Kátia Bones Rocha

Assessment of primary care in health surveys: a population perspective

BACKGROUND The objective of this study was to evaluate the metric properties of a selection of items of the Primary Care Assessment Tool (PCAT) included into 2006 Catalonia Health Survey and adapted to evaluate experiences of primary care (PC) under population perspective. METHODS This was a cross-sectional study. The study population was composed of non-institutionalized residents of Catalonia over 15 years of age (n = 12,933). The instrument used was a 10-item selection of the adult users version of the PCAT (PCAT10-AE). We assessed internal consistency, correlation between items and performed exploratory factor analysis and external validity analysis. RESULTS The instrument presented adequate internal consistency (0.72). All items showed acceptable correlation with other items that constitute the scale. The single extracted factor explained 64% of the common variance in the responses, allowing the construction of a global index for evaluation of PC. We observed an association between better evaluation of PC and more satisfaction with the health system. CONCLUSIONS Metric analysis supported the integrity and general adequacy of this very short tool included in a population health survey. The global index proposed could be a good measure for assessing and monitoring the adequacy of part of the PC experiences in first-contact care and person-focused care over time, under population perspective. On the other hand, the loss of content as a consequence of the selection of items, suggesting use of the expanded versions of the PCAT-AE whenever a global evaluation of PC is desired and it is possible.

Properties of a short questionnaire for assessing Primary Care experiences for children in a population survey

BackgroundThe Primary Care Assessment Tool (PCAT) is an interesting set of tools for primary care research. A very short version could inform policy makers about consumer experiences with primary care (PC) through health surveys. This work aimed to investigate the validity and reliability of a selection of items from the child short edition (CS) of the PCAT.MethodsA 24 item questionnaire permitted the identification of a regular source of care and the assessment of the key attributes of first contact, ongoing care over time, coordination, services available and services received (comprehensiveness), and cultural competence. Structural validity, reliability, and construct validity were assessed using responses from 2,200 parents of a representative sample of the population aged 0 to 14 years in Catalonia (Spain) who participated in the 2006 Health Survey. Structural validity was analyzed using exploratory and confirmatory factor analyses and reliability was assessed using Cronbachs alpha. Construct validity was assessed using linear regression analysis between PC experience scores and a measure of overall user satisfaction with healthcare services.ResultsA total of 2,095 (95.2%) parents provided useable responses on PC. After Confirmatory Factor Analysis (CFA), the best fitting model was a 5-factor model in which the original dimensions of first contact and ongoing care were collapsed into one. The CFA also showed a second order factor onto which all domains except services available loaded (root mean square error of approximation = 0.000; comparative fit index = 1.00). Cronbachs alpha values for one of the original scales (first-contact) was poor (alpha < 0.50), but improved using the modified factor structure (alpha > 0.70). Scores on the scales were correlated with satisfaction with healthcare services (p < 0.01), thereby providing some preliminary evidence of construct validity.ConclusionsThis very short questionnaire obtained from the PCAT-CE yields information about five attributes of PC and a summary score. It has shown evidence of validity and reliability for judgments about experiences with primary care overall. If space on surveys is at a premium, the instrument could be useful as a measure of PC experiences.

Paradigmas em psicologia: compreensões acerca da saúde e dos estudos epidemiológicos

This article aims is investigate how health is understood by differents paradigms in psychology and how they evaluated epidemiology studies. Seven investigators and psychology health professional from Brazil, Spain and Argentina were interviews, this professionals guide their practices by differents conceptual theories: Social Critique, Clinical (Psychodynamic and Cognitive Behavior), Ecological Contextual and Community. After the evaluation of those interviews it was possible identify that exist a diversity of health compression. The health concepts are related with the human, world, reality, social context and possibility of change compression concepts. In relation to the epidemiology studies we realizes that some participations use a superficial and large description, related to the medical conception about the epidemiology; others emphasizes the relevance of to consider the contexts that the studies are achieves. Only one participant mentioned the role of epidemiology specifically for psychology. We conclude that is of fundamental importance that the professional of health has conscience of the paradigm that directs your practice can to evaluate the consequences of your action like professional and citizen.

Clase social y salud en América Latina

This paper reviews the principal concepts of social class, occupation, and social stratification, and their contribution to the analysis of the social determinants of health (SDH), and reviews empirical studies conducted in Latin America that use employment relations as an SDH. The review focuses on studies of the relationship between health and social class based on neo-Weberian or neo-Marxist perspectives. A search of the BIREME Virtual Health Library and the SciELO database found 28 articles meeting these characteristics. This relative dearth contrasts with the profusion of papers that use these approaches written in Europe and in the United States, with a long tradition in the analysis of SDH. In this regard, the political and programmatic implications of research on social class and employment relations are different from and complementary to studies of health gradients associated with income and education. Globalization of employment relations requires the development of new concepts to explain and measure the mechanisms of action of the SDH going beyond what is strictly labor related; in particular, the importance in the current Latin American reality of the impact of informal work on health.

