Ana Cristina Reis

Qualidade da atenção ao parto em maternidades do Rio de Janeiro

OBJETIVO: Avaliar a qualidade da atencao durante o processo de trabalho de parto de acordo com normas da Organizacao Mundial de Saude. METODOS: Trata-se de estudo do tipo caso-controle, realizado em duas maternidades: publica e conveniada com o Sistema Unico de Saude, no Municipio do Rio de Janeiro. A amostra foi composta por 461 mulheres na maternidade publica (230 partos vaginais e 231 cesareas) e por 448 mulheres na maternidade conveniada (224 partos vaginais e 224 cesareas). De outubro de 1998 a marco de 1999, foram realizadas entrevistas com puerperas e revisao de prontuarios. Foi construido escore sumarizador da qualidade do atendimento. RESULTADOS: Observou-se baixa frequencia de algumas praticas que devem ser encorajadas, como presenca de acompanhante (1% na maternidade conveniada, em ambos os tipos de parto), deambulacao durante o trabalho de parto (9,6% das cesareas na maternidade publica e 9,9% dos partos vaginais na conveniada) e aleitamento na sala de parto (6,9% das cesareas na maternidade publica e 8,0% das cesareas na conveniada). Praticas comprovadamente danosas e que devem ser eliminadas como uso de enema (38,4%), tricotomia, hidratacao venosa de rotina (88,8%), uso rotineiro de ocitocina (64,4%), restricao ao leito durante o trabalho de parto (90,1%) e posicao de litotomia (98,7%) para parto vaginal apresentaram alta frequencia. Os melhores resultados do escore sumarizador foram obtidos na maternidade publica. CONCLUSOES: As duas maternidades apresentam frequencia elevada de intervencoes durante a assistencia ao parto. A maternidade publica, apesar de atender clientela com maior risco gestacional, apresenta perfil menos intervencionista que maternidade conveniada. Procedimentos realizados de maneira rotineira merecem ser discutidos a luz de evidencias de seus beneficios.

Differential trends in mortality from AIDS in men and women in Brazil (1984-1995).

ObjectiveTo analyse trends in AIDS mortality in men and women in Brazil, for the period 1984–1995. Design and methodsNational statistics on yearly numbers of reported deaths by cause, in conjunction with census population counts and inter-censory estimates, were used to calculate age- and sex-specific AIDS mortality rates for Brazil as a whole and for São Paulo and Rio de Janeiro, the two largest cities in Brazil, and those most affected by the AIDS epidemic to date. ResultsNumbers of reported deaths from AIDS have increased yearly in Brazil since 1984, to approximately 15 000 in 1995. The data suggest that after a very dramatic rise in mortality rates, the epidemic may have started to slow even before the introduction of freely available highly-active anti-retroviral therapy, although unequally in terms of both geographical and sex distributions. Women also tended to die at relatively younger ages than men in all areas studied, and by 1995 the impact of AIDS on overall mortality was practically the same for men and women aged 25–34 years (21% in São Paulo). ConclusionsTrends in mortality from AIDS in Brazil reflect both the geographical expansion of the epidemic outwards from its original epicentres, and the fact that women are becoming increasingly affected by the AIDS epidemic.

A mortalidade por aids no Brasil: um estudo exploratório de sua evolução temporal

Summary This descriptive and exploratory study was based on the analysis of AIDS standardized mortality rates in Brazil along the period of 1982 to 2002. The analysis of the AIDS mortality profile considered the following variables of the Mortality Information System: sex; age; marital status; educational level; and occupation. The results evidenced the decrease of mortality rate after 1996 when public health services introduced antiretroviral treatment, although there was an important deceleration of this decrease in the last three years. The reduction of the mortality rate is greater in the male sex than in the female one; and young adults and lower-class people are still the most affected ones. It can be inferred that the deceleration of the decrease of AIDS mortality rate in the country suggests the need of increasing the early diagnosis access and assistance, the improvement in the quality of the care for those who live with HIV/AIDS, and the adjustment of the epidemiological surveillance and monitoring of AIDS deaths to more effectively control of the epidemic.

