Virginia Alonso Hortale

Avaliação estratégica de educação em grupo e individual no programa educativo em diabetes

OBJECTIVE To compare the effectiveness of individual and group strategies in a diabetes education program. METHODS A total of 104 type-2 diabetes outpatients enrolled in an education program of a teaching hospital in Belo Horizonte, Southeastern Brazil, were randomly selected and assigned to two different education strategies: group education (54 subjects) and individual education (50 subjects). Group education comprised three monthly sessions, which involved play and interactive dynamics. In parallel, a second group received individual education. Subjects were follow up for six months during 2006 and they were evaluated using specific questionnaires: knowledge of diabetes, psychological attitudes, change in behavior, quality of life. Clinical evaluation was performed at baseline, three and six months of intervention. RESULTS Mean age was 60.6 years. The results of group and individual education were similar in the assessment tests of attitude, change of behavior and quality of life. A reduction in HbA1c levels was seen in both groups, but a statistically significant difference (p=0.012) was found only in the group education. CONCLUSIONS Both strategies of diabetes education were effective, however, group education was more effective than individual education for blood glucose control.OBJETIVO: Comparar a efetividade de estrategias, em grupo e individual, de programa educativo em diabetes. METODOS: Cento e quatro pacientes com diabetes tipo 2, atendidos no ambulatorio e com seguimento em programa educativo de hospital de Belo Horizonte (MG), foram aleatoriamente recrutados e alocados em dois grupos: educacao em grupo (n=54) e individual (n=50). A educacao em grupo consistia de tres encontros mensais, nos quais eram desenvolvidas dinâmicas ludicas e interativas. Simultaneamente, o outro grupo era acompanhado individualmente. O acompanhamento ocorreu por seis meses durante o ano de 2006, sendo avaliados por questionarios especificos: conhecimentos em diabetes, atitudes psicologicas, mudanca de comportamento, qualidade de vida. Foi realizada avaliacao clinica no tempo inicial, depois de tres e seis meses da intervencao. RESULTADOS: A media de idade dos pacientes era de 60,6 anos. Os resultados da educacao em grupo e individual foram semelhantes no teste de atitudes, mudanca de comportamento e qualidade de vida. Observou-se reducao nos niveis de HbA1c nos dois grupos, entretanto apenas no de educacao em grupo a diferenca apresentou significância estatistica (p= 0,012). CONCLUSOES: As duas estrategias do programa educativo em diabetes foram efetivas, porem a educacao em grupo apresentou melhores resultados de controle glicemico do que a individual.

Cuidados paliativos oncológicos: elementos para o debate de diretrizes nesta área

The aim of this study was to present elements for debating guidelines on palliative care programs for cancer. A literature survey searched various databases (MEDLINE, LILACS, and Cochrane Library), homepages of palliative care organizations, publications by renowned authors in this area, reference textbooks on the subject, relevant articles cited by these books, and the thesis/dissertation database of CAPES (the Brazilian Coordinating Body for Training University Level Personnel). The data were grouped into four thematic categories: symptomatic palliation, organization of services, psychosocial characteristics, and spiritual characteristics. The article then proceeds to discuss cancer as a public health problem and its impact on individuals, the concept of palliative care and its context in health care, program models and their guidelines, death and dying, and care and caregivers. The study concludes by discussing the challenges for the Brazilian National Health System in structuring end-of-life programs as a consequence of the populations aging and increasing cancer incidence.

Operacionalizando as categorias acesso e descentralização na análise de sistemas de saúde

This paper presents a proposal for operationalization of access and decentralization in a health systems analytical model. It supports the hypothesis that decentralization of health systems fosters better access by users. This proposal is intended to contribute to a closer link between these categories and observed reality.

Óbitos perinatais evitáveis e ambiente externo ao sistema de assistência: estudo de caso em município da Região Metropolitana do Rio de Janeiro

This paper focuses on the role of environmental factors external to the health care system in the occurrence of perinatal deaths in maternity hospitals belonging to the local health system in a city in Greater Metropolitan Rio de Janeiro in 1994. Elements from the political and administrative context that contribute to an understanding of the relationship between failures in health care and structural deficiencies in these maternity hospitals were divided into four groups of variables: distribution of resources, spatial and temporal factors, organizational and managerial features, and action by interest groups. Semi-structured interviews were conducted. The study concluded that poor performance in four groups of variables may have contributed to perinatal mortality: distribution of resources was insufficient to provide quality in health care, especially in private maternity hospitals; there was no formal or informal regional or hierarchical organization of obstetric care in the city; Ministry of Health guidelines were ignored in all four maternity hospitals, while in three of the hospitals there were no admissions procedures and delivery and fetal follow-up listed in their own rules; and the level of actual participation was low.

A qualidade nos serviços de emergência de hospitais públicos e algumas considerações sobre a conjuntura recente no município do Rio de Janeiro

The main focus of the QUALISUS Program run by Brazils Ministry of Health is the quest for quality in healthcare services, particularly in hospital emergency rooms. Taking as an example the crisis in health emergency services in Rio de Janeiro, this paper discusses some structural characteristics of this Program, emphasizing enhanced responsibility and a stronger team spirit for modified intake systems and building up of seamlessly integrated healthcare networks. Identifying possible solutions for this crisis based not only on funding, it suggests a quest for a new identity, redefining and integrating healthcare vocations, structuring flows and revising the work processes of healthcare services through a systemic approach focused on the user.

