Assessing the vulnerability of women to sexually transmitted diseases STDS/ HIV: construction and validation of markers.

Objective To construct and validate markers of vulnerability of women to STDs/HIV, taking into consideration the importance of STDs/HIV. Method Methodological study carried out in three stages: 1) systematic review and identification of elements of vulnerability in the scientific production; 2) selection of elements of vulnerability, and development of markers; 3) establishment of the expert group and validation of the markers (content validity). Results Five markers were validated: no openness in the relationship to discuss aspects related to prevention of STDs/HIV; no perception of vulnerability to STDs/HIV; disregard of vulnerability to STDs/ HIV; not recognizing herself as the subject of sexual and reproductive rights; actions of health professionals that limit women's access to prevention of STDs/HIV. Each marker contains three to eleven components. Conclusion The construction of such markers constituted an instrument, presented in another publication, which can contribute to support the identification of vulnerabilities of women in relation to STDs/HIV in the context of primary health care services. The markers constitute an important tool for the operationalization of the concept of vulnerability in primary health care and to promote inter/multidisciplinary and inter/multi-sectoral work processes.

[Health needs according to the perception of people with pulmonary tuberculosis]. / Necessidades em saúde segundo percepções de pessoas com tuberculose pulmonar.

The objective of this study was to identify the perceptions of people with tuberculosis regarding their health needs. This qualitative study was performed in the administrative district of Capão Redondo, São Paulo. Data collection was performed in January of 2010 via semi-directed interviews. The interviews were conducted with eleven people undergoing tuberculosis treatment. The participants were at least eighteen years of age and presented no cognition limitations. The empirical material was decoded through discourse analysis. The health needs perceptions are related to the difficulties that emerge in the health-disease process, and acknowledging health needs appeared to be tied to the current illness. The identified needs result from biological alterations, changes to their daily lives, and the limited availability of healthcare services. The quality of assistance offered to people with tuberculosis is a condition of factors related to identifying and meeting their health needs.

[International Classification of Public Health Nursing Practices - CIPESC®: a pedagogical tool for epidemiological studies]. / Classificação Internacional das Práticas de Enfermagem em Saúde Coletiva - CIPESC®: instrumento pedagógico de investigação epidemiológica.

The CIPESC® is a tool that informs the work of nurses in Public Health and assists in prioritizing their care in practice, management and research. It is also a powerful pedagogical instrument for the qualification of nurses within the Brazilian healthcare system. In the teaching of infectious diseases, using the CIPESC® assists in analyzing the interventions by encouraging clinical and epidemiological thinking regarding the health-illness process. With the purpose in mind of developing resources for teaching undergraduate nursing students and encouraging reflection regarding the process of nursing work, this article presents an experimental application of CIPESC®, using meningococcal meningitis as an example.

The health needs and vulnerabilities of tuberculosis patients according to the accessibility, attachment and adherence dimensions. / As necessidades de saúde e vulnerabilidades de pessoas com tuberculose segundo as dimensões acesso, vínculo e adesão.

The objective was to know the experience of people with tuberculosis, identify their health needs and vulnerability in face of the disease, and in terms of their accessibility to treatment, their attachment to the health team, and adherence to the treatment. This qualitative study was performed at family health care units. Interviews were performed with patients following treatment, using the criterion of information saturation. The statements were analyzed using Alceste software. The late diagnosis reflects the lack of knowledge about the disease and come professionals' lack of preparation. The support consists a determinant aspect in patient follow up, who, by feeling welcomed, were encouraged to follow the therapeutic scheme. The health needs were related to the good life conditions, such as the right to food, work, housing, education, leisure, and taking on healthy life habits. The authors emphasize on the valorization of the experience of people following treatment to support the health care practice of professionals centered on the health needs and vulnerabilities of the population.

[Systematic review: general notions]. / Revisão sistemática: noções gerais.

Systematic review is a useful methodology in health, as it makes it possible to identify the best evidence and sumamrize them so as to found proposals for changes in the areas of prevention, diagnosis, treatment and rehabilitation. The purpose of this article is to provide support for planning systematic reviews by answering the following questions: What is evidence-based practice? What is systematic review? Should systematic reviews be anchored on qualitative or quantitative research? What are the pertinent information sources to identify the evidence? What is evidence? What are the procedures to validate a systematic review? How can the quality of evidence be evaluated? What methodology is used to summarize the evidence? How should a systematic review be planned?

The potential of the concept of vulnerability in understanding transmissible diseases. / Potencialidade do conceito de vulnerabilidade para a compreensão das doenças transmissíveis.

