Juliane de Almeida Crispim

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.

Avaliação, por graduandos de enfermagem, de ambiente virtual de aprendizagem para ensino de fisiologia endócrina

Objective: To describe the evaluation of the Virtual Learning Environment of TelEduc in teaching endocrine physiology for graduates of a nursing degree course at a public university in the state of Sao Paulo. Methods: Cross-sectional, descriptive study with quantitative analysis of data and a sample of 44 students. To collect data, we used an instrument that included educational aspects of the virtual learning environment: content, interaction and activities, and technical aspects: response time and quality of the interface. Results: In the evaluation of students, data indicated that for the majority of responses obtained, the items included the following characteristics: content (84.0%), interaction (83.2%), activities (89.3%), response time (94.0%), and interface quality (95.8%). Conclusion: The virtual learning environment,

Evaluation by nursing students in virtual learning environments for teaching endocrine physiology

Objective: To describe the evaluation of the Virtual Learning Environment of TelEduc in teaching endocrine physiology for graduates of a nursing degree course at a public university in the state of Sao Paulo. Methods: Cross-sectional, descriptive study with quantitative analysis of data and a sample of 44 students. To collect data, we used an instrument that included educational aspects of the virtual learning environment: content, interaction and activities, and technical aspects: response time and quality of the interface. Results: In the evaluation of students, data indicated that for the majority of responses obtained, the items included the following characteristics: content (84.0%), interaction (83.2%), activities (89.3%), response time (94.0%), and interface quality (95.8%). Conclusion: The virtual learning environment,

Factors associated with knowledge about tuberculosis and attitudes of relatives of patients with the disease in Ribeirão Preto, São Paulo, Brazil

OBJECTIVE To investigate the knowledge regarding tuberculosis among relatives of patients with tuberculosis and the possible factors associated with this event and also to conduct comparative analyses between groups of relatives with or with few knowledge regarding tuberculosis, considering their attitudes in both groups. METHODS Cross-sectional study in which the sample was obtained through simple and randomized method. The data were collected by trained interviewers and validated tool. Logistic regression analyses were done using statistical software SPSS, version 22.0. RESULTS Among the 110 subjects recruited for the study, 85 (87.5%) were women, and the mean age was 49 years. Regarding common symptoms of tuberculosis, 102 relatives (90.9%) pointed the chronic cough; regarding the knowledge about tuberculosis transmission modes, 100 (90.9%) of them pointed symptomatic respiratory as the probable infection source. The relatives also reported other tuberculosis transmission models: sharing of clothes (n = 87; 79.1%) and household utensils (n = 66; 60%); sexual relations (n = 50; 50%). Illiterate relatives (adjusted OR = 4.39; 95%CI 1.11 - 17.36), those who do not watch or watch little television (adjusted OR = 3.99; 95%CI 1.2 - 13.26), and also those who do not have the Internet access (adjusted OR = 5.01; 95%CI 1.29 - 19.38) were more likely to have low knowledge regarding tuberculosis. Regardless the group, with or without tuberculosis knowledge, the attitudes of both were satisfactory. CONCLUSION There are evidences that social inequity is associated to the tuberculosis knowledge of patient relatives.

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.

Agente Comunitário de Saúde no controle da tuberculose na Atenção Primária à Saúde

RESUMO Objetivo: Avaliar o desempenho do Agente Comunitario de Saude (ACS) no controle da tuberculose (TB) em areas assistidas pela Estrategia Saude da Familia (ESF), sendo estabelecida uma analise comparativa com os ACSs inscritos nas Unidades Basicas de Saude (UBS) tradicionais. Metodos: Estudo transversal, realizado em um municipio prioritario para o controle da TB no Estado de Sao Paulo, com uma amostra minima de 108 ACSs das ESFs e das UBSs. Para a coleta de dados, utilizou-se um instrumento elaborado para a Atencao Primaria a Saude (APS), adaptado para atencao a TB. Resultados: No que concerne as acoes de controle da TB, observou-se que nao houve diferencas com significância estatistica entre o desempenho dos ACSs das unidades da ESF e os inscritos nas UBSs. Conclusao: O estudo evidenciou a fragilidade dos ACSs em incorporar na sua pratica as acoes de controle da TB nas distintas modalidades de APS, apesar do destaque dado a ESF. Descritores: Agentes comunitarios de saude; Tuberculose/prevencao & controle; Atencao primaria a saudeObjective: To evaluate the performance of the Community Health Agent (CHA) in the control of tuberculosis (TB) in areas served by the Family Health Strategy (FHS), which established a comparative analysis with the CHAs enrolled in the traditional Basic Health Units (BHU) . Methods: A cross-sectional study in a priority municipality for TB control in the state of Sao Paulo, with a minimum sample of 108 CHAs of FHSs and the BHUs. For the collection of data, we used an instrument developed for Primary Health Care (PHC), adapted for TB care. Results: With regard to the actions of TB control, it was observed that there were no statistically significant differences between the performance of CHAs, the units of the FHS, and those enrolled in the BHUs. Conclusion: The study highlighted the fragility of CHAs to incorporate into their practice actions to control TB in the distinct modalities of PHC, despite the prominence given to the FHS.

