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Zhou X, Chen Y, Yang H, Wang Y, Sun Y, Zhou J. [Level and health evaluation of rare earth elements in human blood and hair in the mining areas in Northwest Hubei]. Wei Sheng Yan Jiu 2024; 53:275-281. [PMID: 38604964 DOI: 10.19813/j.cnki.weishengyanjiu.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To investigate the content of rare earth elements(REs)in blood and hair of residents in a RE mining area in Northwest Hubei, and evaluate the impact of REs on the health status of local residents. METHODS A total of 191 residents from the core area of RE mining areas and 186 residents from non RE mining areas, aged 20-69, were selected. The content of REs in the blood and hair of the survey subjects was measured using inductively coupled plasma mass spectrometry, and compared with existing literature values. At the same time, blood tests and questionnaire surveys will be conducted on the health status of residents to examine whether human RE enrichment can lead to endemic diseases. RESULTS The average total content of REs in the blood of residents in the mining area was 60.22 ng/mL, which was 3.35 times that of the control area; The average total content of REs in hair was 1197.91 ng/g, which was 6.32 times higher than the control area. As age increasing, the abundance of REs in the blood and hair of both men and women in mining areas increased. The proportion of Yttrium and Scandium in the blood and hair were much higher than that in the soil. Compared to hair, Yttrium and Scandium were more easily enriched in the blood. There was no significant difference in the probability of fatty liver, hepatitis B, hypoglycemia, hypotension, hypertension and heart disease and the average life span between residents in RE mining areas and those in the control area. CONCLUSION The high daily average dietary intake of REs in residents leads to a relatively large accumulation of REs in human blood and hair, but no significant and substantial human health damage has been found at present.
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Affiliation(s)
- Xin Zhou
- College of Chemistry and Environmental Engineering, Hanjiang Normal University, Shiyan 442000, China
| | - Yun Chen
- College of Chemistry and Environmental Engineering, Hanjiang Normal University, Shiyan 442000, China
| | - Haibo Yang
- College of Chemistry and Environmental Engineering, Hanjiang Normal University, Shiyan 442000, China
| | - Yuxi Wang
- College of Chemistry and Environmental Engineering, Hanjiang Normal University, Shiyan 442000, China
| | - Yong Sun
- College of Chemistry and Environmental Engineering, Hanjiang Normal University, Shiyan 442000, China
| | - Jia Zhou
- College of Chemistry and Environmental Engineering, Hanjiang Normal University, Shiyan 442000, China
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Guirardello EDB, de Jesus MVN, Vieira LC, Oliveira HC, Vergilio MSTG. Nurses' perceptions about the patient safety climate in Primary Health Care. Rev Lat Am Enfermagem 2024; 32:e4092. [PMID: 38294053 PMCID: PMC10825895 DOI: 10.1590/1518-8345.6374.4092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/19/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE to evaluate the patient safety climate in Primary Health Care from the perspective of nurses working in the services. METHOD a quantitative and cross-sectional study conducted with 148 nurses from a municipality in the state of São Paulo. The Brazilian version of the Primary Care Safety Questionnaire Survey and personal, professional, and organizational performance variables (intention to stay at work, job satisfaction, care quality, and frequency of incidents) were used. Parametric and non-parametric comparison tests and Spearman's correlation coefficient were performed, considering a 5% significance level. RESULTS the safety climate was positive, varying from 4.52 to 5.33 and differing across districts for workload (p=0.0214) and leadership (p=0.0129). The safety climate professional variables and dimensions differed in relation to the frequency of incidents. Teamwork and safety and learning system were strongly correlated with job satisfaction and moderately with perceived care quality. CONCLUSION teamwork and safety and learning system stood out for their positive correlations with job satisfaction and care quality. A positive safety climate favors the involvement of Primary Care nurses to develop improvement plans aligned with the National Patient Safety Program. BACKGROUND (1) The safety climate is perceived differently across health districts. (2) There is a correlation between the climate dimensions and professional satisfaction. (3) Workload and leadership exert an influence on the safety climate perception. (4) There is a relationship between the safety climate and reporting of care-related incidents. (5) The safety climate is perceived differently among nurses regarding their role.
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Affiliation(s)
| | - Mariana Véo Nery de Jesus
- Universidade Estadual de Campinas, Faculdade de Enfermagem, Campinas, SP, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Lilian Ceroni Vieira
- Universidade Estadual de Campinas, Faculdade de Enfermagem, Campinas, SP, Brazil
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Figueirôa BDQ, Lira PICD, Vanderlei LCDM, Vidal SA, Frias PGD. [Evaluation of the effectiveness of the intervention to improve the Brazilian Mortality Information System in Pernambuco, Brazil: a quasi-experimental study]. CAD SAUDE PUBLICA 2024; 40:e00077523. [PMID: 38198385 PMCID: PMC10775963 DOI: 10.1590/0102-311xpt077523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/12/2023] [Accepted: 09/01/2023] [Indexed: 01/12/2024] Open
Abstract
This study evaluated the influence of the variation in the implementation of the Brazilian Mortality Information System (SIM) on the results, before and after the intervention to improve the system in Pernambuco, Brazil. The SIM logical model and matrix of indicators and assessment were described, primary data were collected from the 184 municipalities and secondary data were collected from the system database. The degree of implementation (DI) was obtained from the indicators of structure and process, and then related to result indicators, based on the model. The intervention was directed at the shortcomings identified, and developed using strategic stages. The percentage of annual variation of the DI and the results before and after the intervention were calculated. The SIM was classified as partially implemented in the pre- (70.6%) and post-intervention (73.1%) evaluations, with increments in all components. The Health Regions followed the same classification of the state level, except for XII (80.3%), regarding implemented score after the intervention. The coverage of the system; deaths with a defined underlying cause; monthly transfer; and timely submission of data were above 90% in both evaluations. There was an improvement in the completeness of infant Death Certificates and in the timely recording of notifiable events. Strengthening the management and operationalization of the SIM with interventions applied to data registration can improve the system's results.
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Affiliation(s)
- Barbara de Queiroz Figueirôa
- Programa de Pós-graduação em Saúde da Criança e do Adolescente, Universidade Federal de Pernambuco, Recife, Brasil
- Secretaria Estadual de Saúde de Pernambuco, Recife, Brasil
| | - Pedro Israel Cabral de Lira
- Programa de Pós-graduação em Saúde da Criança e do Adolescente, Universidade Federal de Pernambuco, Recife, Brasil
| | | | - Suely Arruda Vidal
- Programa de Pós-graduação em Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brasil
| | - Paulo Germano de Frias
- Programa de Pós-graduação em Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brasil
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Fréz AR, Alouche SR, Binda AC, Nunes Cabral CM. Content validity of the International Classification of Functioning, Disability and Health core set for knee dysfunction: a Delphi study. Physiother Theory Pract 2024; 40:110-117. [PMID: 35837751 DOI: 10.1080/09593985.2022.2101037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To assess the content validity of the preliminary core set for knee dysfunction based on the opinion of experts. DESIGN A panel of 180 experts in knee disorders or on the use of the International Classification of Functioning, Disability, and Health for musculoskeletal conditions was invited for this Delphi study. The experts gave their opinion on whether to include the categories of the preliminary core set for knee dysfunction in a more comprehensive core set, using a six-item Likert scale. Kappa coefficient was used to analyze the agreement between the experts, and a consensus of 75% among responses was considered acceptable. RESULTS Nineteen experts participated in all rounds. Of the 24 categories from the preliminary core set for knee dysfunction, 15 remained in the comprehensive core set and one category was further detailed into three new categories. Seven new categories were included. Thus, the comprehensive core set for knee dysfunction was composed of 25 categories with an agreement of 81.5% among responses and a Kappa value of 0.63. CONCLUSION After validation by experts, the comprehensive core set for knee dysfunction was composed of 25 categories that can be used to assess the functioning of patients with knee dysfunction.
