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BACKGROUND: The 22q11.2 Deletion Syndrome (22q11.2 DS) presents unique healthcare challenges for affected individuals, families, and healthcare systems. Despite its rarity, 22q11.2 DS is the most common microdeletion syndrome in humans, emphasizing the need to understand and address the distinctive healthcare requirements of those affected. This paper examines the multifaceted issue of health service access and caregivers' quality of life in the context of 22q11.2 DS in Brazil, a condition with diverse signs and symptoms requiring multidisciplinary care. This study employs a comprehensive approach to evaluate health service accessibility and the quality of life of caregivers of individuals with 22q11.2 DS. It utilizes a structured Survey and the WHOQOL-bref questionnaire for data collection. RESULTS: Individuals with 22q11.2 DS continue to receive incomplete clinical management after obtaining the diagnosis, even in the face of socioeconomic status that enabled an average age of diagnosis that precedes that found in sample groups that are more representative of the Brazilian population (mean of 3.2 years versus 10 years, respectively). In turn, caring for individuals with 22q11.2 DS who face difficulty accessing health services impacts the quality of life associated with the caregivers' environment of residence. CONCLUSIONS: Results obtained help bridge the research gap in understanding how caring for individuals with multisystem clinical conditions such as 22q11.2 DS and difficulties in accessing health are intertwined with aspects of quality of life in Brazil. This research paves the way for more inclusive healthcare policies and interventions to enhance the quality of life for families affected by this syndrome.
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Síndrome de DiGeorge , Accesibilidad a los Servicios de Salud , Calidad de Vida , Humanos , Brasil , Masculino , Femenino , Niño , Adulto , Adolescente , Cuidadores/psicología , Preescolar , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Resumo A correlação do aumento na incidência de casos de microcefalia em 2015, simultaneamente ao surto do zika vírus, levou ao reconhecimento de uma epidemia pela síndrome congênita pelo vírus zika (SCVZ), que ressaltou as já conhecidas fragilidades nas ações do cuidado em saúde. O objetivo do artigo é analisar a rede virtual de informações sobre a oferta de serviços de saúde para crianças com SCVZ no Rio de Janeiro. A partir da análise de redes sociais, foram coletados dados de fontes virtuais sobre informações de serviços e instituições de atendimento, utilizando o buscador Google, a fim de avaliar as relações entre esses atores em 2018. Os resultados apresentaram uma rede fragmentada, com centralização em fontes virtuais e serviços públicos da atenção secundária e terciária, destacando-se a proximidade das fontes de imprensa com os serviços públicos. Destacou-se também o isolamento dos serviços privados e a não interlocução entre os serviços filantrópicos e os serviços públicos. Além disso, as informações oferecidas mostraram-se insuficientes e superficiais, apesar da lacuna da rede formal de reabilitação. Consequentemente, as evidências apontam para a importância de uma rede bem estabelecida de serviços, bem como a necessidade de fomentar a comunicação por meio de mídias virtuais.
Abstract In 2015 the correlation between increasing numbers of cases of microcephaly and a zika virus outbreak led to recognition of an epidemic of congenital zika virus syndrome (CZVS), highlighting well-known weaknesses in health care measures. This article examines the network of virtual information available on health service provision for children suffering from CZVS in Rio de Janeiro. Using social media analysis, data on information about services and care institutions were collected from virtual sources using the Google search engine, so as to assess relations among these actors in 2018. The results revealed a fragmented network centred on virtual sources and secondary and tertiary public care services, with striking proximity of press sources to public services. Also salient was the isolation of private services and the lack of dialogue between philanthropic and public services. Moreover, the information offered was found to be insufficient and superficial, despite the gaps in the formal rehabilitation network. The evidence thus suggested the importance of a well-established health care service network and the necessity of fostering communication through virtual media.
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Humanos , Niño , Virus Zika , Infección por el Virus Zika/complicaciones , Infección por el Virus Zika/terapia , Infección por el Virus Zika/epidemiología , Microcefalia/epidemiología , Brasil/epidemiología , Análisis de Redes SocialesRESUMEN
BACKGROUND: Due to the high transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), governments adopted preventive measures, such as social distancing and obligatory social immobilization, which negatively affected access to health services, including oral health services. Similarly, dental care restraint arose in this context, with the aim of reducing the possibility of cross-infection caused by aerosols, which notably restricted dental care activity. OBJECTIVES: The aim of the study was to determine the impact of the COVID-19 pandemic on the timing of dental care in Peruvian children. MATERIAL AND METHODS: A cross-sectional study with a population of 42,115 respondents for 2019 and 20,510 for 2020 was conducted. The participants were children aged 0-11 years. The records of those who responded to the question on the time since their last dental care were considered, extracting a total of 22,166 (69.03%) subjects for 2019 and 9,945 (30.97%) subjects for 2020. The dependent variable consisted of the time since the last dental care measured in years; the variables of health, geographic and sociodemographic characteristics were grouped within 3 dimensions. Descriptive bivariate and multivariate analyses were applied by means of multiple linear regression in order to analyze the variables. RESULTS: The time since the last dental care during 2019 was 5.25 ±4.30 years, and it increased to 6.64 ±4.90 years in 2020. Within the multivariate analysis, the dimensions and their variables were ordered hierarchically for 2019 and 2020 separately, and as a whole. Each model was not significant when observed independently (p > 0.05); however, when evaluated as a whole, validity was observed only in model 1 of the year (p = 0.018), with R2 = 2.90, a constant equal to 3.852, the non-standardized regression coefficient (ß) of 1.653, and a 95% confidence interval (CI) of 0.289-3.018. CONCLUSIONS: The 2020 COVID-19 pandemic year had a negative impact on the timing of dental care in Peruvian children, increasing it by 1.39 years as compared to 2019.
