Resultados maternos e neonatais em centro de parto normal peri-hospitalar e hospital

OBJETIVO: Comparar os resultados maternos e neonatais em mulheres de baixo risco atendidas em centro de parto normal peri-hospitalar e hospital. M��TODOS: Estudo transversal com amostra representativa de mulheres de baixo risco atendidas em S��o Paulo, SP, de 2003 a 2006. Foram inclu��das 991 mulheres que tiveram o parto no centro de parto normal e 325 que deram �� luz no hospital. Os dados foram obtidos dos prontu��rios. A an��lise comparativa foi realizada para o total de mulheres e estrati��� cada segundo a paridade. Foram aplicados os testes qui-quadrado e exato de Fisher. RESULTADOS: Houve distribui����o homog��nea das mulheres segundo a paridade (45,4% nul��paras e 54,6% mulheres com um ou mais partos anteriores). Foram encontradas diferen��as estatisticamente signi��� cantes em rela����o ��s seguintes interven����es: amniotomia (mais freq��ente entre nul��paras do hospital); utiliza����o de ocitocina no trabalho de parto e utiliza����o de analg��sico no p��s-parto (mais freq��entes no hospital entre as mulheres de todas as paridades). A taxa de episiotomia foi maior entre as nul��paras, tanto no centro de parto como no hospital. Houve maior freq����ncia de interven����es com o neonato no hospital: aspira����o das vias a��reas superiores, aspira����o g��strica, lavagem g��strica, oxig��nio por m��scara aberta. Tamb��m ocorreram com mais freq����ncia no hospital bossa serossangu��nea, desconforto respirat��rio e interna����o na unidade neonatal. N��o houve diferen��a nos valores de Apgar no quinto minuto nem casos de morte materna ou perinatal. CONCLUS��ES: A assist��ncia no centro de parto normal foi realizada com menos interven����es e com resultados maternos e neonatais semelhantes aos do hospital.

Atendimentos decorrentes de queimaduras em servi��os p��blicos de emerg��ncia no Brasil, 2009

O objetivo foi analisar os atendimentos por queimaduras em servi��os de emerg��ncia, e fatores associados. Estudo transversal de 761 atendimentos coletados pelo Sistema de Vigil��ncia de Viol��ncias e Acidentes em 2009. A maioria foi do sexo masculino (58,6%); adultos de 30 a 49 anos (23,1%) e crian��as de 0 a 9 anos (23%). A resid��ncia foi o local de ocorr��ncia mais frequente (62,1%), especialmente para crian��as e mulheres; em seguida com��rcio, servi��os, ind��stria e constru����o (19,1%), especialmente entre homens de 20 a 49 anos. Queimaduras no trabalho foram 29,1% do total. Uso de ��lcool chegou a 5,1%. Agentes causadores em todas as idades: subst��ncia quente (43,6%) e fogo/chama (24,2%); na faixa produtiva: subst��ncias qu��micas. As queimaduras entre 0 e 14 anos foram associadas com resid��ncia, subst��ncia e objeto quente e interna����o hospitalar; entre os de 15 a 49 anos associaram-se com fogo/chama e choque el��trico, via p��blica e alta da emerg��ncia. Estrat��gias de preven����o para crian��as e trabalhadores devem ser implantadas.

Spatial regimes: dynamics of intentional homicides in the city of Sao Paulo between 2000 and 2008

Objective. To identify the existence of spatial and temporal patterns in the occurrence of intentional homicides in the municipality of Sao Paulo (MSP), Brazil, and to discuss the analytical value of taking such patterns into account when designing studies that address the dynamics and factors associated with the incidence of homicides. Methods. A longitudinal ecological study was conducted, having as units of analysis 13 205 census tracts and the 96 census districts that congregate these sectors in Sao Paulo. All intentional homicides reported in the city between 2000 and 2008 were analyzed. The gross homicide rates per 100 000 population was calculated as well as the global and local Bayesian estimates for each census tract during the study period. To verify the possibility of identifying different patterns of the spatial distribution of homicides, we used BoxMap and Moran's I index. Results. The homicide trends in the city of Sao Paulo in the last decade were not homogeneous and systematic. Instead, seven patterns of spatial distribution were identified; that is, seven spatial regimes for the occurrence of intentional homicides, considering the homicide rates within each census tract as well as the rates in adjacent tracts. These spatial distribution regimes were not contained within the limits of the census tracts and districts. Conclusions. The results show the importance of analyzing the spatial distribution of social phenomena without restriction of political and administrative boundaries.

