The challenge of the reference and counter-reference system in the prenatal assistance to pregnant women with infectious diseases.

The objective of this study was to determine the prevalence of infectious diseases, such as syphilis, acquired immune deficiency syndrome (AIDS) and hepatitis B and C, in pregnant women who undertook their prenatal care in thirteen basic health units (BHU) in São Paulo city. The efficiency of the reference and counter-reference system in such prenatal infectious diseases was evaluated considering the medical recordings of the final result of the pregnancy and the vertical transmission rates of these diseases. It consists of an epidemiologic study whose observations were based on the notes of the prenatal medical and nurse records of pregnant women who had infectious diseases susceptible to vertical transmission and final infectious status registers of their concepts. Women's syphilis prevalence was 0. 86%, HIV and Hepatitis B was 0. 22% and Hepatitis C was 0. 36%. It's possible to conclude that there is no register of the reference and counter-reference system of these infectious diseases analyzed at the thirteen basic health units of the south-east region of São Paulo city evaluated in 2005. This lack of register makes it impossible to know the preventive measures taken and the vertical transmission rates. Making the professionals and the Health Coordination authorities aware of the importance of the dynamic of the prenatal attendance is necessary.

[Sociodemographic profile and self-referred health conditions of the elderly in a city of Southern Brazil]. / Perfil sociodemográfico e condições de saúde auto-referidas de idosos de Porto Alegre.

OBJECTIVE: To assess the association between gender and age groups and socioeconomic and health variables among older adults. METHODS: Cross-sectional study carried out in the a city in Southern Brazil, in 2004. Elderly over 60 years of age (N= 292) were selected through two-stage probabilistic sampling. Data from socioeconomic and demographic variables were collected through household survey. Health conditions were self-referred. Descriptive statistics, and Pearson's Chi-square test with linear-by-linear association model were used for data analysis. RESULTS: Among the elderly, 67.8% were female, 84% were between 60 to 79 years and 81% considered themselves healthy. Compared to men, women were more likely to live alone (p=0.046), have no partner (p<0.001), be less educated (p=0.021), report more health conditions (p=0,003), use more medications (p=0.016), exercise less (p=0.015), be more dependent to perform activities of daily living (p<0.001), receive lower pension benefits (p<0,001), have less paid jobs (p=0.002). But women perceived themselves as having more social support (p=0.023), consumed less alcohol (p=0.003) and were not smokers (p<0.001). Those with more advanced age were less educated (p<0.001), had poorer economic conditions (p=0.004), received lower pension benefits (p<0,001), were less likely have a partner (p<0.001) and were more dependent to perform activities of daily living (p<0.001) but perceived themselves with more social support (p=0.014) and were not smokers (p<0.001). CONCLUSIONS: Differences between gender and age group were evidenced and they were more marked among women and those with more advanced age.

[Lower extremity amputations in diabetic patients: a case-control study]. / Amputações de extremidades inferiores por diabetes mellitus: estudo caso-controle.

OBJECTIVE: Lower extremity amputation is an increasing problem among diabetic patients and an important public health problem. The study purpose was to identify factors associated with lower extremity amputation. METHODS: A matched case-control study was carried out among diabetic patients. Cases were selected in public health programs of the city of São Paulo, Brazil. One hundred and seventeen cases of diabetics with lower extremity amputation were compared to 234 controls of diabetics without amputation, matched by sex, age, and duration of disease. Sociodemographic variables, life habits (smoking and alcohol drinking), clinical aspects, and health education in diabetes were included. Univariate analyses and conditional logistic regression method were applied to data. RESULTS: Data showed evidence of association for: smoking, last glucose test > or = 200 mg/dl, presence of peripheral somatic neuropathy and vibratory perception (tuning fork 128 Hz), and peripheral vascular disease. Diabetes treatment and attending nursing appointments for diabetes education were important factors for preventing lower extremity amputation in diabetic patients. CONCLUSIONS: The knowledge of determinants and intervening factors for this condition will lead to cost reduction and better quality of care delivered in public health services.

