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Int J Equity Health ; 18(1): 155, 2019 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615516


BACKGROUND: Various factors influence health service utilization at the community level. Research on the barriers to uptake of local health services is essential to reduce maternal and child mortality and morbidity. The Amazon region of Peru has some of the poorest health indicators in the country. The current study set out to better understand the health-seeking behavior and perspectives of mothers in Amazonian communities, exploring individual- and contextual-level barriers for seeking care at local health facilities for common maternal and child health issues. METHODS: The study employed a mixed-methods design by conducting 50 structured interviews with mothers of children under the age of 4. The study took place in 5 communities in Loreto, Peru. The quantitative data was analyzed with descriptive statistics to identify participants' socio-demographic characteristics and reported utilization of health services. The qualitative data was analyzed in three rounds: inductive codebook development, application of the codebook, and thematic synthesis to contextualize the quantitative results and better understand the perspectives of the mothers regarding maternal and child health issues and the local health services. RESULTS: Overall, reported health service utilization among study participants was relatively high. However, the mothers identified several individual- and contextual-level factors that may affect their experiences and the health-seeking behaviors of other mothers in their communities: (i) embarrassment, fear, and trust, (ii) insufficient number and poor attitudes of health personnel, (iii) limited supply of basic medicines and materials in the health facility, and (iv) low demand for family planning services and limited awareness of adolescent-specific services. CONCLUSION: Several findings in the current study reflect the reduced conditions of health services, while others display that many mothers maintain a positive outlook on the health services available to them and are proactive in the care of their child. The study provides valuable insight into the use of local health services and the common perspectives that are hindering further uptake at the community level in the Amazon of Peru, with important implications for health policy.

Servicios de Salud del Niño/organización & administración , Conductas Relacionadas con la Salud , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud Materna/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Niño , Servicios de Planificación Familiar/organización & administración , Femenino , Política de Salud , Humanos , Masculino , Perú , Características de la Residencia , Factores Socioeconómicos
Nutr. hosp ; 36(4): 758-763, jul.-ago. 2019. tab, graf
Artículo en Inglés | IBECS | ID: ibc-184697


Background and aims: home enteral nutrition (HEN) is an established treatment for clinically stable patients. The objective of this study was to determine the frequency and the situation of patients in HEN, in the capital city in the south of Brazil. Methods: in this retrospective study, we recorded all new cases of HEN in adults in Curitiba, Brazil, from January 2006 to December 2015. Data were collected by a dietitian from medical records of patients attending public health settings. The following data were analyzed: clinical diagnosis, diet prescribed during hospitalization and at discharge, and feeding access types. Kaplan-Meier and Cox regression analyses were used to calculate survival. Results: a total of 1,231 patients were included. There was a 425% increase in the frequency of HEN over the years studied. The mean age was 66.7 years, and 54.4% were men. Neurological diseases were the most prevalent (46.4%), followed by cancer (33.6%). Eight hundred and one patients (65.1%) died during this period. Mean HEN duration was 180 days (95% CI 163.6-193.4), with a significant difference between neurological diseases (median: 180 days) and cancer (median: 210 days) (p < 0.05). Neurological disease was an independent risk factor for mortality in patients on HEN (HR: 1.17; CI: 1.08-1.27). Conclusions: the study shows an increase in HEN. Neurological diseases prevailed and presented a risk of mortality, and more than half of the patients with NED died in this period

Introducción y objetivos: la nutrición enteral domiciliaria (NED) es un tratamiento establecido para pacientes clínicamente estables. El objetivo de este estudio fue determinar la frecuencia y la situación de los pacientes con NED en la capital del sur de Brasil. Métodos: en este estudio retrospectivo se registraron todos los nuevos casos de NED en adultos en Curitiba, Brasil, de enero de 2006 a diciembre de 2015. Los datos fueron recolectados por un nutricionista de historiales clínicos de pacientes que frecuentan establecimientos de salud pública. Se analizaron los siguientes datos: diagnóstico clínico, dieta prescrita durante la estancia hospitalaria y en el momento del alta y acceso alimenticio. Se utilizaron los análisis de Kaplan-Meier y regresión de Cox para calcular la supervivencia. Resultados: fueron incluidos 1.231 pacientes. Hubo un aumento del 425% en la frecuencia de NED a lo largo de los años estudiados. La edad media fue de 66,7 años y el 54,4% eran hombres. Las enfermedades neurológicas fueron las más prevalentes (46,4%), seguidas de las neoplasias (33,6%). Durante este periodo murieron 801 pacientes (65,1%). La duración media de la NED fue de 180 días (IC 95%, 163,6-193,4), con una diferencia significativa entre enfermedades neurológicas (mediana: 180 días) y cáncer (mediana: 210 días) (p < 0,05). La enfermedad neurológica fue un factor de riesgo independiente para la mortalidad en pacientes en NED (HR: 1,17; IC: 1,08-1,27). Conclusiones: el estudio muestra un aumento en la NED. Las enfermedades neurológicas prevalecieron y presentaron riesgo de mortalidad y más de la mitad de los pacientes murieron durante la NED

Humanos , Masculino , Femenino , Persona de Mediana Edad , Política Pública , Nutrición Parenteral en el Domicilio/métodos , Nutrición Parenteral en el Domicilio/normas , Registros de Dieta , Factores de Riesgo , Enfermedades del Sistema Nervioso/epidemiología , Estudios Retrospectivos , Dieta/estadística & datos numéricos , Dietoterapia/estadística & datos numéricos , Estimación de Kaplan-Meier , Brasil/epidemiología
Int J Equity Health ; 18(1): 80, 2019 05 31.
Artículo en Inglés | MEDLINE | ID: mdl-31151452


BACKGROUND: Implementation research is increasingly used to identify common implementation problems and key barriers and facilitators influencing efficient access to health interventions. OBJECTIVE: To develop and propose an equity-based framework for Implementation Research (EquIR) of health programs, policies and systems. METHODS: A systematic search of models and conceptual frameworks involving equity in the implementation of health programs, policies and systems was conducted in Medline (PubMed), Embase, LILACS, Scopus and grey literature. Key characteristics of models and conceptual frameworks were summarized. We identified key aspects of equity in the context of seven Latin American countries-focused health programs We gathered information related to the awareness of inequalities in health policy, systems and programs, the potential negative impact of increasing inequalities in disadvantaged populations, and the strategies used to reduce them. RESULTS: A conceptual framework of EquIR was developed. It includes elements of equity-focused implementation research, but it also links the population health status before and after the implementation, including relevant aspects of health equity before, during and after the implementation. Additionally, health sectors were included, linked with social determinants of health through the "health in all policies" proposal affecting universal health and the potential impact of the public health and public policies. CONCLUSION: EquIR is a conceptual framework that is proposed for use by decision makers and researchers during the implementation of programs, policies or health interventions, with a focus on equity, which aims to reduce or prevent the increase of existing inequalities during implementation.

