A tuberculose (TB) ainda se destaca como uma emergência global, apresentando elevada magnitude, transcendência e vulnerabilidade. Assim, objetivou-se investigar os determinantes das internações por tuberculose e sua distribuição espacial e tendência temporal. Estudo ecológico, cujos dados primários foram obtidos a partir de entrevistas com os profissionais da saúde da Atenção Primária à Saúde (APS) no ano de 2014 e os dados secundários das internações por TB entre 2006 e 2015 registrados no Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS). Além disso, recorreu-se ao Índice Paulista de Vulnerabilidade Social - versão 2010 para mensurar a vulnerabilidade social nos territórios. Procedeu-se inicialmente às análises dos dados por meio da estatística descritiva, realizadas no Statistica 12.0. Para análise espacial realizou-se a geocodificação das internações no TerraView versão 4.2.2. Considerou-se como unidades de análise as 46 áreas de abrangência da APS, classificadas segundo suas modalidades. Estimou-se a taxa bruta e bayesiana empírica das internações evitáveis por TB, sendo suavizada pelo Método Bayesiano Empírico. Recorreu-se, ainda, à regressão linear múltipla pelo método dos mínimos quadrados e à regressão espacial para verificar a relação de dependência espacial das internações evitáveis por TB com a capacidade da APS de coordenar as Redes de Atenção à Saúde (RAS) e ao Índice de Vulnerabilidade Social. Mapas coropléticos foram construídos no ArcGis 10.2. Das 46 unidades de APS, apenas cinco foram classificadas na condição regular para coordenar as RAS. Em relação aos atributos, nenhuma das áreas foi classificada na condição insatisfatória e apenas uma, na condição ótima. Na modelagem espacial, não se observaram atributos que fossem significativamente relacionados às internações evitáveis por TB. Foram identificados 265 casos de internações evitáveis por TB. As taxas variaram de 1,24 a 10,66 internações por TB por 100.000 habitantes/ano. O Distrito Norte apresentou as taxas mais altas (> 6,57); os Distritos Sul, Oeste e Norte apresentaram taxas moderadas (3,70 - 6,56); os Distritos Leste e Central apresentaram as taxas mais baixas (< 3,69). Houve uma maior concentração de internações em regiões mais densas e entre os anos de 2008 a 2009 e 2014 a 2015. Referente ao IVS, os Distritos Sul, Leste, Oeste e Central foram classificados em sua maioria no Grupo 2 (vulnerabilidade muito baixa); os Distritos Norte e Oeste, no Grupo 3 (vulnerabilidade baixa) e uma área foi classificada com vulnerabilidade muito alta (Distrito Norte). Na modelagem espacial também não se observou relação estatisticamente significativa do IVS com as internações evitáveis por TB. O estudo, identificou as áreas da APS mais deficientes quanto à coordenação das RAS e cartografou as áreas mais vulneráveis às internações por TB, possibilitando à gestão local um planejamento em saúde mais direcionado àqueles grupos mais vulneráveis, a fim de diminuir o número de internações evitáveis e injustas e avançar na melhoria da qualidade e fortalecimento de um sistema de saúde orientado pela APS sob a conformação de Redes / Tuberculosis (TB) still stands as a global emergency and presents high magnitude, transcendence and vulnerability. Thus, the aim was to investigate determinants of tuberculosis hospitalizations, their spatial distribution and temporal trend. An ecological study whose primary data were obtained from interviews with Primary Health Care (PHC) professionals in the year 2014 and secondary data of hospitalizations for TB were collected between 2006 and 2015 and recorded in the Hospital Information System of the Health Unique System (SIH/SUS). Also, it was possible to use the Paulista Social Vulnerability Index, 2010 version, to measure social vulnerability in the territories. Initially, data analyses were carried out through descriptive statistics and performed by Statistica 12.0. For spatial analysis, it was carried out hospitalizations geocoding through TerraView, version 4.2.2. The 46 areas covered by the APS were considered as analyses units and classified according to their modalities. It was possible to estimate the gross and empirical Bayesian rate of avoidable hospitalizations by TB and smoothed by the Bayesian Empiric Method. It was also used the multiple linear regression through the method of least squares and spatial regression to verify the spatial dependence relation of avoidable hospitalizations by TB, with the APS capacity to coordinate the Health Care Networks (RAS) and Index of Social vulnerability. Coropletic maps were constructed in the ArcGis 10.2. Of a total of 46 