Health Services In Brazil Research Articles

Responsabilidade solidária dos entes federativos pela obrigação de prestar serviço de saúde e vedação do chamamento ao processo: análise jurídica e econômica dos entendimentos do STF e STJ

O artigo aborda os atuais entendimentos jurisprudenciais sobre a responsabilidade dos entes federativos pelas prestações de serviços de saúde no Brasil e suas consequências processuais. Relaciona-se o Princípio da Solidariedade como fundamento do Federalismo Cooperativo e confronta-se seu significado com a obrigação solidária, categoria jurídica conceituada no Código Civil. Verifica-se as consequências materiais das decisões, conjugando-se o enfoque econômico ao critério de justiça, a fim de avaliar a necessidade de revisão dos entendimentos e adoção de providências legislativas, em busca da maximização de resultados.

What haematopoietic stem cell transplant patients think about health and oral care: A qualitative study in a Brazilian health service.

Differences in the perceptions of treatment between healthcare team and patients should be identified, aiming to provide a more humanised health care. We sought to understand and evaluate the concepts regarding oral health and dental care among haematopoietic stem cell transplant patients. Individual semi-structured interviews were conducted with patients, from both sexes, in the post-haematopoietic stem cell transplant stage, who underwent dental treatment. All interviews were recorded and transcribed, respecting the spelling and syntax used by the interviewees. A thematic content analysis was performed, and three themes were assessed: what is oral health, why was pre-transplant dental treatment performed, and what was the relevance of dental treatment for the haematopoietic stem cell transplant. Oral health was understood as the act of dental care through oral hygiene. The reason for performing prior dental treatment involves strict guidelines for transplants, and when questioned as to the importance of the dental treatment for transplants, the interviewed subjects' statements focused on the prevention of infections during the low-immunity stage. The individuals saw dental treatment as a step towards a successful transplant; their main concerns were not to re-establish their oral health, but rather to end the dental treatment as quickly as possible.

Analysis of Potential Drug Interactions in Brazilian Mental Health Services: Prevalence and Associated Factors

: Background: In the mental health field, the psychotropic polypharmacy is frequently observed, a significant risk factor for the occurrence of drug interactions. Objective: Identify potential drug interactions on the prescriptions of mental health services users and describe the associated factors. Methods: A cross-sectional study was conducted in 11 services. Sociodemographic data and information about the use of drug were obtained through interviews of users, analysis of prescriptions and medical charts, using a semi-structured questionnaire. Potential drug interactions were identified using the Micromedex® database, the association with sociodemographic characteristics and aspects related to the medicines prescribed were analyzed using the prevalence ratio. Results: The number of medicines prescribed ranged from 0 to 9, with an average of 3.38 (SD=1.76) per user, the most prescribed being haloperidol (12.3%), clonazepam (8.2%) and biperiden (7.9%). The proportion of interactions considering the number of users interviewed was 35.1%. The most frequent between potential interactions were haloperidol and fluoxetine (9.1%); haloperidol and carbamazepine (8.8%); and carbamazepine and chlorpromazine (5.9%). The highest prevalence ratio (PR) for the occurrence of potential interactions was in women (PR=1.36; 95% CI 1.08:1.71), users who had reported improper medicine use (PR=1.36; 95% CI: 1.07:1.72) and those with more than 5 prescribed medicines (PR=1.87; 95% CI: 1.49:2.33). Conclusion: Potential drug interactions were observed in more than one-third of the user’s Brazilian mental health services. The profile of interactions detected could guide the pharmacotherapeutic follow-up of priority users, and help the multidisciplinary team identify signs and symptoms that can influence the treatment of users.Key words: Drug interactions, Drug prescriptions, Psychotropic drugs, Mental health, Mental health services.

Avaliação dos serviços ambulatoriais de assistência a pessoas vivendo com HIV no Sistema Único de Saúde: estudo comparativo 2007/2010

Health services play a crucial role in reaching the 90-90-90 target of controlling the HIV epidemic. This study evaluates the organization of Brazilian health services in improving, monitoring, and retention in HIV care and adherence support. Percentage variation (PV) was used to compare the responses by services to an evaluation questionnaire on organizational quality (Qualiaids) in 2007 and 2010. The study analyzed the 419 services that completed the questionnaire in 2007 (83.1% of respondents) and 2010 (63.6%). Management actions of retention and support although increased in the period, but remained at low rates, for example: systematic meetings for case discussion (32.7% in 2010; PV = 19.8%) and recording of missed medical appointments (35.3%; PV = 36.8%). Patient care actions related to adherence to ART remained largely exclusive to the attending physician. The supply of funds and resources from the Federal Government (medicines and specific HIV tests) remained high for the vast majority of the services (~90%). It will not be possible to achieve a significant decrease in HIV transmission as long as retention in treatment is not a priority in all the health services.