The prevalence of falls and associated factors among the elderly according to ethnicity

The historical and cultural characteristics reflect the Brazilian population. Elderly blacks are disadvantaged in socio-economic and demographic, clinical, functional and psychosocial aspects, reducing their social autonomy and functional independence. The decline in functional status due to variables associated with age and ethnicity can contribute to disabling events, such as falls. Socio-demographic, clinical and functional aspects related to falls were analyzed; Mobility, functional status and cognition were measured, with a statistical significance of pd '' 0.05. The sample of 196 elderly people was 48.5% white, 28% brown, 23.5% black, with an average of 69.9 years. There was reduced mobility classified as a medium risk for falls in 60% (p<0.013) among the elderly. With reference to groups analyzed, there were significant differences between variables for family income (p < 0.029), the occurrence of falls (p < 0.006), fear of falls (p < 0.023) and near-falls (p < 0.000). Blacks fall more often (p < 0.03). Statistical significance was revealed between ethnicity and self-reported occurrence of falls, fear of falling and the occurrence of near-falls, functional limitation and medium risk falls due to reduced mobility, with increased frequency of falls for elderly blacks.

Matrix Support in Mental Health: Achievements and Limits in Primary Health Care

Changes in mental health care in the city of Fortaleza (Northeastern Brazil) have a recent historical and political process. Compared to other municipalities of the State of Ceara, which in the early 1990s were already pioneers in the process, Fortaleza has not implemented the changes due to the interests of psychiatric hospitals, of psychiatric outpatient clinics of the public network, and because of the difficulty in managing the new mental health devices and equipment present in Primary Care. In the municipality, the reorganization of mental health actions and services has required that the Primary Care Network faces the challenge of assisting mental health problems with the implementation of Matrix Support. In light of this context, we aimed to evaluate Matrix Support in mental health in Primary Care Units and to identify achievements and limitations in the Primary Care Units with Matrix Support. This study used a qualitative approach and was carried out by means of a case study. We interviewed twelve professionals from the Family Health Teams of four Units with implemented Matrix Support. The analysis of the information reveals that access, decision making, participation and the challenges of implementing Matrix Support are elements that are, in a dialectic way, weak and strong in the reorganization of services and practices. The presence of Matrix Support in Primary Care highlights the proposal of dealing with mental health within the network in the municipality. The process has not ended. Mobilization, awareness-raising and qualification of Primary Care have to be enhanced constantly, but implementation has enabled, to the service and professionals, greater acceptance of mental health in Primary Care.

Factors associated with smoking in the elderly: a health survey in Sao Paulo (ISA-SP)

This article reports on smoking prevalence and associated factors in the elderly, based on a population-based cross-sectional study with multistage sampling including 1,954 individuals 60 years or older living in four areas of Sao Paulo State, Brazil. Overall smoking prevalence was 12.2%, and higher rates were associated with male gender, age 60-69 years, not belonging to an Evangelical church, lower income, low body weight, lack of leisure-time physical activity, depression/anxiety, and hypertension. There was a high prevalence of smokers among individuals with a history of stroke, cancer, and chronic obstructive pulmonary disease. The results point to the need for effective interventions in healthcare services to promote smoking cessation among the elderly, since many are unable to stop on their own, even when they have tobacco-related illnesses. Special attention should be paid to individuals that depend on the National Health System, since smoking prevalence is higher in underprivileged socioeconomic groups.

An approach to aircraft seat comfort using interface pressure mapping

The objective of the present study is to propose a method to dynamically evaluate discomfort of a passenger seat by measuring the interface pressure between the occupant and the seat during the performance of the most common activities of a typical flight(1). This article reports the results of resting and reading studies performed in a simulator that represents the interior of a commercial aircraft.

Evaluation of the capability of decentralized management of epidemiological surveillance in the state of Bahia

Evaluative research into the capability of decentralized management of epidemiological vigilance (EV) was conducted in the operational, organizational and sustainable dimensions in the state of Bahia, Brazil. The quantitative approach was used in the construction of a baseline, with primary data obtained through an online questionnaire answered by thirty-eight municipal EV managers. In the qualitative approach to analyze the context and assess the management capability of municipalities in two case studies, techniques adapted to the analysis of discursive practices were used. This was done through semi-structured interviews with managers of regional and municipal government, health workers and representatives of the municipal health council. The case studies showed that the municipality with enhanced management capability is that in which the manager has the greatest potential of using the resources of his position, in addition to his ability to control, negotiate and coordinate with other actors. Due to decentralization of EV, considering the shared nature of management between the three spheres of government, there is a marked variation in the management capability of municipalities, determined by social, economic, political inequalities and management mechanisms adopted.