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COVID-19 , Niño , Preescolar , Estudios Transversales , Atención Odontológica , Humanos , Lactante , Recién Nacido , Pandemias , Perú/epidemiología , SARS-CoV-2RESUMEN
Colombia has one of the largest burdens of Chagas disease globally, with about 438,000 people affected according to 2015 estimates. Despite this, < 1% of the population has had access to diagnosis and treatment. A patient-centered roadmap for Chagas disease was developed from 2015 onwards to address access barriers and increase diagnostic and therapeutic coverage and was implemented in five municipalities where Chagas disease is endemic. The mean number of people tested per year increased from 37 before the project to 262 following implementation, and the average days between medical order and diagnostic confirmation results decreased from 258 to 19. The mean days from diagnostic confirmation to treatment initiation decreased from 354 before the project to 135 after implementation. The 5,654 people tested included 3,467 women of childbearing age. The prevalence of T. cruzi infection was 11.5%, and thus far 266 people have received antitrypanosomal treatment. Collaborative creation and implementation of a patient-centered roadmap can address access barriers in specific contexts, helping to reduce the invisibility and burden of this neglected disease.
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Enfermedad de Chagas , Trypanosoma cruzi , Enfermedad de Chagas/diagnóstico , Enfermedad de Chagas/tratamiento farmacológico , Enfermedad de Chagas/epidemiología , Colombia/epidemiología , Femenino , Humanos , PrevalenciaRESUMEN
Rationale: Pneumonia is the leading cause of death in children worldwide. Identifying and appropriately managing severe pneumonia in a timely manner improves outcomes. Little is known about the readiness of healthcare facilities to manage severe pediatric pneumonia in low-resource settings. Objectives: As part of the HAPIN (Household Air Pollution Intervention Network) trial, we sought to identify healthcare facilities that were adequately resourced to manage severe pediatric pneumonia in Jalapa, Guatemala (J-GUA); Puno, Peru (P-PER); Kayonza, Rwanda (K-RWA); and Tamil Nadu, India (T-IND). We conducted a facility-based survey of available infrastructure, staff, equipment, and medical consumables. Facilities were georeferenced, and a road network analysis was performed. Measurements and Main Results: Of the 350 healthcare facilities surveyed, 13% had adequate resources to manage severe pneumonia, 37% had pulse oximeters, and 44% had supplemental oxygen. Mean (±SD) travel time to an adequately resourced facility was 41 ± 19 minutes in J-GUA, 99 ± 64 minutes in P-PER, 40 ± 19 minutes in K-RWA, and 31 ± 19 minutes in T-IND. Expanding pulse oximetry coverage to all facilities reduced travel time by 44% in J-GUA, 29% in P-PER, 29% in K-RWA, and 11% in T-IND (all P < 0.001). Conclusions: Most healthcare facilities in low-resource settings of the HAPIN study area were inadequately resourced to care for severe pediatric pneumonia. Early identification of cases and timely referral is paramount. The provision of pulse oximeters to all health facilities may be an effective approach to identify cases earlier and refer them for care and in a timely manner.
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Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Neumonía/diagnóstico , Neumonía/terapia , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/estadística & datos numéricos , Adolescente , Niño , Preescolar , Femenino , Geografía , Guatemala , Humanos , India , Lactante , Recién Nacido , Masculino , Oximetría , Perú , Pobreza/estadística & datos numéricos , Población Rural/estadística & datos numéricos , RwandaRESUMEN
OBJECTIVE: To identify factors associated with oral health care services for individuals with and without rare genetic diseases. MATERIALS AND METHOD: A cross-sectional study was undertaken, with 140 individuals paired by sex and age (70 with rare genetic diseases and 70 without), aged between 3 and 27 years, and their parents. The sample was selected from two reference hospitals for patients with rare genetic diseases in southeastern Brazil. The parents completed a questionnaire on individual aspects and their child's medical/dental history. Participants who did and did not suffer from rare genetic diseases were examined for dental caries, malocclusion, dental anomalies, and oral hygiene. The theoretical model Directed Acyclic Graphs (DAG) was used to identify possible confounding variables in the association between rare diseases and access to dental care. Descriptive analyses and non-matched and matched logistic regression models (p < 0.05) were carried out. RESULTS: The chance of individuals without rare genetic disease having access to oral health care service was 5.32 times higher (95% CI 2.35-12.01) than those with such conditions. Individuals who had not suffered upper respiratory tract infections had a 3.16 times greater chance of being in the group with access to oral health care service (95% CI 1.45-6.90). CONCLUSION: Individuals with no rare genetic diseases and no history of upper respiratory tract infections had a greater chance of belonging to the group of individuals with access to a dental service. Individuals with rare genetic diseases have less access to oral health care.
