Health surveys and use of maternal and child health care services in three municipalities within the São Paulo metropolitan area

Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the São Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes.Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the São Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions.Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of São Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance.Conclusions. The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.

Malnutrition in the second year of life and psychosocial care: a case-control study in an urban area of Southeast Brazil

O objetivo do estudo foi identificar e medir a presença de associação entre cuidado psicossocial e desnutrição. Realizou-se estudo caso-controle incluindo 101 crianças desnutridas (peso/idade < percentil 5 do padrão NCHS/OMS), com idades entre 12 e 23 meses, que foram comparadas a 200 controles eutróficos (peso/ idade > percentil 25) em termos de sua exposição a uma série de comportamentos maternos indicadores da qualidade de seu cuidado psicossocial. Criou-se um escore de cuidado psicossocial, variando de 0 a 14, de acordo com o número de comportamentos maternos desejáveis não observados: quanto maior o escore, pior a qualidade do cuidado psicossocial. Mediante análise de regressão logística verificou-se maior risco de desnutrição para as crianças no 2º e 3º tercis do escore de cuidado psicossocial. Esta associação foi modificada pela renda per capita. Após ajustes para possíveis confundidores, nas crianças dos estratos superiores de renda não houve associação entre cuidado psicossocial e desnutrição. Para as crianças com nível mais baixo de renda, pior cuidado psicossocial dobrou o risco de desnutrição (OR = 7,26; IC95%: 2,42-21,82) em relação àquele associado apenas à baixa renda (OR = 3,08; IC95%: 1,28-7,42).

HIV attitudes and practices among professors in a Brazilian dental school.

Although there is considerable published research on Acquired Immunodeficiency Syndrome (AIDS), individual biases persist because of lack of information regarding HIV virus transmission. As a result, both infected patients and health care professionals suffer. The objective of this study was to determine if there is prejudice among university professors at the School of Dentistry at Aracatuba's Sao Paulo State University (FOA-UNESP) concerning HIV-positive patients or HIV-positive health care professionals. Out of the seventy-seven professors who responded to the questionnaire, 62.3 percent (forty-eight) stated that they advise their students not to refuse to treat a patient with HIV. Although 96.2 percent (fifty-two) of the fifty-four professors who treat patients have reported that they treat patients who are HIV-positive, only 65.3 percent of them were aware of infection control precautions, and only 32.7 percent reported that they would treat an HIV-positive patient like any other patient. There is also prejudice regarding HIV-positive professionals because only 48.1 percent (thirty-seven) of the professors responded that they would be willing to be treated by an infected professional. It can be concluded that there is prejudice among some of the FOA-UNESP university professors regarding individuals who are HIV-positive.

Millennium development goals: progress towards the right to health in Latin america and the Caribbean

Includes bibliography

Mathematics education and democracy

In this paper, we investigate the relationship between mathematics education and the notions of education for all/democracy. In order to proceed with our analysis, we present Marx's concept of commodity and Jean Baudrillard's concept of sign value as a theoretical reference in the discussion of how knowledge has become a universal need in today's society and ideology. After, we engage in showing mathematics education's historical and epistemological grip to this ideology. We claim that mathematics education appears in the time period that English becomes an international language and the notion of international seems to be a key constructor in the constitution of that ideology. Here, we draw from Derrida's famous saying that there is nothing beyond the text. We conclude that a critique to modern society and education has been developed from an idealistic concept of democracy. © FIZ Karlsruhe 2009.

Education and the labour market in Latin America: why measurement is important and what it tells us about policies, reforms and performance

Includes bibliography

Education and income distribution in urban Brazil, 1976-1996

Includes bibliography

Population, ageing and development

Includes bibliography

The invisible face of child labour in Latin America and the Caribbean

Child labour has a gender bias related to the dominant stereotypes regarding gender roles. While out-of-home paid work is carried out predominantly by boys, girls bear the greater burden in unpaid domestic tasks, whether in their own homes or the homes of others. Boys are more exposed to the risks of being out on the street and find it more difficult to combine work and education. For girls it may be easier to reconcile the spheres of work and education, but they suffer costs that remain hidden and that reinforce their disadvantages throughout the life cycle. On the one hand, they are marked by the assumption that the burden of the care economy is entirely their responsibility, which determines future labour prospects. Indeed, even when girls show greater educational achievement, their occupational options are more limited. On the other hand, girls are exposed to risk within the household, where overexploitation, maltreatment and abuse are as frequent as they are unpunished.

