Elaine Thumé

Desempenho do PSF no Sul e no Nordeste do Brasil: avaliação institucional e epidemiológica da Atenção Básica à Saúde

A pesquisa, desenvolvida dentro dos Estudos de Linha de Base do Proesf analisou o desempenho do Programa Saude da Familia (PSF) em 41 municipios dos Estados de Alagoas, Paraiba, Pernambuco, Piaui, Rio Grande do Norte, Rio Grande do Sul e Santa Catarina. Utilizou delineamento transversal, com grupo de comparacao externo (atencao basica tradicional). Entrevistou 41 presidentes de Conselhos Municipais de Saude, 29 secretarios municipais de Saude e 32 coordenadores de Atencao Basica. Foram caracterizados a estrutura e o processo de trabalho em 234 Unidades Basicas de Saude (UBS), incluindo 4.749 trabalhadores de saude; 4.079 criancas; 3.945 mulheres; 4.060 adultos e 4.006 idosos. O controle de qualidade alcancou 6% dos domicilios amostrados. A cobertura do PSF de 1999 a 2004 cresceu mais no Nordeste do que no Sul. Menos da metade dos trabalhadores ingressaram por concurso publico e o trabalho precario foi maior no PSF do que em UBS tradicionais. Os achados sugerem um desempenho da Atencao Basica a Saude (ABS) ainda distante das prescricoes do SUS. Menos da metade da demanda potencial utilizou a UBS de sua area de abrangencia. A oferta de acoes de saude, a sua utilizacao e o contato por acoes programaticas foram mais adequados no PSF.

Prevalência de quedas em idosos e fatores associados

OBJECTIVE: Increased life expectancy and consequent growth of the elderly population has resulted in changes in the epidemiological morbidity and mortality profile. In the group of chronic degenerative diseases, falls are a prevailing among those preventable conditions. The objective of the study was to assess prevalence of falls in the elderly and to describe their associated factors. METHODS: Cross-sectional study comprising 4,003 elderly subjects (aged 65 years or more) living in areas covered by primary health care in 41 municipalities with more than 100,000 inhabitants from seven Brazilian states. Wald test for heterogeneity and linear trend were used for the estimation of significance level. Adjusted analysis was conducted using Poisson regression and adjusted prevalence rates were estimated. RESULTS: The prevalence of falls among the elderly was 34.8%, significantly higher in women (40.1%) than men. Among those who experienced falls, 12.1% had fractures as a consequence. The prevalence of falls was directly associated with older age, sedentary lifestyle, self-perception of poor health and more chronic drug use reported. The prevalence of falls was similar in the elderly attending different care services (basic health care units and Family Health Program). CONCLUSIONS: The prevalence of falls among elderly could be reduced through actions targeting their needs in health care units, especially regarding preventable associated factors.

Atividade física em adultos e idosos residentes em áreas de abrangência de unidades básicas de saúde de municípios das regiões Sul e Nordeste do Brasil

Shifts in Brazils demographic structure have expanded the countrys elderly population and consequently increased the rates of chronic diseases. This paper describes the prevalence of sedentary lifestyle and associated factors in a cross-sectional study, including 4,060 non-elderly and 4,003 elderly adults in 41 cities in seven States of the country. Prevalence of sedentary lifestyle was 31.8% (95%CI: 30.4-33.2) in non-elderly adults and 58.0% (95%CI: 56.4-59.5) in the elderly; sedentary lifestyle was more frequent in the Northeast and among males. Low family income was associated with higher prevalence of sedentary lifestyle in both non-elderly and elderly adults, while low schooling was only observed among the elderly. There was an inverse association between self-reported health status and sedentary lifestyle. Mean prevalence of sedentary lifestyle was higher in areas covered by pre-PROESF units in comparison to other health system models. We conclude that sedentary lifestyle is highly prevalent and that disadvantaged socioeconomic groups are more likely to be sedentary.

