Edgar Merchán Hamann

Programa Saúde da Família no Brasil: uma agenda incompleta?

Este artigo trata de uma analise longitudinal da experiencia brasileira com o Programa Saude da Familia (PSF), ao longo dos doze anos da sua implantacao e implementacao. Toma como ponto de partida o proposito fundamental desta estrategia, que e a reorganizacao da atencao basica de saude, contextualizando a luz da experiencia que e unica e peculiar ao Sistema Unico de Saude (SUS). Evidencia os avancos e desafios do PSF, apontando nesse sentido as necessidades mais urgentes em termos de incorporacao tecnologica, formacao da forca de trabalho, estabelecimento de novos mecanismos e pactos em torno do financiamento da atencao basica e encaminhamento de novas estrategias e tecnologias nos processos de monitoramento e avaliacao. Finaliza apontando elementos para subsidiar um debate sobre as questoes em pauta, o qual deve ser permanente e lucido na perspectiva da construcao do SUS e do direito a saude.

Metabolic syndrome in central Brazil: prevalence and correlates in the adult population

BackgroundThe prevalence of metabolic syndrome (MetS) has increased in developing countries in recent decades. This syndrome, a clustering of metabolic abnormalities, has been correlated to various socioeconomic and behavioral variables. We investigated the prevalence and prevalence ratios (PR) of MetS and related factors in an adult population of the Federal District (FD) of Brazil, which is located in the central region of the country.MethodsA cross-sectional, population-based study conducted in 2007, with 2130 adults (aged 18 years or older) in the FD of Brazil. Metabolic syndrome was defined according to the recently harmonized criteria. The prevalence of MetS and PR were estimated for each sex according to the diagnostic components and the overall contribution of the selected correlates.ResultsThe overall prevalence of MetS was 32.0% (95%CI: 28.9–35.2), with no gender difference. The single component with the greatest contribution to the diagnosis of MetS was hypertension in men (PR 5.10, 95%CI: 3.17–8.22) and high waist circumference in women (PR 5.02, 95%CI: 3.77–6.69). The prevalence of MetS increased significantly and progressively with age and excess weight. In women, higher education was protective against MetS (PR 0.66, 95%CI: 0.49–0.89) compared to 8 or less years of education. There was no association between the prevalence of MetS and behavioral variables studied.ConclusionsThis study provides comprehensive and alarming data about the prevalence of MetS among the adult population of Brazil’s FD. The results suggest that reducing education inequalities may be an important public policy goal to improve health outcomes, especially among women.

Por que o Brasil ainda registra elevados coeficientes de transmissão vertical do HIV? Uma avaliação da qualidade da assistência prestada a gestantes / parturientes infectadas pelo HIV e seus recém-nascidos

OBJECTIVES: to assess the health care provided to HIV+pregnant women and their children and determine vertical transmission rates in four Brazilian capitals. METHODS: a cohort study was performed in a population of 1475 HIV+pregnant women and their children, who received health care between 1996 and 2003, in 17 public maternities. Data were collected retrospectively from clinical records and 274 women were interviewed (prospective phase) based on a structured questionnaire. RESULTS: regarding quality of health care, it was verified in the retrospective and prospective phases of the study, respectively, that 24% and 27% of women did not even receive oral AZT; 19% and 10% did not receive intravenous AZT; 8% and 7% of babies did not receive oral AZT. The vertical transmission rate was 5,6% varying from 2,9% to 7,5% between cities and being higher in vaginal delivers (8%) and non-elective caesarian section (7%). CONCLUSIONS: Brazilian Program for Reducing HIV Vertical Transmission is vulnerable due to the lack of organization, administration and evaluation in the health services. A model-guidance is suggested with steps necessary for a better understanding in all levels of these managerial steps.

Práticas e mudanças no comportamento alimentar na população de Brasília, Distrito Federal, Brasil