This article presents the evolution and the contribution of the scientific production related to the concept of vulnerability and its potential to help studying transmissible diseases. It presents the concept of vulnerability and the production of knowledge in nursing, developed particularly by the CNPq Research Group Vulnerability, Adherence, and Health Needs. The purpose is to improve the understanding of health issues, based on this concept, and permit the proposition of coping interventions that surpass the individual domain, thus contemplating the organization of health care work and the social determination of the health-disease process.

The potential of an instrument to identify social vulnerabilities and health needs: collective health knowledge and practices.

OBJECTIVES: To analyze an instrument that aims to understand the health-disease process, its potential to identify social vulnerabilities and health needs to enable the most appropriate interventions in a given territory. PROCEDURES: analysis of the data collection instrument--composed of closed and open questions to identify different profiles of social reproduction (ways of working and living)--used in the Project of Pedagogical Development and activities reported by students at a Collective Health Nursing department. CONCLUSIONS: The instrument enables health care professionals, especially those from Collective Health Nursing, to identify social vulnerabilities and health needs, and guide interventions in different contexts, according to the health promotion perspective. Thus, it reveals potential to transform current health practices, dynamism and constant innovation of these practices in different contexts, according to the 'radicality' that is characteristic of Collective Health.

Interfaces of vulnerability dimensions in violence against children.

OBJECTIVE: present and discuss the potential use of the concept of vulnerability for the development of practices to address violence against children. METHOD: this is a theoretical study that presents the characteristics of the phenomenon of violence against children, to which the concept of vulnerability is applied. RESULTS: proposal of a framework for the analysis of violence against children in the perspective of vulnerability, creating individual and collective dimensions. Violence against children, when analyzed in the perspective of this concept, broadens the understanding of this phenomenon, as it exposes aspects and conditions from outside the family that are co-responsible for the occurrence of this phenomenon. CONCLUSION: developing studies to identify the vulnerability of children to violence is essential for the development of practices to address this issue.

The use of the "vulnerability" concept in the nursing area.

The objective of this article was to briefly retrieve the meaning of the vulnerability concept, which has been used in the healthcare area; also, to discuss how it has been used in the Nursing area. Amidst several different focuses and objects, studies have been attempting to overcome the classical reasoning of risk in epidemiology, advancing towards the discussion of the social determinants for the production of health problems.

Validation of vulnerability markers of dysfunctions in the socioemotional development of infants.

OBJECTIVES: to validate the vulnerability markers of dysfunctions in the socioemotional development of infants. METHODS: study with a sequential exploratory mixed-method design. The vulnerability markers elaborated in the qualitative phase were analyzed by experts in the quantitative phase using the Delphi technique with a minimum consensus of 70%. Seventeen judges answered the questionnaire in the first round of analysis and 11 answered in the second round. RESULTS: in the first round, two markers did not reach minimum consensus: the presence of instability in family relationships (66%) and delinquency and/or drug abuse by parents/caregivers (65%). In the second round, all markers were validated, with more than 90% agreement in most of the attributes, and reached the minimum consensus of 73%. CONCLUSION: the eight vulnerability markers reached the minimum consensus for validation, and a relevant instrument for infant care can be developed after assessing the reliability and clinically validating these markers.

Tuberculosis control from the perspective of health professionals working in street clinics.

PURPOSE: to present the opinion of professionals about street dwellers undergoing treatment of tuberculosis and identify strategies of control of tuberculosis in this population. METHOD: an exploratory and descriptive study involving 17 health professionals working in street clinics. A semi-structured study composed of closed questions and a guiding question. The statements were analyzed using the discourse analysis technique, resulting in the identification of two analytical categories: 1. Meanings attributed to street dwellers with tuberculosis, and 2. Control of tuberculosis in homeless people. RESULTS: the analysis identified situations that limited adherence to tuberculosis treatment, including the reasons for staying in the streets, living conditions, and risk factors (dependence on alcohol and other drugs, short-sightedness, constant relocations, and lack of perspectives). Street dwellers were knowledgeable about the disease. Furthermore, there were difficulties in solving several problems of people living in the streets, including living conditions and lifestyle, social stigma, relocations, drug abuse, and lack of life project. CONCLUSION: coping with the complexity of situations related to living in the streets limits to the work of health professionals because these situations go beyond health care and require intersectoral actions.

Factors associated with HIV co-infection in cases of acquired syphilis reported in a Reference Center for Sexually Transmitted Diseases and AIDS in the municipality of São Paulo, Brazil, 2014. / Fatores associados à coinfecção por HIV em casos de sífilis adquirida notificados em um Centro de Referência de Doenças Sexualmente Transmissíveis e Aids no município de São Paulo, 2014.

