Cardiovascular risk among health professionals working in pre-hospital care services

The objective of this study was to assess the cardiovascular risk factors among health professionals, particularly hypertension, and stratify them according to the Framingham Risk Score (FRS). The participants were 154 professionals working in pre-hospital care in Sao Paulo, Brazil, and on the Br-116 highway. Values were considered significant for p<0.05. The prevalence of hypertension was 33%, 20.1% were smokers, 47% consumed alcoholic beverages, 64% were sedentary, 66% were obese/overweight and 70% had an altered abdominal circumference. In terms of laboratory values: glucose >= 110mg/dL11%, total cholesterol >= 200mg/dL-36%, LDL-c >= 130mg/dL-33%, HDL-c<60mg/dL89%, triglycerides >= 150mg/dL-30% and C reactive protein >= 0.5mg/dL-16%. The FRS was average in 10.3% and high in 1.3%. In logistic regression analysis, it was verified that hypertension was associated with: HDL-c (odds ratio: 0.257,) and FRS (odds ratio: 23.159). There was strong correlation between hypertension and FRS. Data are noteworthy, as this is a relatively young sample of health professionals.

A TRAINING COURSE ON BIOETHICS FOR FAMILY HEALTH STRATEGY PROFESSIONALS IN SANTO ANDRE, SP

This case report presents the experience of a training course on bioethics for nurses and physicians of the Family Health Strategy in Santo Andre, SP. This study is based on problem-based learning and deliberative bioethics, and aimed at presenting the deliberation procedure as a means of handling ethical issues. Contents were addressed in a cross-section manner through five sequential activity sessions at two different moments of concentration with one dispersion interval. In the first moment of concentration, key concepts and deliberative bioethics contents were developed. The second involved deliberation sessions on moral conflicts, which were selected and prepared during the dispersion interval. Participants evaluated the deliberation as an appropriate instrument to deal with the ethical issues they are faced with. Problem-based learning was an effective educational strategy for continuing education in deliberative bioethics.

Family Health Strategy Professionals Facing Medical Social Needs: difficulties and coping strategies

Professionals of Family Health Strategy (FHS) work in communities where there are complex medical social problems. These contexts may lead them to psychological suffering, jeopardizing their care for the users, and creating yet another obstacle to the consolidation of FHS as the primary health care model in Brazil. The study investigated the difficulties and coping strategies reported by health professionals of the FHS teams when they face medical social needs of the communities where they work. Focus groups and semi-structured interviews were carried out with 68 professionals of three primary care units in the city of Sao Paulo (Southeastern Brazil). Drug dealing and abuse, alcoholism, depression and domestic violence are the most relevant problems mentioned by the study group. Professionals reported lack of adequate training, work overload, poor working conditions with feelings of professional impotence and frustration. To overcome these difficulties, professionals reported collective strategies, particularly experience sharing during team meetings and matrix support groups. The results indicate that the difficulties may put the professionals in a vulnerable state, similar to the patients they care for. The promotion of specialized and long term support should be reinforced, as well as the interaction with the local network of services and communities leaders. That may help professionals to deal with occupational stress related to medical and social needs present in their routine work; in the end, it may as well contribute to the strengthening of FHS.

The Environmental Theme in Representations and Practices of Family Health Professionals in the Municipality of Manaus - State of Amazonas/Brazil

There are abundant scientific evidences showing that the increased risk of exposure to diseases is a consequence of anthropogenic environmental changes. In the Family Health Strategy, tasks with a clear environmental focus are prescribed, indicating to the professional teams that they should consider these aspects in their health practices. The objective of this research was to study representations and practices of Family Health Professionals of Manaus - State of Amazonas, Northern Brazil - about environmental issues and their interface with public health. Data were collected by means of participant observation and semi-structured interviews, and the qualitative analysis was carried out through Content Analysis and Methodological Triangulation. The results showed that most professionals do not understand the environment in a systemic way, even though they recognize the great impact that environmental factors have on human health; as interventions, the educational practices follow traditional methodologies and focus on blaming the individual and on the simple transmission of knowledge; the professionals' relationship with the community is limited to personal and/or collective care. It is concluded that in order to the Family Health Strategy to contribute to restructure the system, it is essential to redirect this new health policy model so that it becomes effective as a social and environmental practice.

