RESUMO
OBJECTIVE: To measure the prevalence and evaluate the risk factors of anemia. METHODS: Cross sectional populational based study of the urban area of Criciuma town, in the state of Santa Catarina, Southern Brazil. The study population was a probabilistic sample of 476 children aged under three years. RESULTS: The prevalence of anemia found in the sample was 60.4% for children aged 0 to 35.9 months according to the Brault-Dubuc criteria and 54% for children aged 6 to 35.9 months according to the OMS criteria. The prevalence of anemia increases with age up to 18 months-old and then decreases. It is less prevalent in families where the father has a higher education level and where there is a higher total family income. Nevertheless, even within the 25% higher income group 40% of the children are anemic. The prevalence of anemia is higher among children living in unfinished and overcrowded houses, where the toilet is not equipped with flush, and among children who have two or more older brothers. It is also higher among teenager mothers (<20 years), and 35 years old or older mothers. The prevalence of anemia is lower among women who had 5 to 9 prenatal visits during pregnancy. Low weight at birth was associated with iron deficiency. The nutritional condition was associated with anemia only according to weight/age criteria. Hospitalizations in the last 12 months were not associated with the disease. In the hierarchical multivariate analysis children age, family income, and crowded house were the only significant variables. Reproductive health history, health service visits, birth weight, breast-feeding, anthropometry, and morbidity did not characterize a risk factor of anemia in the multivariate analysis. CONCLUSIONS: The study makes it evident that social inequality is a strong determinant of anemia. The risk imposed by anemia to children in regard to their health and intellectual development requires immediate action.
Assuntos
Anemia/epidemiologia , Fatores Etários , Anemia/diagnóstico , Anemia/prevenção & controle , Peso Corporal , Brasil/epidemiologia , Pré-Escolar , Estudos Transversais , Feminino , Hemoglobinas/análise , Humanos , Lactente , Masculino , Prevalência , Características de Residência , Fatores de Risco , Fatores Socioeconômicos , Organização Mundial da SaúdeRESUMO
This piece analyzes the funding of the public Unified Health System (UHS) in the state of Mato Grosso, Brazil, in order to identify the model of care that has been taking shape there since 1994. We studied 16 municipalities, selected according to their size, degree of involvement with the UHS, and socioeconomic and health conditions. We found that between 1994 and 1998 there were large increases in health spending, due to higher municipal expenditures and to rising intergovernmental transfers for outpatient care. However, the health care system taking shape in a large number of Mato Grosso municipalities is increasingly focused on an individual, curative, specialized, and highly technological type of care. Indicative of this trend is the fact that the biggest increases in spending for outpatient care--up to 300% in some municipalities--have come from diagnostic and therapeutic procedures that are of medium or high complexity. Since the resources for health care are limited, and since the model of care adopted by many municipalities continues to shift resources from primary health care to more complex procedures, we believe that the financial viability of the Unified Health System is coming into question. Although this study was limited to the state of Mato Grosso, other Brazilian municipalities are no doubt facing similar situations. The same is probably true for municipalities in other South American countries that have adopted decentralization of the health care system as one of the strategies for State reform.
Assuntos
Reforma dos Serviços de Saúde , Administração em Saúde Pública/economia , Assistência Ambulatorial/economia , Assistência Ambulatorial/organização & administração , Brasil , Bases de Dados Factuais , Odontologia/organização & administração , Países em Desenvolvimento/economia , Gastos em Saúde , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Programas de Imunização/economia , Programas de Imunização/organização & administração , Medicina , Modelos Teóricos , Visita a Consultório Médico/economia , Visita a Consultório Médico/estatística & dados numéricos , Vigilância da População , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/organização & administração , Especialização , Saúde da População UrbanaRESUMO
In Brazil, in recent years, as a result of the increasing participation of county authorities in health care, a need for tools which would contribute to the better preparation of local administrators, complementary to the activities of a more academic nature, has been recognized. One of the possible alternatives is the exploitation of experiences, regarded as successful, in local health care planning and administration, by using them as material for "case studies" in activities with selected groups of health care administrators thus, stimulating the identification of those elements which contributed to the favorable results attained, and their interactions, in the quest for analogies which would facilitate the identification of new perspectives for their own situations. In this article an experience of a "case studies" development, in response to a demand from UNICEF, based on 8 counties in from the North and Northeast, which were successful in using a "focus approach" in their organization of data and their utilisation in a seminar with 21 local managers from both regions, is presented. During the seminar the local health managers attained greater knowledge of the strategies implemented and identified feasible intervention alternatives. The methodological proposition of teaching on the basis of case studies, using a conceptual strategy of grouping experiences according to specific dimensions enabled local health managers to learn from their practical experiences.