APS, only five were classified in the regular condition to coordinate the RAS. Regarding the attributes, none of the areas was classified as unsatisfactory condition and only one of them was categorized in the optimal condition. In the spatial modeling, there were no attributes significantly related to avoidable hospitalizations for TB. A total of 265 cases of preventable hospitalizations for TB were identified. Rates ranged from 1.24 to 10.66 hospitalizations for TB per 100,000 inhabitants a year. The Northern District had the highest rates (> 6.57); The South, West and North Districts presented reasonable rates (3.70 - 6.56); The Eastern and Central Districts had the lowest rates (<3.69). There was a greater concentration of hospitalizations in denser regions between the years 2008-2009 and 2014-2015. Regarding the IVS, South, East, West and Central Districts were classified mostly in the Group 2 (very low vulnerability). North and West Districts in Group 3 (low vulnerability) and one area was ranked with very high vulnerability (Northern District). In the spatial modeling, there was no statistically significant relationship between the IVS and avoidable hospitalizations for TB. The study identified the most deficient areas of APS in the coordination of RAS and mapped the most vulnerable areas to hospitalizations for TB. Thus, it was possible for the local management to plan a health care more targeted to the most vulnerable groups to reduce the number of avoidable and unjust hospitalizations and advance in quality and strengthening improvement of a health system oriented to the APS, under the formation of Networks

Aim: The motivation of this explorative study is to analyze the changing age structure of individuals misusing narcotics presenting with events of hospitalization or mortality. Methods: The data is derived from three anonymous, aggregated data sets for the mortality (n=4,999), hospitalization (n=143,264), and general population data. Descriptives, independent T-Tests, and simple linear regression is used for the analysis of age among events of mortality and hospitalizations throughout time. Results: The structure of ages among individuals with mortality linked to narcotic misuse does not significantly change. The trends in ages among males and females present themselves differently in mortality related to narcotic misuse as the female median ages continue to increase in age, whereas male median ages remain relatively stable. The age structure of individuals with hospitalizations linked to narcotic misuse has changed over time, with the males and females presenting similar significant trends in declining age. Conclusion: The changes in age structure among individuals misusing narcotics differ when measuring mortality and hospitalizations. Significant changes indicate that hospitalizations have increased over time and are more prevalent in younger adults, suggesting that more individuals are misusing narcotics at younger ages and requiring more medical care as they age and live longer lives.

The ever-increasing prevalence of diabetes mellitus and its associated healthcare costs in the United States has led to our healthcare system's need for cost-effective health resources and chronic disease management. The interventions of Community Health Workers (CHWs) can cost-effectively improve population health and prevent the unnecessary utilization of some medical services especially in rural, low-income, minority populations, where there is often limited access to healthcare. The purpose of this study is to investigate the relationship between the number of total CHWs in rural counties and the mean diabetes-related preventable hospitalization rates in Latino patients diagnosed with diabetes in those rural counties. The main goal of this research study is to contribute to the existing literature about the importance of CHWs especially in rural counties and the effect their presence has on diabetes-related preventable hospitalizations. Quantitative rural county data sets were analyzed to determine the correlation between the number of CHWs per rural county and the rate of diabetes-related preventable hospitalizations per rural county. Due to the COVID-19 pandemic outbreak, this research project was modified to be completed in a timely manner. A statistically insignificant moderately negative linear relationship was found between the two variables. Therefore, there was not enough statistical evidence in the sample to say that this correlation exists in the rural America population. Future research is needed to investigate this relationship more thoroughly.