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Affiliation(s)
- Andersom Ricardo Fréz
- Physical Therapy Department, Universidade Estadual do Centro-Oeste, Guarapuava, Brazil
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Sandra Regina Alouche
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Aline Cristiane Binda
- Physical Therapy Department, Universidade Estadual do Centro-Oeste, Guarapuava, Brazil
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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Correia NS, Oliveira JMD, Schneider LP, Morita AA, Pitta F, Furlanetto KC. Do Functional Tests Estimate Physical Activity in COPD? COPD 2023; 20:162-166. [PMID: 37166420 DOI: 10.1080/15412555.2023.2165905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The association between physical activity in daily life (PADL) and simple functional tests is not yet clearly understood in subjects with chronic obstructive pulmonary disease (COPD). Therefore, the aim of this study was to investigate the association of two functional tests (Sit-to-Stand test [STS] and the 4-Metre Gait Speed test [4MGS]) with PADL, as well as to identify whether these tests can discriminate those subjects who are physically inactive. In this cross-sectional study, 28 subjects with COPD performed the five repetitions Sit-to-Stand (STS5r), the 4MGS and used the DynaPort activity monitor for 7 days in order to assess PADL. Walking time, movement intensity while walking (MI) and Physical Activity Level index (PAL) were considered as PADL outcomes. STS5r and 4MGS, respectively, were significantly associated with walking time (R2 = 0.16; p = 0.024 and R2 = 0.25; p = 0.006) and PAL index (R2 = 0.17; p = 0.002 and R2 = 0.30; p = 0.003), whereas movement intensity was associated only with the 4MGS (R2 = 0.23; p = 0.009). Additionally, both tests were able to discriminate physically inactive subjects (cutoffs: STS5r = 11.48s [AUC = 0.73]; 4MGS = 1.09m/s [AUC = 0.88]). In conclusion, STS5r and 4MGS can predict up to 30% of PADL in subjects with COPD. Both tests are related to PADL duration (e.g. time spent walking), while only the 4MGS reflects movement intensity. Both tests presented discriminative capacity to identify subjects with worse PADL pattern.
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Affiliation(s)
- Natielly Soares Correia
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Londrina State University (UEL), Londrina, Brazil
- Research Center in Health Sciences, University of Northern Parana (UNOPAR), Londrina, Brazil
| | - Joice Mara de Oliveira
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Londrina State University (UEL), Londrina, Brazil
- Research Center in Health Sciences, University of Northern Parana (UNOPAR), Londrina, Brazil
| | - Lorena Paltanin Schneider
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Londrina State University (UEL), Londrina, Brazil
- Research Center in Health Sciences, University of Northern Parana (UNOPAR), Londrina, Brazil
| | - Andrea Akemi Morita
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Londrina State University (UEL), Londrina, Brazil
- Research Center in Health Sciences, University of Northern Parana (UNOPAR), Londrina, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Londrina State University (UEL), Londrina, Brazil
- Research Center in Health Sciences, University of Northern Parana (UNOPAR), Londrina, Brazil
| | - Karina Couto Furlanetto
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Londrina State University (UEL), Londrina, Brazil
- Research Center in Health Sciences, University of Northern Parana (UNOPAR), Londrina, Brazil
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de Souza CRA, Vanderlei LCDM, de Frias PG. Measles epidemiological surveillance system before and during the COVID-19 pandemic in Pernambuco, Brazil, 2018-2022: a descriptive evaluation. Epidemiol Serv Saude 2023; 32:e2023545. [PMID: 38018649 PMCID: PMC10684126 DOI: 10.1590/s2237-96222023000300008.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/11/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To evaluate the measles epidemiological surveillance system, before and during the COVID-19 pandemic in Pernambuco, Brazil. METHODS This was a descriptive evaluation of the quality (duplicity; completeness; consistency), timeliness and usefulness attributed, classified as excellent ≥ 90.0%, regular ≥ 70.0% and < 90.0%, and poor (< 70.0%). Data from the Notifiable Health Conditions Information System and Laboratory Environment Management System were used, before (03/11/2018-03/10/2020) and during (03/11/2020-03/10/2022) the pandemic. RESULTS 1,548 suspected measles cases were registered (1,469 before and 79 during the pandemic). In the two periods studied, there were 11 and 1 duplicate records, average completeness in filling out the variables was 99.2% and 95.7%, while average consistency was 96.7% and 97.5%, respectively. Timeliness (receipt of samples, 16.2% and 33.0%. Release of results, 1.3% and 1.3%) and usefulness (43.5% and 24.4%) were poor. CONCLUSION Quality was classified as excellent in the periods studied, timeliness and usefulness were classified as poor, signaling non-compliance with the purpose of the system. MAIN RESULTS The quality of data from the measles epidemiological surveillance system in Pernambuco was excellent, while its timeliness and usefulness were poor during both periods. IMPLICATIONS FOR SERVICES The limited timeliness and, therefore, the low usefulness of the measles epidemiological surveillance system must be discussed in the three government spheres of health service management, with the aim of training the professionals involved, as well as monitoring and evaluating the system. PERSPECTIVES Systematic monitoring and evaluation generates evidence that supports health service managers and workers in the timely identification of gaps that compromise the full fulfillment of the objectives proposed.
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Affiliation(s)
| | | | - Paulo Germano de Frias
- Instituto de Medicina Integral Prof. Fernando Figueira, Programa de Pós-Graduação em Avaliação em Saúde, Recife, PE, Brazil
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Schönholzer TE, Zacharias FCM, Amaral GG, Fabriz LA, Silva BS, Pinto IC. Performance indicators of Primary Care of the Previne Brasil Program. Rev Lat Am Enfermagem 2023; 31:e4007. [PMID: 37937593 PMCID: PMC10631306 DOI: 10.1590/1518-8345.6640.4007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/12/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE to analyze the scope of the performance indicators of the Previne Brasil Program of Primary Health Care. METHOD an observational, descriptive study with a quantitative approach was carried out using secondary data, referring to the years 2020 and 2021, in the five Brazilian regions (North, Northeast, South, Southeast and Midwest), available in the Primary Health Care Information System. Descriptive statistics, relative frequencies and measures of central tendency and semiparametric modeling were used considering a 5% confidence interval. RESULTS there was evidence of evolution in the rates of performance indicators in most Brazilian regions in 2021, compared to 2020, however, the North and Midwest regions had incipient or negative rates, compared to the Southeast region. Despite the evolution in the rates of the indicators, few States managed to reach the goals established by the Ministry of Health for the strategic actions of prenatal care and women's health; and no state achieved the goal in strategic action on chronic diseases. CONCLUSION it is considered important to monitor the evolution of current indicators, envisioning their qualification so that they can evaluate primary health care and assistance, as well as guarantee the achievement of goals by ensuring funding for primary care actions.
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Affiliation(s)
| | - Fabiana Costa Machado Zacharias
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil
- Becaria de la Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Gabriela Gonçalves Amaral
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil
| | | | - Brener Santos Silva
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil
| | - Ione Carvalho Pinto
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil
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Gomes Chaves B, Alami H, Sonier-Ferguson B, Dugas EN. Assessing healthcare capacity crisis preparedness: development of an evaluation tool by a Canadian health authority. Front Public Health 2023; 11:1231738. [PMID: 37881342 PMCID: PMC10594116 DOI: 10.3389/fpubh.2023.1231738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction The COVID-19 pandemic presented health systems across the globe with unparalleled socio-political, ethical, scientific, and economic challenges. Despite the necessity for a unified, innovative, and effective response, many jurisdictions were unprepared to such a profound health crisis. This study aims to outline the creation of an evaluative tool designed to measure and evaluate the Vitalité Health Network's (New Brunswick, Canada) ability to manage health crises. Methods The methodology of this work was carried out in four stages: (1) construction of an evaluative framework; (2) validation of the framework; (3) construction of the evaluative tool for the Health Authority; and (4) evaluation of the capacity to manage a health crisis. Results The resulting evaluative tool incorporated 8 dimensions, 74 strategies, and 109 observable elements. The dimensions included: (1) clinical care management; (2) infection prevention and control; (3) governance and leadership; (4) human and logistic resources; (5) communication and technologies; (6) health research; (7) ethics and values; and (8) training. A Canadian Health Authority implemented the tool to support its future preparedness. Conclusion This study introduces a methodological strategy adopted by a Canadian health authority to evaluate its capacity in managing health crises. Notably, this study marks the first instance where a Canadian health authority has created a tool for emergency healthcare management, informed by literature in the field and their direct experience from handling the SARS-CoV-2 pandemic.
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Affiliation(s)
- Breitner Gomes Chaves
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Hassane Alami
- École de Santé Publique, Université de Montréal, Montreal, QC, Canada
| | | | - Erika N. Dugas
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
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Barufaldi LA, de Albuquerque RDCR, do Nascimento A, Martins LFL, Zimmermann IR, de Souza MC. Cost-Effectiveness Analysis of Monoclonal Antibodies Associated With Chemotherapy in First-Line Treatment of Metastatic Colorectal Cancer. Value Health Reg Issues 2023; 37:33-40. [PMID: 37207532 DOI: 10.1016/j.vhri.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES This study aimed to evaluate the cost-effectiveness of anti-epidermal growth factor receptor (cetuximab and panitumumab) or anti-vascular endothelial growth factor (bevacizumab) monoclonal antibodies associated with conventional chemotherapy (CT) (fluorouracil and leucovorin with irinotecan) as a first-line treatment for unresectable metastatic colorectal cancer. METHODS A partitioned survival analysis model was adopted to simulate direct health costs and benefits comparing therapeutic options in a 10 years' time horizon. Model data were extracted from the literature and costs were obtained from Brazilian official government databases. The analysis considered the perspective of the Brazilian Public Health System; costs were measured in local currency (BRL) and benefits in quality-adjusted life-years (QALY). A 5% discount rate was applied to costs and benefits. Alternative willingness-to-pay scenarios, varying from 3 to 5 times the cost-effectiveness threshold established in Brazil, were estimated. The results were presented incremental cost-effectiveness ratio (ICER), and both deterministic and probabilistic sensitivity analyses were performed. RESULTS The most cost-effective choice would be the association of CT with panitumumab, with an ICER of $58 330.15/QALY compared with isolated CT. The second-best option was CT with bevacizumab and panitumumab, with an ICER of $71 195.40/QALY compared with panitumumab alone. Although having higher costs, the second-best option was the most effective. Both strategies were cost-effective in part of the Monte Carlo iterations, considering the 3× threshold. CONCLUSIONS The therapeutic option CT + panitumumab + bevacizumab represents the most significant effectiveness gain in our study. It is the second-lowest cost-effectiveness, and this option includes monoclonal antibodies association for patients with and without KRAS mutation.