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Caries Dental , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Atención a la Salud , Humanos , Salud Bucal , Enfermedades Raras , Adulto JovenRESUMEN
ABSTRACT Purpose: to analyze the profile and access of patients who need speech-language pathology care in a Primary Health Unit (UBS). Methods: a descriptive analytical study, including data obtained from a spreadsheet with information provided by patients from May 2013 to February 2020. The following variables were analyzed: gender, age at referral, speech-language pathology complaint, year of referral, year of the first visit and service, and professional responsible for the health referral, speech therapy conduct after first visit, and outcome after therapy. Categorical variables were analyzed by means of frequency and numeric variables by measures of central tendency and dispersion. For inferential statistical analysis, the Mann-Whitney test was used, considering 5% as the significance level. Results: in total, 171 individuals were referred, most were males, aged 4 to 6 years, with language complaints; 73.66% were referred by professionals from the UBS, mainly by pediatricians. After the speech-language pathology assessment, 27.49% were referred to the specialty. Among the 78 individuals who started speech-language therapy at the UBS, 24.36% were discharged and 32.05% were dismissed, due to absences. A statistically significant correlation was observed when analyzing data of waiting time and non-attendance at the first speech therapy visit. Conclusion: as it addresses a large part of the demands in Primary Care, speech-language pathology helps to increase solubility at this level of the health system. Lack of compliance is considered a barrier in service organization and in promoting access to other patients.
RESUMO Objetivo: analisar o perfil de crianças e adolescentes encaminhados à avaliação fonoaudiológica e caracterizar o acesso destes usuários a este atendimento em uma Unidade Básica de Saúde (UBS). Métodos: estudo quantitativo descritivo-analítico, cujos dados foram obtidos de planilha com informações de usuários atendidos de maio/2013 a fevereiro/2020. Foi realizada análise descritiva das seguintes variáveis: sexo, idade na data do encaminhamento, queixa fonoaudiológica, ano do encaminhamento e do acolhimento, origem do encaminhamento, condutas pós-acolhimento e desfecho após terapia fonoaudiológica. As variáveis categóricas foram analisadas por meio de frequência e as variáveis numéricas por medidas de tendência central e dispersão. Para verificar a associação entre o tempo de fila de espera e o não comparecimento ao acolhimento fonoaudiológico, foi utilizado o teste de Mann-Whitney considerando 5% como nível de significância. Resultados: foram encaminhados 171 casos, a maioria do sexo masculino, entre 4 e 6 anos, com queixas de linguagem; 73,66% foram encaminhados por profissionais da UBS, principalmente pelo pediatra. Após a avaliação fonoaudiológica, 27,49% foram encaminhados para a níveis mais complexos de atenção à saúde. Dentre os 78 que iniciaram fonoterapia na UBS, 24,36% tiveram alta e 32,05% foram desligados por faltas. Houve relação estatisticamente significante na análise dos dados de tempo de fila de espera e o não comparecimento ao acolhimento fonoaudiológico. Conclusão: a atuação da Fonoaudiologia na Atenção Básica contribui com sua resolutividade, pois quando está presente neste nível do sistema de saúde, absorve grande parte das demandas.
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ABSTRACT Objective: to investigate the evolution and estimate the shortage of Speech, Language and Hearing professionals in Primary Health Care between 2005 and 2015. Methods: a mixed ecological study using data from the National Registry of Health Facilities and the Primary Health Care Information System. A descriptive analysis regarding the evolution of the number of professionals working in Primary Health Care over this period, in Brazilian states and regions, was conducted. The ratio of professionals per 100,000 inhabitants for the years 2005, 2010 and 2015, and the shortages in 2015, were estimated. Results: in 2005, there were 1,717 professionals working in Primary Health Care, that is, one per 100,000 inhabitants. In 2015, there were 4,124, increasing to 2.1/100,000. In 2015, the shortage in supply was 55.1%, varying widely across the states. Conclusion: the shortage in supply is equivalent to an absence of Speech, Language and Hearing service coverage within Primary Health Care for more than half of the Brazilian population. It is worth noting that a conservative parameter was adopted to conduct this estimate. The results suggest a process of consolidation for the inclusion of Speech, Language and Hearing professionals within Primary Health Care, however, still characterized by insufficient and unequal supply across the nation.
RESUMO Objetivo: investigar a evolução e estimar o déficit da oferta da Fonoaudiologia na Atenção Básica entre 2005-2015. Métodos: neste estudo ecológico misto, foram utilizados dados do Cadastro Nacional de Estabelecimentos em Saúde e do Sistema de Informação da Atenção Básica para análise descritiva da evolução do número de fonoaudiólogos na Atenção Básica, por Unidade da Federação e região. Foi estimada a razão de fonoaudiólogos por 100.000 habitantes para os anos de 2005, 2010 e 2015 e o déficit da oferta desses profissionais em 2015. Resultados: em 2005 havia 1.717 fonoaudiólogos na Atenção Básica, correspondendo à oferta de um profissional por 100.000 habitantes. Em 2015, havia 4.124 fonoaudiólogos, elevando a oferta para 2,1/100.000. Identificou-se déficit de 55,1% na oferta de fonoaudiólogos em 2015, variando entre as Unidades da Federação. Conclusão: o déficit da oferta equivale à ausência de cobertura dos serviços em Fonoaudiologia na Atenção Básica para mais da metade da população brasileira. Deve-se ressaltar que para essa estimativa, um parâmetro conservador foi adotado como pressuposto. Os resultados sugerem um processo de consolidação da inserção do fonoaudiólogo na Atenção Básica, porém ainda caracterizado por uma oferta insuficiente e desigual no território nacional.
