Ione Carvalho Pinto

Collective health: a challenge for nursing

This study takes public health as the point of departure to discuss both the concept of collective health and its object and field of action, emphasizing the concepts of man, collective and individual spheres, and health-disease, through a discussion of the interdisciplinary construction of the collective health field. The authors then place nursing within this field, emphasizing what appears to be the greatest challenge, i.e., to approach nursing as a practice of relationships.

Percepção da equipe de saúde da família sobre a utilização do sistema de informação da atenção básica-SIAB

Objetivo do estudo foi identificar e analisar a utilizacao do Sistema de Informacao da Atencao Basica-SIAB como instrumento de trabalho da equipe saude da familia-ESF, identificando finalidade, possiveis dificuldades e facilidades na utilizacao das fichas do SIAB. E um estudo exploratorio, descritivo, com abordagem qualitativa. Utilizou-se de entrevistas semi-estruturadas, gravadas, com a ESF de Franca - Sao Paulo - Brasil. Estruturou-se a analise em quatro grupos: SIAB instrumentalizando o trabalho da ESF; contradicoes na utilizacao do SIAB; limitacoes quanto a alimentacao dos dados e sugestoes para solucoes dos problemas. Identificou-se que e esporadica a utilizacao e o envolvimento da ESF com o SIAB, pelas dificuldades da equipe em trabalhar com analise, monitoramento e avaliacao de dados para a realizacao da programacao local e em relacao aos agentes comunitarios de saude, onde a alta rotatividade dos mesmos reflete diretamente no inadequado preenchimento, interpretacao e dificuldade no entendimento da finalidade das fichas.This study aimed to identify and analyze the use of the Basic Health Care Information System-SIAB by the family health care team, identifying the aim, possible difficulties and facilities of using these forms. This is an exploratory, descriptive study with a qualitative approach. We have used semi-structured taped interviews with the family health care team in Franca-São Paulo--Brazil. The analysis was structured into four groups: the usage of SIAB as a work instrument for the health care team; contradictions in the usage of SIAB; limitations as to data input; and suggestions on how to solve these problems. We will show that the teams use and involvement with SIAB is sporadic, due to difficulties in analyzing, monitoring and evaluating data for complying with local programs related to community health agents, whose high turnover directly affects the inadequate completion and interpretation of forms, as well as difficulties to understand the aim of these forms.

Vínculo doente-profissional de saúde na atenção a pacientes com tuberculose

Objective: To evaluate the effectiveness of health care services in the management of tuberculosis in Ribeirao Preto, SP, during the year of 2007 in promoting interaction between patient and health care professionals. Methods: An adapted questionnaire that contains 10 indicators of interaction was used. The sample consisted of 100 patients with tuberculosis. Results: More than 60% of patients reported they engaged in conversations about other issues besides tuberculosis with their health care professionals. The majority of the sample (90%) reported they have enough time to clarify their questions about the treatment of tuberculosis. More than 50% of patients from each outpatient clinic reported to contact their physician when they were in need for food or transportation voucher. Conclusion: The structure of the delivery of health care by specialized health care teams from the “Programs for Tuberculosis Control” had good indicators of interaction between patient and health care professionals, which may contribute to the identification of patients’ needs and searching for resources to address those needs.

A atencao primaria a saude na coordenacao das redes de atencao: uma revisao integrativa

Health systems organized in health care networks and coordinated by Primary Health Care can contribute to an improvement in clinical quality with a positive impact on health outcomes and user satisfaction (by improving access and resolubility) and a reduction in the costs of local health systems. Thus, the scope of this paper is to analyze the scientific output about the evidence, potential, challenges and prospects of Primary Health Care in the coordination of Health Care Networks. To achieve this, the integrative review method was selected covering the period between 2000 and 2011. The databases selected were Medline (Medical Literature Analysis and Retrieval System online), Lilacs (Latin American Literature in Health Sciences) and SciELO (Scientific Electronic Library Online). Eighteen articles fulfilled the selection criteria. It was seen that the potential impacts of primary care services supersede the inherent weaknesses. However, the results revealed the need for research with a higher level of classification of the scientific evidence about the role of Primary Healh Care in the coordination of Health Care Networks.