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Affiliation(s)
- Laura A Barufaldi
- Health Technology Assessment Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil.
| | - Rita de C R de Albuquerque
- Health Technology Assessment Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Aline do Nascimento
- Health Technology Assessment Department, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Luís Felipe L Martins
- Division of Surveillance and Situation Analysis, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Ivan R Zimmermann
- Faculty of Health Sciences, Department of Public Health, University of Brasilia, Brazil
| | - Mirian C de Souza
- Division of Populational Research, Brazilian National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
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Ribeiro KSQS, Saldanha JHS, Zanela ÂK, Ferrari FP, Freitas GKF, Barroso RB, Silva SLAD, Chaves SCL, Aquino VDS, Schmitt ACB, Fernandes TG. [Evaluation of the implementation of the Care Network for People with Disabilities in the Brazilian Unified National Health System: a multiple case study]. CAD SAUDE PUBLICA 2023; 39:e00186122. [PMID: 37162117 PMCID: PMC10549978 DOI: 10.1590/0102-311xpt186122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 05/11/2023] Open
Abstract
The Care Network for People with Disabilities (RCPCD) was implemented in 2012 as a consequence of the actions of the Viver sem Limite (Living without Limits) plan and has been the research object of recent studies. However, no published studies address the degree of implementation of this network. This study aimed to evaluate the degree of implementation of the RCPCD in eight states in the five regions of Brazil. This multiple case study performed evaluative research of the degree of implementation of the RCPCD in the states of Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul, and São Paulo. A logical model of the policy and a measurement matrix were developed. The degree of implementation of seven states was moderate, but Amazonas had an incipient degree of implementation. The evaluation of each stage of the process showed important differences, as the regional diagnosis and network adhesion stages presented moderate to advanced degrees of implementation in most states. In the service contracting stage, no state had an advanced degree of implementation, and the stage of follow-up and monitoring of the RCPCD was not even reached. The measurement matrix helps evaluate the degree of implementation of the RCPCD, and, by recognizing its results, the state steering groups and technical area recommend its use. Actions to improve this implementation, such as strengthening regionalization, establishing regional steering groups, ensuring contracting mechanisms, and defining criteria for certification of the care points, are necessary.
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Pinho CM, de Lima MCL, Silva MAS, Dourado CARDO, de Oliveira RC, de Aquino JM, Pinto ESG, Andrade MS. Development and validation of an instrument for the evaluation of HIV care in Primary Health Care. Rev Bras Enferm 2023; 76:e20220247. [PMID: 36722649 PMCID: PMC9885365 DOI: 10.1590/0034-7167-2022-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/09/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To develop and validate an instrument to evaluate the decentralization process of care for People Living with HIV in Primary Health Care. METHOD Methodological study, developed in four stages: elaboration of the logical model based on the triad Structure-Process-Outcomes; development of the instrument; content validation by expert judges and technical reviewers; and semantic validation. Online questionnaires were used, and the Kappa index was used for analysis. RESULTS The instrument with 68 items and 8 factors was submitted to validation by expert judges who recommended the exclusion of 3 items and the alteration of 2 factors. In the validation by technical reviewers, 2 items were excluded and 6 factors were highlighted; the agreement index was ≥0.75. In the semantic validation, 87.3% of the judges answered "totally agree" for the items presented. CONCLUSION The instrument is validated for its content, has 63 items and has the potential to assess the care provided for people living with HIV in Primary Health Care.
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McCullough MC, Wlodarczyk J, Jacob L, Hershenhouse K, Seruya M. Surgical Complexity and Physician Compensation: An Analysis of Relative Under-Valuation for Pediatric Brachial Plexus Surgery. Hand (N Y) 2022:15589447221120845. [PMID: 36168295 DOI: 10.1177/15589447221120845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Brachial plexus reconstruction (BPR) is a rapidly advancing field within hand surgery. BPR procedures are complex, time-intensive, and require microsurgical expertise. As physician reimbursement rates for BPR are poorly defined, relative to more common hand procedures, we sought to analyze compensation for BPR across different payor groups and understand the factors contributing to their reimbursement. METHODS A retrospective review was performed of surgeries by a single senior staff member in a 4-year period to evaluate Current Procedural Terminology (CPT) codes from BPR cases. For comparison, all finger fracture fixations and skin graft reconstructions performed by the same surgeon over the same time period were analyzed as well. RESULTS A total of 57 BPR cases, 94 finger fracture fixation cases, and 69 skin grafting cases met inclusion criteria. Among the top 5 insurance providers, average work relative value unit (wRVU)/hour was 6.55, 3.49, and 12.67 for BPR, fracture fixation, and skin grafts, respectively. Reimbursements were an average $685.76/hour for BPR, compared to $590.10/hour for fracture fixation and $1,197.94/hour for skin grafts. CONCLUSIONS BPR demonstrates a relative undervaluation, in terms of reimbursement per hour, given the time and surgical skill required for such cases, particularly compared to shorter, less complex cases such as skin grafting and fracture fixation. We find that this discrepancy is amplified across multiple levels of coding, billing, and reimbursement. We suggest specific strategies for physician leadership to more directly participate in the financial decisions that affect themselves, their patients, and their specialty.
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Affiliation(s)
- Meghan C McCullough
- University of Southern California, Los Angeles, USA
- Children's Hospital of Los Angeles, CA, USA
| | - Jordan Wlodarczyk
- University of Southern California, Los Angeles, USA
- Children's Hospital of Los Angeles, CA, USA
| | - Laya Jacob
- University of Southern California, Los Angeles, USA
- Children's Hospital of Los Angeles, CA, USA
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dos Santos DMA, Alves CMC, Rocha TAH, da Silva NC, Queiroz RCDS, Pinho JRO, Lopes CGDS, Thomaz EBAF. [Factors associated with hospitalizations for primary care-sensitive conditions in Brazil: an ecological studyFactores asociados a las hospitalizaciones infantiles por afecciones que podrían tratarse en la atención primaria en Brasil: estudio ecológico]. Rev Panam Salud Publica 2022; 46:e63. [PMID: 36060205 PMCID: PMC9426956 DOI: 10.26633/rpsp.2022.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate whether structural aspects of primary care units (PCUs) and the work processes of primary care teams are associated with the rate of hospitalizations for primary care-sensitive conditions (HPCSC) in children younger than 5 years of age in Brazil. Method For this longitudinal ecological study, secondary data were obtained from the Brazilian Hospital Information System and from three cycles of the National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) (2012, 2014, 2017/2018). The analysis included 42 916 PCUs. A multilevel random intercept model with fixed slope was used. In the first level, the outcome (HPCSC rates) and explanatory variables (structure and process indicators) aggregated by PCU were analyzed. Social determinants (represented by a stratification criterion combining municipality population and health care management indicators) were entered in the second level. The t test with Bonferroni correction was used to compare indicator means between regions, and multilevel linear regression was used to estimate the correlation coefficients. Results The HPCSC rate in children younger than 5 years was 62.78/100 thousand population per estimated PCU coverage area. A direct association with the outcome was observed for: participation in one or more PMAQ-AB cycles; team planning; special hours; dedicated pediatric care area; and availability of vaccines. Equipment, materials, supplies, and being a small or medium-size municipality were inversely associated with HPCSC. Conclusions HPCSC rates in children below 5 years of age may potentially be reduced through improvements in PCU structure and process indicators and in municipal social determinants.
