Gabriela Tavares Magnabosco

Validity and reliability of a health care service evaluation instrument for tuberculosis

OBJECTIVE To evaluate the validity and reliability of an instrument that evaluates the structure of primary health care units for the treatment of tuberculosis. METHODS This cross-sectional study used simple random sampling and evaluated 1,037 health care professionals from five Brazilian municipalities (Natal, state of Rio Grande do Norte; Cabedelo, state of Paraíba; Foz do Iguaçu, state of Parana; Sao José do Rio Preto, state of Sao Paulo, and Uberaba, state of Minas Gerais) in 2011. Structural indicators were identified and validated, considering different methods of organization of the health care system in the municipalities of different population sizes. Each structure represented the organization of health care services and contained the resources available for the execution of health care services: physical resources (equipment, consumables, and facilities); human resources (number and qualification); and resources for maintenance of the existing infrastructure and technology (deemed as the organization of health care services). The statistical analyses used in the validation process included reliability analysis, exploratory factor analysis, and confirmatory factor analysis. RESULTS The validation process indicated the retention of five factors, with 85.9% of the total variance explained, internal consistency between 0.6460 and 0.7802, and quality of fit of the confirmatory factor analysis of 0.995 using the goodness-of-fit index. The retained factors comprised five structural indicators: professionals involved in the care of tuberculosis patients, training, access to recording instruments, availability of supplies, and coordination of health care services with other levels of care. Availability of supplies had the best performance and the lowest coefficient of variation among the services evaluated. The indicators of assessment of human resources and coordination with other levels of care had satisfactory performance, but the latter showed the highest coefficient of variation. The performance of the indicators “training” and “access to recording instruments” was inferior to that of other indicators. CONCLUSIONS The instrument showed feasibility of application and potential to assess the structure of primary health care units for the treatment of tuberculosis.

Areas of vulnerability to HIV/ TB co-infection in Southeastern Brazil

OBJETIVO: Identificar areas de vulnerabilidade para os casos novos de co-infeccao HIV/tuberculose (TB). METODOS: Estudo descritivo ecologico realizado por meio do georreferenciamento dos casos novos de HIV/TB notificados em Ribeirao Preto, SP, em 2006. Os dados foram obtidos do sistema de informacao estadual paulista de notificacao de TB. Os casos novos de co-infeccao HIV/TB foram analisados conforme caracteristicas sociodemograficas e clinicas e, posteriormente, georreferenciados na base cartografica do municipio segundo endereco residencial. Os setores do municipio foram categorizados em tres niveis socioeconomicos: inferior, intermediario e superior, com base na analise de componentes principais das variaveis do censo demografico de 2000 (renda, instrucao e percentagem de domicilios com cinco ou mais moradores). Foi calculada a incidencia da co-infeccao HIV/TB para cada nivel socioeconomico. RESULTADOS: A co-infeccao HIV/TB acometeu mais adultos do sexo masculino em idade economicamente ativa e a forma pulmonar da TB foi a mais comum. A distribuicao espacial mostrou que as incidencias nas areas com niveis socioeconomicos intermediarios e inferiores (8,3 e 11,5 casos por 100 mil habitantes, respectivamente) foram superiores aquela (4,8 casos por 100 mil habitantes) de nivel socioeconomico superior. CONCLUSOES: A taxa de incidencia de co-infeccao HIV/TB analisada por niveis socioeconomicos mostrou padraÞo espacial de distribuicaÞo nao homogeneo e apresentou valores mais altos em areas de maior vulnerabilidade social. O estudo diagnosticou aireas geograificas prioritairias para o controle da co-infeccao e a tecnologia do sistema de informacao geografica pode ser empregada no planejamento das acoes em saude pelos gestores municipais.OBJECTIVE To identify areas of vulnerability to new cases of HIV/tuberculosis (TB) co-infection. METHODS An ecological descriptive study was conducted by georeferencing new HIV/TB cases reported in the city of Ribeirão Preto, Southeastern Brazil, in 2006. Data were obtained from the São Paulo state information system for TB notification (TB-WEB) database. New cases of HIV/TB co-infection were analyzed according to sociodemographic and clinical characteristics and, subsequently, georeferenced in the citys cartographic basis, based on home addresses. City sectors were categorized into three socioeconomic levels: lower, average and upper levels, based on the analysis of the main components of the 2000 Demographic Census variables (income, level of education and percentage of households with five or more residents). The incidence of HIV/TB co-infection was calculated for each socioeconomic level. RESULTS HIV/TB co-infection affected a higher number of economically active adult males and the pulmonary form of TB was the most frequent. Spatial distribution showed that the incidences in areas with average and lower socioeconomic levels (8.3 and 11.5 cases per 100,000 inhabitants, respectively) were higher than that with a higher socioeconomic level (4.8 cases per 100,000 inhabitants). CONCLUSIONS The incidence rate of HIV/TB co-infection, analyzed according to socioeconomic levels, showed a non-homogeneous spatial pattern of distribution and higher values in more socially vulnerable areas. The present study identified priority geographical areas to control co-infection and revealed that the geographical information system technology can be used by city managers to plan health actions.

