The general aims of this dissertation are to analyse how family situation, and especially lone parenting, influence health and life chances in Sweden and the extent to which possible relations are influenced by socioeconomic circumstances and health selection. In two population-based cohort studies we analysed overall and cause-specific mortality (1991-95), and also severe morbidity (1991-94) from different causes among lone mothers in comparison with mothers with partners. Information on the mothers was obtained from the Swedish Population and Housing censuses of 1985 and 1990. The outcomes considered were death or utilisation of (overnight) hospital care, with data taken from population-based national health registers. In the analyses we adjusted for socioeconomic and demographic circumstances, such as socioeconomic status, country of birth, receipt of social-welfare benefit, and housing situation. To take health-selection effects into account, we adjusted for previous inpatient history (1987-90). Our findings suggest that lone motherhood entails health disadvantages with regard to mortality, severe morbidity and injury. Socioeconomic circumstances were found to play a major role in accounting for increased risks, but the risks are partly independent of both socioeconomic conditions and health selection into lone motherhood. In two further studies we analysed mortality (1991-98), severe morbidity and injury (1991-99), and also educational achievement (in 1998 at ages 24-25 of offspring), of children who had lived in lone-parent families in comparison with children in two-parent families. We mainly used data from the Swedish censuses and national health-data registers. Living in a lone parent family was found to be associated with increased risks of a variety of unfavourable outcomes: psychiatric disease, suicide/suicide attempt, injury, addiction, and low educational attainment. Relatively poor educational performance and also health disadvantages are explicable to a large extent by socioeconomic conditions, especially a lack of economic resources (as measured here by receipt of social-welfare benefit and having rented accommodation). Educational achievement among children varies with cause of lone parenthood, with the best prospects found among the children of widows/widowers. In a fifth study we analysed mortality from different causes (1991-2000) among lone fathers (fathers with and without custody of their children) and childless men (with and without partners) in comparison with cohabiting fathers with children in the household. For this purpose we linked information from the Swedish censuses of 1985 and 1990 to Sweden’s Multi-Generation Register (which contains information about all known biological relations between children and parents). Lone non-custodial fathers and lone childless men suffer from the most pronounced elevated risks, especially of death from injury or addiction, but also from all-cause mortality and death from ischaemic heart disease. Being a lone custodial father also seems to entail an increased mortality risk, although generally to a much lesser degree, and not for all outcomes studied. The elevated risks for all subgroups fell when variables assumed to control health selection and socioeconomic circumstances were introduced into the initial regression model employed. However, even following adjustments, significantly increased risks, albeit greatly attenuated, remained in all the subgroups investigated. Key Words: Single parent, single mother, single father, children, risk factor, socio-economic status, mortality, morbidity, injury, psychiatric disease, education, epidemiology, longitudinal

Background: Incidence of death and hospitalizations have been observed to depend on short-term changes in weather and to increase with extreme temperatures. This thesis aims to strengthen the scientific knowledge on the relationship between temperature and daily deaths, but also the relationship between temperature and daily hospital admissions. Methods: We constructed time series regression models using daily counts of death and daily weather from the Stockholm area incorporating adjustment for potential confounding factors, season, and long-term time trends. From these models, we established the short-term relationship with daily temperatures and the associated relative risks on daily deaths allowing for a delay between exposure and subsequent deaths. Daily hospital admissions and daily temperatures were analyzed correspondingly using data from Skåne. Results: Hot and cold temperatures significantly impact on mortality rates as well as rates of hospitalization in Sweden. We found an immediate heat effect on daily deaths, while the impacts of cold temperatures were delayed up to a week after exposure. Cold-related deaths are generally cardiovascular in nature, while deaths resulting from warm temperatures are cardiovascular, respiratory as well as non-cardiorespiratory in nature. The impacts following a heat wave appear to increase proportionally with the length of the extreme hot conditions. The results suggest that the population aged 45 years and older is the main group at elevated risk of death when exposed to high and low temperatures. Moreover, the results suggest that there are several factors of susceptibility on an individual basis that correspond to larger relative risk with high and/or low temperatures. Daily hospitalisations increased in particular among individuals with respiratory illnesses during extreme persistent heat, whereas high temperatures in general have little impact. In contrast, hospitalizations increased for up to two weeks following exposure to cold temperatures. Conclusions: The health impacts related to temperature are a serious concern and the attributed impacts are likely to increase to some extent in the future due to an ageing population. Public health preventive strategies should be developed to prevent health consequences related to heat waves and cold temperatures. Future studies should aim at identifying susceptible individuals with elevated death risk at hot and cold ambient temperature conditions.

