Ana Cláudia Figueiró

Óbito por dengue como evento sentinela para avaliação da qualidade da assistência: estudo de caso em dois municípios da Região Nordeste, Brasil, 2008

Despite the existing resources for adequate dengue patient care in the Brazilian healthcare system, the case-fatality rate for the disease is still high in the country. In order to identify factors associated with dengue-related death, this study evaluated quality of care according to the degree of implementation of specific measures, the technical and scientific quality of care, and access to health services in two municipalities (counties) in Northeast Brazil. An evaluative study of the implementation analysis type was performed, with death from dengue as the sentinel event for quality of care. To assess the degree of implementation and quality of care, the study scored the interview criteria and patient chart analysis; access was evaluated by thematic analysis. As for structure and process, the health services were found to be partially adequate (70%). No geographic or economic barriers were found to explain the occurrence of deaths. Technical and scientific quality failed to achieve adequate levels in the municipalities (46% and 30%) or in the specific services, and clinical management of dengue by the health services proved insufficient.

Análise da lógica de intervenção do Programa Nacional de Controle da Dengue

OBJECTIVES: to evaluate the logical coherence of the Brazilian National Dengue Fever Control Program (PNCD) with regard to its objectives and the measures taken to achieve results. METHODS: an evaluative study, an intervention logic analysis, using a review of documentation from three information sources on the PNCD: the report produced by a panel of specialists meeting at an international seminar to evaluate the program; technical documents and the opinions of specialists; and scientific studies. The analysis of the program was compared to the Pan-American Health Organization model for the prevention and control of dengue fever -the Integrated Management Strategy-Dengue Fever. RESULTS: convergence was found between the strategies with regard to presuppositions, objectives, overarching goals and components, and the content of interventions. PNCD implementation was found to be weak in terms of integration at municipal level, especially in its management structure, as well as in the components analyzed, with a greater emphasis on the vector control component. CONCLUSIONS: the model lacks coherence and there is a need to update it at different PNCD management levels, in view of the fact that little progress has been made in meeting the overall and specific objectives of the components.

A tool for exploring the dynamics of innovative interventions for public health: the critical event card.

ObjectivesPublic health interventions are increasingly represented as complex systems. Research tools for capturing the dynamic of interventions processes, however, are practically non-existent. This paper describes the development and proof of concept process of an analytical tool, the critical event card (CEC), which supports the representation and analysis of complex interventions’ evolution, based on critical events.MethodsDrawing on the actor-network theory (ANT), we developed and field-tested the tool using three innovative health interventions in northeastern Brazil. Interventions were aimed to promote health equity through intersectoral approaches; were engaged in participatory evaluation and linked to professional training programs. The CEC developing involve practitioners and researchers from projects. Proof of concept was based on document analysis, face-to-face interviews and focus groups.ResultsAnalytical categories from CEC allow identifying and describing critical events as milestones in the evolution of complex interventions. Categories are (1) event description; (2) actants (human and non-human) involved; (3) interactions between actants; (4) mediations performed; (5) actions performed; (6) inscriptions produced; and (7) consequences for interventions.ConclusionsThe CEC provides a tool to analyze and represent intersectoral internvetions’ complex and dynamic evolution.

Formação de avaliadores na modalidade educação a distância: necessidade transformada em realidade

This article presents the proposal for the Basic Course in Health Evaluation of the Instituto Materno Infantil Prof. Fernando Figueira - IMIP - which aims to teach the main concepts and approaches adopted in this field of work, the use of distance learning principles and technology. The course forms an integral part of the National Policy for Institutionalization of Health Evaluation, with a view to training professionals occupying strategic positions in the three management levels of the Brazilian National Health Service, in various parts of the country. Given the expected profile of the health evaluator, the necessary qualifications for this professional were established and a teaching proposal centered on critical, reflective, autonomous learning and based on a dialogue between theory and the practical work of the student. To design the course, a multi-professional team was set up (including evaluators, teaching consultants, computer technicians and designers). The work was divided into the following stages: design and production of teaching materials, development of the website, training of tutors, and selection of students.

