La télémédecine en radiothérapie : développement d’un modèle et analyse des coûts

But : La radiothérapie (RT) est disponible seulement dans les grandes villes au Québec. Les patients atteints de cancer vivant en zone rurale doivent voyager pour obtenir ces soins. Toute proportion gardée, moins de ces patients accèdent à la RT. L’accessibilité serait améliorée en instaurant de petits centres de RT qui dépendraient de la télémédecine (téléRT). Cette étude tente (1) de décrire un modèle (population visée et technologie) réaliste de téléRT; (2) d’en estimer les coûts, comparativement à la situation actuelle où les patients voyagent (itineRT). Méthode : (1) À l’aide de données probantes, le modèle de téléRT a été développé selon des critères de : faisabilité, sécurité, absence de transfert des patients et minimisation du personnel. (2) Les coûts ont été estimés du point de vue du payeur unique en utilisant une méthode publiée qui tient compte des coûts en capitaux, de la main d’oeuvre et des frais généraux. Résultats : (1) Le modèle de téléRT proposé se limiterait aux traitements palliatifs à 250 patients par année. (2) Les coûts sont de 5918$/patient (95% I.C. 4985 à 7095$) pour téléRT comparativement à 4541$/patient (95%I.C. 4351 à 4739$) pour itineRT. Les coûts annuels de téléRT sont de 1,48 M$ (d.s. 0,6 M$), avec une augmentation des coûts nets de seulement 0,54 M$ (d.s. 0,26 M$) comparativement à itineRT. Si on modifiait certaines conditions, le service de téléRT pourrait s’étendre au traitement curatif du cancer de prostate et du sein, à coûts similaires à itineRT. Conclusion : Ce modèle de téléRT pourrait améliorer l’accessibilité et l’équité aux soins, à des coûts modestes.

A utilização de serviços odontológicos entre crianças e fatores associados em Sobral, Ceará, Brasil

NORO, L. R. A. et al. A utilização de serviços odontológicos entre crianças e fatores associados em Sobral, Ceará, Brasil. Cad. Saúde Pública, v. 24, n. 7, p. 1509-1516. 2008. ISSN 0102-311X.

Inclusão da criança com deficiência na estratégia de saúde da família

The objective of analyze the shift of the working process of the ESF team in care of children with disabilities, from awareness-raising actions. It is a qualitative study, with the action-research method. Thirteen health professionals were involved from two teams of ESF unit area of the Unidade de Saúde da Família Dr. Chico Porto (UBSFCP) in Mossoró, from March to August 2011. Data were analyzed following the direction of freirean s thematic analysis. In the situational diagnosis of the current reality of CwD assistance in that UBSFCP, through participant observation and application of semi-structured interviews with professionals, we realize that despite these actions carry some assistance to the CwD, in practice few are used for inclusion and accessibility. The monitoring of the CwD is done through individual consultations by each team professional, home visits when possible, both ruled on the complaints and problems, with little solving in the used actions. Since the need for a change in the treatment model and training requirements as pointed out by professionals in the interview, then we decided to build the proposed of training suggested by the multidisciplinary team and put together collectively the achievement of this moment in all its phases. In the step of implementation (action), aspects related to the current situation in Brazil and Mossoró (Laws, policies and health care) for the CwD and CwD Assistance and their family in the ESF in the first two moments of the first training (action) were contemplate. On the second day we discussed the specialized care to CwD, contribution of the Handicapped Parents and Friends Association of Mossoró and in a second moment a workshop was held in which awareness for inclusion of CwD and actions of ESF were discussed. All these moments were discussed and collectively constructed. In the evaluation, we found that implementation (action) allowed to the professional the comprehension of new understandings about people with disabilities, on ways to include, guiding, caring, watching, and mainly to have a new vision on health assistance of the CwD, expanding assistance beyond clinical aspects and recognizing the educational aspects of the rights and duties of citizens and the inclusion of these children in the social spaces area. As difficulties, we face the need for some professionals to be absent to attend another job, solve personal problems, and little or no participation. Thus, during this action-research, the subjects were able to realize the importance of carrying out their practice to the quality of life for him and to the one they care

Centros de especialidades odontológicas: avaliação da atenção de média complexidade na rede pública da Grande Natal

