Cláudio Gastão Junqueira de Castro

Hanseníase no município de Fortaleza, CE, Brasil: aspectos epidemiológicos e operacionais em menores de 15 anos (1995-2006)

This is a sectional study that aims to analyze the occurrence of Hansens disease cases in 15 year-old minors in the Municipality of Fortaleza and notified in SINAN. The epidemiological indicators in this population show hiperendemicity. In operational terms is observed the maintenance of the service concentration in some reference units, in spite of some progress. Late diagnosis, a high degree of incapacity in the diagnosis and low degree of evaluation of contacts registered reveal the fragility of the actions of control. This study emphasizes the possibility of error diagnostic front to the characteristics of the infection in this population. The occurrence of cases of leprosy in this population represents an epidemiologic indicator of great importance and its analysis extends the discussion on operational problems in the network of health services.Estudio transversal con el objetivo de analizar las ocurrencias de los casos de lepra en menores de 15 anos de edad sitiados en la ciudad de Fortaleza y enterados en el SINAN. Los indicadores epidemicos en esta poblacion se presentaron hiperendemicos. En la operacinalizacion, se observa el mantenimiento de la concentracion de atencion en algunas unidades recomendables, a pesar de algunos avances. Diagnosticos muy tardes, gran grado de incapacidad en el diagnostico y bajo grado de evaluacion de contactos registrados, muestran la fragilidad de las acciones de control. Se resalta asi la posibilidad de error de diagnostico delante de las caracteristicas de la infeccion en esta poblacion. La ocurrencia de casos de lepra en esta poblacion representa un indicador epidemico de gran importancia y su analisis amplia la discusion sobre los problemas operacionales en la red de servicios publicos.

Pós-alta em Hanseníase no Ceará: limitação da atividade funcional, consciência de risco e participação social

Caracterizar a limitacao funcional, de atividade, consciencia de risco, e restricao a participacao social em pessoas atingidas pela hanseniase no pos-alta. Estudo seccional-descritivo com 69 residentes em Sobral, Ceara, com alta entre 2003 a 2005. Foram realizados exame fisico dermato-neurologico, avaliacao demografica, de limitacao funcional-atividade-consciencia de risco e de restricao a participacao social. Vinte (28,9%) apresentaram escores SALSA 19 e 20 e escore EHF zero. O maior escore EHF foi alcancado por dois participantes, com 25 e 28 na escala SALSA. Na escala de participacao 37 (53,6%) nao apresentaram restricao e tinham escore EHF zero. Dois (2,9%) com escore EHF zero tinham leve restricao e 1 (1,5%), grande restricao. Reafirma-se a potencialidade destas ferramentas para a atencao integral aos portadores.

Organizações sociais de saúde: o modelo do Estado de São Paulo

The experience with a new model of public health services management, introduced in the Sao Paulo State is analyzed in this paper based on the characterization of the specificity of the law that referring to the creation of Social Organizations of Health. It has still as a referential the state management of the Single Health System given by the antecedents and actual situation. The data showed were collected from reports produced by the technical team responsible by the agreement between the Health Secretary of State and the Public Health Faculty ¾ Sao Paulo University. The results achieved showed from the fixed aim in the management agreement, by the Secretary, for the first year of activity a satisfactory performance by the Social Organizations of Health. The paper discuss the perspectives of a new model and the actual politics, taking in care the threatens and opportunities. The authors distinguish aspects related to a new regulation linked to process, results and systems since health regional demand.

Saúde bucal em Diadema: da odontologia escolar à estratégia saúde da família

Abstract Although oral health policy in the city of Diadema, Sao Paulo, Brazil, from 1972 to 2007, the subject of this article, has accompanied the process of transformation of the sector’s practices in Brazil, its evolution in this industrial city located in the metropolitan region of Sao Paulo has been marked by the singularity of the local history. This paper analyzes this evolution and relates it to the process of social struggles that led to the creation of the Sistema Unico de Saude (Brazil’s National Health System) and to the national, state and local oral health policies. This is a qualitative exploratory study. Data were obtained from official documents and various literature sources and also through semi-structured interviews with mayors, municipal health secretaries, oral health coordinators and den -tists who have undergone the various stages of the oral health policies in the municipality. The major features in the organization of health care practices developed in the city were identified, locating them in the state and national scenario. We conclude that, despite the consolidation of the integration of oral health in the SUS and the experience acquired in the city in managing this type of care, in Diadema we also observed difficulties to overcome the model of care focused on population groups which have been traditionally prioritized, with emphasis on school children, preschoolers and babies. In this sense, Diadema shares with other Brazilian cities the challenge of restructuring primary care in oral health, overcoming the traditional model of school dentistry and creating new possibilities, such as the family approach, in order to ensure the universality and comprehensiveness of care.Keywords: Health Policy; Oral Health; Family Health Program; National Health System.

