RESUMEN
BACKGROUND: Although sickle cell disease is an important public health problem in Brazil, there is a gap in the literature on the level of knowledge of primary health care professionals about the treatment and management of sickle cell disease. Therefore, this study aimed to evaluate the level of knowledge about sickle cell disease of physicians and nurses who work in the Family Health Program in a region of Brazil with a high prevalence of this disease. METHODS: This is a descriptive, cross-sectional study conducted at the municipality of Montes Claros, in the north of Minas Gerais, Brazil. Study participants included 96 physicians and nurses who work at the Family Health Program in an urban area of the city. Data was collected using an original, partially tested questionnaire based on health care check points for children with sickle cell disease established in educational protocols from the State Health Secretary of Minas Gerais and the Ministry of Health. The structured questionnaire contained 47 questions addressing three axes: epidemiology (8 questions); clinical manifestations (13 questions); and management of children with sickle cell disease (26 questions). Knowledge was measured through mean correct responses to proposed questions. Ethical principles were respected and this project was approved by the Committee of Ethics in Research. RESULTS: 59.4% (57) of the study participants were nurses and 40.6% (39) were physicians. The median length of training and median length of service in primary health care were 4.3 (2.8-8.0) years and 4.0 (2.0-7.1) years, respectively. The mean performance in knowledge tests was < 75%, with 5.7/8 (SD = 1.4) for the "epidemiology" questions; 8.6/13 (SD = 2.2) for "clinical manifestations"; and 17.0/26 (SD = 2.9) for "management of children with sickle cell disease" questions; resulting in a mean total of 31.4/47 (SD = 5.10) correct responses. A statistically significant association was found between the number of correct responses and family health care qualifications (p = 0.015). CONCLUSION: There is an urgent need to improve primary health care professional training in the care of children with sickle cell disease.
Asunto(s)
Anemia de Células Falciformes , Medicina Familiar y Comunitaria/normas , Conocimientos, Actitudes y Práctica en Salud , Calidad de la Atención de Salud/normas , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/epidemiología , Anemia de Células Falciformes/fisiopatología , Anemia de Células Falciformes/terapia , Brasil/epidemiología , Niño , Estudios Transversales , Medicina Familiar y Comunitaria/educación , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Evaluación de Necesidades , Médicos de Atención Primaria/educación , Prevalencia , Enfermería de Atención Primaria , Servicios Urbanos de Salud/organización & administración , Recursos HumanosRESUMEN
OBJECTIVE: To evaluate the impact of the Baby-Friendly Hospital Initiative on the breastfeeding practices of mothers from the urban area of Montes Claros, MG, Brazil. METHODS: A comparative analysis was performed of two cross-sectional breastfeeding indicator studies with randomized samples of children under 2 years of age. One study was carried out before and the other after the Baby-Friendly Hospital Initiative had been implemented throughout all public pregnancy and childbirth care services in the city. Kaplan-Meyer survival curves were constructed for different breastfeeding patterns. Log rank testing was used to calculate the level of significance of differences between curves for before and after the Initiative. RESULTS: The survival curves demonstrate that breastfeeding rates increased during the study period. The log rank test detected significance for increases in all patterns of breastfeeding (p < 0.000). Median overall breastfeeding duration increased from 8.9 to 11.6 months and median duration of exclusive breastfeeding rose from 27 days to 3.5 months. CONCLUSIONS: Implementation of the Baby-Friendly Hospital Initiative in all public maternity units in Montes Claros significantly increased breastfeeding rates in the city. Since the ideal state of affairs has not yet been reached, further strategies must be implemented to promote and support breastfeeding practices.
