Virgínia Torres Schall

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.

Health education: new perspectives

igualdade social e com a pre s e rvação da natureza). En t re t a n t o, a par dessa noção amplia-da de saúde, observando-se a prática, ve rifica-se que atualmente persistem diversos mo-delos ou diferentes paradigmas de educação em saúde, os quais condicionam difere n t e s p r á t i c a s, muitas das quais re d u c i o n i s t a s, o que requer questionamentos e o alcance de p e r s p e c t i vas mais integradas e part i c i p a t i va s. Uma educação em saúde ampliada inclui políticas públicas, ambientes apro p ri a d o s

Validação dos questionários de conhecimento (DKN-A) e atitude (ATT-19) de Diabetes Mellitus

OBJETIVO: Apresentar a adaptacao transcultural dos instrumentos Diabetes Knowledge Scale e Attitudes Questionnaires, especificos para avaliacao do conhecimento e atitudes de pacientes com Diabetes Mellitus. METODOS: Os instrumentos foram submetidos as seguintes etapas: apresentacao, traducao, back-translation, avaliacao das equivalencias semântica e idiomatica, cultural e conceitual, e pre-teste. Os questionarios foram aplicados em duas oportunidades, com intervalos de um mes, em uma amostra de 61 pacientes com Diabetes Tipo 2 cadastrados num hospital universitario. Utilizou-se um desenho de estudo de confiabilidade teste-reteste das respostas, que foram analisadas e estimadas pelo Coeficiente de Kappa. RESULTADOS: Os achados sugerem adequacao do processo de adaptacao cultural dos instrumentos para a lingua portuguesa. Na analise de confiabilidade, o coeficiente de Kappa alcancou nivel de concordância de moderada a forte (0,44 a 0,69) em grande parte das questoes. CONCLUSOES: Os instrumentos mostraram ser de facil compreensao pelos sujeitos do estudo e confiaveis e validos para uso na avaliacao de programas educativos em Diabetes Mellitus na realidade brasileira.

Acute schistosomiasis outbreak in the metropolitan area of Belo Horizonte, Minas Gerais: alert about the risk of unnoticed transmission increased by growing rural tourism

The present article describes the occurrence of 17 cases of acute schistosomiasis in the metropolitan area of Belo Horizonte, state of Minas Gerais, Brazil. All individuals affected took a bath in a swimming pool of a holiday resort that was provided with water from a nearby brook. The apparently clean water and the absence of snails in the pool gave the wrong impression that there was no risk for infection. During a malacological survey at the site snails of the species Biomphalaria glabrata were found and tested positive for Schistosoma mansoni. All the patients live in the middle-class area of Barreiro, metropolitan area of Belo Horizonte and have medium grade school education. The difficulties in establishing the right diagnosis is expressed by the search for medical attention in 17 different medical facilities, the wide range of laboratory test and the inadequate treatment administration. A lack of knowledge about the disease was found in all groups studied. The booming rural tourism in endemic areas is identified as a probable risk factor for infection, especially for individuals of the non-immune middle and upper class parts of the society in urban centers. Special attention is given to a multidisciplinary approach to the complex issue of disease control and prevention.

Rumos da educação em saúde no Brasil e sua relação com a educação ambiental

A brief survey of the historical development of health education in Brazilian elementary schools leads to a critical evaluation of modern practices. The authors point to deficiencies in school facilities, in the quality of the available textbooks and in the training of school teachers. Some guidelines for future action are presented and briefly discussed.

The control of the schistosome-transmitting snail Biomphalaria glabrata by the plant Molluscicide Euphorbia splendens var. hislopii (syn milli Des. Moul): a longitudinal field study in an endemic area in Brazil

Under laboratory conditions, latex from Euphorbia splendens has shown promise as a plant molluscicide for control of Biomphalaria species, intermediate hosts for Schistosoma mansoni. The purpose of this study was to evaluate its efficiency under field conditions. Application of filtered latex at 12 ppm to one stream in an endemic rural area in Minas Gerais state, Brazil, in September 1995, did result in a reduction in snail density as compared to an untreated stream but the snail population recovered quickly. However, two applications with a two-week interval of unfiltered E. splendens latex at 5 ppm in November 1996 in the same stream resulted in complete disappearance of B. glabrata and snails did not reappear until the 14th month after the applications. In the control stream, without treatment, the snails were found during all months. Laboratory studies confirmed that unfiltered latex is a more potent molluscicide than filtered latex. Considering the advantages of the latex such as its low toxicity to other aquatic animals and its photobiodegradability, as well as the simple method of application, this natural product is promising as an effective molluscicide.

