Resumo O texto aborda a representatividade nos conselhos de saúde no Brasil, a partir de diretrizes propostas pelo Conselho Nacional de Saúde. O objetivo do estudo foi verificar a adequação dos conselhos aos critérios descritos na Resolução 453/2012, que demonstram a representatividade dos segmentos que compõem o coletivo. Foi realizado estudo descritivo, do tipo transversal, durante os meses de maio e junho de 2017. A população do estudo foi composta pelos conselhos de saúde cadastrados no Sistema de Acompanhamento dos Conselhos de Saúde, de acesso público e disponível na internet. Os resultados obtidos foram organizados considerando a distribuição geográfica dos conselhos. Foram identificadas as regiões com maiores índices de descumprimento do critério de paridade. Ficou demonstrado que as diretrizes para reformulação dos conselhos estão alinhadas a noção de representatividade, porém, não são garantia para a efetividade da representação. Estudos futuros poderão aprofundar as análises sobre a representatividade nos conselhos de saúde no Brasil, e identificar quais mecanismos são adotados pelas entidades para garantir efetividade da representação, bem como se ocorre renovação da representação. É recomendável que as normas que ordenam o funcionamento dos conselhos sejam permanentemente atualizadas para favorecer a participação social na saúde.

Abstract The text addresses the representativeness in health councils in Brazil, based on guidelines proposed by the National Health Council. This study aimed to verify the adequacy of the councils to the criteria described in Resolution 453/2012, which demonstrate the representativeness of the segments that make up the collective. A descriptive cross-sectional study was conducted during May and June 2017. The study population was composed of health councils registered in the Health Councils Monitoring System, with public access and available on the Internet. The results obtained were organized considering the geographical distribution of the councils. The regions with the highest rates of non-compliance with the parity criterion were identified. It has been demonstrated that the guidelines for reformulating the councils are aligned with the notion of representativeness, but they are not a guarantee for the effectiveness of the representation. Future studies may deepen the analyses on representativeness in health councils in Brazil, and identify which mechanisms are adopted by entities to ensure the effectiveness of representation, as well as whether representation is renewed. It is recommended that the rules ordering the functioning of councils be permanently updated to promote social participation in health.

Resumo O texto aborda a representatividade nos conselhos de saúde no Brasil, a partir de diretrizes propostas pelo Conselho Nacional de Saúde. O objetivo do estudo foi verificar a adequação dos conselhos aos critérios descritos na Resolução 453/2012, que demonstram a representatividade dos segmentos que compõem o coletivo. Foi realizado estudo descritivo, do tipo transversal, durante os meses de maio e junho de 2017. A população do estudo foi composta pelos conselhos de saúde cadastrados no Sistema de Acompanhamento dos Conselhos de Saúde, de acesso público e disponível na internet. Os resultados obtidos foram organizados considerando a distribuição geográfica dos conselhos. Foram identificadas as regiões com maiores índices de descumprimento do critério de paridade. Ficou demonstrado que as diretrizes para reformulação dos conselhos estão alinhadas a noção de representatividade, porém, não são garantia para a efetividade da representação. Estudos futuros poderão aprofundar as análises sobre a representatividade nos conselhos de saúde no Brasil, e identificar quais mecanismos são adotados pelas entidades para garantir efetividade da representação, bem como se ocorre renovação da representação. É recomendável que as normas que ordenam o funcionamento dos conselhos sejam permanentemente atualizadas para favorecer a participação social na saúde.

Abstract The text addresses the representativeness in health councils in Brazil, based on guidelines proposed by the National Health Council. This study aimed to verify the adequacy of the councils to the criteria described in Resolution 453/2012, which demonstrate the representativeness of the segments that make up the collective. A descriptive cross-sectional study was conducted during May and June 2017. The study population was composed of health councils registered in the Health Councils Monitoring System, with public access and available on the Internet. The results obtained were organized considering the geographical distribution of the councils. The regions with the highest rates of non-compliance with the parity criterion were identified. It has been demonstrated that the guidelines for reformulating the councils are aligned with the notion of representativeness, but they are not a guarantee for the effectiveness of the representation. Future studies may deepen the analyses on representativeness in health councils in Brazil, and identify which mechanisms are adopted by entities to ensure the effectiveness of representation, as well as whether representation is renewed. It is recommended that the rules ordering the functioning of councils be permanently updated to promote social participation in health.

