Access to tuberculosis diagnosis in Itaborai City, Rio de Janeiro, Brazil: the patient`s point of view

SETTING: Itaborai Municipality in Rio de Janeiro, Brazil. OBJECTIVE: To evaluate access to tuberculosis (TB) diagnosis for users of the Family Health Program (FHP) and Reference Ambulatory Units (RAUs). DESIGN : A cross-sectional study was conducted in Itaborai City, Rio de Janeiro, Brazil. Between July and October 2007, a sample of 100 TB patients registered consecutively with the TB Control Program was interviewed using the primary care assessment tool. The two highest scores, describing `almost always` and `always`, or `good` and `very good`, were used as a cut-off point to define high quality access to diagnosis. RESULTS: FHP patients were older and had less education than RAU interviewees. Sex and overcrowding did not differ in the two groups. Patient groups did not differ with regard to the number of times care was sought at a unit, transport problems, cost of attending units and availability of consultation within 24 h. Adequate access to diagnosis was identified by 62% of the FHP patients and 53% of the RAU patients (P = 0.01). CONCLUSION: In Itaborai, Rio de Janeiro, TB patients believe that the FHP units provide greater access to TB diagnosis than RAUs. These findings will be used by the Department of Health to improve access to diagnosis in Itaborai.

Knowledge and practices of medical students to prevent tuberculosis transmission in Rio de Janeiro, Brazil

Objectives. To describe knowledge, practices, and associated factors of medical students to prevent transmission of tuberculosis (TB) in five medical schools. Methods. Cross-sectional survey of undergraduate medical students in preclinical and in early and late clinical years. Information was obtained on sociodemographic profile, previous lectures on TB, knowledge about TB transmission, exposure to patients with active pulmonary TB, and use of respiratory protective masks. Results. Among 1 094 respondents, 575 (52.6%) correctly answered that coughing, speaking, and sneezing can transmit TB. Early [adjusted odds ratio = 4.0 (3.0, 5.5)] and late [adjusted odds ratio = 4.2 (3.1, 5.8)] clinical years were associated with correct answers, but having had previous lectures on TB was not. Among those who had previous lectures on TB, the rate of correct answers increased from 42.1% to 61.6%. Among 332 medical students who reported exposure to TB patients, 194 (58.4%) had not used protective masks. More years of clinical experience was associated with the use of masks [adjusted odds ratio = 2.9 (1.4, 6.1)], while knowledge was inversely associated with the use of masks [adjusted odds ratio = 0.4 (0.2, 0.6)]. Conclusions. Many medical students are not aware of the main routes of TB infection, and lectures on TB are not sufficient to change knowledge and practices. Regardless of knowledge about TB transmission, students engage in risky behaviors: more than two-thirds do not use a protective mask when examining an active TB case. We suggest innovative, effective active learning experiences to change this scenario.

Prevalence of trachoma in a population of the upper Rio Negro Basin and risk factors for active disease

Purpose: To determine the prevalence of trachoma in Sao Gabriel da Cachoeira (SGC), the only urban community of the upper Rio Negro Basin of the Amazon state in Brazil, near the Colombian border, and to investigate the risk factors associated with the active forms of the disease. Methods: A total of 1702 people (440 children up to 9 years and 1069 adults aged 15 years and above) were examined. The sample was selected from a probabilistic household sampling procedure based on census data and a previous study of trachoma prevalence in Sao Gabriel da Cachoeira. A two-stage probabilistic household cluster sample was drawn. Household units were randomly selected within each cluster. A variety of socioeconomic and hygiene variables were studied in order to determine the risk factors for active trachoma in a household. Results: The total prevalence of trachoma was 8.9%. Prevalence of active trachoma (TF and/or TI) in children aged 1-9 years was 11.1% and trachomatous trichiasis in adults aged 15 years and above was 0.19%. Trachomatous scarring reached a peak of 22.4% for subjects between 50 to 60 years of age. Corneal opacity occurred in subjects aged 50 years and older with a prevalence of 2.0%. No sex effect was found on the overall prevalence of trachoma in SGC. Risk factors associated with active trachoma were mainly related to poor socioeconomic indicators. Conclusions: Despite the ubiquitous presence of water, the analysis of the risk factors associated with the active forms of the disease supports the idea that a low personal standard of hygiene and not water availability per se, is the key factor associated with trachoma.