Family Health Support Centers: challenges and opportunities from the perspective of primary care professionals in the city of Sao Paulo, Brazil

Family Health Support Centers (NASF) were created in Brazil to increase the case-resolution capacity of primary healthcare. Prior to their implementation in the West Side of the city of Sao Paulo, Brazil, a series of workshops were held for primary healthcare professionals to prepare a proposal for such centers. Hermeneutic analysis was used to study the transcribed material. The thematic categories were: role, constitution, and functioning of the NASF, relationship with family health teams, and interdisciplinarity. The participants' expected the NASF to be an empowering device for comprehensiveness of care, intervening in an existing culture of unnecessary referrals while fostering linkage with other levels of care. The participants also expected the NASF to contribute to the discussion on health professionals' training and stimulating reflection with policy-makers on health indicators based exclusively on the number of consultations. These indicators fail to reflect the impact on the services' activities and the quality of care offered to the population in the coverage area.

A Reappraisal in Sao Paulo, Brazil (2008) of "The Ecology of Medical Care:" The "One Per Thousand's Rule"

BACKGROUND AND OBJECTIVES: Medical ecology is a conceptual framework introduced in 1961 to describe the relationship and utilization of health care services by a given population. We applied this conception to individuals enrolled in a private health maintenance organization (HMO) in Sao Paulo, Brazil, with the aim of describing the utilization of primary health care, verifying the frequency of various symptoms, and identifying the roles of different health care sources. METHODS: This was a cross-sectional telephone survey among a random sample of people enrolled in a private HMO. We interviewed a random sample of non-pregnant adults over age 18 using 10 questions about symptoms and health care use during the month prior to interview. RESULTS: The final sample consisted of 1,065 participants (mean age 68 years, 68% female). From this sample, 424 (39.8%) reported the presence of symptoms, 311 (29.2%) had a medical office consult, 104 (9.8%) went directly to an emergency medical department, 63 (5.9%) were hospitalized, 22 (2.1%) used complementary medicine resources, seven (0.7%) were referred to home care, and one (0.1%) was admitted to an academic hospital. CONCLUSIONS: The proportion of study participants referred to an academic care center was similar to that observed in previous "medical ecology" studies in different populations.

PCR colorimetric dot-blot assay and clinical pretest probability for diagnosis of Pulmonary Tuberculosis in Smear-Negative patients

Abstract Background Smear-negative pulmonary tuberculosis (SNPTB) accounts for 30% of Pulmonary Tuberculosis (PTB) cases reported annually in developing nations. Polymerase chain reaction (PCR) may provide an alternative for the rapid detection of Mycobacterium tuberculosis (MTB); however little data are available regarding the clinical utility of PCR in SNPTB, in a setting with a high burden of TB/HIV co-infection. Methods To evaluate the performance of the PCR dot-blot in parallel with pretest probability (Clinical Suspicion) in patients suspected of having SNPTB, a prospective study of 213 individuals with clinical and radiological suspicion of SNPTB was carried out from May 2003 to May 2004, in a TB/HIV reference hospital. Respiratory specialists estimated the pretest probability of active disease into high, intermediate, low categories. Expectorated sputum was examined by direct microscopy (Ziehl-Neelsen staining), culture (Lowenstein Jensen) and PCR dot-blot. Gold standard was based on culture positivity combined with the clinical definition of PTB. Results In smear-negative and HIV subjects, active PTB was diagnosed in 28.4% (43/151) and 42.2% (19/45), respectively. In the high, intermediate and low pretest probability categories active PTB was diagnosed in 67.4% (31/46), 24% (6/25), 7.5% (6/80), respectively. PCR had sensitivity of 65% (CI 95%: 50%���78%) and specificity of 83% (CI 95%: 75%���89%). There was no difference in the sensitivity of PCR in relation to HIV status. PCR sensitivity and specificity among non-previously TB treated and those treated in the past were, respectively: 69%, 43%, 85% and 80%. The high pretest probability, when used as a diagnostic test, had sensitivity of 72% (CI 95%:57%���84%) and specificity of 86% (CI 95%:78%���92%). Using the PCR dot-blot in parallel with high pretest probability as a diagnostic test, sensitivity, specificity, positive and negative predictive values were: 90%, 71%, 75%, and 88%, respectively. Among non-previously TB treated and HIV subjects, this approach had sensitivity, specificity, positive and negative predictive values of 91%, 79%, 81%, 90%, and 90%, 65%, 72%, 88%, respectively. Conclusion PCR dot-blot associated with a high clinical suspicion may provide an important contribution to the diagnosis of SNPTB mainly in patients that have not been previously treated attended at a TB/HIV reference hospital.