Avaliação do grau de implantação do programa de controle da transmissão vertical do HIV em maternidades do "Projeto Nascer": Implementation evaluation of Brazil's National vertical HIV transmission control program in maternity clinics participating in the "Nascer" Project

OBJECTIVE: to evaluate the implementation of the National Control Program of HIV Vertical Transmission in brazilian maternities. METHODOLOGY: data from medical records, interview with pregnant women and pre-birth care observation were compared to a retrospective cohort of positively diagnosed pregnant women from the same maternity clinics. RESULTS: sixty-seven percent out of 30 clinics had rapid HIV test kits and IV and syrup AZT. In 324 cohort pregnant women previously diagnosed for HIV, 18% had not taken AZT and 7% have not had their children medicated. CONCLUSION: unavailability of human resources, rapid HIV test kits, inappropriate conditions for testing and lack of HIV counseling and testing for pregnant women were major negative findings.

Em busca de melhores informações sobre a causa básica do óbito por meio de linkage: um recorte sobre as causas externas em idosos - Estado do Rio de Janeiro, Brasil, 2006

Objective: to improve data regarding the underlying cause of deaths due to external causes, among the elderly (60 years and older) in the state of Rio de Janeiro, Brazil, in 2006. Methods: exploratory study based on probabilistic record linkage between Mortality Information System and Hospital Information System/National Unified Health System, databases, using Reclink method. Results: 15,804 pairs of records were identified as possible matches; concerning the distribution of specific categories of external causes, at first, events of undetermined intent were the main cause of deaths (55.9%); after record linkage, proportional mortalities due to transport accidents (21.5%; previously, 7.0%) and due to falls (27.4%; previously, 11.7%) represented un increase of almost three fold. Conclusion: the results indicate the possibility of improving information on mortality by means of a feasible methodology.

Usos do planejamento e autoavaliação nos processos de trabalho das equipes de Saúde da Família na Atenção Básica

ABSTRACT: The PMAQ-AB analyzed access and quality of health primary care having axes structure, process and user satisfaction. The aim of this study was to characterize the use of plan-ning and auto evaluation for improving the work process of the teams, identifying strengths and weaknesses. Sectional study was conducted with data collected by the instrument for external evaluation whose variables relate to planning, self-evaluation and institutional support. Teams plan and self-evaluate their actions with support from and access to data produced. However, these practices are very poorly integrated and should be improved as to better guide adjustments in the teams working process. KEYWORDS: Health planning; Self-assessment; Family Health Strategy; Primary Health Care. Usos do planejamento e autoavaliacao nos processos de trabalho das equipes de Saude da Familia na Atencao Basica Uses of the planning and self-evaluation in the working processes of Family Health teams in Primary Care

Evaluability of the Program to Value Primary Healthcare Professionals (PROVAB): management challenges

The objective of this article is to present the results of a study on the evaluability of the Program to Value Primary Healthcare Professionals (PROVAB in the Portuguese) that was created by the Brazilian Ministry of Health in 2011. The Program is part of the Manage Healthcare Work and Educationstrategy which seeks to invest in a number of measures aimed at improving and valuing the work carried out by primary healthcare teams. The research, which used qualitative methods, was carried out between February and November 2013 and involved five stages: (a) analysis of documents; (b) identification of potential users; (c) strategic analysis; (d) modelling of the intervention; (e) sharing of lessons learned. Data collection took place in three iterative phases: document analysis, key informant interviews and a workshop. The activities of the program were grouped into three areas: functional and working conditions, teaching/learning and management. The results showed that the program can be evaluated, since it was possible to specify its feasibility by means of a logical model. The potential and priority areas were mapped for future evaluations, whose central focus is to address the problem of unequal distribution of Brazilian health professionals.

