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- ItemAcesso aberto (Open Access)Desfecho do tratamento de tuberculose em pacientes internados em dois hospitais de grande porte do município do São Paulo comparado a pacientes não internados(Universidade Federal de São Paulo (UNIFESP), 2008) Perrechi, Mirtes Cristina Telles [UNIFESP]; Ribeiro, Sandra Aparecida [UNIFESP]Objetivos: Esta pesquisa teve como objetivo avaliar características de pacientes internados por tuberculose em dois hospitais do município de São Paulo que internam mais de cinqüenta casos/ano verificando o desfecho de tratamento comparativamente a pacientes ambulatoriais, bem como identificar as variáveis mais relacionadas à internação, cura e óbito de pacientes internados e o fluxo de acesso entre hospitais e Unidades Básicas de Saúde (UBS). Métodos: Foi realizado um estudo de campo prospectivo no qual foram entrevistados 166 pacientes internados consecutivamente por tuberculose em dois hospitais e verificadas as variáveis secundárias de 308 pacientes não internados, tratados em UBS, no período de janeiro a dezembro de 2007, no Distrito Administrativo de Santana e de Vila Mariana, município de São Paulo. Para verificação do desfecho de tratamento dos pacientes internados e não internados foi consultado o Sistema de Informação de Tuberculose (TB-WEB-SES/SP). Resultados: Dos 474 pacientes estudados 67,51% eram do sexo masculino e 32,49% do feminino, faixa etária predominante de 20 a 59 anos e a forma clinica pulmonar em 71,65%. Destes, 81,00% tinham baciloscopia positiva entre os internados e 62,00% entre os ambulatoriais. O teste de HIV foi positivo em 27,70% dos pacientes internados e 13,30% dos não internados. Nos pacientes internados (166), 72,00% foram descobertos em P.S/Hospitais, 68,67% eram de casos novos e 69,12% haviam procurado outro serviço antes do diagnóstico. Nos pacientes ambulatoriais (308), 56,82% foram descobertos em ambulatórios, 85,38% de casos novos e 55,19% haviam procurado outro serviço antes do diagnóstico. O desfecho de tratamento entre os internados revelou 41,57% de cura, 29,52% de abandono e 29,52% de óbito e entre os não internados 78,25% de cura, 16,55% de abandono e 2,60% de óbito. Associaram-se à internação por tuberculose as variáveis: descoberta em P.S/Hospitais (OR 55,42), ter procurado outro serviço previamente (OR 12,32), casos de retratamento (OR 18,51) e ser HIV positivo (OR 18,57). Associaram-se à cura: HIV negativo (OR 9,16) e ser diagnosticado em menos de 12 semanas (OR 34,12) e associaram-se ao óbito ter HIV positivo (OR 9,02) e ter sido descoberto em ambulatório (OR 7,13). Em relação ao fluxo de acesso a maioria dos pacientes não internados e internados no Hospital do Mandaqui são tratados na Coordenadoria Regional de Saúde referente à região do Distrito Administrativo de moradia, o que não foi evidenciado nos pacientes internados no Hospital São Paulo, evidenciando menor grau de regionalização. Conclusões: O desfecho de tratamento nos pacientes internados mostraram graves indicadores de morbimortalidade hospitalar por tuberculose com menor taxa de cura e maior taxa de óbito em relação aos pacientes não internados. A AIDS contribuiu para a gravidade dos indicadores de desfecho hospitalar. A regionalização dos casos foi menor nos pacientes internados no Hospital São Paulo. É importante o acompanhamento da chegada dos pacientes internados às UBS, a fim de se melhorar os indicadores de desfecho de tratamento destes pacientes.