As doenças respiratórias e a poluição do ar são temas de muitos trabalhos científicos, porém a relação entre doenças respiratórias e queimadas de cana-de-açúcar ainda é pouco estudada. A queima da palha da cana-de-açúcar é uma prática comum em grande parte do Estado de São Paulo, com especial destaque para os dados da região de Ribeirão Preto. Os focos de queimadas são detectados por satélites do CPTEC/INPE (Centro de Previsão de Tempo e Estudos Climáticos do Instituto Nacional de Pesquisas Espaciais) e neste trabalho consideramos o tempo entre dias de extrapolação do número de internações diárias. Neste trabalho introduzimos diferentes modelos estatísticos para analisar dados de focos de queimadas e suas relações com as internações por doenças respiratórias. Propomos novos modelos para analisar estes dados, na presença ou não da covariável, que representa o número de queimadas. Sob o enfoque Bayesiano, usando os diferentes modelos propostos, encontramos os sumários a posteriori de interesse utilizando métodos de simulação de Monte Carlo em Cadeias de Markov. Também usamos técnicas Bayesianas para discriminar os diferentes modelos. Para os dados da região de Ribeirão Preto, encontramos modelos que levam à obtenção das inferências a posteriori com grande precisão e vericamos que a presença da covariável nos traz um grande ganho na qualidade dos dados ajustados. Os resultados a posteriori nos sugerem evidências de uma relação entre as queimadas e o tempo entre as extrapolações do número de internações, ou seja, de que quando observamos um maior número de queimadas anteriores à extrapolação, também observamos que o tempo entre as extrapolações é menor. / Relations between respiratory diseases and air pollution has been the goals of many scientic works, but the relation between respiratory diseases and sugar cane burning still is not well studied in the literature. Pre-harvest burning of sugarcane elds used primarily to get rid of the dried leaves is common in most of São Paulo state, Southeast Brazil, especially in the Ribeirão Preto region. The locals of pre-harvest sugar cane burning are detected by surveillance satellites of the CPTEC/INPE (Center of Climate Prediction of the Space Research National Institute). In this work, we consider as our data of interest, the time in days, between peaks numbers of hospitalizations due to respiratory diseases. Dierent statistical models are assumed to analyze the data of pre-harvest burning of sugar cane elds and their relations with hospitalizations due to respiratory diseases. These new models are considered to analyze data sets in presence or not of covariates, representing the numbers of pre-harvest burning of sugar cane elds. Under a Bayesian approach, we get the posterior summaries of interest using MCMC (Markov Chain Monte Carlo) methods. We also use dierent existing Bayesian discrimination methods to choose the best model. In our case, considering the data of Ribeirão Preto region, we observed that the models in presence of covariates give accurate inferences and good t for the data. We concluded that there is evidence of a relationship between respiratory diseases and sugar cane burning, that is, larger numbers of pre-harvest sugar cane burning, implies in larger numbers of hospitalizations due to respiratory diseases. In this case, we also observe small times (days) between extra numbers of hospitalizations.

Made available in DSpace on 2016-01-26T12:51:30Z (GMT). No. of bitstreams: 1 margaretearticobaptista_tese.pdf: 3014770 bytes, checksum: a4b4de19204259991aae1ec3ae61a0aa (MD5) Previous issue date: 2011-10-07 / In the last 30 years, the increasing health care expenditures resulted in an outburst of studies aimed at new proposals on the methodological evaluation of health services. With the aid of computing, several studies have been developed with the purpose of analyzing nonlinear and complex systems. The most outstanding among those methods was the Recurrence Plot, first described by Erickman et al. (1987).Objectives: To analyze the temporal behavior of the weekly amount of admissions by some nosologic groups (Appendix Diseases, Bacterial Diseases, Neoplastic Disease, and Acute Coronary Syndrome), which has occurred over a decade, through Recurrence Plots and Poincaré Recurrence Plots, as well as checking whether the systems are presenting a periodic, chaotic, or random behavior pattern. Material and Methods: The database containing all hospitalizations recorded at the Hospital de Base Regional Medical School Foundation (FUNFARME) of Sao Jose do Rio Preto, a teaching hospital, from January 1, 1998 to December 31, 2007 was peered into a microscope. As a reference to classify all these admissions, the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) was used. The Microsoft Office Excel 2003® was the software used to arrange the data into columns. The admissions were systematically set to the right array, such as day, month, and year. They were arranged into columns according to the uniform criteria of identification of the epidemiological weeks. The recurrence graphs and the respective quantitative analyses of recurrence were developed with the aid of the Visual Recurrence Analysis (VRA) software, which is freely available on the Internet. To perform the comparison among the behavior patterns, mathematical models of time series for random behavior pattern, series time for chaotic behavior pattern, series times for periodic behavior pattern, and series time for linear behavior pattern were constructed. And it has also been performed a comparison between the Recurrence Plots and the Quantitative Analysis of Recurrence with clinical cases of specific groups (young, adult, child, premature newborn, and brain