Background: Adverse birth outcomes present a difficult and chronic challenge in Ontario, in Canada and in developed countries in general. Increasing proportions of preterm births, significant regional disparities and the high cost of treating all adverse birth outcomes have focused attention on explaining them and developing effective treatments. Methods: Birth outcomes and maternal characteristics for approximately 626,000 births, about 90% of births in 2005–2009, were linked to small geographic areas throughout Ontario. For each of four adverse outcomes: late preterm, moderate to very preterm, small for gestation age and still births, proportions of total births were calculated for the full province and for each small geographic area. Geographic hotspots of elevated rates were identified for each of the different adverse birth outcomes using the local Moran’s I statistic. Data for nine known ecologic and individual risk factors were then linked to the areas. Hierarchical regression analysis was used to model each of the outcomes for the full province and for dispersed local areas. The resulting models for the different outcomes were contrasted. Results: Significant geographic hotspots exist for each of the four outcomes. Hotspots for the different outcomes were found to be largely spatially exclusive. For like outcomes, predictive models differed markedly between local areas (i.e. local groups of hotspots) as well as between full-province and local areas. Ecologic level variables played a strong role in all models; the influence of individual level risk factors was consistently modified by ecologic risk factors except for small for gestational births. Conclusions: The finding of significant hotspots for different adverse birth outcomes indicates that certain geographic areas have aetiologies or patterns of predictors sufficient to create significantly elevated levels of particular outcomes. The finding that hotspots for the different adverse outcomes are largely exclusive implies that the aetiologies are specific; i.e., those that are sufficient to create significantly higher levels for one outcome do not also create significantly higher levels of others. The consistently strong role of ecologic level risk factors in modifying individual level risk factors implies that contextual characteristics are an important part of the aetiology of adverse birth outcomes. Differences in local area models suggest the existence of location-specific (rather than universal) aetiologies. The findings support the need for more careful attention to local context when explaining birth outcomes.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

Trata-se de um estudo epidemiológico descritivo retrospectivo, com abordagem quanti e qualitativa, da morbidade por causas externas não intencionais (acidentes) entre os atendimentos dos serviços de Atenção Básica de Saúde das regiões da Lomba do Pinheiro e Partenon, do município de Porto Alegre/RS, de janeiro de 2002 a dezembro de 2008. Objetivou descrever e analisar as principais características da morbidade por causas acidentais. A partir da década de 80, as causas externas passaram a ocupar o segundo lugar entre as causas de morte no Brasil, chegando a 12,5% do total de mortes no ano 2000. Entre os tipos de agravo destacam-se as lesões acidentais e os acidentes de transporte. Este estudo se propôs a uma análise dos registros, a fim de traçar um perfil frequencial e tipológico dos atendimentos (vítimas e agravos), além de geoprocessar as informações para contextualizar os eventos. O tratamento e análise dos dados contaram com o auxílio de uma planilha eletrônica e dos softwares SPSS versão 16 e TABWIN versão 3.6 para análise dos dados quantitativos, MAPINFO versão 7.8 e TERRAVIEW versão 3.3.1 para o georreferenciamento e análise dos dados espaciais. Utilizou-se o teste estatístico qui-quadrado (p < 0,05) em conjunto com o coeficiente de contingência a fim de verificar possíveis associações e o grau das mesmas entre as variáveis. Os registros profissionais discursivos foram analisados considerando a descoberta de sentidos nas comunicações e na identificação dos comportamentos presentes nos mesmos. A análise dos dados indicou que o domicílio, com 53,8% do total de dados, foi o local de ocorrência mais registrado e que existem diferenças de comportamento na constituição das