Atenção pós-alta em hanseníase no Sistema Único de Saúde: aspectos relativos ao acesso na região Nordeste

Universal access to health services represents a complex process of inter-relationships between users and health services. In a broader sense it includes economic, technical, political and symbolic aspects. For neglected diseases such as leprosy, this is a major challenge. This cross-sectional study aims to characterize access to health care services for people affected by leprosy after release from treatment in the cities of Sobral and Fortaleza. The study included a representative sample 10% of those concluding treatment from 2003 to 2005 (304 cases). Participants were characterized regarding socio demographic and clinical variables and access to health services after release from treatment. The study population was mostly male (58%), physical disabilities (34%) and with leprosy reactions (37%). The biomedical approach of leprosy reactions contemplated in large part to search for and supply of care in this period. The access to care after discharge was particularly weak in rehabilitative interventions such as surgery and psychological attention. We identified important gaps in the operationalization of attention to people affected after release from treatment in both cities. The date also shows the negligence of leprosy as a chronic condition and the resulting difficulties regarding on integrated distance to the comprehensive approach to people with leprosy after release from treatment in the Unified Health System (SUS).

Municipalização de serviços de saúde segundo profissionais de saúde bucal em um município do interior do estado de São Paulo, Brasil

No periodo de construcao institucional do Sistema Unico de Saude (SUS), o processo de descentralizacao teve na municipalizacao dos servicos de saude um dos seus principais vetores estrategicos. Contudo, sao raros os estudos que se ocuparam da percepcao que os trabalhadores do setor tem sobre esse processo, notadamente na area de saude bucal. Neste artigo coloca-se em relevo a opiniao de profissionais de odontologia do municipio de Itapira (SP) a respeito da municipalizacao da saude e seu significado. Os dados foram obtidos mediante entrevista individual e semiestruturada com um grupo de oito informantes-chave, composto por cirurgioes-dentistas e auxiliares de saude bucal, com trajetoria de atuacao no servico municipal de saude anterior a criacao do SUS. Fez-se analise de discurso empregando-se a tecnica do discurso do sujeito coletivo. Constatou-se que, em relacao a municipalizacao, os entrevistados apresentaram dificuldade em conceitua-la e identificaram-na como favorecedora de uma presenca mais bem organizada da odontologia no SUS, tais como a proximidade com instâncias gestoras beneficiando, por exemplo, a implantacao e acompanhamento de programas e a aquisicao de equipamentos e materiais. Alem disso, reconheceram que a municipalizacao: 1) impulsionou a qualificacao dos cuidados basicos; 2) possibilitou uma gradativa ampliacao da resolutividade dos servicos contribuindo para responder as demandas mais prevalentes; e 3) criou condicoes favorecedoras da superacao da excessiva valorizacao de procedimentos mutiladores, que caracterizou o setor no periodo pre-SUS. Conclui-se que os entrevistados perceberam, na concretude de sua acao cotidiana, o impacto positivo da municipalizacao na organizacao do servico publico odontologico.

Post-treatment of Leprosy in Ceará: activity and functional limitation, safety awareness and social participation

Caracterizar a limitacao funcional, de atividade, consciencia de risco, e restricao a participacao social em pessoas atingidas pela hanseniase no pos-alta. Estudo seccional-descritivo com 69 residentes em Sobral, Ceara, com alta entre 2003 a 2005. Foram realizados exame fisico dermato-neurologico, avaliacao demografica, de limitacao funcional-atividade-consciencia de risco e de restricao a participacao social. Vinte (28,9%) apresentaram escores SALSA 19 e 20 e escore EHF zero. O maior escore EHF foi alcancado por dois participantes, com 25 e 28 na escala SALSA. Na escala de participacao 37 (53,6%) nao apresentaram restricao e tinham escore EHF zero. Dois (2,9%) com escore EHF zero tinham leve restricao e 1 (1,5%), grande restricao. Reafirma-se a potencialidade destas ferramentas para a atencao integral aos portadores.