Equidad en Salud , Política de Salud , Promoción de la Salud , Servicios de Salud , Disparidades en Atención de Salud , Investigación , Formación de Concepto , Prestación de Atención de Salud , Humanos , América Latina , Pobreza , Determinantes Sociales de la Salud , Factores Socioeconómicos , Cobertura Universal del Seguro de Salud , Poblaciones Vulnerables
Biomedica ; 39(1): 132-146, 2019 03 31.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31021553


Introduction: Thinking about how neonatal screening should be done requires explaining the relevance of the bioethical factors involved. Objective: To understand the relationship between bioethical considerations and the way neonatal screening is done and to identify its relevance in the Colombian legislation. Materials and methods: A comparative study of public policies in the United States and the United Kingdom was done, as they exemplify extreme cases of neonatal screening. The influence of bioethical principles was interpreted based on similarities and differences. With this information, locally affected bioethical considerations were identified in the Colombian legislation on neonatal screening. Results: In the United Kingdom, paternal autonomy prevails allowing parents to deny obligatory beneficence. In the USA, beneficence prevails and a significant number of anomalies must be screened for. This increases the likelihood of false positives and causes a high opportunity cost. Both countries have similarities which are also partially accepted in Colombia, such as the demand for equity of access. Others, such as specialized professional advice or the right to refuse screening, are not considered in the Colombian legislation on neonatal screening. Additionally, there are circumstances in Colombia such as different perspectives on what respecting justice means and how to apply that in choosing which abnormalities are screened for and lack of harmony between norms that prevents efficacious detection. Conclusion: Bioethical considerations explain the differences between countries and sometimes prevail in the development of public policies on neonatal screening. Their inclusion in high-level norms in Colombia for effective screening is proposed.

Discusiones Bioéticas , Tamizaje Neonatal/ética , Política Pública , Colombia , Humanos , Recién Nacido , Reino Unido , Estados Unidos
Cien Saude Colet ; 24(2): 659-668, 2019 Feb.
Artículo en Portugués | MEDLINE | ID: mdl-30726398


The scope of this article is to analyze the evolution of the profile of psychiatric admissions via the Unified Health System in psychiatric hospitals of the State of Minas Gerais, Brazil, between 2001 and 2013. Data were obtained from the Information Technology Department of the Unified Health System. The analyses of trends were conducted by regression procedures, in which the independent variable was the year, and the dependent variables were the patients (sex, age, diagnosis) and admission characteristics (city, hospital administrative status, length of internment). A total of 202,188 admissions to 25 hospitals were appraised. There were significant changes in the diagnostic profiles of psychiatric admissions during the period under scrutiny, notably an increase in the proportion of admissions for substance abuse-related disorders and a reduction for psychotic disorders. This study is in tune with the context of the reform of mental healthcare in Minas Gerais, providing relevant input to support the mental health policies towards universalization, humanization and the overcoming of inequalities in access to health services.

Hospitalización/tendencias , Hospitales Psiquiátricos/estadística & datos numéricos , Trastornos Mentales/epidemiología , Programas Nacionales de Salud , Adulto , Brasil/epidemiología , Femenino , Política de Salud , Accesibilidad a los Servicios de Salud , Humanos , Tiempo de Internación , Masculino , Trastornos Mentales/terapia , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia
Glob Public Health ; 14(6-7): 923-938, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30081746


The concepts Vivir Bien and Buen Vivir, often translated as 'living well' or 'collective well-being,' are central to contemporary social medicine reforms in Latin America. Owing to increasing social inequalities, notably in the public healthcare sector, Vivir Bien has regional significance as it redefines the neoliberal development goals from economic improvement to so-called post-neoliberal social goals of harmonious co-existence between society and the physical environment. To examine how this abstract concept is conceptualised, is incorporated into, and shapes state-sponsored public health strategies, I analyze the 'Vivir Limpio, Vivir Sano, Vivir Bonito, Vivir Bien … !' ('Live Clean, Live Healthy, Live Beautiful, Live Well … !') national campaign in Nicaragua that began in 2013. The campaign promotes normative socio-political ideals around environmental health citizenship, including the adoption of indigenous grammars and solidarity. However, analyses of dozens of interviews and 143 household surveys in four historically impoverished, untidy, and unhygienic communities suggest that the campaign's discourses do not resonate with citizens or their socio-economic contexts. In highlighting discrepancies between state-sponsored normative sociopolitical ideals and citizens' lived realities and perspectives, this paper introduces the term 'post-neoliberal citizenship' to reflect contemporary - and changing - conceptualizations of health, wellbeing, and citizenship in post-neoliberal Latin America.

Salud Ambiental , Reforma de la Atención de Salud , Promoción de la Salud/organización & administración , Política , Medicina Social , Objetivos , Humanos , Nicaragua , Evaluación de Programas y Proyectos de Salud
Glob Public Health ; 14(6-7): 863-874, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-29592787


Community participation as a strategy in health aims to increase the role of citizens in health decision-making which are contextualised within the institutions of democracy. Electoral representation as the dominant model of democracy globally is based on the elite theory of democracy that sees political decision-making a prerogative of political elites. Such political elitism is counter to the idea of democratic participation. Neoliberalism together with elitism in political sphere have worsened social inequities by undermining working class interests. Latin America has seen adverse consequences of these social inequities. In response, social movements representing collective struggles of organised citizens arose in the region. This paper explores the theoretical underpinnings of democratic participation in contemporary Latin American context at the nexus of emerging social movement activism and policy responses. The paper will use empirical examples to highlight how such democratic practices at the societal level evolved while demanding political inclusion. These societal democratic practices in Latin America are redefining democracy, which continues to be seen in the political sphere only. Health reforms promoting participatory democracy in several Latin American countries have demonstrated that establishing institutions and mechanisms of democratic participation facilitate collective participation by the organised citizenry in state affairs.

