OBJECTIVE:To analyze the confi guration of mobile emergency health care policy in Brazil. METHODOLOGICAL PROCEDURES:The study was based on public policy analysis. Bibliographic and document review, analysis of offi cial data and interviews with federal administrators related to formulation and implementation of the Mobile Emergency Care Service (SAMU) in Brazil in the 2000s were performed. ANALYSIS OF RESULTS:Priority was given to SAMU at the federal level since 2003. During the fi rst years of implementation, municipal level services predominated; in 2008, services with regional scope became more signifi cant. Estimated coverage reached 53.9% of the population in 2009, in 20.5% of Brazilian municipalities. Implementation varied between States, and there were less advanced support ambulances than recommended, both nationally and in several States.CONCLUSIONS: SAMU was adopted nationwide since 2003 upon development of federal norms. Implementation of the policy involves challenges, including adequate investment, integration of the service into an established urgent care network, arrangement of appropriate information systems and personnel capacity. Addressing these challenges will allow SAMU to become a key health care strategy in the unifi ed health system.

O Serviço de Atendimento Móvel de Urgência (SAMU) foi o primeiro componente da Política Nacional de Atenção às Urgências implantado no país no começo dos anos 2000. O artigo analisou o processo de implantação da urgência pré-hospitalar móvel no Brasil. Os métodos incluíram análise documental, entrevistas com coordenadores estaduais de urgência e um painel de especialistas. Utilizou-se o referencial teórico da análise da conduta estratégica da Teoria da Estruturação de Giddens. Os resultados evidenciaram uma implantação do SAMU desigual entre estados e regiões, identificando seis padrões de implantação considerando-se a capacidade dos estados de expandir a cobertura populacional e de regionalizar. As dificuldades estruturais incluíram a fixação de médicos, centrais de regulação mal equipadas e escassez de ambulâncias. Norte e Nordeste foram as regiões mais atingidas. O SAMU está configurado como estratégia estruturante da rede de urgências, mas seu desempenho sofreu o impacto da pouca participação da atenção primária na rede de urgências e principalmente da falta de leitos hospitalares.

IntroductionSarcopenia is a condition diagnosed when the patient presents low muscle mass, plus low muscle strength or low physical performance. Muscle weakness in the oldest (dynapenia) is a major public health concern because it predicts future all-cause mortality and is associated with falls, disability, cardiovascular mortality and morbidity. Grip strength is a simple method for assessment of muscle function in clinical practice.ObjectiveTo estimate the grip strength and identify factors associated with handgrip strength variation in elderly people with low socioeconomic status.MethodsCross-sectional study based on a multidimensional assessment of primary care users that were 60 years or older. The sample size was calculated using an estimated prevalence of depression in older adults of 20%. A kappa coefficient of 0.6 with a 95% confidence interval was used to generate a conservative sample size of 180 individuals. Procedures: tests and scales to assess humor, cognition (MMSE), basic (ADL) and instrumental activities (IADL) of daily living, mobility (Timed Up and Go), strength, height, Body Mass Index (BMI) and social support were applied. Questions about falls, chronic diseases and self-rated health (SRH) were also included. Statistical Analysis: Mean, standard deviation and statistical tests were used to compare grip strength means by demographic and health factors. A multivariate linear model was used to explain the relationship of the predictors with grip strength.ResultsThe group was composed predominantly by women (73%) with a very low level of education (mean 3 years of schooling), mean age of 73.09 (± 7.05) years old, good mobility and without IADL impairment. Mean grip strength of male and female were 31.86Kg (SD 5.55) and 21.69Kg (SD 4.48) [p- 0.0001], respectively. Low grip strength was present in 27.7% of women and 39.6% of men. As expected, men and younger participants had higher grip strength than women and older individuals. In the adjusted model, age (p- 0.03), female sex (p- 0.0001), mobility (p- 0.05), height (p- 0.03) and depression (p- 0.03) were independently associated with low grip strength. For every second more in the mobility test, there was a mean decrease of 0.08 Kg in the grip strength. Elders with depression had a mean reduction of 1.74Kg in the grip strength in relation to those in the comparison groups. There was an average reduction of 8.36Kg in the grip strength of elderly females relative to males. For each year of age after 60 years, it was expected an average reduction of 0.11 Kg in the grip strength.Conclusionour results suggest that low grip strength is associated with age, female sex, height, depression and mobility problems in poor elderly. Grip strength can be a simple, quick and inexpensive means of stratifying elders’ risk of sarcopenia in the primary care setting. Efforts should be made to recognize weaker persons and the conditions associated to low grip strength in order to target early interventions to prevent frailty and disability.