OBJECTIVE: to describe sociodemographic and behavioral characteristics and to identify factors associated with human immunodeficiency virus (HIV) co-infection in cases of acquired syphilis reported in a Reference Center for Sexually Transmitted Diseases (STD) and AIDS. METHODS: cross-sectional study with secondary data from a Reference Center for STD and AIDS in the municipality of São Paulo, Brazil, in 2014; the Poisson regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS: 648 cases of acquired syphilis were reported, and 98% were male; 88% were men who have sex with men (MSM) and 57% had HIV co-infection; male sex (PR=1.95; 95%CI 1.05;3.61) and MSM (PR=1.87; 95%CI 1.38;2.53) were factors independently associated with HIV co-infection. CONCLUSION: there was a high prevalence of HIV co-infection in the service analyzed, disproportionately affecting MSM who were notified with acquired syphilis.

Clinical and epidemiological teaching of dengue through simulated practice.

OBJECTIVE: to describe the experience of clinical teaching on dengue and the practice of epidemiological surveillance using problematization methodology. METHOD: report of experience on educational activity with undergraduate nursing students, held in March 2016, at a public university in the city of São Paulo, conceived in four stages: dialogic lecture, active search of Aedes aegypti, case study and simulation of nursing consultation to individuals with dengue. RESULTS: The activity allowed to retrieve previous knowledge about the disease, respond to exercises that addressed different clinical situations and epidemiological surveillance, including in situ evaluation of possible mosquito outbreaks, and discuss the need to expand prevention and health of the individual and the community, the impact of the media in the dissemination of cases and the coping difficulties experienced in the different levels of attention. CONCLUSION: the methodology adopted enabled qualified training of students to cope with dengue.

[Policies and practices towards equity: a broad approach]. / Políticas e práticas de saúde rumo a eqüidade: uma abordagem geral.

This paper presents a preliminary overview of policies and practices in health focusing equity. It begins with a brief description of the actions developed by the Collective Health Nursing Department of the School of Nursing of the University of Sao Paulo, Brazil, to support the struggle for social equity. It also presents the different perspectives of the concept that can be identified in health literature, each of them shaping distinct policies and practices.

Indicators to assess the quality of programs to prevent occupational risk for tuberculosis: are they feasible?

OBJECTIVE: to analyze the feasibility of quality indicators for evaluation of hospital programs for preventing occupational tuberculosis. METHOD: a descriptive cross-sectional study. We tested indicators for evaluating occupational tuberculosis prevention programs in six hospitals. The criterion to define feasibility was the time spent to calculate the indicators. RESULTS: time spent to evaluate the indicators ranged from 2h 52min to 15h11min 24sec. The indicator for structure evaluation required less time; the longest time was spent on process indicators, including the observation of healthcare workers' practices in relation to the use of N95 masks. There was an hindrance to test one of the indicators for tuberculosis outcomes in five situations, due to the lack of use of tuberculin skin test in these facilities. The time requires to calculate indicators in regarding to the outcomes for occupational tuberculosis largely depends upon the level of organizational administrative structure for gathering data.

[Building knowledge in collective health: an analysis of thesis and dissertations]. / Construindo o conhecimento em saúde coletiva: uma análise das teses e dissertações produzidas.

The aim of this study was to analyze scientific production in Collective Health developed by Collective Health Nursing Department of the School of Nursing Sao Paulo University within 1992 and 2004. A total of 86 master dissertations and doctoral thesis were produced, concerning a variety of study objects, mainly epidemiologic profiles and social reproduction, connected to health-illness processes of social groups. Qualitative analysis predominated, as well as the historical and dialectical theoretical referential. Empirical data were obtained predominantly from different social groups of specific territories. The adoption of analytical categories such as social production and reproduction, gender and generation enabled approaching to comprehend and propose intervention on the study objects, thus improving Collective Health scientific knowledge.

The incidence of tuberculosis and its relation to social inequalities: Integrative Review Study on PubMed Base / La incidencia de la tuberculosis y su relación con las desigualdades sociales: Estudio de revisión integradora en la Base PubMed / A ocorrência da tuberculose e sua relação com as desigualdades sociais: Estudo de revisão Integrativa na Base PubMed

Abstract Objective: to identify how the literature presents the relation between tuberculosis and social inequalities. Method: integrative review in which the combination of the descriptors "tuberculosis" and "social iniquity" guided the search for articles available in PubMed. A total of 274 articles were identified, and after reading the title and abstract, 13 studies were selected. The empirical material was analyzed according to the hermeneutics, highlighting the variables related to social inequalities, seeking to understand the main themes that embody the association between tuberculosis and social inequalities. Results: In general, the literature presents the social inequalities as factors that can interfere in the cure and/or control of the disease, such as age, income, unemployment, unskilled labor, access to health services, among others. Therefore, it does not include a deeper relationship between the organization of society and the production of the disease. Conclusion and implications for practice: A comprehensive understanding of tuberculosis disease is required, in order to expand interventions to support the control and elimination of the disease and, above all, the reduction of social inequalities. The understanding of tuberculosis as a disease enables expanding strategies to face it.

