3 thousand/year (49.3/104inhab.) reaching US$ 243.9 millions/year (US$ 14.4 thousand/104inhab.). DM as fist-list diagnosis (13.1%), CC (41.5%) and GMC (45.4%) depicted 6.7%, 51.4% e 41.9% respectively of annual expenditures. Average value of attributable hospitalizations (US$ 292) was 36% higher than non-attributable. Peripheral vascular diseases posed the largest excess based on average values (24%) although cardiovascular ones represented the major quantity (27%) and expenditure group (37%). Men were less admitted (48%) than women, but incurred more expenditure (53%). People 45-64 years old consisted the largest (45%) and most expensive (48%) group while 75+ generated the highest coefficients of hospitalization (350/104inhab.) and expenditure (US$ 93.4 thousands/104inhab.). Most developed regions accounted for nearly twice expenses than other regions. Conclusions and Recommendations: Patterns of hospitalization were similar to those most developed countries. Important regional and gender inequalities did exist. Governmental expenditures related exclusively to DM attributable hospitalizations was meaningful (2.2% of the budget of the Ministry oh Health). Broadening preventive health care actions could diminish the incidence of DM, reduce the need for hospitalizations, minimize complications and minors the severity of general medical conditions.

No description available.

The number of people aged 60 years and over has doubled since 1980and the World Health Organization predicts that the population of over60s will reach 2 billion by the year 2050. An ageing population poses bothchallenges and opportunities for society and for individuals. Whilst theseare positive statements, increases in life spans do not directly lead to increasesin health spans. The naturally occurring ageing process can leadto reductions in functionality and, in order to address this, scholars haveargued the benefits of regularly engaging in physical activity, and especiallyresistance training. Therefore, an important challenge for modernsociety is to develop strategies that delay the onset of disease, such as interventionsthat include physical activity. This licentiate thesis investigatesolder women’s physical activity in a resistance training context and howthis affects different aspects of their health.The overall aim of the thesis is to explore healthy and physically activeolder women’s experiences of what maintains and enhances their healthafter starting resistance training.This thesis used a quantitative and a qualitative approach to investigatea group of old adult women. Data collection was structured in questionnaires(n=32) with one intervention group and one control group for thepaper I, and focus group interviews (n=14) in paper II. Paper I studied theeffects of resistance training on physically active and healthy olderwomen. Paper II relates to the women who continued to exercise after theresistance training intervention ended in order to explore their health resources.The theoretical framework used in this thesis is a movement towardshealth as explained by salutogenic theory.This thesis showed that resistance training has positive effects on psychologicalwell-being and is important because it not only benefits thosewho are physically inactive, but also those who are already physically activeand healthy.From a salutogenic perspective, physical activity provides a meaningful,comprehensible and manageable way for older women to engage in theongoing process of maintaining health.

Due to the demanding structure of caring for a child with a life-threatening disease (LTD), parents experience psychosocial distress. Studies have shown that stress in parents of children with LTDs can be increased by unmet needs or fragmented care and may be mitigated by coordinated and comprehensive care. Limited literature exists about unmet needs of parents of children with LTDs and the barriers they encounter to accessing mental health resources within pediatric palliative care (PPC) programs. This research study applied quantifiable descriptive methods including a purposive sample of ninety-eight (98) PPC and other pediatric practitioners through the distribution of anonymous online surveys in order to examine unmet needs for mental health resources as they relate to parents of children with LTDs who experience psychological distress exacerbated from psychosocial stressors of care giving. Influenced by Andersen’s predisposing, enabling, and need factors, this study found that PPC practitioners perceived parents encountering waitlists and/or denials when referred to community mental health resources as demonstrating resistance against seeking help.