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Affiliation(s)
- Danilo Marcelo Araujo dos Santos
- Universidade Federal do Maranhão (UFMA)Programa de Pós-graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Cláudia Maria Coelho Alves
- Universidade Federal do Maranhão (UFMA)Programa de Pós-graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Thiago Augusto Hernandes Rocha
- Duke University Medical CenterDivision of Emergency MedicineDepartment of SurgeryDurham (NC)EUADuke University Medical Center, Division of Emergency Medicine, Department of Surgery, Durham (NC), EUA.
| | - Núbia Cristina da Silva
- Methods Analytics and Technology for Health (MATH) ConsortiumBelo Horizonte (MG)BrasilMethods Analytics and Technology for Health (MATH) Consortium, Belo Horizonte (MG), Brasil.
| | - Rejane Christine de Sousa Queiroz
- Universidade Federal do Maranhão (UFMA)Programa de Pós-graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Judith Rafaelle Oliveira Pinho
- Universidade Federal do Maranhão (UFMA)Programa de Pós-graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Clarissa Galvão da Silva Lopes
- Universidade Federal do Maranhão (UFMA)Programa de Pós-graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-graduação em Saúde Coletiva, São Luís (MA), Brasil.
| | - Erika Barbara Abreu Fonseca Thomaz
- Universidade Federal do Maranhão (UFMA)Programa de Pós-graduação em Saúde ColetivaSão Luís (MA)BrasilUniversidade Federal do Maranhão (UFMA), Programa de Pós-graduação em Saúde Coletiva, São Luís (MA), Brasil.
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Cantalino JLR, Scherer MDDA, Soratto J, Schäfer AA, dos Anjos DSO. User satisfaction in relation to Primary Health Care services in Brazil. Rev Saude Publica 2021; 55:22. [PMID: 34008779 PMCID: PMC8102024 DOI: 10.11606/s1518-8787.2021055002533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/21/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To analyze user satisfaction in relation to access, infrastructure and quality of Primary Health Care (PHC) services in Brazil. METHODS This cross-sectional study was conducted with data from 114,615 users linked to 30,523 health teams, obtained through the database of the Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB -National Program for the Improvement of Access and Quality of Primary Care). Independent variables related to access, infrastructure and quality of services in PHC were studied. The outcome, user satisfaction, was measured using the variables: "if given the option, I would change the staff or health service" and "I would recommend this health service to a friend or family member." To assess satisfaction according to independent exposure variables, Pearson's chi-squared test was used, considering a significance level of 5%. Descriptive analyses of the variables were performed using absolute (n) and relative (%) frequencies. RESULTS User satisfaction was associated with the variables of access (p < 0.001), infrastructure (p < 0.001) and quality of services (p < 0.001) in PHC. The proximity of the service, attention to spontaneous demand, listening and the respect of professionals to the singularities of the patient, as well as the problem-solving capacity of the services, without the need for referrals to others and the good infrastructure, were related to user satisfaction. CONCLUSION To ensure the improvement of the quality of services offered in PHC in Brazil, the aspects of user satisfaction identified in this study should be considered in the organization and management of services.
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Affiliation(s)
- Juliana Leal Ribeiro Cantalino
- Universidade de BrasíliaPrograma de Pós-Graduação em Saúde ColetivaFaculdade de Ciências da SaúdeBrasíliaDFBrasilUniversidade de Brasília. Faculdade de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva. Brasília, DF, Brasil.
| | - Magda Duarte dos Anjos Scherer
- Universidade de BrasíliaPrograma de Pós-Graduação em Saúde ColetivaFaculdade de Ciências da SaúdeBrasíliaDFBrasilUniversidade de Brasília. Faculdade de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva. Brasília, DF, Brasil.
| | - Jacks Soratto
- Universidade do Extremo Sul CatarinensePrograma de Pós-Graduação em Saúde ColetivaCriciúmaSCBrasilUniversidade do Extremo Sul Catarinense. Programa de Pós-Graduação em Saúde Coletiva. Criciúma, SC, Brasil.
| | - Antônio Augusto Schäfer
- Universidade do Extremo Sul CatarinensePrograma de Pós-Graduação em Saúde ColetivaCriciúmaSCBrasilUniversidade do Extremo Sul Catarinense. Programa de Pós-Graduação em Saúde Coletiva. Criciúma, SC, Brasil.
| | - Davllyn Santos Oliveira dos Anjos
- Universidade de BrasíliaPrograma de Pós-Graduação em Saúde ColetivaFaculdade de Ciências da SaúdeBrasíliaDFBrasilUniversidade de Brasília. Faculdade de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva. Brasília, DF, Brasil.
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Patrício NA, Rios MA, Barbosa PC, Ribeiro JR, Vidal DG, Sá KN, Baptista AF. Balance assessment in HTLV-1 associated myelopathy or tropical spastic paraparesis. Rev Soc Bras Med Trop 2020; 53:e20200388. [PMID: 33263686 PMCID: PMC7723374 DOI: 10.1590/0037-8682-0388-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/01/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION A good rating of the device in people with HTLV-1 in this population is essential for accuracy in prescribing data (walking). Thus, this study aimed to analyze the counterpart assessment methods that are best suited to patients with human T-cell lymphotropic virus (HTLV)-1 associated myelopathy or tropical spastic paraparesis (HAM/TSP). METHODS This cross-sectional study related stabilometric and kinematic variables of postural oscillations with Berg's balance scale (BBS) and Timed Up and Go (TUG) in subjects with HAM/TSP compared to asymptomatic subjects. To assess the posterior and lateral postural projection, baropodometry and the Footwork® system was used, and the CVMob system was applied to kinematic parameters. The means comparison tests and correlations were applied with an alpha of 5%. RESULTS Thirty-nine subjects (predominantly female) made up the sample. There was an increase in barodopometric oscillations, in the total oscillation area (p = 0.004), in the anteroposterior oscillation in the left (p = 0.015) and right views (p = 0.036), and in the lateral oscillation (p = 0.039) in the HAM/TSP group. Moderate correlations were found between oscillation baropodometry and the angular variation of the ankle, as well as with the BBS in the three angles and the TUG for lateral oscillation (p = 0.406). CONCLUSIONS Each method has advantages and disadvantages, including cost accuracy. The best resources available at no additional cost for outpatient to use are the kinematic evaluation using a simple smartphone camera and free analysis software, and the TUG.
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Affiliation(s)
| | - Mônica Andrade Rios
- Escola Bahiana de Medicina e Saúde Pública, Graduação de
Fisioterapia, Salvador, BA, Brasil
| | | | - Jéssica Ramos Ribeiro
- Escola Bahiana de Medicina e Saúde Pública, Graduação de
Fisioterapia, Salvador, BA, Brasil
| | - Diogo Guedes Vidal
- Universidade Fernando Pessoa, Unidade de Investigação UFP em
Energia, Ambiente e Saúde (FP-ENAS), Porto, Portugal
| | - Kátia Nunes Sá
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA,
Brasil
| | - Abrahão Fontes Baptista
- Universidade Federal da Bahia, Pós-graduação em Medicina e Saúde,
Salvador, BA, Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA,
Brasil
- Universidade Federal do ABC, Centro de Matemática, Cognição e
Computação, São Bernardo, SP, Brasil
- Universidade de São Paulo, Laboratório de Investigações Médicas 54
(LIM-54), São Paulo, SP, Brazil
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Guimarães EADA, Morato YC, Carvalho DBF, Oliveira VCD, Pivatti VMS, Cavalcante RB, Gontijo TL, Dias TMR. Evaluation of the Usability of the Immunization Information System in Brazil: A Mixed-Method Study. Telemed J E Health 2020; 27:551-560. [PMID: 32673172 DOI: 10.1089/tmj.2020.0077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Usability is a quality attribute that can evaluate the ease of use of user interfaces, based on standards called usability heuristics. Objective: To evaluate the usability components of the Brazilian Immunization Information System (IIS), focusing on the users and their interaction and agility with the interfaces. Materials and Methods: It was a concomitant and convergent mixed-method study that used a cross-sectional design for the quantitative approach and the indirect method of heuristic evaluation for the qualitative approach. Participants were 137 nursing professionals working in vaccination rooms, who completed a structured questionnaire on standards of usability quality, and 4 specialists in information technology, who used a semistructured form to carry out a software inspection. Descriptive and inferential statistics and the heuristic inspection were used for the analyses. Results: The evaluation resulted in 10 violated heuristics and identified 14 usability problems on the 68 screens of the IIS. The system presented simple usability problems (grade 2 severity), which can be repaired, with a low correction priority. The heuristics best evaluated were error prevention (3.03 ± 0.54) and help and documentation (3.00 ± 0.68); and the worst evaluated was visibility of system status, with a mean of 2.62 ± 0.55. Professionals with a technical education level presented a higher score on the scales for the recognition rather than recall heuristic when compared with the nurses (2.77 ± 0.49 vs. 3.67 ± 0.66, p = 0.003). Conclusion: The system provides easy access for users, however, has weaknesses in its ability to allow the users to easily achieve their goals of interaction with the interface.
