RESUMO A pesquisa teve por objetivo estudar se o macrocusteio, baseado no valor médio identificado no Sistema de Internação Hospitalar (SIH/SUS), constitui um bom estimador do custo de profissionais de saúde por paciente, tendo como comparação o método de microcusteio. O estudo foi desenvolvido no contexto da assistência hospitalar oferecida ao portador da deficiência de glicose-6-fosfato desidrogenase (dG6PD) do sexo masculino com evento adverso grave devido ao uso da primaquina, na Amazônia Brasileira. O macrocusteio baseado no gasto em serviços profissionais do SIH/SUS, como proxy desse custo, correspondeu a R$60,71, e o microcusteio, baseado nos salários do médico (R$30,43), do enfermeiro (R$16,33) e do técnico de enfermagem (R$5,93), estimou um custo total de R$52,68. A diferença foi de apenas R$8,03, mostrando que os valores pagos pela Autorização de Internação Hospitalar (AIH) são estimadores próximos daqueles obtidos por técnica de microcusteio para os profissionais envolvidos diretamente no cuidado.

ABSTRACT The aim of this study has been to study whether the top-down method, based on the average value identified in the Brazilian Hospitalization System (SIH/SUS), is a good estimator of the cost of health professionals per patient, using the bottom-up method for comparison. The study has been developed from the context of hospital care offered to the patient carrier of glucose-6-phosphate dehydrogenase (G6PD) deficiency with severe adverse effect because of the use of primaquine, in the Brazilian Amazon. The top-down method based on the spending with SIH/SUS professional services, as a proxy for this cost, corresponded to R$60.71, and the bottom-up, based on the salaries of the physician (R$30.43), nurse (R$16.33), and nursing technician (R$5.93), estimated a total cost of R$52.68. The difference was only R$8.03, which shows that the amounts paid by the Hospital Inpatient Authorization (AIH) are estimates close to those obtained by the bottom-up technique for the professionals directly involved in the care.

RESUMO A pesquisa teve por objetivo estudar se o macrocusteio, baseado no valor médio identificado no Sistema de Internação Hospitalar (SIH/SUS), constitui um bom estimador do custo de profissionais de saúde por paciente, tendo como comparação o método de microcusteio. O estudo foi desenvolvido no contexto da assistência hospitalar oferecida ao portador da deficiência de glicose-6-fosfato desidrogenase (dG6PD) do sexo masculino com evento adverso grave devido ao uso da primaquina, na Amazônia Brasileira. O macrocusteio baseado no gasto em serviços profissionais do SIH/SUS, como proxy desse custo, correspondeu a R$60,71, e o microcusteio, baseado nos salários do médico (R$30,43), do enfermeiro (R$16,33) e do técnico de enfermagem (R$5,93), estimou um custo total de R$52,68. A diferença foi de apenas R$8,03, mostrando que os valores pagos pela Autorização de Internação Hospitalar (AIH) são estimadores próximos daqueles obtidos por técnica de microcusteio para os profissionais envolvidos diretamente no cuidado.

ABSTRACT The aim of this study has been to study whether the top-down method, based on the average value identified in the Brazilian Hospitalization System (SIH/SUS), is a good estimator of the cost of health professionals per patient, using the bottom-up method for comparison. The study has been developed from the context of hospital care offered to the patient carrier of glucose-6-phosphate dehydrogenase (G6PD) deficiency with severe adverse effect because of the use of primaquine, in the Brazilian Amazon. The top-down method based on the spending with SIH/SUS professional services, as a proxy for this cost, corresponded to R$60.71, and the bottom-up, based on the salaries of the physician (R$30.43), nurse (R$16.33), and nursing technician (R$5.93), estimated a total cost of R$52.68. The difference was only R$8.03, which shows that the amounts paid by the Hospital Inpatient Authorization (AIH) are estimates close to those obtained by the bottom-up technique for the professionals directly involved in the care.

