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- ItemAcesso aberto (Open Access)Análise da viabilidade econômica da unidade móvel de um serviço de referência em oftalmologia(Conselho Brasileiro de Oftalmologia, 2005-10-01) Lima, Luiz Henrique Soares Gonçalves De; Sousa, Luciene Barbosa De [UNIFESP]; Hospital Oftalmológico de Sorocaba; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To analyse the economic viability of a mobile eye clinic of a tertiary referral Ophthalmology Service. METHODS: The amount of money spent with the purchase and construction of the unit in 2000, and the expenses with its maintenance and operation in 2001 were considered, comparing these expenses with the income obtained from appointments, supplementary tests and eye surgeries through the Sistema Único de Saúde (a health care service provided by the government), in 2001. In order to make an economic analysis, an interest rate of 10% per year and a period of depreciation of 10 years were stipulated. RESULTS: The total amount spent to buy and set up a mobile unit of Hospital Oftamológico de Sorocaba was R$ 184,140,00. The amount spent with its maintenance and operation during 2001 was R$ 28,000.00. The unit was used on average during 2 days each week in 2001 and 6492 appointments were made in this period, generating an income of R$ 32,460.00. The appointments generated complementary tests and eye surgeries making up R$ 51,540.00. Therefore, the total amount received directly with the appointments, complementary tests and eye surgeries during 2001 was R$ 84,000.00 paid by the Sistema Único de Saúde, according to values established beforehand. Using these values it is possible to make an economic analysis of this enterprise and this was done with and without money savings for depreciation, taking into account the income and the expenses. CONCLUSION: Besides attending poor communities that are located in distant neighborhoods, a mobile eye clinic can be a source of income for ophthalmologic services.
- ItemAcesso aberto (Open Access)Apontamentos socioantropológicos sobre comunidade e saúde(Faculdade de Saúde Pública da Universidade de São Paulo, 2006-06-01) Gomes, Mara Helena de Andrea [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The notion of community utilized by planners and healthcare providers is doubly deceptive. On the one hand, it presupposes apparent equality and absence of conflicts between people in the same population group. On the other hand, it supposes a certain possibility of intervention by healthcare services in relation to behavioral patterns that are considered undesirable, from the point of view of disease control or health promotion. Used this way, this concept ends up concealing the social nature of the target population: poor people and the setbacks that their condition of poverty causes. To bring to light the problem of the euphemism implicit in this notion of community, the objective of the present article was to present Simmel's radically relational approach for characterizing the subordination of these population groups to healthcare policies and programs. For this purpose, the starting point was the appropriation of the sociological notion of community by the healthcare services, from Tönnies' classic formulation and its influence on the authors of the Chicago school.
- ItemAcesso aberto (Open Access)Avaliação clínica fonoaudiológica, integralidade e humanização: perspectivas gerais e contribuições para reflexão(Sociedade Brasileira de Fonoaudiologia, 2007-12-01) Goulart, Bárbara Niegia Garcia de; Chiari, Brasilia Maria [UNIFESP]; Centro Universitário Feevale Instituto de Ciências da Saúde; Universidade Federal de São Paulo (UNIFESP)Clinical evaluation is an important instrument for the speech-language pathologist (SLP) successful approach. The aims of this article are: to present some issues concerning the SLP's assessment and approach; contribute to the discussions about SLP's clinical practice; provide some input to the considerations about the individual approach that is possible to each SLP, for better interpersonal contact with the patients and their families in accordance with their peculiarities and demands. With SLP assessment it is possible to achieve a functional communication diagnosis and design an intervention plan. Several studies published in other health related sciences show evidence on the need to review the way the relations between health professionals, patients and their families have been established. Clinical assessment has enormous importance in the SLP approach and constitutes one of the first contacts of the patient and their family with the SLP. Therefore, it is important that these questions are considered in this initial stage of the SLP clinical performance. So, it is crucial that the evaluation management and its correlates receive more attention by SLP undergraduate students, professors and tutors. Also, evaluations of the speech-language and audiology treatment progress must be considered at all times.