situações de vulnerabilidade aos acidentes, principalmente, ao se levar em consideração condutas pessoais, fatores ambientais, aspectos geracionais e de gênero. Constatou-se também que os olhares profissionais são predominantemente dirigidos para a lesão, desconsiderando o contexto social dos acidentes. Os registros atestam a baixa gravidade das lesões atendidas na Atenção Básica, sugerindo que muitas das mesmas possam ser tratadas localmente, sem a exigência de serviços de maior complexidade, sustentando o potencial da Atenção Básica na implementação de ações preventivas e promocionais em saúde no campo desses agravos. / It is about an epidemiologic, descriptive and retrospective study with quantitative and qualitative approach on morbidity due to non-intentional external causes (accidents) among attendances of services at the Health Basic Care units located in the city quarters of Lomba do Pinheiro and Partenon in the municipality of Porto Alegre – RS from January 2002 to December 2008. It aimed at describing and analyzing the main characteristics of morbidity due to accidental causes. From the 1980´s on, external causes started occupying the second position among death causes in Brazil, reaching 12.5% of the total deaths in the year 2000. Among the types of injuries, accidental lesions and transportation accidents stand out. This study had the proposal of making an analysis of the records in order to trace a frequency and type profile of the attendances (victims and injuries) besides processing the information geographically in order to contextualize the events. The treatment and analysis of the data were carried out with the aid of an electronic table and of software such as the 16-version SPSS and the 3.6-version TABWIN for the analysis of quantitative data and the 7.8-version MAPINFO and the 3.3.1-version TERRAVIEW for the geographic referral and space data analysis. The statistic chi-square test (p < 0.05) was utilized in association with the contingency coefficient in order to verify possible associations and their degree among the variables. The discursive professional records were analyzed by considering the discovery of meanings upon communication and in the identification of the behaviors present in such meanings. The analysis of the data indicated that the domicile comprising 53,8% of the total data was the most registered place of occurrences and that there are differences of behavior in the constitution of the situations of vulnerability to accidents mainly when one takes into consideration personal conducts, environmental factors, generation and gender aspects. It has also been found out that professional glances are mostly addressed to the lesion and do not consider the social context of the accidents. The records evidence the low severity of the lesions attended at the Basic Care Services, suggesting that they can be treated locally without requiring services of more complexity what supports the potential of the Basic Care Services in the implementation of preventive and promotional health actions in the field of these injuries. / Se trata de un estudio epidemiológico descriptivo y retrospectivo, con abordaje cuantitativo y cualitativo, de la morbilidad por causas externas no intencionales (accidentes) entre los atendimientos de los servicios de Atención Básica de Salud de las regiones de Lomba do Pinheiro y Partenon en la municipalidad de Porto Alegre/RS, de enero de 2002 hasta diciembre de 2008. El objetivo fue describir y analizar las principales características de la morbilidad por causas accidentales. A partir de la década de 1980, las causas externas pasaron a ocupar la segunda posición entre las causas de muerte en Brasil, llegando a 12.5% del total de muertes en el año 2000. Entre los tipos de agravios, sobresalen las lesiones accidentales y los accidentes de transporte. Este estudio se propuso a un análisis de los registros, a fin de trazar un perfil de frecuencia y de clase de los atendimientos (víctimas y agravios), además de procesar geográficamente las informaciones para contextualizar los eventos. El tratamiento y análisis de los datos contaron con el auxilio de una planilla electrónica y de los programas computacionales SPSS versión 16 y TABWIN versión 3.6 para el análisis de los datos cuantitativos, MAPINFO versión 7.8 y TERRAVIEW versión 3.3.1 para el referencial geográfico y