The challenge of the reference and counter-reference system in the prenatal assistance to pregnant women with infectious diseases

The objective of this study was to determine the prevalence of infectious diseases, such as syphilis, acquired immune deficiency syndrome (AIDS) and hepatitis B and C, in pregnant women who undertook their prenatal care in thirteen basic health units (BHU) in São Paulo city. The efficiency of the reference and counter-reference system in such prenatal infectious diseases was evaluated considering the medical recordings of the final result of the pregnancy and the vertical transmission rates of these diseases. It consists of an epidemiologic study whose observations were based on the notes of the prenatal medical and nurse records of pregnant women who had infectious diseases susceptible to vertical transmission and final infectious status registers of their concepts. Women's syphilis prevalence was 0. 86 percent, HIV and Hepatitis B was 0. 22 percent and Hepatitis C was 0. 36 percent. It's possible to conclude that there is no register of the reference and counter-reference system of these infectious diseases analyzed at the thirteen basic health units of the south-east region of São Paulo city evaluated in 2005. This lack of register makes it impossible to know the preventive measures taken and the vertical transmission rates. Making the professionals and the Health Coordination authorities aware of the importance of the dynamic of the prenatal attendance is necessary.

O objetivo deste estudo foi determinar a prevalência dos agravos, tais como sífilis, síndrome da imunodeficiência adquirida (SIDA) e hepatite por vírus B e C, em gestantes que realizaram pré-natal em treze unidades básicas de saúde (UBS) no município de São Paulo e avaliar a eficácia do sistema de referência e contra referência para esses agravos, considerando o registro nas UBS do resultado final da gestação e as taxas de transmissão vertical desses agravos. Constitui-se de um estudo epidemiológico, cujo objeto de observação foi anotações em prontuário de atendimento pré-natal das gestantes com infecções passíveis de transmissão vertical e seus conceptos. A prevalência de sífilis foi 0, 86 por cento; de HIV e Hepatite B, 0, 28 por cento;e de Hepatite C, 0, 36 por cento. Conclui-se que não há registro do sistema de referência e contra referência para os agravos estudados nas 13 unidades básicas de saúde da região sudeste do Município de São Paulo que foram avaliadas em 2005. Este fato impossibilita o conhecimento das medidas profiláticas efetuadas e das taxas de transmissão vertical. A sensibilização do profissional e das Coordenadorias de Saúde sobre a importância da dinâmica do atendimento pré-natal é necessária.

Perfil sociodemográfico e condições de saúde auto-referidas de idosos de Porto Alegre / Sociodemographic profile and self-referred health conditions of the elderly in a city of Southern Brazil

OBJETIVO: Avaliar a associação entre sexo e grupo etário com variáveis socioeconômicas e de saúde dos idosos. MÉTODOS: Estudo transversal realizado no Distrito Noroeste de Porto Alegre, Rio Grande do Sul, em 2004. Foram estudados indivíduos acima de 60 anos (N=292), selecionados por amostra probabilística em dois estágios. Os dados de variáveis socioeconômicas e demográficas foram coletados por inquérito domiciliar. As condições de saúde foram auto-referidas. Foram realizadas análises descritivas, de qui-quadrado de Pearson e tendência linear. RESULTADOS: Entre os idosos, 67,8 por cento eram do sexo feminino, 84 por cento encontravam-se na faixa dos 60 aos 79 anos, 81 por cento consideravam-se saudáveis. Em comparação com os homens, as mulheres moravam mais sozinhas (p=0,046), sem companheiro (p<0,001), tinham menor escolaridade (p=0,021); relatavam mais problemas de saúde (p=0,003) e uso de medicação sistemática (p=0,016); realizavam menos atividades físicas (p=0,015) e eram mais dependentes nas atividades de vida diária (p<0,001), recebiam menos aposentadoria (p<0,001), exerciam menos atividades remuneradas (p=0,002), mas se percebiam mais apoiadas pela rede social informal (p=0,023), consumiam menos bebidas alcoólicas (p=0,003) e não eram fumantes (p<0,001). Os mais idosos tinham menor escolaridade (p<0,001), piores condições econômicas (p=0,004), recebiam menos aposentadoria (p<0,001), não tinham companheiro (p<0,001), eram mais dependentes nas atividades de vida diária (p<0,001), mas se percebiam mais apoiados pela rede social informal (p=0,014) e não eram fumantes (p<0,001). CONCLUSÕES: Foram evidenciadas diferenças quanto a gênero e grupo etário para variáveis socioeconômicas e de saúde, sendo piores para as mulheres e para os idosos mais velhos.