Situation of Endodontics in the Public Health Service in Brazil through the Access and Quality Improvement Program (PMAQ-CEO)

Objective: To describe and analyze the situation of endodontics in the Brazilian public service. Material and Methods: Data from questions about endodontics were divided by states and regions and organized in spreadsheets for descriptive statistical analysis, with absolute and relative data. Results: It was found that the northern region of Brazil concentrates the smaller number of services (6.4%). Pre-established protocols with basic attention to the endodontics specialty are applied in 73.3% of CEOs. Overall, 24% of services use rotating instruments and 38% use apical locators; 87.4% perform endodontic treatment in teeth with 3 or more roots. In these centers, 75.7% of dentists who perform endodontics are specialists, masters or PhD in dentistry. Endodontics has the highest absenteeism rate and the longer waiting time to initiate treatment compared to the other basic specialties. Conclusion: The endodontics situation of the resulting PMAQ-CEO revealed that the specialty is the most requested, but services lack more effective management mechanisms to minimize the observed absenteeism problem by reducing existing waiting lines. The situation also revealed that endodontics services at CEOs are provided by specialists, almost half of the services perform single session treatment on vital pulp teeth and that the same proportion of CEOs use apical locators and / or rotating instruments to perform endodontic treatment. Investments in the installed capacity, permanent management and education are still needed to improve the quality of services provided to the population.

Saberes de puérperas sobre o planejamento reprodutivo

O estudo objetivou identificar saberes de puérperas sobre o planejamento reprodutivo. Trata-se de um estudo descritivo e exploratório, com abordagem qualitativa e enfoque na Teoria do Autocuidado de Dorothea Orem. A coleta de dados ocorreu em unidades de saúde da família de um município da região médio norte de Mato Grosso, no período compreendido entre junho e julho de 2016, junto a 17 puérperas, por meio de entrevista semiestruturada gravada. Para análise dos dados utilizou-se a análise de conteúdo. Observou-se que o planejamento reprodutivo não está sendo realizado integralmente, bem como a constatação de ausência de acompanhamento gestacional pelo enfermeiro durante o processo gravídico-puerperal. Esse comportamento profissional tende a representar problemas na adesão às práticas de autocuidado nessa fase e induzir as mulheres e seus parceiros a atitudes pouco seguras. Por fim, verificou-se que o planejamento reprodutivo é pouco conhecido pelas mulheres do estudo e há forte relação com a inércia dos profissionais. Assim, novos estudos devem ser realizados, verificando as relações dos profissionais com as novas configurações familiares, libertando da hegemônica concepção de controle de natalidade e esterilidade, tão presente nos ambientes assistenciais dos serviços de saúde brasileiros.

The work process and care production in a Brazilian indigenous health service

Abstract Objective: To understand the constitutive elements of the work process and care production in an Indigenous Health Support Service. Methods: Case study. Systematic observation and semi-structured interviews were conducted in January and February of 2012. The participants were 10 nursing professionals of an Indigenous Health Support Center, located in Mato Grosso do Sul state, Brazil. The work process was used as a conceptual and analytical category. Results: Through interpretative analysis, the data were organized into three categories. The results showed that care production was focused on procedures and guided by rigid institutional rules and bureaucracy. The prioritization of institutional rules and procedures was detrimental to the provision of person-centered care. Conclusion: The temporary employment contracts and rigid bureaucratic organization generated a tense work environment. These aspects do not maximize the efforts of the nursing staff to provide person-centered care.

