Maria Helena Kovacs

Access to basic care for children seen at emergency departments

OBJECTIVE To investigate access to basic actions among children attended at emergency departments, reconstructing their trajectories to contact with the service for the event in question, characterizing links with basic care and the appropriateness of morbidity to the organizational profile of the service attended. METHODS Cross-sectional study, carried out in November 2002 and from February to May 2003 at five public pediatric emergency services, of a sample of 383 children under five years old, resident in Recife, calculated for an estimated 20% of appropriate morbidity, 5% error and 10% loss. Using standard instruments applied by eight purposely-trained interviewers. RESULTS During their trajectories to reach the contact in question, 38.5% of the children had sought other services, primarily: emergency (48.3%), family health team (19.7%) and health centers (17%), with 18.4% having experienced difficulties with primary care. 39.4% only used emergency and at some point 54.4% had resorted to this type of service. Approximately 88% are registered with a unit: 34.5% with the family health team (56.8% of these didn t use the service and 25.6% had sought them), 42% at health centers (59.1% of those didn t use the service and 18.2% had resorted to them). Only 18.9% preferred a basic unit when their child was ill, and therefore for the contact in question, the majority had been brought to their preferred service (like/confide in our professionals, geographic accessibility, and quality of care). Just 36.5% of the demand was defined as appropriate. CONCLUSIONS Despite of difficulties with the basic network in guaranteeing access and resolution, a substantial part of this spontaneous demand came from the enormous legitimacy of the emergency services as seen by the population.

Percepções e práticas de adolescentes grávidas e de familiares em relação à gestação

OBJECTIVES: to investigate information on perception and behavior of pregnant adolescents and their families related to current pregnancy. METHODS: descriptive study involving 19 pregnant adolescents from 10 to 19 years old under prenatal care in the family health units located in the Chie Island in Recife, from August to September 2002, and 14 family members and caretakers of these adolescents. Two collection tools were used and open questions were submitted to content analysis. RESULTS: adolescents are under the care of their mothers (71.5%), experienced their first sexual intercourse with their boyfriends (85.7%) when they were between 10-14 years old (52.7%) using contraceptives (68.4%) and have been pregnant before (42.1%). Half of them accepted their current pregnancy, 78.5% receive financial and psychological support from the childs father and 57.2% from their mother. Before becoming pregnant 10.5% were not going to school or held a job, currently 57.9% are in this condition. Their caretakers are women, 21.4% illiterate and 64.3% support them. When informed of the pregnancy they were happy/satisfied (35.7%) and unhappy (28.5%), 92.9% accepted the fact. CONCLUSIONS: pregnancy during adolescence is not always perceived as a problem and that reinforces the value of designing prevention strategies considering local reality.

Superposição de atribuições e autonomia técnica entre enfermeiras da Estratégia Saúde da Família

OBJETIVO: Compreender como enfermeiras da Estrategia Saude da Familia vivem a superposicao de atribuicoes e construcao da autonomia tecnica. PROCEDIMENTOS METODOLOGICOS: Pesquisa qualitativa realizada com 22 enfermeiras em Recife, PE, entre agosto de 2005 e novembro de 2006. A partir de avaliacao da gerencia (acesso geografico, conflitos na equipe, entre equipe e distrito, entre equipe e comunidade e violencia publica na area), em cada um dos seis distritos sanitarios foram selecionadas quatro equipes. Foram realizadas entrevistas semi-estruturadas. Os principais temas no roteiro referiram-se a expectativas e relevância do trabalho, organizacao e processo de trabalho e sentimentos sobre as praticas. Os resultados foram interpretados sob a perspectiva do burnout. ANALISE DOS RESULTADOS: Foi recorrente a opiniao das enfermeiras sobre numero excessivo de familias, suporte organizacional insuficiente e pressoes advindas de demandas insatisfeitas dos usuarios. A sobreposicao de assistencia e administracao provocou sobrecarga, gerando ansiedade, impotencia, frustracao e sentimento de ser injusticada na divisao de tarefas na equipe. A dimensao clinica da pratica motivou inseguranca de natureza tecnica e etica, alem de satisfacao pelo poder e prestigio conquistados pela categoria profissional. A formacao medica especializada representou um obstaculo para concretizar a interdependencia da autonomia e responsabilidade. Foram relatados estresse, insatisfacao, adoecimento fisico e mental, reconhecimento da relevância do trabalho e importância do proprio desempenho e baixo envolvimento laboral. CONCLUSOES: Diante da falta de expectativa de mudancas em curto prazo, a sobreposicao de baixa realizacao profissional e esgotamento provocam atitudes negativas, indicando a importância da promocao da saude para ampliar a possibilidade de interferencia e mudanca nas condicoes de trabalho.