- ItemAcesso aberto (Open Access)Avaliação da resolutividade e da satisfação da clientela de um serviço de referência secundária em oftalmologia da Universidade Federal de São Paulo (UNIFESP) - UNIFESP(Conselho Brasileiro de Oftalmologia, 2003-01-01) Gentil, Rosana Maura; Leal, Sandra Maria Reis [UNIFESP]; Scarpi, Marinho Jorge [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)In developing countries blindness prevalence could be reduced if access to ophthalmic assistance for the population were not impaired by the lack of organization of the resources. Besides the primary level, organization of ocular care establishes secondary and tertiary care levels, according to the complexity of the diagnosis and treatment of the ocular diseases. The Ophthalmic Secondary Reference Center (CERESO) of the Department of Ophthalmology, Federal University of São Paulo, according to an internal flow model of assistance, selects cases of low complexity to be seen on the same day, the others being referred to the tertiary level. PURPOSE: To evaluate CERESO's resolution and its user's satisfaction. METHODS: By means of applying a questionnaire based on the resolution of the main complaint and for the client's satisfaction, a sample of 238 users was interviewed from February to July, 1998. RESULTS: CERESO's resolution degree was 85.96%; the user's satisfaction was 100%; 6.8% of the users chose CERESO because it was close to their homes; 21.3% because they could be seen on the same day; 13.9% because they were already UNIFESP patients and 58.1% because they like UNIFESP or were indicated by another patient. CONCLUSIONS: The customers were very pleased with the assistance they were given, and their major aims were achieved. The organization of the ophthalmological services, with the secondary care service establishment, would certainly have a positive impact on the solution of ophthalmic problems - especially refractive errors. For this reason, this organization would case an important public health problem.
- ItemAcesso aberto (Open Access)Clinical and demographic profile of users of a mental health system for medical residents and other health professionals undergoing training at the Universidade Federal de São Paulo (UNIFESP)(Associação Paulista de Medicina - APM, 2004-01-01) Fagnani Neto, Rafael [UNIFESP]; Obara, Cristina Sueko [UNIFESP]; Macedo, Paula Costa Mosca [UNIFESP]; Citero, Vanessa de Albuquerque [UNIFESP]; Nogueira-Martins, Luiz Antonio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT: A postgraduate and resident trainee mental health assistance center was created in September 1996 within our university. OBJECTIVE: To describe the clinical and demographic profile of its users. TYPE OF STUDY: Retrospective. SETTING: Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (UNIFESP-EPM). METHODS: The study was carried between September 1996 and November 2002, when 233 semi-structured registration forms were filled out either by the psychologist or the psychiatrist during their first contact with the trainees, who were medical and nursing residents, and postgraduate students at specialization, master or doctoral levels. The registration forms included demographic, occupational and clinical data. RESULTS: The trainees were predominantly young (mean of 27 years old), single (82.0% of cases), women (79.4%), seeking help especially during the first year of training (63.1%). In 70.8% of the cases, they came to the service spontaneously. Such individuals showed greater adherence to the treatment than those who were referred by supervisors (p < 0.05). In 30% of the cases, the trainee sought psychological guidance or support at the service due to specific situational conflicts. Depression and anxiety disorders were the most frequent diagnoses; 22.3% of the trainees followed up mentioned a tendency towards suicidal thoughts. In comparison with other trainees, there was a higher prevalence of males among the medical residents (p < 0.01), with more cases of sleep disorders (p < 0.05), a smaller number of individuals refraining from the use of alcohol (p < 0.05) and a higher number of trainees requiring leave of absence (p < 0.001). DISCUSSION: The first year of training in health sciences is the most stressful, especially for women. Depression and anxiety symptoms are common, reflecting transitory self-limited deadaptation. However, the severity of the cases can also be evaluated in view of the large number of trainees who mentioned suicidal tendencies. CONCLUSIONS: This study emphasizes the need and importance of providing formal, structured and confidential mental health services for medical residents and postgraduate students from other health professions, in the training programs of academic institutions.