Comparison of two laboratory-developed PCR methods for the diagnosis of Pulmonary Tuberculosis in Brazilian patients with and without HIV infection

Abstract Background Direct smear examination with Ziehl-Neelsen (ZN) staining for the diagnosis of pulmonary tuberculosis (PTB) is cheap and easy to use, but its low sensitivity is a major drawback, particularly in HIV seropositive patients. As such, new tools for laboratory diagnosis are urgently needed to improve the case detection rate, especially in regions with a high prevalence of TB and HIV. Objective To evaluate the performance of two in house PCR (Polymerase Chain Reaction): PCR dot-blot methodology (PCR dot-blot) and PCR agarose gel electrophoresis (PCR-AG) for the diagnosis of Pulmonary Tuberculosis (PTB) in HIV seropositive and HIV seronegative patients. Methods A prospective study was conducted (from May 2003 to May 2004) in a TB/HIV reference hospital. Sputum specimens from 277 PTB suspects were tested by Acid Fast Bacilli (AFB) smear, Culture and in house PCR assays (PCR dot-blot and PCR-AG) and their performances evaluated. Positive cultures combined with the definition of clinical pulmonary TB were employed as the gold standard. Results The overall prevalence of PTB was 46% (128/277); in HIV+, prevalence was 54.0% (40/74). The sensitivity and specificity of PCR dot-blot were 74% (CI 95%; 66.1%-81.2%) and 85% (CI 95%; 78.8%-90.3%); and of PCR-AG were 43% (CI 95%; 34.5%-51.6%) and 76% (CI 95%; 69.2%-82.8%), respectively. For HIV seropositive and HIV seronegative samples, sensitivities of PCR dot-blot (72% vs 75%; p = 0.46) and PCR-AG (42% vs 43%; p = 0.54) were similar. Among HIV seronegative patients and PTB suspects, ROC analysis presented the following values for the AFB smear (0.837), Culture (0.926), PCR dot-blot (0.801) and PCR-AG (0.599). In HIV seropositive patients, these area values were (0.713), (0.900), (0.789) and (0.595), respectively. Conclusion Results of this study demonstrate that the in house PCR dot blot may be an improvement for ruling out PTB diagnosis in PTB suspects assisted at hospitals with a high prevalence of TB/HIV.

A humaniza����o do cuidado na forma����o dos profissionais de sa��de nos cursos de gradua����o

A proposta desta pesquisa bibliogr��fica �� conhecer e analisar a produ����o cient��fica do campo da sa��de, em peri��dicos nacionais, sobre o ensino da humaniza����o do cuidado nos cursos de gradua����o. Realizou-se um levantamento bibliogr��fico na base de dados LILACS, utilizando o termo humaniza����o, com textos publicados a partir do ano de 2000 at�� 2010, sendo analisados 42 artigos. Da an��lise dos artigos emergiram tem��ticas centrais: Humaniza����o: algumas considera����es sobre seus conceitos; Universidade e as Diretrizes Curriculares Nacionais para os Cursos de Gradua����o na ��rea da Sa��de: rela����es com o ensino da humaniza����o; Mudan��as curriculares, conte��dos e estrat��gias de ensino-aprendizagem no cuidado humanizado e Sujeitos do processo ensino-aprendizagem: alunos e professores na aprendizagem da humaniza����o do cuidado. Alguns elementos te��rico-pr��ticos v��m sendo constru��dos sobre o ensino da humaniza����o no contexto de sa��de, sendo imprescind��vel, todavia, maiores investimentos na constru����o efetiva de novos modos de cuidar.

