Marly Marques da Cruz

A mortalidade por aids no Brasil: um estudo exploratório de sua evolução temporal

Summary This descriptive and exploratory study was based on the analysis of AIDS standardized mortality rates in Brazil along the period of 1982 to 2002. The analysis of the AIDS mortality profile considered the following variables of the Mortality Information System: sex; age; marital status; educational level; and occupation. The results evidenced the decrease of mortality rate after 1996 when public health services introduced antiretroviral treatment, although there was an important deceleration of this decrease in the last three years. The reduction of the mortality rate is greater in the male sex than in the female one; and young adults and lower-class people are still the most affected ones. It can be inferred that the deceleration of the decrease of AIDS mortality rate in the country suggests the need of increasing the early diagnosis access and assistance, the improvement in the quality of the care for those who live with HIV/AIDS, and the adjustment of the epidemiological surveillance and monitoring of AIDS deaths to more effectively control of the epidemic.

Trends and characteristics of AIDS mortality in the Rio de Janeiro city after the introduction of highly active antiretroviral therapy

We examined the characteristics of AIDS mortality in Rio de Janeiro city from 1995 to 2003. During this period, highly active antiretroviral therapy with protease inhibitors was made available, and it changed the pattern of the epidemics. There was a 47.5% reduction in the number of AIDS deaths within the period, with an increase in the proportion of women among the deceased; their schooling was lower than that of the men, similar to the trends of the national-level epidemics. The main place of death changed from university hospitals to emergency rooms. The proportion of cases reported to the National Diseases Surveillance System (SINAN) reported only through the death certificate remained high. Although there is free distribution of antiretrovirals by the public health system, many patients still lack access to diagnosis and treatment. We need to give priority to access to anti-HIV testing and treatment, to increase the quality of care and to look into the issue of adherence in order to further reduce AIDS mortality.

O sistema de informação de AIDS do Município do Rio de Janeiro: suas limitações e potencialidades enquanto instrumento da vigilância epidemiológica

This study analyzes the Rio de Janeiro Municipal AIDS Information System, specifically the systems strengths and limitations in the epidemics current context, from a broader perspective of epidemiological surveillance. The objective was to provide a brief description of the system, considering its different components. The authors further analyzed records pertaining to the reporting and investigation of AIDS cases from 1985 to 1995 and an update of the database as a contribution to the systems quality. The results showed improvement in the consistency of the AIDS database, particularly for the following variables: occupation, neighborhood, school, and exposure category, although the study found concrete limitations in the systems design and structure for dealing with the complexity and heterogeneity of AIDS surveillance. The study thus identified the need to construct an efficient HIV/AIDS surveillance system, based on epidemiological indicators aimed at monitoring and evaluating changes in the epidemiological pattern and analysis of the impact on morbidity and mortality resulting from access to more efficient forms of prevention and new treatments.

Phenylketonuria, congenital hypothyroidism and haemoglobinopathies: public health issues for a Brazilian newborn screening program

In this study, the frequency of detected congenital hypothyroidism, phenylketonuria and haemoglobinopathies in the State of Rio de Janeiros (Brazil) Newborn Screening Program (NBSP) was analyzed between the years of 2005 and 2007. There were two Newborn Screening Reference Centers (named NSRC A and B) with programmatic differences. In 2007, overall detection coverage reached 80.7%. The increase in the incidence of congenital hypothyroidism (1:1,030 in 2007) was attributed to the reduction of neonatal TSH value limits over time. The incidence discrepancy of phenylketonuria between NSRC A (1:28,427) and B (1:16,522) might be partially explained by the small number of cases. The incidence of sickle cell disease and its traits were uniformly high (1:1,288 and 1:21, respectively). This was coherent with the ethnic composition of the population. The differences in laboratory methods and critical values, in addition to other programmatic issues, may explain the variances in the results and limited analysis of the role of biological and environmental determinants in the occurrence of these diseases.

Sistema de Vigilância em Saúde no Brasil: avanços e desafios

O objetivo deste artigo e refletir sobre o percurso politico e organizacional do Sistema de Vigilância em Saude no Brasil. Trata-se de um estudo exploratorio e descritivo, realizado por meio de uma revisao narrativa em bases de dominio publico, no periodo compreendido entre 1998 e 2013. Os autores apresentam uma breve trajetoria do campo das vigilâncias epidemiologica, ambiental e sanitaria em direcao a um sistema mais integrado e resolutivo. Por fim, faz-se um debate acerca dos avancos e dos desafios de articulacao das propostas de mudanca organizacional e da integracao de praticas em busca de respostas mais efetivas no âmbito da Vigilância em Saude.