Multiple chronic conditions (MCCs) are defined as two or more health conditions, each requiring treatment and limiting activities for a year or more. In the United States (US), MCCs are more common and costly than any individual chronic condition. The number of adults aged 65 years and older with MCCs is projected to nearly double between 2020 and 2050. Patients with MCCs often experience poor self-reported health and negative symptoms. In addition, they frequently visit emergency departments (EDs) and are hospitalized. Patients with MCCs need ongoing primary care services to manage their symptoms and prevent health deterioration. However, over 20% of the US population (many of whom have MCCs) resides in a primary care Health Professional Shortage Area (HPSA) and experiences poor access to primary care. The growing nurse practitioner (NP) workforce, which is projected to almost double in size between 2018 and 2030, can help meet the demand. Most NPs are trained to diagnose, treat, and manage chronic conditions and can provide a scope and quality of primary care comparable to physicians in many populations. Therefore, if distributed and supported strategically, the NP workforce can meet the complex care needs of patients with MCCs, especially in HPSAs. Maximizing the potential of the NP workforce to deliver MCC care will require enhanced care environments in the practices where NPs work, characterized by administrative support for NP care delivery and autonomous practice, collegial relationships between NPs and physicians, and NP professional visibility. On the other hand, poor NP care environments can negatively affect the quality of chronic disease care. Thus, improving the NP care environments within practices may increase the capacity of the NP workforce to care for MCC patients. Despite the potential of the NP workforce to meet the need for primary care among patients with MCCs, little is known about the impact of NP-delivered primary care models on outcomes in this population. Furthermore, the impact of HPSA status and NP care environments on NPs’ ability to care for patients with MCCs remains poorly understood. Thus, the overall purpose of this dissertation is to produce evidence on NP-delivered primary care models for patients with MCCs and examine the interplay between practice and community factors in shaping outcomes for these patients. In chapter 1, we introduce the unique healthcare needs of patients with MCCs, and the role of NPs in delivering and expanding access to care. In chapter 2, we synthesize the existing evidence on the effect of NP primary care models, compared to models without NP involvement, on cost, quality, and service utilization by patients with MCCs. Our synthesis suggests that NP-delivered primary care has similar or better impacts on outcomes among patients with MCCs compared to care delivered without NP involvement. In chapter 3, we perform secondary data analysis using multiple linked data sources including 1) patient data from the Medicare claims of 394,424 older adults with MCCs, 2) NP survey data on practice characteristics from 880 NPs at 779 primary care practices across five US states, and 3) data on HPSA status of the practice locations from the Health Resources and Services Administration. We examine differences in hospitalization and ED use among patients who receive care from NP practices in HPSAs compared to those in non-HPSAs. We find a higher likelihood of ED use among patients receiving care in NP practices located in HPSAs compared to practices in non-HPSAs, and no difference in the likelihood of being hospitalized. Our results suggest that relieving provider shortages may reduce ED use by MCC patients in HPSA practices that employ NPs, but may be insufficient to lower hospitalization rates unless combined with other interventions. Finally, in chapter 4, we analyze the same linked secondary data source as in chapter 3 to examine the effect of the NP care environment (measured by the NP survey) on the relationship between the HPSA status of the practice location and ED or hospital use among patients with MCCs. We find that the NP care environment moderates the association between primary care provider shortage areas and hospitalization but not ED use. Further analysis reveals that improved NP care environments have a more pronounced association with lowered odds of hospitalization among patients receiving care from practices located in areas with no shortage of primary care providers (i.e., non-HPSAs) compared to those receiving care in practices with provider shortages (i.e., HPSAs). Our findings suggest that improving the care environment may not have the effect of reducing MCC patients’ need for hospitalization unless sufficient providers are also available to care for patients. We suggest that cohesive solution sets addressing practice- and community-level interventions simultaneously may be needed to improve hospitalization outcomes for patients with MCCs. In the concluding chapter of this dissertation, chapter 5, we present a summary of findings, discuss the dissertation’s strengths, limitations, and its contributions to science. In this chapter, we also discuss implications for policy, practice, and directions for future research.