Participación de la Comunidad , Reforma de la Atención de Salud , Política de Salud , Política , Toma de Decisiones , Democracia , Humanos , América Latina , Cambio Social
Rio de Janeiro; s.n; 2019. 232 f p. fig, tab, graf.
Tesis en Portugués | LILACS | ID: biblio-998336


Esta tese tem como objeto analisar a Política Nacional de Saúde Bucal (PNSB) e a sua conexão com a Rede de Cuidados à Pessoa com Deficiência (RCPD) no estado do Amazonas. Para compreender a configuração da Política e a transversalidade com a Rede nessa localidade, os processos de pesquisa foram delineados para o cerne dessa questão e o enfoque dos referenciais teóricos e levantamento de dados obtidos a partir desse direcionamento. Os encaminhamentos metodológicos partiram de duas frentes de busca - configuração da Política e atenção à saúde bucal às pessoas com deficiência (PcD) no Amazonas, nos três níveis de atenção. Desta forma os dados foram coletados através dos bancos de dados oficias do governo federal - Sistemas de Informações Ambulatoriais (SIA/SUS), Sistema de Informações Hospitalares (SIH/SUS) e Cadastro Nacional de Estabelecimentos de Saúde (CNES), todos do Departamento de Informática do Sistema Único de Saúde (DATASUS), através das ferramentas TABNET e TABWIN. Os resultados das pesquisas verificaram que este estado possui os mesmos problemas de ordem nacional que os demais estados brasileiros, somados ao desfavorecimento regional e aos problemas locais, a falta de infraestrutura associada ao isolamento geográfico e político, a grande dispersão populacional e a dificuldade de locomoção são características peculiares desse estado. Além de existirem grandes desigualdades socioeconômicas entre os municípios amazonenses, expressas pela desigualdade de renda no Amazonas (maior que no Brasil) e pelos indicadores sociais insatisfatórios (40,3% dos municípios têm Índice de Desenvolvimento Humano (IDH) baixo e o estado possui o progresso social baixo ­ Índice de Progresso Social IPS/54,92). Essas adversidades não podem ser tratadas de maneira singular e, por consequência, esse estado demanda atenção diferenciada com necessidade de investimentos em diversos setores, incluindo a saúde. A configuração da PNSB está fortemente concentrada na cidade de Manaus, principalmente no que diz respeito a atenção terciária, pois os dois hospitais aderidos à RCPD estão localizados nessa cidade. A atenção à saúde bucal, na atenção básica (AB), no Amazonas, apresenta baixa cobertura populacional tanto no estado (36,1%) quanto na capital (14,0%), refletindo em baixo acesso à saúde bucal individualizada. E a lógica do SIA/SUS não permite separar a população individualmente, o que prejudica o planejamento, programação, regulação, avaliação, controle e auditoria dos serviços ambulatoriais de saúde bucal para as PcD na AB. Na média complexidade, constatamos que dos 62 municípios amazonenses apenas nove (14,5%) possuem oferta da atenção à saúde bucal especializada, sendo 13 Centros de Especialidades Odontológicas (CEO) no estado, o que significa que 35% da população do Amazonas (1.427.527 habitantes), encontra-se desassistida da atenção à saúde bucal nesse nível de atenção. Sendo assim apresentamos algumas sugestões com o intuito de aprimorar a PNSB e a atenção à saúde bucal das PcD

This thesis aims to analyze the National Oral Health Policy (PNSB) and its connection to the Care Network for the Disabled Person (RCPD) in the state of Amazonas. In order to understand the configuration of the Policy and the transversality with the Network in that locality, the research processes were delineated to the core of this issue and the focus of the theoretical references and data collection obtained from this targeting. The methodological guidelines started from two fronts of search - configuration of the Policy and Oral Health Care for People with Disabilities (PwD) in Amazonas, in the three levels of attention. In this way the data were collected through the official databases of the federal government - Outpatient Information Systems (SIA/SUS), Hospital Information System (SIH/SUS) and National Registry of Health Establishments (CNES), all from the Department of Informatics of the Unified Health System (DATASUS), through the tools TABNET and TABWIN. The results of the surveys verified that this state has the same problems of national order as other Brazilian states, together with regional disadvantage and local problems: the lack of infrastructure associated with the geographical and political isolation, a large population dispersion and the difficulty of locomotion are peculiar characteristics of this state. In addition to the large socioeconomic inequalities between Amazonas municipalities, expressed by income inequality in Amazonas (higher than in Brazil) and by unsatisfactory social indicators (40.3% of municipalities have a low Human Development Index (HDI), and the state has low social progress - Social Progress Index IPS/54,92). These adversities cannot be treated in a singular way and, as consequence, this state demands differentiated attention with the need of investments in several sectors, including health. The configuration of the PNSB is strongly concentrated in the city of Manaus, especially regarding tertiary care, as the two hospitals adhered to RCPD are located in that city. The oral health care in primary care (AB) in Amazonas has low population coverage in both the state (36.1%) and the capital (14.0%), reflecting low access to individualized oral health. And the SIA/SUS logic doesn't allow the separation of the individual population, which impairs the planning, programming, regulation, evaluation, control and audit of outpatient oral health services for the PwD in AB. In terms of complexity, we found that only nine (14.5%) of the 62 municipalities of Amazonas have specialized oral health care, 13 of which are Dental Specialty Centers (CEO) in the state, which means that 35% of the Amazonas population (1.427.527) is disassociated from oral health care at this level of care. Thus, we present some suggestions with the aim of improving the PNSB and the oral health care of PcD

Humanos , Atención Primaria de Salud , Sistema Único de Salud , Brasil , Salud Bucal , Personas con Discapacidad , Atención Dental para Personas con Discapacidades/organización & administración , Servicios de Salud Dental/organización & administración , Política de Salud
São Paulo; s.n; 2019. 234 p.
Tesis en Portugués | LILACS | ID: biblio-998493