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Affiliation(s)
| | - Ygor Colen Morato
- Federal University of São João del-Rei, Midwest Campus Dona Lindu, Divinópolis, Minas Gerais, Brazil
| | | | | | | | | | - Tarcísio Laerte Gontijo
- Federal University of São João del-Rei, Midwest Campus Dona Lindu, Divinópolis, Minas Gerais, Brazil
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Malta DC, Bernal RTI, de Carvalho QH, Pell JP, Dundas R, Leyland A, de Vasconcelos LLC, de Magalhaes Cardoso LS, Stopa SR, Barreto ML. Women and evaluation of inequalities in the distribution of risk factors for Chronic non-communicable diseases (NCD), Vigitel 2016-2017. Rev Bras Epidemiol 2020; 23:e200058. [PMID: 32520106 PMCID: PMC7613912 DOI: 10.1590/1980-549720200058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/09/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare the distribution of chronic non-communicable diseases (CNCD) indicators among adult female beneficiaries and non-beneficiaries of the Bolsa Família Program (BFP) in Brazilian capitals. METHODS Analysis of Vigitel telephone survey data in 2016 and 2017. Gross and adjusted prevalence ratios (PR) and their respective confidence intervals were estimated using Poisson Regression model. RESULTS Women with BF have lower schooling, are young people, live more frequently in the Northeast and North of the country. Higher prevalence of risk factors were found in woman receiving BF. The adjusted PR of the BF women were: smokers (PR = 1.98), overweight (PR = 1.21), obesity (PR = 1.63), fruits and vegetables (PR = 0.63), consumption of soft drinks (PR = 1.68), bean consumption (PR = 1.25), physical activity at leisure (PR = 0.65), physical activity at home (PR = 1.35), time watching TV (PR = 1.37), self-assessment of poor health status (PR =2.04), mammography (PR = 0.86), Pap smears (PR = 0.91), hypertension (PR = 1.46) and diabetes (PR = 1,66). When women were compared among strata of the same schooling, these differences were reduced. CONCLUSION Worst indicators among women receiving BF reflect social inequalities inherent in this most vulnerable group. The study also shows that BF is being targeted at the most vulnerable women.
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Affiliation(s)
| | | | | | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Lilybank Gardens – Glasgow, United Kingdom
| | - Ruth Dundas
- MRC/SCO Social and Public Health Sciences Unit, University of Glasgow – Glasgow, Reino Unido
| | - Alastair Leyland
- MRC/SCO Social and Public Health Sciences Unit, University of Glasgow – Glasgow, Reino Unido
| | | | | | | | - Mauricio Lima Barreto
- Centro of Health Data and Knowledge Integration, Fundação Oswaldo Cruz – Salvador (BA), Brazil
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Campero L, Suárez-López L, Cruz-Jiménez L. Intervention for the comprehension of menstrual cycle, body function and pregnancy in adolescents from rural context. Salud Publica Mex 2019; 61:572-581. [PMID: 31661735 DOI: 10.21149/9988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/21/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To measure the impact of an intervention on adolescents' knowledge of the phase of the menstrual cycle with more likelihood of pregnancy and identify its associated factors. MATERIALS AND METHODS A quasi-experimental study in two rural communities. Difference-in-differences analyses was performed. RESULTS There was a 22.1% average reduction in wrong answers on the phase of the menstrual cycle with more likelihood of pregnancy in the intervention group versus the control group (p<0.001). We founded six factors associated with this knowledge: marry and have children, right to receive education and information on sexual and reproductive health; gender equity; use of the condom; condom self-efficacy; emergency and contraceptive pills. CONCLUSIONS There is a prevailing need to improve -among sexuality topics- basic knowledge of reproductive biology, while at the same time insisting on the benefits of using birth control methods provided for practicing responsible sexuality.
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Affiliation(s)
- Lourdes Campero
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Mexico
| | - Leticia Suárez-López
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Mexico
| | - Lizeth Cruz-Jiménez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Mexico
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Elorriaga N, Garay OU, Belizán M, González VB, Rossi ML, Chaparro M, Caporale JE, Ruggiero MD, Antún MC, Pichon-Riviere A, Rubinstein A, Irazola V, Augustovski F. [Health impact assessment of the Program Healthy Centers in the Autonomous City of Buenos Aires, ArgentinaAvaliação do impacto na saúde do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires, Argentina]. Rev Panam Salud Publica 2019; 42:e150. [PMID: 31093178 PMCID: PMC6386035 DOI: 10.26633/rpsp.2018.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/09/2018] [Indexed: 02/05/2023] Open
Abstract
Objective To explore the motivations and expectations of the users of the Program for Healthy Centers in the Autonomous City of Buenos Aires and to evaluate its potential health impact. Methods In-depth interviews were conducted (n = 34) and a self-administered survey was sent to users of the program (n = 605). An epidemiological model was developed to estimate the impact of the program on cardiovascular events (CVE) and disability-adjusted life years (DALYs). Results The main motivating factors for using the healthy centers were geographic and economic accessibility (free services) and satisfaction with the care received. 14.4% (95% CI, 10.3-18.5%) of hypertensive users and 24.8% (95% CI, 17.6-32.0%) of diabetic users reported having learned of their altered values in the healthy center. More than half of the respondents reported some improvement in their knowledge about the benefits of physical activity and healthy eating; this was more frequent among those who were younger, of lower educational level, users of the public health system, users of a healthy center in the South zone and those who had a cardiometabolic risk factor (p<0.05). It was estimated that the healthy centers would prevent 12.5 cardiovascular and cerebrovascular events per year in the assisted population (4.75 events/100 000) and 47.75 DALYs due to these causes. Conclusions The healthy centers are a favorable space for the implementation of health promotion and prevention actions, contributing to the detection of and facilitating the monitoring of risk factors, with a potential to prevent cardiovascular events and its consequences.
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Affiliation(s)
- Natalia Elorriaga
- Departamento de Investigación en Enfermedades Crónicas, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Osvaldo Ulises Garay
- Departamento de Evaluación de Tecnologías Sa nitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - María Belizán
- Unidad de Investigación Cualitativa, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Verónica Beatriz González
- Dirección General de Desarrollo Saludable, Gobierno de la Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - María Laura Rossi
- Dirección General de Desarrollo Saludable, Gobierno de la Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Martin Chaparro
- Departamento de Investigación en Enfermedades Crónicas, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Joaquín E Caporale
- Departamento de Evaluación de Tecnologías Sa nitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Marina De Ruggiero
- Dirección General de Desarrollo Saludable, Gobierno de la Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - María Cecilia Antún
- Dirección General de Desarrollo Saludable, Gobierno de la Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Departamento de Evaluación de Tecnologías Sa nitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | | - Vilma Irazola
- Departamento de Investigación en Enfermedades Crónicas, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Federico Augustovski
- Departamento de Investigación en Enfermedades Crónicas, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
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da Silva AWM, Meiners MMMDA, Noronha EF, de Toledo MI. The Use of Assessment of Chronic Illness Care Technology to Evaluate the Institutional Capacity for HIV/AIDS Management. Front Pharmacol 2019; 10:165. [PMID: 30873036 PMCID: PMC6400989 DOI: 10.3389/fphar.2019.00165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/11/2019] [Indexed: 11/30/2022] Open
Abstract
The effectiveness of antiretroviral therapy has rendered HIV infection a manageable chronic condition. Currently, the health systems face the challenge of adopting organizational healthcare models capable of ensuring the delivery of comprehensive care. The Chronic Care Model has been reported for its effectiveness, particularly in terms of delivery system design. In this study, the Assessment of Chronic Illness Care (ACIC) questionnaire, a soft technology widely used for other chronic conditions, was employed on a teaching hospital to evaluate healthcare provided to people living with HIV/AIDS. The ACIC technology is a self-explanatory instrument which diagnoses, among the six components of the Chronic Care Model Framework, areas for quality improvements, indicating at the same time, intervention strategies and achievements. These components are healthcare network organization, delivery system design, self-management support, decision support, clinical information systems, and community. From May to October 2014, the tool was applied to the multidisciplinary teamwork at the points of care identified, as well as to the hospital management board. Respondents broadly rated care as basic. A pronounced contrast was observed from evaluation by management board and health professional staff in some components like organization of healthcare and clinical information system. The self-management support and delivery system design were the components best evaluated by the multidisciplinary team. Combined with the array of services offered, the entry points available at the hospital can ensure healthcare comprehensiveness. However, some gaps were detected, precluding the delivery of an effective care. The ACIC was considered an adequate technology to provide knowledge of the gaps, to promote productive discussions and reflections within teams and to indicate actions to achieve improvements on healthcare for people living with HIV/AIDS.