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Introdução: As Redes de Atenção à Saúde (RAS) configuram-se como possibilidade de articular e coordenar ações e serviços, sendo hoje prioridade na organização do sistema de saúde. Considerando a necessidade de seu aprimoramento, o Programa de Educação pelo Trabalho (PET) na saúde é desenvolvido como uma estratégia para tal. Nesse contexto é preciso compreender os desafios e potências para a efetivação da RAS na produção do cuidado em rede. Objetivo: Identificar e analisar as percepções de profissionais preceptores de um PET Redes (Rede Cegonha/Bebês de risco e Rede Cuidado da Pessoa com Deficiência) sobre como se conforma a atenção em rede e sobre possíveis desafios das ações profissionais nessa configuração. Método: Estudo qualitativo, realizado por meio de dois grupos focais com profissionais preceptores de um PET Redes. Resultados: Em ambas as Redes o acesso, o atendimento integral e a comunicação apareceram como categorias da configuração do trabalho em rede. Alguns dos desafios mencionados envolvem: barreiras geográficas e arquitetônicas, falta de apoio social e transporte para deslocamento aos serviços, falhas de fluxos e descontinuidades nos processos comunicativos. Para lidar com esses desafios, foram mencionadas como estratégias: uso de prontuário eletrônico e constituição e participação em fóruns específicos de discussão e articulação de ações, entre outros. Destaca-se que as categorias estão articuladas e que os participantes apontaram mais desafios do que estratégias para superá-los. Conclusão: Os desafios para efetivação das RAS colocam-se em diferentes níveis e a construção de estratégias necessita ser pactuada entre os atores sociais envolvidos.
Introduction: Health Care Networks (HCN) are seen as a possibility for articulating and coordinating actions and health services and a priority in the health system. One strategy to assure their improvement is the Tutorial Education Program (PET-Redes) in the health area. Within this context, it is important to understand the challenges and strengths for the effectiveness of HCN in health care. Objective: To identify and analyze the perceptions of professionals who are preceptors of PET-Networks (Stork/at-risk infants Network and Disabled People Network) about the configuration of the care network and the challenges of professional actions. Method: Qualitative study conducted through two focus groups with professionals that are preceptors of the PET-Networks. Thematic analysis was used for data analysis. Results: Both networks presented the following categories related to the care network configuration: access, comprehensive health care and communication. For this care network configuration, some challenges mentioned include geographical and architectural barriers, lack of social support, lack of transportation, failure on care flow and discontinuities in the communicative process. To deal with these challenges, the following strategies were mentioned: implementation of electronic medical records and formulation of specific forums for debate and articulation of actions, among others. It is important to notice that these categories are intertwined and that more challenges than strategies to overcome them were pointed out by the participants. Conclusion: There are several challenges for effective HCN from different levels and the construction of strategies needs to be convened among all persons involved in the HCN.
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Contexto: los tiempos de espera para la atención son una de las principales barreras en el acceso a los servicios de salud en Argentina. Objetivo: analizar los tiempos diferenciales que la población tuvo que aguardar en la sala de espera y entre la solicitud de un turno y la atención con un médico especialista, según sus características socioeconómicas, demográficas, el tipo de cobertura de salud y el lugar de residencia. Método: cuantitativo, basado en el análisis de datos secundarios. Se utilizó la Encuesta de la Deuda Social Argentina del año 2013, realizada por el Observatorio de la Deuda Social Argentina de la Universidad Católica Argentina. Resultados: los tiempos de espera para consultar con un médico estuvieron estratificados socialmente, según las características socioeconómicas, tipo de cobertura y lugar de residencia de la población. No existieron diferencias significativas según el sexo y entre los grupos etarios.
Contexto: os tempos de espera para os cuidados são um dos principais obstáculos no acesso aos serviços de saúde na Argentina. Objetivo: analisar os tempos diferenciais que as pessoas tiveram que esperar na sala de espera e entre o pedido para um compromisso e cuidado com um médico especialista, de acordo com suas características demográficas, socioeconómicas, tipo de cobertura de saúde e residência. Método: quantitativo, com base na análise de dados secundários. Foi utilizada a pesquisa "Encuesta de la Deuda Social Argentina" 2013, realizada pelo "Observatorio de la Deuda Social Argentina (Universidad Católica Argentina)". Resultado: os tempos de espera para ver um médico estiveram socialmente estratificados de acordo com as características socioeconómicas, tipo de cobertura e residência da população. Não houve diferenças significativas por sexo e grupos etários.
Context: The waiting times for medical attention constitutes one of the main barriers to access to the Healthcare System in Argentina. Objective: Analyse different times that people have to keep in the waiting room and between the request for an appointment and the medical attention with a specialist according to their socio-economic and demographic characteristics, the type of health coverage and place of residence. Method: quantitative, based on the analysis of secondary data. It was implemented in the Survey of "La Deuda Social Argentina" of the year 2013, conducted by the "Observatorio de la Deuda Social Argentina (Universidad Católica Argenitna)". Results: The waiting time to see a doctor it's socially stratified according to socioeconomic characteristics, type of medical coverage and place of residence of the population. There are no significant differences between gender and across age groups.