el análisis de los datos espaciales. Se utilizó el teste estadístico chi cuadrado (p < 0,05) en conjunto con el coeficiente de contingencia a fin de verificar posibles asociaciones y el grado de las mismas entre las variables. Los registros profesionales discursivos fueron analizados considerando el descubrimiento de sentidos en las comunicaciones y en la identificación de los comportamientos presentes en los mismos. El análisis de los datos indicó que el domicilio, con 53,8% del total de los datos, fue el local de ocurrencia más registrado y que existen diferencias de comportamiento en las constituciones de las situaciones de vulnerabilidad a los accidentes, principalmente, al llevarse en consideración conductas personales, factores ambientales, aspectos de generación y género. Se constató, también, que las miradas profesionales son predominantemente dirigidas para la lesión y no consideran el contexto social de los accidentes. Los registros atestan la baja gravedad de las lesiones atendidas en la Atención Básica, sugiriendo que muchas de las mismas pueden ser tratadas localmente, sin la exigencia de servicios de mayor complejidad, sustentando el potencial de la Atención Básica en la implementación de acciones preventivas y promocionales de salud en el campo de estos agravios.

Submitted by Carlos Saiani (ssaiani@yahoo.com.br) on 2012-04-30T18:40:51Z No. of bitstreams: 1 Tese - FGV - Carlos César Santejo Saiani.pdf: 5421316 bytes, checksum: 7065939598ebc1cf0b41062e1f2384c6 (MD5) / Approved for entry into archive by Gisele Isaura Hannickel (gisele.hannickel@fgv.br) on 2012-05-02T14:48:33Z (GMT) No. of bitstreams: 1 Tese - FGV - Carlos César Santejo Saiani.pdf: 5421316 bytes, checksum: 7065939598ebc1cf0b41062e1f2384c6 (MD5) / Made available in DSpace on 2012-05-02T14:50:20Z (GMT). No. of bitstreams: 1 Tese - FGV - Carlos César Santejo Saiani.pdf: 5421316 bytes, checksum: 7065939598ebc1cf0b41062e1f2384c6 (MD5) Previous issue date: 2012-04-13 / Esta tese analisou os determinantes e os efeitos da privatização dos serviços de saneamento básico no Brasil (abastecimento de água e coleta de esgoto). Em relação aos seus determinantes, as evidências são consistentes com a hipótese de que as privatizações foram adotadas como estratégias políticas, com o propósito de reduzir a discricionariedade de eventual sucessor político, o que se depreende da maior probabilidade de privatização à medida que eleva o risco eleitoral. Estratégia análoga é a redução do escopo de atuação dos governos estaduais, apontada pela maior probabilidade de privatização em municípios nos quais os prefeitos não pertencem a partidos da coligação dos governadores de seus estados. Em relação aos efeitos da privatização sobre indicadores epidemiológicos (morbidade e mortalidade) e de acesso, foram comparadas duas modalidades de provisão privada: provisão centralizada (regional), que pode gerar ganhos de escala; e provisão descentralizada (local), que pode resultar em maior controle social e redução dos custos de monitoramento. Os resultados indicam que o modelo de provisão privada descentralizada resultou em menor incidência de morbidade e de mortalidade. Como esses indicadores refletiriam os efeitos sobre a qualidade dos serviços, o resultado contradiz a hipótese de existência de um trade-off custo-qualidade na provisão privada de serviços públicos, como argumentado por Hart et al (1997). O mesmo resultado não é observado na modalidade de privatização regional, o que sugere que a forma de privatização é relevante para desempenho das empresas privadas. Por último, foi verificado que a privatização local expande o acesso em municípios nos quais os níveis de cobertura eram baixos, o que poderia refletir suas capacidades de investimento. Além disso, ao contrário da provisão pública, a privatização local não privilegia o abastecimento de água e os domicílios com maiores níveis de renda. Portanto, a competição política, ao influenciar o risco eleitoral dos prefeitos, determina a privatização, que impacta positivamente sobre o acesso e a qualidade dos serviços e, por esta via, reduz a morbidade e a mortalidade. / This dissertation analyzes the determinants and effects of the privatization of sanitation services in Brazil (water supply and sewage). Regarding the determinants, it is noteworthy that privatization is more likely the higher the political