Reinaldo Antonio da Silva Sobrinho

Perspectivas de eliminação da hanseníase como problema de saúde pública no Estado do Paraná, Brasil

Leprosy, an endemic contagious/infectious disease, is still a public health problem in most States of Brazil, despite an important decrease in the prevalence rate in recent years. The current study aims to analyze the prospects for the elimination of leprosy in the State of Paraná, based on detection and prevalence rates for the years 2000 to 2005, in addition to data on gender, age, clinical form, operational classification, and number of skin lesions. Data were obtained from the Reportable Diseases Information System (SINAN) and the Tabnet software. Leprosy detection and prevalence rates in Paraná remained unaltered during the study period. The leprosy detection rates were high or very high in the majority of the health districts in the State. In terms of prevalence, eight health districts had reached the goal of eliminating the disease. In conclusion, the State of Paraná is close to reaching the goal of eliminating leprosy. Based on the study results, actions are recommended to eliminate the disease as a public health problem.

Atraso na busca por serviço de saúde para o diagnóstico da tuberculose em Ribeirão Preto (SP)

The scope of this paper is to analyze delays in locating health services for the diagnosis of tuberculosis in Ribeirao Preto in 2009. An epidemiological and cross-sectional study was conducted with 94 TB patients undergoing treatment. A structured questionnaire, based on the Primary Care Assessment Tool adapted for TB care was used. A median (15 days or more) was established to characterize delay in health attendance. Using the Prevalence Ratio, the variables associated with longer delay were identified. The first healthcare services sought were the Emergency Services (ES) (57.5%). The longest period between seeking assistance occurred among males, aged between 50 and 59, who earned less than five minimum wages, had pulmonary TB, were new cases, were not co-infected with TB/HIV, did not consume alcohol, had satisfactory knowledge about TB before diagnosis (with a statistically significant association with delay) and who did not seek healthcare close to home before developing TB. There is a perceived need for training healthcare professionals about the signs and symptoms of the disease, reducing barriers of access to timely diagnosis of TB and widely disseminating it to the community in general.

Avaliação do grau de incapacidade em hanseníase: uma estratégia para sensibilização e capacitação da equipe de enfermagem

Los principales problemas originados de la lepra son las inhabilidades. El actual estudio evaluo elgrado de incapacidad de los pacientes en tratamiento y los que ya habian sido curados en 11 ciudades de la14a Regional de la Salud de Parana, Brasil. Al mismo tiempo, promovio discusion y capacitacion de losprofesionales de enfermeria de los equipos locales. Fue verificado que el 79,8% de la poblacion evaluadapresento cierto grado de incapacidad y que los profesionales no conocian la tecnica de evaluacion. Era alto elporcentaje de pacientes con grado de incapacidad I e II, hecho que comprueba la diagnosis retrasada de loscasos. Se destaca la necesidad de un proceso permanente de autocuidado, asociado a la poliquimioterapia y laevaluacion continua de los casos nuevos y viejos para prevenir las inhabilidades consiguientes de la enfermedad.DESCRIPTORES: lepra; capacitacion en servicio; enfermeria en salud publica; equipo de enfermeria

Validity and reliability of a health care service evaluation instrument for tuberculosis