Este estudo tem como objetivo caracterizar o processo de implantação das equipes de saúde da família (ESF) no Estado de São Paulo (ESP) no período de 1996 a 2001. Foram utilizados dados secundários referentes ao Estado, produzidos por uma pesquisa nacional realizada pelo Ministério da Saúde em 2001 e 2002. Esta pesquisa foi ampliada com questões específicas desenvolvidas pela Coordenação Estadual do Programa Saúde da Familia (PSF). Estes dados referem-se às 1058 ESF implantadas em 54% dos municípios do Estado, e foram estruturados abrangendo os seguintes aspectos: 1. caracterização das ESF; 2. infraestrutura (área física, equipamentos disponíveis e recursos humanos); 3. ações desenvolvidas pelas ESF; 4. instrumentos de planejamento e organização do atendimento do trabalho das ESF; 5. capacitações das ESF. As variáveis utilizadas no plano de análise foram o tempo de implantação das equipes e o porte dos municípios. Também foi desenvolvida uma classificação de adequação das caracteristicas estudadas que objetivou verificar maior ou menor aproximação com a situação ideal preconizada pelas diretrizes do PSF. Os resultados do presente estudo fornecem elementos que podem contribuir para implantação de novas ESF e servir como linha de base para estudos futuros. / The objective of this study is to evaluate the implantation of family health teams (FHTs) in the State of São Paulo (SSP), Brazil, during the period 1996-2001. Secondary data from the SSP obtained through a national survey carried out by the Ministry of Health in 2001-2202 were utilized. This survey was expanded by the State Coordination of the Family Health Program (PSF) to include specific questions. These data refer to 1058 FHTs implemented in 54% of the municipalities of the SSS, and were structured to encompass the following aspects: 1. characterization of the FHTs; 2. infrastructure (physical area, available equipment and human resources); 3. actions developed by the FHTs; 4. planning instruments and organization of the work of the FHTs; 5. FHTs training. The variables used for the analysis included time of implementation of the FHTs and size of the municipalities. An adequateness scoring classification for the studied characteristics was developed in order to assess greater or smaller approximation to the ideal situation envisioned by the Family Heath Program (PSF) of guidelines. The results of this study provide elements that may contribute to the implementation of new FHTs and serve as baseline data for future studies.

Este estudo tem como objetivo caracterizar o processo de implantação das equipes de saúde da família (ESF) no Estado de São Paulo (ESP) no período de 1996 a 2001. Foram utilizados dados secundários referentes ao Estado, produzidos por uma pesquisa nacional realizada pelo Ministério da Saúde em 2001 e 2002. Esta pesquisa foi ampliada com questões específicas desenvolvidas pela Coordenação Estadual do Programa Saúde da Familia (PSF). Estes dados referem-se às 1058 ESF implantadas em 54% dos municípios do Estado, e foram estruturados abrangendo os seguintes aspectos: 1. caracterização das ESF; 2. infraestrutura (área física, equipamentos disponíveis e recursos humanos); 3. ações desenvolvidas pelas ESF; 4. instrumentos de planejamento e organização do atendimento do trabalho das ESF; 5. capacitações das ESF. As variáveis utilizadas no plano de análise foram o tempo de implantação das equipes e o porte dos municípios. Também foi desenvolvida uma classificação de adequação das caracteristicas estudadas que objetivou verificar maior ou menor aproximação com a situação ideal preconizada pelas diretrizes do PSF. Os resultados do presente estudo fornecem elementos que podem contribuir para implantação de novas ESF e servir como linha de base para estudos futuros. / The objective of this study is to evaluate the implantation of family health teams (FHTs) in the State of São Paulo (SSP), Brazil, during the period 1996-2001. Secondary data from the SSP obtained through a national survey carried out by the Ministry of Health in 2001-2202 were utilized. This survey was expanded by the State Coordination of the Family Health Program (PSF) to include specific questions. These data refer to 1058 FHTs implemented in 54% of the municipalities of the SSS, and were structured to encompass the following aspects: 1. characterization of the FHTs; 2. infrastructure (physical area, available equipment and human resources); 3. actions developed by the FHTs; 4. planning instruments and organization of the work of the FHTs; 5. FHTs training. The variables used for the analysis included time of implementation of the FHTs and size of the municipalities. An adequateness scoring classification for the studied characteristics was developed in order to assess greater or smaller approximation to the ideal situation envisioned by the Family Heath Program (PSF) of guidelines. The results of this study provide elements that may contribute to the implementation of new FHTs and serve as baseline data for future studies.