Os povos indígenas vivem há mais de 500 anos na luta pela superação do colonialismo interno. Com a homogeneização das formas de vida, estes povos são sistematicamente produzidos como não existentes nas políticas integracionistas. A Constituição Federal de 1988 rompe com esta prática garantindo o direito do reconhecimento de suas identidades e modos de vida, expressos pela sua cultura, e o direito à saúde. O direito dos povos originários à saúde pautou três Conferências de Saúde Indígena que estabeleceram as diretrizes para a criação do Subsistema de Atenção à Saúde Indígena em 1999. Desde o início de sua estruturação nos 34 Distritos Sanitários Especiais Indígenas (DSEI), foram organizados os Conselhos Distritais de Saúde Indígena (CONDISI) e o Fórum de Presidentes de CONDISI no nível central. Este estudo tem como objetivo analisar a participação e o protagonismo dos povos indígenas no processo de construção e implementação da Política Nacional de Saúde Indígena, após a Constituição Federal de 1988, a partir das Epistemologias do Sul. Foi utilizada a metodologia qualitativa com diversas fontes e materiais: análise documental das atas de reuniões, legislações, relatórios das cinco Conferências Nacionais de Saúde Indígena e 24 entrevistas em profundidade com indígenas, gestores, indigenistas e representante do MPF. A análise das legislações reconhecidas como pertinentes ao tema indicam uma grande quantidade e diversidade de normas que tratam de forma segregada as temáticas indígenas e as normas do Sistema Único de Saúde. Demonstram, para além da fragmentação legal e normativa, algumas iniciativas que avançam na integralidade da assistência, bastante pontuais, como a criação de incentivos financeiros específicos. Destaca-se a complexidade e a fragilidade da articulação interfederativa, que se torna mais complexa com a gestão federal e a territorialização dos DSEI, que não coincidem com os territórios de estados e municípios. No que tange à participação, pode-se afirmar que a maioria dos entrevistados reconhecem o CONDISI como espaço legítimo de diálogo entre indígenas e governo para debater a política de saúde e sua execução nas aldeias indígenas. Contudo, é evidente o predomínio das pautas de interesse da gestão e a repercussão nas reuniões de CONDISI de temas já discutidos no Fórum de Presidentes. Nas pautas do CONDISI Litoral Sul, que foram objeto deste estudo, por exemplo, a discussão da divisão territorial do DSEI, de interesse dos indígenas, não ganhou espaço e reconhecimento pela gestão. Chama a atenção à ausência de discussão nos espaços formais de temas que predominam nas entrevistas com os indígenas, como a valorização da medicina tradicional e a atenção diferenciada. Esta última é a justificativa central para existência do Subsistema e pauta-se nas desigualdades em saúde, na necessidade de modos de produção de cuidado que articulem as medicinas indígenas e a biomedicina e na diversidade cultural dos mais de 300 povos. O predomínio da biomedicina como forma científica e legítima do saber sobre a saúde acaba por interditar as pautas referentes às medicinas indígenas. Esta lógica perpetua a relação colonial do governo com os povos originários, principalmente sobre o saber, comprometendo a efetivação da atenção diferenciada, e, por consequência, do direito à saúde. Esta política, para ser efetiva, deveria se organizar na perspectiva da Ecologia de Saberes, considerando os modos de existência destes povos, principalmente sua relação com a terra, e sua construção como sujeitos coletivos

Indigenous Peoples have been living for more than 500 years in the struggle to overcome internal colonialism. With the homogenization of the way of life, these peoples are systematically considered as non-existent in integrationist policies. The Federal Constitution of 1988 breaks with this logic assuring them the right to their identities and their ways of life, expressed by their culture, and also their right to health. The Indigenous Peoples' right to health established three Indigenous Health Conferences that set the guidelines for the creation of the Indigenous Health Care Subsystem, in 1999. Since its beginning, along with the establishiment of the 34 Special Indigenous Sanitary Districts (DSEI), participatory Councils were organized (CONDISI), and also the CONDISI Presidents' Forum at the central level. Based on Epistemologies of the South, this study aims to analyze the participation and the protagonism of Indigenous Peoples in the construction and implementation processes of the National Indigenous Health Policy, after the Federal Constitution of 1988. The qualitative methodology used with several sources and materials: documenta analysis of minutes of meetings, legislations, reports of the five National Indigenous Health Conferences and 24 in-depth interviews with Indigenous Peoples, managers, indigenists and Federal Prosecution Service. Relevant legislation analyzed showed great quantity and diversity of norms that separate the indigenous themes and the norms of the Unified Health System. They demonstrate, in addition to legal and normative fragmentation, some initiatives towards care integrality quite specific ones, such as the creation of financial incentives. We highlight the complexity and fragility of the interfederative articulation, which becomes more complex with federal management and territorialisation of the DSEI, which do not match with the limits of states and municipalities territories. Regarding participation, it can be said that most interviewees recognize the CONDISI as a legitimate space for dialogue between Indigenous Peoples and the government to discuss the health policy and its implementation in indigenous communities. However, there is a clear predominance of agendas in the interest of the management representatives and the repercussions on the CONDISI meetings of topics already discussed in the Presidents' Forum. For example, on the agenda of the CONDISI Litoral Sul, object of this study, the discussion of the territorial division of the DSEI, on the interest of the indigenous representatives, did not gain space and recognition by the management representatives. What also draws attention is the absence of discussions of topics that were predominant on the interviews with Indigenous Peoples on formal spaces, such as traditional medicine and differentiated care. This last one is central to the existence of the Subsystem and it is based on inequalities in health, the need for care production methods that articulate traditional indigenous medicine and biomedicine, and the cultural diversity of more than 300 tribes. The predominance of biomedicine as a scientific and legitimate way of health knowledge inhibits the agenda related to traditional indigenous medicine. This logic perpetuates the colonial relationship of the government upon the Indigenous Peoples, especially regarding knowledge, compromising the effectiveness of differentiated care and, consequently, the right to health. This policy, in order to be effective, should be organized in the perspective of the Ecology of Knowledges, considering the ways of existence of these peoples, especially their relationship with the land, and their construction as collective subjects