Evaluation of informative materials on leishmaniasis distributed in Brazil: criteria and basis for the production and improvement of health education materials

Based on categories related to structure, content, language, and illustrations, the present study provides an evaluation of the quality of educational materials on leishmaniasis available to health services in Brazil. The 18 publications evaluated consisted of four handbooks, four guided studies, four booklets, and six leaflets. Of the total publications assessed, nine were produced by the Brazilian National Health Foundation (FUNASA), five by State and Municipal Health Departments jointly with FUNASA, and one by the Pan-American Health Organization. The evaluations were also performed by three professionals: a physician specialized in leishmaniasis, a parasitologist, and an information/communications expert. The publications failed to specify key items such as target public, objective, and bibliography. The illustrations, especially in the booklets and leaflets, failed to clarify the text, portrayed biased concepts, and omitted credits and scale. According to this study, informative materials on leishmaniasis distributed in Brazil present major limitations which jeopardize the quality of information they contain.

Rural tourism as risk factor for the transmission of schistosomiasis in Minas Gerais, Brazil

Recently, the booming rural tourism in endemic areas of the state of Minas Gerais was identified as a contributing factor in the dissemination of the infection with Schistosoma mansoni. This article presents data from six holiday resorts in a rural district approximately 100 km distant from Belo Horizonte, MG, Brazil, where a possibly new and until now unperceived way of transmission was observed. The infection takes place in swimming pools and little ponds, which are offered to tourists and the local population for fishing and leisure activities. The health authorities of the district reported cases of schistosomiasis among the local population after visiting these sites. As individuals of the non-immune middle class parts of the society of big urban centers also frequent these resorts, infection of these persons cannot be excluded. A malacological survey revealed the presence of molluscs of the species Biomphalaria glabrata and Biomphalaria straminea at the resorts. The snails (B. glabrata) of one resort tested positive for S. mansoni. In order to resolve this complex problem a multidisciplinary approach including health education, sanitation measures, assistance to the local health services, and evolvement of the local political authorities, the local community, the tourism association, and the owners of the leisure resorts is necessary. This evidence emphasizes the urgent need for a participative strategic plan to develop the local tourism in an organized and well-administered way. Only so this important source of income for the region can be ensured on the long term without disseminating the disease and putting the health of the visitors at risk.

Evaluation of a pamphlet on visceral leishmaniasis as a tool for providing disease information to healthcare professionals and laypersons

Although educational materials are frequently produced and used as part of control programs in Brazil, little is known about the efficacy of this type of information. This study evaluated the potential for disseminating information on visceral leishmaniasis using a pamphlet. The sample consisted of 551 healthcare workers and 379 laypeople from a metropolitan area located in southeast Brazil. Both before and after reading the pamphlet, subjects completed a multiple-choice questionnaire. Overall baseline knowledge of the disease was estimated by the proportion of correct answers before reading the pamphlet. Although specific knowledge among zoonosis control workers was higher (90.0% on average), overall baseline knowledge of the disease varied from 45.0% to 77.0%. After reading the pamphlet, the levels increased to 71.0% and 96.0%, respectively. Before reading, the lowest proportion of correct answers in all groups related to the disease symptoms. Analysis of incorrect answers showed that visceral leishmaniasis is mainly confused with leptospirosis. The increased proportion of correct answers after reading the pamphlet is evidence of its potential as an educational tool.

Evaluation of the molluscicidal properties of Euphorbia splendens var. hislopii (N.E.B.) latex: experimental test in an endemic area in the State of Minas Gerais, Brazil.

Following the positive results obtained regarding the molluscicidal properties of the latex of Euphorbia splendens that were corroborated in laboratory and field tests under restricted conditions, a field study was conducted in experimental streams located in an endemic area. After recording the average annual fluctuations of vectors in three streams, a solution of E. splendens latex at 12 ppm was applied in stream A, a solution of niclosamide at 3 ppm that was applied in stream B and a third stream (C) remained untreated for negative control. Applications of E. splendens and niclosamide resulted in a mortality of 100% among the snails collected in the streams A and B. No dead snails were found in the negative control stream. A monthly follow-up survey conducted during three consecutive months confirmed the return of vectors to both experimental streams treated with latex and niclosamide. This fact has called for a need to repeat application in order to reach the snails that remained buried in the mud substrate or escaped to the water edge, as well as, newly hatched snails that did not respond to the concentration of these molluscicides. Adults snails collected a month following treatment led us to believe that they had migrate from untreated areas of the streams to those previously treated.