Reforming health-care management in Latin America

Includes bibliography

Preliminary risk analysis applied to the handling of health-care waste

Between 75% and 90% of the waste produced by health-care providers no risk or is "general" health-care waste, comparable to domestic waste. The remaining 10-25% of health-care waste is regarded as hazardous due to one or more of the following characteristics: it may contain infectious agents, sharps, toxic or hazardous chemicals or it may be radioactive. Infectious health-care waste, particularly sharps, has been responsible for most of the accidents reported in the literature. In this work the preliminary risks analysis (PRA) technique was used to evaluate practices in the handling of infectious health-care waste. Currently the PRA technique is being used to identify and to evaluate the potential for hazard of the activities, products, and services from facilities and industries. The system studied was a health-care establishment which has handling practices for infectious waste. Thirty-six procedures related to segregation, containment, internal collection, and storage operation were analyzed. The severity of the consequences of the failure (risk) that can occur from careless management of infectious health-care waste was classified into four categories: negligible, marginal, critical, and catastrophic. The results obtained in this study showed that events with critics consequences, about 80%, may occur during the implementation of the containment operation, suggesting the need to prioritize this operation. As a result of the methodology applied in this work, a flowchart the risk series was also obtained. In the flowchart the events that can occur as a consequence of a improper handling of infectious health-care waste, which can cause critical risks such as injuries from sharps and contamination (infection) from pathogenic microorganisms, are shown.

Synergistic effect of green coffee oil and synthetic sunscreen for health care application

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Prevalence of health promotion programs in primary health care units in Brazil

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

Characteristics of physical activity programs in the Brazilian primary health care system

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

Knowledge and practice of women regarding cervical cancer in a primary health care unit

Objectives: evaluating the level of information about the examination of uterine cervical cancer and its association with sociodemographic variables in women of a health care unit in the city of Bauru, São Paulo, Brazil. Methods: we conducted a cross-sectional descriptive study with 370 women aged 25 to 59, through structured interviews in their own homes; we used descriptive statistics and the χ2 test. Results: 40.5% of the women had not undergone the Papanicolaou test at the recommended frequency; 58.2% incorrectly defined the test, and 69.5% did not know about the risk factors for the development of cervical cancer; the knowledge about the test showed statistically significant association with schooling and family income of the studied population. Conclusions: women present deficiencies on the proper practice of the Papanicolaou test, on knowledge about the test, risk factors and prevention methods. Therefore, it is necessary to develop primary health actions for the most vulnerable population.

The Effect of a Community-Based, Primary Health Care Exercise Program on Inflammatory Biomarkers and Hormone Levels

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A METHODOLOGY TO EVALUATE OBSOLETE INVENTORY IN HEALTH CARE

Many organizations are currently facing inventory management problems such as distributing inventory on-time and maintain the correct inventory levels to satisfy the customer or end users. Organizations understand the need for maintaining the accurate inventory levels but sometimes fall short leading a wide performance gap in maintaining inventory accurately. The inventory inaccuracy can consume much of the investment on purchasing inventory and many times leads to excessive inventory. The research objective of thesis is to provide a decision making criteria to the management for closing or maintaining the warehouse based on basic purchasing and holding cost information. The specific objectives provide information regarding the impact of inventory carrying cost, obsolete inventory, inventory turns. The methodology section explains about the carrying cost ratio that would help inventory managers to adopt best practices to avoid obsolete inventory and also reduce excessive inventory levels. The research model was helpful in providing a decision making criteria based on the performance metric developed. This research model and performance metric had been validated by analysis of warehouse data and results indicated a shift from two-echelon inventory supply chain to a one-echelon or Just In Time (JIT) based inventory supply chain. The recommendations from the case study were used by a health care organization to reorganize the supply chain resulting in the reduction of excessive inventory.

Lean diesel technology and human health: a case study in six Brazilian metropolitan regions

OBJECTIVE: Due to their toxicity, diesel emissions have been submitted to progressively more restrictive regulations in developed countries. However, in Brazil, the implementation of the Cleaner Diesel Technologies policy (Euro IV standards for vehicles produced in 2009 and low-sulfur diesel with 50 ppm of sulfur) was postponed until 2012 without a comprehensive analysis of the effect of this delay on public health parameters. We aimed to evaluate the impact of the delay in implementing the Cleaner Diesel Technologies policy on health indicators and monetary health costs in Brazil. METHODS: The primary estimator of exposure to air pollution was the concentration of ambient fine particulate matter (particles with aerodynamic diameters, <2.5 mu m, [PM2.5]). This parameter was measured daily in six Brazilian metropolitan areas during 2007-2008. We calculated 1) the projected reduction in the PM2.5 that would have been achieved if the Euro IV standards had been implemented in 2009 and 2) the expected reduction after implementation in 2012. The difference between these two time curves was transformed into health outcomes using previous dose-response curves. The economic valuation was performed based on the DALY (disability-adjusted life years) method. RESULTS: The delay in implementing the Cleaner Diesel Technologies policy will result in an estimated excess of 13,984 deaths up to 2040. Health expenditures are projected to be increased by nearly US$ 11.5 billion for the same period. CONCLUSIONS: The present results indicate that a significant health burden will occur because of the postponement in implementing the Cleaner Diesel Technologies policy. These results also reinforce the concept that health effects must be considered when revising fuel and emission policies.