Participación de la Comunidad , Equidad en Salud , Conferencias de Salud , Consejos de Salud , Salud de Poblaciones Indígenas , Integralidad en Salud , Sistema Único de Salud , Investigación Cualitativa , Atención a la Salud
Physis (Rio J.) ; 29(2): e290214, 2019. tab
Artículo en Portugués | LILACS | ID: biblio-1040758


Resumo Objetivos: Descrever o perfil dos usuários e cuidadores atendidos pelo Serviço de Atenção Domiciliar; verificar associações e correlações entre as variáveis. Método: Estudo do tipo documental, quantitativo, realizado entre maio e novembro de 2017. A análise dos dados foi feita por meio de estatística básica, teste qui-quadrado e coeficiente de correlação de Pearson. Resultados: Dos 46 usuários, a maioria era idosa, do sexo feminino (71,74%), com renda de até dois salários mínimos (65,22%), dependentes para o autocuidado (89,13%). A variável "grau de dependência" teve associação estatisticamente significante com o sexo (p=0,025), o motivo de inclusão (p=0,003), especialidade médica (p=0,013), classificação no SAD (p<0,001) e a presença de cuidador familiar (p=0,017). Demandavam 7,46 equipamentos de saúde, sendo que 70% eram arcados pela família; e 6,78 procedimentos de enfermagem, dos quais 52% eram realizados pelo cuidador. Houve diferença estatisticamente significante entre os custos e gastos assumidos pelas famílias (p<0,001), o número de equipamentos de saúde (p<0,001) e o número de procedimentos de enfermagem demandados (p<0,001). Sobre os cuidadores, a maioria era do sexo feminino (85,71%), com idade média de 62,3 anos, 50% eram filhos(as) e 23,81% esposos(as). Conclusão: Funções, responsabilidades, custos e gastos são transferidos às famílias, onerando o cuidado domiciliar.

Abstract Objectives: To describe the profile of the users and caregivers attended by the Home Care Service; to verify associations and correlations among variables. Method: Documentary, quantitative study conducted between May and November 2017. Data analysis was performed using basic statistics, chi-square test and Pearson's correlation coefficient. Results: Of the 46 users, most were elderly, female (71.74%), with income of up to two minimum wages (65.22%), dependent for self-care (89.13%). The variable "degree of dependence" had a statistically significant association with sex (p = 0.025), inclusion motive (p = 0.003), medical specialty (p = 0.013), SAD classification (p <0.001) and presence of caregiver (p = 0.017). They demanded 7.46 health equipment, 70% of which were housed by the family; and 6.78 nursing procedures, of which 52% were performed by the caregiver. There was a statistically significant difference between the costs and expenses assumed by the families (p <0.001), the number of health facilities (p <0.001) and the number of nursing procedures required (p <0.001). Among caregivers, most of them were female (85.71%), with a mean age of 62.3 years, 50% were children and 23.81% were spouses. Conclusion: Functions, responsibilities, costs and expenses are transferred to families, burdening home care.

Humanos , Sistema Único de Salud , Costos de la Atención en Salud , Cuidadores , Necesidades y Demandas de Servicios de Salud , Atención Domiciliaria de Salud , Brasil , Política de Salud
Planej. polít. públicas ; (52): 489-528, 2019.
Artículo en Portugués | Coleciona SUS, ECOS | ID: biblio-1101997


Este artigo visa investigar as condições para a implementação do processo de modernização de uma economia através da inovação dos serviços públicos tendo como instrumento relevante o governo eletrônico, comparando empiricamente a situação de avanço de países de níveis diferenciados de desenvolvimento. Por meio de uma abordagem teórica, são examinadas primeiramente as possibilidades e a dinâmica de operacionalização da mudança nestes serviços, por parte da governança das economias. Em sequência são investigados os agentes indutores e facilitadores desta forma de inovação, que determinam os resultados advindos das mudanças nestes serviços. O texto enfoca em seguida as características e impactos da inovação através do governo eletrônico e investiga os indicadores-chaves e ampliados existentes para a avaliação deste paradigma de governança eletrônica. A partir desta base teórica, são avaliados índices elaborados pela Organização das Nações Unidas (ONU) e pelo (BM), que mensuram o avanço desta forma de inovação e possibilitam a comparação entre o Brasil e países mundiais de níveis diferenciados de desenvolvimento econômico, destacando também a comparação entre países da América Latina. A seção final investiga as condições de implementação do governo eletrônico no Brasil.

The article aims to investigate the conditions for the implementation of the modernization process of an economy through the innovation of public services, having as a relevant tool the electronic government, comparing empirically the progress of countries with differentiated levels of development. First, the possibilities and the dynamics of change in these services by the governance of economies are examined through a theoretical approach. In sequence, the inducing agents and facilitators of this form of innovation, which determine the results of the changes in these services, are investigated. The text then focuses the characteristics and impacts of innovation through e-government and investigates the existing key and expanded indicators for the evaluation of the e-governance paradigm. Based this theoretical basis, the indexes prepared by the UN and the World Bank, which measure the progress of this form of innovation are used, to allow the comparison among Brazil and selected countries of different economic development levels, as well as among Latin American countries. The final section investigates the conditions of implementation of e-government in Brazil.

Innovación , Política Pública , Servicios de Salud
Cien Saude Colet ; 23(12): 4339-4349, 2018 Dec.
Artículo en Portugués | MEDLINE | ID: mdl-30540017


The scope of this paper was to evaluate the satisfaction regarding dental care services and to identify the association between dissatisfaction and contextual/individual variables. It involved a cross-sectional study of a representative sample of 8,943 adults from 177 municipalities, in which 14.9% of adults were dissatisfied. In the multiple analysis there was a greater chance of dissatisfaction with dental services among adults residing in cities with greater social inequality (OR: 1.53, 95% CI: 1.31-1.81) and with a lower proportion of dentists per inhabitant (OR: 1.17; 95% CI: 1.00-1.37); yellow/black/brown/indigenous (OR: 1.12; 95% CI: 0.99-1.27); lower schooling (OR: 1.14; 95% CI: 0.98-1.33); consultation due to oral problems (OR: 1.23; 95% CI: 1.04-1.44); (OR: 2.60; 95% CI: 2.53-3.02) and impact of oral disorders on daily performance (OR: 1.48; 95% CI: 1.30-1.69). The implementation or adequacy of public policies with the aim of improving satisfaction with dental services should prioritize those municipalities with greater social inequality and with fewer dentists and socially disadvantaged users, who self-perceive oral problems, are dissatisfied with their oral health and suffer impacts resulting from oral problems.

