Solena Ziemer Kusma

Promoção da saúde: perspectivas avaliativas para a saúde bucal na atenção primária em saúde

The evaluation of health promotion activities is a methodological and strategic challenge for establishing evidence to support health management processes. The use of adequate evaluation methods based on participatory analysis of local processes and contexts is essential to the success of interventions and policy formulation and implementation. Brazils Policy for Oral Health Promotion and Surveillance explicitly states the need to improve evaluation strategies for oral health promotion activities conducted in the context of primary care, allowing to evaluate not only their results and impact, but also the political and social process for achieving the objectives. This article proposes to systematize the literature on the evaluation of effectiveness in health promotion strategies, define a theoretical model, and propose a matrix of descriptors, exploring the basic references for health promotion and practices with the potential to reduce situations of vulnerability in population groups, combat inequalities, and incorporate community participation in health management.

Vacina como agente de imunização contra o HPV

Considerada uma infeccao de alta prevalencia em todo o mundo, o papiloma virus humano (HPV) e um DNA virus que infecta a mucosa genital e possui grande potencial oncogenico, sendo relacionado ao risco aumentado de lesoes do trato genital inferior, como o câncer cervical. Este câncer e responsavel pela morte de cerca de 231 mil mulheres por ano no mundo, o que torna o HPV um grande problema para a saude publica. Sabendo que a maneira mais eficaz e com melhor custo-beneficio para controlar uma doenca infecciosa e o desenvolvimento de vacinas, duas profilaticas foram desenvolvidas e aprovadas no Brasil, uma bivalente e outra quadrivalente. Essa revisao de literatura se propoe a apresentar as caracteristicas do virus HPV, os tipos de vacinas presentes no mercado, suas indicacoes e contraindicacoes, seus efeitos adversos, sua eficacia, seus titulos de anticorpos (GMT) e seu custo-efetividade.

Prevalência da hepatite viral C em adultos usuários de serviço público de saúde do município de São José dos Pinhais - Paraná

OBJECTIVES We aimed to investigate the prevalence of Hepatitis C in adult users of the Public Health Services of São José dos Pinhais - Paraná. METHODS We performed an epidemiological survey with a probabilistic sample of 5,017 volunteers who answered a questionnaire and were submitted to an anti-HCV quick test. Data were organized using Epi-info 3.5.1. The association between the presence of the disease and the factors of interest in the study were evaluated by the Chi-square test. We used a Logistic Regression Adjusted Model for risk factor analysis and the Wald test for decision making on the importance of the risk factors. RESULTS The absolute frequency of positive anti-HCV was 13, with a prevalence of 0.30%, (IC = 0.12% - 0.40%). A higher probability of the disease was reported in males (p = 0.008) and in single, separated and widowed subjects (p = 0.045); in subjects with prior HCV symptoms (p < 0.001) and a previous blood transfusion (p < 0.001); and with the presence of a tattoo (p = 0.033). Drug abuse, blood transfusion and age > 40 years increased the risk for disease, regardless of sex, age and marital status. CONCLUSION We found a low prevalence of Hepatitis C, albeit expected for Southern Brazil. Our results did not differ from other studies as to contamination risks. The study may contribute to highlight the importance of Hepatitis C, the need to implement strategies to cope with it, and stimulate better understanding of Hepatitis C.

Percepção de inovações na atenção às Doenças/Condições Crônicas: uma pesquisa avaliativa em Curitiba

Tradicionais modelos biomedicos de assistencia a saude, voltados para condicoes agudas e episodicas, nao tem respondido adequadamente as Condicoes Cronicas que requerem cuidado diferenciado, longitudinal e proativo. Esta pesquisa avaliativa sobre atencao a Condicoes Cronicas buscou identificar, em abordagem quantitativa, a percepcao de usuarios e equipes de saude sobre inovacoes, com a implantacao de um novo modelo de atencao. Os resultados demonstram associacao entre a implantacao do modelo e as mudancas ocorridas, tais como o cuidado compartilhado e o autocuidado. A forma como e dispensado o cuidado mostra relacao direta com o nivel de satisfacao das equipes de saude e pessoas usuarias.

To participate or not participate in unprofessional behavior – Is that the question?

