848 resultados para health service managers
Resumo:
Purpose. To describe the occurrence of self-reported problems of accessibility to health services used by persons with disabilities in terms of social and health services variables. Methods. We performed a cross-sectional household survey designed to assess problems with accessibility to health services faced by persons with disabilities. We interviewed 333 persons in Sao Paulo city, in 2007. Variables related to the presence of accessibility problems, disabilities, gender, age, family head income, ethnicity, use of health services and others were analysed using frequencies, percentages, chi(2)-test, ANOVA and Poisson regression models. Results. 15.92% of the interviewed persons reported problems with accessibility to health services. Persons having multiple (prevalence ratios; PR = 2.91) or mobility disability (PR = 6.46) had more problems with accessibility than persons with hearing disability. Persons younger than 78 years old had more problems with accessibility; those who needed help to go to the health service (PR = 3.01) also. Conclusions. Persons with multiple or mobility disability, younger than 78 years, and those who needed help of others to go to the health service were more likely to have problems with accessibility to health services. This information could be one of the first steps to the management and/or planning of appropriate health services for persons with disabilities.
Resumo:
In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5.5% a year in the 1980s and 1990s, and by 4.4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2.5 months in the 1970s to 14 months by 2006-07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil`s progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988 (coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women`s health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries.
Resumo:
Objective: To describe some of the characteristics of men who underwent a vasectomy in the public health network of Campinas, Sao Paulo, Brazil. Methods: A descriptive study including 202 men randomly selected from a list of all the men vasectomized between 1998 and 2004 in the public health network. Results: Most of the men were 30 years of age or older when vasectomized, had completed elementary school and had two or more children of both sexes. Most of the men came from the lowest income segment of the population: 47.6% in 1998-1999 and 61.3% in 2003-2004. Although the men knew various contraceptive methods, 51.2% reported that their partners were using combined oral contraceptives at the time of surgery. Most men initially sought information on vasectomy at health-care clinics where care was provided by a multidisciplinary team; most received counselling, however, 47.9% of the men waited more than 4 months for the vasectomy. Conclusions: The profile of the vasectomized men in this study appears to indicate that the low-income population from Campinas, Sao Paulo, Brazil has access to vasectomy; however, the waiting time for vasectomy reveals that difficulties exist in obtaining this contraceptive method in the public health service.
Resumo:
Background: The number of childbearing adolescents in Vietnam is relatively low but they are more prone to experience adverse outcome than adult women. Reports of increasing rates of abortion and prevalence of STIs including HIV among youth indicate a need to improve services and counselling for these groups. Midwives are key persons in the promotion of young people’s sexual and reproductive health in Vietnam. Aim: The overall aim of this thesis is to describe the prevalence and outcome of adolescent pregnancies in Vietnam (I), to explore the social context and health care seeking behavior of pregnant adolescents (II), as well as to explore the perspectives of health care providers and midwifery students regarding adolescent sexuality and reproductive health service needs (III, IV). Methods: The studies were conducted from 2002 to 2005, combining qualitative and quantitative research methods. A population based prospective survey was used to estimate rates and outcomes of adolescent pregnancies (I). Pregnant and newly delivered adolescents’ experiences of childbearing and their encounters with health care providers were studied using qualitative interviews (II). Health care providers’ perspective on adolescent sexual and reproductive health (ASRH) and views on how to improve the quality of abortion care was explored in focus group discussions (FGD). The values and attitudes of midwifery students about ASRH were investigated using questionnaires and interviews (IV). Descriptive statistics was used to analyse quantitative data (I, IV) and content analysis were applied for qualitative data (II, III, and IV). Findings: Adolescent birth rate was similar to previously reported in Vietnam but lower when compared to other Asian countries. The incidence of stillborn among adolescents was higher than for women in higher reproductive ages. The proportion of preterm deliveries was 20 % of all births, higher than previous findings from Vietnam. About 2 % of the deliveries were home deliveries, more common among women with low education, belonging to ethnic minority and/or living in mountainous areas (I). Ambivalence facing motherhood, pride and happiness but also worries and lack of self-confidence emerged as themes from the interviews; and experience of ‘being in the hands of others’ in a positive, caring sense but also in a sense of subordination in relation to husband, family and health care providers (II). Health care providers at abortion clinics and midwifery students generally disapproved of pre-marital sex, but had a pragmatic view on the need for contraceptive services and counselling to reduce the burden of unwanted pregnancies and abortions for young women. Providers and midwifery students expressed a need for training on ASRH issues (III, IV). Conclusion: Cultural norms and gender inequity make pregnant adolescent women in Vietnam vulnerable to sexual and reproductive health risks. Health care providers experience ethical dilemmas while counselling unmarried adolescents who come for abortion and this has a negative impact on the quality of care. Integrated ASRH in education and training programmes for health care providers, including midwives, as well as continued in-service training on these issues are suggested to improve reproductive health care services in Vietnam.