Prevalence of beta-hemolytic Streptococcus in children with special health care needs

Pharyngotonsillitis by beta-hemolytic Streptococcus mostly affects children and imunocompromissed, being Streptococcus pyogenes (Group A) the most common agent in bacterial pharyngotonsillitis. Aim: This work targeted the research of beta-hemolytic Streptococcus Group-A (SBHGA) and No-A (SBHGNA) in the oropharynx of individuals with special health needs from the APAE (Maceio-AL). Method: A prospective study with oropharynx samples from patients with Down syndrome and other mental disorders (test) and students from a private school (control) aged 5-15 years. Cultures in blood agar (5%) were identified through Gram/catalase tests and bacitracin/trirnethoprim-sulfamethoxazole disk diffusion method, applying the chi-squared statistical analysis. Results: A total of 222 bacterial colonies were isolated in 74 individuals from APAE and 65 in the control group. In the test group, previous episodes of pharyngotonsillitis were reported by 36.49% (27/74) and 9.46% (7/74) were diagnosed with symptoms and/or signs suggestive of oropharynx infection. No positive sample of S. pyogenes was confirmed at APAE, being all samples classified as SBHGNA, with 5 SBHGA in the control group. Conclusion: The early identification of beta-hemolytic Streptococcus is important for the fast treatment of pharyngotonsillitis and the absence of S. pyogenes avoid future suppurative or not-suppurative sequels in the group from APAE.

The Brazilian National Health Agency and the Mental Health Policy in the Context of the Private Health System: developments and challenges

This work analyses the mental health policy-making activity of the Brazilian National Health Agency (ANS), responsible for controlling health insurance companies. Three points are discussed: a) the framework of an economic and private health assistance regulatory activity, b) the ANS and its regulation activity and c) the rules produced by ANS in the mental health care field. It was concluded that, despite advances like the legal obligation to ensure medical treatment to all the diseases listed in ICD-10, the inclusion of suicidal patient damage and self-inflicted damage care, care provided by a multiprofessional team, the increase in the number of sessions with a psychologist, with an occupational therapist and of psychotherapy sessions, and mental health day hospitals included as part of the services offered, the authors identified specific regulatory gaps in this area. Some issues that ANS has to solve so that it can really play its institutional role of defending the public interest in the private health system are: the regulation of co-participation and franchise mechanisms, the increasing co-participation as a limitation of psychiatric hospitalization, and the limited number of crisis intervention psychotherapy sessions.

Production of nursing care in primary health care services

This descriptive and quantitative study aimed to characterize the production of nursing care in primary health care services in a region of the city of Ribeirao Preto, state of Sao Paulo, Brazil. The study sample comprised care actions delivered by nurses and registered in the HygiaWeb Information System, from 2006 to 2009. Statistical analysis was performed. Results showed that nursing care delivered by nurses accounted for 9.5 to 14.6% of total professional care provided by professionals. Eventual care actions were the most frequent. The concentration of programmatic care was higher for children, women, pregnant and postpartum women. In conclusion, the predominance of eventual care demonstrated that the health system has been focused on acute conditions. Little of nursing work has been directed at the achievement of comprehensiveness, considering the inexpressive share of longitudinal follow up in total care delivery. The expansion of nursing staff represents potential for care delivery to the population, but further qualification of nursing actions is needed.

Fighting Misconceptions to Improve Compliance with Influenza Vaccination among Health Care Workers: An Educational Project

The compliance with influenza vaccination is poor among health care workers (HCWs) due to misconceptions about safety and effectiveness of influenza vaccine. We proposed an educational prospective study to demonstrate to HCWs that influenza vaccine is safe and that other respiratory viruses (RV) are the cause of respiratory symptoms in the months following influenza vaccination. 398 HCWs were surveyed for adverse events (AE) occurring within 48 h of vaccination. AE were reported by 30% of the HCWs. No severe AE was observed. A subset of 337 HCWs was followed up during four months, twice a week, for the detection of respiratory symptoms. RV was diagnosed by direct immunofluorescent assay (DFA) and real time PCR in symptomatic HCWs. Influenza A was detected in five episodes of respiratory symptoms (5.3%) and other RV in 26 (27.9%) episodes. The incidence density of influenza and other RV was 4.3 and 10.8 episodes per 100 HCW-month, respectively. The educational nature of the present study may persuade HCWs to develop a more positive attitude to influenza vaccination.

The participation of the nutritionist in Primary Health Care in a large urban center

Nutritionists are important professionals for ensuring the implementation of health promotion, treatment and rehabilitation. However, their participation in primary healthcare from a quantitative standpoint is limited. The city of Sao Paulo has experienced an uneven urbanization process triggering new problems of insecurity in terms of food and nutrition. This article analyzes the performance of the primary healthcare nutritionist in a large urban center. It is a quantitative study that used data from the Municipal Health Department, population data of Sao Paulo and a semi-structured questionnaire applied in individual interviews. All regions of the city are found to have fewer nutritionists than the recommendation of the Federal Council of Nutritionists. There are 123 nutritionists in the basic healthcare network and 51 in the Family Health Support Nuclei (FHSN) (57.3%). Each nutritionist from the FHSN accompanies 7.1 family health strategy teams on average. The age groups corresponding to children are less frequently seen by nutritionists. Comparing the activities, the transition from a model of primary health care focused on individual care to a model that prioritizes group care was observed.

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.