Assuntos
Administradores de Instituições de Saúde/educação , Administração de Serviços de Saúde , Capacitação em Serviço/métodos , Brasil , Currículo , Humanos , Técnicas de PlanejamentoRESUMO
INTRODUCTION: Determining the prevalence of mental disturbances in childhood and adolescence gives us a better knowledge of their distribution in a given age group and provide us data for planning, implementing and evaluating health care programs. This survey was centered on complaints of "nervous problems" in a population group ranging from 1 to 19 years old as a tool to measure mental illness prevalence in that age group. METHODS: A group of 141 children and teenagers with complaints of nervous problems participated in the study, drawn by applying questionnaires from June, 1989 to July, 1990 to a sample of 3,158 people in the age group 1-19 years old, living in the Southeast area of Grande São Paulo. It was conducted an analysis of the nature of the complaints, their referred reasons and behavior, age, and gender. RESULTS: The prevalence of complaints of nervous problems was 4.7%. The older they were the more they complained. It was noticed a male predominance in the younger group and female preponderance in the group 14 years old or older. One in five tried to get any help, and severity of their complaint was the most important predictor for that. CONCLUSION: The prevalence was due to the population's ability to identify mental illnesses and it also reflects the family understandings of these problems. As only a few sought for health care, possible causes were identified and intervention actions were proposed to satisfy the unattended needs.
Assuntos
Transtornos Mentais/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Transtornos Mentais/etiologia , Morbidade , Prevalência , Fatores SexuaisRESUMO
This study aims to identify the generic competence required of doctors and nurses working in a primary health care. It was based on a series of 3 round of the Delphi technique which identified 8 generic competencies: ability to communicate, ability to be community oriented, ability in teamwork, management skills, educational skills, ability to problem solving, professional skills, ability to make-decision. Only the competence management skills there was not consensus by doctors. They disagree that this competence is required by them working in primary health care.
Assuntos
Atitude do Pessoal de Saúde , Corpo Clínico/educação , Corpo Clínico/psicologia , Recursos Humanos de Enfermagem/educação , Recursos Humanos de Enfermagem/psicologia , Atenção Primária à Saúde/normas , Competência Profissional/normas , Comunicação , Técnica Delphi , Avaliação de Desempenho Profissional , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Relações InterprofissionaisRESUMO
OBJECTIVE: The relationship between the structure of the health center and the population seeking comprehensive health care. METHOD: It was studied a health center of the county of S. Paulo (Brazil) in the period of 1989 to 1992. The speech of managers at three levels, regional, district and local, as well as the speech of physicians who were working at the Primary Health Care Units, was analysed. The concept of comprehensive care covers five dimensions: 1) the individual and not the illness itself as the primary aim; 2) the individual or group as a whole; 3) the intervention provided by other types of care; 4) different treatment for those who live in different situations; 5) the intervention in the general living conditions of the population. RESULTS: It was concluded that the relationship between the district structure and the seek for comprehensive care was dependent on the following: health planning, emphasizing a wider view of the real life situation of the population connected to the Primary Health Care Unit; the kind of interaction between different members of the staff; better organization of the work and of the reference and counter-reference networks and a good relationship with other health departments, thus making possible better comprehensive care. COMMENTS: Being a local care unit does not enable the health district to meet the challenge of being the "locus" of knowledge, work and power as between the population and the workers and among the different groups within these two sectors.
Assuntos
Administração de Instituições de Saúde , Brasil , Prestação Integrada de Cuidados de Saúde , Assistência Técnica ao Planejamento em Saúde , Serviços de Saúde , Programas Nacionais de Saúde/organização & administraçãoRESUMO
The shared management put into effect by the "Ações Integradas de Saúde" (Integrated Health Actions) in the State of S. Paulo (Brazil), in the early 80s is analysed. The relevant data were collected from the minutes of the meetings of the "Comissão Interinstitutional de Saúde" (Interinstitutional Health Committee). The data collected show the most frequent subjects discussed by the members at the meetings, the number of members related to each of the different government levels, in addition to the kind of resolutions taken at the meetings. The data analysis has demonstrated that important changes took place in public health management in the State of S. Paulo in the decade in question. The shared management process was replaced by one in which government powers were clearly divided a towards the end of the 80s. Those changes have led the public health members from each level of governmental administration to give up the common goals and the shared negotiations among them.
Assuntos
Atenção à Saúde/organização & administração , Administração em Saúde Pública , BrasilRESUMO
A working proposal for the integration of the activities of public health assistance is presented. Two health clinics in the city of S. Paulo, Brazil, were studied. Taking as a starting-point that all activity in the health sector depends on community participation, this study sought to discover how the population has received and used the geographically integrated health services. For this purpose, information was collected from the users of both of these services, by means of a questionnaire, as to the motive for the use of the service, the service's ability to meet the need, the degree of user-satisfaction, etc. The analysis of the above information as well as of the objective and the working method of these services, leads to the conclusion that they are used by the public in a selective way for the purpose of meeting immediate needs related to present illnesses.