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Affiliation(s)
| | | | | | - Maria Inês de Toledo
- Tropical Medicine, Faculty of Medicine, University of Brasília, Brasília, Brazil
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Abstract
Ongoing research on the assessment of children's health has led to the development of a large number of quantitative tools. The Child Health Questionnaire-Parent Form (CHQ-PF) is a set of questionnaires aimed at measuring different facets of children's health as perceived by their parents. The present multi-trait multi-sample study tested the validity and the reliability of the 50-item version of the CHQ with families (N = 1095) living in contexts of low-intensity warfare. The validation procedures implemented (exploratory and confirmatory factor analysis, convergent validity, and reliability testing) yielded a new, shorter version of the questionnaire (CHQ-PF-25). We discuss the potential of using the CHQ-PF-25 in Arabic-speaking crisis contexts and the limitations of the present study.
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Affiliation(s)
- Guido Veronese
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milano, Italy
| | - Alessandro Pepe
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milano, Italy
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de Almeida ER, de Sousa ANA, Brandão CC, de Carvalho FFB, Tavares G, Silva KC. [National primary health care policy in Brazil: an analysis of the review process (2015-2017)Política Nacional de Atención Básica en Brasil: un análisis del proceso de revisión (2015-2017)]. Rev Panam Salud Publica 2018; 42:e180. [PMID: 31093208 PMCID: PMC6385635 DOI: 10.26633/rpsp.2018.180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 09/07/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe and discuss events associated with the latest review of the national primary health care (PHC) policy in Brazil (Política Nacional de Atenção Básica, PNAB) so as to highlight narratives that may contribute to future analyses focusing on the formulation, implementation, and assessment of this policy. METHOD Participant observation report of the PNAB review process, based on content and document analyses. RESULTS The review process of PNAB, which took place between 2015 and 2017, was strongly marked by technical and political dispute among the Ministry of Health and authorities representing municipal and state health departments. The main changes introduced by the new version of PNAB are the financing of other PHC organizational models in addition to the Family Health Strategy; attribution of additional responsibilities to community health agents; introduction of a national set of core and extended PHC services and actions; and introduction of a manager role as part of PHC teams. CONCLUSIONS Implementation of the revised PNAB, which was the result of interfederation dispute, will depend on the convergence of interests in a PHC that is accessible and effective, strengthening the Unified Health System. This will substantially require societal engagement and leadership in the fight for the right to health in Brazil.
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Affiliation(s)
- Erika Rodrigues de Almeida
- Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica, Brasília (DF), Brasil.
| | - Allan Nuno Alves de Sousa
- Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica, Brasília (DF), Brasil.
| | - Celmário Castro Brandão
- Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica, Brasília (DF), Brasil.
| | - Fabio Fortunato Brasil de Carvalho
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sérgio Arouca, Programa de Pós-Graduação Stricto Sensu em Saúde Pública, Rio de Janeiro (RJ), Brasil.
| | - Graziela Tavares
- Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica, Brasília (DF), Brasil.
| | - Kimielle Cristina Silva
- Universidade do Estado do Rio de Janeiro (UERJ), Instituto de Medicina Social, Rio de Janeiro (RJ), Brasil.
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Entringer AP, Gomes MADSM, da Costa ACC, Pinto M. [Budgetary impact of spontaneous vaginal delivery and elective cesarean section without clinical indication in BrazilImpacto presupuestario del parto vaginal espontáneo y de la cesárea electiva sin indicación clínica en Brasil]. Rev Panam Salud Publica 2018; 42:e116. [PMID: 31093144 PMCID: PMC6386090 DOI: 10.26633/rpsp.2018.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/06/2018] [Indexed: 11/28/2022] Open
Abstract
Objetivos Estimar o impacto orçamentário do excesso de cesarianas sem indicação clínica em comparação ao parto vaginal para gestantes de risco habitual no Sistema Único de Saúde (SUS) no Brasil. Métodos A análise se baseou em um modelo estático. A população de referência foi a de gestantes de risco habitual. O horizonte temporal foi de 5 anos. Utilizou-se um modelo de regressão de Poisson para projetar o número de nascidos vivos de 2016 a 2020. O cálculo do custo direto da cesariana eletiva e do parto vaginal foi baseado em dois estudos prévios, nos quais foi calculado o valor esperado dos procedimentos através de um modelo de decisão analítico que incluiu as intercorrências clínicas da internação até a alta da maternidade. O cenário de referência dessa análise considerou 29% de cesarianas em excesso no país. Resultados O custo total da assistência ao parto e nascimento para as primíparas e multíparas sem cicatriz uterina no cenário de referência foi de US$ 707,5 milhões para o ano de 2016. No cenário 1 (melhor cenário), que considerou apenas o parto vaginal para essas gestantes, houve uma redução de custos de US$ 76,5 milhões ao ano. Para multíparas, a comparação do cenário de referência com o melhor cenário gerou economia de mais de US$ 4 milhões ao ano. Conclusões Os resultados indicam que o incentivo ao parto vaginal gera economia.
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Affiliation(s)
- Aline Piovezan Entringer
- Fundação Oswaldo Cruz, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Rio de Janeiro (RJ), Brasil
| | | | - Ana Carolina Carioca da Costa
- Fundação Oswaldo Cruz, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Rio de Janeiro (RJ), Brasil
| | - Márcia Pinto
- Fundação Oswaldo Cruz, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Rio de Janeiro (RJ), Brasil
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Gottems LBD, Carvalho EMPD, Guilhem D, Pires MRGM. Good practices in normal childbirth: reliability analysis of an instrument by Cronbach's Alpha. Rev Lat Am Enfermagem 2018; 26:e3000. [PMID: 29791667 PMCID: PMC5969829 DOI: 10.1590/1518-8345.2234.3000] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 01/04/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the internal consistency of the evaluation instrument of the adherence to the good practices of childbirth and birth care in the professionals, through Cronbach's Alpha Coefficient for each of the dimensions and for the total instrument. METHOD this is a descriptive and cross-sectional study performed in obstetric centers of eleven public hospitals in the Federal District, with a questionnaire applied to 261 professionals who worked in the delivery care. RESULTS The study was attended by 261 professionals, 42.5% (111) nurses and 57.5% (150) physicians. The reliability evaluation of the instrument by the Cronbach Alfa resulted in 0.53, 0.78 and 0.76 for dimensions 1, 2 and 3, after debugging that resulted in the exclusion of 11 items. CONCLUSIONS the instrument obtained Cronbach's alpha of 0.80. There is a need for improvement in the items of dimension 1 that refer to attitudes, knowledge, and practices of the organization of the network of care to gestation, childbirth, and birth. However, it can be applied in the way it is used to evaluate practices based on scientific evidence of childbirth care.
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Affiliation(s)
- Leila Bernarda Donato Gottems
- PhD. Professor. Escola Superior de Ciencias da Saude, Fundação de
Ensino e Pesquisa em Ciencias da Saude, Brasilia, DF, Brazil
| | - Elisabete Mesquita Peres De Carvalho
- MSc. Doctor degree student. Post Graduate Program in Health
Science, Escola Superior de Ciências da Saúde e Universidade de Brasília, Brasília,
DF, Brazil. Doctor Degree Interinstitutional in Health Sciences. RN.
Superintendencia da Região de Saude Norte, Secretaria de Estado da Saude do DF,
Brasilia, DF, Brazil
| | - Dirce Guilhem
- PhD. Professor. Departamento de Enfermagem, Universidade de
Brasilia, Brasilia, DF, Brazil. Bolsista de Produtividade em Pesquisa do CNPq -
Nível 1-D
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Bovolenta TM, de Azevedo Silva SMC, Saba RA, Borges V, Ferraz HB, Felicio AC. Average annual cost of Parkinson's disease in São Paulo, Brazil, with a focus on disease-related motor symptoms. Clin Interv Aging 2017; 12:2095-2108. [PMID: 29276379 PMCID: PMC5734235 DOI: 10.2147/cia.s151919] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Although Parkinson's disease is the second most prevalent neurodegenerative disease worldwide, its cost in Brazil - South America's largest country - is unknown. Objective The goal of this study was to calculate the average annual cost of Parkinson's disease in the city of São Paulo (Brazil), with a focus on disease-related motor symptoms. Subjects and methods This was a retrospective, cross-sectional analysis using a bottom-up approach (ie, from the society's perspective). Patients (N=260) at two tertiary public health centers, who were residents of the São Paulo metropolitan area, completed standardized questionnaires regarding their disease-related expenses. We used simple and multiple generalized linear models to assess the correlations between total cost and patient-related, as well as disease-related variables. Results The total average annual cost of Parkinson's disease was estimated at US$5,853.50 per person, including US$3,172.00 in direct costs (medical and nonmedical) and US$2,681.50 in indirect costs. Costs were directly correlated with disease severity (including the degree of motor symptoms), patients' age, and time since disease onset. Conclusion In this study, we determined the cost of Parkinson's disease in Brazil and observed that disease-related motor symptoms are a significant component of the costs incurred on the public health system, patients, and society in general.
