Methodological contributions towards the study of health care production: lessons from a research study on barriers and access in mental health

This article presents methodological contributions and a conceptual innovation for thinking about the production of health care, stemming from a study on access and barriers in mental health carried out in the municipality of Campinas (Sao Paulo, Brazil). The study used a cartographic approach and, after an initial identification of the most complex cases (on the part of the teams of workers), adopted the users as guides to explore the different levels of production of their lives and to evaluate the possibility of forming a network of existential connections that produce life as a fundamental analyzer of access or barriers to care.

The viewpoint of health professionals on the role of basic units in the healthcare network of the Brazilian Unified Health System

In the process of creation of the Unified Health System (SUS) as a universal policy seeking to ensure comprehensive care, unscheduled assistance in primary healthcare units (UBS) is an unresolved challenge. The scope of this paper is to analyze the viewpoint of health professionals on the role of primary healthcare units in meeting this demand. It is a transversal study of qualitative data obtained through questionnaires and interviews with 106 medical practitioners from 6 emergency medical services and 190 professionals from 30 units. They explained why people seek emergency care for occurrences pertaining to primary care. The content analysis technique with thematic categories was used for data analysis. Lack of resources and problems with primary health unit work processes (50.8%) were the reasons most frequently cited by emergency care physicians to explain this inadequate demand. Only 33.3% of the health unit professionals agreed that these occurrences should be attended in the primary healthcare services. The limited viewpoint of the role of health services on the unscheduled care, particularly among primary care professionals, possibly leads to restrictive practices for access by the population.

Women's knowledge of health effects of oral contraceptives in five Brazilian cities

Background: Although acceptability of combined oral contraceptives (COCs) is widespread, patients are often unaware of the noncontraceptive benefits. Study Design: An opinion survey through telephone interview was conducted to evaluate the knowledge of 500 Brazilian women 15-45 years of age who were current users or had recently used COCs. Data were obtained on their knowledge of adverse events, the effects of COCs on health- and menstrual-related symptoms, noncontraceptive benefits and aspects related to sexual response. Results: Most of the women interviewed learned about the pill from doctors or the Internet. Other than the pill, the best-known contraceptive methods were the condom and intrauterine device. The majority of women believe that COCs do not change the risk of gynecological cancers. Most believed that they had no significant effect on sexual response. Conclusions: COCs users in Brazil lack precise information on aspects related to general health, particularly menstrual-related symptoms and noncontraceptive health benefits. (C) 2012 Elsevier Inc. All rights reserved.

Work and Inter-subjectivity: a theoretical reflection on its dialectics in the field of health and nursing

This theoretical reflection intends to show the inter-subjective relationship that takes place in health and nursing practices under the following theoretical perspectives: Institutional Analysis, Psychodynamics of Labor and the Theory of Communicative Action, with an emphasis on the latter. Linking these concepts to the Marxist approach to work in the field of health emerges from recognizing the need for its continuous reconstruction-in this case, with a view to understand the interaction and communication intrinsic to work in action. The theory of Communicative Action seeks to consider these two inextricable dimensions: work as productive action and as interaction. The first corresponds to instrumental action based on technical rules with a production-guided rationale. The second refers to the interaction that takes place as communicative action and seeks understanding among subjects. We assume that adopting this theoretical perspective in the analysis of health and nursing practices opens new possibilities for clarifying its social and historical process and inter-subjective connections.

Short Assessment of Health Literacy for Portuguese-Speaking Adults

OBJECTIVE: To develop and validate a short health literacy assessment tool for Portuguese-speaking adults. METHODS: The Short Assessment of Health Literacy for Portuguese-speaking Adults is an assessment tool which consists of 50 items that assess an individual's ability to correctly pronounce and understand common medical terms. We evaluated the instrument's psychometric properties in a convenience sample of 226 Brazilian older adults. Construct validity was assessed by correlating the tool scores with years of schooling, self-reported literacy, and global cognitive functioning. Discrimination validity was assessed by testing the tool's accuracy in detecting inadequate health literacy, defined as failure to fully understand standard medical prescriptions. RESULTS: Moderate to high correlations were found in the assessment of construct validity (Spearman's coefficients ranging from 0.63 to 0.76). The instrument showed adequate internal consistency (Cronbach's alpha=0.93) and adequate test-retest reliability (intraclass correlation coefficient=0.95). The area under the receiver operating characteristic curve for detection of inadequate health literacy was 0.82. A version consisting of 18 items was tested and showed similar psychometric properties. CONCLUSIONS: The instrument developed showed good validity and reliability in a sample of Brazilian older adults. It can be used in research and clinical settings for screening inadequate health literacy.