risk, which is consistent with the hypothesis of privatization as a political strategy, aiming to mitigate the discretion of the future incumbent. An analogous strategy is to reduce the scope of activities of rival state government, as the privatization is more likely in municipalities where mayors do not belong to the coalition parties of their states’ governors. Regarding the effects of privatization on epidemiological indicators (morbidity and mortality) two different models of private provision were contrasted: centralized provision (regional), which might benefit from economies of scale; and decentralized provision (local), which might result in higher social control, and lower monitoring costs. The latter resulted in lower levels of morbidity and mortality directly associated to the quality of sanitation services. These results contradict the cost-quality trade-off, as presented by Hart et al (1997). In contrast, the regional privatization does not present equally favorable results, so as to suggest that the privatization model is relevant to the performance of private companies. Finally, local privatization expands the access in cities where coverage levels were low, what may be due to former investment constraints by public companies. Moreover, unlike the public provision, local privatization seems not to be biased towards water supply and higher income households. Therefore, political competition, for its effect on the incumbent electoral risk, brings about privatization, which has a positive effect on access and quality of services and, thereby, reduces morbidity and mortality.

The study attempted to identify factors influencing women’s preference for home births in the Mutare District, Zimbabwe. A quantitative, descriptive, exploratory, cross sectional survey, gathering data by conducting structured interviews with 150 women, was used. All 150 women attended antenatal clinics but did not deliver their babies at health care facilities. The research results indicated that home deliveries might decline if: • the hospital/clinic fees were reduced or removed • transport would be available for women in labour to reach hospitals/clinics • shelters were built for pregnant women at hospitals/clinics • clinics were well equipped and had sufficient numbers of midwives • women had received more effective health education on the advantages of institutional deliveries and on the danger signs of pregnancy/labour complications • nurses/midwives would treat patients respectfully. Unless these factors are addressed, the number of home deliveries might not decline, and the high maternal/infant mortality and morbidity rates in this district will persist. / Health Studies / M. Public Health

Esta pesquisa se ocupou em analisar as condições de saúde das mulheres pobres de Porto Alegre, mais detidamente das internadas na Santa Casa de Misericórdia nas duas últimas décadas do século XIX, buscando examinar e compreender a relação estabelecida entre as mulheres pobres enfermas e suas doenças, com o saber médico e as ações médicas produzidas naquele hospital. Como consequência desse direcionamento de olhar para a medicina mais voltada às mulheres, a pesquisa também se deteve na área médica que distinguia a medicina feminina da masculina naquele dado período: a incipiente medicina da mulher, que se desenvolvia por meio das especialidades denominadas como obstetrícia e ginecologia. Desse modo, em decorrência, explorou a construção da medicina da mulher, ocupando-se sobre os primeiros desenvolvimentos da obstetrícia e da ginecologia na Santa Casa de Porto Alegre. A partir de tal exame, também foi verificado se o desenvolvimento destas especialidades representou melhorias para a saúde das mulheres lá internadas e/ou avanços na forma como os médicos se preocupavam com o tratamento das mulheres naquele local, de um modo geral. A perspectiva teórica seguida vincula-se aos estudos da História Social, utilizando-se principalmente das categorias analíticas gênero e classe social. A argumentação principal da pesquisa foi buscada por meio de dados demográficos quantitativos. Entretanto, por meio de exame sobre vasto material de pesquisa, procurou-se qualificar não somente os números apresentados, mas também a análise e a argumentação sobre os mesmos. Do ponto de vista metodológico, seguiu diversos preceitos advindos dos estudos demográficos, em