Avaliação dos serviços hospitalares de emergência do programa QualiSUSEvaluation of emergency services of the hospitals from the QualiSUS program

RESUMO A adesão ao tratamento é um dos maiores desafios ao tratamento de HIV (Vírus da Imunodeficiência Humana), e a depressão, um fator de impacto. Objetivou-se identificar se a depressão interfere na adesão. Para tanto, utilizou-se um método de multiabordagem de adesão, entrevista aberta e o Inventário de Depressão de Beck para rastreamento de depressão. A relação entre depressão e não adesão não se verificou, apesar de a prevalência de depressão ser de 22,24%. Os pacientes admitiram medo do estigma e dificuldade em seguir o tratamento antirretroviral em decorrência dos efeitos adversos do medicamento. Detectou-se a importância da rede social de proteção e evidenciou-se a necessidade da construção de uma rede de cuidados.

Resumo O estudo analisou as ações de prevenção e controle da obesidade infantil, especialmente as de Promoção da Alimentação Adequada e Saudável (PAAS), que integram Políticas do governo federal brasileiro nos últimos 15 anos. Foram analisados todos os documentos que apresentam ações de PAAS no âmbito das políticas de saúde e segurança alimentar e nutricional a partir das seguintes dimensões: (1) a abordagem das ações de PAAS; (2) os condicionantes da obesidade que pretendem afetar e (3) as potenciais disputas de interesses. As principais ações de PAAS identificadas visam fomentar: a educação alimentar e nutricional; os sistemas produtivos de base agroecológica; a agricultura familiar; a acessibilidade alimentar; os ambientes saudáveis e as ações regulatórias. Essas ações interferem em diferentes condicionantes da obesidade infantil, apresentam distintas concepções sobre o problema e afetam distintos interesses. Destacam-se as disputas entre os interesses das corporações comerciais de alimentos processados e do agronegócio e os setores governamentais e societários norteados pelos objetivos de PAAS. As ações voltadas para a regulamentação das compras e espaços públicos, além da publicidade de produtos não saudáveis para crianças, são as que melhor expressam os interesses em disputa.

BackgroundThe organisation and systematisation of health actions and services are essential to ensure patient safety and the effectiveness and efficiency of cancer care. The objective of this study was to analyse the structure of cancer care envisaged in Brazilian norms, describe the types of accreditations of cancer services and their geographic distribution, and determine the planning and evaluation parameters used to qualify the health units that provide cancer care in Brazil.MethodsThis observational study identified the current organisation of cancer care and other health services that are accredited by Brazil’s national health system (SUS) for cancer treatment as of February 2017. The following information was collected from the current norms and the National Registry of Health Establishments: geographic location, type of accreditation, type of care, and hospital classification according to annual data of the number of cancer surgeries. The adequacy of the number of licensed units relative to population size was assessed. The analysis considered the facilitative or restrictive nature of policies based on the available rules and resources.ResultsThe analysis of the norms indicated that these documents serve as structuring rules and resources for developing and implementing cancer care policies in Brazil. A total of 299 high-complexity oncology services were identified in facilities located in 173 (3.1%) municipalities. In some states, there were no authorised services in radiotherapy, paediatric oncology and/or haematology-oncology. There was a significant deficit in accredited oncology services.ConclusionsThe parameters that have been used to assess the need for accredited cancer services in Brazil are widely questioned because the best basis of calculation is the incidence of cancer or disease burden rather than population size. The results indicate that the availability of cancer services is insufficient and the organisation of the cancer care network needs to be improved in Brazil.

Resumo: O envelhecimento populacional ocasionou aumento da dependência e da sobrecarga de cuidadores familiares de idosos dependentes. O objetivo foi verificar, entre cuidadores familiares, a prevalência de sobrecarga e os fatores associados a ela em uma região pobre e violenta do Rio de Janeiro, Brasil. Trata-se de estudo transversal com 140 idosos e cuidadores familiares, para investigar apoio social, maus tratos, coabitação e sobrecarga nos cuidadores familiares, além de dependência, declínio cognitivo e depressão no idoso. Modelos logísticos múltiplos foram construídos no intuito de explicar a sobrecarga dos cuidadores familiares. As seguintes características dos idosos se associaram à sobrecarga: idade (OR = 0,94; p < 0,002), depressão (OR = 2,59; p < 0,005) e declínio cognitivo (OR = 3,19; p < 0,03). Em relação aos fatores dos cuidadores familiares, apenas apoio social manteve a relevância (OR = 2,35; p < 0,005). Conclui-se que investigar e tratar depressão e demência em idosos, assim como prover apoio aos seus cuidadores, podem contribuir para o manejo efetivo da sobrecarga de cuidadores familiares, melhorando a qualidade do cuidado e a saúde de ambos.