Perfil de atendimento e satisfação dos usuários do Serviço de Atendimento Móvel de Urgência (SAMU) / Perfil de atención y satisfacción de los usuarios del Servicio de Atención Móvil de Urgencia (SAMU) / Profile of service and satisfaction of users of the Mobile Emergency Care Service (SAMU)

Resumo OBJETIVO Conhecer o perfil de atendimento e satisfação dos usuários atendidos pelo Serviço de Atendimento Móvel de Urgência (SAMU). MÉTODOS Estudo transversal dos 854 atendimentos realizados pelas equipes de Suporte Avançado de Vida (SAV) do SAMU de Porto Alegre/RS, no primeiro trimestre de 2016. Participaram 164 usuários ou responsáveis que responderam via telefone questões referentes ao atendimento realizado. Análise realizada através dos Testes de Spearman e Qui-quadrado. Estudo aprovado em Comitê de Ética e Pesquisa das Instituições envolvidas. RESULTADOS Observou-se maior percentual de atendimentos clínicos (48,2%) seguidos pelos atendimentos aos traumas (32,8%). Sobre o atendimento pelo telefone, 71,4% dos participantes classificaram o serviço como 'muito bom' enquanto o atendimento presencial foi assim classificado por 76,8% dos respondentes. Desses, 81,1% afirmaram que o atendimento foi resolutivo. CONCLUSÕES O tipo clínico se destaca entre os atendimentos e os usuários revelam satisfação com o serviço prestado, considerando que esse atende a população resolutamente.

Resumen OBJETIVO Conocer el perfil de atención y satisfacción de los pacientes atendidos por el Servicio de Atención Móvil de Urgencia (SAMU). MÉTODOS Estudio transversal de 854 atenciones realizadas por los equipos de Soporte Avanzado de Vida (SAV) del SAMU de Porto Alegre/RS, en el primer trimestre de 2016. Participaron 164 pacientes o responsables que respondieron vía teléfono las preguntas referentes a la atención realizada. Análisis realizado a través de las pruebas de Spearman y Chi-cuadrado. Estudio aprobado por el Comité de Ética e Investigación de las Instituciones involucradas. RESULTADOS Se observó un mayor porcentaje de atenciones clínicas (48,2%) seguido por traumas (32,8%). Sobre la atención telefónica, 71,4% de los participantes clasificaron el servicio como 'muy bueno', mientras que la atención presencial fue clasificada de la misma forma por el 76,8% de los encuestados. De ellos, 81,1% afirmó que la atención fue resolutiva. CONCLUSIONES El tipo clínico se destaca entre las atenciones y los usuarios que revelan satisfacción con el servicio brindado, considerando que este atiende a la población resolutivamente.

Abstract OBJECTIVE To know the profile of service and satisfaction of users served by the Mobile Emergency Care Service (SAMU). METHODS A cross-sectional study of the 854 services performed by the Advanced Life Support (SAV) teams from SAMU of Porto Alegre/RS, in the first quarter of 2016. A total of 164 users or respondents answered by phone to the questions regarding the service performed. Analysis performed using the Spearman and Chi-square tests. Study approved in Ethics and Research Committee of the Institutions involved. RESULTS A higher percentage of clinical visits (48.2%) followed by trauma care (32.8%). Regarding telephone calls, 71.4% of respondents rated the service as 'very good' while the service was classified by 76.8% of the respondents. From them, 81.1% stated that the service was resolving. CONCLUSIONS The clinical type stands out among the assistances and the users reveal satisfaction with the service provided, considering that it serves the population resolutely.

Cost-Effectiveness analysis of family planning services offered by mobile clinics versus static clinics in Assiut, Egypt

Cost effectiveness studies of family planning (FP) services are very valuable in providing evidence-based data for decision makers in Egypt. Cost data came from record reviews for all 15 mobile clinics and a matched set of 15 static clinics and interviews with staff members of the selected clinics at Assiut Governorate. Effectiveness measures included couple years of protection (CYPs) and FP visits. Incremental cost-effectiveness ratios (ICER) and sensitivity analyses were calculated. Mobile clinics cost more per facility, produced more CYPs but had fewer FP visits. Sensitivity analysis was done using: total costs, CYP and FP visits of mobile and static clinics and showed that variations in CYP of mobile and static clinics altered the ICER for CYP from $2 -$6. Mobile clinics with their high emphasis on IUDs offer a reasonable cost effectiveness of $4.46 per additional CYP compared to static clinics. The ability of mobile clinics to reach more vulnerable women and to offer more long acting methods might affect a policy decision between these options. Static clinics should consider whether emphasizing IUDs may make their services more cost-effective

Frequência de ocorrência das afecções dos anexos oculares e do olho externo / Frequency of occurrence of affections of the adnexa and external eye