Asunto(s)
Lactancia Materna/estadística & datos numéricos , Promoción de la Salud/organización & administración , Relaciones Paciente-Hospital , Maternidades/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Peso al Nacer , Brasil/epidemiología , Preescolar , Estudios Transversales , Femenino , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Mortalidad Infantil , Edad Materna , Madres/educación , Análisis de Supervivencia , Población UrbanaRESUMEN
RESUMEN Introducción La leishmaniasis visceral (LV) es una enfermedad infecciosa causada por protozoos del género Leishmania; predomina en las regiones tropicales, subtropicales y templadas. Objetivo Caracterizar una serie de casos de LV en pacientes mayores de 18 años atendidos en un hospital de referencia del norte de Minas Gerais, así como describir la ocurrencia de casos, según la caracterización climatológica, y correlacionar la distribución de los casos con la lluvia y la temperatura ambiente. Métodos El diseño del estudio fue una serie de casos recopilados entre 1999 y 2016. Los datos se extrajeron de historias clínicas seleccionadas cronológicamente. La información climática se recopiló en el Centro de estudios del Semiárido de la Universidad Federal de Montes Claros (Unimontes). Resultados Hubo un ligero predominio del sexo masculino (54,4%) y de edades comprendidas entre uno y cuatro años (42,9%). El tiempo de evolución de las manifestaciones clínicas hasta el momento de la hospitalización osciló entre cinco y 120 días, siendo la duración más frecuente entre 16 y 30 días (34,4%). Hepatomegalia, esplenomegalia, palidez cutánea y fiebre fueron manifestaciones presentes en más del 90% de los pacientes al ingreso. El diagnóstico se realizó por métodos serológicos en la mayoría de los casos (85,9%). La mayor parte de los ingresos duró entre 16 y 30 días (44%) y el alta hospitalaria con orientación para el control ambulatorio fue el resultado más frecuente de los ingresos. El porcentaje de muertes fue del 2%. Conclusión Las características predominantes son niños varones de 1 a 4 años, que acudió al servicio de salud con la clásica tríada LV: hepatoesplenomegalia, palidez y fiebre prolongada. En este estudio no hubo asociación estadísticamente significativa entre temperatura, precipitación y número de casos, sin embargo, existen matices en los factores ambientales que influyen en la dinámica de transmisión de LV, los cuales varían de región a otra.
RESUMEN
This study aimed to characterize the profile of morbidity among users of family health teams in the northeastern macroregion of Minas Gerais, Brazil. This is a cross-sectional population-based study, developed with the teams of the Family Health Strategy (FHS). It was conducted by data collection, using semi-structured questionnaires with specific instruments adjusted for three categories of professional teams of the FHS: physicians, nurses and community health agents (CHA). We used the International Classification of Primary Care, second edition (ICPC-2) to encode morbidity. Information was collected from 17,988 people, and 10,855 (60.3%) were females; 1,662 (9.2%) questionnaires were related to care by the physician; 2,530 (14.1%) were related to care by nurses and 13,796 (76.7%) corresponded to visits by and meetings with the CHA. The main health problems were: circulatory diseases (especially hypertension), musculoskeletal problems (especially back pain) and diseases of the digestive tract (especially intestinal parasites), which accounted for more than 40% of the medical consultations. Nonspecific complaints and visits related to women's health were the most prevalent in the care by nurses. In meetings with CHA, complaints about respiratory, musculoskeletal and cardiovascular diseases were the most pointed. The morbidity profile observed does not differ substantially from the results of other studies. Small differences can be attributed to regional particularities.
Asunto(s)
Salud de la Familia , Atención Primaria de Salud , Adolescente , Adulto , Brasil , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Atopic dermatitis (AD) has severe impact on the quality of life (QoL) of children suffering from the disease and their families. The infant's dermatitis quality of life index (IDQoL) and the dermatitis family impact questionnaire (DFI) were designed to study this impact. AIMS: To compare the impact of AD on children and their families in different countries. METHODS: 419 children with AD from six countries representing three continents under the age of 4 years were included into the study. English, Ukrainian, Czech, Portuguese, and Korean versions of the IDQoL and the DFI and Dutch version of the IDQoL questionnaires were used. RESULTS: The highest scored items for the IDQoL and the DFI were rather similar. The IDQoL and the DFI results were well correlated with parental assessment of disease severity and between each other in all countries. Some differences mostly in the IDQoL assessment were found. CONCLUSION: Despite some reported peculiarities, parents in different counties assessed QoL and family QoL of their AD children in a similar way. The IDQoL and the DFI may be reliable initial measures for international studies. International study on the influence of the same treatment methods on the IDQoL and the DFI assessments is important.