Single early prenatal lipopolysaccharide exposure impairs striatal monoamines and maternal care in female rats

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

Analysis of the feasibility of early hospital discharge after autologous hematopoietic stem cell transplantation and the implications to nursing care

Autologous hematopoietic stem cell transplantation is a conduct used to treat some hematologic diseases and to consolidate the treatment of others. In the field of nursing, the few published scientific studies on nursing care and early hospital discharge of transplant patients are deficient. Knowledge about the diseases treated using hematopoietic stem cell transplantation, providing guidance to patients and caregivers and patient monitoring are important nursing activities in this process. Guidance may contribute to long-term goals through patients' short-term needs. To analyze the results of early hospital discharge on the treatment of patients submitted to autologous transplantation and the influence of nursing care on this conduct. A retrospective, quantitative, descriptive and transversal study was conducted. The hospital records of 112 consecutive patients submitted to autologous transplantation in the period from January to December 2009 were revisited. Of these, 12 patients, who remained in hospital for more than ten days after transplantation, were excluded from the study. The medical records of 100 patients with a median age of 48.5 years (19-69 years) were analyzed. All patients were mobilized and hematopoietic stem cells were collected by leukapheresis. The most common conditioning regimes were BU12Mel100 and BEAM 400. Toxicity during conditioning was easily managed in the outpatient clinic. Gastrointestinal toxicity, mostly Grades I and II, was seen in 69% of the patients, 62% of patients had diarrhea, 61% of the patients had nausea and vomiting and 58% had Grade I and II mucositis. Ten patients required hospitalization due to the conditioning regimen. Febrile neutropenia was seen in 58% of patients. Two patients died before Day +60 due to infections, one with aplasia. The median times to granulocyte and platelet engraftment were 12 days and 15 days, respectively, with median red blood cell and platelet transfusions until discharge of three and four units, respectively. Twenty-three patients required rehospitalization before being discharged from the outpatient clinic. The median time to granulocyte engraftment was 12 days and during the aplasia phase few patients were hospitalized or suffered infections. The toxicity of the conditioning was the leading cause of rehospitalization. The nursing staff participated by providing guidance to patients and during the mobilization, transplant and outpatient follow-up phases, thus helping to successfully manage toxicity.

Brazilian community health agents and qualitative primary healthcare information

The aim of this study was to explore female community health agents’ views about the value of recording qualitative information on contextual health issues they observe during home visits, data that are not officially required to be documented for the Brazilian System of Primary Healthcare Information. Background: The study was conducted in community primary healthcare centres located in the cities of Araçatuba and Coroados (state of São Paulo) and Rio de Janeiro (state of Rio de Janeiro), Brazil. Methods: The design was a qualitative, exploratory study. The purposeful sampling criteria were being female, with a minimum of three years of continuous service in the same location. Data collection with 62 participants was conducted via 11 focus groups (in 2007 and 2008). Audio files were transcribed and submitted to the method of thematic analysis. Four themes guided the analysis: working with qualitative information and undocumented observation; reflecting on qualitative information; integrating/analysing quantitative and qualitative information; and information-sharing with agents and family health teams. In 2010, 25 community health agents verified the final interpretation of the findings. Findings: Participants valued the recording of qualitative, contextual information to expand understanding of primary healthcare issues and as an indicator of clients’ improved health behaviour and health literacy. While participants initiated the recording of additional health information, they generally did not inform the family health team about these findings. They perceived that team members devalued this type of information by considering it a reflection of the clientele’s social conditions or problems beyond the scope of medical concerns. Documentation of qualitative evidence can account for the effectiveness of health education in two ways: by improving preventative care, and by amplifying the voices of underprivileged clients who live in poverty to ensure the most appropriate and best quality primary healthcare for them.

Pharmaceutical care in Brazilian community pharmacies: knowledge and practice

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Community Life and Housing in Rural Nebraska: 2005 Nebraska Rural Poll Results