death).Results: It has become clear that the number of weekly admissions for diseases of the appendix has had a tendency over the years from a random behavior pattern. In hospitalizations due to bacterial diseases, there was a chaotic behavior pattern and the neoplastic diseases showed a chaotic behavior pattern tending to a linear behavior pattern. Hospitalizations because of Acute Coronary Syndrome presented a predominantly linear behavior pattern. Conclusions: The visual aspects of Recurrence Plot and Poincaré Recurrence plot exhibited different patterns when comparing quantities of admissions of certain nosologic groups over a decade. The quantitative analysis of recurrence that was useful in classifying the behavior pattern of the quantities of admissions is likely to constitute a useful tool of evaluation and decision making regarding hospital administration. / Nos últimos trinta anos, o crescimento dos gastos com a atenção médica resultou numa expansão dos estudos voltados para novas propostas metodológicas sobre avaliação dos serviços de saúde. Com a utilização da informática, vários estudos têm sido desenvolvidos para análise de sistemas complexos e não lineares, destacando-se, entre esses métodos, os gráficos de recorrência, descritos pela primeira vez por Erickman et al. (1987). Objetivos: Analisar o comportamento temporal da quantidade semanal de internações por alguns grupos nosológicos (Doenças do Apêndice, Doenças Bacterianas, Doenças Neoplásicas e por Síndrome Coronária Aguda) ocorridas ao longo de uma década, por meio de Gráficos de Recorrência e Gráficos de Poincaré e verificar se são sistemas que apresentam comportamentos periódicos, aleatórios ou caóticos. Material e Método: Foi avaliado o banco de dados contendo todas as internações no Hospital de Base da Fundação Faculdade Regional de Medicina de São José do Rio Preto, no período de 01 de janeiro de 1998 a 31 de dezembro de 2007. Como referência para classificação dessas internações, utilizou-se a Décima Revisão da Classificação Internacional de Doenças e de Problemas Relacionados à Saúde (CID 10). Foi utilizado o programa Microsoft Office Excel 2003 para a tabulação dos dados. As internações foram ordenadas em dia, mês, ano e tabuladas, seguindo o critério uniforme de identificação das semanas epidemiológicas. Os gráficos de recorrência e respectiva análise quantitativa foram construídos com o auxílio do software Visual Recurrence Analysis (VRA), disponível gratuitamente na Internet. Para realizar a comparação de padrões de comportamentos foram construídos modelos matemáticos de séries temporais aleatória, caótica, periódica e linear. E também foi realizada comparação entre Gráficos de Recorrência e Análise Quantitativa da Recorrência com casos clínicos de grupos específicos (jovem adulto, criança, Recém- nascido prematuro e morte cerebral). Resultados: Evidenciou-se que a quantidade de internações semanal por doenças do apêndice tiveram uma tendência ao longo dos anos de comportamento aleatório. Nas internações por doenças bacterianas houve comportamento caótico e as internações por doenças neoplásicas apresentaram um comportamento caótico tendendo a linear. As internações por Síndrome Coronária Aguda apresentaram predominantemente comportamento linear, Conclusões: Os aspectos visuais dos Gráficos de Recorrência e de Poincaré exibiram padrões diferentes na comparação entre quantidades de internações de determinados grupos nosológicos ao longo de uma década. A análise quantitativa da recorrência que auxiliou na classificação do comportamento das quantidades de internações e pode constituir-se em ferramenta útil de avaliação e tomada de decisão em administração hospitalar.

Améliorer la qualité de la prise en charge des personnes âgées vivant en EHPAD est un impératif. L'influence des caractéristiques organisationnelles des EHPAD sur la qualité de la prise en charge des résidents est mal connue. Nos travaux de recherche ont porté sur trois objectifs : 1) Rechercher les facteurs organisationnels en EHPAD qui ont un impact sur les prescriptions potentiellement inappropriées de neuroleptiques, ces médicaments faisant l'objet d'une attention particulière chez les personnes âgées en EHPAD ; 2) Déterminer la valeur ajoutée de l'intervention d'un gériatre au sein d'EHPAD pendant 18 mois par rapport à la restitution simple d'un audit qualité, sur les prescriptions potentiellement inappropriées de neuroleptiques ; 3) Proposer des actions concrètes d'amélioration de la prise en charge globale des résidents d'EHPAD concernant notamment les transferts inappropriées des résidents d'EHPAD vers les urgences, et la prévention du déclin fonctionnel des résidents. Pour répondre aux deux premiers objectifs, nous avons utilisé les données de l'étude IQUARE (Impact d'une démarche QUAlité sur l'évolution des pratiques et le déclin fonctionnel des Résidents en EHPAD) un essai multicentrique comparatif ayant pour objectif d'évaluer l'impact d'une intervention globale d'éducation gériatrique pour le personnel d'EHPAD sur des indicateurs de qualité. Pour le troisième objectif, nous proposons d'une part la structuration d'un hôpital de jour ayant pour vocation de ne recevoir que des résidents d'EHPAD avec la possibilité de les prendre en charge dans des délais courts afin de limiter les transferts inappropriés des résidents d'EHPAD vers les urgences. D'autre part, nous avons participé à une task force d'experts composée de médecins gériatres cliniciens et chercheurs dont l'objectif était de proposer des actions de prévention du déclin fonctionnel des résidents d'EHPAD. Sur les 6275 résidents inclus dans IQUARE, 1532 (24.4%) avaient au moins une prescription de neuroleptique parmi lesquels 1019 (66.5%) étaient potentiellement