Perinatal and early life factors associated with symptoms of depression in Brazilian children

Background: Few studies have been conducted on the association between perinatal and early life factors with childhood depression and results are conflicting. Our aim was to estimate the prevalence and perinatal and early life factors associated with symptoms of depression in children aged 7 to 11 years from two Brazilian birth cohorts. Methods: The study was conducted on 1444 children whose data were collected at birth and at school age, in 1994 and 2004/2005 in Ribeirao Preto, where they were aged 10-11 years and in 1997/98 and 2005/06 in Sao Luis, where children were aged 7-9 years. Depressive symptoms were investigated with the Child Depression Inventory (CDI), categorized as yes (score >= 20) and no (score < 20). Adjusted and non-adjusted prevalence ratios (PR) were estimated by Poisson regression with robust estimation of the standard errors. Results: The prevalence of depressive symptoms was 3.9% (95% CI = 2.5-5.4) in Ribeirao Preto and 13.7% (95% CI = 11.0-16.4) in Sao Luis. In the adjusted analysis, in Ribeirao Preto, low birth weight (PR = 3.98; 95% CI = 1.72-9.23), skilled and semi-skilled manual occupation (PR = 5.30; 95% CI = 1.14-24.76) and unskilled manual occupation and unemployment (PR = 6.65; 95% CI = 1.16-38.03) of the household head were risk factors for depressive symptoms. In Sao Luis, maternal schooling of 0-4 years (PR = 2.39; 95% CI = 1.31-4.34) and of 5 to 8 years (PR = 1.80; 95% CI = 1.08-3.01), and paternal age < 20 years (PR = 1.92; 95% CI = 1.02-3.61), were independent risk factors for depressive symptoms. Conclusions: The prevalence of depressive symptoms was much higher in the less developed city, Sao Luis, than in the more developed city, Ribeirao Preto, and than those reported in several international studies. Low socioeconomic level was associated with depressive symptoms in both cohorts. Low paternal age was a risk factor for depressive symptoms in the less developed city, Sao Luis, whereas low birth weight was a risk factor for depressive symptoms in the more developed city, Ribeirao Preto.

The role of evaluation in decision-making in the management of health services

The management of health services is a complex administrative practice due to the breadth of the field of health and the need to reconcile individual, corporate and collective interests that are not always convergent. In this context, the evaluation needs to have specific characteristics in order to fulfill its role. The scope of this study was to establish the characteristics that the evaluation for the management of health services should have to contribute to decision-making. Usefulness, opportunity, feasibility, reliability, objectivity and directionality represent the set of principles upon which the evaluation should be based. Evaluations should lead to decisions that guarantee not only their efficiency and effectiveness but also their implementation. The evaluation process should ensure that decisions involve all stakeholders in order to render the implementation of decisions feasible, and take into account the health needs of the population and the goals set for the services. The scope of this article is to elicit a debate among different stakeholders in the evaluation in the hope that it can contribute to the reflection on the real usefulness of evaluations in which the political component in management has been increasingly prevalent.

Cadeia de valor da sa��de: um modelo para o sistema de sa��de brasileiro

Este artigo apresenta um modelo de cadeia de valor da sa��de que representa, de maneira esquem��tica, o sistema de sa��de do Brasil. O modelo proposto tem como intuito apresentar uma adequa����o �� realidade brasileira, bem como abrang��ncia e flexibilidade para utiliza����o em atividades acad��micas e an��lises do setor de sa��de do Brasil. O modelo coloca ��nfase em tr��s componentes: principais atividades dessa cadeia, agrupadas em elos verticais e horizontais; miss��o de cada um desses elos; e principais fluxos da cadeia. A cadeia proposta �� formada por seis elos verticais e tr��s horizontais, perfazendo um total de nove: desenvolvimento de conhecimento em sa��de; fornecimento de produtos e tecnologias; servi��os de sa��de; intermedia����o financeira; financiamento da sa��de; consumo de sa��de; regula����o; distribui����o de produtos de sa��de; e servi��os de apoio e complementares. A an��lise da cadeia proposta pode ser realizada por meio de quatro fluxos: inova����o e conhecimento; produtos e servi��os; financeiro; e de informa����o.