Molecular characteristics of extended-spectrum beta-lactamase-producing Escherichia coli from Rio de Janeiro, Brazil

Twenty-five extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli clinical isolates from Rio de Janeiro, Brazil were characterized by isoelectric focusing, PCR and sequencing of bla(ESBL) genes, plasmid-mediated quinolone resistance determinants, phylogenetic groups, replicon typing, pulsed-field electrophoresis, and multilocus sequencing typing. Twenty-three (92%) ESBL-producing E. coli isolates were positive for bla(CTX-M) genes, aac(6`)-lb-cr, and qnrB. Genetic relatedness of ESBL producers clustered seven (28%) CTX-M-15-producing isolates as sequence type (ST) 410, clonal complex (CC) 23, and two (8%) as clone O25-ST131. Our results illustrate the predominance of phylo-group A (52%), ST410 (CC 23) and CTX-M-15 among ESBL-producing E. coli isolates from hospitals in Rio de Janeiro.

Prevalence of anti-Toxoplasma gondii and anti-Neospora caninum antibodies in sheep from Mossoro, Rio Grande do Norte, Brazil

Toxoplasma gondii is an obligate intracellular parasite with a variety of hosts, responsible for reproductive problems and economic losses in sheep flocks. Neospora caninum was recently identified and its clinical presentation in sheep is similar to that of toxoplasmosis, which can cause repeated abortions, though less frequently in this species. In order to confirm the prevalence of these agents in the city of Mossoro, Rio Grande do Norte, Brazil, 409 serum samples from adult sheep (364 females and 45 males) were tested by the indirect immunofluorescence antibody test, using cut-off point at a dilution of 1:64 and 1:50 for T. gondii and N. caninum, respectively. From the 35 properties examined, 23 (65.7%)had at least one seropositive animal for T gondii and six (17.1%) for N. caninum. The prevalence of seropositive animals for T. gondii was 20.7% and for N. caninum 1.8%. There was no association between the presence of the agent`s antibody and gender, reports of reproductive problems and presence of dogs and/or cats in the properties. T. gondii is well distributed and N. caninum has low prevalence in sheep and in the properties of the studied region. (C) 2008 Elsevier B.V. All rights reserved.

Prevalence and risk factors for anti-Toxoplasma gondii antibodies in goats of the Serido Oriental microregion, Rio Grande do Norte state, Northeast region of Brazil

The prevalence and risk factors for anti-Toxoplasma gondii antibodies were investigated in goats of the Serido Oriental microregion, Rio Grande do Norte state, Northeast region of Brazil. Three hundred and sixty-six blood samples from goats collected by jugular venopuncture were used. For the serologic diagnosis of Toxoplasma gondii infection, the indirect fluorescent-anti body test (IFAT) with cut-off value 1:64 was carried out. The prevalence of anti-T. gondii antibodies was 30.6% [95% CI = 25.9-35.6%] with titers ranging from 1:64 to 1: 16,384. The multivariate logistic regression analysis showed that the risk factors associated to anti-T. gondii antibodies were presence of cats in the herd, extensive/semi-intensive management systems and lack of mineral supplementation. (c) 2008 Elsevier B.V. All rights reserved.

