Health Units Research Articles

Prevalence of Trichomonas vaginalis Infection in Women Screened for Precursor Lesions of Cervical Cancer in a Brazilian Population

Trichomonas vaginalis infection is one of the most prevalent curable STIs. Although treatments are available, T. vaginalis infections pose a significant challenge, especially in resource-limited regions, as the prevalence of this STI is often unknown. We aimed to determine the prevalence of Trichomonas vaginalis infection in women screened for cervical cancer precursor lesions in Botucatu in São Paulo, Brazil. We conducted a descriptive and retrospective study that included 23,735 women who attended the cervical cancer screening program at health units in 2019 and 2022. Clinical and sociodemographic data were collected from the cancer information system (SISCAN) and test requisition forms. Descriptive analysis was conducted, and comparisons were performed using the X2 Test and Student’s t-test (SigmaPlot version 13.0). The prevalence of T. vaginalis infection was 0.84% in 2019 and 0.57% in 2022. The mean age of patients with trichomoniasis was 42 (±11.2) years; 75% self-reported as white, 43% were married or in a stable relationship, and 40% had not completed primary education. Regarding the vaginal microbiota, only 15.3% of the cytology exams with infection by T. vaginalis showed a predominance of lactobacilli species, while inflammation was present in 82% of the smears. Cytological analysis revealed precursor lesions of cervical cancer in 0.05% of patients with trichomoniasis, including ASC, LSIL, and HSIL. The study showed a low prevalence of infection with T. vaginalis in low-risk women screened for precursor lesions of cervical cancer in Botucatu in São Paulo, Brazil.

Demanda por serviços de saúde durante a pandemia de Covid-19: estudos de base populacional

Objective: To evaluate the demand for health services during the Covid-19 pandemic and its associated factors. Methods: A population-based cross-sectional study was conducted in two cities in southern Brazil: Criciúma, in the state of Santa Catarina, and Rio Grande, in the state of Rio Grande do Sul. The study included individuals aged 18 years and older residing in urban areas of these municipalities. Participants self-reported their health service utilization and the type of service sought. Sociodemographic, behavioral, and health-related variables were examined as exposures. Poisson regression was used to analyze the adjusted associationsbetween service demand and exposure variables. Results were presented as prevalence ratios (PR) with 95% confidence intervals (95% CI). Results: A total of 2,167 individuals were analyzed. Approximately 25% of participants reported experiencing at least one Covid-19-related symptom. Among these, 51.3% soughthealth services, with Basic Health Units being the most frequently sought (46.7%). Health service demand was higher among individuals aged 50 to 59 years (PR=1.60; 95% CI 1.18, 2.17), those with higher education (PR=1.52; 95% CI 1.13, 2.03), those who engaged in physical activity (PR=1.29; 95% CI 1.07, 1.59), and those who had contact with someone who tested positive for Covid-19 (PR=1.76; 95% CI 1.40, 2.21). Conclusion: The results highlight two distinct population groups: those with greater exposureto Covid-19 and those more attentive to health care. Additionally, the Basic Health Unit was the most sought-after service, underscoring the importance of Primary Care and the Unified Health System in addressing the pandemic in Brazil.

Ugandan optometry students’ experiences of their clinical training: a qualitative study

BackgroundThere is a gradual increase in the number of optometry education programs in Africa yet there is limited knowledge on optometry students’ experiences of their clinical training. Therefore, the purpose of this study was to explore the optometry students’ experiences of their clinical learning environment at a national referral and teaching hospital in Uganda.MethodsBetween April 2023 and May 2023, face to face in-depth interviews were conducted to explore the experiences of the participants. All 16 optometry students in fourth-year at university were purposefully recruited into the study. Data was collected at the end of the students’ clinical training at the eye clinic of a national referral and teaching hospital. Interviews were audio recorded and transcribed for analysis using an inductive thematic approach.ResultsTwo themes, learning at the eye clinic and organization of the eye clinic, were identified to represent participants’ experiences. Each theme had three sub themes.ConclusionTraining optometry students at an eye clinic enhances their clinical skills and knowledge of diagnosing and managing various eye conditions. Future studies should compare optometry students’ experiences in lower-level health units to those in national referral hospitals.

Improving the Use of Sensory Approaches in an Acute Inpatient Mental Health Unit Using a Co-Designed Multifaceted Implementation Strategy.

Despite the therapeutic benefits of sensory approaches being well documented, little research has focused on improving their implementation in acute mental health units. The use of implementation frameworks to improve the use of evidence-based practices has shown promising results in healthcare; however, there is little evidence for their use in acute mental health units. A pre-post comparison design was used to determine the effect of an 11-month co-designed theory-informed multifaceted implementation strategy on the use of sensory approaches and the use of seclusion/restraint in one acute mental health ward. This study was guided by Integrated Knowledge Translation (IKT) and informed by the Behaviour Change Wheel (BCW) approach. Implementation strategies were co-designed and included provision of sensory materials/resources; education/training; prompts/reminders; modelling; audit and feedback; workplace coalition; and facilitation. Data were collected through pre- and post-project questionnaires (pre- n = 37, post- n = 40) and routine clinical data. Data were analysed using SPSS and thematic analysis. Data for matched pairs (n = 19) revealed significant improvements between pre- and post-perceived levels of knowledge and confidence in using sensory approaches. Significant increases were found in the use of sensory kits, weighted modalities and sensory assessment/plans. Post participants' recommendations to sustain the use of sensory approaches in their unit included ongoing training; funding; maintenance and supply of sensory equipment; increased staffing; and support from colleagues. This is the first study to use the IKT and BCW to design, facilitate and evaluate a co-designed, theory-informed implementation strategy to improve the use of sensory approaches in an acute mental health unit.

