Elisabeth Niglio de Figueiredo

Avaliação da assistência pré-natal em unidades básicas do município de São Paulo

The aim of this study was to evaluate the quality of prenatal care offered in 12 Basic Health Units (BHU) in the city of Sao Paulo, Brazil, through a review of medical and nurse charts, before and after the municipalization of the public health system. The indicator used considered excellence in care as: starting prenatal care in the first quarter of pregnancy; at least six medical visits; at least two results of blood screening for syphilis and one for HIV; returning to BHU up to 42 days after delivery. This indicator was not present in any care delivered in 2000, and only 7.7% of the care delivered in 2004 obtained it (1.1% to 30% of the care per unit assessed). Although there was an evident improvement in care during the period, the low proportion of excellent prenatal care shows an urgent need to improve this care in the BHU of São Paulo city.El objetivo de este estudio fue evaluar la calidad de la asistencia prenatal ofrecida en doce Unidades Basicas de Salud (UBS) del municipio de San Pablo a traves de la revision de los registros medicos y de enfermeria antes y despues de la municipalizacion del sistema de salud. Fue utilizado un indicador que consideraba como atencion de excelencia aquella con: inicio del acompanamiento prenatal en el primer trimestre de la gestacion; con un minimo de seis consultas; registro de por lo menos dos resultados de examenes serologicos para sifilis y una prueba para el VIH; retorno a la UBS hasta 42 dias despues del parto. Ese indicador no fue obtenido en ninguna atencion realizada en el 2000 y apenas en 7,7% de las atenciones en el 2004 (1,1% a 30% de las atenciones por unidad evaluada). A pesar de que con evidente mejoria de la atencion en el periodo, la baja proporcion de atencion prenatal de excelencia, revela una urgente necesidad de mejorar esa asistencia en las UBS en el Municipio de San Pablo.

Evaluation of prenatal care at basic health units in the city of Sao Paulo

The aim of this study was to evaluate the quality of prenatal care offered in 12 Basic Health Units (BHU) in the city of Sao Paulo, Brazil, through a review of medical and nurse charts, before and after the municipalization of the public health system. The indicator used considered excellence in care as: starting prenatal care in the first quarter of pregnancy; at least six medical visits; at least two results of blood screening for syphilis and one for HIV; returning to BHU up to 42 days after delivery. This indicator was not present in any care delivered in 2000, and only 7.7% of the care delivered in 2004 obtained it (1.1% to 30% of the care per unit assessed). Although there was an evident improvement in care during the period, the low proportion of excellent prenatal care shows an urgent need to improve this care in the BHU of São Paulo city.El objetivo de este estudio fue evaluar la calidad de la asistencia prenatal ofrecida en doce Unidades Basicas de Salud (UBS) del municipio de San Pablo a traves de la revision de los registros medicos y de enfermeria antes y despues de la municipalizacion del sistema de salud. Fue utilizado un indicador que consideraba como atencion de excelencia aquella con: inicio del acompanamiento prenatal en el primer trimestre de la gestacion; con un minimo de seis consultas; registro de por lo menos dos resultados de examenes serologicos para sifilis y una prueba para el VIH; retorno a la UBS hasta 42 dias despues del parto. Ese indicador no fue obtenido en ninguna atencion realizada en el 2000 y apenas en 7,7% de las atenciones en el 2004 (1,1% a 30% de las atenciones por unidad evaluada). A pesar de que con evidente mejoria de la atencion en el periodo, la baja proporcion de atencion prenatal de excelencia, revela una urgente necesidad de mejorar esa asistencia en las UBS en el Municipio de San Pablo.

Satisfação profissional de enfermeiros do Trabalho no Brasil

OBJECTIVE: To know if nurses working in Brazil are satisfied with the exercise of their practice and what factors are associated with it. METHODS: Exploratory cross-sectional study of 130 nursing professionals from the five Brazilian regions. We collected demographic data and administered the Job Satisfaction Scale of Occupational Stress Indicator (OSI), at three times during the period of August 2006 to March 2007. RESULTS: The five aspects of the OSI associated with job satisfaction were: relationship with others in the [...]Objective: To know if nurses working in Brazil are satisfied with the exercise of their practice and what factors are associated with it. Methods: Exploratory cross-sectional study of 130 nursing professionals from the five Brazilian regions. We collected demographic data and administered the Job Satisfaction Scale of Occupational Stress Indicator (OSI), at three times during the period of August 2006 to March 2007. Results: The five aspects of the OSI associated with job satisfaction were: relationship with others in the organization in which one works, the type (content) of the work performed, degree of motivation felt about one’s work, degree of job security and current level of flexibility and freedom one believes s/he has at work. Conclusion: Professional satisfaction presents in a significantly different manner between genders, referring to the fact that professionals have different perceptions of their work. In the women, the importance and degree of concern about job security was evident. In the men, the predominant motivation was participation in important decisions, and the flexibility and freedom at work.