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Dermatitis Atópica/psicología , Calidad de Vida/psicología , Índice de Severidad de la Enfermedad , Preescolar , República Checa , Dermatitis Atópica/fisiopatología , Inglaterra , Salud de la Familia , Femenino , Humanos , Lactante , Masculino , Países Bajos , Portugal , República de Corea , Factores Socioeconómicos , Estadística como Asunto , Encuestas y Cuestionarios , UcraniaRESUMEN
OBJECTIVE: To measure the impact of atopic dermatitis (AD) on the quality of life of pediatric patients and their families, establishing correlations with scores of disease severity. METHODS: This was an observational study of the correlations between clinical indicators of severity and two questionnaires on quality of life: IDQOL and DFI. The study also included scoring of eczema severity EASI. Forty-two children with AD, fulfilling established diagnostic criteria, and 44 children with other dermatologic diseases were investigated for the effect of eczema on quality of life. Pearson's correlation was used for the correlation analysis and the comparison between the groups was carried out using the Mann-Whitney test. RESULTS: Data analysis demonstrated significant differences between the scores for the two groups. The mean score in the eczema group was 9.2 (range 1-19) for IDQOL and 8.5 (range 0-17) for DFI. The highest scoring questions for IDQOL referred to itching and scratching, mood changes and problems caused by treatment. For the FDI, the highest impact domains were treatment-related expenditure and sleep disturbance affecting family members. CONCLUSIONS: AD has a negative impact on the quality of life of pediatric patients and their families. Data obtained in studies of quality of life in AD should be used to guide clinical practice in order to identify individual treatment strategies and should lead to the adoption of measures to reduce the impact of the disease on patients and their families.
Asunto(s)
Dermatitis Atópica/psicología , Calidad de Vida , Preescolar , Costo de Enfermedad , Métodos Epidemiológicos , Familia/psicología , Femenino , Humanos , Masculino , Prurito/psicología , Enfermedades de la Piel/psicología , Privación de SueñoRESUMEN
This study aimed to characterize the profile of morbidity among users of family health teams in the northeastern macroregion of Minas Gerais, Brazil. This is a cross-sectional population-based study, developed with the teams of the Family Health Strategy (FHS). It was conducted by data collection, using semi-structured questionnaires with specific instruments adjusted for three categories of professional teams of the FHS: physicians, nurses and community health agents (CHA). We used the International Classification of Primary Care, second edition (ICPC-2) to encode morbidity. Information was collected from 17,988 people, and 10,855 (60.3%) were females; 1,662 (9.2%) questionnaires were related to care by the physician; 2,530 (14.1%) were related to care by nurses and 13,796 (76.7%) corresponded to visits by and meetings with the CHA. The main health problems were: circulatory diseases (especially hypertension), musculoskeletal problems (especially back pain) and diseases of the digestive tract (especially intestinal parasites), which accounted for more than 40% of the medical consultations. Nonspecific complaints and visits related to women's health were the most prevalent in the care by nurses. In meetings with CHA, complaints about respiratory, musculoskeletal and cardiovascular diseases were the most pointed. The morbidity profile observed does not differ substantially from the results of other studies. Small differences can be attributed to regional particularities.
Este estudo objetivou caracterizar o perfil de morbidade referida por usuários das equipes de saúde da família na macrorregião nordeste de Minas Gerais. Trata-se de um estudo transversal de base populacional, desenvolvido junto às equipes da Estratégia Saúde da Família (ESF), com uso de questionários semiestruturados adaptados para três categorias profissionais das equipes de saúde da família: médicos, enfermeiros e agentes comunitários de saúde (ACS). Utilizou-se a Classificação Internacional da Atenção Primária, segunda edição (CIAP 2), para codificação da morbidade referida. Foram coletadas informações de 17.988 pessoas, em 204 equipes da ESF, sendo 10.855 (60,3%) do sexo feminino; 1.662 (9,2%) questionários foram referentes ao atendimento do médico, 2.530 (14,1%) do enfermeiro e 13.796 (76,7%) corresponderam aos encontros com ACS. Os principais problemas de saúde foram: doenças do aparelho circulatório (especialmente hipertensão), queixas musculoesqueléticas (especialmente as lombalgias) e doenças do aparelho digestório (especialmente as parasitoses intestinais), que juntas responderam por mais de 40% das consultas médicas. As queixas inespecíficas e atendimentos relacionados à saúde da mulher foram prevalentes nos atendimentos de enfermeiros. Os ACS registraram mais as queixas referentes a problemas respiratórios, musculoesqueléticos e cardiovasculares. O perfil de morbidade observado não difere substancialmente de outros estudos, com pequenas diferenças que podem ser atribuídas às particularidades regionais.