inappropriées. Nous avons montré que les résidents d'EHPAD dans lesquels intervenait un nombre important de médecins généralistes différents (plus de 30 pour 100 lits), étaient plus à risque de recevoir une prescription inappropriée de neuroleptiques que ceux vivant dans des EHPAD avec moins de 10 médecins généralistes pour 100 lits. Dans cette même étude IQUARE, nous n'avons pas mis en évidence d'effet positif de l'intervention d'un gériatre au sein d'EHPAD pendant 18 mois par rapport à la restitution simple d'un audit qualité, sur la réduction des prescriptions inappropriées de neuroleptiques 18 mois plus tard. [...] / Improving the quality of care for nursing home residents is a real concern. A better understanding of the factors determining a good quality of care in nursing homes (NH) is necessary. This thesis deals with three aims: 1) Determining whether facility characteristics - and in particular the number of attending general practitioners (GPs) in NH - are associated with inappropriate neuroleptic prescribing ; 2) Studying the effect of a quality assurance approach in a NH, with or without the intervention of a geriatrician, on potentially inappropriate neuroleptics prescription at 18 months (T18); 3) Offering practical actions improving medical care in NH in order to reduce potentially avoidable transfers to emergency rooms and to prevent disability and functional decline for NH residents. To meet the two first objectives, we used the data from the Impact of a QUAlity exercise study on the change in practices and the functional decline of Residents in EHPAD (IQUARE), a comparative multicenter trial aiming at assessing the impact of a global education intervention for NH staff based on quality indicators. As for the third objective, on the one hand, we implemented a new day hospital characterized by its being exclusively dedicated to NH residents and its ability to provide patient care within a short period of time. On the other hand, we took part in a Task Force discussion of experts in NH care and research, to implement strategies to prevent or to slow disability and functional decline for NH residents.Among the 6275 residents included in IQUARE study, 1532 (24.4%) had at least one prescription for a neuroleptic drug. Compared with nursing homes with <10 GPs/100 beds, nursing homes with more than 30 GPs/100 beds were exposed to a greater risk of potentially inappropriate neuroleptic prescribing. We have not shown the added benefit of geriatrician intervention in a global effort to decrease potentially inappropriate neuroleptic prescribing. This result can be explained by the strong impact of the quality assurance audit restoration at each NH with a 20% decrease of the potentially inappropriate neuroleptic prescribing for the two study groups. Over this thesis, we have opened a responsive day hospital dedicated to NH residents. This day hospital could be a practical response to the problem of inappropriate and avoidable transfers of NH residents to emergency rooms. Improving the quality of care for nursing home residents also means preventing and/or slowing the functional decline of residents. A Task Force of experts emphasized the need for cultural change to incorporate physical activity for nursing home residents and implement multidomain interventions to delay disability. To conclude, this work has identified factors having an influence on potentially inappropriate care and suggests simple areas to improve the quality of care.

Multiple transitions between care settings have been reported to affect the quality of life of the older adults and their families. In Canada, there have been no studies that have examined transitions between care settings at the end of life in older adults who are on homecare. The aim of this thesis was to address this gap, and to describe transitions between care settings in older homecare clients towards the end of their life and examine what personal, health system and health service use factors predict these transitions. The sample used in this study was the cohort of individuals 65 years and older(n=7866) who died in Manitoba within the fiscal years 2003-2006, and who received homecare for at least 30 days in the last year of their life. The outcome variables in this study were transitions and independent variables included demographic (e.g., age, sex), health service use (homecare days) and system factors (e.g., hospital bed supply). The study involved secondary data analysis of anonymized administrative data (the hospital, homecare and personal care home (PCH) data), vital statistics data, health insurance registry, census data, and annual provincial statistical reports. Descriptive and inferential data analyses methods were used to analyze the data in the study. It was found in the study that more than half of the homecare clients had one or more transitions between care settings in their last month of life, and more than half of the homecare clients in the study died in hospitals. Homecare clients who were males, in the 75-84 years age group, received more homecare days and lived in regions of high hospital bed supply were more likely to have one or more transitions in the last month of their life, and those who were single, in the lower income quintile groups, lived in regions of high physician and PCH bed supply had lower odds of having one or more transitions. The findings suggest the need for increasing palliative care and homecare services to reduce transitions and hospital deaths at the end of life. Increasing physician supply, particularly in rural areas should also be considered. Future studies should also attempt to classify which of the transitions towards the end of life were essential or burdensome.