Boletim eletr??nico de bibliografias especializadas: pol??tica de transfer??ncia condicionada de renda

As pol??ticas de Transfer??ncia Condicionada de Renda (TCR) s??o consideradas a mais nova gera????o de pol??ticas sociais. O fato tem chamado a aten????o de profissionais do setor p??blico e de acad??micos de diferentes ??reas. Nos ??ltimos anos, diversas experi??ncias, sobretudo na Am??rica Latina, t??m-se destacado pelo impacto positivo sobre os indicadores sociais da popula????o, entre elas: o Programa Bolsa Fam??lia, no Brasil; o Programa de Desarrollo Humano Oportunidades, no M??xico; e o Sistema Chile Solid??rio, no Chile. O Programa Bolsa Fam??lia, criado em 2003, constitui a maior pol??tica p??blica de TCR da Am??rica Latina, tanto em or??amento quanto em cobertura. Atualmente, atende cerca de 13.800.000 fam??lias, em todos os munic??pios do Pa??s. O Programa tem servido de modelo para a difus??o desse tipo de pol??tica no mundo. O tema envolve v??rias dimens??es da ??rea social, por se tratar de uma pol??tica essencialmente intersetorial. O Bolsa Fam??lia vem se destacando nos debates da administra????o p??blica, devido ?? sua forte capacidade de melhoria das condi????es das fam??lias benefici??rias. Diante disso, a 5a edi????o do Boletim Eletr??nico de Bibliografias Especializadas apresenta uma reuni??o de publica????es do acervo da Biblioteca Graciliano Ramos que abordam os seguintes temas: transfer??ncia condicionada de renda, programas sociais, desigualdade social, combate da pobreza e pol??ticas p??blicas. O objetivo ?? divulgar obras que auxiliem servidores p??blicos na reflex??o e compreens??o desses assuntos

Cobertura tem??tica do Reposit??rio Institucional da ENAP

A Cobertura Tem??tica do Reposit??rio Institucional da ENAP ?? uma linguagem document??ria que objetiva identificar as grandes ??reas tem??ticas existentes no contexto institucional da ENAP e refletir os conceitos utilizados na ??rea de conhecimento Administra????o P??blica, observando os limites de atua????o da escola. Tal estudo permitir?? um melhor controle dos termos autorizados nos diversos sistemas de informa????o da ENAP e parcerias, inclusive o Reposit??rio Institucional da ENAP.

Termo de Ajuste Sanit??rio (TAS)

O Termo de Ajuste Sanit??rio, regulamentado no ??mbito do Minist??rio da Sa??de pela Portaria GM/MS n?? 2.046, de 3 de setembro de 2009, ?? o instrumento de compromisso que pode ser formalizado entre gestores do Sistema ??nico de Sa??de (SUS) das tr??s esferas de governo. Consiste na necessidade de conferir efic??cia e qualidade ao processo de descentraliza????o, organiza????o e gest??o das a????es e servi??os de sa??de do SUS, assim como de consolidar os compromissos e as responsabilidades sanit??rias dos gestores das tr??s esferas de governo, em especial sobre a otimiza????o dos recursos destinados ao SUS. O resultado esperado ?? a corre????o de impropriedades decorrentes do descumprimento de obriga????es previstas em normativas do Minist??rio da Sa??de relativas ?? gest??o do Sistema P??blico de Sa??de

Projeto Pensando o Direito

O projeto Pensando o Direito tem por objetivo qualificar o trabalho jur??dico da Secretaria de Assuntos Legislativos do Minist??rio da Justi??a, abrindo espa??o para a absor????o da produ????o acad??mica de ponta e fortalecendo seu trabalho de elabora????o normativa. O projeto ?? realizado pela Secretaria de Assuntos Legislativos do Minist??rio da Justi??a (SAL/MJ), por meio de acordo de coopera????o t??cnica com o Programa das Na????es Unidas para o Desenvolvimento (PNUD) ??? acordo BRA/07/004: Democratiza????o de Informa????es no Processo de Elabora????o Normativa - e implementado por meio de cartas-acordo com institui????es de ensino e pesquisa de todo o pa??s. Foram firmadas parcerias, por meio de seis sele????es p??blicas, com institui????es acad??micas de ensino e pesquisa em 42 ??reas tem??ticas previamente definidas pela SAL/MJ. O objetivo ?? o fomento ?? pesquisa de car??ter emp??rico e multidisciplinar de assuntos jur??dicos pouco debatidos na academia, mas em discuss??o na sociedade. De 2007 a 2010, foram apresentadas 265 propostas de projetos de pesquisa por 152 institui????es e, dessas, 43 foram aprovadas