The challenge of the reference and counter-reference system in the prenatal assistance to pregnant women with infectious diseases.

The objective of this study was to determine the prevalence of infectious diseases, such as syphilis, acquired immune deficiency syndrome (AIDS) and hepatitis B and C, in pregnant women who undertook their prenatal care in thirteen basic health units (BHU) in São Paulo city. The efficiency of the reference and counter-reference system in such prenatal infectious diseases was evaluated considering the medical recordings of the final result of the pregnancy and the vertical transmission rates of these diseases. It consists of an epidemiologic study whose observations were based on the notes of the prenatal medical and nurse records of pregnant women who had infectious diseases susceptible to vertical transmission and final infectious status registers of their concepts. Womens syphilis prevalence was 0. 86%, HIV and Hepatitis B was 0. 22% and Hepatitis C was 0. 36%. Its possible to conclude that there is no register of the reference and counter-reference system of these infectious diseases analyzed at the thirteen basic health units of the south-east region of São Paulo city evaluated in 2005. This lack of register makes it impossible to know the preventive measures taken and the vertical transmission rates. Making the professionals and the Health Coordination authorities aware of the importance of the dynamic of the prenatal attendance is necessary.

Validação de instrumento para identificar ações de rastreamento e detecção de neoplasia de mama

Objective: To develop and validate a questionnaire to identify the actions performed in screening and detection of breast cancer in Brazil, and to determine its applicability. Methods: A methodological study, with the participation of three experts and a pilot test with 85 users of four primary health care services, with a descriptive data analysis. Results: Of the 132 questions formulated and organized in the structure and process dimensions undergoing validation, there was a 96.7% and 78.8% agreement of the evaluators in the first and second rounds, respectively. Most of the questions were understood by those involved in the investigation. The absence of the medical record resulted in the exclusion of 40 questions, resulting in 83 questions in the final version. Conclusion: The content of the instrument was adequate to evaluate actions to control breast cancer in primary care. The pilot test confirmed its applicability, and the need for improvements in documenting information.

Opportunistic screening actions for breast cancer performed by nurses working in primary health care

OBJECTIVE To identify opportunistic screening actions for breast cancer performed by nurses working in primary health care units in Ribeirão Preto, São Paulo. METHOD Cross-sectional study with 60 nurses from 28 units, who had been working for at least one year in the public municipal health care network. Data were collected between December 2013 and March 2014, by means of a questionnaire, using descriptive analysis and the software IBM SPSS version 20 and Microsoft Excel 2010. RESULTS The results showed that 71.7% of the participants questioned their female patients as for risk factors for breast cancer, mainly during nursing consultation; 70.0% oriented users about the age to perform clinical breast exam, whereas 30.0% did not due to lack of knowledge and time; 60.0% explained about the age to perform mammogram; 73.3% did not refer patients with suspicious breast exam results to the referral department, citing scheduling as the main obstacle to referral. Educational activities were not performed by 78.3% of participants. CONCLUSION Investment is needed in professional training and management of breast cancer screening.OBJETIVO Identificar las acciones de rastreo oportunista del cancer de mama llevadas a cabo por enfermeros de unidades basicas de salud (UBS) de Ribeirao Preto. METODO Estudio transversal, con 60 enfermeros de 28 Unidades, actuantes desde hace un ano en la red municipal de salud. Los datos fueron recogidos entre diciembre de 2013 y marzo de 2014, mediante formulario, analizado descriptivamente empleandose los softwares IBM SPSS 20 y Excel 2010. RESULTADOS Senalaron que el 71,7% realizaron investigacion acerca de los factores de riesgo del cancer de mama, especialmente durante la consulta de enfermeria; el 70,0% orientan a la mujer con respecto a la edad para realizar el Examen Clinico de las Mamas; el 30,0% de ellos no lo realizan por falta de conocimiento y tiempo; el 60,0% explican sobre la edad para la realizacion de la mamografia; el 73,3% no derivan a las usuarias con resultado sospechoso a la unidad de referencia, alegando la programacion como principal obstaculo para su ejecucion. Las actividades educativas no las llevan a cabo el 78,3% de los profesionales. CONCLUSION Existe necesidad de inversiones en capacitacion profesional y gestion de los servicios sanitarios.