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PURPOSE: Although the relevance of dental intervention before transplant is recognized, many patients are undergoing transplantation without receiving dental care. The objective of this study was to identify the searching profile, access, and use of dental services by candidates to hematopoietic stem cell transplantation (HSCT), and the difficulties faced by those candidates. METHODS: All candidates for an allogeneic HSCT from a bone marrow transplant unit were invited to take part in this research from March 2014 to March 2015. A questionnaire was developed consisting of five sections with questions about personal information, hematologic disease, access to dental services, and history of dental treatment, patient's preferences, and knowledge. RESULTS: One hundred and ten candidates for allogeneic HSCT participated in this study. Fifty-five participants received professional oral care in the previous year of interview. The majority of patients (64 %) went to a dentist not linked to transplant staff, and private dental service was the most visited (42 %). To visit a dentist during the previous year was statistically associated with the habit of going to a dentist outside the hospital (p < 0.001), which was statistically associated with the family income (p = 0.001). The main barriers to access to dental treatment were lack of guidance (66 %), apprehension (45 %), and lack of confidence (29 %) in an "external" dentist. CONCLUSIONS: Most of the barriers seem to be associated to lack of confidence and information among patients and professionals, as well as a lack of parameters for scheduling or referrals to dental care, especially for those with a low-socioeconomic background.
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Atención Odontológica/métodos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Trasplante de Células Madre Hematopoyéticas/métodos , Acondicionamiento Pretrasplante/métodos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJETIVO: descrever o acesso aos serviços de saúde pelos índios das etnias Kanela e Guajajara e sua satisfação com a assistência prestada pelo Sistema Único de Saúde (SUS). MÉTODOS: estudo descritivo sobre amostra não probabilística de indígenas do município de Barra do Corda, estado do Maranhão, assistidos em Teresina, estado do Piauí, Brasil, em 2011; foi utilizado um questionário sobre os serviços de saúde utilizados com frequência, e as formas, facilidades e dificuldades no acesso a esses serviços. RESULTADOS: responderam ao formulário 67 chefes de família; destes, 48 utilizaram hospital e 43 referiram satisfação com os serviços; entre aqueles que utilizaram internações hospitalares, 17 consideraram a alimentação oferecida no hospital diferente dos costumes ou ruim, e 28 não dormiram conforme o hábito em suas aldeias. CONCLUSÃO: o acesso aos serviços do SUS foi facilitado pelos profissionais e a maioria sentiu-se satisfeita com o atendimento recebido.
OBJECTIVE: to describe access to health services by Indians of Kanela and Guajajara ethnic groups and their satisfaction with care provided by the Unified Health System (SUS). METHODS: a descriptive study of a non-probabilistic sample of Indigenous people living in Barra do Corda, State of Maranhão, receiving SUS healthcare in Teresina, State of Piauí, Brazil, in 2011; a questionnaire was administered on frequently used health services, forms of access and ease or difficultly in accessing them. RESULTS: 67 heads of family replied; 48 of them had used hospitals and 43 were satisfied with the services; among those admitted to hospital, 17 considered the meals offered there different to their customs or bad and 28 did not sleep as they traditionally did in their villages. CONCLUSION: access to SUS was facilitated by health professionals and the majority were satisfied with the care received.
OBJETIVO: describir el acceso a los servicios de salud por los indios de etnias Kanela y Guajajara, y su satisfacción acerca de la asistencia proporcionada por el Sistema Único de Salud (SUS). MÉTODOS: estudio descriptivo de una muestra no probabilística de indígenas del municipio de Barra do Corda, Estado de Maranhão, y asistida en Teresina, Estado de Piauí, Brasil, en 2011; fue utilizado un cuestionario sobre los servicios de salud, formas de acceso, facilidades y dificultades de acceso. RESULTADOS: respondieron 67 jefes de familia, de estos, 48 utilizaron hospitales y43dijeronqueestaban satisfechos con los servicios recibidos; entre los que utilizaron los servicios hospitalarios, 17 refirieron que las comidas que se ofrecen en el hospital son diferente de la habitual o malay 28 no dormían como era el hábito en sus aldeas. CONCLUSIÓN: el acceso al SUS fue facilitado por los profesionales y la mayoríaestaba contento conla atención recibida.
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Humanos , Masculino , Femenino , Calidad, Acceso y Evaluación de la Atención de Salud , Accesibilidad a los Servicios de Salud , Satisfacción del Paciente/estadística & datos numéricos , Epidemiología Descriptiva , Indígenas Sudamericanos , Sistema Único de SaludRESUMEN
Este relato descreve o uso do correio eletrônico por uma equipe de saúde da família para comunicação com os pacientes e agendamento. Tal uso surgiu como consequência de um processo de facilitação do acesso presencial e não presencial. No período de 25 meses houve crescimento no número de mensagens e de remetentes. Das 1437 mensagens recebidas, 61,5% foram para agendar consultas, 27,8% solicitavam informações em saúde e 7,6% eram sobre serviços oferecidos. As mulheres enviaram 87% das mensagens (63,3% delas tinham 20-40 anos). Em 60% das vezes, o contato referia-se à demanda do remetente e mais de 30% à de familiares. A equipe respondeu a 83% das mensagens em até 8 horas úteis. Na percepção da equipe, o uso do correio eletrônico melhorou a comunicação e o acesso e foi bem aceito pelos usuários, não prejudicando grupos mais vulneráveis. Investigações mais aprofundadas serão necessárias para avaliar a contribuição dessa ferramenta na Atenção Primária à Saúde.