Resumo O crack é uma droga devastadora pelos efeitos que provoca. É um desafio para os profissionais da saúde que atuam na prevenção e no tratamento dos usuários, e para os professores dos ciclos básicos. O acesso à informação é uma forma eficiente para combater a droga e suas consequências. A pesquisa buscou identificar as Tecnologias de Informação e Comunicação utilizadas por esses profissionais para auxiliar no conhecimento sobre o crack e no desenvolvimento de programas de prevenção ao consumo e tratamento dos dependentes. Foram usadas metodologia qualitativa, amostra intencional por critérios e técnicas de investigação por meio de entrevistas semiestruturadas, triangulação da análise e informantes-chave. A fonte de busca de informações preferida pelos informantes-chave e profissionais foi a internet, onde se concentram as fontes de informação sobre o crack. A literatura pesquisada não reflete um escopo amplo sobre a área específica, comprometendo a capacitação e a ampliação de atuação desses profissionais.

Abstract Crack is a devastating drug due to its effects. It is a challenge for healthcare professionals who work in the prevention and treatment of users and for teachers of basic cycles. Access to information is an efficient way to fight drugs and their consequences. This paper aimed to identify the Information and Communication Technologies used by these professionals to help gain knowledge about crack and develop programs for the prevention of consumption and treatment of addicts. Qualitative methodology, intentional sample by criteria, and investigation techniques have been used through semi-structured interviews, analysis triangulation, and key informants. The preferred source of information search by key informants and professionals was the internet, where the sources of information about crack are concentrated. The researched literature does not reflect a broad scope on the specific area, which compromises the training of these professionals and the expansion of possibilities for their performance.

OBJECTIVE: To verify whether health councils in Brazil carry out permanent education activities for municipal, state and federal district councilors. METHOD: This was a cross-sectional study with secondary data collection in the Health Council Monitoring System (Sistema de Acompanhamento dos Conselhos de Saúde - Siacs) from May to August 2017. The Siacs is publicly accessible and available on the internet. It provides data from thousands of health councils throughout Brazil. Analysis and interpretation of the data were based on the literature and the enacted legislation, particularly Resolution 453/2012 and the National Policy of Permanent Education for Social Control in the Unified Health System (Política Nacional de Educação Permanente para o Controle Social no Sistema Único de Saúde). RESULTS: Despite the fact that Resolution 453/2012 establishes the deliberation, elaboration, support and promotion of permanent education for social control as functions of the councils (in accordance with the guidelines of the National Policy of Permanent Education), approximately 40% of councils do not carry out permanent education. CONCLUSIONS: It is necessary to strengthen the role of health councils in the elaboration of educational initiatives across the national territory. This includes the allocation of financial resources to increase access to and participation in these initiatives, which would strengthen social control in the Unified Health System. This study emphasizes that the discussion of permanent education is not given sufficient attention in the agendas and routines of health councils. This compromises the effectiveness of councils’ monitoring and deliberation of public health policy.

RESUMO Objetivo: Descrever o estado de empregabilidade de uma amostra brasileira de pessoas com esclerose múltipla (EM). Métodos: Estudo transversal incluindo informações demográficas e ocupacionais no momento do diagnóstico e atual, e o tempo do primeiro sintoma ao diagnóstico. Resultados: Foram incluídos 804 pacientes com EM, com mediana de idade de início dos sintomas e atual de 28,3 e 36,2 anos; tempo mediano para diagnóstico e duração da doença de 2,7 e 7,9 anos. Desta amostra, 67% possuíam diploma universitário e 29% terminaram o ensino médio. No total, 94% tiveram uma ocupação remunerada pelo menos uma vez na vida, 77% estavam empregados no diagnóstico, mas apenas 59% estavam empregados no momento da pesquisa. Maior duração de doença, maior tempo para o diagnóstico e menor idade no 1° sintoma foram os fatores relacionados ao desemprego. Conclusões: A taxa de desemprego dobra após os primeiros sintomas da EM, e apenas 59% das pessoas com alto nível educacional com EM em seus anos produtivos estão empregados. Maior tempo para o diagnóstico pode implicar atraso no tratamento, e estratégias com foco no diagnóstico precoce e tratamento adequado podem favorecer a retenção de emprego e reduzir os custos relacionados à doença, como benefícios sociais e uso de fundos de pensão.