Acesso a medicamentos de uso contínuo em adultos e idosos nas regiões Sul e Nordeste do Brasil

O objetivo deste estudo foi avaliar a prevalencia de acesso a medicamentos de uso continuo para tratar hipertensao arterial sistemica, diabetes mellitus e/ou problemas de saude mental e fatores associados. Foi desenvolvido estudo transversal no âmbito do Projeto de Expansao e Consolidacao Saude da Familia (PROESF) em 41 municipios do Sul e Nordeste do Brasil. A amostra incluiu 4.060 adultos e 4.003 idosos residentes na area das unidades basicas de saude (UBS). A prevalencia de acesso a medicamentos de uso continuo em adultos foi de 81% e em idosos, 87%. O maior acesso entre os adultos da Regiao Sul esteve associado com maior idade, melhor nivel economico, tipo de morbidade cronica e participacao em grupos na UBS; entre os adultos do Nordeste, com hipertensao arterial sistemica exclusiva ou combinada com diabetes mellitus; entre os idosos do Sul, com maior escolaridade; entre os idosos do Nordeste, com maior idade, maior escolaridade, nao fumantes, vinculo com a UBS e modelo de atencao Programa Saude da Familia (PSF). Os resultados revelam importante iniquidade em saude, reforcando a necessidade de politicas para ampliar o acesso principalmente para populacoes de menor poder aquisitivo.

Prevalence of falls in elderly in Brazil: a countrywide analysis

We conducted a cross-sectional study of a sample of 6,616 elderly living in urban areas of 100 municipalities in 23 Brazilian states, who responded to questions on the occurrence of falls in the 12 months prior to the interview, and occurrence of fractures due to the falls. The prevalence of falls among the elderly was 27.6% (95%CI: 26.5-28.7). Among those reporting falls, 11% had suffered fractures as a result. Of the elderly, 36% had received guidance about the precautions necessary to prevent falls, and about 1% had required surgery. Falls were associated with female gender, older age, low socioeconomic status, obesity and sedentary lifestyles. The prevalence of falls differed significantly between the North and other regions of Brazil. The study shows a high prevalence of falls, and underlines the need for preventive strategies targeting modifiable risk factors.

Programa Saúde da Família e condições sensíveis à atenção primária, Bagé (RS)

OBJETIVO: Condicoes sensiveis a atencao primaria (CSAP) sao problemas de saude atendidos por acoes do primeiro nivel de atencao. A necessidade de hospitalizacao por essas causas deve ser evitada por uma atencao primaria oportuna e efetiva. O objetivo do estudo foi estimar a probabilidade do diagnostico de CSAP em pacientes hospitalizados pelo Sistema Unico de Saude. METODOS: Estudo transversal com 1.200 pacientes internados entre setembro/2006 e janeiro/2007 em Bage (RS). Os pacientes responderam a questionario aplicado por entrevistadoras, sendo classificados segundo o modelo de atencao utilizado previamente a hospitalizacao. As CSAP foram definidas em oficina promovida pelo Ministerio da Saude. Analisaram-se variaveis demograficas, socioeconomicas, de situacao de saude e relativas aos servicos de saude utilizados. A analise multivariavel foi realizada por modelo de Poisson, seguindo modelo teorico hierarquico de determinacao da hospitalizacao segundo sexo e modelo de atencao. RESULTADOS: O total de 42,6% das internacoes foi por condicoes sensiveis a atencao primaria. A probabilidade de que o diagnostico principal de internacao seja por uma dessas condicoes aumenta com as caracteristicas: ser do sexo feminino, ter idade menor de cinco anos, ter escolaridade menor de cinco anos, ter sido hospitalizado no ano anterior a entrevista, ter consulta medica na emergencia, estar internado no hospital universitario. Associaram-se a probabilidade de CSAP: (a) mulheres: faixa etaria, escolaridade, tempo de funcionamento da unidade de saude, residir em area de saude da familia, ser usuaria do Programa Saude da Familia, consulta medica na emergencia no mes anterior a pesquisa e hospital de internacao; (b) homens: faixa etaria, ter sofrido outra internacao no ano anterior a entrevista e o hospital de internacao. CONCLUSOES: As condicoes sensiveis a atencao primaria permitem identificar grupos carentes de atencao a saude adequada. Embora o estudo nao permita inferencias sobre o risco de internacao, as analises por sexo e modelo de atencao sugerem que o Programa Saude da Familia e mais equitativo que a atencao basica tradicional.