Este trabalho teve o objetivo de analisar o registro dos prontuários hospitalares como subsídio para a gestão em saúde. Foram analisados 430 prontuários de egressos de 2 hospitais públicos municipais de São Paulo internados em abril de 2010. Os resultados mostraram que os registros dos hospitais foram diferentes na maioria das variáveis estudadas, motivo pelo qual foram tratados separadamente. Observou-se que as variáveis sexo, idade, número de diagnósticos, motivo da saída, tempo de permanência e número de cuidados foram totalmente registradas. Enquanto que as variáveis pressão arterial, freqüência cardíaca, freqüência respiratória, temperatura, dor, alimentação, banho e locomoção foram parcialmente registradas. Analisando as variáveis totalmente registradas verificou-se que no Hospital A e B, respectivamente, adultos de 30 a 59 anos (35.9%, 42.3%), idosos com 60 anos ou mais (22.8%, 16.3%) e crianças menores de 4 anos (20.1%, 17.2%) foram os que mais demandaram internações. Da mesma forma, crianças (4 a 5 dias, 4 a 6 dias) e idosos (2 a 6 dias, 4 a 6 dias) necessitaram de maior tempo de permanência. No Hospital A, as doenças do aparelho respiratório (20.5%) foram as principais responsáveis pelas internações, seguidas pelos transtornos mentais e comportamentais (14.4%). Enquanto que, no Hospital B, as doenças do aparelho respiratório (15.4%) foram as principais responsáveis pelas internações, seguidas pelas doenças do aparelho circulatório (13.5%). No Hospital A e B, respectivamente, os cuidados básicos foram mais freqüentemente registrados na saída (n=278, n=315) em comparação à admissão (n=271, n=234), enquanto que os cuidados invasivos foram mais freqüentemente registrados na admissão (n=505, n=618), em comparação à saída (n=201, n=208). Analisando a presença do registro parcial das variáveis, houve ocorrência no Hospital A na admissão e saída, respectivamente, em: pressão arterial (73.5%, 73.5%), freqüência cardíaca (72.1%, 71.6%), freqüência respiratória (39.1%, 29.3%), temperatura (89.3%, 80.5%), dor (12.6%, 11.2%), alimentação (92.6%, 95.3%), banho (91.6%, 94.4%) e locomoção (94.9%, 95.8%). Enquanto que, no Hospital B, houve presença de registro parcial na admissão e saída, respectivamente, em: pressão arterial (80%, 73.5%), freqüência cardíaca (80.5%, 73%), freqüência respiratória (21.4%, 12.1%), temperatura (96.7%, 89.8%), dor (1.4%, 0.5%), alimentação (100%, 99.5%), banho (99.1%, 99.1%) e locomoção (99.5%, 99.1%). A associação entre as variáveis indicativas: tempo de permanência e número de cuidados na admissão e na saída com as demais variáveis, mostrou que, quanto maior o tempo de permanência e o número de cuidados na admissão e saída, maior a idade, o número de diagnósticos e o comprometimento clínico e funcional. / This work aims to set the basis for a health management by analyzing the key informations of 430 medical records, which were taken from two public hospitals in the city of São Paulo, in April 2010.The research showed that the records were different in both hospitals in most of the variables studied. Consequently, they had to be analysed distinctively. It was observed that, while the variables: gender, age, diagnosis, hospital discharge reasons, lengh of stay and medical cares were entirely recorded, variables like blood pressure, cardiac and breathing frequency, body temperature, pain, food, bath and locomotion were partially recorded. Considering the variables entirely recorded, it was verified that in the hospitals A and B, respectively, the most medical admission requirements were for adults between 30-59 years of age (35.9%, 42.3%), elderly aged 60 