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Affiliation(s)
| | | | - Roberta Arb Saba
- Neurology Department, Federal University of São Paulo, UNIFESP, São Paulo, Brazil
| | - Vanderci Borges
- Neurology Department, Federal University of São Paulo, UNIFESP, São Paulo
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Dos Santos RR, Niquini RP, Bastos FI, Domingues RMSM. Diagnostic and Therapeutic Knowledge and Practices in the Management of Congenital Syphilis by Pediatricians in Public Maternity Hospitals in Brazil. Int J Health Serv 2017; 49:322-342. [PMID: 28735562 DOI: 10.1177/0020731417722088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The study aimed to assess conformity with Brazil's standard protocol for diagnostic and therapeutic practices in the management of congenital syphilis by pediatricians in public maternity hospitals. A cross-sectional study was conducted in 2015 with 41 pediatricians working in all the public maternity hospitals in Teresina, the capital of Piauí State, Northeast Brazil, through self-completed questionnaires. The study assessed the conformity of knowledge and practices according to the Brazilian Ministry of Health protocols. The study has made evident low access to training courses (54%) and insufficient knowledge of the case definition of congenital syphilis (42%) and rapid tests for syphilis (39%). Flaws were observed in the diagnostic workup and treatment of newborns. Requesting VDRL (88%) and correct treatment of neurosyphilis (88%) were the practices that showed the highest conformity with standard protocols. Low conformity with protocols leads to missed opportunities for identifying and adequately treating congenital syphilis. Based on the barriers identified in the study, better access to diagnostic and treatment protocols, improved recording on prenatal cards and hospital patient charts, availability of tests and medicines, and educational work with pregnant women should be urgently implemented, aiming to reverse the currently inadequate management of congenital syphilis and to curb its spread.
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Affiliation(s)
| | - Roberta Pereira Niquini
- 2 Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco Inácio Bastos
- 3 Instituto de Comunicação e Informação Científica e Tecnológica em Súde, Rio de Janeiro, Brazil
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Solon Tajra F, Soares Pontes RJ, Costa Carvalho FH. The possible meanings of care: self-care and care-for-the-other. Invest Educ Enferm 2017; 35:199-209. [PMID: 29767939 DOI: 10.17533/udea.iee.v35n2a09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/10/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To understand and to reflect about care based on the experiences of managers, professionals and users of maternal and child health services. METHODS We developed an evaluative research with a qualitative approach in a Northeastern state of Brazil with extensive experience in the regionalization and implementation process of integrated health networks. Semi-structured interviews were carried out with 68 subjects and direct observation of the maternal and child health services. We adopted the theoretical reference framework of Gadamer's hermeneutics to analyze the narratives. RESULTS Some units of meaning were present, such as: perception and knowledge about oneself; exercise of autonomy; weaknesses in the provision of resources for the materialization of self-care; and difficulties in accessing health services and care practices. We perceive that care is dynamic, comprises various subjective aspects with respect to the singularities of the subjects and is related to the possibility of generating both individual and collective transformation. CONCLUSIONS Care is built based on a movement among the subjects and between them and the social and health services. Thus, when we intend to take care, we need to consider this instead of focusing care solely on the technical support of health professionals.
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Chen ZL, Huang L, Zhou CY, Zhong SX, Wang X, Dai Y, Jiang XL. [Characteristics and Evaluation of Heavy Metal Pollution in Vegetables in Guangzhou]. Huan Jing Ke Xue 2017; 38:389-398. [PMID: 29965071 DOI: 10.13227/j.hjkx.201606138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Vegetable is an indispensible component of human daily diet,and contamination of vegetables by heavy metals directly threatens human health.In this study,116 vegetable samples were collected from 12 administrative districts of Guangzhou City for analysis of six heavy metals,Cu,Zn,Pb,Cd,Ni,Cr.A combination of single factor evaluation and Nemero Index analysis was employed to determine specific heavy metals exceeding allowable standards and analyze the characteristics of pollution.Risk of exposure was utilized to assess human health risks originating from eating locally planted vegetables contaminated by heavy metals.The results showed that contents of Cu,Zn in the 8 sorts of vegetables were below the standards of maximum allowable content and the contents of heavy mental Cr of up to 91.67% vegetable samples were higher than their standard.Lettuce sativa var.angustana Irish,Luffa acutangula L.,Lycopersicon esculentum Mill.and Daucus carota L.were the 4 species of Pb exceeding vegetables,with the exceed ratio reaching up to 35.71% and Daucus carota L.exceeded the target value most seriously.Only the content of Cd in Lycopersicon esculentum Mill.was over-standard,with the rate of 31.25%.And the highest rate of over-standard of the content of Ni in 3 species of vegetables,which included Lactuca sativa L.,Ipomoea aquatica Forsk and Brassica parachinensis,reached 8.33%.For the contamination level of the eight kinds of vegetable,Lactuca sativa L.,Ipomoea aquatica Forsk,Brassica parachinensis,Raphanus sativus L.and Daucus carota L.were put into the class of alarming,while Lettuce sativa var.angustana Irish,Luffa acutangula L.and Lycopersicon esculentum Mill.were classified as secure.Heavy metals' comprehensive pollution degree of 4 species of vegetables presented a trend of leafy vegetables >rootstalk vegetables >stem vegetables >solanaceous fruits.Health risk assessment showed that Guangzhou citizens eat more frequently Ipomoea aquatica Forsk and Lactuca sativa L.and Brassica parachinensis were prone to higher accumulation of heavy metals,and the dietary intake of heavy metal Cr might cause harm to human health and intake of Cd would bring potential health risk to the human body.Risk of exposure to heavy metal through oral ingestion of vegetables was proved to be higher for children than adults.
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Affiliation(s)
- Zhi-Liang Chen
- South China Institute of Environmental Science, Ministry of Environmental Protection, Guangzhou 510655, China
| | - Ling Huang
- South China Institute of Environmental Science, Ministry of Environmental Protection, Guangzhou 510655, China
- School of Horticulture and Garden, Yangtze University, Jingzhou 434025, China
| | - Cun-Yu Zhou
- School of Horticulture and Garden, Yangtze University, Jingzhou 434025, China
| | - Song-Xiong Zhong
- South China Institute of Environmental Science, Ministry of Environmental Protection, Guangzhou 510655, China
| | - Xin Wang
- South China Institute of Environmental Science, Ministry of Environmental Protection, Guangzhou 510655, China
| | - Yu Dai
- South China Institute of Environmental Science, Ministry of Environmental Protection, Guangzhou 510655, China
| | - Xiao-Lu Jiang
- South China Institute of Environmental Science, Ministry of Environmental Protection, Guangzhou 510655, China
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Fontela PC, Winkelmann ER, Pretto LM, Berlezi EM. Sleep respiratory disorders and clinical profile in patients with type 2 diabetes mellitus. Int Arch Otorhinolaryngol 2015; 19:67-73. [PMID: 25992154 PMCID: PMC4392518 DOI: 10.1055/s-0034-1395998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 10/18/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction Sleep respiratory disorders (SRDs) are often found in patients with type 2 diabetes mellitus (T2DM). Objective The aim was to establish the prevalence of risk to develop an SRD using the Clinical Berlin Questionnaire (CBQ) and Epworth Sleepiness Scale (ESS) in patients with T2DM and verifying the correlation of anthropometric measurements and life quality (LQ) with ESS. Methods A descriptive and analytical study of a case series evaluating 208 patients with T2DM, submitted to clinical and biochemical evaluation and implementation of CBQ, ESS, and WHOQOL-bref to evaluate LQ. Results Mean age was 60.8 ± 8.8 years, and 65.4% were women. Most diabetics were overweight (36.1%), and 29.8% were class I obese. One-third had positive risk signals for a SRD, with 87.0 and 34.1% having high risk in CBQ and sleep disorders in ESS, respectively. There was a significant difference in the general LQ between the low- and high-risk groups in the CBQ. Conclusion In this scenario, it is noteworthy that the active search for sleep disorders must start from simple methods, such as application of protocols.