Resumo:
Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.
Resumo:
OBJECTIVES: The aim of the Tromstannen - Oral Health in Northern Norway (TOHNN) study was to investigate oral health and dental-related diseases in an adult population. This article provides an overview of the background of the study and a description of the sample characteristics and methods employed in data collection. STUDY DESIGN: Cross-sectional population-based study including a questionnaire and clinical dental examination. METHODS: A randomly selected sample of 2,909 individuals (20-79 years old) drawn from the population register was invited to participate in the study. The data were collected between October 2013 and November 2014 in Troms County in northern Norway. The questionnaire focused on oral health-related behaviours and attitudes, oral health-related quality of life, sense of coherence, dental anxiety and symptoms from the temporomandibular joint. The dental examinations, including radiographs, were conducted by 11 dental teams in 5 dental offices. The examination comprised of registration of dental caries, full mouth periodontal status, temporomandibular disorders, mucosal lesions and height and weight. The participants were grouped by age (20-34, 35-49, 50-64 and 65-79) and ethnicity (Norwegian, Sámi, other European and other world). RESULTS: From the original sample of 2,909 individuals, 1,986 (68.3%) people participated, of whom 1,019 (51.3%) were women. The highest attendance rate was among women 20-34 years old (80.3%) and the lowest in the oldest age group of women (55.4%). There was no difference in response rate between rural and urban areas. There was a positive correlation between population size and household gross income (p < 0.001) and education level (p < 0.001). The majority of Sámi resided in smaller municipalities. In larger cities, most participants used private dental health care services, whereas, in rural areas, most participants used the public dental health care service. CONCLUSION: The TOHNN study has the potential to generate new knowledge on a wide range of oral health conditions beneficial to the population in Troms County. Due to the high participation rate, generalization both nationally and to the circumpolar area ought to be possible.
Resumo:
O objetivo deste estudo é avaliar o processo de implementação da Licença Compulsória no caso do anti-retroviral efavirenz. Esta pesquisa é de caráter descritivo, o meio de investigação foi o estudo de caso e foi conduzido com entrevistas semi-estruturadas contendo questões abertas para um conjunto de atores representativos da área da Saúde Pública que participaram do processo da licença compulsória residentes nos estados do Rio de Janeiro e São Paulo e no Distrito Federal durante os meses de outubro a dezembro de 2009. Permitiu-se que esses indivíduos se expressassem mais ou menos livremente de forma que eles produzissem discursos. Para a análise dos discursos, utilizou-se a técnica do Discurso do Sujeito Coletivo (DSC). Os resultados demonstraram que o Brasil possui capacitação tecnológica para desenvolver e produzir anti-retrovirais em um prazo relativamente curto. Os resultados mostram ainda que a Licença Compulsória ajudou a refrear os gastos com anti-retrovirais e que o instrumento pode ser utilizado para garantir o acesso da população a medicamentos anti-retrovirais de alto custo e estratégicos para o Sistema Único de Saúde em um ambiente de recursos limitados sempre que se chegar a um impasse na negociação para redução de preços com os laboratórios farmacêuticos transnacionais.