Resumen Objetivo: identificar cómo la literatura presenta la relación de la tuberculosis y desigualdades sociales. Método: revisión integrativa en que la combinación de los descriptores "tuberculosis" y "social iniquity" orientaron la investigación de artículos disponibles en el PubMed. Se identificaron 274 artículos, y después de la lectura del título y resumen, se seleccionaron 13 estudios. El material empírico fue analizado según la hermenéutica, con destaque a las variables relacionadas a las desigualdades sociales, buscando aprehender los principales temas que corporifican la asociación entre tuberculosis y desigualdades sociales. Resultados: En general, la literatura presenta las desigualdades sociales como factores que pueden interferir en la cura y/o control de la enfermedad, especialmente: edad, ingresos, desempleo, trabajo no calificado, acceso a servicios de salud, entre otros. No incluye, por lo tanto, una relación más profunda entre la organización de la sociedad y la producción de la enfermedad. Conclusión e implicación para la práctica: Se requiere comprensión totalizante de la enfermedad por tuberculosis, con la finalidad de ampliar intervenciones para que apoyen el control y la eliminación de la enfermedad y, sobre todo, la reducción de las desigualdades sociales. La comprensión de la tuberculosis como una enfermedad relacionada con la determinación social posibilita ampliar las estrategias para su enfrentamiento.

Resumo Objetivo: Identificar como a literatura apresenta a relação entre a tuberculose e as desigualdades sociais. Método: Revisão integrativa em que a combinação dos descritores "tuberculosis" e "social inequity" orientaram a pesquisa de artigos disponíveis no PubMed. Foram identificados 274 artigos e, após a leitura do título e resumo, foram selecionados 13 estudos. O material empírico foi analisado segundo a hermenêutica, com destaque às variáveis relacionadas às desigualdades sociais, buscando-se apreender os principais temas que corporificam a associação entre a tuberculose e as desigualdades sociais. Resultados: De modo geral, a literatura apresenta as desigualdades sociais como fatores, que podem interferir na cura e/ou no controle da doença, com destaque para: idade, renda, desemprego, trabalho não qualificado, acesso aos serviços de saúde, entre outros. Não inclui, portanto, uma relação mais profunda entre a organização da sociedade e a produção da doença. Conclusão e Implicações para a prática: Requer-se compreensão totalizante do adoecimento por tuberculose, com a finalidade de ampliar intervenções que apoiem o controle e a eliminação da enfermidade e, sobretudo, a redução das desigualdades sociais. A compreensão da tuberculose como uma doença relacionada à determinação social possibilita ampliar as estratégias para o seu enfrentamento.

Cholera in Brazil during 1991-1998: socioeconomic characterization of affected areas.

The paper describes the trends in, and spatial patterns of, the incidence of cholera in Brazil from 1991 to 1998. During this period, 161,432 cases and 1,296 deaths from cholera were reported. The poorest (North and Northeast) regions of the country had the highest morbidity and mortality rates. The remaining regions had self-limited outbreaks. Seventy-eight percent of affected municipalities had populations of fewer than 30,000, and about 65% of them lived in rural areas. The affected municipalities of the North and Northeast regions had consistent indications of deprivation: average Human Development Index was 0.41, infant mortality rate 90.3%, average life expectancy 59.4 years, and adult illiteracy rate 46.5%. The epidemiological profile of the disease in Brazil highlights intra- and inter-regional socioeconomic differentials in the country and indicates the importance of planning and implementing public-health interventions and specific policies aimed at reducing health inequalities.

[Nursing care in immunization programs]. / CUIDADOS DE ENFERMAGEM NA ÁREA DE IMUNIZAÇÕES.

The authors answer questions asked by nursing personnel, who work in teaching hospitals and in health centers, about immunization against measles and poliomyelitis, as well as questions about general care in other types of immunization. They recommend specific research on the subject.

[Evolution of isolation in communicable diseases: knowledge in contemporary practice]. / Evolução dos isolamentos em doenças transmissíveis: os saberes na prática contemporânea.

The identification of new infectious agents and the ever increasing expansion of known infections and diseases have been stimulating the revision of biosafety measures in the activities of professional health care workers. In the present article, the evolution of knowledge and practices of isolation and precautions were reviewed, which allowed us to recover the concepts and the interventions that were formulated and implemented. Since the beginning of the modern nursing, in the XIX century, the elements of the isolation practice for contagious diseases have remained basically the same. In other words, the emphasis on the use of mechanical, chemical and environmental barriers are given, based on inherent specificities of each part of the infectious chain process.