Escala de estresse percebido aplicada a estudantes universitárias: estudo de validação

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

Barriers related to non-adherence in a mammography breast-screening program during the implementation period in the interior of São Paulo State, Brazil

Mammography is the best exam for early diagnosis of breast cancer. Developing countries frequently have a low income of mammography and absence of organized screening. The knowledge of vulnerable population and strategies to increase adherence are important to improve the implementation of an organized breast-screening program. A mammography regional-screening program was implemented in a place around 54.238 women, aged 40-69 years old. It was proposed to perform biannual mammography free of cost for the women. We analyze the first 2 years of the implementation of the project. Mammography was realized in 17.964 women. 42.1% of the women hadn't done de mammography in their lives and these women were principally from low socio-economic status (OR=2.99), low education (OR=3.00). The best strategies to include these women were mobile unit (OR=1.43) and Family Health Program (OR=1.79). The incidence of early breast tumors before the project was 14.5%, a fact that changed to 43.2% in this phase. Multivariate analysis showed that the association of illiterate and the mobile unit achieve more women who had not performed mammography in their lives. The strategies to increase adherence to mammography must be multiple and a large organization is necessary to overpass the barriers related to system health and education.

Avaliação do conhecimento dos profissionais de saúde sobre o programa de cessação do tabagismo

Pós-graduação em Enfermagem - FMB

Relação entre a presença da equipe de saúde bucal na estratégia saúde da família com o nível de conhecimento dos agentes comunitários de saúde

Objective: to identify the relation between the level of knowledge of community health workers on oral health and the presence of the Oral Health Team in the Family Health Strategy. Methods: we performed a survey with 173 community health workers allocated in public health services of five municipalities in the northwest of São Paulo, Brazil, through a self-administered and structured instrument. The survey instrument contemplated questions related to the presence of the Oral Health Team in the Family Health Strategy and questions regarding oral health. Results: the majority of community health workers was inserted in strategies with the presence of Oral Health Teams (60.1%). We found that the oral health knowledge of most participants was good (48%). Conclusion: there is relation between the level of knowledge of community health workers and the presence of the Oral Health Team in the Family Health Strategy.

Book Review of Laud Humphreys: Prophet of Homosexuality and Sociology by John F. Galliher, Wayne H. Brekhus, and David P. Keys

As an undergraduate sociology major, the only thing I learned about Oklahoman Laud Humphreys's classic, Tearoom Trade (1970) was how it violated standards of informed consent in social science research. As Galliher, Brekhus, and Keys recount in their biography, Laud Humphreys: Prophet of Homosexuality and Sociology, sociology graduate student Laud Humphreys needed to supplement his (quite likely, participant) observational research of men who had sex in public bathrooms (i.e., tearooms) in St. Louis in the mid-1960s with a formal questionnaire. Knowing that these men would never agree if they knew they were selected because of their participation in highly stigmatized and criminal behavior, Humphreys recorded their license plates, got their home addresses, and interviewed them as part of a "community health survey." Herein lies the deception and the major source of the controversy. What I didn't fully appreciate when I was a student, however, and what the authors so deftly illuminate is the importance of this work not only for debates around ethical issues of social science research, but more importantly, perhaps, for the study of sexuality, deviance, and urban life.

Bovine Tb Eradication Project – Recognizing Hot Button Issues

The Michigan Departments of Agriculture, Community Health, and Natural Resources, US Department of Agriculture (USDA) and Michigan State University work cooperatively together as the bovine TB eradication project partners. The interagency group combines expertise in epidemiology, veterinary and human medicine, pathology, wildlife biology, animal husbandry, regulatory law and policy and risk communications. The stakeholders, those impacted by the disease, include agriculture and tourism industry representatives, “Mom-and-Pop” businesses, hunters, wildlife enthusiasts, farmers, Local Health Departments and legislators. The regulatory agencies are the above mentioned project partners, excluding MSU and USDA Wildlife Services, both of which offer services to agencies and stakeholders. Eradicating bovine TB would not be difficult if there were no social issues surrounding it. The economy, hunting traditions, animal management, tourism and human health are all impacted by regulatory response to the disease. Often the social issues play a large role in decision making, therefore it is important to understand your clientele and anticipate public reaction to policy changes and requirements.

Micropolítica do trabalho dos profissionais de saúde na UBS: visão sobre necessidades de saúde das famílias

Este estudo teve como objetivo compreender as potencialidades e limitações do processo de trabalho da enfermagem de uma Unidade Básica de Saúde para o reconhecimento das necessidades de saúde da população. A vertente metodológica utilizada foi a pesquisa social, na perspectiva qualitativa, tendo como base de análise dos discursos a hermêutica-dialética, e como alicerce a Teoria da Interpretação Práxica da Enfermagem em Saúde Coletiva. Os dados foram coletados por meio da entrevista semiestruturada e os processos de trabalho das equipes foram analisados através do Fluxograma Analisador do Modelo de Atenção de um Serviço de Saúde. Concluiu-se que há limitações no cotidiano do processo de trabalho da equipe de enfermagem à medida em que o reconhecimento e enfrentamento das necessidades de saúde perpassavam pela identificação de agravos instalados, deixando em segundo plano os determinantes sociais das más condições de vida associadas ao processo saúde-doença.