OBJETIVOS: investigar as praticas e mudancas alimentares na populacao de Brasilia, Distrito Federal, com as variaveis escolaridade, renda e sexo. METODOS: estudo transversal, com uma amostra probabilistica de 500 domicilios, com entrevista a pessoas >15 anos. As entrevistas foram feitas no Plano Piloto, Cidades Satelites e Vila Estrutural do Distrito Federal, entre marco de 2003 e marco de 2004. O marco amostral foi definido com base nos setores censitarios do Instituto Brasileiro de Geografia e Estatistica, referentes ao censo demografico de 2000. Foram sorteados 20 setores censitarios dentre os 2548 existentes no Distrito Federal. RESULTADOS: os alimentos consumidos diariamente foram: arroz, feijao, pao, frutas, legumes e verduras. Consumo semanal de frango (85,0%), carne bovina (76,0%), massas (69,6%) e ovos (62,0%). A maioria (71,0%) relatou preocupar-se com alimentacao saudavel. Apenas, 37% dos entrevistados relataram mudanca alimentar nos ultimos seis meses, e dentre eles 32,6% atribuiram a perda de peso, 25,4% a preocupacao com a saude e 20,0% a reeducacao alimentar. A mudanca foi mantida por 84,2% dos respondentes. CONCLUSOES: os dados apontam a preocupacao com a alimentacao saudavel e mudancas nas praticas alimentares. As razoes alegadas para as mudancas estao relacionadas com a estetica e preocupacao com a saude. Renda e escolaridade constituem preditores significativos das mudancas nas praticas alimentares.

Incidência da sífilis congênita no Brasil e sua relação com a Estratégia Saúde da Família

OBJETIVO: Estimar la incidencia de la sifilis congenita e identificar su relacion con la cobertura de la Estrategia Salud de la Familia. METODOS: Estudio ecologico observacional, con componentes descriptivos y analiticos, desarrollado por medio de dos abordajes: en serie temporal (2003 a 2008) y focalizando datos de 2008. Los datos secundarios utilizados (epidemiologicos, demograficos y socioeconomicos) se obtuvieron del Departamento de Informatica del Sistema Unico de Salud e Instituto Brasileno de Geografia y Estadistica. El analisis de posibles efectos de la implantacion de esta Estrategia sobre la prevencion de la sifilis congenita fue realizada en subgrupos seleccionados de municipios, por medio de dos abordajes: a) variacion promedio anual de la tasa de incidencia de sifilis congenita en diferentes estratos de cobertura de la Estrategia, durante el periodo de 2003 a 2008, con calculo del coeficiente de regresion linear simple y b) analisis de regresion binomial negativo, con datos de 2008, para control de algunos factores de confusion. RESULTADOS: Hay tendencia de aumento de las notificaciones de sifilis congenita en Brasil, con desigualdades sociales en la distribucion de los casos. Se observa una asociacion negativa entre la incidencia de sifilis congenita en municipios con altas coberturas de la Salud de la Familia; pero, posterior al control de co-variables, tal efecto puede ser atribuido a la cobertura de prenatal y a caracteristicas demograficas de los municipios donde esta Estrategia fue prioritariamente implantada. CONCLUSIONES: A pesar del aumento de las coberturas de prenatal, aun se observa una baja efectividad de estas acciones para la prevencion de la sifilis congenita. No se identifico una asociacion mejor entre el prenatal realizado por los equipos de la Estrategia Salud de la Familia y el control de la sifilis congenita, como aquella observada donde el prenatal es realizado por otros modelos de atencion.OBJECTIVE To estimate the incidence of congenital syphilis and identify its relationship with Family Health Strategy coverage. METHODS An observational ecological study was carried out with both descriptive and analytical components, by two different approaches: one that explores a temporal series (2003 to 2008) and one that focuses on the 2008 data. The secondary data (epidemiological, demographic, and socioeconomic) were obtained from the Department of Informatics of the Unified Health System and the Brazilian Institute of Geography and Statistics. Analysis of the possible effects of the implementation of the Family Health Strategy on the prevention of congenital syphilis was performed on selected subgroups of counties according to two approaches: a) the variation of the average annual rate of incidence of congenital syphilis in different strata of Family Health Program coverage between 2003 and 2008 and the calculation of the simple linear regression coefficient; and b) a negative binomial regression analysis of data from 2008 to control for confounding factors. RESULTS Increasingly trends of congenital syphilis notification in Brazil reflect social inequalities in the distribution of cases. The incidence of congenital syphilis was lower in the counties with high Family Health Strategy coverage; however, after controlling for the co-variables, such an effect might be attributed to the coverage of prenatal care and the demographic characteristics of the counties where the implementation of the Strategy was a priority. CONCLUSIONS Despite the increase in prenatal care coverage, the actions implemented still exhibit low effectiveness in the prevention of congenital syphilis. Prenatal care performed by Family Health Strategy teams did not control syphilis better than the prenatal care performed within the context of other models of assistance.