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No. of bitstreams: 1 ritamariarodriguesbastos.pdf: 1524374 bytes, checksum: 8535080e6aa7b72c421e1b656a44a254 (MD5) Previous issue date: 2013-04-05 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / A necessidade de se avaliar as políticas de saúde implementadas para a estruturação da atenção primária em todo o território nacional levou o Ministério da Saúde a institucionalizar indicadores de avaliação já utilizados em diversos países, entre eles, as Internações por Condições Sensíveis à Atenção Primária (ICSAP). Objetivo: Avaliar a atenção primária no Estado de Minas Gerais entre 2000 e 2011, com o uso do indicador ICSAP. Métodos: Trata-se de um estudo ecológico dos municípios mineiros, utilizando dados do Sistema de Informação Hospitalar, Sistema de Informação Ambulatorial, Departamento de Informática do Sistema Único Brasileiro, Censos 2000-2010 e dados do Instituto Brasileiro de Geografia e Estatística. A dimensão espacial correspondeu ao estado de Minas Gerais e a dimensão temporal teve como limites os anos de 2000 e 2011. Ambas foram submetidas a três recortes, para que a análise das ICSAP fossem realizadas sob diferentes perspectivas. Utilizou-se os municípios mineiros como unidades de análise, agregando-os por Regionais de Saúde (RS). Analisou-se as taxas de ICSAP quanto à permanência hospitalar, proporção de óbitos e relação com a cobertura pela Saúde da Família. Foram comparados os anos de 2000 e 2010. Posteriormente os municípios foram analisados no triênio 2009-2011, utilizando-se a análise das internações por infecções de rins e trato urinário sensíveis à atenção primária (IRTU-CSAP) em indivíduos enrte 40 e 59 anos, agregando-os por RS, porte populacional e cobertura pela saúde da família. As IRTU-CSAP foram analisadas, por sexo, quanto à permanência hospitalar, proporção de óbitos e os gastos com as internações. Por fim, analisou-se as causas mais freqüentes de ICSAP por sexo e faixa etária no município de Juiz de Fora, comparando-se os quadriênios 2002-2005 e 2006-2009. Para as análises estatísticas foram utilizados o Teste t para dados pareados, Anova seguida do teste post hoc de Scheffe e Dunnett T3 e correlação de pearson. Resultados: As taxas gerais de ICSAP no estado diminuíram entre 2000 e 2010, mas não foram observadas correlação com a expansão da Estratégia de Saúde da Família. As RS que apresentaram maiores taxas foram as de Ubá e Leopoldina. As causas mais freqüentes das hospitalizações foram a Insuficiência Cardíaca e as Gastroenterites. Algumas causas apresentaram aumento das taxas, a exemplo das Infecções de Rim e Trato Urinário, tornando-se a terceira causa mais freqüente no estado, em 2010. A permanência hospitalar e a proporção de óbitos por ICSAP aumentaram no estado. Juiz de Fora se destacou por ser sede de uma das 7 duas únicas RS que apresentaram elevação das taxas de ICSAP no estado. Conclusão: As iniciativas governamentais, como a expansão da Estratégia de Saúde da Família e a Regionalização da Saúde, não foram efetivas para a diminuição das internações por condições sensíveis à atenção primária em Minas Gerais. As características dos municípios influenciaram de formas distintas no comportamento das taxas, permanência hospitalar e proporção de óbitos por ICSAP. Evidencia-se aumento das desigualdades entre algumas Regionais de Saúde, o que alerta para a necessidade de se priorizar a estruturação da atenção primária em regiões do estado onde as internações potencialmente evitáveis permanecem mais elevadas. / The need to evaluate the health policies implemented for the structuring of primary care nationwide prompted the Ministry of Health to institutionalize assessment indicators already in use in several countries, including the indicator Hospitalizations for Primary Health Care Sensitive Conditions (HPHSC). Objective: To evaluate the primary care in the State of Minas Gerais, between 2000 and 2011, using the indicator HSPHC. Methods: This is an ecological study of Minas Gerais municipalities, using data from the Hospital Informations System, Ambulatory Information System, Computing Department of System Unique of Healph, and 2000- 2010 Census data from the Brazilian Institute of Geography and Statistics. The spatial dimension corresponded to the state of Minas Gerais and the temporal dimension was limited to the years between 2000 and 2011. Both were subjected to three selections, so that an analysis of HPHSC were performed under different views. Used the Minas Gerais municipalities as units of analysis, aggregating them by Regionals Health (RH). HPHSC rates were analyzed regarding to hospital stay, proportion of deaths and the relation with coverage by Family Health. The years between 2000 and 2010 were compared. Subsequently, the cities were analyzed in the three-years period 2009-2011, using the analysis of hospitalizations for infections of the kidneys and urinary tract sensitive to primary health (IKUT-PH) in individuals from 40 to 59 years, aggregated by RH, population size