Atención Odontológica/psicología , Salud Bucal , Satisfacción del Paciente/estadística & datos numéricos , Política Pública , Adulto , Brasil , Estudios Transversales , Atención Odontológica/organización & administración , Odontólogos/provisión & distribución , Escolaridad , Femenino , Humanos , Masculino , Análisis Multinivel , Autoimagen , Factores Socioeconómicos , Poblaciones Vulnerables/estadística & datos numéricos
Rev. polis psique ; 8(3): 88-110, set.-dez. 2018.
Artículo en Portugués | LILACS, Index Psicología - Revistas técnico-científicas | ID: biblio-1058812


O objetivo deste artigo é apresentar os resultados da análise documental realizada a partir dos documentos que legislam e orientam a Política de Assistência Social. A análise pautou-se no rastreio de como as expressões 'vulnerabilidade', 'risco' e 'autonomia' emergem e são operados na política em questão. A análise aponta que, inicialmente, as expressões vulnerabilidade e risco aparecem frequentemente juntas e sem discernimento. Ao longo dos anos vulnerabilidade para a ser conceituada; já a situação de risco se mantém caracterizada apenas a partir de exemplos. Autonomia também não é conceituada e ganha maior importância em 2013, onde é enfatizado que está atrelada a garantia dos direitos básicos. Finalizamos com problematizações quanto à homogeneização da população pobre, bem como com a possibilidade da universalidade nas políticas públicas sustentar as desigualdades sociais que deveria combater. (AU)

The purpose of this article is to present the results of the documentary analysis done from the documents that legislate and guide the Social Assistance Policy. The analysis was based on the screening of how the expressions 'vulnerability', 'risk' and 'autonomy' emerge and are operated in this policy. The analysis points out that, initially, the expressions vulnerability and risk often appear together and without discernment. Over the years, vulnerability becomes conceptualized while the risk situation remains characterized only by examples. Autonomy is also not conceptualized, but gains more importance in 2013, where it is emphasized that it is linked to the guarantee of basic rights. We conclude with problematizations regarding the homogenization of the poor population, as well as with the possibility of universality in public policies to sustain the social inequalities that it should combat. (AU)

El objetivo de este artículo es presentar los resultados del análisis documental realizado a partir de los documentos que legislan y orientan la Política de Asistencia Social. El análisis se baseó en el rastreo de cómo las expresiones 'vulnerabilidad', 'riesgo' y 'autonomía' emergen y son operadas en la política en cuestión. El análisis apunta que, inicialmente, las expresiones vulnerabilidad y riesgo aparecen frecuentemente juntas y que sean discernidas. A lo largo de los años la vulnerabilidad pasa a ser conceptuada; ya la situación de riesgo se mantiene caracterizada sólo a partir de ejemplos. La autonomía tampoco es conceptuada, pero gana mayor importancia en 2013, donde se enfatiza que está vinculada a la garantía de los derechos básicos. Finalizamos con problematizaciones sobre la homogeneización de la población pobre, así como la posibilidad de que la universalidad en las políticas públicas sostenga las desigualdades sociales que debería combatir. (AU)

Política Pública , Servicio Social , Riesgo , Vulnerabilidad Social , Autonomía Personal , Brasil
J Ethnobiol Ethnomed ; 14(1): 69, 2018 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-30458832


BACKGROUND: The problem of childhood undernutrition in low-income countries persists despite long-standing efforts by local governmental and international development agencies. In order to address this problem, the Peruvian Ministry of Health has focused on improving access to primary healthcare and providing maternal and child health monitoring and education. Current maternal-child health policies in Peru introduce recommendations that are in some respect distinct from those of Indigenous highland communities. This paper analyses the similarities and differences between public health and mothers' infant feeding recommendations. Furthermore, it analyses persistence and change in those recommendations among women who were mothers before and after the introduction of current public health policies. METHODS: Semi-structured interviews were conducted with 18 older mothers, 15 currently breastfeeding mothers, and 15 public health staff in highland rural communities of Peru. During data analysis, thematic codes and text passages were used in an iterative analytic process to document emerging themes. RESULTS: The results highlight the existence of a traditional corpus of beliefs surrounding infant feeding and care that is consistent with Andean ethnomedical beliefs. This is illustrated by mother's accounts referring to the importance of maintaining a dietary balance of fluids and semi-fluids and of maintaining harmony with the elements in the natural environment. Mothers also incorporate aspects of public health recommendations that they find useful including initiating breastfeeding immediately after birth and exclusive breastfeeding up until 6 months. There are also tensions between the two systems including differences in the conceptualization of breastfeeding and infant food, the imposition of public health care services by coercive means, and negative stereotyping of rural Andean diets and mothers. CONCLUSIONS: Identifying similarities and differences between distinct systems may provide useful input for effective intercultural health policies. Sources of tension should be carefully assessed with the aim of improving public health policies. Such efforts should apply a process of cultural humility engaging health care professionals in exchange and conversations with patients and communities acknowledging the assumptions and beliefs that are embedded in their own understanding. This process should also recognize and value the knowledge and practices of Andean mothers and their role as primary caretakers.

