The differences in the SF-36 scores between age groups, genders and countries confirm that these Brazilian norms are necessary for comparative purposes. The data will be useful for assessing the health status of the general population and of patient populations, and the effect of interventions on health-related quality of life.

Com o objetivo de contribuir para a avaliação da Atenção Básica, desenvolveu-se estudo que tem por referência a qualidade de prontuários dos pacientes, considerando os registros dos atendimentos realizados em quatro municípios acima de 100 mil habitantes no Estado do Rio de Janeiro, Brasil, em 2004, esta pesquisa se trata de estudo transversal com base em dados primários, levantados por verificação direta no prontuário. Os atendimentos foram sorteados em amostra probabilística por conglomerado em dois estágios: estabelecimentos de atenção básica e atendimentos/prontuários. Verificou-se a completitude de atributos relativos à identificação dos usuários atendidos, em todos os prontuários, e a características do processo de atendimento (como peso, pressão arterial, colpocitologia e glicemia) nos prontuários de mulheres acima de 19 anos, hipertensas e diabéticas. Na identificação dos usuários, encontrou-se baixa presença dos atributos sociais e somente metade dos prontuários possuía registro da data de abertura. Os registros de características do processo de atendimento em mulheres, hipertensas e diabéticas, ficaram longe das proposições do Ministério da Saúde. A análise da completitude sugere discutível qualidade na continuidade do cuidado oferecido, dificuldades para a prática gerencial na Atenção Básica e para implementação da Estratégia Saúde da Família.

BackgroundIn Brazil, despite the growing use of SF-36 in different research environments, most of the psychometric evaluation of the translated questionnaire was from studies with samples of patients. The purpose of this paper is to examine if the Brazilian version of SF-36 satisfies scaling assumptions, reliability and validity required for valid interpretation of the SF-36 summated ratings scales in the general population.Methods12,423 individuals and their spouses living in 8,048 households were selected from a stratified sample of all permanent households along the country to be interviewed using the Brazilian SF-36 (version 2). Psychometric tests were performed to evaluate the scaling assumptions based on IQOLA methodology.ResultsData quality was satisfactory with questionnaire completion rate of 100%. The ordering of the item means within scales clustered as hypothesized. All item-scale correlations exceeded the suggested criteria for reliability with success rate of 100% and low floor and ceiling effects. All scales reached the criteria for group comparison and factor analysis identified two principal components that jointly accounted for 67.5% of the total variance. Role emotional and vitality were strongly correlated with physical and mental components, respectively, while social functioning was moderately correlated with both components. Role physical and mental health scales were, respectively, the most valid measures of the physical and mental health component. In the comparisons between groups that differed by the presence or absence of depression, subjects who reported having the disease had lower mean scores in all scales and mental health scale discriminated best between the two groups. Among those healthy and with one, two or three and more chronic illness, the average scores were inverted related to the number of diseases. Body pain, general health and vitality were the most discriminating scales between healthy and diseased groups. Higher scores were associated with individuals of male sex, age below 40 years old and high schooling.ConclusionsThe Brazilian version of SF-36 performed well and the findings suggested that it is a reliable and valid measure of health related quality of life among the general population as well as a promising measure for research on health inequalities in Brazil.

Abstract

Digital inclusion and health counselors: a policy for the reduction of social inequalities in BrazilInclusão digital e conselheiros de saúde: uma política para a redução da desigualdade social no Brasil Bertolt Brecht

ObjectiveTo characterize the Brazilian philanthropic hospital network and its relation to the public and private sectors of the Sistema Unico de Saude (SUS) [Brazilian Unified Health System]. Methods This is a descriptive study that took into consideration the geographic distribution, number of beds, available biomedical equipment, health care complexity as well as the productive and consumer profiles of philanthropic hospitals. It is based on a sample of 175 hospitals, within a universe of 1,917, involving 102 distinct institutions. Among these, there were 66 Brazilian Unified Health System (SUS) inpatient care providers with less than 599 beds randomly included in this study. Twenty-six of the twenty-seven SUS inpatient care providers with at least 599 beds, as well as ten institutions which do not provide their services to SUS, were also included. This is a cross-sectional study and the data was obtained in 2001. Data collection was conducted by trained researchers, who applied a questionnaire in interviews with the hospital's managers. ResultsWithin the random sample, 81.2% of the hospitals are located in cities outside of metropolitan areas, and 53.6% of these are the only hospitals within their municipalities. Basic clinical hospitals, without ICUs, predominate within the random sample (44.9%). Among the individual hospitals of the large philanthropic institutions and the special hospitals, the majority -53% and 60% respectively -are level II general hospitals, a category of greater complexity. It was verified that complexity of care was associated to hospital size, being that hospitals with the greatest complexity are situated predominantly in the capitals. Conclusions Given the importance of the philanthropic hospital sector within the SUS in Brazil, this paper identifies some ways of formulating appropriate health policies adjusted to the specificities of its different segments.

OBJECTIVE:To describe the management performance of philanthropic hospitals that operate their own health plans, in comparison with philanthropic hospitals as a whole in Brazil. METHODS:The managerial structures of philanthropic hospitals that operated their own health plans were compared with those seen in a representative group from the philanthropic hospital sector, in six dimensions: management and planning, economics and finance, human resources, technical services, logistics services and information technology. Data from a random sample of 69 hospitals within the philanthropic hospital sector and 94 philanthropic hospitals that operate their own health plans were evaluated. In both cases, only the hospitals with less than 599 beds were included. RESULTS:The results identified for the hospitals that operate their own health plans were more positive in all the managerial dimensions compared. In particular, the economics and finance and information technology dimensions were highlighted, for which more than 50% of the hospitals that operated their own health plans presented almost all the conditions considered. CONCLUSIONS:The philanthropic hospital sector is important in providing services to the Brazilian Health System (SUS). The challenges in maintaining and developing these hospitals impose the need to find alternatives. Stimulation of a public-private partnership in this segment, by means of operating provider-owned health plans or providing services to other health plans that work together with SUS, is a field that deserves more in-depth analysis.

This paper presents the management characteristics of charity hospitals in