- ItemAcesso aberto (Open Access)Cobertura de Planos de Saúde na população brasileira, segundo a Pesquisa Nacional de Saúde, 2013(Abrasco, 2017) Malta, Deborah Carvalho; Stopa, Sheila Rizzato; Pereira, Cimar Azeredo; Szwarcwald, Celia Landmann; Oliveira, Martha; Chioro, Arthur [UNIFESP]This study aims to present the percentages of the Brazilian population holding health insurance plans, itemized by social-demographic characteristics, based on the data of the National Health Survey carried out in 2013, and to compare this information with the administrative data of the National Supplementary Health Agency for the same year. Data from the National Health Survey, and from the Beneficiaries Information System of the National Health Agency for the year 2013, were used. The percentage of people having a health plan was described according to stratification for: all of Brazil, urban/rural, Brazilian official Regions, Brazilian States and state capitals, gender, age group, level of schooling, position in the workforce, ethnic classification, and self-assessed state of health. Results include the following: The percentage of people saying they had some health plan in Brazil was 27.9% (CI 95%: 27.1-28.8). A significant difference was found relating to level of schooling - the percentage being highest for those who stated they had complete secondary education (68.8% CI 95%: 67.2-70.4) and for those who said they were currently in work (32.5% CI 95%: 31.5-33.5). The increase in health plan coverage in the Brazilian population reflects the improvement of the suply of employment and the growth in the country's economy.
- ItemAcesso aberto (Open Access)A dinâmica do aleitamento materno entre famílias em vulnerabilidade social: o que revela o sistema de busca ativa(Pontifícia Universidade Católica de Campinas, 2011-02-01) Domene, Semíramis Martins Álvares [UNIFESP]; Medeiros, Maria Angélica Tavares de [UNIFESP]; Martins, Paula Andrea [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: This study describes the breastfeeding practices of vulnerable groups living in an area covered by the Northwest Health District of Campinas (SP), Brazil. METHODS: A cross-sectional study was done by visiting all families in the studied area and performing a census-like survey called active search. An exploratory study was done of the breastfeeding practices of a socially vulnerable population living in the outskirts of Campinas. This area has approximately 165,000 inhabitants and three primary healthcare facilities. RESULTS: The survey found 1,139 children under six years of age and 72.6% of the families were below the poverty line; 93.3% of the children were breastfeed for a median of 8 months (CI 95% 7.0 - 8.9 months); exclusive breastfeeding lasts a median of 4 months (CI 95% 3.9 - 4.1 months), and more than 20% of the children were given other foods during their first month of life. Most of the families reported that the primary healthcare facilities gave them no information on breastfeeding. CONCLUSION: Breastfeeding and exclusive breastfeeding in the studied area found by active search lasted longer than the national average and longer than those of families with similar socioeconomic characteristics. This reinforces the importance of primary healthcare incorporating this strategy in actions that promote breastfeeding.
- ItemAcesso aberto (Open Access)Glycemic control in adult type 1 diabetes patients from a brazilian country city: comparison between a multidisciplinary and a routine endocrinological approach(Sociedade Brasileira de Endocrinologia e Metabologia, 2006-10-01) Mourão-júnior, Carlos A. [UNIFESP]; Sá, João Roberto de; Guedes, Olívia M. Silveira [UNIFESP]; Dib, Sergio Atala [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Juiz de Fora Departamento de FisiologiaOBJECTIVE: To evaluate the metabolic control of a cohort of adult type 1 diabetes mellitus (T1DM) patients assisted in a public Diabetes Center (DC) that follows the rules of a national diabetes society. METHODS: We compared for one year the metabolic control and the characteristics of 175 T1DM patients attended by a multidisciplinary team in a DC (test group) with 30 patients assisted only by endocrinologists at a public endocrinology outpatient center (control group). RESULTS: The test group presented a larger proportion of well-controlled patients (p= 0.002). The proportions (test x control group) were as follows: 51.4% x 16.7% in the subgroup with A1C < 7%; 21.7% x 36.7% in the subgroup with A1C between 7.1% and 8.0%; and 26.9% x 46.7% in the subgroup with A1C > 8%. Patients assisted in the DC presented a likelihood 4.38 times higher of reaching levels of A1C up to 7%. CONCLUSIONS: This study shows the effectiveness of a DC and emphasizes the importance of education, adherence and multidisciplinarity as cornerstones for the treatment, showing that in developing countries it is possible to treat T1DM with satisfactory results.