Actitud Frente a la Salud/etnología , Lactancia Materna/estadística & datos numéricos , Política de Salud , Servicios de Salud del Indígena , Salud Pública , Adulto , Países en Desarrollo , Femenino , Educación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Entrevistas como Asunto , Masculino , Medicina Tradicional , Perú , Formulación de Políticas , Población Rural
Rev Panam Salud Publica ; 42, sep. 2018. Special Issue Alma-Ata.
Artículo en Inglés, Español, Portugués | PAHO-IRIS | ID: phr-49507


[RESUMEN]. Objetivo. En la Región de las Américas se han realizado pocas evaluaciones de redes integradas de servicios de salud (RISS). Honduras ha avanzado en la implementación de herramientas y estrategias basadas en los atributos esenciales de las RISS. Este estudio tiene como objetivo valorar y comparar el desarrollo de RISS en su planteamiento teórico-documental y en su aplicación práctica, por tipo de gestión, en cinco redes de Honduras. Métodos. El estudio se realizó en dos etapas: 1) valoración teórico-documental, mediante la revisión y síntesis de seis documentos oficiales de RISS publicados entre 2012 y 2017, y 2) valoración práctica con los equipos de coordinación de cinco redes, dos descentralizadas y tres mixtas, usando la Herramienta de Valoración de RISS de la Organización Panamericana de la Salud. Resultados. La valoración teórica global alcanzó 55 puntos de desarrollo comparada con la valoración práctica de las cinco redes, que alcanzó 42,8. Según el análisis por ámbitos, el Modelo asistencial obtuvo mejores resultados en ambas valoraciones, mayor en la valoración teórica (62,5). Gobernanza y estrategia fue el ámbito que recibió la valoración más baja (41,7). Entre la valoración teórica y la práctica las diferencias en el análisis de ámbitos y de atributos fueron estadísticamente significativas (p = 0,007 y p < 0,001, respectivamente). Las redes con gestión descentralizada alcanzaron mejores valoraciones que las mixtas (p = 0,017). Conclusiones. Existe una brecha entre la valoración teórica y la práctica que sugiere que la aplicación de las herramientas y las estrategias definidas en los documentos son incompletas. El componente provisional sigue siendo el que genera mayor interés e importancia. En las redes mixtas se observó mayor dificultad de integración, probablemente debido a la doble gobernanza. Es necesario seguir evaluando las RISS.

[ABSTRACT]. Objective. There have been few evaluations of integrated health service delivery networks (IHSDN) in the Region of the Americas. Honduras has made progress in the implementation of tools and strategies based on the essential attributes of IHSDNs. The objective of this study is to assess and compare the development of IHSDNs in theoretical and practical terms, by type of management, in five networks in Honduras. Methods. The study was conducted in two stages: 1) a theoretical assessment based on a review and summary of six official documents on IHSDNs published between 2012 and 2017, and 2) a practical assessment in conjunction with the coordination teams of five networks, two of them with decentralized management and three of them with mixed management, using the IHSDN Assessment Tool of the Pan American Health Organization. Results. The overall theoretical assessment yielded a development score of (55 points), compared with the 42.8 of the practical assessment of the five networks. In the analysis by area, the model of care had better results in both assessments, with higher scores in the theoretical assessment (62.5). The area with the lowest score (41.7) was governance and strategy. The differences between the theoretical and practical assessment in the area and attribute analyses were statistically significant (p = 0.007 and p < 0.001, respectively). The networks with decentralized management had higher scores than those with mixed management (p = 0.017). Conclusions. There is a gap between the theoretical and practical assessment that suggests that application of the tools and strategies defined in the documents is incomplete. The provisional component remains the one that elicits the most interest and is considered the most important. Greater difficulties with integration were observed in the networks with mixed management, probably because of their dual governance. Continued evaluation of IHSDNs is necessary.

[RESUMO]. Objetivo. As redes integradas de serviços de saúde (RISS) têm sido pouco avaliadas na Região das Américas. Honduras fez avanços com a implementação de ferramentas e estratégias baseadas nos componentes básicos das RISS. O objetivo do presente estudo foi avaliar e comparar o desenvolvimento das RISS segundo o planejamento teórico-documental e a aplicação prática, por tipo de gestão, em cinco redes de Honduras. Métodos. O estudo foi realizado em duas etapas. Na primeira etapa foi feita uma avaliação teórico-documental, com a revisão e o resumo de seis documentos oficiais das RISS publicados entre 2012 e 2017. E, na segunda etapa, foi feita uma avaliação prática com as equipes de coordenação de cinco redes (duas descentralizadas e três mistas) com o uso da ferramenta de avaliação das RISS da Organização Pan-Americana da Saúde (OPAS). Resultados. A avaliação teórica atingiu 55 pontos de desenvolvimento geral comparados a 42,8 na avaliação prática das cinco redes. A análise por âmbitos demonstrou que o modelo assistencial obteve melhores resultados em ambas as avaliações, com uma pontuação maior na avaliação teórica (62,5). Governança e estratégia foi o âmbito que teve a menor pontuação (41,7). Entre as avaliações teórica e prática, as diferenças na análise dos âmbitos e atributos foram estatisticamente significativas (p = 0,007 e p < 0,001, respectivamente). As redes com gestão descentralizada comparada à mista obtiveram uma pontuação maior nas avaliações (p = 0,017). Conclusões. Existe uma defasagem entre a avaliação teórica e a prática que aponta para a aplicação incompleta das ferramentas e estratégias definidas nos documentos. O componente de prestação de serviços continua sendo o de maior interesse e importância. Observou-se uma maior dificuldade de integração nas redes mistas, possivelmente devido à dupla governança. É preciso continuar avaliando as RISS.

Servicios de Salud , Política , Honduras , Servicios de Salud , Reforma de la Atención de Salud , Política , Reforma de la Atención de Salud , Servicios de Salud , Reforma de la Atención de Salud , Política
Rev Gaucha Enferm ; 39: e20170115, 2018 Aug 02.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-30088600


OBJECTIVE: To analyze the perception of relatives of patients with mental disorders about the support group in a psychiatric hospitalization ward. METHOD: This is a research with a qualitative, exploratory an descriptive approach, performed at a General Hospital in Rio Grande do Sul with ten relatives of patients who had been participating in a weekly support group. Data collection took place in October 2016, through semi-structured interviews. A thematic content analysis was used for the treatment of data, whence emerged the category: Perception of family members about the support group. RESULTS: The relatives perceive the group as a space that gives them strength and support, allowing for listening and experience exchange among its members, giving information on the disease and treatment, safety, and inserting the family in the treatment. FINAL CONSIDERATIONS: The support group can be understood as a strategic action of caring for the family, affecting their lives and the treatment of those who are hospitalized.

