Heloisa Maria Mendonça de Morais

A expansão da hanseníase no nordeste brasileiro

Caracterizou-se a situacao epidemiologica da hanseniase na cidade de Recife, Estado de Pernambuco, Brasil, entre 1960 e 1985, pela analise de 3.923 fichas clinico-epidemiologicas de pacientes notificados a Secretaria de Saude do Estado de Pernambuco, Brasil. Foram calculados os coeficientes de deteccao de casos brutos e especificos por sexo, grupo etario e forma clinica, alem de analisados o modo de deteccao dos casos e o intervalo de tempo decorrido entre o aparecimento dos sintomas e o diagnostico de hanseniase. O estudo da tendencia temporal do coeficiente de deteccao de casos revelou um crescimento progressivo de 5,5:100 000 habitantes em 1960 para 36,1:100 000 habitantes, em 1985. O predominio da forma tuberculoide e o elevado percentual de menores de 15 anos acometidos pela doenca podem estar refletindo a expansao da endemia na cidade do Recife, PE. A diminuicao e estabilizacao do intervalo de tempo decorrido desde o aparecimento dos sintomas ate o diagnostico de hanseniase, a partir de 1979, foram consideradas indicadores da deteccao mais precoce dos casos e, consequentemente, da aproximacao do coeficiente de deteccao de casos do coeficiente de incidencia. Entre 1970 e 1985, o modo de deteccao de casos mais frequente foi a consulta dermatologica, seguida pela notificacao; apenas 14,2% dos casos foram descobertos atraves da vigilância de comunicantes. A analise dos indicadores epidemiologicos e operacionais sugere que o aumento expressivo do coeficiente de deteccao de casos deve ser resultado tanto da expansao da endemia quanto da implementacao de algumas das acoes de controle. Ja o coeficiente de prevalencia calculado para a cidade do Recife, em dezembro de 1985, foi de 2,04/mil habitantes, situando-se a cidade como area de alta endemicidade para a hanseniase, pelos criterios da Organizacao Mundial de Saude.: The epidemiological aspects of hanseniasis in Recife from 1960 to 1985 were studied. Clinical-epidemiological records of 3,923 leprosy patients reported to the Secretaria de Saude do Estado de Pernambuco were reviewed. The cruce as well as the age, sex and type-specific detection rates were calculated. The way the cases were detected and the time elapsed between the appearance of the first symptoms and the disease was analysed. The analysis of the time trend during the observation period showed an increase in the detection rate with time, rising from 5.5 per 100,000 inhabitants in 1960 to 36.1 per 100,000 inhabitants in 1985. The higher frequency of the tuberculoid type of leprosy and the high percentage of patients under 15 might refleet the expansion of the disease in Recife. The decline and the stabilization in the time elapsed between the appearance of the disease and its detection, from 1979 onwards, indicates a more prompt detection and, as a consequence of that, that the rate of detection is approaching the incidence rate. From 1970 to 1985 the most common means of detecting cases of Hanseniasis was through dermatological consultation followed by disease notification. Only 14.2% of the cases were discovered through the surveillance of contacts. The analysis of the epidemiological and operational indicators suggest that the increase in the detection rate over the period from 1960 to 1985 was due both to expansion of the disease and improvement in control measures. The prevalence rate of Hanseniasis in Recife in December 1984 was 2.04 per 100,000 inhabitants; according to the WHO criteria Recife may be considered an area of high endemicity.Caracterizou-se a situacao epidemiologica da hanseniase na cidade de Recife, Estado de Pernambuco, Brasil, entre 1960 e 1985, pela analise de 3.923 fichas clinico-epidemiologicas de pacientes notificados a Secretaria de Saude do Estado de Pernambuco, Brasil. Foram calculados os coeficientes de deteccao de casos brutos e especificos por sexo, grupo etario e forma clinica, alem de analisados o modo de deteccao dos casos e o intervalo de tempo decorrido entre o aparecimento dos sintomas e o diagnostico de hanseniase. O estudo da tendencia temporal do coeficiente de deteccao de casos revelou um crescimento progressivo de 5,5:100 000 habitantes em 1960 para 36,1:100 000 habitantes, em 1985. O predominio da forma tuberculoide e o elevado percentual de menores de 15 anos acometidos pela doenca podem estar refletindo a expansao da endemia na cidade do Recife, PE. A diminuicao e estabilizacao do intervalo de tempo decorrido desde o aparecimento dos sintomas ate o diagnostico de hanseniase, a partir de 1979, foram consideradas indicadores da deteccao mais precoce dos casos e, consequentemente, da aproximacao do coeficiente de deteccao de casos do coeficiente de incidencia. Entre 1970 e 1985, o modo de deteccao de casos mais frequente foi a consulta dermatologica, seguida pela notificacao; apenas 14,2% dos casos foram descobertos atraves da vigilância de comunicantes. A analise dos indicadores epidemiologicos e operacionais sugere que o aumento expressivo do coeficiente de deteccao de casos deve ser resultado tanto da expansao da endemia quanto da implementacao de algumas das acoes de controle. Ja o coeficiente de prevalencia calculado para a cidade do Recife, em dezembro de 1985, foi de 2,04/mil habitantes, situando-se a cidade como area de alta endemicidade para a hanseniase, pelos criterios da Organizacao Mundial de Saude.