- ItemAcesso aberto (Open Access)História da evolução da qualidade hospitalar: dos padrões a acreditação(Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2005-06-01) Feldman, Liliane Bauer; Gatto, Maria Alice Fortes; Cunha, Isabel Cristina Kowal Olm [UNIFESP]; Consultoria Saúde Brasil Responsabilidade Profissional/ Hospitalar e Gerenciamento de Riscos; UNG Curso de Pós-graduação; Universidade Federal de São Paulo (UNIFESP)This work contemplates the literature revision of Quality Standardization and the evaluation process by means of Hospital Accreditation literature. A historic resume have been worked out, about the beginnings of quality evaluation within the health services, from the Hospital Standardization Program, elaborated by the American Surgeons College, in the middle of 1924, to the creation of ONA - National Accreditation Organization, who has as main goals the installation and implementation of a health assistance permanent improvement process, thus stimulating the services to reach higher quality standards. After a reflection exercise, it was considered that, in the evaluation of services, it's necessary to seek a higher value of the assistentials results, as well as the elaboration of more equanimous patterns in the structure, processes and results of the assistential quality.
- ItemAcesso aberto (Open Access)Integralidade na assistência à mulher na prevenção do câncer cérvico-uterino: um estudo de caso(Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem, 2006-09-01) Ximenes Neto, Francisco Rosemiro Guimarães; Cunha, Isabel Cristina Kowal Olm [UNIFESP]; Universidade Estadual do Vale do Acaraú; Escola de Formação em Saúde da Família; Universidade Federal de São Paulo (UNIFESP); Universidade Santo Amaro Faculdade de EnfermagemThis study aimed at analysing attention-based management based upon women's health integration in the prevention of cervical-uterine cancer, using interviews with two patients who were given care in a healthcare service in the northeast region of Brazil. In this case study the data was analysed according to the Analysis Fluxogram of the Healthcare Attention Model. In one of the cases total integration of attention scores was identified; while in the other total fragmentation of attention scores was identified. In this study the relevance of greatest attention was played by the manager in the sense of better planning, organization, and evaluation of the service's interventions in women's healthcare; services that sought efficiency, and effectiveness, assuring that the principles of the Brazilian National Health Care System are respected.
- ItemAcesso aberto (Open Access)Monitoramento das doenças crônicas: hipertensão arterial e diabetes mellitus por meio do geoprocessamento em Montes Claros-Minas Gerais(Universidade Federal de São Paulo (UNIFESP), 2016-05-31) Dias, Orlene Veloso [UNIFESP]; Ramos, Lais Helena Domingues [UNIFESP]; http://lattes.cnpq.br/3587544311218723; http://lattes.cnpq.br/1143651575805012; Universidade Federal de São Paulo (UNIFESP)As Doenças Crônicas Não Transmissíveis possuem perfil epidemiológico complexo, com características diferentes entre regiões e populações. O monitoramento dos fatores de risco dessas doenças e do estilo de vida da população fornece importantes subsídios para o gerenciamento em saúde, principalmente na fase de estabelecimento de estratégias de intervenção, com o propósito de reduzir a prevalência e a consequente redução da ocorrência de doenças. O objetivo deste estudo foi analisar as Doenças Crônicas Não Transmissíveis ? Hipertensão Arterial e Diabetes Mellitus em Montes Claros - Minas Gerais por meio do geoprocessamento. Trata-se de estudo epidemiológico, transversal de base populacional com abordagem quantitativa. A amostragem foi por conglomerado auto ponderada, constituída por 2150 adultos e idosos, residentes em Montes Claros, Minas Gerais, Brasil. Esta pesquisa envolve aspectos referentes ao acesso aos serviços de saúde, fatores de risco e estilo de vida dos usuários com Hipertensão Arterial e Diabetes Mellitus autorreferidas. Para a análise dos dados, optou-se pelo uso de testes estatísticos que envolvem a análise bivariada e a múltipla. Também foi utilizada a tecnologia de Sistema de Informação Geográfica para a espacialização dos dados. Os achados possibilitaram correlacionar a HAS e DM com as variáveis do estudo e identificar a distribuição espacial da exposição da população de Montes Claros, aos fatores de risco e o estilo de vida dos usuários acometidos por essas doenças. A prevalência da HAS e do DM em Montes Claros é semelhante ao cenário nacional. Por meio da espacialização dos dados (acesso, HAS, DM e formas de controle dessas doenças) foi possível visualizar as áreas no município de Montes Claros com maior proporção de cada variável analisada. Os hipertensos e diabéticos utilizaram mais consultas no setor público. A Hipertensão foi associada ao perfil demográfico (mulheres, sem união estável/casados e idosos), estilo de vida (ex-tabagismo, consumo de bebida alcoólica e obesidade). O DM foi associado a idosos e tomar refrigerantes. E para ambas doenças foi associada autopercepção regular ou ruim de saúde. Ao final desse estudo é possível afirmar que a associação do Inquérito Epidemiológico com o Geoprocessamento possibilita o monitoramento das doenças e seus determinantes de forma mais eficaz.