- ItemAcesso aberto (Open Access)Desigualdades sociais e uso de serviços de saúde: evidências de análise estratificada(Faculdade de Saúde Pública da Universidade de São Paulo, 2000-02-01) Silva, Nilza Nunes da [UNIFESP]; Pedroso, Glaura César [UNIFESP]; Puccini, Rosana Fiorini [UNIFESP]; Furlani, Wellington de Jesus [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The study aims to identify children who are not benefited by local health programs, looking for to characterize the excluded segment of the population in order to broaden the access to and use of the main actions provided by local health programs. METHODS: A sample of 465 children aged less than 1 year was studied, living in the year of 1996 in Embu, a city of the metropolitan area of S. Paulo, Brazil. Our hypothesis was that there is a higher availability of private health care resources among families who haven't been using the local health program. The statistical analysis consisted of stratified association analysis to study the heterogeneity between and intra four strata of families defined by different socialeconomic conditions. RESULTS: Although only 85.4% of the study children were enrolled in local health services, 91.2% of them were being benefited by main health care actions. The analysis of differences intra strata revealed that our hypothesis was only corroborated in one stratum. It is in the stratum 3, which concentrates the peripheral population, where we could find children who have not been using the local health program in Embu city. CONCLUSIONS: In the same social segment it was detected some inner heterogeneity among families related to the availability of private resources for their children health care.
- ItemAcesso aberto (Open Access)The expression of vulnerability through infant mortality in the municipality of Embu(Associação Paulista de Medicina - APM, 2008-09-01) Ventura, Renato Nabas [UNIFESP]; Puccini, Rosana Fiorini [UNIFESP]; Silva, Nilza Nunes da [UNIFESP]; Silva, Edina Mariko Koga da [UNIFESP]; Oliveira, Eleonora Menicucci de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Infant mortality expresses a set of living, working and healthcare access conditions and opens up possibilities for adopting interventions to expand equity in healthcare. This study aimed to investigate vulnerability and the consequent differences in access to health services and occurrences of deaths among infants under one year of age in the municipality of Embu. DESIGN AND SETTING: This was a descriptive study in the municipality of Embu. METHODS: Primary data were collected through interviews with the families of children living in the municipality of Embu who died in the years 1996 and 1997 before reaching one year of age. Secondary data were obtained from death certificates. The variables collected related to living conditions, income, occupation, prenatal care, delivery and the healthcare provided for children. These data were compared with the results obtained from a study carried out in 1996. RESULTS: Statistically significant differences were found with regard to income, working without a formal employment contract and access to private health plans among the families of the children who died. There were also differences in access to and quality of prenatal care, frequency of low birth weight and neonatal intercurrences. CONCLUSIONS: The employment/unemployment situation was decisive in determining the degree of family stability and vulnerability to the occurrence of infant deaths, in addition to the conditions of access to and quality of healthcare services.
- ItemAcesso aberto (Open Access)Risk factors for incomplete vaccination in children less than 18 months of age attending the nurseries of day-care centres in São Paulo, Brazil(Elsevier B.V., 2011-11-21) Konstantyner, Tulio [UNIFESP]; Taddei, Jose Augusto de Aguiar Carrazedo [UNIFESP]; Rodrigues, Laura Cunha; Universidade Federal de São Paulo (UNIFESP); Univ London London Sch Hyg & Trop MedTo estimate the proportion of children in day-care centres with incomplete vaccination and to identify associated risk factors, we conducted a cross-sectional study among 258 children less than 18 months of age attending public and philanthropic day-care centres in the city of São Paulo, Brazil. Interviews, blood collection and anthropometry were performed. Unconditional logistic regression was adjusted for incomplete vaccination risk factors. 10.9% of children had incomplete vaccination. Children who were born prematurely (OR = 4.27; p = 0.004), or were malnourished (OR = 4.99; p = 0.049), or lived in inadequate housing (OR = 2.88; p = 0.039), or whose mothers had had poor prenatal care (OR = 4.98; p = 0.040) were more likely to have incomplete vaccination. Opportunities are being missed to identify children with incomplete vaccination; strategies to enhance vaccination coverage should pay special attention to the needs of families living in inadequate housing; and health promotion actions in primary health facilities and day-care centres should be performed as concomitant activities. (C) 2011 Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Serviços de saúde mental para crianças e adolescentes: recomendações para o planejamento de políticas públicas de saúde mental(Universidade Federal de São Paulo (UNIFESP), 2010-04-28) Graeff-Martins, Ana Soledade [UNIFESP]; Mercadante, Marcos Tomanik [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction There is clear evidence of social and economic impact of mental health disorders started in childhood and adolescence and of the inefficiency of health systems to deal with the problem