OBJECTIVE To evaluate the validity and reliability of an instrument that evaluates the structure of primary health care units for the treatment of tuberculosis. METHODS This cross-sectional study used simple random sampling and evaluated 1,037 health care professionals from five Brazilian municipalities (Natal, state of Rio Grande do Norte; Cabedelo, state of Paraíba; Foz do Iguaçu, state of Parana; Sao José do Rio Preto, state of Sao Paulo, and Uberaba, state of Minas Gerais) in 2011. Structural indicators were identified and validated, considering different methods of organization of the health care system in the municipalities of different population sizes. Each structure represented the organization of health care services and contained the resources available for the execution of health care services: physical resources (equipment, consumables, and facilities); human resources (number and qualification); and resources for maintenance of the existing infrastructure and technology (deemed as the organization of health care services). The statistical analyses used in the validation process included reliability analysis, exploratory factor analysis, and confirmatory factor analysis. RESULTS The validation process indicated the retention of five factors, with 85.9% of the total variance explained, internal consistency between 0.6460 and 0.7802, and quality of fit of the confirmatory factor analysis of 0.995 using the goodness-of-fit index. The retained factors comprised five structural indicators: professionals involved in the care of tuberculosis patients, training, access to recording instruments, availability of supplies, and coordination of health care services with other levels of care. Availability of supplies had the best performance and the lowest coefficient of variation among the services evaluated. The indicators of assessment of human resources and coordination with other levels of care had satisfactory performance, but the latter showed the highest coefficient of variation. The performance of the indicators “training” and “access to recording instruments” was inferior to that of other indicators. CONCLUSIONS The instrument showed feasibility of application and potential to assess the structure of primary health care units for the treatment of tuberculosis.

Early diagnosis of tuberculosis in the health services in different regions of Brazil

13 Objetivo: analisar o primeiro contato do doente com os servicos de saude para o diagnostico oportuno da tuberculose (TB), em diferentes regioes do Brasil. Metodo: trata-se de estudo de coorte transversal, em 6 municipios das Regioes Sudeste, Sul e Nordeste. Para a coleta utilizaram-se fontes secundarias e entrevista com os doentes. Os dados foram analisados por meio de tecnicas descritivas e analise fatorial de correspondencia multipla. Resultados: a Atencao Primaria a Saude apresentou maior tempo e menor proporcao de diagnosticos. Os servicos associados ao diagnostico, na primeira consulta, foram os servicos especializados e os Programas de Controle da TB, que oferecem consulta e exames no proprio local. Conclusao: faz-se necessaria a organizacao do trabalho de forma integrada, entre as equipes dos diferentes servicos, para as acoes de controle da TB. Na Atencao Primaria a Saude, e preciso ainda observar o grau de incorporacao e sustentabilidade na execucao dessas acoes a pratica diaria dos servicos.

Evaluation of incapacity level in leprosy: a strategy to sensitize and train the nursing team

Los principales problemas originados de la lepra son las inhabilidades. El actual estudio evaluo elgrado de incapacidad de los pacientes en tratamiento y los que ya habian sido curados en 11 ciudades de la14a Regional de la Salud de Parana, Brasil. Al mismo tiempo, promovio discusion y capacitacion de losprofesionales de enfermeria de los equipos locales. Fue verificado que el 79,8% de la poblacion evaluadapresento cierto grado de incapacidad y que los profesionales no conocian la tecnica de evaluacion. Era alto elporcentaje de pacientes con grado de incapacidad I e II, hecho que comprueba la diagnosis retrasada de loscasos. Se destaca la necesidad de un proceso permanente de autocuidado, asociado a la poliquimioterapia y laevaluacion continua de los casos nuevos y viejos para prevenir las inhabilidades consiguientes de la enfermedad.DESCRIPTORES: lepra; capacitacion en servicio; enfermeria en salud publica; equipo de enfermeria

Diagnóstico oportuno da tuberculose nos serviços de saúde de diversas regiões do Brasil

13 Objetivo: analisar o primeiro contato do doente com os servicos de saude para o diagnostico oportuno da tuberculose (TB), em diferentes regioes do Brasil. Metodo: trata-se de estudo de coorte transversal, em 6 municipios das Regioes Sudeste, Sul e Nordeste. Para a coleta utilizaram-se fontes secundarias e entrevista com os doentes. Os dados foram analisados por meio de tecnicas descritivas e analise fatorial de correspondencia multipla. Resultados: a Atencao Primaria a Saude apresentou maior tempo e menor proporcao de diagnosticos. Os servicos associados ao diagnostico, na primeira consulta, foram os servicos especializados e os Programas de Controle da TB, que oferecem consulta e exames no proprio local. Conclusao: faz-se necessaria a organizacao do trabalho de forma integrada, entre as equipes dos diferentes servicos, para as acoes de controle da TB. Na Atencao Primaria a Saude, e preciso ainda observar o grau de incorporacao e sustentabilidade na execucao dessas acoes a pratica diaria dos servicos.