Multi-strategy in the Evaluation of Health Promotion Community Interventions: An Indicator of Quality

There is a general agreement in the specialized literature on the need to design and conduct multi-strategy evaluation in health promotion and in social sciences. “Many community-based health interventions include a complex mixture of many disciplines, varying degrees of measurement difficulty and dynamically changing settings . . . understanding multivariate fields of action may require a mixture of complex methodologies and considerable time to unravel any causal relationship” (McQueen & Anderson, 2001, p. 77). The meaning of the term multi-strategy, however, varies greatly. For some, multi strategy corresponds to the use of multiple methods and information data that allow for the participative evaluation of multiple dimensions, like outcome, process, and social and political context (Carvalho, Bodstein, Hartz, & Matida, 2004; Pan American Health Organisation, 2003). For others, the support for using multiple methods and strategies is rooted in wills to deploy multi-paradigm designs (Goodstadt et al., 2001). More generally, however, the term refers to studies mixing qualitative and quantitative methods of enquiry (Gendron, 2001; Green & Caracelle, 1997). Exceptionally, in the evaluation literature, multi-strategy also refers to the possibility to mix all kinds of evaluation approaches or models from diverse categories, such as advocacy, responsive, and theory-driven evaluation (Yin, 1994; Datta, 1997a,b; Stufflebeam, 2001). In all these references, the use of multi-strategy evaluation is justified as the best approach to minimize validity problems in dealing with the complexity of multi-strategy interventions and in multi-centers evaluation research. Unfortunately, in examining research synthesis studies it is often impossible to estimate the real utilization and the effective contribution of multi-strategy evaluation, despite the fact that such multi-strategy evaluation is largely recommended to improve knowledge resulting from health promotion intervention evaluations. Meta-analysis and other research synthesis methods are based on a very limited classification system of evaluation study design that consists in whether a Randomized Control Trial (RCT) has been used (Hulscher, Wensing, Grol, Weijden, & Weel, 1999; International Union for Health Promotion and Education, 1999). This impedes the capacity to judge the appropriateness of evaluation approaches, in

Estudo de avaliabilidade do Programa Academia Carioca da Saúde: desafios para a promoção da saúde

ABSTRACT This article aims to present the results of the evaluability study of the Carioca Health Academy Program in order to expand the comprehension about the intervention and to maxi-mize the utility of the evaluation. The study was divided into the following steps: documental analyses, interviews with key informants, intervention modeling and elaboration of the evalua-tive questions. The construction of the Logic Model allowed to describe the dimensions and com -ponents of the program, the strategic actions and expected results with emphasis on the regular access to body practices and physical activities, on the health promotion groups and on the stren -gthening of community participation. ERDS Program evaluation; Health promotion; Health programs and plans. SAUDE DEBATE | rio de Janeiro, v. 39, n. 105, p.375-386, aBr-JUn 2015 375 Estudo de avaliailidade do rograma Academia Carioca da Sade desafios para a promocao da sade evaluabilit stud o the Carioca ealth academ proram: challenes or health promotion

Prevention and early diagnosis of oral cancer – a literature review

INTRODUCTION: The present study identified and described scientific production on primary and secondary prevention of oral cancer worldwide. This is an integrative review of the literature, focusing on the description of oral cancer prevention experiences. METHODS: The search was performed in the Virtual Health Library (VHL), using the descriptors: early diagnosis, oral neoplasms, primary prevention and secondary prevention. We found 225 articles and selected 22 after evaluation, divided into three themes. RESULTS: Four articles awareness-raising and population-tracking campaigns with the valorization of the role of the dental surgeon and the involvement of health teams. The non-invasive diagnostic methods, considered in fifteen articles, addressed the implementation of new strategies for the early detection of this pathology by different diagnostic methods. The reorganization of the health system (3 articles) encompassed the permanent education of oral health professionals, epidemiological surveillance and reorganization of health services with integration of health care levels. The great majority of the reviewed experiences showed positive results in the prevention of oral cancer. An exception was the active search for suspected cases in the population, since the cost benefit did not compensate the expenditure with human resources for this purpose. The non-invasive methods reported are useful for screening but do not substitute the biopsia for diagnosis.

Disseminação e uso dos resultados de pesquisas financiadas pela Secretaria de Ciência, Tecnologia e Insumos Estratégicos do Ministério da Saúde, Brasil, 2004 a 2007

RESUMO Este artigo verifica a disseminacao e o uso das pesquisas financiadas pelo Departamento de Ciencia e Tecnologia do Ministerio da Saude. Trata-se de um estudo de seis casos com analise imbricada, em que se verifica que a politica de descentralizacao do fomento contribuiu para a reducao da desigualdade na producao de conhecimento em saude, embora haja desigualdade no volume de recursos alocados. A disseminacao dos resultados foi o limitador da incorporacao dos resultados de pesquisa. Os formatos de acompanhamento das pesquisas devem ser melhorados. O fator determinante na incorporacao de conhecimentos e tecnologias pelo sistema de saude e a intencionalidade tecnica e politica para o uso dos resultados.