Organization of health practices and vulnerability to childhood diarrhea

OBJECTIVES: This study aimed to characterize, the organization of health practices related to the reduction of vulnerability to childhood diarrhoea. METHODS: A longitudinal study was carried out, with two interconnected transversal cuts, in 14 health services (11 health centres and 3 hospitals), located in six municipalities of Pernambuco that participated of the Diarrhoea Control Implementation Project coordinated by the Health State Department. The data collection was performed through observation, interviews with professionals and mothers of the children, and clinic histories revision. RESULTS: Overall, there was a high proportion of patients who either did not get consulted or had to wait for a long time after their arrival at the health service. No orientation was given on the use of oral rehydration salts at home; little advice on the signs and symptoms of an aggravating episode was given, an elevated number of drugs were prescribed to the children with diarrhoea; and there was high degree of omission to record the patientś hydration status and the treatment offered. The educational practice is systematic only in 3 services, and only in these services there is delegation of activities to the nursing team and articulation with community health agents. On the 2nd phase of the study, one of the few changes identified was a discrete increase in weight measurement and its recording on a Chart. However, in the intervention period 69.6% of the health team members noticed an improvement on the pediatric assistance. CONCLUSIONS: The results reveal the great deficiency of the evaluated services in operating educational and healing activities related to diarrhoea control. So the observed practices concerning the attention to the children have contributed to increase childhood vulnerability, which shows the need to reorganize disease control actions, among the myriad of other actions related to this social group.

Avaliação continuada da educação permanente na atenção à criança na estratégia saúde da família

This article presents a continuous evaluation of work involving permanent education regarding childcare and the results that can be attributed to it, as carried out by family health teams managed jointly by the Community Outreach Program of the Instituto Materno Infantil Prof. Fernando Figueira, IMIP and the Municipal Departments of Health of the city Recife and the city of Olinda, State of Pernambuco, Brazil. With the support of external consultants, the group carried out systematic critical reflection, organized around the categories of performance, effects and effectiveness, with a view to enhancing the work under way. The sources of information used were the daily registers of the group and the teams and their views regarding the work. Despite the difficulty of transforming the changes brought about into routines, continuous education seems to have improved the quality of childcare. The satisfaction the teams feel corroborates this feeling that this work is both feasible and productive.

Opinöes sobre a doença entre membros da rede social de pacientes de hanseníase no Recife

O presente artigo descreve um estudo realizado no Recife, Brasil, entre novembro de 1993 e julho de 1994, com a finalidade de explorar as opinioes dos membros da rede social (por exemplo, familiares, amigos e vizinhos) de portadores de hanseniase na avaliacao, interpretacao e manejo das manifestacoes corporais da doenca na trajetoria que levou ao diagnostico. A amostra constou de 93 membros da rede social, com idade entre 20 e 70 anos, que apoiaram o curso de acao de 83 pacientes diagnosticados no periodo do estudo. A analise buscou detectar variaveis capazes de discriminar os membros da rede de apoio dos pacientes de hanseniase classificados como casos (presenca de incapacidades ou lesoes precursoras de incapacidades) ou controles. O estudo evidenciou a escassez de informacoes sobre a transmissao da hanseniase e revelou um quadro transicional onde se confrontam expectativa de cura e uma visao estigmatizante das consequencias da doenca. Apenas uma quarta parte dos sujeitos do estudo suspeitou, antes do diagnostico, que o paciente era portador de hanseniase, o que sugere baixa percepcao do risco representado pela doenca e reforca a concepcao da invisibilidade das suas manifestacoes corporais. Os resultados mostram um perfil de percepcao e manejo da hanseniase que pode facilitar a propagacao da doenca e a instalacao ou agravamento das suas consequencias fisicas e sociais.

Vulnerabilidade programática na prevenção da transmissão materno-fetal da AIDS

OBJECTIVES: to assess the effectiveness of maternal-fetal HIV transmission prevention programs at the pre-natal care stage. METHODS:a descriptive study was held in the city of Recife, Pernambuco, from May to July 1998, in 27 locations of six Sanitary Districts: 19 Health Centers, two Maternity Clinics and six Family Health Programs (PSF). The study focused on observation and interviews of managers and technical teams. Their work was followed for at least two shifts in randomly selected weekdays, totaling 214 hours. The 355 pregnant women present filled a questionnaire requiring the following information: age, obstetrics history, number of medical vi-sits, accessibility and orientation received. RESULTS: unmet demand was found in 63,0% of the institutions. Only 41,6% of pregnant women being followed had their present medical visit scheduled by the service following the previous one (PSF). In relation to sexually transmitted diseases: all prescribed the Lues Test and 67,0% summoned sexual partners in case of positive testing. The anti-HIV test was not universally offered and counseling was not provided. Only 26,7% of the doctors having identified pregnant women at risk of AIDS prescribed the test and 19,8% of the pregnant women received guidance for sexually transmissible diseases. CONCLUSIONS: institutional vulnerability in the execution of program measures and the broad range of health requirements for women in the reproductive age group emphasizes the need of organizing pre-natal care.