Abstract: INTRODUCTION: In the Brazilian Amazon, malaria infections are primarily caused by Plasmodium vivax. The only drug that kills the hypnozoite form of P. vivax is primaquine, thereby preventing relapse. However, treating glucose-6-phosphate dehydrogenase (G6PD)-deficient individuals with primaquine can lead to severe hemolysis. G6PD deficiency (G6PDd) affects approximately 400 million people worldwide, most of whom live in malaria-endemic areas. Therefore, clinicians need tools that can easily and reliably identify individuals with G6PDd. This study estimated the accuracy of the Carestart(tm) G6PD rapid test (Access Bio) in the diagnosis of G6PDd in male participants with and without P. vivax acute malaria. METHODS: Male participants were recruited in Manaus. Malaria diagnosis was determined by thick blood smear. G6PD quantitative analysis was performed spectro photometrically at a wave length of 340nm. The Carestart(tm) G6PD test was performed using venous blood. Genotyping was performed for individuals whose samples had an enzyme activity less than 70% of the normal value. RESULTS: Six hundred and seventy-four male participants were included in this study, of whom 320 had a diagnosis of P. vivax malaria. In individuals with enzyme activity lower than 30% (n=13), the sensitivity, specificity, positive predictive value, and negative predictive value of the Carestart(tm) G6PD test were as follows: 61.5% (95%CI: 35.5%-82.3%), 98.3% (95%CI: 97.0%-99.1%), 42.1% (95%CI: 23.1%-63.7%), and 99.2% (95%CI: 98.2%-82.3%), 98.3% (95%CI: 97.0%-99.1%), 42.1% (95%CI: 23.1%-63.7%), and 99.2% (95%CI: 98.2%-99.7%), respectively. Increases in sensitivity were observed when increasing the cut-off value. CONCLUSIONS: Despite low sensitivity, Carestart(tm) G6PD remains a good alternative for rapid diagnosis of G6PDd in malaria-endemic regions.

Objetivou-se com este trabalho caracterizar os fornecedores de leite de um laticínio comercial localizado no Território de Identidade de Itapetinga por meio da aplicação de um questionário semiestruturado. Do total de 28 fornecedores foram entrevistados 17, estes estratificados em pequenos (até 50kg de leite/dia), médios (51 a 200kg de leite/dia) ou grandes (maior que 200kg de leite/dia). A análise dos dados foi realizada por meio de análises unidimensionais e análises não paramétricas e comparação de médias. Não foram observados pequenos fornecedores de leite. Dos entrevistados, 17,6% foram caracterizados como médios e 82,4% como grandes fornecedores de leite. O tempo médio na atividade leiteira variou entre 20 e 22 anos, respectivamente para grandes e médios fornecedores de leite. O agrupamento genético observado nos dois estratos foi o cruzamento Zebu X Taurinos, com produção média de 1.260kg/leite/lactação e 1.594kg/leite/lactação, respectivamente para os médios e grandes fornecedores. O período de lactação foi semelhante entre os estratos (274 dias). A idade ao primeiro parto variou entre 28 (médios) e 25 meses (grandes). O intervalo de partos foi de 406 dias (médios) e 480 dias (grandes). Todos os fornecedores entrevistados vacinavam seus animais contra febre aftosa. Apenas um fornecedor realiza o teste com tuberculina. Os sistemas de produção estudados apresentam deficiência no uso de tecnologias disponíveis e necessitam de planejamento para melhorar os indicadores zootécnicos.

This study aimed to characterize the dairy producers in Territory of Itapetinga region using a semi-structured questionnaire. Seventeen dairy producers were interviewed and stratified into: small (up to 50kg milk/day), medium (51 to 200kg of milk/day) and large (more than 200kg of milk/day). The data analysis was performed using one-dimensional analysis and nonparametric analysis. Small producers have not been identified. Of all dairy producers interviewed, 17.6% were characterized as medium and 82.4% as large dairy producers. The average time in dairy activity was 22 years to medium dairy producers and 20 years to large dairy producers. The herd genetic composition was crossbreed Zebu x Taurus. The average milk production was 1260kg/milk/lactation to medium dairy producers and 1594kg/milk/lactation to large dairy producers. The lactation period was 274 days to both strata. The age at first calving ranged from 25 to 28 months, respectively, to large or medium dairy producers. The calving interval was 406 days to medium dairy producers and 480 days to large producers. All interviewed dairy producers vaccine their herds against foot and mouth disease. Only one dairy producer realizes the tuberculin´s test. The production systems evaluated showed low use of technologies and require a strategic management to improve animal production.