History and Epistemology of Science in the Classroom: The Synthesis of Quinine as a Proposal

The history of the quinine synthesis can be used as a case study to emphasize that science is influenced by social and historical processes. The first efforts toward the synthesis of this substance, which until recently was the only treatment for malaria, were by Perkin in 1856 when, trying to obtain quinine,,. he synthesized mauveine. Since then, the quest for the total synthesis of quinine involved several characters in a web of controversies. A major step in this process was made in 1918 by Rabe and Kindler, who proposed the synthesis of quinine from quinotoxine. Twenty-six years later, after obtaining the total synthesis of quinotoxine, Woodward and Doering announced the total synthesis of quinine. However, the lack of experimental details about Rabe and Kindler's process, associated with Woodward and Doering's failure to reproduce it, raised a series of doubts about the synthesis. Stork and colleagues questioned the veracity of the experimental data and even the scientific reputation of the involved researchers. Doubts remained alive until 2008, when Williams and Smith reported, not without reservations, the reproducibility of Rabe and Kindler's protocol. The scientific knowledge as a social and historical development, its legitimating process, and the absence of neutrality in science constitute aspects that can be discussed from this case study, providing significant contributions to science education, in particular, to the initial or continued training of chemistry teachers.

Short Assessment of Health Literacy for Portuguese-speaking Adults

OBJECTIVE: To develop and validate a short health literacy assessment tool for Portuguese-speaking adults. METHODS: The Short Assessment of Health Literacy for Portuguese-speaking Adults is an assessment tool which consists of 50 items that assess an individual's ability to correctly pronounce and understand common medical terms. We evaluated the instrument's psychometric properties in a convenience sample of 226 Brazilian older adults. Construct validity was assessed by correlating the tool scores with years of schooling, self-reported literacy, and global cognitive functioning. Discrimination validity was assessed by testing the tool's accuracy in detecting inadequate health literacy, defined as failure to fully understand standard medical prescriptions. RESULTS: Moderate to high correlations were found in the assessment of construct validity (Spearman's coefficients ranging from 0.63 to 0.76). The instrument showed adequate internal consistency (Cronbach's alpha=0.93) and adequate test-retest reliability (intraclass correlation coefficient=0.95). The area under the receiver operating characteristic curve for detection of inadequate health literacy was 0.82. A version consisting of 18 items was tested and showed similar psychometric properties. CONCLUSIONS: The instrument developed showed good validity and reliability in a sample of Brazilian older adults. It can be used in research and clinical settings for screening inadequate health literacy.

The evolution of health status and chronic conditions in Catalonia, 1994-2006: the paradox of health revisited using the Blinder - Oaxaca decomposition

[EN] Background: The paradox of health refers to the improvement in objective measures of health and the increase in the reported prevalence of chronic conditions. The objective of this paper is to test the paradox of health in Catalonia from 1994 to 2006. Methods: Longitudinal cross-sectional study using the Catalonia Health Interview Survey of 1994 and 2006. The approach used was the three-fold Blinder - Oaxaca decomposition, separating the part of the differential in mean visual analogue scale value (VAS) due to group differences in the predictors (prevalence effect), due to differences in the coefficients (severity effect), and an interaction term. Variables included were the VAS value, education level, labour status, marital status, all common chronic conditions over the two cross-sections, and a variable for non-common chronic conditions and other conditions. Sample weights have been applied. Results: Results show that there is an increase in mean VAS for men aged 15-44, and a decrease in mean VAS for women aged 65-74 and 75 and more. The increase in mean VAS for men aged 15-44 could be explained by a decrease in the severity effect, which offsets the increase in the prevalence effect. The decrease in mean VAS for women aged 65-74 and 75 and more could be explained by an increase in the prevalence effect, which does not offset the decrease in the severity effect. Conclusions: The results of the present analysis corroborate the paradox of health hypothesis for the population of Catalonia, and highlight the need to be careful when measuring population health over time, as well as their usefulness to detect population's perceptions.

L’«educativo» in sanità: reti di complessità e orizzonti di possibilità

La tesi analizza il dialogo tra due prospettive disciplinari: pedagogia e scienze mediche aprendo ad una serie di riflessioni operative e metodologiche per lo sviluppo della competenza educativa in sanità. Si tratta di un lavoro di ricerca pedagogica articolata in due parti:una teoretica e una empirica. La prima parte pone l’attenzione in modo particolare all’epistemologia della cura sanitaria nella prospettiva della complessità e agli elementi che definiscono la competenza educativa degli operatori. La seconda parte presenta i dati di una indagine esplorativa realizzata tramite focus group che ha coinvolto medici, infermieri, ostetriche e fisioterapisti della provincia di Bologna e medici, infermieri e fisioterapisti del Canton Ticino, Svizzera per far emergere le esperienze, i vissuti e le opinioni legate alle azioni educative sanitarie

Impact of Various Insurance Types on Level and Appropriateness of Health Care Consumption

The goal of this study was to examine the extent to which insurance type, or method of care management, impact the appropriate delivery of health care. Previous studies indicate a relationship between insurance type and patterns of consumption but do not directly link the incentives or disincentives inherent in each plan with trends inconsumption of health care. This study explores how different types of health insurance coverage affect the location, the degree, and the frequency of health care consumption in order to gain insight into which plans promote appropriate delivery and consumption ofcare.