Risco cardiovascular em profissionais de sa��de de servi��os de atendimento pr��-hospitalar

Avaliar os fatores de risco cardiovascular, com ��nfase na hipertens��o, e estratific��-los de acordo com o Escore de Risco de Framingham (ERF). Estudo com 154 profissionais que atuavam em aten-dimento pr��-hospitalar na cidade de S��o Paulo e rodovia Br-116. Foi considerado significante o valor de p<0,05. A preval��ncia de hipertens��o foi de 33%, sendo que 20,1% eram tabagistas, 47% ingeriam bebidas alco��licas, 64% eram sedent��rios, 66% apresentaram obesidade/sobrepeso e 70% cintura abdominal alterada, glicemia&gt;110mg/dL- 11%, colesterol total&gt;200mg/dL- 36%, LDL-c&gt;130mg/dL- 33%, HDL-c<60mg/dL- 89%, triglic��rides&gt;150mg/dL- 30% e prote��na C reativa&gt;0,5mg/dL- 16%. O ERF foi m��dio em 10,3% e alto em 1,3%. Na an��lise de regress��o log��stica verificou-se que a hipertens��o associou-se com as vari��veis: HDL-c (odds ratio: 0,257) e ERF (odds ratio: 23,159). Houve forte associa����o entre ERF e hipertens��o. Os dados chamam a aten����o, por se tratar principalmente de profissionais da ��rea da sa��de relativamente jovens.

Capacita����o em bio��tica para profissionais da Sa��de da Fam��lia do munic��pio de Santo Andr��, SP

Relato de experi��ncia da capacita����o em bio��tica para enfermeiros e m��dicos da Estrat��gia Sa��de da Fam��lia, Santo Andr��, SP. Trata-se de trabalho calcado na problematiza����o e bio��tica deliberativa, que objetivou apresentar o procedimento da delibera����o para subsidiar o manejo de problemas ��ticos. Trabalharam-se os conte��dos transversalmente em cinco sequ��ncias de atividades, em dois momentos de concentra����o, intercalados por um de dispers��o. Na primeira concentra����o, desenvolveram-se conceitos chaves e conte��dos da bio��tica deliberativa. Na segunda, houve sess��es de delibera����o para situa����es de conflito moral, selecionadas e preparadas durante a dispers��o. Os participantes avaliaram a delibera����o como um instrumental adequado para lidar com as quest��es ��ticas que vivem. A problematiza����o mostrou-se efetiva como estrat��gia educativa na forma����o cont��nua em bio��tica deliberativa.

Atitudes dos profissionais de enfermagem relacionadas ao Processo de Enfermagem

Os objetivos do estudo foram descrever a disposi����o sobre o Processo de Enfermagem (PE) e a percep����o de poder cl��nico dos profissionais de enfermagem; analisar associa����es entre atitudes relacionadas ao PE e vari��veis selecionadas. Participaram 1.605 auxiliares de enfermagem e enfermeiros (86,9% mulheres, idade m��dia 44,12 anos; DP=9,55). O escore m��dio no instrumento Posi����es sobre o Processo de Enfermagem (PPE) foi 112,37 (DP=22,28) e no Power as Knowing Participation in Change Tool - vers��o brasileira (PKPCT) foi 281,12 (DP= 38,72). Os escores nos instrumentos foram mais altos para enfermeiros quando comparados aos auxiliares. Houve correla����o positiva moderada entre escores do PPE e PKPCT. Para os auxiliares houve associa����o entre os escores no PPE, sexo e p��s-gradua����o; e entre percep����o de poder e sexo. Para os enfermeiros houve associa����o entre PKPCT e cargo de chefia. Mais estudos devem ser desenvolvidos com vistas a identificar vari��veis potencialmente associadas ao uso do Processo de Enfermagem na pr��tica cl��nica.