Cognitive and functional assessment about elderly people users of health public service

Abstract Objective: To evaluate the functional capacity, cognition and mood in three different care models for older adults. Method: A cross-sectional study conducted in 2014 with 140 older adults (37 institutionalized, 53 hospitalized and 50 outpatients). The MMSE, Clock Drawing Test (CDT), Activities of Daily Living Scale - ADLs (Katz, Lawton) and the Geriatric Depression Scale (GDS) were applied. Results: Of those institutionalized, the majority were totally dependent for ADLs and 100% presented cognitive decline. Of those hospitalized and the outpatients, the majority were independent for ADLs, with 62.3% and 48.0% presenting cognitive decline, respectively. The minority presented depressive symptoms. The results indicated that age was a predictor of cognitive decline and the likelihood of prevalence in hospitalized and outpatient older adults increased by 8.7% for each year of life. Conclusion: It is important to pay attention to the cognitive and functional performance of older adults with the aim of preventing their decline, which is so frequent in the public health services in Brazil.

Permanent professional education in healthcare services

Abstract Objective: To analyze the literature on permanent education, identifying the conceptual evolution and its application in health services in Brazil. Method: An integrative review of the literature was performed. A total of 54 studies written in English, Portuguese and Spanish, published from January 1970 to May 2016 from the databases of the Virtual Health Library, were included. Results: Conceptual problematization was highlighted as a contribution to educational actions, indicating a conceptual development of permanent education in Brazil. However, permanent education actions sometimes occur independently from the work process. There are difficulties in understanding and application, with repercussions for health services, revealing that professionals' and managers' commitment is a challenge. Implications for practice: Continuing education is a field that lacks investments for the transformation of reality in the health service routine in Brazil.

Knowledge, behaviour and microbial load of workers handling dental solid waste in a public health service in Brazil.

Healthcare wastes are those generated inside healthcare services, including dental clinics. Workers coming into close proximity to hazardous healthcare waste are potentially at risk. In an attempt to assess the knowledge and attitudes of workers dealing with infectious waste, a questionnaire was administered. The biological risk was investigated by evaluating the microbial load and screening some clinically relevant micro-organisms in the nasal mucosa, hands and coats of these workers. The results showed that 66.6% of the study population had incomplete primary education. Only two workers have had their blood tested to confirm anti-HBs levels. Microbial load evaluation on hand surfaces of morning workers showed statistically significant lower microbial loads after the workday when compared with the beginning of the work period. It is important to highlight that some clinically relevant bacteria, such as Pseudomonas aeruginosa and Klebsiella pneumoniae were isolated from worker's hands. This study revealed the need for more training programmes regarding awareness of safe waste disposal protocols and also the necessity of discussing vaccination and its implications. Data regarding microbial loads of the worker's hands, mostly at the beginning of the workday when handwashing is recommended worldwide, emphasise that hygiene measures should receive more attention during training exercises.

The opinion of children and their parents about four different types of dental restorations in a public health service in Brazil.

To investigate the opinion of children and their parents of four different types of restoration placed in primary molars. A mixed method study in which both children and their parents were involved. In the quantitative study, children and parents gave their opinion using a face scale about four different types of restoration immediately after placement, evaluating how satisfied they were. In the qualitative part, children and their parents were interviewed to report their preference among the four types of restoration using dental models and photos. In the quantitative study, 1045 restorations were placed, being conventional restorations (198 with amalgam and 205 with composite resin) and atraumatic interventions [408 with glass ionomer: ART, atraumatic restorative treatment, and 234 with preformed metal crowns (PMCs): Hall technique]. Almost all participants (children and parents) gave a positive opinion (from 94.9 to 100%) on the four types of restoration placed in the children's teeth. There was no statistical significant difference in opinion in terms of acceptance of the four types of restoration placed (Chi square test, p value>0.05). In the qualitative approach, 18 children and 11 parents were interviewed. If they could choose, children (16/18) preferred the PMCs, while parents (10/11) preferred aesthetic materials such as composite resin and glass ionomer cement. A high degree of satisfaction was observed with children and their parents in the four types of restoration after placement. However, if it could be chosen in advance, children prefer the PMCs and parents a tooth-coloured material.

Use of and access to health services in Brazil, 2013 National Health Survey.