RESUMO Objetivo: Observar a frequência de ocorrência das afecções que acometem os anexos oculares e o olho externo, assim como descrever o perfil demográfico dos portadores, na região centro oeste do estado de São Paulo. Métodos: Estudo prospectivo, populacional e aleatorizado, no qual foram avaliadas 11.000 pessoas da região centro-oeste do Estado de São Paulo, nos anos de 2004/2005, por meio de consultas oftalmológicas e utilizando uma unidade móvel. Foi realizado exame oftalmológico completo. Os dados foram transferidos para tabela Excel, utilizando-se para o presente estudo dados referentes aos anexos e doenças do olho externo. A frequência de ocorrência dos problemas detectados foi analisada estatisticamente. Resultados: Foram detectadas 1.581 (14,6%) afecções de anexos ou do olho externo, sendo as mais frequentes o pterígio (9,4%), o hordéolo (0,8%) e as alterações do posicionamento palpebral (1,7%) (ectrópio, ptose e triquíase). Trauma, ectrópio e pterígio foram estatisticamente mais frequentes na população masculina. Conclusão: Das afecções pesquisadas, a de maior ocorrência na população foi o pterígio, seguido das alterações inflamatórias e do posicionamento palpebral.

ABSTRACT Purpose: To observe the frequency of occurrence of affections involving the adnexa or the external eye, as well as to describe the demographic profile of patients. Methods: A prospective, population based, randomized study was done in the Midwest region of the state of São Paulo, in the years 2004/2005. Using a Mobile Ophthalmic Unit we evaluated 11,000 people. A comprehensive eye exam was performed. Data were transferred to excel table and for this study we used information relating to annexes and external eye diseases. The frequency of occurrence of the problems detected was statistically analyzed. Results: We identified 1,581(14.4%) disorders in the adnexa or in the external eye. The most common disorders were pterygium (9.4%), hordeolum (0.8%) and changes in eyelid position (1.7%) (ectropion, ptosis and trichiasis). Trauma, ectropion and pterygium were statistically more frequent in the male population. Conclusion: Of the surveyed disorders the most frequent in the population was pterygium, followed by inflammatory changes and alterations in the eyelid position.

Equidade no acesso ao rastreamento mamografico do cancer de mama com intervencao de mamografo movel no sul do Rio Grande do Sul, Brasil / Equity in access to breast cancer screening in a mobile mammography program in southern Rio Grande do Sul State, Brazil / Equidad en el acceso a la deteccion por mamografia del cancer de mama con el uso del mamografo movil en el sur del Rio Grande do Sul, Brasil

O objetivo foi avaliar um programa de prevenção e diagnóstico precoce de câncer de mama, realizado com uma unidade móvel de mamografia que visitou municípios da região sul do Rio Grande do Sul, Brasil, onde não havia um aparelho de mamografia disponível. As características das mulheres avaliadas pelo mamomóvel foram comparadas com as de mulheres encaminhadas para exame mamográfico na cidade de Pelotas. Com a unidade móvel foram examinadas 8.607 mulheres residentes em 33 municípios da zona sul, e foram identificados 37 casos de câncer de mama (4,7 casos por mil exames realizados). Em Pelotas, foram examinadas 1.312 pacientes, e a prevalência de câncer de mama foi de 6,9 casos por mil exames. A prevalência de casos positivos foi estatisticamente semelhante nos dois grupos, mesmo após o ajuste para possíveis fatores de confusão. A intervenção proposta demonstra que a disponibilização de exames é necessária na prevenção e diagnóstico precoce do câncer de mama, determinando a identificação de casos cujos diagnósticos teriam sido retardados se esta unidade não estivesse presente.

This study aimed to evaluate a program for the prevention and early diagnosis of breast cancer in a mobile mammography unit that visited several cities in Rio Grande do Sul, the southernmost State in Brazil, where the test was not available through routine services. The authors compared the characteristics of these patients with a group of women referred for mammography in the city of Pelotas, where such equipment is widely available. The mobile unit examined 8,607 women residing in 33 municipalities. The study identified 37 cases of breast cancer, or 4.7 cases per 1,000 tests. In Pelotas, 1,312 patients underwent mammography, and breast cancer prevalence was 6.9 cases per 1,000 tests. There were no statistical differences between the two prevalence rates, even after adjusting for potential confounders. The proposed intervention demonstrates that the availability of tests is needed for prevention and early diagnosis of breast cancer, determining the identification of cases when diagnosis would have been delayed without the mobile unit.