Accuracy of Screening for Potentially Malignant Disorders of the Oral Mucosa by Dentists in Primary Care

Purpose: To examine the accuracy of a screening programme for potentially malignant disorders of the oral mucosa by visual inspection in primary health care. Materials and Methods: The study was based on secondary data from the Primary Care Information System maintained by seven units of family health in Sao Paulo City managed by a non-governmental agency. The reference population was composed of 15,072 residents 50 years old or more of both genders. The study population comprised 2,980 individuals. During screening in community settings, the oral mucosa was examined by trained dentists and distributed into two categories: (a) screen negative (b) screen positive. All participants underwent comprehensive clinical exams by a general dental practitioner supervised by a specialist. Individual records were grouped in a working dataset. Point and 95% confidence interval estimates were calculated regarding measures of sensitivity (Se), specificity (Sp) and positive and negative predictive values (PPV and NPV, respectively). Results: 18.0% of the population was considered screen positive. A total of 133 lesions (4.5%) were identified and 8 cases of oral cancer were confirmed, which corresponded to a prevalence rate of 27 cases in 10,000 people, a much higher rate than expected. The measures found were Se: 91.7% (85.3-95.6), Sp: 85.4% (84.1-86.7), PPV: 22.7% (19.3-26.5), NPV: 99.5% (99.2-99.8). The visual screen presented high accuracy. Conclusion: The test presented high sensibility and specificity values. From a public health point of view, the high accuracy levels showed the importance of oral health teams on family health strategy for more comprehensive primary care. Targeting risk groups and delegating the screening to community health agents may improve PPV and coverage.

Cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the universal immunisation of infants in Brazil

Background Cost-effectiveness studies have been increasingly part of decision processes for incorporating new vaccines into the Brazilian National Immunisation Program. This study aimed to evaluate the cost-effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) in the universal childhood immunisation programme in Brazil. Methods A decision-tree analytical model based on the ProVac Initiative pneumococcus model was used, following 25 successive cohorts from birth until 5 years of age. Two strategies were compared: (1) status quo and (2) universal childhood immunisation programme with PCV10. Epidemiological and cost estimates for pneumococcal disease were based on National Health Information Systems and literature. A 'top-down' costing approach was employed. Costs are reported in 2004 Brazilian reals. Costs and benefits were discounted at 3%. Results 25 years after implementing the PCV10 immunisation programme, 10 226 deaths, 360 657 disability-adjusted life years (DALYs), 433 808 hospitalisations and 5 117 109 outpatient visits would be avoided. The cost of the immunisation programme would be R$10 674 478 765, and the expected savings on direct medical costs and family costs would be R$1 036 958 639 and R$209 919 404, respectively. This resulted in an incremental cost-effectiveness ratio of R$778 145/death avoided and R$22 066/DALY avoided from the society perspective. Conclusion The PCV10 universal infant immunisation programme is a cost-effective intervention (1-3 GDP per capita/DALY avoided). Owing to the uncertain burden of disease data, as well as unclear long-term vaccine effects, surveillance systems to monitor the long-term effects of this programme will be essential.

Propensity score matching approach to test the association of income inequality and mortality in Sao Paulo, Brazil

Background Support for the adverse effect of high income inequality on population health has come from studies that focus on larger areas, such as the US states, while studies at smaller geographical areas (eg, neighbourhoods) have found mixed results. Methods We used propensity score matching to examine the relationship between income inequality and mortality rates across 96 neighbourhoods (distritos) of the municipality of Sao Paulo, Brazil. Results Prior to matching, higher income inequality distritos (Gini >= 0.25) had slightly lower overall mortality rates (2.23 per 10 000, 95% CI -23.92 to 19.46) compared to lower income inequality areas (Gini <0.25). After propensity score matching, higher inequality was associated with a statistically significant higher mortality rate (41.58 per 10 000, 95% CI 8.85 to 73.3). Conclusion In Sao Paulo, the more egalitarian communities are among some of the poorest, with the worst health profiles. Propensity score matching was used to avoid inappropriate comparisons between the health status of unequal (but wealthy) neighbourhoods versus equal (but poor) neighbourhoods. Our methods suggest that, with proper accounting of heterogeneity between areas, income inequality is associated with worse population health in Sao Paulo.

Consolidation of international guidelines for the management of canine populations in urban areas and proposal of performance indicators

Consolidation of international guidelines for the management of canine populations in urban areas and proposal of performance indicators The objective of this study is to propose a generic program for the management of urban canine populations with suggestion of performance indicators. The following international guidelines on canine population management were revised and consolidated: World Health Organization, World Organisation for Animal Health, World Society for the Protection of Animals, International Companion Animal Management Coalition, and the Food and Agriculture Organization. Management programs should cover: situation diagnosis, including estimates of population size; social participation with involvement of various sectors in the planning and execution of strategies; educational actions to promote humane values, animal welfare, community health, and responsible ownership (through purchase or adoption); environmental and waste management to eliminate sources of food and shelter; registration and identification of animals; animal health care, reproductive control; prevention and control of zoonoses; control of animal commerce; management of animal behavior and adequate solutions for abandoned animals; and laws regulating responsible ownership, prevention of abandonment and zoonoses. To monitor these actions, four groups of indicators are suggested: animal population indicators, human/animal interaction indicators, public service indicators, and zoonosis indicators. The management of stray canine populations requires political, sanitary, ethologic, ecologic, and humanitarian strategies that are socially acceptable and environmentally sustainable. Such measures must also include the control of zoonoses such as rabies and leishmaniasis, considering the concept of "one health," which benefits both the animals and people in the community.