Práticas e percepções de educadores quanto ao aleitamento materno

Objective: To know education professionals’ breastfeeding-related practices and perceptions. Methods: Descriptive and exploratory study, with a qualitative approach. Data collection took place in 2015, with 19 education professionals working in nurseries of day-care centers in a bordering municipality of Southern Brazil. The Collective Subject Discourse technique was used in order to organize and tabulate the qualitative data. Results: The construction of the collective subject discourses led to the evidence that, in the teachers’ perception, breastfeeding is considered negative and there are no benefits in this practice for children enrolled in nursery I, mainly because the mothers could not manage to go to the daycare center. Thus, the place was regarded as an unsuitable location for the mother to breastfeed. The professional’s perception of breastfeeding renders it a hindrance to their professional practice and, therefore, the teaching, maintenance and promotion of breastfeeding doesn´t occur. Moreover, issues regarding the school infrastructure were mentioned as difficulties for the implementation of breastfeeding. Conclusion: The professionals consider that breastfeeding may represent a barrier to their professional performance; they report the existing difficulties for such practice and do not actually encourage it.

Self Care Assisted In People With Tuberculosis Treatment

Introduction: In supported self-care, health professionals encourage individuals to take care of themselves from the adoption of healthy habits. In the case of patients with TB, self-care is important because it can contribute to the reduction of treatment abandonment. Objective: To analyze self-care in treating people with tuberculosis assisted in health facilities of primary care and compare the scores of self-care supported by the type of service and the professional health function. Method: a Cross-sectional study in a city in northeastern Brazil, with 100 professionals (nurses, nursing technicians, medical and health community agents) working in the health units of primary care. Data collection was conducted from November 2013 to January 2014, using a structured questionnaire proposed by MacCooll Institute for Health Care Innovation, specifically the area of supported self-care. Descriptive and inferential statistics were used for the analysis. The study was approved by the Research Ethics Committee, by the protocol: 456,332. Results: the four items of supported self-care were identified (support, records, reception and behavior change interventions), most of the health facilities, a reasonable capacity of attention to people with TB. When it was assessed among professionals and the types of units, it was also rated with a reasonable capacity, statistical difference. Conclusion: it was found that the self-care supported practiced by primary health care professionals is effective in helping the individuals with tuberculosis, having in view the homogeneity found in capacity classified as reasonable between the various units of the municipality, the types of unit and the categories of professionals.

PERCEPÇÃO DE AÇÕES PREVENTIVAS E AUTOCUIDADO DO ACADÊMICO DO CURSO DE ENFERMAGEM

O autocuidado pode ser definido como a pratica de atividades que as pessoas realizam em seu proprio beneficio na manutencao da saude e bem-estar. O objetivo foi identificar a pratica do autocuidado entre os academicos de Enfermagem/Unioeste, Foz do Iguacu/PR. Trata-se de um estudo transversal exploratorio, cuja populacao constitui-se dos 188 academicos do curso de Enfermagem, a coleta de dados foirealizadano primeiro semestre de 2012,apos a aprovacao no Comite de Etica/Unioeste. Os dados foram colhidos mediante aplicacao de um questionario para os 120 alunos que aceitaram participar voluntariamente da pesquisa.Sobre o tema autocuidado, 91 alunos (75,83%) citaram a pratica de exercicios fisicos, porem apenas 44 (36,66%) praticam, e o mesmo ocorreu para todas as outras medidas de autocuidado apresentadas. A maioria tambem nao realizou exames preventivos. Embora os academicos tenham conhecimentos para executar o autocuidado, nao o praticam. Existe uma dualidade entre o discurso de um futuro profissional e o que eles efetivamente vivenciam.