or older (22.8%, 16.3%) and children under 4 years old (20.1%, 17.2%). On the same way, children (4 a 5 days, 4 a 6 days) and elderly (2 a 6 days, 4 a 6 days) had longer lenght of stay. In hospital A respiratory system diseases (20.5%) were the leading cause of medical admissions followed by mental and behavioral disorders (14.4%), compared to hospital B, respiratory system diseases (15.4%) followed by circulatory system illnesses(13.5%). In both cases A and B, respectively, the basic care were more frequent on the hospital discharge (n=278, n=315) if compaired to admissions (n=271, n=234), while invasive care were more frequent in the admissions (n=505, n=618) if compaired to hospital discharge (n=201, n=208). Upong analyzing the presence of the variables partial record, it has occurred in hospital A at the time of admissions and medical discharges, respectively,: blood pressure (73.5%, 73.5%), cardiac frequency (72.1%, 71.6%), breathing frequency(39.1%, 29.3%), body temperature (89.3%, 80.5%), pain (12.6%, 11.2%), food (92.6%, 95.3%), bath (91.6%, 94.4%) and locomotion (94.9%, 95.8%), while in the the hospital B, it has occurred respectively;: blood pressure (80%, 73.5%), cardiac frequency (80.5%, 73%), breathing frequency (21.4%, 12.1%), body temperature (96.7%, 89.8%), pain (1.4%, 0.5%), food (100%, 99.5%), bath (99.1%, 99.1%) and locomotion (99.5%, 99.1%). The association between the variables: lenght of stay and number of cares at the time of hospital admissions and discharges with the other parameters, showed that the longer the length of stay and the greater the number of cares in admissions and discharges, the older are the inpatients and the greater are the number of diagnosis and the clinical and functional impairements.

Este trabalho teve o objetivo de analisar o registro dos prontuários hospitalares como subsídio para a gestão em saúde. Foram analisados 430 prontuários de egressos de 2 hospitais públicos municipais de São Paulo internados em abril de 2010. Os resultados mostraram que os registros dos hospitais foram diferentes na maioria das variáveis estudadas, motivo pelo qual foram tratados separadamente. Observou-se que as variáveis sexo, idade, número de diagnósticos, motivo da saída, tempo de permanência e número de cuidados foram totalmente registradas. Enquanto que as variáveis pressão arterial, freqüência cardíaca, freqüência respiratória, temperatura, dor, alimentação, banho e locomoção foram parcialmente registradas. Analisando as variáveis totalmente registradas verificou-se que no Hospital A e B, respectivamente, adultos de 30 a 59 anos (35.9%, 42.3%), idosos com 60 anos ou mais (22.8%, 16.3%) e crianças menores de 4 anos (20.1%, 17.2%) foram os que mais demandaram internações. Da mesma forma, crianças (4 a 5 dias, 4 a 6 dias) e idosos (2 a 6 dias, 4 a 6 dias) necessitaram de maior tempo de permanência. No Hospital A, as doenças do aparelho respiratório (20.5%) foram as principais responsáveis pelas internações, seguidas pelos transtornos mentais e comportamentais (14.4%). Enquanto que, no Hospital B, as doenças do aparelho respiratório (15.4%) foram as principais responsáveis pelas internações, seguidas pelas doenças do aparelho circulatório (13.5%). No Hospital A e B, respectivamente, os cuidados básicos foram mais freqüentemente registrados na saída (n=278, n=315) em comparação à admissão (n=271, n=234), enquanto que os cuidados invasivos foram mais freqüentemente registrados na admissão (n=505, n=618), em comparação à saída (n=201, n=208). Analisando a presença do registro parcial das variáveis, houve ocorrência no Hospital A na admissão e