Acessibilidade organizacional de crianças com paralisia cerebral à reabilitação motora na cidade do Recife

OBJECTIVES: to characterize organizational access to motor rehabilitation services for children with cerebral paralysis. METHODS: a descriptive, retrospective, censusbased study, carried out between January and June 2009, at three rehabilitation services in Recife. The study covered 38 children aged less than five years, with the disorder, residing in Recife. A questionnaire was used to obtain information from the individual accompanying the child and the childs medical records. The variables were organized according to current service, first service used, and number of services used. RESULTS: of the people accompanying the children, 94.7% were one of the childs parents or legal guardian (76.3% mother) and 68.4% of the children were aged between 25 and 59 months. Half had attended more than one service, in 28.2% of cases simultaneously. For 28.2% rehabilitation was commenced more than six months after diagnosis. The children were mostly referred to the service by a doctor (75.8%) and 86.4% had a maximum waiting time of 30 days for the first consultation with a physiotherapist. The parents or legal guardians generally found it difficult to schedule the first consult (68.4%). Greater difficulty in continuing physiotherapy was found among those who used more than one service. CONCLUSIONS: there appears to be a hidden demand. Use of more than one service (at times simultaneously) suggests dissatisfaction with the level of care. Political and organizational processes relating to the referral/counter-referral system should be accorded high priority.

Prevalência de cárie e fatores associados em crianças da comunidade do Vietnã, Recife

OBJETIVOS: conhecer a prevalencia de carie e fatores associados em criancas de 6 a 12 anos cadastradas na unidade de saude da familia do Vietna, Recife. METODOS: inquerito realizado de setembro a novembro de 2002. A amostra de 128 criancas foi estratificada por idade e microarea, calculada com 90% de prevalencia de carie, 5% de erro e 10% de perdas. Utilizaram-se ficha clinica para avaliar a condicao dentaria (preenchida apos calibracao por dois cirurgioes-dentistas) e questionario. RESULTADOS: 14,1% das criancas estavam livres de carie. Aos 11 e 12 anos, num polo, 29,7% tinham o CPO-D (numero de dentes permanentes cariados, perdidos e restaurados) = 0, noutro, 29,7% valores entre 4-8. O CPO-D diminui significativamente com o crescimento da renda familiar (p=0,02). O numero de dentes deciduos cariados, perdidos e restaurados (ceo-d) atinge valor maximo aos sete anos (4,50) - idade que acumula a maior experiencia relativa de carie e necessidade de tratamento - sendo quase significativamente maior (p=0,05) nas familias com maior numero de filhos com ate 12 anos (4,50). A escolaridade dos responsaveis, o numero de limpezas diarias e o acesso a atencao odontologica nao afetam esses indices. CONCLUSOES: a alta prevalencia e polarizacao da carie reiteram a importância de conhecer as necessidades de saude para priorizar os grupos mais vulneraveis.

Diagnóstico precoce da hanseníase: o caso dos serviços de saúde no Recife(Pernambuco), Brasil

O presente trabalho e um estudo descritivo, realizado na cidade do Recife de marco a setembro de 1994. O estudo buscou caracterizar as condicoes existentes nos servicos de saude para o diagnostico precoce de hanseniase, com enfase na acessibilidade dos usuarios aos servicos e na qualidade do atendimento. A amostra constou de 32 servicos de saude utilizados durante o processo diagnostico de 183 pacientes de hanseniase. A infra-estrutura organizacional foi caracterizada atraves de entrevistas com os gerentes dos servicos. O funcionamento foi investigado atraves de observacoes da rotina dos servicos, em particular as atividades de arquivo e triagem. Um total de 1998 pacientes foram entrevistados para determinar a facilidade de acesso. Para 1 000 pacientes foi estabelecido o tempo de consulta com os 123 medicos que estavam nas unidades no momento da amostragem. Para explorar a atitude e o conhecimento dos medicos sobre a hanseniase, selecionou-se, aleatoriamente, a partir de uma listagem nominal, 133 medicos destes servicos. Identificaram-se como dificuldades para o diagnostico precoce de hanseniase: a sistematica demanda reprimida (pessoas que procuravam os servicos mas nao eram atendidas); o longo tempo entre momento de marcacao e momento de realizacao de consultas (para pessoas que nao eram atendidas no mesmo dia); os longos tempos de espera pela consulta dentro dos servicos; a curta duracao da consulta; a baixa disponibilidade de recursos humanos treinados; a baixa proporcao de medicos que examinam toda a superficie corporal; as deficiencias no reconhecimento clinico da doenca e no conhecimento que leva ao diagnostico diferencial. Estes obstaculos podem facilitar a deterioracao fisica dos portadores de hanseniase e a persistencia da transmissibilidade; portanto, necessitam ser superados para que seja possivel eliminar a hanseniase.