ABSTRACT Objective: To describe the employment status of Brazilians with multiple sclerosis (MS). Methods: Analysis of a cross-sectional online survey including questions on demographic and occupational status at the time of diagnosis and survey completion, and time from the first symptom to diagnosis. Results: Of those who answered the survey, 804 Brazilians with MS were included. Median age of onset and current age were 28.3 and 36.2 years; median time to diagnosis and disease duration were 2.7 and 7.9 years; 67% held a university degree and 29% finished high school; 94% had a paid occupation contributing to the family income at least once in their lives, 77% were employed at the time of diagnosis but only 59% were employed at the time of survey. Longer disease duration, longer time to diagnosis and younger age at the first symptom, were identified as factors correlated with being unemployed. Conclusions: The rate of unemployment doubled after the first symptoms of MS, and only 59% of highly-educated people with MS in their productive years were employed. The longer time to diagnosis may imply treatment delay, and strategies focusing on early diagnosis and adequate treatment may favor employment retention and reduce disability related costs, such as social benefits and pension fund use.

ABSTRACT Objective: Recent data indicates an increasing incidence of thyroid cancer not accompanied by a proportional increase in mortality, suggesting overdiagnosis, which may represent a big public health problem, particularly where resources are scarce. This article aims to describe and evaluate the procedures related to investigation of thyroid nodules and treatment and follow-up of thyroid cancer and the costs for the Brazilian public health system between 2008 and 2015. Materials and methods: Data on procedures related to investigation of thyroid nodules and treatment/follow-up of thyroid cancer between 2008 and 2015 in Brazil were collected from the Department of Informatics of the Brazilian Unified Health System (Datasus) website. Results: A statistically significant increase in the use of procedures related to thyroid nodules investigation and thyroid cancer treatment and follow-up was observed in Brazil, though a reduction was noted for procedures related to the treatment of more aggressive thyroid cancer, such as total thyroidectomy with neck dissection and higher radioiodine activities such as 200 and 250 milicuries (mCi). The procedures related to thyroid nodules investigation costs increased by 91% for thyroid ultrasound (p = 0.0003) and 128% in thyroid nodule biopsy (p < 0.001). Costs related to treatment and follow-up related-procedures increased by 120%. Conclusion: The increase in the incidence of thyroid cancer in Brazil is directly associated with an increased use of diagnostic tools for thyroid nodules, which leads to an upsurge in thyroid cancer treatment and followup-related procedures. These data suggest that substantial resources are being used for diagnosis, treatment and follow-up of a potentially indolent condition.

RESUMO Objetivo Avaliar os indicadores de tempo do centro cirúrgico de um hospital universitário para melhoraria de sua eficiência. Métodos Foi realizado um estudo descritivo transversal a partir da base de dados da tecnologia da informação do centro cirúrgico. A amostra foi obtida a partir de janeiro de 2011 a janeiro de 2012. Foram incluídas as operações realizadas em sequência na mesma sala cirúrgica, das 7 às 17h, eletivas ou de urgências. Os procedimentos com dados incompletos no sistema foram excluídos, assim como as operações depois das 17h ou realizadas em fins de semana ou feriados. Resultados Foi medido o tempo operatório e não operatório de 8.420 operações realizadas. Os tempos operatórios (média e desvio padrão) de anestesia e de cirurgia foram 177,6±110 e 129,8±97,1 minutos, respectivamente. O tempo total do paciente em sala cirúrgica (média e desvio padrão) foi de 196,8±113,2. O tempo não operatório, por exemplo, entre a chegada do paciente e o início da anestesia, foi de 14,3±17,3 minutos. O tempo de preparo e entrada do próximo paciente na sala cirúrgica foi 119,8±79,6 minutos. O tempo não operatório total foi de 155 minutos. Conclusão Atrasos frequentes ocorreram nas salas de cirurgia e tiveram um grande efeito sobre o fluxo de pacientes e a utilização de recursos. O tempo não operatório foi maior que o operatório. Portanto, é possível aumentar a capacidade do centro cirúrgico por meio da gestão e do treinamento dos profissionais envolvidos. Os indicadores oferecem uma ferramenta para melhorar a eficiência das salas de cirurgia.

ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.