OBJECTIVE: To assess the association between gender and age groups and socioeconomic and health variables among older adults. METHODS: Cross-sectional study carried out in the a city in Southern Brazil, in 2004. Elderly over 60 years of age (N= 292) were selected through two-stage probabilistic sampling. Data from socioeconomic and demographic variables were collected through household survey. Health conditions were self-referred. Descriptive statistics, and Pearson's Chi-square test with linear-by-linear association model were used for data analysis. RESULTS: Among the elderly, 67.8 percent were female, 84 percent were between 60 to 79 years and 81 percent considered themselves healthy. Compared to men, women were more likely to live alone (p=0.046), have no partner (p<0.001), be less educated (p=0.021), report more health conditions (p=0,003), use more medications (p=0.016), exercise less (p=0.015), be more dependent to perform activities of daily living (p<0.001), receive lower pension benefits (p<0,001), have less paid jobs (p=0.002). But women perceived themselves as having more social support (p=0.023), consumed less alcohol (p=0.003) and were not smokers (p<0.001). Those with more advanced age were less educated (p<0.001), had poorer economic conditions (p=0.004), received lower pension benefits (p<0,001), were less likely have a partner (p<0.001) and were more dependent to perform activities of daily living (p<0.001) but perceived themselves with more social support (p=0.014) and were not smokers (p<0.001). CONCLUSIONS: Differences between gender and age group were evidenced and they were more marked among women and those with more advanced age.

Amputações de extremidades inferiores por diabetes mellitus: estudo caso-controle / Lower extremity amputations in diabetic patients: a case-control study

OBJETIVO: As amputações de extremidades inferiores são cada vez mais freqüentes em pessoas com diabetes mellitus, tornando-se importante problema de saúde pública, no Brasil e no mundo. O estudo objetivou detectar fatores associados a amputações de extremidades inferiores, em pessoas com diabetes mellitus. MÉTODOS: Realizou-se estudo caso controle emparelhado. Foram identificados 117 pessoas com diabetes mellitus e submetidas a amputações de extremidades inferiores, na rede de serviços do Município de São Paulo. Os casos foram comparados com 234 controles, pessoas com diabetes mellitus, mas não submetidas a amputações. As variáveis consideradas no emparelhamento foram sexo, idade e duração da doença. Características sociodemográficas, de hábitos de vida, clínicas e relativas à educação em saúde em diabetes mellitus foram incluídas. Inicialmente, foi realizada análise univariada, verificando a presença de associações entre amputações e variáveis exploratórias. Foi utilizado modelo de regressão logística condicional para a análise multivariada, com adoção do odds ratio como medida de associação. RESULTADOS: Observou-se existência de associação entre amputação e hábito de fumar, última glicemia (superior a 200 mg/dl), presença da polineuropatia simétrica distal e da vasculopatia periférica. O tratamento do diabetes mellitus e o comparecimento às consultas de enfermagem foram importantes fatores associados à prevenção dessas amputações. CONCLUSÕES: O reconhecimento dos determinantes e dos fatores intervenientes para o acometimento desse agravo levarão à redução dos custos na área e à melhoria da qualidade da assistência prestada na rede de serviços de saúde pública.

Incidência de acidentes de trabalho relacionada com a näo utilizaçäo das precauçöes universais / Incidence of the occupational accidents

Entrevistados todos (57) os funcionários do serviço de enfermagem de um hospital geral governamental de Säo Paulo, que sofreram acidentes de trabalho relacionados a materiais pérfuro-cortantes, ou que tiveram contato com sangue ou fluidos corpóreos contaminados no período de janeiro a setembro de 1992. Desses, 15,8 por cento (9) eram enfermeiras, 49,1 por cento (28) auxiliares de enfermagem, 33,3 por cento (19) atendentes de atendentes de enfermagem e 1,8 por cento (1) escriturária, que apresentavam idade inferior a 40 anos. 66,1 por cento possuíam 2§ grau completo ou superior e entre 4 a 7 anos de experiência na funçäo. Em relaçäo ao turno de trabalho, 49,1 por cento dos acidentes ocorreram pela manhä e 38,7 por cento durante a noite, principalmente no Pronto Socorro (36,8 por cento). Materiais pérfuro-cortantes eram respossáveis por 71,9 por cento dos acidentes, sendo 75,0 por cento entre os auxiliares de enfermagem. Os funcionários acidentados atribuíram a causa do acidente: à fatalidade, ao descuido ou imprudência da equipe médica e ao reencape de agulhas. Quanto às consequências, 57,0 por cento dos acidentados por respingo de secreçäo nos olhos desenvolveram conjuntivite e uma das funcionárias, Hepatite B. Este estudo mostrou que 78,1 por cento dos acidentes poderiam ter sido evitados, 57,0 por cento apenas com o uso das Precauçöes Universais.