Rose Ferraz Carmo

Vigilância da qualidade da água para consumo humano: abordagem qualitativa da identificação de perigos

A necessidade de que os servicos de vigilância da qualidade da agua para consumo realizem sistematica/permanente avaliacao de risco dos sistemas de abastecimento e um importante desafio. Como a metodologia de Avaliacao de Risco ainda nao se encontra estruturada para rotineira utilizacao, apresenta-se uma sugestao de identificacao de perigos e categorizacao de riscos associados ao abastecimento de agua, atraves da utilizacao da metodologia proposta no Manual de Procedimentos de Vigilância em Saude Ambiental Relacionada a Qualidade da Agua para Consumo Humano, com modificacoes. Foram identificadas situacoes de perigo na saida do tratamento e na rede de distribuicao do sistema estudado. A aplicacao da metodologia permitiu uma visao abrangente do sistema de abastecimento e informacoes para planejamento/priorizacao de medidas de forma a reduzir os perigos identificados e possiveis riscos a saude da populacao.

O contexto organizacional do Sistema de Informações sobre Nascidos Vivos segundo profissionais de saúde do nível municipal

Objectives: to understand the organizational context of the Live Births Information System (Sinasc), in the municipalities of the Brazilian State of Minas Gerais (MG), in 2010. Methods: a qualitative study was carried out in municipalities with health services where births occurred which adopted a decentralized Sinasc. Thirty health workers were interviewed and their comments submitted to thematic content analysis. Results: the categories analyzed were the importance of information for health management, the technical management of information and organizational features. The health workers interviewed considered Sinasc to be the best decentralized information system, but remarked that information produced by health surveillance is undervalued and underused. Poor professional training, limited infrastructure and information production and management were seen to be shortcomings of the Sinasc system. Conclusions: despite progress in the decentralization of the Sinasc, municipal services have encountered problems relating to the production and management of data. There is a need for greater institutional support, improved material resources, human resource and procedure management, appropriate for information collection and the use of this information to monitor, evaluate and plan maternity services.

Percepções da população e de profissionais de saúde sobre a leishmaniose visceral

Based on theoretical qualitative research reference methodology, this study sought to investigate the perception of visceral leishmaniasis (VL) by social actors directly involved in the prevention and control of the disease. Thirty-eight semi-structured interviews were conducted with residents, focus groups were staged with 18 health workers in an endemic VL area and depositions were collected, which after being processed by content analysis revealed shortcomings and challenges. The population associated VL with dogs, acknowledged their co-responsibility in tackling the disease and demanded information. Health workers identified environmental sanitation as an essential factor for VL prevention. Among the shortcomings, the lack of information about the disease and culpability of the individual because of non-adherence to prevention measures were observed, especially environmental management. Probably, approaches emphasizing the role of the environment as a health promotion agent and the timely definition of specific environmental measures against VL, constitute a prospect for overcoming these shortcomings. The consensus is that the main challenge for enhancing the prevention and control might be the participatory and dialogical construction of these approaches between health professionals and the population.

Social representations of drinking water: subsidies for water quality surveillance programmes

A qualitative study was developed aimed at understanding the social representations of water consumption by a segment of the population of a small town in Brazil. A total of 19 semi-structured interviews were carried out and subjected to a content analysis addressing opinion on drinking water, characteristics of drinking water and its correlation to health and diseases, criteria for water usage and knowledge on the source and accountability for drinking-water quality. Social representations of drinking water predominantly incorporate the municipal water supply and sanitation provider and its quality. The identification of the municipal water supply provider as alone responsible for maintaining water quality indicated the lack of awareness of any health surveillance programme. For respondents, chlorine was accountable for conferring colour, odour and taste to the water. These physical parameters were reported as the cause for rejecting the water supplied and suggest the need to review the focus of health-educational strategies based on notions of hygiene and water-borne diseases. The study allowed the identification of elements that could contribute to positioning the consumers vs. services relationship on a level playing field, enabling dialogue and exchange of knowledge for the benefit of public health.

Roedores inventariados em hospital veterinário e fragmento de mata nativa da Zona da Mata de Minas Gerais, Brasil: caracterização populacional e infecção por Leptospira sp.