Estigma social e as famílias de doentes com tuberculose: um estudo a partir das análises de agrupamento e de correspondência múltipla

The social stigma associated with TB is a challenge facing management of the area of public health care. The aim of this study was to investigate the social stigma in families of patients with TB and identify the profile of those who are affected by the event in relation to socioeconomic and demographic conditions. It is a cross-sectional study that was conducted in 2011 in the city of Ribeirao Preto, state of Sao Paulo, Brazil, with a sample of 110 individuals. The data were analyzed using the univariate descriptive technique and cluster and multiple correspondence assessment. The stigmatized groups tend to have lower scholarity, incipient access to the media and little understanding about TB, as opposed to those that have higher educational levels, continuous access to the media, consider themselves well informed and show proactive attitudes to deal with the disease. The identification of varied profiles highlights the need to develop health interventions to cater to the singularities of families with respect to the social stigma of the disease.

Adaptação cultural para o Brasil da escala Tuberculosis-related stigma

The process of stigmatization associated with TB has been undervalued in national research as this social aspect is important in the control of the disease, especially in marginalized populations. This paper introduces the stages of the process of cultural adaptation in Brazil of the Tuberculosis-related stigma scale for TB patients. It is a methodological study in which the items of the scale were translated and back-translated with semantic validation with 15 individuals of the target population. After translation, the reconciled back-translated version was compared with the original version by the project coordinator in Southern Thailand, who approved the final version in Brazilian Portuguese. The results of the semantic validation conducted with TB patients enable the identification that, in general, the scale was well accepted and easily understood by the participants.The process of stigmatization associated with TB has been undervalued in national research as this social aspect is important in the control of the disease, especially in marginalized populations. This paper introduces the stages of the process of cultural adaptation in Brazil of the Tuberculosis-related stigma scale for TB patients. It is a methodological study in which the items of the scale were translated and back-translated with semantic validation with 15 individuals of the target population. After translation, the reconciled back-translated version was compared with the original version by the project coordinator in Southern Thailand, who approved the final version in Brazilian Portuguese. The results of the semantic validation conducted with TB patients enable the identification that, in general, the scale was well accepted and easily understood by the participants.

Spatial analysis of avoidable hospitalizations due to tuberculosis in Ribeirao Preto, SP, Brazil (2006-2012)

ABSTRACT OBJECTIVE To describe the spatial distribution of avoidable hospitalizations due to tuberculosis in the municipality of Ribeirao Preto, SP, Brazil, and to identify spatial and space-time clusters for the risk of occurrence of these events. METHODS This is a descriptive, ecological study that considered the hospitalizations records of the Hospital Information System of residents of Ribeirao Preto, SP, Southeastern Brazil, from 2006 to 2012. Only the cases with recorded addresses were considered for the spatial analyses, and they were also geocoded. We resorted to Kernel density estimation to identify the densest areas, local empirical Bayes rate as the method for smoothing the incidence rates of hospital admissions, and scan statistic for identifying clusters of risk. Softwares ArcGis 10.2, TerraView 4.2.2, and SaTScanTM were used in the analysis. RESULTS We identified 169 hospitalizations due to tuberculosis. Most were of men (n = 134; 79.2%), averagely aged 48 years (SD = 16.2). The predominant clinical form was the pulmonary one, which was confirmed through a microscopic examination of expectorated sputum (n = 66; 39.0%). We geocoded 159 cases (94.0%). We observed a non-random spatial distribution of avoidable hospitalizations due to tuberculosis concentrated in the northern and western regions of the municipality. Through the scan statistic, three spatial clusters for risk of hospitalizations due to tuberculosis were identified, one of them in the northern region of the municipality (relative risk [RR] = 3.4; 95%CI 2.7–4,4); the second in the central region, where there is a prison unit (RR = 28.6; 95%CI 22.4–36.6); and the last one in the southern region, and area of protection for hospitalizations (RR = 0.2; 95%CI 0.2–0.3). We did not identify any space-time clusters. CONCLUSIONS The investigation showed priority areas for the control and surveillance of tuberculosis, as well as the profile of the affected population, which shows important aspects to be considered in terms of management and organization of health care services targeting effectiveness in primary health care.

The impact of social inequities on mortality due to pulmonary tuberculosis in São Luis, Maranhão, Brazil.

Introduction: Authors theorize about the relation between social inequities and death by tuberculosis. Nevertheless, the literature is restricted as to verifying the relation between these events in view of space. Therefore, the study objective was to identify areas with social inequity and its impact on the mortality rate by pulmonary tuberculosis.Methods: Ecological study, which considered deaths from pulmonary tuberculosis in the urban area of the city between 2008 and 2012, available in Mortality Information System. For the construction of the social inequity indicator, the principal component analysis was used, Multiple linear regression with the least squares method and spatial regression were used to verify the impact of inequity on mortality by TB. The spatial dependence was confirmed using Moran’s Global Index.Results: 193 deaths were identified. The social inequity was statistically associated with the mortality (R2=23.86%) in the multiple linear regression model with spatial dependence (Moran I=0.285; p<0.001), which evidenced the highest rates of mortality in the weighted areas with high and intermediate social inequity.Conclusion: Social inequity explains mortality by tuberculosis in the city investigated. To reduce the deaths by 95% until 2035, the actions the health authorities have established should not only promote better access to medical and diagnostic technologies, but also actions that promote the social development of the areas and their resident populations