ABSTRACTOBJECTIVE To analyze the use of health services in the Brazilian population by sociodemographic factors, according to data from the 2013 Brazilian National Health Survey.METHODS The study analyzed data from 205,000 Brazilian citizens in all age groups who participated in the Brazilian National Health Survey, a cross-sectional study carried out in 2013. Prevalence and confidence intervals were estimated for indicators related to access to and use of health services according to age group, level of education of head of household, and Brazilian macroregions.RESULTS Among individuals who sought health services in the two weeks prior to the survey, 95.3% (95%CI 94.9–95.8) received care in their first visit. Percentages were higher in the following groups: 60 years of age and over; head of household with complete tertiary education; living in the South and Southeast regions. In addition, 82.5% (95%CI 81.2–83.7) of individuals who received health care and prescriptions were able to obtain all the necessary medicines, 1/3 of them from SUS. Less than half the Brazilian population (44.4%; 95%CI 43.8–45.1) visited a dentist in the 12 months prior to the survey, with smaller percentages among the following groups: 60 years of age or older; head of household with no education or up to incomplete elementary; living in the North region of Brazil.CONCLUSIONS People living in the South and Southeast regions still have greater access to health services, as do those whose head of household has a higher level of education. The (re)formulation of health policies to reduce disparities should consider differences encountered between regions and social levels.

Methodological challenges in the use of focus groups with people with severe mental illness.

This study addresses the practical, methodological and ethical challenges that were found in three studies that used focus groups with people with severe mental illness, in the context of community mental health services in Brazil. Focus groups are a powerful tool in health research that need to be better discussed in research with people with severe mental illness, in the context of community mental health facilities. This study is based on the authors' experience of conducting and analyzing focus groups in three different cities - Campinas, Rio de Janeiro and Salvador - between 2006-2010. The implementation of focus groups with people with severe mental illness is discussed in the following categories; planning, group design, sampling, recruitment, group interview guides, and conduction. The importance of connecting mental healthcare providers as part of the research context is emphasized. Ethical issues and challenges are highlighted, as well as the establishment of a sensitive and empathic group atmosphere, wherein mutual respect can facilitate interpersonal relations and enable people diagnosed with severe mental illness to make sense of the experience. We emphasize the relevance of the interaction between clinical and research teams in order to create collaborative work, achieve inquiry aims, and elicit narratives of mental health users and professionals.

Socioeconomic inequalities in dental health services in Sao Paulo, Brazil, 2003-2008.

BackgroundAccess to, and use of, dental health services in Brazil have improved since 2003. The increase of private health care plans and the implementation of the “Smiling Brazil” Program, the largest public oral health care program in the world, could have influenced this increase in access. However, we do not yet know if inequalities in the use of dental health services persist after the improvement in access. The aims of this study are to analyze socioeconomic differences for dental health service use between 2003 and 2008 in São Paulo and to examine changes in these associations since the implementation of the Smiling Brazil program in 2003.MethodData was obtained via two household health surveys (ISA-Capital 2003 and ISA-Capital 2008) which investigated living conditions, lifestyle, health status and use of health care services. Logistic regression was used to analyze associations between socioeconomic factors and dental services use. Additionally, trends from 2003 to 2008 regarding socioeconomic characteristics and dental health service use were explored.ResultsOverall, dental health service use increased between 2003 and 2008 and was at both time points more common among those who had higher income, better education, better housing conditions, private health care plans and were Caucasian. Inequalities in use of dental health care did not decrease over time. Among the reasons for not seeking dental care, not having teeth and financial difficulty were more common in lower socioeconomic groups, while thinking it was unnecessary was more common in higher socioeconomic groups.ConclusionsThe Brazilian oral health policy is still in a period of expansion and seems to have contributed slightly to increased dental health service use, but has not influenced socioeconomic inequalities in the use of these services. Acquiring deeper knowledge about inequalities in dental health service use will contribute to better understanding of potential barriers to reducing them.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1928-y) contains supplementary material, which is available to authorized users.

The Brazilian Community Mental Health Care Services: Social Inclusion and Psychosocial Rehabilitation

A series of transformations have occurred in Brazilian mental health services, for which psychosocial care centres (CAPS) are a care device. This study aims to examine the potentials and limitations of this Brazilian service model for promoting the social inclusion of people with mental health problems. A qualitative research methodology was used. A semi-structured interview was developed and then carried out with 29 service users and people in their social network. Discourse analysis was used for data comprehension. Besides the participation and interaction provided by CAPS, many service users had no other social options. Nonetheless, CAPS are a good starting point for social integration, offering new options for the everyday life for people with mental health problems. However, other health services and society as a whole must participate in this process, creating a context more favourable for the social inclusion of people with mental health problems.