- ItemAcesso aberto (Open Access)Quality of the ophthalmological service to outpatients of the public and private healthcare systems(Consel Brasil Oftalmologia, 2017) Santos Hercos, Benigno Vicente [UNIFESP]; Berezovsky, Adriana [UNIFESP]Purpose: To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. Methods: This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Results: Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Conclusions: Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.
- ItemAcesso aberto (Open Access)A trajetória dos serviços e a atenção primária à saúde na história de vida de duas usuárias(Universidade Federal de São Paulo (UNIFESP), 2010-04-28) Sousa, Patrícia Leal [UNIFESP]; Bretas, Ana Cristina Passarella [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The Dawson report, 1920, consider a new model of organization about health services of the Primary Health Care - PHC. According to World Health Organization WHO - (1978) this model is the first level of contact of individuals, family and community with the national health system, leading the health attention to the next place where people live and work, constituting the first element of a process of continued attention to the health. With the use of the qualitative method of Thematic Oral History, this research has for objective to understand a historical trajectory of the primary care in health services, by the history of two users’ individual care in a basic unit health (UBS). Had been interviewed two users of the UBS Vila Renato, located in Sapopemba - SP, which had been called by Maria and Antônia. From the data analysis two periods of their life history had been selected: one in relation to the health care before the arrival of these women (Maria and Antônia) in São Paulo city, and another one in relation to this care while residents in São Paulo. The second moment was divided in six periods: 1983, before the inauguration of the UBS Vila Renato; between 1983 and 1987, with the beginning of the activities of the UBS Vila Renato and before implantation of the SUS; of 1988 to the 1992, with the politics of health of the SUS and the Erundina management; between 1993 and 2000, with the Plano de Atendimento à Saúde (PAS) and other actions of the health in the management Maluf and Pitta; of 2001 the 2004, with the Programa Saúde da Família (PSF) and other actions of the Health in the management Marta Suplicy e; of 2005 the 2009, with the units of Assistência Medica Ambulatorial (AMA) among others action of the Health, in the managements of mayors Serra and Kassab. During these periods, Maria and Antônia told the evolution of the service quality not only regarding the workers’ partnership but also the programs related to the actions of Primary Health Care that, depending on the current public administration, had been developed in different forms, provoking discontinuity and lack of completeness in health care. We believe that the development of actions focused on the Primary Health Care demands the managements and the workers’ commitment, aiming at the improvement in the population’s health.
- ItemAcesso aberto (Open Access)Utilização e acesso de idosos a serviços de atenção básica em Porto Alegre (RS, Brasil)(ABRASCO - Associação Brasileira de Saúde Coletiva, 2011-06-01) Paskulin, Lisiane Manganelli Girardi; Valer, Daiany Borghetti; Vianna, Lucila Amaral Carneiro [UNIFESP]; Universidade Federal do Rio Grande do Sul Escola de Enfermagem Departamento de Assistência e Orientação Profissional; Universidade Federal de São Paulo (UNIFESP)A cross-sectional study was carried out in the second semester of 2004 by means of a household survey with 292 elderly people in a Southern Brazilian city, selected by probabilistic sampling. The objectives were: to describe the use and geographic access of the elderly to primary healthcare (PHC) in Porto Alegre (RS), and to analyze the association between variables of interest to the study and access to PHC. Descriptive and bivariate analysis was used. The primary health care services were used by 49.7% of the respondents, motivated by their location, quality and free service. The factors negatively associated with the use of PHC services were level of education and perception of good health and the variable related positively was self-diagnosed chronic condition. The elderly exposed to frailty related with economic and health conditions were more likely to use PHC, showing signs of equity in the health system. On the other hand, it is necessary to broaden the coverage to the elderly that do not have access, as well as implement healthcare strategies to meet the heterogenous demands of this age group.