The Specialized Dental Care Centers (CEO) were developed to provide specialized dental care to the population, given the accumulated needs of health since the past. They must operate as units of reference for the Oral Health Team of the Primary Care, complementing the dental procedures performed at this level of attention. This study aims to assess the performance of CEOs of the Grande Natal Health Region as a strategy of Secondary Care consolidation in oral health through users, dentists and managers. For this to try to identify factors about access, hosting and satisfaction with the service, the actions developed in these centers, integration between the CEOs and the Basic Health Units (UBS), considering the reference and counter reference. Data were collected through semi-structured interview, conducted in four CEOs, among 253 users, 31 dentists and 4 managers. It was submitted to descriptive statistical analysis and to content analysis by software ALCESTE 4.5. The results revealed that the specialties of prosthesis, endodontics and surgery were the most sought by 38.2%, 23.7% and 21.7% of respondents, respectively. It was noticed that among users aged 18 to 30 years-old the greatest demand is for the specialty of endodontics (44.4%) and over 50 years for prosthesis (76.4%). There is a weakness in the reference and counter reference between UBS and CEO, because part of users goes directly to the centers without going before to the Primary Care and the majority does not want to return to the dentist of Health Unit. Satisfaction with care was reported by 90.9% of users, because they resolved the problems needed and were welcomed by the team. But the delay in care was the main factor for not satisfaction. For most dentists, some users could solve their problems completely in Primary Care, which shows the existence of unnecessary referrals to the CEOs, however they consider the existence of limiting factors in UBS that compromise the service. Most dentists revealed that some users do not get to CEOs with the basic dental treatment done, and some of them do not counter reference users. It can be concluded that the studied CEOs are being resolutive for those who access them, offering necessary care for the population, and if they don t account with this service, will encounter obstacles to resolution of problems, ranging seek care service in particular, in another public sector, or even giving up treatment. However, it is perceived the need of professionals training to understand the importance of the reference and counter reference, to that they can better serve and guide users. It is also important that cities offer better conditions to UBS and CEOs, so they can work together, with complementary actions of oral health, seeking full care, aiming for better resolution to the users' health problems

Avaliação em saúde bucal na perspectiva do usuário: enfoque ao estudo da acessibilidade organizacional

Due to the fact of oral health sector reestructuration within Brazilian public health politics, this work had the object of evaluating, under users point of view, the accessibility to oral health services in Santa Cruz (RN), focusing on the organizational aspect. To achieve this, questionnaires were given to users in their homes, considering the censitary sector. Nine sectors of the urban zone were evaluated, selected by chance, and one from the rural zone, selected by convenience. The sample was composed by 194 users, calculated considering the estimated prevalence of event represented by the indicator I ve never been to the dentist + I ve been to the dentist more than three years ago from the Projeto SB Brasil Report . To complement the results, interviews were made with others actors involved in the process of oral health care: professionals (dentists) and manager (Health Municipal Secretary). From the data obtained it was possible to identify that 12,9% of the population had never visited the dentist, and that the search for the service was not influenced by the users individual and socioeconomics characteristics, excepting the gender. It was verified that 36,1% of the users went to the dentist in less than one year, with the youngests (p<0,05) being among those who went to the dentist more frequently. 63,3% of the interviewed related that they found some kind of difficulty when they search for dentistry services, with the difficulties for schedule, the queues and the long wait among the most cited. It was identified that 43,2% of the users wait three weeks or more for the appointment. It is still pointed out that 71,4% of the interviewed find difficulties to get urgency appointment, the long wait to be attended by the dentist was the most found. 92,9% and 94,1% of the interviewed had never been headed to especialized appointments and complementary exams, respectively. Due to the data founded, it was possible to verify that the accessibility to oral health services in Santa Cruz (RN) is damaged by factors related to the organization of public polices developed, mainly in relation to the working process

A saúde bucal do idoso brasileiro: revisão sistemática sobre o quadro epidemiológico e acesso aos serviços de saúde bucal

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Epidemiologia do transtorno obsessivo-compulsivo: uma revisão

Os inquéritos populacionais são importantes, pois amostras clínicas tendem a apresentar vieses de seleção. Aspectos sociodemográficos e relacionados à própria condição mórbida podem interferir na procura por tratamento. Pela natureza egodistônica do transtorno obsessivo-compulsivo, seus portadores tendem a ocultar o problema, podendo não procurar ou demorar a procurar tratamento. Porém, a maior parte do conhecimento atual sobre o transtorno obsessivo-compulsivo advém de amostras clínicas, que não representam a totalidade dos casos. Foi feita uma revisão convencional da literatura através do Medline, PsicoInfo e Lilacs de inquéritos populacionais sobre o transtorno obsessivo-compulsivo, cobrindo o período de 1980 a 2004, utilizando-se como palavras-chave epidemiologia, transtorno obsessivo-compulsivo, inquéritos populacionais e prevalência. Estudos realizados em diferentes países indicam para o transtorno obsessivo-compulsivo uma prevalência atual em torno de 1,0% e ao longo da vida de 2,0 a 2,5%. Diferentemente de amostras clínicas, em quase todas as amostras populacionais há predomínio de mulheres e portadores que têm apenas obsessões. A freqüente comorbidade com outros transtornos mentais, particularmente depressão e outros transtornos ansiosos, repete-se em casos da população geral, que apresentam ainda uma associação com abuso de substâncias. Muitos portadores não estão em tratamento, particularmente os casos puros. Indicadores de incapacitação funcional demonstram um considerável impacto negativo do transtorno obsessivo-compulsivo. É preciso melhorar o conhecimento da população e dos profissionais de saúde sobre os sintomas do transtorno obsessivo-compulsivo para aumentar a procura de atendimento, assim como a correta identificação e abordagem terapêutica deste grave problema de saúde.