Análise de desempenho do Programa de Triagem Neonatal do Estado do Rio de Janeiro, Brasil, de 2005 a 2007

Guidelines emphasize that the appropriate time frame for neonatal screening with the heel stick test is from the 3rd to 7th day of life, in 100% of newborns. Treatment for congenital hypothyroidism and phenylketonuria, when initiated in the first two weeks of life, is capable of preventing the neurological sequelae of these diseases. The Rio de Janeiro State Neonatal Screening Program was accredited for Phase 2 of the National Neonatal Screening Program, with two program models (A and B). A performance analysis was conducted for the Neonatal Screening Program, for the years 2005 to 2007. Coverage increased from 2002 to 2007, reaching 80.4%, with 33.8% of the blood samples drawn in the first 7 days of life. The two models showed similar performance, short of the targets, with 50% of the confirmed cases receiving their diagnosis at more than 48 days of life. The delays accumulated in the various stages of the process can impede the benefits of early detection, the cornerstone of neonatal screening. The deleterious long-term effects transcend the individual sphere, with an impact on the health system and a major social burden.

Usos do planejamento e autoavaliação nos processos de trabalho das equipes de Saúde da Família na Atenção Básica

ABSTRACT: The PMAQ-AB analyzed access and quality of health primary care having axes structure, process and user satisfaction. The aim of this study was to characterize the use of plan-ning and auto evaluation for improving the work process of the teams, identifying strengths and weaknesses. Sectional study was conducted with data collected by the instrument for external evaluation whose variables relate to planning, self-evaluation and institutional support. Teams plan and self-evaluate their actions with support from and access to data produced. However, these practices are very poorly integrated and should be improved as to better guide adjustments in the teams working process. KEYWORDS: Health planning; Self-assessment; Family Health Strategy; Primary Health Care. Usos do planejamento e autoavaliacao nos processos de trabalho das equipes de Saude da Familia na Atencao Basica Uses of the planning and self-evaluation in the working processes of Family Health teams in Primary Care

Serviços farmacêuticos na atenção primária no município do Rio de Janeiro: um estudo de avaliabilidade

Objetivou-se descrever o desenvolvimento de etapas do estudo de avaliabilidade dos servicos farmaceuticos na Atencao Primaria a Saude do municipio do Rio de Janeiro. Pesquisa documental, com entrevistas realizadas para identificar objetivos, metas e envolvidos nos servicos na atencao primaria. Estes subsidiaram a construcao do Modelo Logico de intervencao que priorizou o desenvolvimento de atividades voltadas para o cuidado com o usuario e as comunidades, considerando duas celulas operacionais: gestao tecnica do medicamento e gestao do cuidado. O estudo de avaliabilidade mostrou-se fundamental por possibilitar organizar a construcao do modelo do servico farmaceutico com base em seus pressupostos.

Práticas de cuidado e população em situação de rua: o caso do Consultório na Rua

O estudo visa compreender as praticas de cuidado de um Consultorio na Rua, em Manguinhos/RJ, de forma a contribuir com o debate da Atencao Primaria a Saude para populacoes especificas. Trata-se de estudo de caso, tendo por procedimentos metodologicos: analise documental, observacao direta, entrevistas com profissionais e representante do movimento social. Os resultados apontam para a construcao de vinculos e para o rompimento com uma logica prescritiva, prevalecendo uma escuta qualificada. Os profissionais exprimiram existir ainda resistencias em atender a populacao em situacao de rua, comumente associada a imagens estigmatizantes, que expressam os desafios na garantia do acesso desta populacao ao SUS.

Evaluability of the Program to Value Primary Healthcare Professionals (PROVAB): management challenges

The objective of this article is to present the results of a study on the evaluability of the Program to Value Primary Healthcare Professionals (PROVAB in the Portuguese) that was created by the Brazilian Ministry of Health in 2011. The Program is part of the Manage Healthcare Work and Educationstrategy which seeks to invest in a number of measures aimed at improving and valuing the work carried out by primary healthcare teams. The research, which used qualitative methods, was carried out between February and November 2013 and involved five stages: (a) analysis of documents; (b) identification of potential users; (c) strategic analysis; (d) modelling of the intervention; (e) sharing of lessons learned. Data collection took place in three iterative phases: document analysis, key informant interviews and a workshop. The activities of the program were grouped into three areas: functional and working conditions, teaching/learning and management. The results showed that the program can be evaluated, since it was possible to specify its feasibility by means of a logical model. The potential and priority areas were mapped for future evaluations, whose central focus is to address the problem of unequal distribution of Brazilian health professionals.