El objetivo fue evaluar un programa de prevención y diagnóstico precoz del cáncer de mama, realizado con un equipo móvil de mamografía que visitó ciudades de Río Grande do Sul, el estado más austral en Brasil, donde estos exámenes no estaban disponibles. Se compararon las características de esas mujeres con las de mujeres que fueron remitidas a mamografía en la ciudad de Pelotas, donde ese equipo tiene amplia disponibilidad. Con la unidad móvil fueron examinadas 8.607 mujeres en 33 municipios, se identificaron 37 casos de cáncer de mama, que corresponden a 4,7 casos por 1.000 exámenes. En Pelotas, 1.312 pacientes se sometieron a la mamografía, y la prevalencia del cáncer de mama era de 6,9 casos por 1.000 exámenes. No hubo diferencias estadísticamente significativas entre las dos prevalencias, aun después de ajuste para posibles factores de confusión. La intervención demuestra que la disponibilidad de las pruebas es necesaria para la prevención y diagnóstico precoz, así como para determinar la identificación de los casos, cuyo diagnóstico sufriría atrasos, si este servicio no estuviera activo.

Monitoring and evaluation of a model demonstration project for the control of cervical cancer in Nakhon Phanom province, Thailand.

Cancer of the uterine cervix is the second most common cancer in females in the world with about half a million new patients per year. Since the introduction by Papanicolaou of cervical smear screening, the incidence of cervical cancer has declined in many developed countries. The decrease in the incidence of and mortality from cervical cancer is mainly due to the organized mass screening using Pap smear programmes. Uterine cervical cancer is the leading cancer among women in Thailand with age-standardized incidence rates of 24.7 per 100,000 in 1999. Most cases present at advanced stages with poor prognoses of survival and cure. In the present study, cervical cancer screening programme with cervical cytology was organized for Nakhon Phanom province, Thailand. The specific objectives were: 1) to evaluate the reduction in incidence and mortality from cervical cancer in the province by means of an organised low-intensity cervical cytology programme. 2) to demonstrate the different aspects of programme implementation as a potential model for nationwide implementation. The screening activities were integrated in the existing health care system. Organized screening for women in the target population (aged 35-54 years) at 5-year intervals was free of charge. Sample taking was done by trained nurses (midwives) and primary health care personnel in the local health care centers. Sample quality was under continuous controlled by the cytology laboratories and pathologists. Confirmation and treatment were integrated into the normal health care routines. The screening results of the programme, including histologically confirmed diagnosis, were registered at the National Cancer Institute using PapReg and CanReg 4 programmes. A population-based cancer registry in Nakhon Phanom province was also set up in 1997. In the period 1999-2002, 32,632 women aged 35-54 years were screened. Women with low-grade lesions returned for routine follow-up smears. High-grade preinvasive disease was further evaluated by repeating Pap smear, conization or biopsy and subsequent treatment through surgical removal or ablation. This organized low-intensity cervical cytology programme showed a considerable increase in early carcinoma in situ and CIN II -III cases and should reduce incidence of and mortality from cervical cancer in Nakhon Phanom province in the future. Screening with the Papanicolaou smear plus adequate follow-up diagnosis and therapy can achieve major reductions in both incidence and mortality rates.

Morbidity and mortality patterns, health beliefs, and health risk factors of Karen highlanders of northwest Thailand.

Morbidity and mortality patterns, health care practices, and health care beliefs were assessed over three seasons in Pwo and Sgaw Karen preschool children living in the highlands of northwest Thailand. The sample consisted of all preschool children from 77 Pwo and 71 Sgaw households. Although the Pwo and Sgaw Karen residing in the highlands of northwest Thailand live in isolated villages in the same ecozone, utilize similar technologies, have similar access to health facilities, and maintain a certain level of sociocultural homogeneity through their identification as Karen, Pwo preschool children exhibit significantly higher levels of morbidity and mortality than their Sgaw counterparts. It is argued that these differences in morbidity and mortality are primarily the function of historical patterns which resulted in an earlier contact of the Sgaw with modem societies and particularly with an earlier exposure to western health care.

Yavatmal District Blindness Control Society: a case study.

PURPOSE: To retrospectively study the records and reports available at the District Blindness Control Society (DBCS), Yavatmal in terms of target fixation, performance and utilisation of manpower and equipment. METHODS: All the available records, reports, correspondence, and proceedings of meetings from 1981-98 were scrutinized and analyzed. RESULTS: The performance records and reports showed that over the last 10 years the target achievement of DBCS is close to 100%. However, the fixed facility (District hospital/Tertiary hospital where cataract surgeries are being performed under strict aseptic conditions) performance does not match the targets. The district mobile unit camp performance achieved 35-40% of the target in the last quarter of the financial year. CONCLUSION: The target fixation is irrational and needs improvement, and it is necessary for the program managers in the district to undertake analysis of the available data to ensure performance improvement.