Percepção das usuárias sobre as ações de Prevenção do Câncer do Colo do Útero na Estratégia Saúde da Família em uma Distrital de Saúde do município de Ribeirão Preto, São Paulo, Brasil

OBJECTIVES: to analyze the perception of women seen at the Family Health Units (FHU) of the Basic Health District in the municipality of Ribeirao Preto, Sao Paulo, on the practices of cervix cancer prevention developed by these services. METHODS: a theoretical reference of primary healthcare was utilized. This is a qualitative survey of the exploratory, descriptive type. Fourteen women were interviewed. A semi-structured interview was used for data collection, data analysis oriented by thematic analysis. Data analysis was structured in three themes: Theme 1 - Womens view of the Health-Disease Process; Theme 2 - Women and Cervix Cancer Prevention; Theme 3: Cervix Cancer Prevention in Family Health Centers. RESULTS: the majority of women involved demonstrated a holistic concept of health and a rather elaborate concept of prevention. CONCLUSIONS: education practices in healthcare need to be reinforced based on staff inclusion. Family Health Units have the potential to improve cervix cancer prevention practices and to further integrate primary health care programs.

Interaction between patient and health care professionals in the management of tuberculosis

Objective: To evaluate the effectiveness of health care services in the management of tuberculosis in Ribeirao Preto, SP, during the year of 2007 in promoting interaction between patient and health care professionals. Methods: An adapted questionnaire that contains 10 indicators of interaction was used. The sample consisted of 100 patients with tuberculosis. Results: More than 60% of patients reported they engaged in conversations about other issues besides tuberculosis with their health care professionals. The majority of the sample (90%) reported they have enough time to clarify their questions about the treatment of tuberculosis. More than 50% of patients from each outpatient clinic reported to contact their physician when they were in need for food or transportation voucher. Conclusion: The structure of the delivery of health care by specialized health care teams from the “Programs for Tuberculosis Control” had good indicators of interaction between patient and health care professionals, which may contribute to the identification of patients’ needs and searching for resources to address those needs.

Accessibility and demand at an Emergency Care Unit: the user's perspective

Resumen pt: Objetivo: Analisar a procura pelo Pronto Atendimento (PA) do Distrito Oeste de Saude do municipio de Ribeirao Preto (Sao Paulo) para identificar os motiv...

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.

Seguimento de enfermagem: monitorando indicadores infantis na saúde da família

Objective: To describe children’s health indicators during the first two years of their life. Method: This was a descriptive study. Data were collected through birth certificates and medical records of 68 children born between January 1 st 2002 and December 31 st 2004. The children were monitored from birth to December 31 st 2006 in an outpatient health unit of the program of family health at Ribeirao Preto, SP. Results: The children were at risk for health problems and a significant number of their mothers were teenagers with more than 3 children. Health care provided by the program of family health consisted of an increase in the amount of prenatal care, expansion of breastfeeding support and coverage, vaccination, and foot testing. Conclusion: Nursing and other professionals care has been very important in improving the children’s health indicators. Monitoring health indicators can promote adequate child care; particularly, among children attending a program of family health.Objetivo: Descrever os indicadores de saude de criancas acompanhadas nos dois primeiros anos de vida em uma unidade de saude da familia. Metodos: Estudo descritivo. Os dados foram coletados atraves dos registros em declaracoes de nascidos vivos e prontuarios de 68 criancas nascidas no periodo de 01/01/2002 a 31/12/2004 e acompanhadas ate 31/12/2006 em uma unidade de saude da familia de Ribeirao Preto-SP. Resultados: A populacao caracterizou-se como de risco, apontando uma parcela significativa de maes adolescentes, com menos de oito anos de estudo, mais de tres filhos. No tocante as praticas de saude na unidade de saude da familia houve um incremento no numero de consultas de pre-natal, ampliacao da cobertura de aleitamento materno, vacinacao e teste do pezinho. Conclusao: A pratica de enfermagem e dos demais profissionais tem sido importante na melhoria dos indicadores de saude infantil. Monitorar os indicadores possibilita fortalecer a organizacao da assistencia a crianca, particularmente no contexto da estrategia Saude da Familia.

Spatial clustering and local risk of leprosy in São Paulo, Brazil

Background Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. Methods Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk—RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. Results A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721–4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133–52.984) and 15.24 (95%CI = 10.114–22.919). Conclusion These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.