grande parte, vinculados à História Social, principalmente, ao examinar os dados de morbidade e mortalidade das mulheres analisadas. Como resultado da análise realizada, verificou-se que no início da década de 1880 poucas mulheres da população porto-alegrense procuravam a Santa Casa para tratamento e, quando o faziam, mormente se encontravam em grave estado de saúde, o que resultava em um alto índice de mortalidade de mulheres naquele hospital. Também se observou que raríssimas eram as mulheres que buscavam a Santa Casa para a realização do parto ou tratamento de moléstias ligadas à obstetrícia e à ginecologia, naquela década. No entanto, ao observar as causas de internação das mulheres em relação às ações médicas voltadas para a medicina da mulher dentro do hospital da Santa Casa até o final do século XIX, percebeu-se que aquela situação se modificava aos poucos, com o aumento do número de mulheres procurando o hospital para tratamento de diversas moléstias e realização do parto. Em um último plano, a partir da verificação sobre os dados de internação, concluiuse que as ações médicas implantadas na Santa Casa, impulsionadas em grande parte pelo maior aprofundamento em torno da obstetrícia e da ginecologia, resultaram no incremento de internações de mulheres e no decréscimo significativo da mortalidade feminina, naquele hospital, no final do século XIX. / This research analyses the conditions of the poor women’s health of Porto Alegre, more specifically the patients in the Santa Casa de Misericórdia Hospital in the last years of the century XIX, it taking to exam and to understand the relationship between the poor sickness women and his illness, with the medical knowledge and their actions in this Hospital. As a consequence of this direction to look for medicine more directed to women, these research also stopped in the medical field that distinguish female from male medicine in that specific period: the incipient women's medicine, which developed through the specific denominated as obstetrics and gynecology. In this way it was explored the construction of the medicine women, occupied themselves about the first developments of obstetrics and gynecologic at the Santa Casa Hospital from Porto Alegre. From this examination, it was also found that the development of these specialties represented improvements to the health of women hospitalized and advances in how doctors were concerned about the treatment of women in that place. The followed theoretical perspective connected to the studies of the Social History, using mainly the analytics categories in gender and social class. The main argumentation of the research was catch trough quantitative demographic bases. However, through the exams about a huge search material looks to qualify not just for the presented numbers, but also the analysis and argumentation about the topics. The methodological point of view, followed by several arising precepts of demographic studies, in the main of the Social History linked, mainly, examined the morbidity and mortality bases of the women analyzed. As the result of the analysis, confirmed that in the beginning of the decade of 1880 few women of the Porto Alegre population looked for the treatment at the Santa Casa Hospital, and when they did this, they usually were in serious healthy troubles that result in a high level of women’s mortality in those hospital. It also was observed that rarely women look for help in Santa Casa Hospital to realize their child-birth or illness treatment connected to the obstetrics and gynecologic methods. However, when it was observed the causes of the women hospitalization in relation to the medical actions that were directed to the women medicine inside the Santa Casa Hospital till the final of the century XIX, it was noticed that this situation modified slowly with the number of women who looking for the Hospital for treatment to several disease and to the child-birth realization. At least, from the verification about the bases of the hospitalization, it was concluded that the medical actions done at the Santa Casa Hospital were driven in the major part by the improvement about the obstetric and gynecologic methods, that resulted in an increasing of the women hospitalization and in the significant decreasing of the female mortality, in those hospital, at the final of the century XIX.