Uso dos serviços públicos de saúde para DST/HIV/aids por comunidades remanescentes de Quilombos no Brasil

INTRODUCAO: A epidemia de aids atinge com maior intensidade os grupos mais vulneraveis. As tendencias de interiorizacao, pauperizacao e feminizacao demonstram que a populacao negra se encontra em desvantagem social no que se refere a construcao de respostas de enfrentamento. OBJETIVO: Descrever as condicoes de acesso da populacao negra ao diagnostico e a assistencia para DST, HIV/aids. METODOS: Estudo transversal com 218 sujeitos maiores de 18 anos com vida sexual ativa em 11 comunidades quilombolas. RESULTADOS: 75% utilizam os servicos publicos na atencao basica. Antecedentes de sinais e sintomas de DST foram relatados por 10% dos entrevistados e a maioria procurou o servico publico de saude. A testagem para HIV foi realizada por 22%. O servico publico nao especializado foi utilizado por 73%. As mulheres que referiram sinais e sintomas de DST procuraram o servico publico e realizaram o teste para HIV com maior frequencia que os homens. Houve uma maior percepcao de dificuldades de atendimento, busca de assistencia no servico privado e testagem mais frequente entre os mais jovens. Pessoas negras perceberam maior dificuldade no atendimento, maior relato de sinais e sintomas de DST e maior frequencia de automedicacao quando comparadas as nao negras. Contudo, a avaliacao do servico foi considerada otima/boa por 45%. Entre pessoas nao negras houve maior procura pelo servico publico. CONCLUSAO: O estudo reafirma a necessidade de politicas publicas voltadas aos segmentos mais vulneraveis. E importante ressaltar a necessidade da capacitacao das equipes do PACS (Programa de Agentes Comunitarios de Saude) e PSF (Programa Saude da Familia) pela sua relevância na assistencia dessas comunidades.

Incidence of congenital syphilis in Brazil and its relationship with the Family Health Strategy

OBJETIVO: Estimar la incidencia de la sifilis congenita e identificar su relacion con la cobertura de la Estrategia Salud de la Familia. METODOS: Estudio ecologico observacional, con componentes descriptivos y analiticos, desarrollado por medio de dos abordajes: en serie temporal (2003 a 2008) y focalizando datos de 2008. Los datos secundarios utilizados (epidemiologicos, demograficos y socioeconomicos) se obtuvieron del Departamento de Informatica del Sistema Unico de Salud e Instituto Brasileno de Geografia y Estadistica. El analisis de posibles efectos de la implantacion de esta Estrategia sobre la prevencion de la sifilis congenita fue realizada en subgrupos seleccionados de municipios, por medio de dos abordajes: a) variacion promedio anual de la tasa de incidencia de sifilis congenita en diferentes estratos de cobertura de la Estrategia, durante el periodo de 2003 a 2008, con calculo del coeficiente de regresion linear simple y b) analisis de regresion binomial negativo, con datos de 2008, para control de algunos factores de confusion. RESULTADOS: Hay tendencia de aumento de las notificaciones de sifilis congenita en Brasil, con desigualdades sociales en la distribucion de los casos. Se observa una asociacion negativa entre la incidencia de sifilis congenita en municipios con altas coberturas de la Salud de la Familia; pero, posterior al control de co-variables, tal efecto puede ser atribuido a la cobertura de prenatal y a caracteristicas demograficas de los municipios donde esta Estrategia fue prioritariamente implantada. CONCLUSIONES: A pesar del aumento de las coberturas de prenatal, aun se observa una baja efectividad de estas acciones para la prevencion de la sifilis congenita. No se identifico una asociacion mejor entre el prenatal realizado por los equipos de la Estrategia Salud de la Familia y el control de la sifilis congenita, como aquella observada donde el prenatal es realizado por otros modelos de atencion.OBJECTIVE To estimate the incidence of congenital syphilis and identify its relationship with Family Health Strategy coverage. METHODS An observational ecological study was carried out with both descriptive and analytical components, by two different approaches: one that explores a temporal series (2003 to 2008) and one that focuses on the 2008 data. The secondary data (epidemiological, demographic, and socioeconomic) were obtained from the Department of Informatics of the Unified Health System and the Brazilian Institute of Geography and Statistics. Analysis of the possible effects of the implementation of the Family Health Strategy on the prevention of congenital syphilis was performed on selected subgroups of counties according to two approaches: a) the variation of the average annual rate of incidence of congenital syphilis in different strata of Family Health Program coverage between 2003 and 2008 and the calculation of the simple linear regression coefficient; and b) a negative binomial regression analysis of data from 2008 to control for confounding factors. RESULTS Increasingly trends of congenital syphilis notification in Brazil reflect social inequalities in the distribution of cases. The incidence of congenital syphilis was lower in the counties with high Family Health Strategy coverage; however, after controlling for the co-variables, such an effect might be attributed to the coverage of prenatal care and the demographic characteristics of the counties where the implementation of the Strategy was a priority. CONCLUSIONS Despite the increase in prenatal care coverage, the actions implemented still exhibit low effectiveness in the prevention of congenital syphilis. Prenatal care performed by Family Health Strategy teams did not control syphilis better than the prenatal care performed within the context of other models of assistance.