A estrat??gia de sa??de da fam??lia

A Sa??de da Fam??lia ?? uma estrat??gia de reorienta????o do modelo assistencial, operacionalizada mediante a implanta????o de equipes multiprofissionais em unidades b??sicas de sa??de. Essas equipes s??o respons??veis pelo acompanhamento de um n??mero definido de fam??lias, localizadas em ??rea geogr??fica delimitada. As equipes atuam com a????es de promo????o da sa??de, preven????o, recupera????o, reabilita????o de doen??as e agravos mais frequentes, e na manuten????o da sa??de dessa comunidade. A responsabilidade pelo acompanhamento das fam??lias coloca para as equipes de sa??de da fam??lia a necessidade de ultrapassar os limites classicamente definidos para a aten????o b??sica no Brasil, especialmente no contexto do SUS. A implanta????o da estrat??gia de Sa??de da Fam??lia tem demonstrado significativa melhoria nos indicadores de sa??de do pa??s, em especial na amplia????o do acesso ?? sa??de da popula????o brasileira, tendo se mostrado tamb??m efetiva na redu????o das iniquidades, cumprindo seu papel de porta de entrada do SUS

Gest??o de condicionalidades e acompanhamento das fam??lias do programa Bolsa Fam??lia

A gest??o das condicionalidades e do acompanhamento das fam??lias do Programa Bolsa Fam??lia consiste em um conjunto de iniciativas, a????es e procedimentos de car??ter intersetorial e intergovernamental para o acompanhamento integral, nominal e massivo de fam??lias em situa????o de vulnerabilidade ou risco social. Atualmente, cerca de 6,5 milh??es de fam??lias s??o acompanhadas em rela????o ?? agenda da sa??de e 14 milh??es de crian??as e adolescentes t??m informa????es sobre sua frequ??ncia escolar registradas. Das fam??lias acompanhadas pela sa??de, 98,3% tiveram cumprimento integral no ??ltimo per??odo. Na educa????o, o percentual foi de 97,3% das crian??as de 6 a 15 anos. As fam??lias em descumprimento s??o prioritariamente inclu??das no acompanhamento familiar realizado pela rede socioassistencial. Tais a????es t??m sua base na institucionaliza????o de inst??ncias e processos de intensa articula????o governamental, envolvendo as ??reas de sa??de, educa????o e assist??ncia social em todos os estados e munic??pios do pa??s

Programa banda larga nas escolas

O Programa Banda Larga nas Escolas tem por objetivo a inclus??o das tecnologias de informa????o e comunica????o (TIC) na realidade das escolas p??blicas urbanas nacionais, sem ??nus para os estados e munic??pios, com dura????o dos servi??os at?? 2025. Para isso foi adotado um modelo de parceria p??blico-privada com reflexo direto na condu????o e na dura????o do programa, que ultrapassa as a????es de um governo para ser reconhecido como a????o de Estado com mais de 20 anos de dura????o e perspectiva para perdurar como obriga????o nas futuras concess??es da explora????o de servi??os de telefonia e transporte multim??dia no pa??s. At?? o segundo trimestre de 2010, j?? estavam conectadas 47.204 escolas, que correspondem a 84% do compromisso inicial (56 mil escolas). Esse n??mero de conex??es beneficia um n??mero aproximado de 30 milh??es de alunos da rede p??blica

Manual do Reposit??rio institucional da ENAP

O Manual do Reposit??rio Institucional da ENAP foi elaborado com o objetivo de auxiliar a compreens??o e utiliza????o dessa ferramenta, visando ?? capacita????o de pontos focais que far??o a submiss??o de ativos digitais, a valida????o dos documentos depositados, e dos revisores de metadados, que ir??o de fato publicar os itens no reposit??rio, orientando quanto ??s regras para o preenchimento do conjunto de metadados, e aos passos necess??rios para o fluxo de submiss??o.