Hansen's Disease in the municipality of Fortaleza, CE, Brazil: epidemiological and operational aspects in children under 15-years-old (1995-2006)

This is a sectional study that aims to analyze the occurrence of Hansens disease cases in 15 year-old minors in the Municipality of Fortaleza and notified in SINAN. The epidemiological indicators in this population show hiperendemicity. In operational terms is observed the maintenance of the service concentration in some reference units, in spite of some progress. Late diagnosis, a high degree of incapacity in the diagnosis and low degree of evaluation of contacts registered reveal the fragility of the actions of control. This study emphasizes the possibility of error diagnostic front to the characteristics of the infection in this population. The occurrence of cases of leprosy in this population represents an epidemiologic indicator of great importance and its analysis extends the discussion on operational problems in the network of health services.Estudio transversal con el objetivo de analizar las ocurrencias de los casos de lepra en menores de 15 anos de edad sitiados en la ciudad de Fortaleza y enterados en el SINAN. Los indicadores epidemicos en esta poblacion se presentaron hiperendemicos. En la operacinalizacion, se observa el mantenimiento de la concentracion de atencion en algunas unidades recomendables, a pesar de algunos avances. Diagnosticos muy tardes, gran grado de incapacidad en el diagnostico y bajo grado de evaluacion de contactos registrados, muestran la fragilidad de las acciones de control. Se resalta asi la posibilidad de error de diagnostico delante de las caracteristicas de la infeccion en esta poblacion. La ocurrencia de casos de lepra en esta poblacion representa un indicador epidemico de gran importancia y su analisis amplia la discusion sobre los problemas operacionales en la red de servicios publicos.

La Lepra en el municipio de Fortaleza, CE, Brasil: aspectos epidemiológicos y operacionales en menores de 15 años (1995-2006)

This is a sectional study that aims to analyze the occurrence of Hansens disease cases in 15 year-old minors in the Municipality of Fortaleza and notified in SINAN. The epidemiological indicators in this population show hiperendemicity. In operational terms is observed the maintenance of the service concentration in some reference units, in spite of some progress. Late diagnosis, a high degree of incapacity in the diagnosis and low degree of evaluation of contacts registered reveal the fragility of the actions of control. This study emphasizes the possibility of error diagnostic front to the characteristics of the infection in this population. The occurrence of cases of leprosy in this population represents an epidemiologic indicator of great importance and its analysis extends the discussion on operational problems in the network of health services.Estudio transversal con el objetivo de analizar las ocurrencias de los casos de lepra en menores de 15 anos de edad sitiados en la ciudad de Fortaleza y enterados en el SINAN. Los indicadores epidemicos en esta poblacion se presentaron hiperendemicos. En la operacinalizacion, se observa el mantenimiento de la concentracion de atencion en algunas unidades recomendables, a pesar de algunos avances. Diagnosticos muy tardes, gran grado de incapacidad en el diagnostico y bajo grado de evaluacion de contactos registrados, muestran la fragilidad de las acciones de control. Se resalta asi la posibilidad de error de diagnostico delante de las caracteristicas de la infeccion en esta poblacion. La ocurrencia de casos de lepra en esta poblacion representa un indicador epidemico de gran importancia y su analisis amplia la discusion sobre los problemas operacionales en la red de servicios publicos.

Pos-alta hospitalária en Lepra en Ceará: limitación de actividad funcional, conciencia de riesgo y participación social

Caracterizar a limitacao funcional, de atividade, consciencia de risco, e restricao a participacao social em pessoas atingidas pela hanseniase no pos-alta. Estudo seccional-descritivo com 69 residentes em Sobral, Ceara, com alta entre 2003 a 2005. Foram realizados exame fisico dermato-neurologico, avaliacao demografica, de limitacao funcional-atividade-consciencia de risco e de restricao a participacao social. Vinte (28,9%) apresentaram escores SALSA 19 e 20 e escore EHF zero. O maior escore EHF foi alcancado por dois participantes, com 25 e 28 na escala SALSA. Na escala de participacao 37 (53,6%) nao apresentaram restricao e tinham escore EHF zero. Dois (2,9%) com escore EHF zero tinham leve restricao e 1 (1,5%), grande restricao. Reafirma-se a potencialidade destas ferramentas para a atencao integral aos portadores.