This report describes the use of electronic mail by a primary health care team (PHT) in order to communicate with patients and aid in scheduling. Such use has emerged as a result of a process of facilitating access, both electronically and face-to-face. During a 25-month study period, users sent a total of 1437 messages with the purpose of scheduling appointments (61.5%), asking health-related questions (27.8%), and inquiring about services offered (7.6%). Women submitted 87% of the messages (63.3% of them were 2040 years of age), with 60% of these messages concerning themselves and over 30% of them concerning their families. The team responded to 83% of messages within 8 business hours. According to the team, the use of electronic mail has improved communication and access, and has been well received by users without harming the most vulnerable groups. Further investigation is needed to assess the full contribution of this tool to primary health care.
Este texto describe la utilización del correo electronico por un equipo de salud de la familia para comunicación con los pacientes y marcación de citas. El correo surgió como consecuencia de un proceso para facilitar el acceso presencial y no presencial. En el periodo de 25 meses hubo crecimiento en el numero de mensajes y de remitentes. De las 1.437 mensajes recibidas, el 61,5% fueron para la marcación de citas, el 27,8% solicitaban informaciones de salud y el 7,6% eran sobre servicios ofrecidos. Las mujeres enviaron el 87% de los correos (el 63,3% de ellas tenían entre 20 y 40 años). En el 60% de las veces, el contacto se refería a la demanda del remitente y más del 30% a las de sus familiares. El equipo contestó al 83% de los mensajes dentro de 8 horas útiles. Según el equipo, el uso del correo electrónico mejoró la comunicación y el acceso y fue bien acepto por los usuarios, sin perjudicar a los grupos más vulnerables. Investigaciones más profundas serán necesarias para evaluar la contribución de esta herramienta en la Atención Primaria a la Salud
Asunto(s)
Grupo de Atención al Paciente , Atención Primaria de Salud , Correo Electrónico , Comunicación en Salud , Accesibilidad a los Servicios de SaludRESUMEN
Access to an optimal treatment is determined by several factors, like availability, pricing/funding, and acceptability. In Latin America (LA), one of the regions with more disparities particularly on healthcare in the world, access is affected by other factors, including socio-demographic factors like poverty, living in rural regions, and/or health coverage. Regarding rheumatoid arthritis (RA), an inadequate access to specialists leads to diagnosis and treatment delays diminishing the probability of remission or control. Unfortunately, in almost every LA country, there are cities with more than 100,000 inhabitants without rheumatologists; furthermore, a primary care reference system is present in only about half the countries. In the public health system, coverage of biologic disease-modifying antirheumatic drugs occurs for less than 10 % of the patients in about half of the countries. Also, as healthcare providers based their funding decisions mainly in direct costs instead of on patient-centered healthcare quality indicators, access to new drugs is more complicated in this region than in high-income countries. More accurate epidemiological data from LA need to be obtained in order to improve the management of patients with rheumatic diseases in general and RA in particular.
Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Accesibilidad a los Servicios de Salud/economía , Atención Primaria de Salud/normas , Artritis Reumatoide/economía , Costos y Análisis de Costo , Humanos , América Latina , PobrezaRESUMEN
Objetivou-se descrever a resolutividade na atenção à saúde de crianças menores de cinco anos em dois municípios do sul do Brasil, na percepção dos cuidadores. Participaram desta pesquisa 25 familiares de crianças atendidas nas Unidades de Pronto Atendimento, em 2010. A coleta de dados foi realizada por meio de entrevistas semiestruturadas no domicílio das famílias. Os dados foram submetidos à análise temática de conteúdo e os resultados apontaram que as famílias procuram as Unidades de Pronto Atendimentopara a resolução imediata de seus problemas, considerando a Atenção Primária à Saúde como de baixa resolutividade, procuram um serviço de maior densidade tecnológica, para resolução dos problemas dos filhos. Na compreensão dos familiares, a resolutividadeexiste quando há agilidade no atendimento e desaparecimento dos sintomas apresentados pela criança. Conclui-se que o acesso ao serviço de saúde na Unidade Básica de Saúde/Unidade de Saúde da Família é dificultado devido à forma de organização dos serviços
The aim of this study was to describe problem solving in health care for children under five in two southern Brazilian cities, under the perspective of caregivers. A total of 25 family members of children assisted in Urgent Care Units in 2010 were the participants of this research. Data collection was carried out through semi-structured interviews at the families' homes. Data were subjected to thematic analysis and the outcomes showed that families seek Urgent Care to immediately solve their problems, considering Primary Health Care as having a low problem solving, problem solving, and search for higher technological density services to solve their children's problems. According to the families' comprehension, problem solving occurs when the service is fast and the child's symptoms disappear. Finally, access to the health service in the Basic Unit/Family Health Unit is hindered due to how services are organized
RESUMEN
RESUMEN Objetivo Describir y comprender de forma integral las experiencias que han vivido personas con cáncer de piel no melanoma en su lucha por recuperar la salud, descifrando el itinerario que recorren en busca de atención, describiendo las relaciones con el sistema de salud, estableciendo la tasa de tutelas y el porcentaje de servicios negados, y documentando los determinantes relacionados con el diagnóstico oportuno. Métodos Se realizó un estudio con metodología mixta desde la perspectiva combinada de la epidemiología y la antropología médica critica. El trabajo incluyó una cohorte retrospectiva con 369 personas, tres grupos focales con 48 participantes y entrevistas en profundidad a 20 casos. Resultados Se documentaron barreras propias del sistema de salud, barreras intermedias (laborales y geográficas) y barreras estructurales (economía, ingresos, poder adquisitivo, cohesión social y educación). Los diagnósticos oportunos fueron del 32,5 %. Los determinantes relacionados fueron: escolaridad igual o superior a la formación técnica (OR:4,4), vivienda propia (OR:4,8), vivir en medio urbano (OR:3,5) y afiliación al régimen contributivo (OR:1,9). El 28 % reportaron la negación de algún tipo de servicio (biopsia, cirugía), y la tasa de uso de recursos legales fue de cinco por cada 100 casos nuevos año. Se documentó el itinerario desde la aparición de la enfermedad, hasta la atención definitiva. Discusión Las personas en condiciones desfavorables presentan los casos más complejos y paradójicamente enfrentan la mayor cantidad de barreras de acceso. Estas barreras trascienden el sistema de salud, y no dependen exclusivamente de una reforma al sector.
