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Background: Multimorbidity is a public health problem with high prevalence and important consequences. The aim of this paper was to verify the prevalence and distribution of multimorbidity in Brazilian older adults.Methods: A population-based survey was carried out in 2008 through face-to-face interviews with 1593 older adults (aged 60 or over) living in Bagé, a medium-sized city in Southern Brazil. Multimorbidity was evaluated by 17 morbidities and operationalized according to two cutoff points: 2 or more and 3 or more morbidities. Descriptive analysis examined the occurrence of multimorbidity by demographic, socioeconomic and health services variables. Observed and expected dyads and triads of diseases were calculated.Results: From total sample, 6 % did not have morbidities. Mean morbidity was 3.6. Morbidities showing higher prevalence were high blood pressure - HBP - (55.3 %) and spinal column disease (37.4 %). The percent of participants with multimorbidity was 81.3 % (95 % CI: 79.3; 83.3) for 2 or more morbidities and 64.0 % (95 % CI: 61.5; 66.4) for 3 or more morbidities. In both measures occurrence was higher among women, the more elderly, less socioeconomic status, the bedridden, those who did not have a health private plan, those who used health services and those living in Family Health Strategy catchment areas. We found 22 dyads of morbidities with prevalence 10 % or more and 35 triads with prevalence 5 % or more. The most prevalent observed pair and triplet of morbidities were HBP and spinal column disease (23.6 %) and HBP, rheumatism/arthritis/arthrosis and spinal column disease (10.6 %), respectively.Conclusions: Multimorbidity frequency was high in the sample studied, in keeping with percentage found in other countries. The social inequities identified increase the health system challenges for the management of multimorbidity, requiring a comprehensive and multidimensional care. The combinations of diseases can provide initial input to include multimorbidity in Brazilian clinical protocols. [ABSTRACT FROM AUTHOR]

The Secretary of Health State of Minas Gerais, with the support of the Ministry of Health, have been making extensive effort to universalize the primary health care, given its strategic role in the formation the networks of the health care in the Unique Health System (SUS). Therefore, began to encourage the adoption of the Family Health Teams through of the "Program Structuring Health at Home". Associated with this program, was created the Master Plan of the Primary Health Care (PDAPS), whose goal it's provide an instrument to territorial planning and management of these service, qualifying them to fulfill the role as gateway of the network of the health in the SUS. The aim of this paper is discuss the territorial planning of the primary health care and the networks of the health care the SUS in Minas Gerais, Brazil. The hypothetical premise of the discussion is the existential interdependence between primary health care, networks and the territory. The methodology is based on a theoretical study and descriptive, on one side, and a theorical analysis and critical, of another. Therefore, have a dimension of discovery of the relationship between networks, territory and primary health care, on one side, and a dimension of note about the ways how this is being planned, of another. The results indicate improvements in the construction of networks in Minas Gerais, but there are also theoretical issues and methodological that needs to be addressed, especially on the forms of territorial definition of the services. [ABSTRACT FROM AUTHOR]

The management processes of the Unified Health System (SUS) are supported by a set of information systems with national scope, having features for the epidemiological, ambulatory, hospital, and administrative areas. This article proposes a model for evaluating health information systems that may be applied to the systems of SUS. It describes the research, analysis, and classification process of evaluation indicators for the model. The indicators were obtained by search in bibliographic databases and they were classified according to the quality attributes of the standard ISO/IEC 25010, adopted as quality model in the study. As a result, 66 indicators were identified and mapped, covering all quality features of the model. This paper will be able to contribute as a further reference for studies involving quality assessment processes for softwares in health and to assist in the standardization of plans for assessing and monitoring the quality of systems and data on public health in Brazil and in projects for improving softwares. [ABSTRACT FROM AUTHOR]

Recent debate on institutional change in the Brazilian public health system pays little attention to organizational innovation in Hospital Units (HUs). Calling upon the analytical framework proposed by Economic Analysis to investigate asymmetric information and innovation, this paper analyzes the connections among effectiveness of rules, routines and protocols, staff training, and service quality in HUs with the help of statistical analysis of Hospital Accreditation reports. The convenience sample consisted of ten reports containing perceived assessment data. As a theoretical contribution, the proposed model analyzes the dynamic relationship between organizational innovation, service quality and growth in HU and development of the market for healthcare services. Empirical findings show that the effect of organizational innovation in Referral Hospital Units is stronger than the effect of staff training. [ABSTRACT FROM AUTHOR]

This article analyses Brazilian state policy for indigenous health based on the inquiry of the recent historical, political and managerial process that resulted in the creation, in 1991, of the National Health Foundation (Funasa). I t attempts to bring together two lines of thought triggered by the examination of the Funasa Museum collection and by interviews with Funasa employees. T he threads thus woven should make possible, on the one hand, (i) to trace a genealogy of the National Health Foundation, and, on the other, (ii) to highlight its role in setting the hurdles that prevent the consolidation of a political field of respect for diversity in indigenous health policy. T he paper, therefore, consists of an approach which aims at pulling together biographic narratives with institutional memory. [ABSTRACT FROM AUTHOR]

The provision of care and support to persons living with human immunodeficiency virus (HIV) in Brazil who also use drugs and/or alcohol represents special challenges because of the combined effects of addiction, poverty, stigma, and discrimination. This paper presents details on a program providing both clinic- and field- based care to HIV-infected injection drug users, highlighting the use of a specialized case management approach to address the clinical and psychosocial needs of this population. This program includes both a mobile case management team that fosters group discussions and provides individual counseling, and provision of medical consultations at 2 major drug treatment centers in Rio de Janeiro. The article also describes the experience of working with injection drug users who regularly attend an outpatient clinic serving marginalized communities through the use of mutual self-help groups and specialized support groups to address to issue of adherence to antiretroviral therapies for the treatment of HIV/acquired immunodeficiency syndrome. [ABSTRACT FROM AUTHOR]