Many rural communities are experiencing population decline. However, rural residents have continued to show a strong attachment to their communities. How do rural Nebraskans feel about their community? Are they satisfied with the services provided? Do they own their home? What is the condition of their home? This report details 2,851 responses to the 2005 Nebraska Rural Poll, the tenth annual effort to understand rural Nebraskans’ perceptions. Respondents were asked a series of questions about their community and housing. Trends for some of these questions are examined by comparing data from the nine previous polls to this year’s results. For all questions, comparisons are made among different respondent subgroups, that is, comparisons by age, occupation, region, etc. Based on these analyses, some key findings emerged: Rural Nebraskans’ views of the change in their community are similar to those expressed last year. This year, 28 percent believe their community has changed for the better, compared to 26 percent last year. And, in 2005, only 20 percent think their community has changed for the worse, compared to 22 percent last year. The proportion of expected movers who plan to leave the state decreased this year. Last year, 56 percent of the persons planning to move from their community expected to leave the state. That proportion decreased to 47 percent this year. Rural Nebraskans living in or near the largest communities are more likely than persons living in or near the smaller communities to say their community has changed for the better. Thirty-nine percent of persons living in or near communities with populations of 10,000 or more believe their community has changed for the better during the past year, but only 15 percent of persons living in or near communities with less than 500 people share this opinion. The community services and amenities that rural Nebraskans are most dissatisfied with include: entertainment, retail shopping and restaurants. At least one-third of rural Nebraskans express dissatisfaction with these three services. They are most satisfied with parks and recreation, library services, basic medical care services, highways and bridges, and education (K - 12). At least one-half of rural Nebraskans are satisfied with the following items in their community: appearance of residential areas (66%), crime control (61%), maintenance of sidewalks and public areas (57%) and noise (54%). Rural Nebraskans generally have positive views about their community. Sixty percent agree that their community is an ideal place to live and 52 percent say their community has good business leaders. Rural Nebraskans have mixed opinions about the future of their community. Fortyfour percent agree that their community’s future looks bright, but 42 percent disagree with this statement. Fourteen percent have no opinion. Rural Nebraskans living in or near the larger communities are more likely than residents of the smaller communities to think their community’s future looks bright. Fifty-nine percent of persons living in or near communities with populations of 10,000 or more agree with this statement, compared to only 25 percent of residents living in or near communities with less than 500 people. Further, 61 percent of the residents of the smallest communities disagree with this statement, compared to only 28 percent of the residents of the largest communities. Over three-quarters of rural Nebraskans disagree that younger residents of their community tend to stay there after completing high school. Seventy-six percent disagree with this statement, 16 percent have no opinion and eight percent agree that younger residents stay after completing high school. When comparing responses by age, younger persons are more likely than older persons to agree that younger residents stay in their community after high school. Sixteen percent of persons age 19 to 29 agree with this statement, compared to only six percent of persons age 50 to 64. Younger persons are more likely than older persons to be planning to move from their community next year. Fifteen percent of persons between the ages of 19 and 29 are planning to move next year, compared to only two percent of persons age 65 and older. An additional 17 percent of the younger respondents indicate they are uncertain if they plan to move. Most rural Nebraskans own their home. Eighty-four percent of rural Nebraskans own their home. Older persons are more likely than younger persons to own their home. Eighty-eight percent of persons over the age of 50 own their home, compared to only 52 percent of persons age 19 to 29. Housing in rural Nebraska has an average age of 50 years. Twenty-four percent of residences were built before 1930. Another 24 percent were built between 1930 and 1959. Twenty-nine percent were built between 1960 and 1979 and the remaining 24 percent were built in 1980 or later. The housing stock in smaller communities is older than the housing located in larger communities. Over one-third (35%) of the residences in communities with less than 1,000 people were built before 1930. Only 12 percent of the homes in communities with populations of 10,000 or more were built in this time period. Most rural Nebraskans appear satisfied with their home. Only 24 percent say the current size of their home does not meet their needs. The same proportion (24%) say their home is in need of major repairs. Thirty-eight percent agree that their home needs a lot of routine maintenance, but 87 percent like the location (neighborhood) of their home. One-third of rural Nebraskans living in or near the smallest communities say their home is in need of major repairs. Only 19 percent of persons living in or near communities with populations of 5,000 or more are facing this problem. Home ownership is very important to most rural Nebraskans. Eighty-two percent believe it is very important to own their home. An additional 12 percent say it is somewhat important and six percent say it is not at all important. However, persons who do not currently own their home do not feel it is important for them to do so. Only 32 percent of renters say it is very important to own their home, compared to 91 percent of home owners. And, 35 percent of renters say it is not at all important to own their home.

Cartographic notes on the work in the Family Health Strategy: relationships between workers and the population

The objective of this intervention study was to map instituted and instituting movements present in the work of the Family Health Strategy in the development of their care practices. The theoretical framework is based on institutional analysis, using the schizoanalytic approach. Group meetings were carried out with the staff to discuss how they provided collective care in continuing health education. The study subjects were professionals from the team and students who were engaged in academic activity in the service. The average attendance was twelve people per meeting, and there were a total of eight meetings from March to July 2010. Data were grouped into two immanent strata: the relationships of the team and the relationship with clients. The strata point to the intersection of education and legal institutions and the social and technical division of labor. Collective thinking in groups appeared to be effective in denaturalizing established processes and interrogating places, knowledge and practices.