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Affiliation(s)
- Paula Caitano Fontela
- Sciences of Life Department, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, RS, Brazil
| | - Eliane Roseli Winkelmann
- Sciences of Life Department, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, RS, Brazil
| | - Luciana Meggiolaro Pretto
- Sciences of Life Department, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, RS, Brazil
| | - Evelise Moraes Berlezi
- Sciences of Life Department, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, RS, Brazil
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Dal Poz MR, Sepulveda HR, Costa Couto MH, Godue C, Padilla M, Cameron R, Vidaurre Franco TDA. Assessment of human resources for health programme implementation in 15 Latin American and Caribbean countries. Hum Resour Health 2015; 13:24. [PMID: 25928346 PMCID: PMC4417531 DOI: 10.1186/s12960-015-0016-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 04/17/2015] [Indexed: 06/03/2023]
Abstract
BACKGROUND The health systems in the Americas region are characterized by fragmentation and segmentation, which constitute an important barrier to expanding coverage, achieving integrated primary health care, and reducing inefficiency and discontinuity of care. An assessment of the human resources for health (HRH) programmes that have been implemented at the country level was developed as part of the measurement of the 20 HRH regional goals for 2007-2015, adopted in 2007 by the Pan American Sanitary Conference (CSPA). METHODS The exercise was a combination of academic research and the development/application of an advocacy tool involving policy makers and stakeholders to influence the decision-making in the development, implementation, or change of HRH programmes while building evidence through a structured approach based on qualitative and quantitative information and the exchange and dissemination of best practices. RESULTS This paper covers the methodological challenges, as well as a summary of the main findings of the study, which included 15 countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone. Despite the different contexts, the results showed that the programmes evaluated faced common challenges, such as lack of political support and financial unsustainability. CONCLUSIONS The evaluation process allowed the exchange and dissemination of practices, interventions, and programmes currently running in the region. A shared lesson was the importance of careful planning of the implementation of programmes and interventions. The similarities in the problems and challenges of HRH among the participating countries highlighted the need for a cooperation programme on the evaluation and assessment of implementation strategies in the Americas region.
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Affiliation(s)
- Mario Roberto Dal Poz
- Institute of Social Medicine, University of the State of Rio de Janeiro, Rua São Francisco Xavier, 524, Pavilhão João Lyra Filho, 7 andar / bloco D, Maracanã, Rio de Janeiro, CEP 20550-013, Brazil.
| | | | - Maria Helena Costa Couto
- Institute of Social Medicine, University of the State of Rio de Janeiro, Rua São Francisco Xavier, 524, Pavilhão João Lyra Filho, 7 andar / bloco D, Maracanã, Rio de Janeiro, CEP 20550-013, Brazil.
| | - Charles Godue
- Human Resources for Health Programme, Pan American Health Organization, Washington, USA.
| | - Monica Padilla
- Human Resources for Health, Pan American Health Organization, San Salvador, El Salvador.
| | - Rick Cameron
- Cameron Health Strategies Group, Halifax, Nova Scotia, Canada.
| | - Thais de Andrade Vidaurre Franco
- Institute of Social Medicine, University of the State of Rio de Janeiro, Rua São Francisco Xavier, 524, Pavilhão João Lyra Filho, 7 andar / bloco D, Maracanã, Rio de Janeiro, CEP 20550-013, Brazil.
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Bernardes ACF, da Silva RA, Coimbra LC, Alves MTSSDB, Queiroz RCDS, Batista RFL, Bettiol H, Barbieri MA, da Silva AAM. Inadequate prenatal care utilization and associated factors in São Luís, Brazil. BMC Pregnancy Childbirth 2014; 14:266. [PMID: 25108701 PMCID: PMC4133632 DOI: 10.1186/1471-2393-14-266] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 08/05/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Over the last decades there has been a reduction of social inequalities in Brazil, as well as a strong expansion of health services, including prenatal care. The objective of the present study was to estimate the rate of inadequate prenatal care utilization and its associated factors in São Luís, Brazil, in 2010 and to determine whether there was a reduction of inequity in prenatal care use by comparing the present data to those obtained from a previous cohort started in 1997/98. METHODS Data from the BRISA (Brazilian birth cohort studies of Ribeirão Preto and São Luís) population-based cohort, which started in 2010 (5067 women), were used. The outcome variable was the inadequate utilization of prenatal care, classified according to the recommendations of the Brazilian Ministry of Health. The explanatory variables were organized into three hierarchical levels based on the Andersen's behavioral model of the use of health services: predisposing, enabling and need factors. RESULTS Only 2.0% of the women did not attend at least one prenatal care visit. The rate of inadequate prenatal care utilization was 36.7%. Despite an improved adequacy of prenatal care use from 47.3% in 1997/98 to 58.2% in 2010, social inequality persisted: both low maternal schooling (prevalence ratio (PR) = 2.78; 95% confidence interval (95% CI) 2.23-3.47 for 0 to 4 years of study) and low family income, less than 0.5 monthly minimum wage per capita (PR = 1.37; 95% CI 1.22-1. 54), continued to be associated with higher rates of inadequate prenatal care utilization. Racial disparity regarding adequate utilization of prenatal services was detected, with black (PR = 1.19; 95% CI 1.04-1.36) and mulatto (PR = 1.14; 95% CI 1.02-1.26) women showing higher rates of inadequate use. On the other hand, women covered by the FHP - Family Health Program (PR = 0.92; 95% CI 0.85-0.98) showed a lower rate of inadequate prenatal care utilization. CONCLUSIONS Despite strong expansion of health services and expressive improvements in adequate prenatal care use and social indicators, inequalities in prenatal care use still persist. The FHP seems to be effective in reducing inadequate prenatal care utilization.
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Affiliation(s)
- Ariane Cristina Ferreira Bernardes
- />Department of Public Health, Federal University of Maranhão, Brazil, Rua Barão de Itapary, 155, Centro, São Luís, Maranhão 65020-070 Brazil
| | - Raimundo Antonio da Silva
- />Department of Public Health, Federal University of Maranhão, Brazil, Rua Barão de Itapary, 155, Centro, São Luís, Maranhão 65020-070 Brazil
| | - Liberata Campos Coimbra
- />Department of Nursing, Federal University of Maranhão, Brazil, Rua Viana Vaz, 230, Centro, São Luís, Maranhão 65020-660 Brazil
| | | | - Rejane Christine de Sousa Queiroz
- />Department of Public Health, Federal University of Maranhão, Brazil, Rua Barão de Itapary, 155, Centro, São Luís, Maranhão 65020-070 Brazil
| | - Rosângela Fernandes Lucena Batista
- />Department of Public Health, Federal University of Maranhão, Brazil, Rua Barão de Itapary, 155, Centro, São Luís, Maranhão 65020-070 Brazil
| | - Heloisa Bettiol
- />Department of Puericulture and Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil, Avenida Bandeirantes, 3900, Hospital das Clínicas de Ribeirão Preto, Monte Alegre, Ribeirão Preto, São Paulo 14049-900 Brazil
| | - Marco Antônio Barbieri
- />Department of Puericulture and Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil, Avenida Bandeirantes, 3900, Hospital das Clínicas de Ribeirão Preto, Monte Alegre, Ribeirão Preto, São Paulo 14049-900 Brazil
| | - Antônio Augusto Moura da Silva
- />Department of Public Health, Federal University of Maranhão, Brazil, Rua Barão de Itapary, 155, Centro, São Luís, Maranhão 65020-070 Brazil
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Cembranel F, Corso ACT, González-Chica DA. Coverage and adequacy of ferrous sulfate supplementation in the prevention of anemia among children treated at health centers of Florianopolis, Santa Catarina. Rev Paul Pediatr 2013; 31:315-23. [PMID: 24142313 PMCID: PMC4182967 DOI: 10.1590/s0103-05822013000300007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 04/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the National Program of Iron Supplementation (PNSF) coverage, the compliance with the directions for of using of this supplementation and the association with sociodemographic factors in children aged six to 18 months old and registered in 35 public health centers of Florinópolis (Southern Brazil). METHODS Cross-sectional study using secondary data obtained from the health information system of the Health Department of Florianópolis, Santa Catarina, Brazil (Infosaúde). Data on ferrous sulfate supplementation and sociodemographic variables were obtained of all children registered in PNSF in Florianópolis in 2010. STATA 11.0 software was used in the analyses. RESULTS The PNSF covered 6.3% (95%CI 5.9-6.7) of the children; the compliance with the directions regarding age at the onset of supplementation and its frequency was adequate only in 2.4% of the cases (95%CI 1.5-3.7). There was no association with the child's gender, maternal education level and ethnicity or the distance from home to the health center. CONCLUSIONS This study showed low coverage and inadequate compliance with the PNSF directions. Measures to improve this strategy are urgent.
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Affiliation(s)
- Francieli Cembranel
- Mestre pelo Programa de Pós-Graduação em Nutrição do
Departamento de Nutrição da UFSC, Florianópolis, SC,
Brasil
| | - Arlete Catarina T. Corso
- Doutor em Saúde Pública pela Universidade de São Paulo
(USP); Professor-Titular do Programa de Pós-Graduação em Nutrição do
Departamento de Nutrição da UFSC, Florianópolis, SC,
Brasil
| | - David Alejandro González-Chica
- Doutor em Epidemiologia pela Universidade Federal de Pelotas
(UFPel); Professor-Adjunto do Programa de Pós-Graduação em Nutrição do
Departamento de Nutrição da UFSC, Florianópolis, SC,
Brasil
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