Perfil sócio-demográfico e epidemiológico dos trabalhadores da atenção básica à saúde nas regiões Sul e Nordeste do Brasil

In order to describe the profile of primary health care teams in 41 municipalities with more than 100 thousand inhabitants each, a total of 4,749 health workers in two States from the South (1,730) and five from the Northeast (3,019) of Brazil were included from a sample of traditional primary care units and the Family Health Program (FHP). After providing informed consent, the health workers answered a self-applied questionnaire with demographic, work-related, and their own health-related data. The principal differences between the two models involved the structuring of the teams, with the FHP including more community health agents, more women, more young workers, fewer hired on the basis of formal admissions exams, more with a single job, more precarious employment arrangements, less employment satisfaction, less time on the job, larger workloads, greater specialization in the area, and better pay. The FHP also showed worse self-perceived health and more medical appointments. Management efforts are needed to support these workers, who form the basis of the health system and are key protagonists in the development and consolidation of primary care.

Avaliação de efetividade da Atenção Básica à Saúde em municípios das regiões Sul e Nordeste do Brasil: contribuições metodológicas

The article presents the methodology used in the Baseline Study that evaluated the effectiveness of the Family Health Strategy as compared to traditional primary health care units. The study included 41 municipalities with more than 100 thousand inhabitants each, 21 from the South and 20 from the Northeast of Brazil. As the principal dependent variable and underlying premise for sampling in the Baseline Study, the effectiveness of program activities in the primary care units was analyzed in the population within the respective coverage areas, using an epidemiological survey. The health care model in the primary care units was the principal independent variable. Its effect on program activities was controlled according to geopolitical region, metropolitan area, and population size in the municipalities. Coverage of the activities was characterized according to socioeconomic, demographic, and health-related factors. The use of comparison groups, multiple-stage samples, standardized measures, adjustment for geographic and socio-demographic characteristics, and well-defined criteria for judging the findings are contributions by the methodology employed here for designing future studies to evaluate primary health care.

Gender and incidence of functional disability in the elderly: a systematic review

This systematic review aimed to assess the effect of gender on the incidence of functional disability in the elderly. The search for publications in the MEDLINE, EMBASE, and ProQuest electronic databases from January 1990 to March 2008 identified 879 publications, from which 21 cohort studies were selected that evaluated gender as an independent variable and incidence of functional disability in elderly as the outcome. Review of the studies found that after adjusting for socioeconomic, health, and social relations indicators, incidence of functional disability was similar between genders. The main risk factors for functional disability in the elderly, regardless of gender, were: lack of schooling, living in rental housing, chronic diseases, arthritis, diabetes, visual impairment, body mass index above 25, poor self-perceived health, cognitive impairment, depression, slow gait, sedentary lifestyle, tiredness while performing daily activities, and limited diversity in social relations.

Necessidades de saúde comuns aos idosos: efetividade na oferta e utilização em atenção básica à saúde

A efetividade na oferta de servicos basicos e sua utilizacao por idosos abordada no Estudo de Linha de Base do Proesf conduzido pela UFPel incluiu 41 municipios dos Estados de Alagoas, Paraiba, Pernambuco, Piaui e Rio Grande do Norte, Rio Grande do Sul e Santa Catarina. O delineamento transversal caracterizou a estrutura e o processo de trabalho de 234 UBS, 4.749 trabalhadores e 4.003 idosos. Os indicadores sociais revelaram pior comportamento na regiao Nordeste e nas comunidades do Programa Saude da Familia (PSF). A necessidade de cuidados domiciliares regulares, a prevalencia de Hipertensao Arterial Sistemica (HAS) e de Diabetes Mellitus (DM) foram elevadas. Metade dos servicos oferecia barreiras arquitetonicas. O uso de protocolos para o cuidado domiciliar foi pouco frequente e a capacitacao para o cuidado de HAS e DM alcancou a metade dos trabalhadores. Metade dos portadores de HAS e DM usaram a Unidade Basica de Saude (UBS) da area; praticamente todos usavam medicacao, a metade obtinha a medicacao na UBS e menos da metade participava das atividades de grupo na UBS. Perda de efetividade foi observada na oferta e na utilizacao de servicos. O desempenho do PSF foi melhor quando comparado ao modelo tradicional.