in most countries. Public policies based on epidemiological data are urgently needed to promote greater access to services, coordination among the various sectors that receive children and adolescents with mental health problems and regular funding for systems. One of the key issues to be studied for planning policies in mental health of children and adolescents is access to mental health services and related factors. Objectives The aims of this study are: to review research findings on the prevalence of mental health services use by children and adolescents and factors associated; to describe the methodological problems of studies and propose a conceptual model to be used in future research; to estimate the prevalence of mental health services use and associated factors in a community sample of students; and to identify factors associated with the presence of components of mental health and the pattern of referral of students with problems in educational institutions from four localities in a state of southeastern Brazil. Recommendations for public policies on mental health for children and adolescents will be done. Methods 1) A systematic review of articles in the literature was performed, to identify studies that reported the prevalence of mental health services use in non-referred samples of subjects up to 18 years old. 2) A stratified random sample of 6986 students was assessed regarding mental health service use in school and out of school, sociodemographic factors, different levels of exposure to the attack, probable psychiatric diagnosis and having talked to parents, teachers and religious leaders about the attack. 3) Responsibles for all special schools and a random sample of regular schools in four areas of Rio de Janeiro State were interviewed about the presence of mental health professionals or procedures in the institutions and associated factors. Results 1) 174 full-text articles were examined, and 56 studies were included in this review. Great variability of mental health services use prevalence rates ! 5 was found. Factors related to services use were listed. 2) 17.1% of the sample had used mental health services, more in schools than out. Mental health service use in school was associated to having talked to teacher about the attack. Mental health service use out of school was associated to direct exposure to the attack, previous exposure to traumatic events, probable diagnosis of major depressive disorder and posttraumatic stress disorder and having talked to teacher and religious leader about the attack. 3) The presence of mental health professionals or procedures in schools seems to be associated to the area in which the institution is located, are more often found in nurseries and pre-schools and institutions that have professionals or procedures of other sectors of care (general health, justice and welfare). Referrals of students with mental health problems occur more frequently in schools with professionals or procedures of mental health, to the resources of the institution. Conclusions It is possible to establish a conceptual model for research on mental health services use by children and adolescents, and some methodological guidelines are suggested. Public policies on mental health of children and adolescents should include measures to promote training of professionals who are in frequent contact to children and adolescents, as teachers, pediatricians, family physicians, nurses, etc., and public awareness campaigns on children and adolescents mental health. The provision of mental health services in school environment should also be considered.
- ItemAcesso aberto (Open Access)Tratamento de tuberculose: integração entre assistência hospitalar e rede básica na cidade de São Paulo(Sociedade Brasileira de Pneumologia e Tisiologia, 2009-11-01) Perrechi, Mirtes Cristina Telles [UNIFESP]; Ribeiro, Sandra Aparecida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the level of access to health care clinics of a population of patients hospitalized for tuberculosis (TB) at two hospitals in the city of São Paulo, Brazil, comparing them with a population of TB patients under outpatient treatment only. METHODS: We compiled sociodemographic, clinical and epidemiological data related to patients hospitalized for TB at two hospitals in the city of São Paulo, Brazil, between January and December of 2007, using a structured questionnaire. We also identified the outpatient clinics to which the patients were referred at discharge. The same variables were evaluated for TB outpatients during the same period, using a database. RESULTS: The study sample consisted of 474 patients (166 inpatients and 308 outpatients: mean age, 41.0 and 39.1 years, respectively). The univariate analysis showed positive associations between hospitalization due to TB and the following variables: 30-39 year age bracket (OR = 2.17); 50-59 year age bracket (OR = 2.17); combination of pulmonary and extrapulmonary forms of TB (OR = 5.31); TB re-treatment (OR = 2.66); seeking treatment at other health care facilities prior to the diagnosis of TB (OR = 2.05); symptom duration of more than 12 weeks (OR = 2.23); and TB diagnosed at hospitals or in emergency rooms (OR = 4.68). The proportion of inpatients who resided in the same regional health district area as that in which the respective hospital was located was 77.6% and 36.8%. The proportion of discharged patients who were referred to outpatient clinics in the same areas was 67.1% and 39.7%, respectively. CONCLUSIONS: Patients hospitalized for TB should be monitored from discharge until their admission to the outpatient clinic.