Resumo:
A necessidade de coibir o descontrole do mercado dos planos de saúde tornou-se uma questão importante no cenário nacional, na década de 90. Desta forma, 10 anos após a criação do Sistema Único de Saúde (SUS), em um contexto de pressões e de baixa regulação dos planos de saúde, instituiu-se a Lei no 9.656/1998, uma legislação inédita no Brasil, pois regulou as atividades das operadoras de planos de saúde (OPSs) em nível nacional. Dentre outras questões, a Lei estabeleceu a política de ressarcimento ao SUS, impondo no Artigo no 32 o ressarcimento pelas OPSs das despesas geradas ao SUS quando um beneficiário usa a rede pública para um procedimento coberto pelo seu plano. No entanto, esta política é parte dos conflitos que se situa no limite dos interesses entre o setor privado e público: as OPSs já em 1998 moveram uma ação direta de inconstitucionalidade contra a mesma e têm recorrido frequentemente ao judiciário para não pagarem os valores cobrados pela Agência Nacional de Saúde Suplementar (ANS). Após 12 anos da Lei, ainda não se conhece o seu real impacto. Portanto, o presente trabalho teve como objetivo avaliar a efetividade da política de ressarcimento ao SUS. A metodologia utilizada baseou-se na avaliação de dados produzidos pela ANS e pelo Ministério da Saúde/DATASUS, e das entrevistas realizadas com gerentes da rede pública e privada. Apesar das ações da ANS, os resultados apontaram a reduzida efetividade da política em termos financeiros, jurídicos e sobre o seu público-alvo. Apenas 22% do cobrado às OPSs foi restituído ao Sistema Único de 1999 a 2006, a política é vista como inconstitucional pelo mercado e tem reduzido impacto sobre as OPSs, o SUS e os beneficiários. Questões como os valores da tabela única nacional de equivalência de procedimentos (TUNEP), a inconstitucionalidade do ressarcimento e a opção do beneficiário pelo uso do SUS foram explicitadas pelos gestores de planos de saúde como fatores geradores de resistência das OPSs frente à política. Os dirigentes públicos afirmaram a importância da mesma para tutela de beneficiários e do SUS, como de ter viabilizado a construção do Cadastro de Beneficiários da ANS, porém, reconhecem os seus baixos resultados. Recomenda-se a manutenção do ressarcimento ao Sistema Único como um instrumento para coibir empresas que procuram contornar as exigências legais da Agência Reguladora, a qual atua promovendo a defesa do interesse público na assistência suplementar à saúde. No entanto, a mesma deve sofrer as devidas reformulações e devem ser estabelecidos consensos entre o SUS e o setor suplementar.
Resumo:
NORO, Luiz Roberto Augusto et al. Incidência de cárie dentária em adolescentes em município do Nordeste brasileiro, 2006, Cadernos de Saúde Pública, Rio de Janeiro, v. 25, n. 4, p. 783-790, abr. 2009.
Resumo:
The aims of this study were to analyze the access of dental services by child population, to determine the prevalence of dental caries, gingivitis and malocclusion in resident children from the municipal district of Sobral Ceará and to evaluate the incidence of the dental decay in adolescents associated with the factors related to socioeconomic condition, access to health services and self-perception. This study had as main factor the multidisciplinary represented by the participation of health professional (doctors, dentists, nurses) in the development of the survey's initial reference; student from Human Sciences area to apply the structured questionnaire in domiciliary visits; statistics professionals in the orientation of the analysis to be held and family health team (community health agents, dentists and dental clinic assistants) in the scheduling of domiciliary visits and the accomplishment of oral exam. The sample was determined from the domicile record that included children born between 1990 and 1994 to develop the research Children health conditions in the municipal district of Sobral Ceará . The first sample comprised 3425 parents of children from 5 to 9 years old, living in the urban area at the municipal district of Sobral Ceará, aiming at identifying the most important factors associated to the access to dental service. From this sample, 1021 children were selected in a systematic way, for the accomplishment to the epidemiological study of decay, gingivitis and malocclusion. In the study's third phase, in order to arrange the group to be followed, 688 adolescents were examined and interviewed, by means of the active search from the 1021 individuals that had been previously examined. It was observed that 50.9% of the children had access to dental service at least once in a lifetime. Of this total, 65.3% accomplished it during the last year, and 85.4% of these did in public services, what allows to identify the importance of this sector in the access to dental services. It was observed that the factors that most affected the access to dental 129 services were related to socioeconomic condition, such as the access to health plan, the possession of toothbrush, garbage collecting, mother s schooling, sewerage treatment and malnutrition. In relation to oral diseases, an increase in the DMF-T index according the age was observed, from 0.10 in five years old to 1.66 in the nine years old, while with the dmf-t index, the inverse happened, since the index decreased from 3.59 in five years old to 2.69 in nine years old. In relation to gingivitis, an average 32.7% of the children presented gum bleeding. In what concerns malocclusion, it was observed that 60.3% of the children didn't present any problem, 30.17% had light malocclusion and 9.5% severe malocclusion. The average incidence of dental caries was 1.86 teeth per youngster. Among the studied variables, tooth pain in the last six months, mother's income and school snack, adjusted by the perception about the need of treatment, the mother's schooling and the dentist's appointment at least once in a lifetime, were the variables that presented positive relationship with the high incidence of dental caries on this population by logistic regression. Variables of socioeconomic nature, related to the access to health services and behavior and biological variables presented a relationship with the high caries incidence. The study point out to the need of developing health actions in a humanized way, by an oral health team effectively bound to the population's interest, with the great objective to provide, with the public health services managers, adequate conditions to improve oral health