N��cleos de Apoio �� Sa��de da Fam��lia: desafios e potencialidades na vis��o dos profissionais da Aten����o Prim��ria do Munic��pio de S��o Paulo, Brasil

Os N��cleos de Apoio �� Sa��de da Fam��lia (NASF) foram criados para ampliar a resolutividade da aten����o prim��ria. A imin��ncia da implanta����o na regi��o oeste do Munic��pio de S��o Paulo, Brasil, motivou a realiza����o de oficinas para elaborar uma proposta de NASF por profissionais da aten����o prim��ria �� sa��de. Utilizamos a an��lise hermen��utica para estudar o material transcrito. As categorias tem��ticas foram: papel, constitui����o, funcionamento, rela����o com a equipes de sa��de da fam��lia e interdisciplinaridade. A expectativa dos participantes foi de que o NASF seja um dispositivo potencializador da integralidade do cuidado, intervindo na cultura dos encaminhamentos desnecess��rios e na articula����o com os outros n��veis de aten����o; al��m de contribuir para a discuss��o da forma����o dos profissionais e de estimular a reflex��o junto aos gestores sobre indicadores de sa��de vinculados exclusivamente ao n��mero de atendimentos, que n��o refletem o impacto das a����es desenvolvidas nem a qualidade do cuidado oferecido �� popula����o adscrita.

O processo de revis��o por pares: uma revis��o integrativa de literatura

OBJETIVO: Avaliar as evid��ncias dispon��veis na literatura sobre o processo de revis��o por pares de artigos cient��ficos na ��rea da sa��de. M��TODOS: Revis��o integrativa de literatura, na qual foram realizadas buscas nas bases de dados da Literatura Latino-Americana e do Caribe em Ci��ncias da Sa��de, National Library of Medicine, Medical Literature Analysis and Retrieval System Online e Cumulative Index to Nursing and Allied Health Literature. Um total de 12 estudos foi analisado. RESULTADOS: Foi demonstrado que existem muitas cr��ticas ao processo em raz��o de sua subjetividade, por��m acredita-se na necessidade dos mesmos. CONCLUS��O: Este processo �� imprescind��vel para a difus��o do conhecimento, sendo uma etapa essencial no julgamento de manuscritos cient��ficos, no entanto, considera-se importante que se fa��am mudan��as no sentido de reduzir a subjetividade para garantir credibilidade ao processo.

A tem��tica ambiental em representa����es e pr��ticas de profissionais de sa��de da fam��lia no munic��pio de Manaus - AM/Brasil

Evid��ncias cient��ficas mostram que mudan��as ambientais antr��picas aumentam riscos de exposi����o a diversas doen��as. Na Estrat��gia Sa��de da Fam��lia - ESF, tarefas com claro enfoque ambiental s��o prescritas indicando ��s equipes de profissionais que considerem esses aspectos em suas interven����es. O objetivo desta pesquisa foi conhecer representa����es e pr��ticas de profissionais de Sa��de da Fam��lia de Manaus (AM) sobre a quest��o ambiental e sua interface com a sa��de p��blica. Os dados foram coletados por meio de observa����o participante e entrevistas semiestruturadas, e a an��lise qualitativa destes deu-se pela An��lise de Conte��do e Triangula����o de M��todos. Resultados da pesquisa revelaram que a maioria dos profissionais n��o compreende o ambiente de forma sist��mica, mesmo tendo declarado que os fatores ambientais t��m grande influ��ncia sobre a sa��de humana; enquanto interven����es, as pr��ticas educativas seguem metodologias tradicionais e s��o centradas na culpabiliza����o do indiv��duo e na simples transmiss��o de conhecimentos pontuais; o relacionamento dos profissionais com a comunidade resume-se ao atendimento individual e/ou coletivo. Concluiu-se que, para a ESF contribuir para o reordenamento do sistema, �� fundamental o redirecionamento desse novo modelo de pol��tica de sa��de para efetivar-se como pr��tica social e ambiental.