Application of the WHOQOL-BREF in a community segment as a subsidy for health promotion actions

INTRODUCTION This article presents the results of a research whose objective was to verify the prevalence of the perception reports regarding quality of life of library attendees in the public libraries in the Brazilian capital Federal District (FD) and the surrounding region and to analyse the factors related to dissatisfaction. METHODS An epidemiological transversal study was conducted in 592 individuals aged above 12 years old through the application of the WHOQOL-BREF/WHO questionnaire. RESULTS Higher frequencies of dissatisfaction were observed among women with ages above 25, with lower personal income and lower educational level. Dissatisfaction regarding the physical domain was more prevalent in the surrounding region than in the FD. Under the psychological domain, dissatisfaction predominated in people in the FD. Negative feelings, concentration difficulties and dissatisfaction regarding personal safety were referred by more than 25% of participants in both regions. Regarding the environment domain, lack of money and of leisure opportunities were the main complaints. In spite of these findings, interviewees referred being very satisfied with their health and quality of life. CONCLUSIONS The results can be a sign that the quality of life in the study region is in alert level. A careful look at these data is needed to identify alternatives to change this situation, with effective actions for Health Promotion and development strategies for the study area. A planning and an intervention in the area of health education in public libraries is recommended, since these are very important social loci, that can be engaged in health promotion and disease prevention actions in the communities.

Alimentação e nutrição na Estratégia Saúde da Família em cinco municípios brasileiros

This work is part of a national study seeking to understand the difficulties and the potential for overcoming the challenges faced in the quest to improve food and nutrition campaigns developed under the aegis of the Family Health Strategy. It is examined from the standpoint of professional teams of the Family Health Strategy and Family Health Support Centers of five major Brazilian cities. A qualitative approach was used to design a multiple case approach and the technique of focus groups was conducted to collect data. The instrument used was a semi-structured pre-tested and validated script with two leading questions. The Collective Subject Discourse technique was used for data analysis, based on which the synthesized discourses were created using the Qualiquantisoft program. Sixty health professionals from various training areas were interviewed, including dietitians, nurses and physicians. The results showed that the difficulties encountered for the provision of food and nutrition campaigns and the lack of professionals in this area have hampered compliance with the principles of comprehensiveness, universality and resolubility of health care.This work is part of a national study seeking to understand the difficulties and the potential for overcoming the challenges faced in the quest to improve food and nutrition campaigns developed under the aegis of the Family Health Strategy. It is examined from the standpoint of professional teams of the Family Health Strategy and Family Health Support Centers of five major Brazilian cities. A qualitative approach was used to design a multiple case approach and the technique of focus groups was conducted to collect data. The instrument used was a semi-structured pre-tested and validated script with two leading questions. The Collective Subject Discourse technique was used for data analysis, based on which the synthesized discourses were created using the Qualiquantisoft program. Sixty health professionals from various training areas were interviewed, including dietitians, nurses and physicians. The results showed that the difficulties encountered for the provision of food and nutrition campaigns and the lack of professionals in this area have hampered compliance with the principles of comprehensiveness, universality and resolubility of health care.

Quem participa em quê?: experiências de construção compartilhada no âmbito da cooperação Brasil - Canadá para o aperfeiçoamento da gestão na Atenção Primária à Saúde

Abstract The article examines processes and outcomes of the shared construction of knowledge and intervention in the Project for Improving Management of Pri-mary Health Care (AGAP) developed cooperatively between Brazil and Canada. It involves four states in the Northeast region, uses the evaluation metho -dology with focus on achievements and learning and presupposes the cooperation and participation of stakeholders; the project, characterized as using multi methods, advocates triangulation through a combination of quantitative and qualitative approa -ches and techniques after identifying the moments in which sharing encounters happened, as well as the elements which hinder or facilitate this process and lessons learned. Evaluative research used the following methodology: document analysis; obser-vation of meetings; workshop with the Evaluation Steering Committee for presentation and agreement of the proposal submitted; evaluation workshops on local projects, observation of health care services in the municipalities, semi–structured interviews with strategic interlocutors of local, regional, national and international levels. The results showed that the cooperation relationship between Brazil and Canada is promising, but needs to be built in a more cooperative and dialogical way, in which objects of cooperation are constructed in a shared form.Keywords: Collective Construction; Primary Health Care; International Cooperation.