Job satisfaction of nurses working in Brazil

OBJECTIVE: To know if nurses working in Brazil are satisfied with the exercise of their practice and what factors are associated with it. METHODS: Exploratory cross-sectional study of 130 nursing professionals from the five Brazilian regions. We collected demographic data and administered the Job Satisfaction Scale of Occupational Stress Indicator (OSI), at three times during the period of August 2006 to March 2007. RESULTS: The five aspects of the OSI associated with job satisfaction were: relationship with others in the [...]Objective: To know if nurses working in Brazil are satisfied with the exercise of their practice and what factors are associated with it. Methods: Exploratory cross-sectional study of 130 nursing professionals from the five Brazilian regions. We collected demographic data and administered the Job Satisfaction Scale of Occupational Stress Indicator (OSI), at three times during the period of August 2006 to March 2007. Results: The five aspects of the OSI associated with job satisfaction were: relationship with others in the organization in which one works, the type (content) of the work performed, degree of motivation felt about one’s work, degree of job security and current level of flexibility and freedom one believes s/he has at work. Conclusion: Professional satisfaction presents in a significantly different manner between genders, referring to the fact that professionals have different perceptions of their work. In the women, the importance and degree of concern about job security was evident. In the men, the predominant motivation was participation in important decisions, and the flexibility and freedom at work.

Barriers to control syphilis and HIV vertical transmission in the health care system in the city of Sao Paulo

OBJECTIVE The objective of this study was to identify possible barriers to control vertical transmission of syphilis and HIV through the analysis of the orientation process of pregnant women from prenatal care to the obstetric center at an university hospital in Sao Paulo (Reference) and their return (with their exposed babies) for follow-up after hospital discharge (counter-reference). METHODS It is a retrospective cross-sectional study including interviews with healthcare personnel. Pregnant women with syphilis and/or HIV-infection admitted for labor or miscarriage were identified from August 2006 to August 2007. Routine care for mothers and babies were analyzed. RESULTS 56 pregnant women were identified: 43 were HIV-infected, 11 had syphilis and two were coinfected (syphilis/HIV); 22 health care professionals were interviewed. Prenatal care was identified in 91.1% of these women: 7/11 (63.6%) with syphilis; 44/45 (97.8%) HIV-infected or coinfected. The reference for delivery was satisfactory for 57.7% of the syphilis-infected women and 97.7% of the HIV-infected ones. The counter-reference was satisfactory for all babies and mothers at hospital discharge, besides the non-adherence to this recommendation. Interviews with health care professionals showed there are better routines for assisting and following-up pregnant women, puerperal women and HIV-infected or exposed babies than for those infected with syphilis. The epidemiological report and surveillance system are also better for HIV-infected patients. CONCLUSION The difficulties in the reference and counter-reference system of these women and their babies are evident barriers to control the vertical transmission of these infectious diseases.

Chronic hepatitis B and D: prognosis according to Child-Pugh score

Objective: compare chronic hepatitis B patients to those superinfected with hepatitis D virus, according to Child-Pugh score regarding disease severity. Method: retrospective descriptive study, performed with 59 patients followed in the ambulatory, of which 22 (37.3%) were chronically infected with hepatitis B virus (Group HBV) and 37 (62.7%) superinfected with Delta virus (Group HBV+HDV); variables of sex, age and items of Child-Pugh score were collected by consulting medical records. Results: out of the patients, 57.6% were male, with a mean age of 30.5 years. Score A, which indicates lesser severity, was found in 100% of group HBV and 78.4% of group HBV+HDV. Score B, which indicates greater severity, was found only in group HBV+HDV in 21.6% of the patients. Conclusion: by means of the Child-Pugh score, it was observed that patients with superinfection by HDV tended to present a worse prognosis. Objetivo: comparar os pacientes com hepatite B crônica com superinfectados pelo vírus D segundo escore de Child-Pugh quanto à gravidade da doença. Método: estudo descritivo retrospectivo, realizado com 59 pacientes acompanhados em ambulatório, sendo 22 (37,3%) cronicamente infectados pelo vírus da hepatite B (Grupo VHB) e 37 (62,7%) com superinfecção por vírus Delta (Grupo VHB+VHD); foram coletadas variáveis quanto ao sexo, idade e referentes ao escore de Child-Pugh por meio de consulta a prontuários. Resultados: entre os pacientes 57,6% era do sexo masculino, com idade média de 30,5 anos. O escore A, que indica menor gravidade, foi encontrado em 100% do grupo VHB e 78,4% do grupo VHB+VHD. O escore B, que indica maior gravidade, foi encontrado apenas no grupo VHB+VHD em 21,6% dos pacientes. Conclusão: por meio do escore de Child-Pugh, observou-se que os pacientes com superinfecção por VHD tendem a apresentar pior prognóstico.

Atuação do enfermeiro da Atenção Primária no controle do câncer de mama

Resumo Objetivo Analisar as acoes realizadas por enfermeiros da Atencao Primaria em Saude para rastreamento oportunistico do câncer de mama, tendo como parâmetro a proposta do Ministerio da Saude. Metodos Estudo descritivo, transversal, realizado com 70 enfermeiros, com auxilio de questionario validado, elaborado segundo as acoes determinadas pelo programa de controle de câncer de mama do Brasil. Resultados 97,1% dos enfermeiros realizavam exame clinico das mamas, 88,6% indicaram a mamografia anualmente e 75,7% orientaram o primeiro exame a partir dos [...]