saída, respectivamente, em: pressão arterial (73.5%, 73.5%), freqüência cardíaca (72.1%, 71.6%), freqüência respiratória (39.1%, 29.3%), temperatura (89.3%, 80.5%), dor (12.6%, 11.2%), alimentação (92.6%, 95.3%), banho (91.6%, 94.4%) e locomoção (94.9%, 95.8%). Enquanto que, no Hospital B, houve presença de registro parcial na admissão e saída, respectivamente, em: pressão arterial (80%, 73.5%), freqüência cardíaca (80.5%, 73%), freqüência respiratória (21.4%, 12.1%), temperatura (96.7%, 89.8%), dor (1.4%, 0.5%), alimentação (100%, 99.5%), banho (99.1%, 99.1%) e locomoção (99.5%, 99.1%). A associação entre as variáveis indicativas: tempo de permanência e número de cuidados na admissão e na saída com as demais variáveis, mostrou que, quanto maior o tempo de permanência e o número de cuidados na admissão e saída, maior a idade, o número de diagnósticos e o comprometimento clínico e funcional. / This work aims to set the basis for a health management by analyzing the key informations of 430 medical records, which were taken from two public hospitals in the city of São Paulo, in April 2010.The research showed that the records were different in both hospitals in most of the variables studied. Consequently, they had to be analysed distinctively. It was observed that, while the variables: gender, age, diagnosis, hospital discharge reasons, lengh of stay and medical cares were entirely recorded, variables like blood pressure, cardiac and breathing frequency, body temperature, pain, food, bath and locomotion were partially recorded. Considering the variables entirely recorded, it was verified that in the hospitals A and B, respectively, the most medical admission requirements were for adults between 30-59 years of age (35.9%, 42.3%), elderly aged 60 or older (22.8%, 16.3%) and children under 4 years old (20.1%, 17.2%). On the same way, children (4 a 5 days, 4 a 6 days) and elderly (2 a 6 days, 4 a 6 days) had longer lenght of stay. In hospital A respiratory system diseases (20.5%) were the leading cause of medical admissions followed by mental and behavioral disorders (14.4%), compared to hospital B, respiratory system diseases (15.4%) followed by circulatory system illnesses(13.5%). In both cases A and B, respectively, the basic care were more frequent on the hospital discharge (n=278, n=315) if compaired to admissions (n=271, n=234), while invasive care were more frequent in the admissions (n=505, n=618) if compaired to hospital discharge (n=201, n=208). Upong analyzing the presence of the variables partial record, it has occurred in hospital A at the time of admissions and medical discharges, respectively,: blood pressure (73.5%, 73.5%), cardiac frequency (72.1%, 71.6%), breathing frequency(39.1%, 29.3%), body temperature (89.3%, 80.5%), pain (12.6%, 11.2%), food (92.6%, 95.3%), bath (91.6%, 94.4%) and locomotion (94.9%, 95.8%), while in the the hospital B, it has occurred respectively;: blood pressure (80%, 73.5%), cardiac frequency (80.5%, 73%), breathing frequency (21.4%, 12.1%), body temperature (96.7%, 89.8%), pain (1.4%, 0.5%), food (100%, 99.5%), bath (99.1%, 99.1%) and locomotion (99.5%, 99.1%). The association between the variables: lenght of stay and number of cares at the time of hospital admissions and discharges with the other parameters, showed that the longer the length of stay and the greater the number of cares in admissions and discharges, the older are the inpatients and the greater are the number of diagnosis and the clinical and functional impairements.

Indiana University-Purdue University Indianapolis (IUPUI) / Oral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.