Abstract Introduction: Medical education provides students with abundant learning opportunities, each of which is embodied with messages concerning what is expected from students. This paper analyses students? exposure to instances of unprofessional behavior, investigating whether they judge such behavior to be unprofessional and whether they also participate in unprofessional behavior. Methods: The survey developed in the Pritzker School of Medicine at the University of Chicago was the basis of this questionnaire that was answered by 276 students from two medical schools in Brazil and Portugal. Results: Unprofessional behavior was observed frequently by students in both universities, and the mean participation rates were similar (26% and 27%). Forty-five percent of students? participation in unprofessional behavior was explained by academic year, prior observation, and judgment. Discussion: The results indicate that once students have observed, participated in or misjudged unprofessional behavior, they tend to participate in and misjudge such behavior. The frequency with which students judged behaviors they had observed or participated in as ?borderline? or unprofessional could mean that they are experiencing moral distress. Conclusion: Proper discussion of unprofessional behavior should foster a broad debate to encourage empowered students, faculties, and physicians to co-create a more professional environment for patient care.

Pediatrician's knowledge on the approach of functional constipation.

Abstract Objective: To evaluate the pediatricians knowledge regarding the diagnostic and therapeutic approach of childhood functional constipation. Methods: A descriptive cross-sectional study was performed with the application of a self-administered questionnaire concerning a hypothetical clinical case of childhood functional constipation with fecal incontinence to physicians (n=297) randomly interviewed at the 36th Brazilian Congress of Pediatrics in 2013. Results: The majority of the participants were females, the mean age was 44.1 years, the mean time of professional practice was 18.8 years; 56.9% were Board Certified by the Brazilian Society of Pediatrics. Additional tests were ordered by 40.4%; including abdominal radiography (19.5%), barium enema (10.4%), laboratory tests (9.8%), abdominal ultrasound (6.7%), colonoscopy (2.4%), manometry and rectal biopsy (both 1.7%). The most common interventions included lactulose (26.6%), mineral oil (17.5%), polyethylene glycol (14.5%), fiber supplement (9.1%) and milk of magnesia (5.4%). Nutritional guidance (84.8%), fecal disimpaction (17.2%) and toilet training (19.5%) were also indicated. Conclusions: Our results show that pediatricians do not adhere to current recommendations for the management of childhood functional constipation, as unnecessary tests were ordered and the first-line treatment was not prescribed.

Potencial de efetividade das estratégias de promoção da saúde bucal na atenção primária à saúde: estudo comparativo entre capitais e regiões do Brasil

Objective: To evaluate the potential effectiveness of strategies of Oral Health Promotion (OHP), which are carried out by teams in primary health care (PHC) in Brazilian capitals and regions. Methods: A sample of 1,848 dentists were interviewed (1,819 valid responses) working in the PHC of 26 capitals and the Federal District. The Effectiveness of the Assessment Tool for the Promotion of Oral Health Strategies was used. It is composed of 23 indicators grouped into three dimensions: oral health, health public policies, and human and social development. The answers were arranged in a Likert scale (1-5), and the final score obtained for each sample unit can range from 23 to 115. Higher score values indicate greater potential for the strategy to promote oral health. Results: Statistically significant differences were identified among the analyzed geopopulation units considering the study object. The Southeast and South regions had better performance for the OHP strategies in comparison to the other regions of Brazil (p ≤ 0.01). Conclusions: The OHP strategies identified in the study were heterogeneous, with better results favoring the Southeast regions, with disadvantages for people living in capitals from the Central-North-Northeast of Brazil. Efforts should be undertaken aiming to qualify the PHC teams, especially for those in disadvantageous regions. Therefore, an alignment of PSB strategies to the principles and values of health promotion is required, addressed to the social health determinants (SHDs) and in order to fight the inequalities in oral health.Objective: To evaluate the potential effectiveness of strategies of Oral Health Promotion (OHP), which are carried out by teams in primary health care (PHC) in Brazilian capitals and regions. Methods: A sample of 1,848 dentists were interviewed (1,819 valid responses) working in the PHC of 26 capitals and the Federal District. The Effectiveness of the Assessment Tool for the Promotion of Oral Health Strategies was used. It is composed of 23 indicators grouped into three dimensions: oral health, health public policies, and human and social development. The answers were arranged in a Likert scale (1-5), and the final score obtained for each sample unit can range from 23 to 115. Higher score values indicate greater potential for the strategy to promote oral health. Results: Statistically significant differences were identified among the analyzed geopopulation units considering the study object. The Southeast and South regions had better performance for the OHP strategies in comparison to the other regions of Brazil (p ≤ 0.01). Conclusions: The OHP strategies identified in the study were heterogeneous, with better results favoring the Southeast regions, with disadvantages for people living in capitals from the Central-North-Northeast of Brazil. Efforts should be undertaken aiming to qualify the PHC teams, especially for those in disadvantageous regions. Therefore, an alignment of PSB strategies to the principles and values of health promotion is required, addressed to the social health determinants (SHDs) and in order to fight the inequalities in oral health.