Coordenação da assistência prestada às pessoas que vivem com HIV/AIDS em um município do Estado de São Paulo, Brasil

Objetivou-se analisar a coordenacao das acoes e servicos de saude na assistencia as pessoas que vivem com HIV/AIDS. Trata-se de um estudo seccional com 301 pessoas que vivem com HIV/AIDS. A analise foi feita por tecnicas descritivas, analise de variância e comparacao multiplas de medias. Encontrou-se que a coordenacao da assistencia foi satisfatoria (media = 3,69 e DP = 1,74). As pessoas que vivem com HIV/AIDS utilizavam outros servicos de saude alem dos Servicos de Assistencia Especializada em HIV/AIDS – SAE (Pronto Atendimento: 67%; atencao basica: 43,2%; outros servicos especializados: 23,6%; servicos privados: 15%). Os cinco SAE apresentaram diferentes desempenhos, bem como distintos contextos e composicoes assistenciais, entretanto adequado manejo dos aspectos clinicos em detrimento dos sociais. O fornecimento da guia de referencia foi tido como satisfatorio, entretanto a guia de contrarreferencia insatisfatorio. Ha necessidade de estrategias que favorecam o desenvolvimento de acoes compartilhadas e cooperadas dentro das equipes dos SAE e entre os diferentes servicos com o intuito de fortalecer a producao de cuidado resolutivo.The aim of this study was to analyze the coordination of health activities and services for persons living with AIDS. This was a cross-sectional study of 301 persons living with AIDS. The analysis used descriptive techniques, analysis of variance, and multiple comparisons of means. Coordination of care was found to be satisfactory (mean = 3.69 and SD = 1.74). Persons living with AIDS used other health services in addition to the Services for Specialized HIV/AIDS Care (67.0% emergency departments, 43.2% primary care, 23.6% other specialized services, 15% private services). The five specialized HIV/AIDS clinics showed different performance levels as well as distinct contexts and healthcare configurations, but adequate clinical management (comparatively better than management of social issues). Provision of the referral guide was considered satisfactory, but the counter-referral guide was found to be unsatisfactory. Strategies are needed to promote the development of shared and cooperative actions within the healthcare teams in the specialized HIV/AIDS clinics and between the different services in order to strengthen the provision of care with case-resolution capacity.

Provision of health care actions and services for the management of HIV/AIDS from the users’ perspective

Objetivo Analizar la oferta de acciones en los servicios de salud que prestan asistencia a las personas que viven con SIDA en el seguimiento de los servicios especializados del municipio de Ribeirao Preto-SP. Metodo Estudo descriptivo, exploratorio, del tipo encuesta. Se llevaron a cabo entrevistas con cuestionario estructurado y analisis de datos por medio de estadisticas descriptivas. Resultados La oferta de acciones y servicios de salud se la ve como regular. Para los 301 sujetos, la atencion de rutina por el equipo de referencia; examenes de laboratorio y facilitacion de antirretrovirales, vacunas y preservativos obtuvieron evaluacion satisfactoria. Evaluadas como regular la oferta de examenes para la prevencion y el diagnostico de comorbilidades, e insatisfactoria la oferta de atencion especializada por otros profesionales; de grupos de apoyo psicosocial y farmacos preventivos de efecto colateral de los antirretrovirales. Conclusion Debilidades permean el seguimiento y la gestion del cuidado, con predominio del enfoque biologicista, centrado en el medico, en el que el control clinico y el acceso a la Terapia Antirretroviral se constituyen como el enfoque esencial de la asistencia prestada.OBJECTIVE To analyse the provision of health care actions and services for people living with AIDS and receiving specialised care in Ribeirão Preto, SP. METHOD A descriptive, exploratory, survey-type study that consisted of interviews with structured questionnaires and data analysis using descriptive statistics. RESULTS The provision of health care actions and services is perceived as fair. For the 301 subjects, routine care provided by the reference team, laboratory tests and the availability of antiretroviral drugs, vaccines and condoms obtained satisfactory evaluations. The provision of tests for the prevention and diagnosis of comorbidities was assessed as fair, whereas the provisions of specialised care by other professionals, psychosocial support groups and medicines for the prevention of antiretroviral side effects were assessed as unsatisfactory. CONCLUSION Shortcomings were observed in follow-up and care management along with a predominantly biological, doctor-centred focus in which clinical control and access to antiretroviral therapy comprise the essential focus of the care provided.


Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study

Serrano-Gallardo P, Martínez-Marcos M, Espejo-Matorrales F, Arakawa T, Magnabosco GT, Pinto IC. Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study. Rev. Latino-Am. Enfermagem. 2016;24:e2803. [Access ___ __ ____]; Available in: ____________________. DOI: http://dx.doi.org/10.1590/1518-8345.0327.2803. dia mês ano URL Artigo Original

Evaluation of the performance of Tuberculosis Control Programs in Brazil and Spain: an integrative review of the literature

This is an integrative review of the literature, which sought to locate evidence regarding the evaluation of the performance of tuberculosis control programs in the Brazilian and Spanish contexts. Articles indexed in databases, search directories and virtual libraries produced in Brazil and Spain from 2002 to 2013 were selected. A total of 17 articles (9 Brazilian and 8 Spanish) were included for analysis. The intention was to identify program evaluation concepts, methodologies and indicators for TB control program evaluation in both countries. In the Spanish context, a concern with results-oriented management and the attempt to develop broader indicators for the assessment of a series of health programs, including those related to tuberculosis control, was identified. The Brazilian references showed greater proximity to the classic methods of evaluation research, and a greater variety of objects of study regarding the activities expected in a control program. The findings highlight the complexity of program evaluation activities, which involve multiple and diverse stakeholders, and point to the need for integration of epidemiological and operational indicators in tuberculosis.

Tuberculosis control in people living with HIV/AIDS.

ABSTRACT Objective: to analyze the offering of health actions and services for the control of tuberculosis for people living with HIV/AIDS being followed up in the Specialized Care Services for HIV/AIDS in Ribeirão Preto, SP, Brazil. Method: quantitative, exploratory survey study. Participated 253 people living with HIV/AIDS followed up by this service, considering as inclusion criteria: individuals older than 18 years living in the city and not inmates. Data collection was conducted from January 2012 to May 2013 through interviews with the support of a specific instrument. Data were analyzed using indicators and a composite index. Results: the offering of services for the control of tuberculosis in people living with HIV/AIDS by municipal services was considered as intermediate, reinforcing the need for better planning for comprehensive assistance, coordination of professionals in teams and among the services network, in addition to professional training and continuing education. Conclusion: it is necessary to implement strategies that promote shared actions between TB and HIV / AIDS programs and between different services in order to strengthen the local care network, aimed at producing an individualized care, comprehensive and responsive.Objetivo: analisar a oferta das ações e serviços de saúde para o controle da tuberculose nas pessoas vivendo com HIV/aids em seguimento pelos Serviços de Atenção Especializada ao HIV/ aids de Ribeirão Preto, SP, Brasil. Método: estudo quantitativo, exploratório, do tipo inquérito. Participaram 253 pessoas vivendo com HIV/aids em seguimento nos serviços, considerando os critérios de inclusão: indivíduos maiores de 18 anos, residentes no município e não pertencentes ao sistema prisional. A coleta de dados foi realizada no período de janeiro/2012 a maio/2013, por meio de entrevistas com apoio de um instrumento específico. Os dados foram analisados mediante indicadores e índice composto. Resultados: a oferta de ações e serviços para o controle da tuberculose nas pessoas vivendo com HIV/aids pelos serviços do município foi considerada regular, reforçando a necessidade de melhor planejamento da assistência de forma integral, articulação dos profissionais nas equipes e entre os serviços da rede, além da formação profissional e educação permanente. Conclusão: faz-se necessário a implementação de estratégias que favoreçam ações compartilhadas entre os programas de tuberculose e HIV/aids e entre os diferentes serviços, com o intuito de fortalecer a rede local de atenção objetivando a produção de um cuidado singular, integral e resolutivo.

Fatores associados à aprendizagem clínica dos alunos de enfermagem nos cuidados de saúde primários: um estudo analítico transversal

Serrano-Gallardo P, Martínez-Marcos M, Espejo-Matorrales F, Arakawa T, Magnabosco GT, Pinto IC. Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study. Rev. Latino-Am. Enfermagem. 2016;24:e2803. [Access ___ __ ____]; Available in: ____________________. DOI: http://dx.doi.org/10.1590/1518-8345.0327.2803. dia mês ano URL Artigo Original

Factores asociados al aprendizaje clínico de los estudiantes de enfermería en la atención primaria de salud: un estudio transversal analítico

Serrano-Gallardo P, Martínez-Marcos M, Espejo-Matorrales F, Arakawa T, Magnabosco GT, Pinto IC. Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study. Rev. Latino-Am. Enfermagem. 2016;24:e2803. [Access ___ __ ____]; Available in: ____________________. DOI: http://dx.doi.org/10.1590/1518-8345.0327.2803. dia mês ano URL Artigo Original

[Nursing practices in the attention to a chronic condition (tuberculosis): analysis of secondary sources].

OBJECTIVE To analyze nursing practiced in the treatment of tuberculosis, based on secondary data records. METHOD Descriptive study of the retrospective survey kind, conducted in Ribeirão Preto, from August to December 2013. The data of 109 electronic and clinical medical records, and a TB reporting system in the state of São Paulo for residents in the municipality monitored in the reference clinics. Descriptive statistic techniques were used. RESULTS The median of 46.0 (IQ: 17.0 to 96.0) calls throughout the treatment shows the patients proximity to the health service and professionals, of which the primary persons responsible for follow-ups were nursing assistants (99.1%), which perform the House Visits (71.5%) for patients under a supervision regime (75.2%). CONCLUSION The actions developed with the patients were mostly focused on the nursing staff, making the importance of this category to achieve the indicators related to the Millennium Development Goals for tuberculosis visible.