ABSTRACT Objectives Describing and understanding the experiences of people suffering non-melanoma skin cancer in their struggles to recuperate, deciphering their itinerary regarding their health-seeking behavior, describing the relationship between patients and the Colombian healthcare system by referring to the number of pertinent writs and the percentage of denied services, and documenting the determinants which are related to timely diagnosis. Methods This was a mixed-methods study, combining epidemiology and critical medical anthropology; the study involved a retrospective cohort of 369 people, 3 focus groups including 48 participants and in-depth interviews regarding 20 cases. Results The data revealed specific healthcare system-related barriers to access to healthcare, intermediate barriers (work-related and geographical) and structural barriers (economic-, income-, purchasing power-, social cohesion- and education-related). Timely diagnosis was made in 32.5% of the reported cases. Related determinants consisted of educational level equal to or above technical training (OR 4.4), home ownership (OR 4.8), living in an urban area (OR3.5) and contributory regime affiliation (OR 1.9); 28% of the people involved in the study reported that they had been denied access to a service (biopsy, surgery) and the rate of resorting to legal means (i.e. writs) was 5 out of every 100 new cases per year. The itinerary from the time of the appearance of a particular disease to definitive resolution was established. Discussion People living in unfavorable social conditions were involved in the severest cases and, paradoxically, faced the largest set of barriers to access to healthcare in Colombia. Such barriers extend beyond the healthcare system and will not become resolved solely through healthcare reform.
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Neoplasias Cutáneas/terapia , Colombia , Estudios RetrospectivosRESUMEN
A análise do atual contexto político e econômico existente nos EUA, que envolve o acesso e utilização de serviços de saúde pelos imigrantes, diz respeito aos mais de 20 milhões de indivíduos estrangeiros que residem naquele país e não possuem seguro de saúde. Essa população corresponde a 43,8 por cento de 46 milhões de pessoas que não possuem cobertura de provedores privados de saúde nos EUA, sendo 10,5 milhões residentes sem a documentação exigida para viver no País. Para explorar as necessidades, o acesso e a utilização dos serviços de saúde americanos pelos emigrantes de Governador Valadares, MG, Brasil, o presente estudo entrevistou uma amostra de 14 emigrantes valadarenses selecionada por meio da técnica bola de neve. Foram elaboradas questões relacionadas à documentação, local de residência, profissões exercidas, necessidade, acesso e utilização de serviços de saúde. As informações recolhidas junto aos emigrantes residentes nos Estados de Massachusetts e Connecticut permitem afirmar a viabilidade do acesso e da utilização dos serviços de saúde subsidiados pelos governos federal e estaduais e de organizações não governamentais.
Asunto(s)
Humanos , Accesibilidad a los Servicios de Salud , Cobertura de Servicios Públicos de Salud , Financiación Gubernamental , Emigración e Inmigración , Política Pública , Seguro de Salud , Sistemas de Salud , Grupos Profesionales , Entrevistas como Asunto , Epidemiología Descriptiva , Investigación CualitativaRESUMEN
Este estudo transversal descritivo objetivou avaliar o acesso ao diagnóstico e tratamento da tuberculose na Estratégia Saúde da Família em Teresina. Os dados foram coletados por meio de entrevista estruturada a 86 doentes de tuberculose, no período de março a maio de 2010. Entre os entrevistados, 52,3% procuraram a unidade de saúde mais próxima do seu domicílio no diagnóstico, 75,6% referiram não ter dificuldade de deslocamento até a unidade de saúde. Em 62,8% dos casos, o tratamento foi autoadministrado nos dois primeiros meses. A maioria precisou procurar o serviço três ou mais vezes para conseguir o primeiro atendimento e avaliou o trabalho da equipe de saúde como razoável. No presente estudo foi predominante a autoadministração do medicamento. Portanto, a forma de organização da atenção não constitui fator determinante para a garantia de acesso ao diagnóstico precoce e ao tratamento adequado.
This cross-sectional descriptive study aimed to evaluate access to diagnosis and treatment of tuberculosis by the Family Health Strategy in Teresina. Data were collected through structured interview of 86 patients with tuberculosis in the period from March to May 2010. Of the respondents, 52.3% attended the nearest clinic to their home; 75.6% reported having no difficulty in getting to the clinic. In 62.8% of cases, treatment was self-administered for the first two months. Most patients had to visit the service three or more times before being attended for the first time, and evaluated the health teams work as fair. In the present study, medication was predominantly self-administered. Therefore, how care was organized did not constitute a determinant factor in ensuring access to early diagnosis and appropriate treatment.