Desinstitucionalización , Familia/psicología , Enfermos Mentales , Servicio de Psiquiatría en Hospital , Grupos de Autoayuda , Percepción Social , Adulto , Niños Adultos/psicología , Brasil , Cuidadores/psicología , Desinstitucionalización/legislación & jurisprudencia , Femenino , Política de Salud , Necesidades y Demandas de Servicios de Salud , Hospitales Generales , Humanos , Entrevistas como Asunto , Masculino , Trastornos Mentales/psicología , Trastornos Mentales/rehabilitación , Trastornos Mentales/terapia , Persona de Mediana Edad , Madres/psicología , Investigación Cualitativa , Hermanos/psicología , Esposos/psicología
Health Policy ; 122(9): 941-944, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30077459


Wales, in 2013, was the first country in the United Kingdom to pass legislation introducing presumed (or deemed) consent for organ donation, and remains the only one. It was introduced in an attempt to increase the number of life-saving transplants taking place in the UK, in a move that policy makers hoped would mirror Spain's success. More recently, pressure has been mounting for England to follow suit, with a public consultation currently in progress. However, the Welsh system has been far from a success, raising the question of why campaigners are so adamant that it should be replicated. Before the Welsh Government introduced the Human Transplantation (Wales) Act there had been no strong evidence to suggest it would make a difference, with countries boasting both high organ donation rates and presumed consent legislation demonstrating no clear causal relationship between the two facts. In addition, a recent report evaluating the Act has highlighted its failure to improve donation rates, and has even presented some potentially concerning statistics that may suggest a negative impact. This paper first considers presumed consent in other countries - Spain and Brazil - before illustrating the underwhelming progression of Wales' new system and the need to look to other options.

Consentimiento Presumido/legislación & jurisprudencia , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Brasil , Política de Salud , Humanos , España , Obtención de Tejidos y Órganos/estadística & datos numéricos , Gales
Rev. polis psique ; 8(2): 140-161, maio-ago. 2018.
Artículo en Portugués | LILACS, Index Psicología - Revistas técnico-científicas | ID: biblio-1058800


O presente texto pretende refletir sobre o dispositivo do Centro de Convivência como uma ferramenta de empoderamento, de auxílio na construção de maior autonomia e promoção da cidadania da pessoa em sofrimento mental. Procura-se pensar a contribuição desse serviço para a efetivação da dimensão sociocultural da Reforma Psiquiátrica brasileira, auxiliando na inserção social do louco, a partir do fomento de atividades laborativas e artísticas e da articulação com diversos setores da sociedade. Assim, por meio da revisão de literatura de legislações sobre o tema, artigos científicos e textos de Conferências e Fóruns da Saúde Mental, busca-se analisar os desafios postos a esse serviço da Rede de Atenção Psicossocial frente a discursos e práticas homogeneizantes em nossa sociedade. Desse modo, verifica-se que, mesmo após grandes avanços da luta antimanicomial para a sensibilização da sociedade sobre a loucura, ainda persiste um imaginário social intolerante à diferença, ao louco. (AU)

The present article intends to reflect how the health mechanism of the Center of Coexistence can be a tool of empowerment, of help in the construction of greater autonomy and promotion of citizenship of the people in mental suffering. It is sought to think about the contribution of this service to the effectiveness at the socio-cultural dimension of the Brazilian Psychiatric Reform, contributing to the social insertion of the people in mental suffering, through the promotion of work and artistic activities and the articulation with various sectors of society. Thus, through the literature review of scientific articles and texts of Mental Health Conferences and Forums we seek to analyze the challenges imposed to this service of Primary Health Care, which works as an open and community space, face to speeches and practices homogenizers in our society. In this way, it is verified that even after great advances of the antimanicomial fight for the awareness of the society on the madness, still persists a social imaginary which is intolerant to the difference, to the madman. (AU)

El presente trabajo se propone reflexionar sobre el dispositivo del Centro de Convivencia como una herramienta de empoderamiento, de ayuda en la construcción de mayor autonomía y promoción de la ciudadanía de la persona en sufrimiento mental. Así, se busca pensar la contribución de ese servicio para la efectividad de la dimensión sociocultural de la Reforma Psiquiátrica brasileña, ayudando en la inserción social del loco, a partir del fomento de actividades laborativas y artísticas y de la articulación con diversos sectores de la sociedad. Por lo tanto, por medio de la revisión de literatura de legislaciones sobre el tema, artículos científicos y textos de Conferencias y Foros de la Salud Mental, se busca analizar los desafíos puestos a ese servicio de la Red de Atención Psicosocial frente a discursos y prácticas homogeneizantes en nuestra sociedad. De ese modo, se verifica que, incluso después de grandes avances de la lucha antimanicomial para la sensibilización de la sociedad sobre la locura, todavía persiste un imaginario social intolerante a la diferencia, al loco. (AU)

Centros Comunitarios de Salud Mental , Participación de la Comunidad , Autonomía Personal , Enfermos Mentales/psicología , Servicios de Salud Mental , Estrés Psicológico/rehabilitación , Brasil , Reforma de la Atención de Salud
Gerontologist ; 58(4): 611-617, 2018 07 13.
Artículo en Inglés | MEDLINE | ID: mdl-30010820


The population in Brazil is aging at a fast pace and in a context of historical socioeconomic and regional disparities. In the last decades, the country has developed important policies and legal mechanisms to guarantee older adults' right to age well and with dignity. The implementation of these policies and laws, however, has been slow and hampered by lack of coordination and resources. With an estimate of 64 million seniors living in the country by 2050, Brazil has important public policy issues to address, such as the poor implementation of the National Policy of the Elderly, the urgency of Social Security Reform, and the need for a comprehensive long-term care policy for older adults.

Envejecimiento , Geriatría , Servicios de Salud para Ancianos , Disparidades en el Estado de Salud , Dinámica Poblacional/estadística & datos numéricos , Anciano , Brasil/epidemiología , Demografía , Geriatría/métodos , Geriatría/organización & administración , Política de Salud , Servicios de Salud para Ancianos/organización & administración , Servicios de Salud para Ancianos/estadística & datos numéricos , Humanos , Evaluación de Necesidades , Formulación de Políticas , Investigación , Factores Socioeconómicos