Homens, sa��de e pol��ticas p��blicas: a equidade de g��nero em quest��o

O artigo tem por objetivo estabelecer quest��es acerca do tema Homens, Sa��de e Pol��ticas P��blicas para a viabiliza����o do debate sobre o assunto, com base em refer��ncias te��ricas e emp��ricas relacionadas a essas quest��es. Inicialmente, alguns marcos hist��ricos de tem��tica s��o apresentados para que melhor se situe o debate. Em seguida, apresenta-se panorama da agenda de g��nero nas pol��ticas p��blicas para se introduzir a discuss��o acerca da inser����o dessa perspectiva no ��mbito das pol��ticas de sa��de. Ap��s essa discuss��o, aborda-se o questionamento sobre o fato de as pol��ticas de sa��de dos homens promoverem ou n��o a equidade de g��nero. Nas considera����es finais, aponta-se para a complexidade que envolve a elabora����o, a implementa����o e a avalia����o das pol��ticas de sa��de que visam �� equidade de g��nero, bem como se destaca a necessidade de a pol��tica brasileira voltada para a sa��de dos homens articular-se com outras pol��ticas para que a matriz de g��nero seja transversal no campo da sa��de.

Meningococcal disease in the Sorocaba region, Sao Paulo State, Brazil, 1999-2008

The objective of this study was to describe the occurrence of meningococcal disease reported to the Regional Health Department in Sorocaba, Sao Paulo State, Brazil, from 1999 to 2008. Annual incidence of the disease was two cases per 100,000 inhabitants, with an increase from 2006 to 2008. Annual incidence rates were highest in the 0 to 4 year age bracket. Case-fatality was 21.8%, higher in the 0 to 4 year age bracket (26.4%), which also showed the highest incidence of the disease, and in the over 30-year age bracket (28%). Diagnosis was confirmed by laboratory test in 71% of cases (culture in 45.3%) and by clinical and epidemiological criteria in 22%. Serological groups were B in 45.7%, C in 47.3%, W135 in 3.7%, and Y in 1.5% of the identified cases, with a predominance of B from 1999 to 2003 and C from 2004 to 2008. The most frequent phenotypes were B:4, 7:P1.19,15 and C:23:P1.14-6. The results emphasize the need for regional surveillance of trends in the disease for early detection of outbreaks and monitoring circulating strains.

The standpoint of professionals on the presence and demands of men on the healthcare services: perspectives for the analysis of the implementation of the Comprehensive Healthcare Policy for Men

In 2009, the Brazilian Comprehensive Healthcare Policy for Men (PNAISH) was launched in Brazil, seeking to reduce morbidity and mortality in this population group. This article strives to analyze the conceptions that health professionals have about the specific demands and behaviors of the male population served by the healthcare services. The data analyzed are part of a larger research project, the objective of which was to evaluate the initial actions of the implementation of PNAISH. Ethnographic observations in 11 health services and semi-structured interviews were conducted with 21 health professionals. From the perspective of health professionals, the presence of men in the healthcare services is still limited. According to them, it is comprised of two types of clients: workers and the elderly. The male behavior characteristics - haste, objectivity, fear and resistance - and the difficulty faced by health services in receiving this population are the main factors that drive men away from health services. Although the concept of gender is central to PNAISH, it is only triggered by healthcare professionals in order to justify the social standards expected in terms of men's behavior. The attribution of men's behavior to cultural factors ultimately obscures the relations of power that underlie gender relations.

Men's health: a population-based study on social inequalities

This study evaluates social inequalities in health according to level of schooling in the male population. This was a cross-sectional, population-based study with a sample of 449 men ranging from 20 to 59 years of age and living in Campinas, Sao Paulo State, Brazil. The chi-square test was used to verify associations, and a Poisson regression model was used to estimate crude and adjusted prevalence ratios. Men with less schooling showed higher rates of alcohol consumption and dependence, smoking, sedentary lifestyle during leisure time, and less healthy eating habits, in addition to higher prevalence of bad or very bad self-rated health, at least one chronic disease, hypertension, and other health problems. No differences were detected between the two schooling strata in terms of use of health services, except for dental services. The findings point to social inequality in health-related behaviors and in some health status indicators. However, possible equity was observed in the use of nearly all types of health services.