Air pollution is extensive problem throughout Moravian-Silesian Region and in addition impacts many lives in so settled agglomeration. Harmful substances that here aloft occur often in several fold go beyond limit for health protection, are toxic to environment and people who live there, therefore it is so important for protection of people to deal with this topic. It is necessary to determine, how much actually air pollution affects the health of the people. Hypothesis H1 deals with question. In cooperation with the Department of Air Protection Hydro meteorological Institute in Ostrava and Regional hygiene station of Moravian-Silesian region, were compared data of the current PM10 pollution particles weekly morbidity and acute respiratory diseases. If condition of the air worsens, sickness does not improve and when air quality is improving, declining disease and acute respiratory infections in the region - between air pollution and health status of the population is correlation. For hypothesis H2 was created questionnaire, and was distributed to resident of region with rate of return of 87 %. The most general questions were answered correctly. The issue came to the question of determining current situation, so H2 hypothesis was confirmed only partially. The only way how to do protecting the population it is functional warning. Also it was investigated by a special comparative method, when resident were warned in which value of the PM10. 38 % residents say, that they were never warned, so the hypothesis H3 was also confirmed partly. After analyzing the problem was created proposal how to deal with this situation in ORP Bohumín case. Inhabitants of the region were divided into two groups. Active group, it is a group of people who have internet connection and do not use it. It was therefore created information leaflet and stickers, whose main task is to attract attention and show the population, where information about current pollution can be found. Part of this leaflet is also notes, in which people were less informed in questionnaire. The second group is passive then ? residents who do not have internet access or they cannot us it. So it was crated a system of rotating information board, and design its location in the ORP Bohumín in an public areas, where accumulate a larger number of people. On such a board could be automatically sent actual time data through network communication. It would be also appropriate add alarm warning system, but its execution would have to be limited to a certain level due to the frequent exceed in most municipalities in the region. There would be also possibility to benefit a warning to citizens through the fire protection of Volunteer firefighter. Especially if was declared by smog situation. Of course there is a also the option to use warning sirens, but I think it such a way of warning could cause unnecessary panic. The following suggestions are valid for both groups. It was displayed map of Low Emission Zone form information available in ORP Bohumín. System of isolation green spaces.. It was also examined whether the type of activity plan prepared long-term inverse situation in the region, but according to HZS does not pose a threat to the region, which would require the declaration of emergency state. So developments of operational plan isn´t necessary yet. However, the time is main aspect for gradual improvement of the warning and informing the population. The results showed that the general awareness of the issue is sufficient, but is also necessary to pay attention to the current situation in order to reduce the health risks to the lowest level. I am not sure that citizens must learn how to reconcile with living in conditions, but they should be patient, of course contribute to improve this situation by for example informing themselves about current pollution.

O uso das informações e indicadores provenientes do Sistema de Informações Hospitalares do SUS (SIH/SUS), tanto para análise de situação de saúde da população como para análise do desse, SUS, é cada vez mais frequente. Tal sistema é, desde sua concepção, fortemente influenciado pelas políticas públicas na área de atenção à saúde, como as definidas pelas Normas Operacionais e os incentivos e restrições a determinadas práticas. Alterações na operação do sistema introduzem descontinuidades e vieses nas informações, provocando eventuais imprecisões ou mesmo distorções nos resultados da extração de dados do sistema. Para que se possa avaliar o resultados de políticas, a situação da assistência à saúde ou as condições de saúde de uma população, é necessário, portanto, que se tenha uma visão clara e objetiva de quais informações são disponíveis, a sua evolução e como utiliza-las, considerando devidamente as influências exógenas e endógenas do sistema. O presente estudo está estruturado de acordo com o contexto do Sistema de Informações Hospitalares. Como componente da Previdência Social, é estudada a criação do Sistema de Assistência médico-Hospitalar da Previdência Social (SAMHPS), as suas origens e seus eixos estruturantes, assim como a sua expansão para a rede filantrópica e de ensino, com a ampliação de sua cobertura. Já no contexto do