Este estudio transversal descriptivo tuvo como objetivo evaluar el acceso al diagnóstico y tratamiento de la tuberculosis en la Estrategia Salud de la Familia, en Teresina-PI-Brasil. Los datos fueron recolectados a través de entrevista estructurada a 86 pacientes con tuberculosis, en el período de marzo a mayo de 2010. Entre los encuestados, 52,3% buscaron la unidad de salud más cercana de su casa en el diagnóstico, el 75,6% informaron no tener dificultades en el transporte para la clínica. En 62,8% de los casos, el tratamiento fue autosuministrado en los dos primeros meses. La mayoría de los pacientes necesitó buscar el servicio tres o más veces para obtener el primer tratamiento y evaluó el trabajo del equipo de salud como razonable. En el presente estudio fue predominante la autoadministración de la medicación. Por lo tanto, la forma de organización de la atención no es un factor determinante para garantizar el acceso al diagnóstico temprano y al tratamiento adecuado.
Asunto(s)
Humanos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Estrategias de Salud Nacionales , Tuberculosis/diagnóstico , Tuberculosis/enfermería , Evaluación de Programas y Proyectos de Salud , Brasil , Estudios Transversales , Investigación en EnfermeríaRESUMEN
A Secretaria Municipal de Saúde de São Paulo desenvolveu o Índice de Necessidades em Saúde (INS) para identificar áreas prioritárias para a oferta de serviços. Em 2008 realizou um Levantamento das Condições de Saúde Bucal. Pretende-se, neste estudo ecológico, analisar o perfil de saúde bucal em relação ao INS. As variáveis, estratificadas para as idades de 5, 12 e 15 anos, foram: porcentagem de indivíduos com dificuldade no acesso ao serviço odontológico; média do ceod e CPOD; prevalência da necessidade de extração e de livres de cárie. As informações foram analisadas para as 25 Supervisões Técnicas de Saúde (STS). Empregou-se o teste estatístico de covariância, o coeficiente de correlação de Pearson e o modelo de regressão linear. Observou-se uma correlação positiva entre maiores INS e a dificuldade de acesso aos serviços. Nas STS com maiores INS houve maior experiência de cárie, maior necessidade de exodontias e menor prevalência de livres de cárie. Reforça-se a necessidade de priorizar as áreas de privação social para melhorar a condição de saúde da população.
The Health Department of São Paulo, Brazil, has developed a Health Necessities Index (HNI) to identify priority areas for providing health assistance. In 2008, a survey of the status of oral health was conducted. The objective of this ecological study was to analyze the status of oral health in relation to the HNI. The variables, stratified by the age of 5, 12 and 15 years old were: percentage of individuals with difficulty of access to dental care services; DMFT and DMFS; prevalence of the need for tooth extraction and treatment of dental caries. Data were analyzed for the 25 Health Technical Supervision Units (HTS). The Statistical Covariance Test was used as well as the Pearson correlation coefficient and linear regression model. A positive correlation was observed between high scores of the HNI and difficulty of access to services. In the HTS with high scores of HNI a higher incidence of dental caries was observed, a greater need for tooth extractions and low caries-free incidence. In order to improve health conditions of the population it is mandatory to prioritize actions in areas of social deprivation.
Asunto(s)
Adolescente , Niño , Preescolar , Humanos , Atención Odontológica , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Salud Bucal , Brasil , Salud UrbanaRESUMEN
Objective: To describe the actions of the public dental service in a small town in the Brazilian state of Minas Gerais. Methods: An historical series study using secondary data obtained from the Outpatient Information System of the National Health Service in Brazil. The study sample consisted of all dental procedures and actions (n= 97.331) and basic medical actions (n= 126.340) performed between 2000 and 2007, as obtained from the Ministry of Health?s official website. Results: The percentage of basic dental actions (44%) was lower than the percentage of actions in the medical area (56%). Direct restorations, ignoring the number of tooth surfaces involved, were the most performed dental procedure (40%). The extractions of deciduous and permanent teeth(including root fragments) ranked second (35%), followed by preventive procedures such as scaling, curettage and crown polishing (11%), plaque control (8%), dental sealing (3%) and direct capping and pulpotomy (3%).Conclusion: Given the data presented, it was possible to suggest that the dental service in this municipality was predominantly curative /restorative, to the exclusion of collective actions, that are not seemingly carried out and/or not recorded.
Objetivo: Descrever as ações odontológicas do serviço público em um município de pequeno porte de Minas Gerais, Brasil. Métodos: Estudo de série histórica com utilização de dados secundários obtidos através do Sistema de Informação Ambulatorial do Sistema Único de Saúde. A amostra do estudo foi composta por todos os procedimentos e ações básicas odontológicas (n=97.331) e ações básicas médicas (n=126.340) realizadas no período de 2000 a 2007 obtidos no site oficial do Ministério da Saúde. Resultados: O percentual de ações básicas odontológicas (44,0%) foi inferior a percentual de ações da área médica (56,0%). As restaurações diretas -independentemente do número de faces dentárias envolvidas - foram o procedimento odontológico mais realizado (40,0%). As exodontias de dentes permanentes e decíduos (incluindo restos radiculares) ocuparam a segunda posição (35,0%), seguidos pelos procedimentos preventivos como a raspagem, curetagem e polimento coronário (11,0%), o controle de placa (8,0%), o selamento dental (3,0%) e o capeamento direto e a pulpotomia (3,0%). Conclusão: Diante os dados apresentados, é possível sugerir que o serviço odontológico desse município predominantemente curativo-restaurador, em detrimento às ações coletivas que parecem não estarem sendo executadas e/ou registradas.