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Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Salud de la Familia , Atención Primaria de Salud , Brasil , Estudios Transversales , Morbilidad , Encuestas y CuestionariosRESUMEN
OBJETIVO: Avaliar o impacto da dermatite atópica (DA) sobre a qualidade de vida de pacientes pediátricos e de seus familiares, estabelecendo correlações com escores de severidade da doença. MÉTODOS: Estudo observacional com correlação entre indicador clínico de gravidade e dois questionários sobre qualidade de vida: o Índice de Qualidade de Vida da Dermatite Atópica em Crianças (IDQOL) e o Impacto da Dermatite Atópica na Família (DFI). O estudo incluiu também um escore de gravidade do eczema (Índice de Gravidade do Eczema por Área). Foram investigadas 42 crianças com DA e 44 crianças com outras dermatoses em relação ao impacto do eczema na qualidade de vida. Na análise de correlação, utilizou-se o teste de correlação de Pearson, e a comparação entre os dois grupos foi realizada através do teste de Mann-Whitney. RESULTADOS: A análise dos dados demonstrou significativa diferença entre a pontuação dos dois grupos. A média de pontuação no grupo com DA foi de 9,2 (variando de 1 a 19) para o IDQOL e de 8,5 (variando de 0 a 17) para o DFI. Os domínios mais comprometidos no IDQOL foram os relativos ao prurido, alterações de humor e problemas com o tratamento. Quanto ao DFI, os domínios de maior impacto foram os relacionados a despesas com o tratamento e a perturbação do sono de membros da família. CONCLUSÕES: A DA interfere negativamente na qualidade de vida dos pacientes pediátricos e dos seus familiares. Dados obtidos nos estudos de qualidade de vida em DA devem nortear a prática clínica de modo a individualizar as estratégias de tratamento e levar à adoção de medidas que possam minimizar o impacto da doença sobre pacientes e familiares.
OBJECTIVE: To measure the impact of atopic dermatitis (AD) on the quality of life of pediatric patients and their families, establishing correlations with scores of disease severity. METHODS: This was an observational study of the correlations between clinical indicators of severity and two questionnaires on quality of life: IDQOL and DFI. The study also included scoring of eczema severity - EASI. Forty-two children with AD, fulfilling established diagnostic criteria, and 44 children with other dermatologic diseases were investigated for the effect of eczema on quality of life. Pearson's correlation was used for the correlation analysis and the comparison between the groups was carried out using the Mann-Whitney test. RESULTS: Data analysis demonstrated significant differences between the scores for the two groups. The mean score in the eczema group was 9.2 (range 1-19) for IDQOL and 8.5 (range 0-17) for DFI. The highest scoring questions for IDQOL referred to itching and scratching, mood changes and problems caused by treatment. For the FDI, the highest impact domains were treatment-related expenditure and sleep disturbance affecting family members. CONCLUSIONS: AD has a negative impact on the quality of life of pediatric patients and their families. Data obtained in studies of quality of life in AD should be used to guide clinical practice in order to identify individual treatment strategies and should lead to the adoption of measures to reduce the impact of the disease on patients and their families.
Asunto(s)
Preescolar , Femenino , Humanos , Masculino , Dermatitis Atópica/psicología , Calidad de Vida , Costo de Enfermedad , Métodos Epidemiológicos , Familia/psicología , Prurito/psicología , Privación de Sueño , Enfermedades de la Piel/psicologíaRESUMEN
OBJETIVO: Avaliar o impacto da Iniciativa Hospital Amigo da Criança sobre as práticas de aleitamento materno entre mães da área urbana de Montes Claros (MG). MÉTODOS: Realizou-se uma análise comparativa dos indicadores de aleitamento materno entre dois estudos transversais com amostras aleatórias de crianças com até 2 anos de idade, antes e depois da implantação da Iniciativa Hospital Amigo da Criança para todos os serviços públicos de assistência ao parto na cidade. Curvas de sobrevida de Kaplan-Meyer foram construídas para os diversos padrões de amamentação. O teste de log rank foi usado para calcular o nível de significância das diferenças entre as curvas antes e após a Iniciativa. RESULTADOS: As curvas de sobrevida mostraram que houve aumento nas taxas de aleitamento materno no período estudado. O teste de log rank mostrou diferenças estatisticamente significantes para os diversos padrões de amamentação (p < 0,000). A duração mediana do aleitamento materno em geral passou de 8,9 para 11,6 meses. A duração mediana do aleitamento materno exclusivo passou de 27 dias para 3,5 meses. CONCLUSÕES A implantação da Iniciativa Hospital Amigo da Criança em todas as maternidades públicas de Montes Claros aumentou significativamente as taxas de aleitamento materno do município. Como a situação ideal ainda não foi alcançada, novas estratégias devem ser implementadas para promover e apoiar as práticas de aleitamento materno.