Qualitative Epistemology: A scientific platform for the study of subjectivity from a cultural-historical approach

This article contributes to the platform of thought proposed by Gonzalez Rey in the development of qualitative epistemology and the theory of subjectivity. We discuss three core aspects: firstly, the general epistemological problems of modern science, with its non-critical, non-theoretical scientific ideals, and low reflexivity; secondly, we propose Qualitative Epistemology as an alternative for the study of subjective processes and their complexity, explaining its fundamental principles and its scientific legitimacy. Finally, we present a set of interpretive constructions based on several cases from a Brazilian mental health service to illustrate the logic in the production of knowledge in Qualitative Epistemology. In this theoretical-empirical type of production, we show the heuristic value of this theoretical-epistemological framework to study phenomena that can only be understood and intervened using an approach that is equal as complex. This epistemological perspective could be useful for research around childhood and adulthood education, health, as well as other cultural processes, such as organisational and political dynamics. The human character of research is emphasised, or in other words, its intrinsically subjective dimension.International Research in Early Childhood Education, vol. 7, no. 1, p. 161-181

Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil.

This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

Time trend of lack of access to health services in Brazil, 1998-2013.

to analyze the time trend on the demand and lack of access to public health services in Brazil. this is a panel of cross-sectional studies with data of the National Household Sample Survey (1998, 2003, 2008) and the National Health Survey (2013); the prevalence of demand and lack of access within the fifteen days prior to the survey was estimated; Poisson regression was used for trend analysis. the demand for health services increased from 13.0% (95%CI 12.3;13.7), in 1998, to 15.0% (95%CI 14.5;15.4), in 2013; the lack of access remained stable, being of 3.7% (95%CI 3.2;4.2) in 1998 and 4.5% (95%CI 4.0;5.0) in 2013. the increase in demand for health services and the stability in the lack of access indicate improvements in the Brazilian public health system performance; additional efforts are required to ensure universal access to public health services in Brazil.

Contribuições da Enfermagem na adesão ao tratamento da hipertensão arterial: uma revisão integrativa da literatura brasileira

Justificativa e Objetivos: A hipertensão é uma doença crônica prevalente nos serviços de saúde do Brasil e a enfermagem é corresponsável no desenvolvimento de estratégias que visem melhorar a adesão do hipertenso ao tratamento. Objetivou-se verificar as contribuições da equipe de enfermagem, atuante em Unidades Básicas de Saúde, para facilitar a adesão ao tratamento da hipertensão. Conteúdo: Realizou-se uma revisão integrativa da bibliografia brasileira do tipo descritiva e qualitativa, realizada a partir de 17 artigos científicos, publicados em periódicos nacionais em Língua Portuguesa entre os anos 2010 e 2015, indexados nas Bases de Dados da Biblioteca Virtual em Saúde/BIREME, Medline, Lilacs e SciELO. Conclusão: Percebeu-se o uso de estratégias que envolvem a participação de equipe multiprofissional e da família, sendo que estas remetem à educação em saúde, na maioria das vezes realizadas pelos profissionais de enfermagem, evidenciando então estes profissionais como protagonistas de práticas que facilitam a adesão do cliente ao tratamento anti-hipertensivo.

Decision making and senior management: the implementation of change projects covering clinical management in SUS hospitals.

This paper analyses the decision making process for senior management in public hospitals that are a part of the National Health Service in Brazil (hereafter SUS) in relation to projects aimed at changing clinical management. The methodological design of this study is qualitative in nature taking a hermeneutics-dialectics perspective in terms of results. Hospital directors noted that clinical management projects changed the state of hospitals through: improving their organizations, mobilizing their staff in order to increase a sense of order and systemizing actions and available resources. Technical rationality was the principal basis used in the decision making process for managers. Due to the reality of many hospitals having fragmented organizations, this fact impeded the use of aspects related to rationality, such as economic and financial factors in the decision making process. The incremental model and general politics also play a role in this area. We concluded that the decision making process embraces a large array of factors including rational aspects such as the use of management techniques and the ability to analyze, interpret and summarize. It also incorporates subjective elements such as how to select values and dealing with people's working experiences. We recognized that management problems are wide in scope, ambiguous, complex and do not come with a lot of structure in practice.