Sistema Único de Saúde (SUS), é estudada a incorporação do SAMHPS ao SUS, levando à criação do SIH/SUS, com a expansão para a rede pública e a sua universalização. A influência das políticas de saúde é analisada a partir da implantação de incentivos e restrições que afetam a assistência hospitalar e seu reflexo nas informações do SIH/SUS. A forma de categorização e a identificação dos prestadores são também examinadas, tendo em vista a sua importância na análise e determinação de políticas de saúde. Outro aspecto que é analisado é a forma de apropriação das informações do diagnóstico que levou à internação: a adoção da 10 Revisão da Classificação Internacional de Doenças, o caso específico das causas externas e a implantação da Tabela de Compatibilidade entre Procedimentos e Diagnósticos. Para identificar as mudanças políticas e operacionais do SUS, da regulamentação da assistência hospitalar e do SIH/SUS, foi pesquisada sua legislação Leis, Decretos, Normas Operacionais, Portarias, Instruções e Manuais. O relacionamento entre as informações e as políticas é analisado identificando a implantação destas políticas e verificando o efeito sobre os indicadores da assistência hospitalar obtidos do SIH/SUS. Como conclusão, foi visto que análises que utilizem as séries históricas devem, obrigatoriamente, levar em consideração as modificações, tanto do SUS como do SIH/SUS, para que possam chegar a conclusões mais precisas. Descontinuidades nas séries históricas efetivamente mostram modificações das políticas e da operação do sistema. A facilidade de acesso, a disponibilidade, a oportunidade e rapidez de atualização das informações do SIH/SUS são fatores positivos do sistema; é possível analisar o efeito de determinada ação pouco após a sua implantação. A análise das informações do diagnóstico denota a necessidade de treinamento dos codificadores no uso da CID-10 em morbidade e de uma ampla revisão da Tabela de Compatibilidade entre Diagnóstico Principal e o Procedimento Realizado. / The use of information and indicators derived from the Hospital Information System (SIH/SUS) of the National Health System in Brazil (SUS) is steadily increasing, either for health situation analysis as for performance analysis. Since its original conception, this system is strongly influenced by public policies in health assistance, as defined by legislation or by incentives and restriction to some medical and hospital practices. Changes in system operation also bring up discontinuities and biases in the information, eventually resulting in imprecision or even distortions in the indicators derived from the system data. In order to evaluate health policies, health assistance situation and population health status, a clear and objective approach is needed, Knowing which information is available, its evolution and how to use it, considering internal and external influences. This study aims to describe and analyze how the SUS health policies influence and are reflected in the information and indicators derived from the SIH/SUS. It is structured according its context. As Social Security component, we study the creation of the Social Security Medical and Hospital Assistance System (SAMHPS), its origins and structure and also its extension to the philanthropic and university hospitals, with its corresponding expansion of coverage. In the context of the National Health system, we have studied the transformation of the SAMPHS into SIH/SUS, its expansion to the public hospital and universal coverage. The influence of health policies is analyzed from the implementation of incentives and restrictions that affected hospital assistance and how if reflects in the SIH/SUS information. Due to their importance in the analysis and determination of health policies, the hospital categorization and identification are also examined. Furthermore, we analyzed how the diagnostic information is captured, considering the adoption of the 10th Revision of the International Classification of Diseases (ICD-10), the specific case of the external causes and the implementation of the Compatibility Table between Procedures and Diagnostics. We have studied the legislation concerning both SUS and SIH/SUS: laws, decrees, operational norms, directives, instructions and manuals, in order to identify SUS operational and political changes, hospital assistance and SIH/SUS regulation. The relationship between information and politics is analyzes identifying the implementation of these policies and verifying the effects in the hospital assistance indicators from the SIH/SUS. Concluding, we have seen that the series analysis must take in account the political and operational changes, either SUS as SIH/SUS, in order to produce more precise conclusions. Time series discontinuities effectively reflect the political and operational changes. The access, availability, opportunity and quick update of the SIH/SUS information are positive factors; they make possible to analyze the effects of some action just after its implementation. Analyzes of the diagnostic information shows the necessity of training in the use of the ICD-10 and also a full revision in the Compatibility Table between Diagnostics and Procedures.