Experiences of antibiotic use among Brazilian healthcare users: An exploratory study.

INTRODUCTION: This article analyzes experiences of antibiotic use and bacterial infections among Primary Health Care users of the Brazilian Unified Health System (SUS) and the possible implications for antimicrobial resistance (AMR). The aim is to map aspects that shape users' lay knowledge regarding antibiotics use and AMR. METHODS: This is an exploratory study, which consists primarily of individual in-depth interviews with 19 respondents. Recurrent interview topics were coded and analysed according to thematic content analysis. RESULTS: Our findings show users' lived experiences constitute three dimensions related to users' previous antibiotic use: (1) lay knowledge about medicines; (2) previous bacterial infections and (3) communication during the consultation. Lay knowledge encompasses the users' understanding of how antibiotics work in comparison to other drugs and experimentations they make with medication. Users' narratives about bacterial infections are divided into situations of urinary tract infections and antibiotic treatments for other conditions. Communication during the consultation is mainly characterized by a lack of shared knowledge and trust in the doctor-patient relationship. DISCUSSION: Users bring together knowledge learned from their own experiences to create the rationale, which shapes how they understand antibiotic use, bacterial infections and medical advice. These experiences are interwoven with information received from healthcare professionals (HPs) on these topics, creating a scenario that goes beyond professional information about antibiotic use. Users have knowledge about medication, antibiotics use and bacterial infection but do not have room to share it with HP, allowing lived experiences to take precedence over professional information. CONCLUSION: Users ascribe symbolic meanings to antibiotics creating a lay knowledge frame, even if this knowledge is not scientifically correct. The personal experiences of bacterial infections and their treatment are also an important source of knowledge about antibiotic use and AMR among users. Users demand from their HPs both trust and willingness to listen to their health narratives and experiences. By considering lay knowledge as part of the assessment of a user's health condition, rather than dismissing it as erroneous and therefore unworthy of attention, HPs may enhance the compliance of users. PATIENT OR PUBLIC CONTRIBUTION: Patients or community members did not participate in the design stage of the study. Primary Care patients were invited to participate as respondents of in-depth interviews, which were carried out by the first author at a Primary Care Unit (PCU) in the suburb of Campo Limpo, Southern region of São Paulo, Brazil. Patients were interviewed after reading and signing a Free and Informed Consent Form, holding with them a copy of the Form. Among the final activities of the project, a feedback session at the same PCU is planned to report on the results of the study. All respondents will have the opportunity to contribute further information regarding their antibiotic use and exchange knowledge and experiences on antimicrobial resistance.

Effects of Maternal Psychopathology and Education Level on Neurocognitive Development in Infants of Adolescent Mothers Living in Poverty in Brazil.

BACKGROUND: Adolescent motherhood remains common in developing countries and is associated with risk factors that adversely impact infant neurodevelopment, including poverty, low maternal education, and increased maternal psychopathology. Yet, no published work has assessed how these factors affect early brain development in developing countries. METHODS: This pilot study examined effects of maternal psychopathology and education on early neurocognitive development in a sample of adolescent mothers (N = 50, final n = 31) and their infants living in poverty in São Paulo, Brazil. Maternal symptoms of anxiety, depression, and attention-deficit/hyperactivity disorder and education level were assessed during pregnancy. Infant neurocognitive development was assessed at 6 months of age, with oscillatory power and functional connectivity in the theta (4-6 Hz), alpha (6-9 Hz), and gamma (30-50 Hz) frequencies derived from resting-state electroencephalography; temperament (negative affect, attention, and regulation); and cognitive, language, and motor skills. Cluster-based permutation testing and graph-theoretical methods were used to identify alterations in oscillatory power and connectivity that were associated with maternal psychopathology and education. Correlations between power and connectivity alterations were examined in relation to infants' overt cognitive behavioral abilities. RESULTS: Increased maternal anxiety and lower maternal education were associated with weaker oscillatory connectivity in alpha-range networks. Infants with the weakest connectivity in the alpha network associated with maternal anxiety also showed the lowest cognitive ability. Greater maternal anxiety and attention-deficit/hyperactivity disorder were associated with increased absolute and relative theta power. CONCLUSIONS: Our findings highlight the importance of addressing maternal psychopathology and improving education in poor adolescent mothers to prevent negative effects on infant neurodevelopment.

Vigilância à Saúde: deve se constituir como política pública? / Health Surveillance: should it be a public policy?

Tendo em vista que a Vigilância à Saúde pode se constituir como um potente modelo para o monitoramento de condições de saúde-doença, o objetivo deste trabalho é refletir sobre a possibilidade de instituir a Vigilância à Saúde como política pública. Para tanto, apresenta-se o conceito de política pública e discorre-se a respeito das potencialidades e limites de os modelos assistenciais se transformarem em mediadores entre as dimensões técnicas e políticas. Os dados que embasam essa discussão derivam de um projeto de pesquisa, desenvolvido entre 2005/2007, sobre a proposta de Vigilância à Saúde no município de São Paulo. Tratou-se de uma pesquisa qualitativa, onde os dados foram coletados através de entrevistas e análise documental. Utilizou-se para análise dos dados a técnica de análise de conteúdo. Nesta perspectiva tomou-se o município de São Paulo como base para se discutir uma proposição de Vigilância da Saúde como processo intersetorial. Conclui-se com esse trabalho que o enfrentamento das condições adversas, provocadas pela desigualdade social, deve ser considerado como objeto da área de saúde, contudo este enfrentamento tem que se partilhado por profissionais de saúde e população, investindo principalmente na intersetorialidade como tecnologia.

Vigilância à saúde: alerta continuado em saúde coletiva / Health Surveillance - Continuous Alert to Collective Health

A proposta de Vigilância à Saúde emergiu do processo de Reforma Sanitária brasileira e do ideário que motivou a implementação do Sistema Único de Saúde, o qual colocou em tela uma nova forma de interpretação do processo saúde-doença, que buscava trascender a multicausalidade, remetendo aos processos de produção e de reprodução social como a primeira instância de sua determinação. O objetivo deste artigo é apresentar algumas reflexões sobre a Vigilância à Saúde, entendida como um modelo de assistência a ser operacionalizado pelos municípios, através de suas Unidades Básicas de Saúde e dos diversos atores sociais. A partir do marco teórico que orienta as práticas de saúde coletiva, apresenta-se uma proposta de aproximação à realidade de vida e de saúde baseada em indicadores sociais e de necessidades de saúde dos indivíduos, famílias e grupos sociais e aquilantando-se as suas vulnerabilidades. Essa sistemática deve envolver ações de caráter intersetorial orientadas para um dado território e dirigidas à promoção, à prevenção e ao tratamento. A intervenção em saúde, nessa ótica, exige uma perspectiva de cuidado como processo contínuo de prontidão em que trabalhadores de saúde acolhem os problemas e necessidades de saúde e buscam a solução com base na intensa participação da comunidade.