Análise do desempenho do sistema de monitoramento do programa de controle de DST/Aids e hepatites virais (MONITORaids) como ferramenta de gestão: desafios e possibilidades

OBJECTIVES: to analyze MONITORaids in the light of the current need to monitor the performance of the program, using the 2009 Action and Targets Plan (PAM). METHODS: the analysis was carried out in three stages: agreement on the meaning of performance and the features to be used to assess program performance; classification of high-priority goals in the PAM according to expected effect and quality criterion; and a review of the indicators used by the system, taking as the PAM goals as a point of reference, and of performance features. RESULTS: it was identified that the current version of the MONITORaids does not reflect the framework or the strategy of the program and is much more geared towards monitoring of the epidemic, since it deals with issues related to surveillance of the epidemic and specific research, rather than the monitoring of the performance of the program itself. Most of the goals contained in the 2009 PAM were classified as products (87%), and showed little in the way of results (13%) and no impact. CONCLUSIONS: the system needs to take into account the logical framework of the program if it is to deal with the issues that are priority for managers and decision-makers aiming to improve program performance. It is recommended that MONITORaids include indicators to monitor the priorities, including issues relating to effectiveness and efficiency.

Mortes de mulheres internadas para parto e por aborto e de seus conceptos em maternidades públicas

Resumo O objetivo deste estudo foi analisar mortes de mulheres internadas para parto e por aborto, e de seus conceptos – fetais e neonatais – em maternidades publicas nas cidades de Sao Paulo, Rio de Janeiro e Niteroi (RJ), em 2011. Estudo seccional de base hospitalar. Participaram 7.845 mulheres resultando em um obito materno, 498 abortos, 65 obitos fetais, 44 obitos neonatais e 7.291 sobreviventes infantis. Dados foram obtidos por meio de entrevista, consulta ao prontuario, cartao da gestante e no Sistema de Informacoes sobre Mortalidade (SIM). Foi descrita a populacao de estudo e estimados a concordância da causa basica (SIM e certificada pela pesquisa) e os indicadores de mortalidade. A mortalidade materna foi 13,6 por cem mil nascidos vivos (NV), fetal 8,8‰ nascimentos e neonatal 6,0‰ NV. Misoprostol foi o medicamento mais utilizado no aborto provocado. Transtornos respiratorios e fatores maternos foram as principais causas entre obitos fetais e neonatais. Sifilis congenita, diabetes e causas de morte fetal nao especificada foram subdeclaradas no SIM. Os coeficientes kappa por capitulo foram 0,70 (neonatais) e 0,54 (natimortos). A assistencia de boa qualidade no planejamento reprodutivo, pre-natal, durante o parto e nascimento resultara na prevencao das mortes.The aim of this cross-sectional hospital-based study of 7,845 pregnancies was to analyze deaths of women hospitalized for childbirth and abortion, and fetal and neonatal deaths, in public hospitals in the cities of São Paulo, Rio de Janeiro and Niteroi (RJ), Brazil, in 2011. Outcomes of the pregnancies were: one maternal death, 498 abortions, 65 fetal deaths, 44 neonatal deaths and 7,291 infant survivors. Data were collected through interviews, medical records and the womens pregnancy records, and from the Mortality Information System (SIM). The study population was described and kappa coefficients of causes of death (from the SIM, and certified by research) and mortality health indicators were estimated. The maternal mortality ratio was 13.6 per 100,000 live births (LB), the fetal death rate was 8.8‰ births and the neonatal mortality rate was 6.0‰ LB. The drug most used to induce abortion was Misoprostol. The main causes of fetal and neonatal deaths were respiratory disorders and maternal factors. Congenital syphilis, diabetes and fetal death of unspecified cause were under-reported in the SIM. Kappa coefficients by chapter were 0.70 (neonatal deaths) and 0.54 (stillbirths). Good quality care in reproductive planning, prenatal care, during labor and at birth will result in prevention of deaths.