Questionnaire for monitoring auditory and language development in the first year of life

Purpose: To validate a monitoring questionnaire about hearing and language development applied by community health agents in the first year of life. Methods: Seventy six community health agents, previously trained on infant hearing health, administered a questionnaire to the families of 304 children with ages from 0 to 1 year. The questionnaire contains questions regarding hearing and language development and, for all age groups, the question “Does your child hear well?” was presented. The validity of the questionnaire was assessed by analyzing false positive and false negative rates of the identified children. A double-blind study was conducted so that all children assessed by the questionnaire were submitted to hearing evaluation performed by audiologists. Results: Four children (1.32%) were diagnosed with sensorineural hearing loss (two unilateral), and 69 (22.7%) with conductive hearing loss. The monitoring questionnaire showed specificity of 96% and sensitivity of 67%, with a false-negative rate of 33% for not identifying the unilateral hearing loss, and a false-positive rate of 4%. Conclusion: The questionnaire used has shown to be feasible and relevant to actions of the community health agents of the Family Health Strategy program, with high specificity and moderate sensitivity. The use of the validated instrument should be considered to complement Newborn Hearing Screening Programs, in order to identify late onset or acquired hearing loss.

Articulação das ações e interação dos Agentes Comunitários de Saúde na equipe de Saúde da Família

O estudo de abordagem qualitativa teve como objetivo compreender as relações sociais entre o Agente Comunitário de Saúde (ACS) e a equipe de Saúde da Família (SF), nesse sentido, destaca-se a articulação das ações e a interação entre trabalhadores. Foram realizadas 23 observações participantes e 11 entrevistas semiestruturadas com uma equipe de SF em um município do interior de São Paulo, Brasil. Identificou-se que o ACS, como elo, desenvolve ações operacionais para agilizar o trabalho da equipe. Como laços de ligação, desempenham ações articuladas ao trabalho da equipe, interagindo com os trabalhadores, construindo planos assistenciais em comum, aproximando equipe e comunidade, adequando ações de cuidado às necessidades das pessoas. Na prática comunicativa, ao falarem de si, falam da própria comunidade, pois é seu representante e porta-voz na equipe. Concluiu-se que o Agente Comunitário de Saúde pode ser um trabalhador estratégico se suas ações compreenderem uma dimensão mais política e social do trabalho em saúde.

A educação em saúde no cuidado de usuários do Programa Automonitoramento Glicêmico

O trabalho relata, de maneira sistematizada e crítica, a experiência de um Projeto de Extensão no período de 2010 a 2011. Teve como foco ações de educação em saúde como estratégia para melhorar a adesão das pessoas com diabetes mellitus e insulinodependentes, de uma Unidade Básica de Saúde do município de São Paulo, ao Programa Automonitoramento Glicêmico. Além disso, pretendeu-se contribuir na reorganização do processo de trabalho em relação ao Programa na unidade. Foram utilizadas estratégias de educação em saúde em grupos educativos e visitas domiciliares, assim, possibilitando cuidados mais singulares. Dados dos usuários foram organizados em planilha e em pastas para as equipes de Saúde da Família, facilitando na identificação dos usuários, inclusive os faltosos, e auxiliando na descentralização do cuidado. Com as ações de educação em saúde, pretendeu-se contribuir para um cuidado mais integral e emancipatório aos usuários, para um contínuo refletir dos trabalhadores quanto a suas práticas.

Agentes comunitárias de saúde e a atenção à saúde sexual e reprodutiva de jovens na estratégia saúde da família

As DST/HIV e a gestação não-planejada entre jovens têm exigido o incremento da atenção em saúde sexual e reprodutiva, desafiando a formação profissional tradicional, os processos de trabalho e gestão na atenção primária. Este estudo etnográfico (observação e entrevistas) foi realizado em duas unidades básicas de município turístico do Estado do Rio de Janeiro, focalizando o trabalho das agentes comunitárias de saúde. As agentes abordavam a sexualidade jovem, principalmente das garotas; orientavam o fluxo de ações e influenciavam as estratégias de prevenção e cuidado, enfatizando "gravidez precoce" e "promiscuidade sexual". A saúde de jovens não era considerada integralmente, embora o trabalho das agentes constituísse uma tecnologia de processo com grande potencial na atenção à saúde sexual de jovens. A juventude se beneficia da atuação dessas profissionais, que podem ter seu saber prático mais valorizado. Sugere-se a formação em abordagens baseadas nos direitos humanos e na construção social da sexualidade.