Rodents can transmit several diseasesto to human and other animals and cause economic damages. This study looked at rodent population in a veterinary hospital concerning the followings aspects: rodent specie, sex, reproductive period, seasonality and research for Leptospira sp. In addition, rodents from an Atlantic forest fragment were captured and examined for Leptospira sp. Infection. Both the hospital and the forest were located at Zona da Mata region, Minas Gerais state, Brazil. 72 animals were captured at the veterinary hospital, 22 (30.6%) had been characterised according to Rattus rattus species and most of them (66.7%) were captured in small animals sector. There were no significant differences between males and females in reproductive period (c2=1.85; p=0.174; a=0.05). Rodents were captured all over the year. The highest percentages were observed in January (12.5%), February (15.2%), May (15.2%) and July (16.7%), and the lowest in August (2.8%), September (4.2%) and October (1.4%). There was no positive identification of animals for Leptospira sp., by microagglutination and histopathological exams. The animals from the forest were identified as wild rodents. 16 (50%) OligOryzomis sp, 11 (34.3%) Akodon sp, 3 (9.3%) Oximicterus sp, 1(3.2%) Bolomys sp, 1 (3.2%) Oryzomis sp. There weren´t either any findings of positive animals by histopathological exam. The presence of Rattus rattus in the veterinary hospital could be explained by the existence of appropriate places for hiding and food availability, in amount and quality suitable to this species. These conditions allow for the maintenance of rodents during all over the year, and of males and females ready for reproduction. At the hospital, the absence of positive results for Leptospira sp. do not exclude the potential of the rodents as reservoirs of such pathogen, since a veterinary hospital can always shelter domestic species for treatment that could be eliminating the Leptospira sp. The captured wild species apparently do not represent reservoirs of Leptospira sp.

O Programa de Qualificação e Desenvolvimento do Agente Comunitário de Saúde na perspectiva dos diversos sujeitos envolvidos na atenção primária em saúde

O Programa de Qualificacao e Desenvolvimento do Agente Comunitario de Saude (ACS) foi instituido pelo Ministerio da Saude visando investir em sua profissionalizacao. Este artigo teve por objetivo identificar, analisar e compreender as implicacoes do Programa de Qualificacao e Desenvolvimento concluido em 2009 pela Escola de Saude Publica do Estado de Minas Gerais na vida pessoal e laboral dos ACS e no processo de atencao a saude, na visao dos diversos sujeitos envolvidos na Atencao Primaria em Saude (APS): ACS, equipe de Saude da Familia, gestores, docentes e usuarios de 4 unidades basicas de saude em uma capital da regiao Sudeste. Este estudo tem carater qualitativo, utilizando como tecnicas de coleta de informacoes a analise documental, entre-vistas, grupo focal e questionarios. As informacoes coletadas foram analisadas por meio da tecnica de analise do discurso do sujeito e utilizando o programa SPSS, versao 16. Foram realizados 14 grupos focais com as unidades da Estrategia Saude da Familia, 4 com ACS e 4 com usuarios; 7 entrevistas, 4 com gestores e 3 com docentes do curso. No grupo dos ACS, ha predominio do sexo feminino e uma baixa rotatividade. Na analise do discurso, verificou-se que o programa investigado trouxe implicacoes favoraveis a vida pessoal e profissional do ACS e a APS. Contudo, e necessario estruturar o programa nos parâmetros da educacao permanente em saude, assegurando uma abordagem que propicie a construcao permanente de estrategias voltadas a melhoria das condicoes de vida e saude e a cidadania plena.

Vigilância da qualidade da água para consumo humano no âmbito municipal: contornos, desafios e possibilidades

A amplitude das atribuicoes da vigilância da qualidade da agua para consumo humano (VQACH) associada a heterogeneidade dos municipios brasileiros (perfil demografico e epidemiologico, recursos humanos e financeiros) impoe ao nivel local de gestao o desafio de implementar com efetividade e sustentabilidade as acoes previstas no modelo de atuacao da VQACH. Tendo como cenario de estudo um municipio mineiro de pequeno porte, o trabalho apresenta desafios e possibilidades vivenciados durante a implementacao do modelo. O atendimento as acoes estrategicas e basicas e aos principios doutrinarios, organizacionais e executivos previstos no modelo de atuacao foi verificado e as estrategias para o enfrentamento dos desafios impostos ao exercicio da VQACH foram apresentadas. A conformacao de uma equipe de profissionais em quantidade e qualidade compativeis com as acoes de VQACH foi aspecto fundamental, alem da melhor explicitacao de procedimentos como analise integrada dos sistemas de informacao e analise e classificacao do grau de risco a saude das diferentes formas de abastecimento de agua. O estudo permite adiantar aos gestores dos diferentes niveis de governo desafios e estrategias para contorna-los, bem como instrumentaliza a coordenacao da VQACH no nivel federal sobre questoes que necessitam tratamento mais detalhado e especifico.