Decentralization of endemic disease control: an intervention model for combating bancroftian filariasis

In Brazil decentralization has become a fundamental strategic element of implementing the countrys new national health policy. The authors present an approach to decentralizing endemic bancroftian filariasis control activities which requires that the problem be placed within a specific spatial context. Filariasis control activities in Recife are examined in the framework of a decentralized model for controlling endemic diseases which involves redefining the epidemiologic analysis model and transforming it into an instrument appropriate for addressing distinct factors which determine the health and morbidity patterns of a given population. Epidemiology and the new health care model are first discussed followed by the presentation and discussion of the intervention model for controlling filariasis. The implementation of such a model will be contingent upon the existence of political will dialogue and negotiation at the various management levels of the local health system.

A produção do conhecimento científico e as políticas de saúde pública: reflexões a partir da ocorrência da filariose na cidade do Recife, Pernambuco, Brasil

This article discusses the relationship between the production of scientific knowledge on filariasis in Brazil and health policy-making and implementation related to control of the disease. The study presents a review of scientific output on filariasis from the creation of the Program to Combat Filariasis in the mid-20th century until the creation of the Unified National Health System (SUS) within the framework of decentralized control of endemic diseases in the country. The focus on empirical observations in Recife, a city where filariasis is present, highlights the relevant institutional processes and the role of various players. The hypothesis is that in the first half of the 20th century there was a lack of scientific knowledge and technological development to control the problem, but that after these advances were obtained, new requirements of a political nature came into play and acted as determinants for persistence of the endemic in the city.

A assistência domiciliar privada em saúde e suas estratégias (aparentes e ocultas)

This paper analyses the findings of an investigation into private home healthcare. Considered the most visible model of Managed Healthcare, it is being developed through the supply of multiple services. This concept is based on a set of principles - out-of-hospital care, lower infection risks, family-based benefits for patients - all linked to a cost-cutting strategy. Some labor relations aspects are also discussed that underpin the development of this type of care.

Relações contratuais e perfil dos cirurgiões-dentistas em centros de especialidades odontológicas de baixo e alto desempenho no Brasil

Introducao: No Brasil, a partir da decada de 1990, quando foram implementadas novas modalidades contratuais flexiveis na administracao publica, tem se destacado o debate sobre as relacoes de trabalho. Esse movimento de mudancas tem repercutido no sistema publico de saude pela tendencia a instabilidade dos vinculos laborais e a desprotecao social. Objetivo: Investigar o perfil profissional de cirurgioes-dentistas dos centros de especialidades odontologicas e analisar a natureza das relacoes de trabalho em vigor nos contratos firmados entre esses profissionais e os municipios. Metodologia:O estudo, de natureza exploratoria, foi realizado a partir de entrevistas semiestruturadas com 289 profissionais alocados em 59 centros de especialidades odontologicas das 5 macrorregioes do pais, selecionados entre os 10% com melhor e pior desempenho na producao de procedimentos. Resultados:Entre os profissionais investigados, a maioria era do sexo feminino (55,0%). Quanto a qualificacao profissional, 72,7% do total dos entrevistados afirmaram ter cursado ou estar cursando pos-graduacao no momento da entrevista. A presenca de vinculos precarios e a instabilidade laboral sobressaem nas entrevistas, o que evidencia algumas distincoes entre as macrorregioes do pais. Conclusoes:Ao ressaltar o debate sobre o conceito de trabalho precario, os autores reafirmam que essa condicao se faz presente no espaco da Politica Nacional de Saude Bucal implementada por estados e municipios.

Contratualização em saúde: arena de disputa entre interesses públicos e privados

This research analyzed the public-private composition in the municipal health network and aspects of the contracting/outsourcing process for services over the period from 2001 to 2008. The research method used was a case study with documentary research and interviews. The interviewees were former secretaries of health, directors of regulation and district managers. The categories of analysis used were public funds, care networks and public control. The results showed that the contracting was restricted to philanthropic units. With respect to the other private establishments linked to the public care network, non-compliance with programmatic aspects was detected, such as the lack of regulation of bidding processes required for contracting. Management authorities did not actively pursue building up state public services, or the formation of care networks. The contracted establishments conducted their activities without effective external and internal control mechanisms, which are paramount for the proper use of public resources. The authors conclude that the contracting process does not significantly alter the standard of buying and selling of services and indeed does not enhance the empowering process of the role of the public domain.This research analyzed the public-private composition in the municipal health network and aspects of the contracting/outsourcing process for services over the period from 2001 to 2008. The research method used was a case study with documentary research and interviews. The interviewees were former secretaries of health, directors of regulation and district managers. The categories of analysis used were public funds, care networks and public control. The results showed that the contracting was restricted to philanthropic units. With respect to the other private establishments linked to the public care network, non-compliance with programmatic aspects was detected, such as the lack of regulation of bidding processes required for contracting. Management authorities did not actively pursue building up state public services, or the formation of care networks. The contracted establishments conducted their activities without effective external and internal control mechanisms, which are paramount for the proper use of public resources. The authors conclude that the contracting process does not significantly alter the standard of buying and selling of services and indeed does not enhance the empowering process of the role of the public domain.