Resumo:
This study aimed to examine the perception of dentist-surgeon about the Permanent Education in Health (PEH). It is characterized as a qualitative research with focus in the field of public health policies. It refers specifically to the development of Permanent Education policy in Health in the state of Rio Grande do Norte. They were participants of this research 42 dentist surgeons and 83.3% females and 16.7% males, participants in Specialization courses approved and agreed by the Permanent Education Center in Health (PEC-RN) in the period 2005 to 2007. These professionals are part of the Family Health Strategy (FHS), and 11.9% work in management at the central level and 88.1% are directly related to oral health care in the Basic Health Units of the Family, 30 cities in the state. Data collection was through a questionnaire, with questions that guided the research development and achieve the objectives proposed. The socio-demographic data were analyzed using the descriptive statistics and subjective content was subjected to content analysis by Bardin. The emerging categories from the textual material generated by respondents were: program content, methodological approach and concepts of Permanent Education in Health. The subjects surveyed reported that the program content is more comprehensive and directs to the reflection of everyday practices, with regard to the methodological approach, concern that occurs through discussion and reflection with dynamic, participative, varied and constructive activities, questioning and putting as the main focus. As for understanding of the concepts of the PEH, there was a consensus that define as education stable strategies which contributing to transform and improve the health workers to have the upgrade, improvement of practices, being based on everyday experience and taking into account the accumulation and renewal of these experiences. Therefore, results presented showed that there is a clear understanding of the subjects on the proposals and guidelines of the PEH. It was concluded that lack continuous access to the policies proposed by Ministry of Health involving health workers, managers, communities, through social control and the teaching-service integration and that they are worked within the health system and can classify all these segments of society favor the existence of a more participatory, effective, fair and better quality health service
Resumo:
A auditoria, na saúde, verifica os processos e resultados da prestação de serviços, pressupondo o desenvolvimento de um modelo de atenção adequado, de acordo com as legislações vigentes. Nesta pesquisa, objetivou-se analisar as atividades da auditoria no Sistema Único de Saúde no serviço de saúde bucal, buscando demonstrar as ações e a sua inserção nas três esferas de governo. Foram realizadas análise documental e levantamentos bibliográficos sobre os sistemas de auditoria e o papel do auditor no serviço odontológico desde 1969. Os resultados mostraram que foram encontrados seis artigos sobre auditoria odontológica no SUS e que a atuação do auditor odontológico é abrangente no gerenciamento do sistema, consistindo no controle, na avaliação, na supervisão e na orientação, bem como na garantia da participação social e acesso aos serviços. Na saúde bucal o auditor analisa, monitora e fiscaliza o planejamento das estratégias e os procedimentos efetuados; realiza o cadastramento dos profissionais, das unidades de saúde e a programação física orçamentária; viabiliza os dados para o sistema de informação e o pagamento dos serviços prestados; examina o cumprimento das pactuações, dando um enfoque educativo e não mais policialesco à resolubilidade dos problemas. Conclui-se que existem poucos estudos sobre auditoria odontológica no SUS e que o sistema de auditoria é um instrumento administrativo confiável e essencial para os gestores no desenvolvimento das ações de saúde.
Resumo:
O processo ensino-pesquisa-extensão realizado com a imersão dos sujeitos em cenários reais possibilita a integração universidade-comunidade, ampliando a inserção social. O objetivo deste trabalho foi apresentar a experiência de um projeto conduzido em cinco municípios brasileiros, com a participação de docentes, pós-graduandos e acadêmicos, em parceria com prefeituras municipais e trabalhadores de saúde como cenário de ensino-pesquisa no SUS. Foram realizadas oficinas e cursos de capacitação com as equipes de saúde, gestores e conselheiros de saúde, visitas técnicas aos municípios para avaliação situacional e supervisão das atividades, avaliação da satisfação dos usuários e formação de lideranças populares. Observou-se a melhoria na organização dos serviços e estímulo ao fortalecimento do vínculo entre os usuários e prestadores de serviços. Essa experiência serviu como laboratório de aprendizagem e pesquisa, fazendo-se ciência a partir da vivência in loco da realidade do SUS e contribuindo para uma formação professional mais humanitária baseada em cenários reais.
Resumo:
Includes bibliography
Resumo:
Pós-graduação em Enfermagem (mestrado profissional) - FMB