and coverage by family health. The IKUT-PH were analyzed by sex, regarding to hospital stay, number of deaths and costs of hospitalizations. Finally, were analyzed the most frequent causes of HPHSC by sex and age in the city of Juiz de Fora, comparing the four-years periods 2002-2005 and 2006-2009. For statistical analyzes we used the t test for paired data, ANOVA followed by post hoc Dunnett T3 and Scheffe test and correlation of Pearson. Results: Overall rates of HPHSC in the state declined between 2000 and 2010, but were not verified any correlations with the expansion on the Family Health Strategy. The RH showed that the highest rates were in Ubá and Leopoldina. The most frequent causes of hospitalization were heart failure and gastroenteritis. Some causes had higher rates, such as infections of the Kidney and Urinary Tract, making it the third most frequent cause in the state in 2010. The hospital stay and the proportion of deaths for HPHSC increased in the state. Juiz de Fora is highlighted as home to one of only two RH in which the HPHSC rate increased in the State. Conclusion: The governmental actions, such as the expansion of the Family Health Strategy and the Health Regionalization, were not efective on decreasing the HPHSC in Minas Gerais. The characteristics of the municipalities affected in different ways in the behavior of rates, hospital stay and proportion of deaths by HPHSC. It is evidenced an increase in inequalities among the Regionals Health, what warns to the need of structuring the primary care in some regions of the State where the hospitalization due to potentially avoidable causes remains high.

As doenças respiratórias e a poluição do ar são temas de muitos trabalhos científicos, porém a relação entre doenças respiratórias e queimadas de cana-de-açúcar ainda é pouco estudada. A queima da palha da cana-de-açúcar é uma prática comum em grande parte do Estado de São Paulo, com especial destaque para os dados da região de Ribeirão Preto. Os focos de queimadas são detectados por satélites do CPTEC/INPE (Centro de Previsão de Tempo e Estudos Climáticos do Instituto Nacional de Pesquisas Espaciais) e neste trabalho consideramos o tempo entre dias de extrapolação do número de internações diárias. Neste trabalho introduzimos diferentes modelos estatísticos para analisar dados de focos de queimadas e suas relações com as internações por doenças respiratórias. Propomos novos modelos para analisar estes dados, na presença ou não da covariável, que representa o número de queimadas. Sob o enfoque Bayesiano, usando os diferentes modelos propostos, encontramos os sumários a posteriori de interesse utilizando métodos de simulação de Monte Carlo em Cadeias de Markov. Também usamos técnicas Bayesianas para discriminar os diferentes modelos. Para os dados da região de Ribeirão Preto, encontramos modelos que levam à obtenção das inferências a posteriori com grande precisão e vericamos que a presença da covariável nos traz um grande ganho na qualidade dos dados ajustados. Os resultados a posteriori nos sugerem evidências de uma relação entre as queimadas e o tempo entre as extrapolações do número de internações, ou seja, de que quando observamos um maior número de queimadas anteriores à extrapolação, também observamos que o tempo entre as extrapolações é menor. / Relations between respiratory diseases and air pollution has been the goals of many scientic works, but the relation between respiratory diseases and sugar cane burning still is not well studied in the literature. Pre-harvest burning of sugarcane elds used primarily to get rid of the dried leaves is common in most of São Paulo state, Southeast Brazil, especially in the Ribeirão Preto region. The locals of pre-harvest sugar cane burning are detected by surveillance satellites of the CPTEC/INPE (Center of Climate Prediction of the Space Research National Institute). In this work, we consider as our data of interest, the time in days, between peaks numbers of hospitalizations due to respiratory diseases. Dierent statistical models are assumed to analyze the data of pre-harvest burning of sugar cane elds and their relations with hospitalizations due to respiratory diseases. These new models are considered to analyze data sets in presence or not of covariates, representing the numbers of pre-harvest burning of sugar cane elds. Under a Bayesian approach, we get the posterior summaries of interest using MCMC (Markov Chain Monte Carlo) methods. We also use dierent existing Bayesian discrimination methods to choose the best model. In our case, considering the data of Ribeirão Preto region, we observed that the models in presence of covariates give accurate inferences and good t for the data. We concluded that there is evidence of a relationship between respiratory diseases and sugar cane burning, that is, larger numbers of pre-harvest sugar cane burning, implies in larger numbers of hospitalizations due to respiratory diseases. In this case, we also observe small times (days) between extra numbers of hospitalizations.