Avaliacao das condicoes de saude bucal dos idosos em um municipio brasileiro

This study assessed the oral health of individuals 60 years or older in the city of Araraquara, Sao Paulo, Brazil, in 1998. Of the 194 people who participated in the study, 91 of them were institutionalized and had an average age of 73.6 years, and 103 were not institutionalized and had an average age of 69.3 years. The study participants were examined by a previously trained oral surgeon who determined the prevalence of the most common oral health problems. The results revealed a large number of edentulous individuals (72% of those institutionalized and 60% of the noninstitutionalized participants) and many persons with extracted teeth (93% and 90%, respectively), as well as a high frequency of periodontal pockets (57% and 75%, respectively) and of inadequate dentures (80% and 61%, respectively). Our results show reduced quality of life for a large proportion of these older individuals, and also indicate that public health services should pay greater attention to this population group.

Avaliação do acesso à saúde aos níveis de atenção de maior complexidade no município de Marília/SP, sob a ótica da integralidade

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Perfil social das pessoas com hipertensão arterial sistêmica atendidas no Programa de Saúde da Família

Pós-graduação em Serviço Social - FCHS

Tempo para acesso ao tratamento do câncer de mama no Distrito Federal, Brasil Central

PURPOSE: To analyze the time between the first symptom and treatment in patients treated for breast cancer in public hospitals in the Federal District. METHODS: This was a cross-sectional analysis. We interviewed 250 women diagnosed with breast cancer treated in six hospitals of the State Department of Health of the Federal District from November 2009 to January 2011. The time intervals studied were the time between the detection of the symptoms and treatment subdivided into intervals until and after the first medical appointment. The variables were: age, menopausal status, color, educational level, average monthly household income, origin, reason for the initial consultation, staging, tumor size, laterality, metastasis to axillary lymph nodes, neoadjuvant chemotherapy, and type of surgery. The Mann-Whtney test was used to assess the association of these variables with the time intervals until treatment. RESULTS: The mean age was 52 years, with a predominance of white women (57.6%), from the Federal District (62.4%), with a family income of up to 2 minimum wages (78%), and up to four years of schooling (52.4%). The staging of the disease ranged from II to IV in 78.8% of the women. The time between the first symptom and treatment was 229 days (median). After detection of the first symptom, 52.9% of the women attended a consultation within 30 days and 88.8% took more than 90 days to start treatment. Women with elementary school education had a greater delay to the start of treatment (p=0.049). CONCLUSIONS: There was a significant delay to start treatment of women with breast cancer in public hospitals of the Federal District, suggesting that efforts should be made to reduce the time needed to schedule medical appointments and to diagnose and treat these patients.

Acessibilidade aos serviços de saúde pública no município de Rio Claro - SP

O acesso da população aos serviços de saúde é de fundamental importância para uma eficiente assistência à saúde. A localização geográfica dos serviços é um dos fatores que interferem nessa acessibilidade, como também as formas de locomoção que possibilitem o acesso e o estado das vias e calçadas que cercam o estabelecimento de saúde. Pretendeu-se estudar o acesso aos serviços de saúde no município de Rio Claro, estado de São Paulo. Assim, a contribuição da abordagem geográfica abre a possibilidade do estabelecimento de novas linhas de estudo, planejamento e gestão, que surgem através da relação entre Geografia Humana e Saúde Pública

Acesso aos níveis de atenção à saúde em um município do Estado de São Paulo: perspectivas de gestores, profissionais e usuários

Pós-graduação em Saúde Coletiva - FMB

Resultado da implantação de um Núcleo Interno de Regulação de Leitos nos indicadores administrativo-assistenciais em um hospital de ensino

Objective To compare hospital indicators before and after implementing an Internal Bed Regulation Committee at a reference hospital. Methods It is an quantitative, evaluation, exploratory, descriptive and cross-sectional research. The data was gathered from the hospital administrative reports for the period 2008-2013, provided by the Information Technology Center of the Complexo FAMEMA. Results The indicators improved after implementation of the Internal Bed Regulation Committee. Conclusion The individuals involved in the process acknowledged the improvement. It is necessary to carry on the regulatory actions, especially in a comprehensive and complex healthcare system, such as the brazilian Sistema Único de Saúde.

Miedo e inseguridad de la gestante durante el trabajo de parto como motivos para la demanda de internación precoz

Objective. To identify reasons why women look for early health care attention at the end of pregnancy. Methodology. Qualitative study based in socio-existential phenomenology proposed by Alfred Schütz. Nine pregnant women who consulted to the maternity service without being in real labor were interviewed. Results. The following analysis categories emerged: Having different symptoms or signals from the ones they had felt or been informed about, not being able to identify real labor, fear to fetal complications for being close to the probable labor date, feeling calmer when being seen by professionals of the institution, lack of problem solving by other services of the health institution, fearing out of hospital delivery, imitating real labor, looking for tranquility in the idealization of labor and modifying behaviors to guarantee attention. Conclusion. Women are insecure and fear because of a fragmented health care, where they do not perceive themselves linked to the prenatal control program anymore, and at the same time they don’t find the health care assistance they want.