Saúde percebida em professores universitários: gênero, religião e condições de trabalho

Este trabajo investiga como los profesores de una universidad particular perciben su salud. La delineacion es de caracter descriptivo-correlacional. Instrumentos utilizados: Questionario de Saude de Goldberg (QGS-60) y una ficha con datos bio-demograficos investigando variables individuales y relativas a la actividad laboral. La muestra se constituyo de 161 profesores que fueron elegidos por estratos por medio de las diferentes areas de formacion. Los resultados revelan que los profesores perciben que su salud general esta como de costumbre, o sea, ni mejor ni peor y que existe una asociacion entre las variables sexo, practica religiosa y variables relativas al ambiente de trabajo (horas de trabajo en la universidad y en sala de aula), influenciando la percepcion que los profesores tienen de su salud.A presente pesquisa investiga como os professores de uma universidade particular percebem sua saude. O delineamento e de carater descritivocorrelacional. Os instrumentos utilizados: Questionario de Saude de Goldberg (QGS-60) e uma ficha com dados biodemograficos investigaram variaveis individuais e relativas a atividade laboral. A amostra se constitui de 161 professores, escolhidos por estratos atraves das diferentes area de formacao. Os resultados revelam que os professores percebem que sua saude geral esta como de costume, ou seja, nem melhor nem pior e que existe associacao entre as variaveis sexo, pratica religiosa e variaveis relativas ao ambiente de trabalho (horas de trabalho na universidade e em sala de aula), influenciando a percepcao que os professores tem de sua saude.

Clase social, desigualdades en salud y conductas relacionadas con la salud de la población trabajadora en Chile

OBJECTIVE: To analyze links between social class and health-related indicators and behaviors in Chilean workers, from a neo-Marxian perspective. METHODS: A cross-sectional study based on the First National Survey on Employment, Work, Health, and Quality of Life of Workers in Chile, done in 2009-2010 (n = 9 503). Dependent variables were self-perceived health status and mental health, examined using the General Health Questionnaire (GHQ-12). Health-related behavior variables included tobacco use and physical activity. The independent variable was neo-Marxian social class. Descriptive analyses of prevalence were performed and odds ratio (OR) models and 95% confidence intervals (95%CI) were estimated. RESULTS: Medium employers (between 2 and 10 employees) reported a lower prevalence of poor health (21.6% [OR 0.68; 95%CI 0.46-0.99]). Unskilled managers had the lowest mental health risk (OR 0.43; 95%CI 0.21-0.88), with differences between men and women. Large employers (more than 10 employees) reported smoking the least, while large employers, expert supervisors, and semi-skilled workers engaged in significantly more physical activity. CONCLUSIONS: Large employers and expert managers have the best health-related indicators and behaviors. Formal proletarians, informal proletarians, and unskilled supervisors, however, have the worst general health indicators, confirming that social class is a key determinant in the generation of population health inequalities.

Clase social, factores de riesgo psicosocial en el trabajo y su asociación con la salud autopercibida y mental en Chile

El objetivo fue examinar la relacion entre clase social, riesgo psicosocial laboral y la salud autopercibida y mental en Chile. Se trata de un estudio transversal con los datos de la Primera Encuesta Nacional de Condiciones de Empleo, Trabajo, Calidad de Vida y Salud de los Trabajadores y Trabajadoras en Chile (N = 9.503). Las variables dependientes son: salud mental y salud autopercibida. Las variables explicativas son: clase social neo-marxista, factores de riesgo psicosocial y privacion material. Se realizaron analisis descriptivos y de regresion logistica. Existen desigualdades en la distribucion de los factores exposicion laboral a riesgos psicosociales, segun clase social y sexo. Ademas, la clase social y los factores de riesgo psicosocial en el trabajo estan asociados a una distribucion desigual de la salud autopercibida y salud mental entre la poblacion trabajadora en Chile. Las intervenciones en el area de la salud de los trabajadores deben considerar la clase social y los factores de riesgo psicosocial a que estan expuestos los trabajadores.O objetivo foi analisar a associacao entre classe social, fatores psicossociais de risco laboral e saude autopercebida e saude mental entre a populacao trabalhadora chilena. Estudo transversal com os dados da Primera Encuesta Nacional de Condiciones de Empleo, Trabajo, Calidad de Vida y Salud de los trabajadores y trabajadoras en Chile (N = 9.503). As variaveis dependentes sao: saude autopercebida e saude mental. As variaveis explicativas sao a classe social (neo-marxista), os fatores psicossociais de risco laboral e privacao material. Foram realizadas analises descritivas e de regressao logistica. Existem desigualdades na distribuicao dos fatores psicossociais de risco laboral segundo classe social e sexo. Alem disso, a classe social e os fatores de risco psicossociais no trabalho estao associados a uma distribuicao desigual da saude autopercebida e saude mental. As intervencoes na area da saude dos trabalhadores devem considerar a classe social e fatores de risco psicossociais a que os trabalhadores estao expostos.