ortalidad en niños menores de 5 años, a pesar de contar con medidas preventivas como la vacunación.  Objetivo: Evaluar el impacto de la vacuna antineumocócica conjugada sobre la incidencia de neumonía en niños menores de 5 años, a nivel nacional y departamental, así como las hospitalizaciones y mortalidad a nivel nacional, desde 2001-2019 en el Perú. Además, realizar un análisis entre departamentos con coberturas altas de vacunación y aquellos que alcanzan coberturas bajas.  Metodología: Diseño: Series de tiempo definidas por la introducción de la vacuna antineumocócica heptavalente (PCV7) en el periodo de tiempo entre 2009 y 2011 a nivel nacional y departamental. Posteriormente, se realizó un análisis multivariado contrastando la incidencia de casos entre los departamentos con alta y baja cobertura de vacunación. Procedimiento de obtención de datos: Los datos agrupados sobre la incidencia, hospitalización y mortalidad por neumonía fue obtenida de la CDC (Centro de Enfermedades Contagiosas); la cobertura de vacunación fue obtenida como base de datos del Ministerio de Salud (MINSA) Análisis específicos: se realizó un análisis multivariado contrastando la incidencia de casos de neumonía entre los departamentos con alta y baja cobertura de vacunación.  Resultados: Para las hospitalizaciones a nivel nacional, la tendencia de cambio post vacunación fue negativa y significativa (p <0.001). La incidencia y mortalidad tuvieron cambios no significativos. A nivel regional, Callao, Lima, Moquegua, Cusco, Huancavelica, Pasco, Loreto, San Martín y Ucayali tuvieron tendencia de cambio post vacunación negativa y significativa (p <0.001). Conclusiones: La vacunación ha demostrado ser efectiva para disminuir hospitalizaciones por neumonía en algunos departamentos y a nivel nacional. Sin embargo, existen factores individuales que pueden alterar la efectividad de la intervención, propias de la estrategia aplicada y del tipo de estudio utilizado. / Introduction: Pneumonia is an acute respiratory infection, the most common bacterial cause is Streptococcus pneumoniae and represents one of the major causes of mortality in children under 5 years of age, despite preventive measures. Objective: Assess the impact of the pneumococcal vaccine on the incidence of pneumonia in children under 5 years of age, at the national and departmental level, as well as hospitalizations and mortality at the national range, over 2001-2019 in Peru. In addition, perform an analysis between departments that achieve high vaccination coverage and those with low coverage.  Methodology: Study design: Time series interrupted by the inclusion of the heptavalent pneumococcal vaccine (PCV7) in the period between 2009 and 2011 at the national and departmental level. Multivariate analysis, contrasting the incidence of cases between departments with high and low vaccination coverage. Data collection procedure: Pooled data on pneumonia incidence, hospitalization, and mortality obtained from the CDC (Center for Communicable Diseases); vaccination coverage obtained as a database from the Ministry of Health (MINSA) Specific analyzes: multivariate contrasting the incidence of pneumonia cases between departments with high and low vaccination coverage. Results: Hospitalizations at the national level had a negative trend of change after vaccination (p <0.001). At regional level, Callao, Lima, Moquegua, Cusco, Huancavelica, Pasco, Loreto, San Martín and Ucayali had a negative and significant change trend post vaccination (p <0.001). Conclusions: Vaccination has proven to be effective in some departments and at the national level. However, there are individual factors and limitations of the study that may affect the outcome. / Tesis