OBJECTIVE: To evaluate the impact of the Baby-Friendly Hospital Initiative on the breastfeeding practices of mothers from the urban area of Montes Claros, MG, Brazil. METHODS: A comparative analysis was performed of two cross-sectional breastfeeding indicator studies with randomized samples of children under 2 years of age. One study was carried out before and the other after the Baby-Friendly Hospital Initiative had been implemented throughout all public pregnancy and childbirth care services in the city. Kaplan-Meyer survival curves were constructed for different breastfeeding patterns. Log rank testing was used to calculate the level of significance of differences between curves for before and after the Initiative. RESULTS: The survival curves demonstrate that breastfeeding rates increased during the study period. The log rank test detected significance for increases in all patterns of breastfeeding (p < 0.000). Median overall breastfeeding duration increased from 8.9 to 11.6 months and median duration of exclusive breastfeeding rose from 27 days to 3.5 months. CONCLUSIONS: Implementation of the Baby-Friendly Hospital Initiative in all public maternity units in Montes Claros significantly increased breastfeeding rates in the city. Since the ideal state of affairs has not yet been reached, further strategies must be implemented to promote and support breastfeeding practices.
Asunto(s)
Preescolar , Femenino , Humanos , Lactante , Lactancia Materna/estadística & datos numéricos , Relaciones Paciente-Hospital , Promoción de la Salud/organización & administración , Maternidades/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Peso al Nacer , Brasil/epidemiología , Estudios Transversales , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Mortalidad Infantil , Edad Materna , Madres/educación , Análisis de Supervivencia , Población UrbanaRESUMEN
Objetivo: identificar os fatores de risco para a mortalidade infantil pós-neonatal por diarréia e pneumonia relacionados à qualidade da assistência médica. Métodos: estudo tipo caso-controle, de base populacional, de 277 óbitos infantis pós-neonatais por diarréia e pneumonia ocorridos na Região Metropolitana de Belo Horizonte, entre maio de 1991 a abril de 1992. Os casos foram comparados com controles hospitalares, emparelhados por patologia, idade e hospital. As informações sobre casos e controles foram coletadas através de prontuários médicos e entrevistas domiciliares, sendo analisadas algumas variáveis relacionadas à qualidade da assistência médica. Utilizou-se o teste de McNemar e o método de regressão logística condicional para a definição dos fatores de risco para o óbito. Resultados: a regressão logística multivariada mostrou os seguintes fatores independentemente associados a maior risco de óbito pós-neonatal por diarréia e pneumonia: atraso vacinal (OR= 2,48; IC95por cento=1,17-5,23), estado geral (grave) à admissão hospitalar (OR=10,94; IC95por cento=4,91-24,34), não realização de procedimentos hospitalares (OR=10,O8; IC95por cento= 3,55-20,59) e desnutrição presente no momento da internação (OR=3,58; IC95por cento=1,42-9,07). Conclusões: os resultados indicam a baixa qualidade da assistência médica como um importante fator de risco para o óbito infantil pós-neonatal por causas evitáveis. Os autores salientam a falta de integralidade entre as atividades ambulatoriais e hospitalares como importante determinante da baixa qualidade. Sem desconsiderar o papel preponderante das variáveis socioeconômicas, salienta-se a necessidade de uma ampla discussão sobre o desempenho dos serviços de saúde e mortalidade...
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Humanos , Lactante , Mortalidad Infantil , Asistencia Médica , Mortalidad InfantilRESUMEN
Objetivos: estudar óbitos pós-neonatais ocorridos em domicílio na Região Metropolitana de Belo Horizonte. Métodos: foram identificados óbitos pós-neonatais por diarréia, pneumonia e desnutrição entre maio de 1991 e abril de 1992. Selecionarm-se 511 óbitos após investigação hospitalar, tendo sido estudados 396. Observou-se que 34,3 por cento desses óbitos ocorreram fora do ambiente hospitalar. Após investigação hospitalar e entrevistas domiciliares, os óbitos domiciliares foram comparados com os óbitos ocorridos em hosppitais. Resultados: a comparação entre os dois grupos de óbitos mostrou semelhança em relação às variáveis socioeconômicas, ambientais, relativas à gestação e parto e relativas à saúde da criança. Na análise multivariada apenas o número de serviços procurados durante a doença que levou ao óbito esteve associado ao local de ocorrência do óbito, com chance 2,5 vezes maior de morrer em domicílio para as crianças cujas famílias procuraram menos de três serviços de saúde nos 15 dias antecedentes ao óbito (OR = 2,53). A assistência especificamente recebida pelas crianças, nas últimas duas semanas anteriores ao óbito, mostrou uma associação significativa entre óbito domiciliar e conduta clínica inadequada (OR = 1,78). Conclusões: a ocorrência de óbitos infantis em domicílio está associada a uma baixa efetividade dos serviços de saúde.