Programa Saúde da Família: supervisão ou "convisão"? Estudo de caso em município de médio porte

This study discusses supervision of the Family Health Program (FHP) in Teresopolis Rio de Janeiro State, Brazil, based on a qualitative case study approach. Considering that supervision is an important tool in health programs management, five main objectives were achieved: analysis of supervisory activities, description of characteristics and working patterns, outlining of FHP supervisor profiles, and identification of subjective factors that could interfere in the supervision process. Finally, supervision was considered as an essential step in program organization and implementation. Information sources were interviews with program supervisors and staff members, observation, and document search. The aim was to identify perceptions, attitudes, values, and tendencies concerning supervision. Thanks to this study, it was possible to discuss participatory supervision in the health area, by providing a more level relationship between participants and their effect on health practices, fostering the autonomy of various players in the supervisory process and fostering program support, both suitable for changes in the Brazilian health care model.

Desafios na construção de um modelo para análise comparada da organização de serviços de saúde

This paper presents different models that describe health determinants, services, and systems. It highlights the important model developed by Contandriopoulos, proposing a separation between the health status and health care circuits. The article is intended as a contribution to the field of comparative analysis with a new theoretical, methodological, and evaluative approach. Problems were identified in the development of a new model. Decentralization and access are introduced as categories, suggesting that they may take part in such new model.

[Avoidable perinatal deaths and obstetric health care structure in the public health care system: a case study in a city in greater metropolitan Rio de Janeiro].

This paper investigates the occurrence of potentially avoidable perinatal deaths by associating failures in obstetric care with structural deficiencies in four maternity hospital comprising the local health care system in a city in Greater Metropolitan Rio de Janeiro in 1994. Information sources were a questionnaire, interview, observation, and hospital records. A theoretical organizational model was applied in data analysis. The four maternity hospitals showed problems in the three groups of factors used in this study: physical infrastructure, services, and equipment; organizational and administrative characteristics; and professional organization. In two maternity hospitals, the delay in cesarean deliveries was explained by deficiencies in the group of factors that includes facilities, services, and equipment. Health care failures directly associated with the physician were explained by high percentages of negative predisposing factors (mainly in the two private hospital), skill-related problems (more clearly in the two public hospitals), and by absence of measures for redirecting practice.

Evaluation of group and individual strategies in a diabetes education program

OBJECTIVE To compare the effectiveness of individual and group strategies in a diabetes education program. METHODS A total of 104 type-2 diabetes outpatients enrolled in an education program of a teaching hospital in Belo Horizonte, Southeastern Brazil, were randomly selected and assigned to two different education strategies: group education (54 subjects) and individual education (50 subjects). Group education comprised three monthly sessions, which involved play and interactive dynamics. In parallel, a second group received individual education. Subjects were follow up for six months during 2006 and they were evaluated using specific questionnaires: knowledge of diabetes, psychological attitudes, change in behavior, quality of life. Clinical evaluation was performed at baseline, three and six months of intervention. RESULTS Mean age was 60.6 years. The results of group and individual education were similar in the assessment tests of attitude, change of behavior and quality of life. A reduction in HbA1c levels was seen in both groups, but a statistically significant difference (p=0.012) was found only in the group education. CONCLUSIONS Both strategies of diabetes education were effective, however, group education was more effective than individual education for blood glucose control.OBJETIVO: Comparar a efetividade de estrategias, em grupo e individual, de programa educativo em diabetes. METODOS: Cento e quatro pacientes com diabetes tipo 2, atendidos no ambulatorio e com seguimento em programa educativo de hospital de Belo Horizonte (MG), foram aleatoriamente recrutados e alocados em dois grupos: educacao em grupo (n=54) e individual (n=50). A educacao em grupo consistia de tres encontros mensais, nos quais eram desenvolvidas dinâmicas ludicas e interativas. Simultaneamente, o outro grupo era acompanhado individualmente. O acompanhamento ocorreu por seis meses durante o ano de 2006, sendo avaliados por questionarios especificos: conhecimentos em diabetes, atitudes psicologicas, mudanca de comportamento, qualidade de vida. Foi realizada avaliacao clinica no tempo inicial, depois de tres e seis meses da intervencao. RESULTADOS: A media de idade dos pacientes era de 60,6 anos. Os resultados da educacao em grupo e individual foram semelhantes no teste de atitudes, mudanca de comportamento e qualidade de vida. Observou-se reducao nos niveis de HbA1c nos dois grupos, entretanto apenas no de educacao em grupo a diferenca apresentou significância estatistica (p= 0,012). CONCLUSOES: As duas estrategias do programa educativo em diabetes foram efetivas, porem a educacao em grupo apresentou melhores resultados de controle glicemico do que a individual.

Projeto Integrar: avaliação da implantação de serviços integrados de saúde no Município de Vitória, Espírito Santo, Brasil

This article describes an experience with the integration of various healthcare services, called the Integrar Project, in Vitória, capital of the State of Espírito Santo, Brazil, and analyzes the projects contribution to the development of comprehensive healthcare practices. The case study used a qualitative approach and covered the period from 2000 to 2003, identifying the projects potential in the areas of maternal and child health, continuing health education, and the family health strategy, but also identified difficulties in establishing integrated treatment projects involving both the Family Health Program teams and the various medical specialties. To a major extent the work proposal failed to materialize, highlighting the need to review the strategy to include new forms of communications and developing greater formal cooperation, beyond the existing informal coordination between individuals, teams, or services, based on a contractual logic in public healthcare services. Standards and norms that are negotiated through dialogue and a management contract would allow the involvement of professionals in sharing common goals and changing work processes. Such changes would involve management tools and new values to ensure accountability.