Prevalence and Factors Associated with Burnout Syndrome in Professionals in Basic Health Units

espanolEl objetivo del estudio es identificar la prevalencia y los factores asociados a Sindrome de Burnout (SB) en 127 profesionales de salud del area metropolitana de Porto Alegre. Se trata de un estudio transversal epidemiologico. Los instrumentos utilizados fueron un cuestionario con datos sociodemograficos y laborales, la bateria de evaluacion de riesgos psicosociales y el Inventario de Maslach Burnout. Fueron realizados analisis de prevalencia, comparacion de medias (ANOVA y test-t) y de correlacion de Pearson. Los resultados muestran una prevalencia del 36,2% de agotamiento emocional, 15,7% de despersonalizacion y el 7,9% de baja realizacion profesional, que cambian segun la categoria profesional. El analisis de asociacion muestra que cuanto menor es la edad y la experiencia profesional mayor es el agotamiento emocional. El feedback positivo de los pacientes disminuye el cansancio emocional y aumenta la realizacion profesional. El feedback positivo de los jefes disminuye el Agotamiento Emocional. A partir de los resultados, es posible pensar en estrategias para reducir la prevalencia de SB entre los profesionales de la salud, teniendo en cuenta las caracteristicas especificas de cada grupo profesional. EnglishThe study aims to identify the prevalence and factors associated with Burnout in 127 graduates from Basic Health Units in the municipal network of a city in the metropolitan area of Porto Alegre. The research tools used were a questionnaire to obtain socio-demographic data and employment variables, the battery of psychosocial risk assessment and the Maslach Burnout Inventory. The results showed a prevalence of 36.2% of Emotional Exhaustion, 15.7% of Depersonalization and of 7.9% Professional Accomplishment. The association analysis shows that psychologists have higher levels of Emotional Exhaustion and Professional Accomplishment and doctors have higher levels of Depersonalization. The higher the pay, the higher Depersonalization and Professional Accomplishment levels go. The role conflict results in an elevation of the dimensions of Emotional Exhaustion and Depersonalization. The positive feedback from patients decreases Emotional Exhaustion and increases Professional Accomplishment, while feedback from supervisors also decreases Emotional Exhaustion.

Un paso más en el estudio de las desigualdades sociales en la provisión de atención primaria desde la perspectiva de la población

Evaluation of Primary Care (PC) must include different perspectives. The objective of the study was to know the assessment of the PC in Catalonia and detecting whether or not a pattern of social inequality exists, through users experience. A cross-sectional study was conducted, in a representative sample (n = 13,292) of the Catalonia population (aged 15), who identify a reference professional. It was studied an index of experience with PC by personal variables and variables about the reference professional. Negative binomial regression models (bivariate and multivariate) were adjusted to obtain the prevalence ratios and confidence intervals of 95%. The index gained an average of 71 (scale 0-100). A rating above 70 was associated with higher age, greater number of visits in the last year, more time with the same professional and living in an area of lower population density. Items with lower scores: telephone attention and availability of mental health services. We concluded that factors associated with a better experience are associated with more frequent visits to professionals. We did not detect social inequalities.

Counselling in STD/HIV/AIDS in the context of rapid test: Perception of users and health professionals at a counselling and testing centre in Porto Alegre

This article discusses the perceptions of professionals and users about counselling practices at a counselling and testing centre in Porto Alegre/RS based on interviews with 27 service users and 14 members of the staff. The following categories emerged from thematic analysis: professionals’ perceptions on counselling, users’ perceptions on counselling and changes in counselling due to the introduction of rapid test procedures. The results show that, although initially there were some imprecision and apparent contradictions in its use, rapid testing was considered an invitation to rethink practices, bringing service closer to users’ needs.