Legal abortion performed by pre-teens: primary health care workers’ perception and knowledge

This study aims to put into evidence Distrito Federal’s (DF) primary health care workers’ perception and knowledge regarding legal abortion, performed by 10 to 14 year old pre-teens. This is a descriptive study of qualitative approach. Semi-structured interviews were done to 17 primary health care workers currently working in Basic Health Units (BHU) of DF, under contract with DF’s Secretariat of Health. This article showed the worker’s lack of knowledge regarding legal abortion and specific care towards the age group, copying their knowledge regarding adults without adaptation for pre-teens. Workers’ personal beliefs influenced their practice and their choice to correctly inform Health Care users.

Hydro-geochemistry and age-dependent health risk assessment of nitrate, nitrite, and fluoride in health facilities water: a multivariate analysis.

Groundwater from alluvial fan plains is the prevailing water source, especially for arid/semiarid regions, but its contamination poses substantial risks to water supply and public health. The recent study aims to assess the hydro-geochemistry, distribution, and potential health risks of NO3-, NO2-, and F- concentrations in the groundwater of previously unexplored health facilities in District Vehari, Punjab, Pakistan. In total, 75 groundwater samples were evaluated for NO3-, NO2-, and F- levels as well as pH, EC, TDS, CO32-, HCO3-, Cl-, Na+, Fe, K+, Ca2+, Mg2+, taste, odor, color, and turbidity. The Durav graph shows that the water type is Na-HCO3-Ca, with Na and HCO3 dominant, weak acids > strong acids, and alkaline ions > alkalis. Results revealed that drinking water samples (21.73% and 20%) taken from Tehsil Mailsi, and the Basic Health Unit (BHU) exceeded the WHO standard (1.5mg/L) for F- concentration, respectively. Moreover, the mean chronic daily intake (CDI) of F- was 0.044, 0.018, and 0.02mg/kg/day in children, men, and women, respectively. Similarly, the average CDI of NO3- was 0.113, 0.046, and 0.050 in children, men, and women, respectively, and the respective values of NO2- were 0.004, 0.001, and 0.001. The NO2- shows a significant range of hazard quotient (HQ) (0.0-1.172) in children. The range of HQ for F- was 0.0-3.114, 0.0-1.290, and 0.0-1.389 in children, men, and women, respectively. Additionally, the health risks analysis revealed an HQ > 1.0 for children in groundwater, indicating a potential carcinogenic risk from the F-. Pearson correlation and PCA analysis found a significant positive correlation (0.8) between NO3- and NO2- and a negative correlation (0.3) between F- and HCO3-. These findings highlight the need for groundwater treatment in healthcare facilities prior to water consumption. Enforcing international and national drinking water standards in healthcare units is vital to strengthening services and providing equitable access to safe drinking water. Legislative and efficient water management measures must be taken for the protection of public health.

Effects of pay for performance in primary care in an under-registration scenario.

To propose a method for detecting and analyzing under-registration and highlight its potential financial effect in view of the implementation of the Previne Brasil Program. An ecological study was carried out to analyze cytopathological exams in programmatic area 3.1 in the municipality of Rio de Janeiro. The data was collected from the Departamento de Informática do Sistema Único de Saúde (DATASUS - Department of Informatics of the Unified Health System) database, including information on reports from outsourced cytopathology laboratories and those available in the Sistema de Informação em Saúde para a Atenção Básica (SISAB - Health Information System for Primary Care) and the Sistema de Informação do Câncer do Colo do Útero (SISCOLO - Cervical Cancer Information System) of DATASUS/Ministry of Health. The estimated under-registrations per health unit totaled 108,511 exams in the last two years in the programmatic area 3.1 area, which corresponds to an estimated total of R$ 435,129.00 that would have been foregone if the Previne Brasil Program had been in place during the period studied. The article's main contribution lies in the presentation of empirical evidence of the potential effects of under-registration on Primary Health Care financing. In addition, there are two other significant findings - firstly, it highlights weaknesses in the process of recording health information inherent to vulnerable regions; secondly, it indicates a vicious circle potentially fueled by sudden changes in Primary Health Care funding conditions, in addition to potential consequences for other levels of care.

Lung cancer and smoking: years lived with disability in Tuscany (Italy). An analysis from the ACAB study

BackgroundLung cancer (LC) is among the most common neoplasms, mostly caused by smoking. This study, carried out within the ACAB project, aims to provide local, updated and systematic estimates of years lived with disability (YLD) from LC due to smoking in the Tuscany region, Italy.MethodsWe estimated YLD for the year 2022 for the whole region and at subregional level by local health unit (LHU) using data from the Tuscany Cancer Registry and local surveys. YLD were calculated by applying the severity-specific LC prevalence, estimated with an incidence-based disease model, to the corresponding disability weight. The burden from smoking was computed by: modelling the prevalence of smokers with a Bayesian Dirichlet-Multinomial regression model; estimating the distribution of smokers by pack-years simulating individual smoking histories; collecting relative risks from the literature.ResultsIn 2022 in Tuscany, LC caused 7.79 (95% uncertainty interval [UI] = 2.26, 17.27) and 25.50 (95% UI = 7.30, 52.68) YLDs per 100,000 females and males, respectively, with slight variations by LHU, and 53% and 66% of the YLDs were caused by smoking.ConclusionThe updated estimates of the burden of LC attributable to smoking for the Tuscany region as a whole and for each LHU provide indications to inform strategic prevention plans and set public health priorities. The impact of smoking on YLDs from LC is not negligible and heterogeneous by LHU, thus requiring local interventions.

A Group Parenting Intervention for Male Postpartum Depression

Male postpartum depression is prevalent across populations; however, there is limited evidence on strategies to address it, particularly in low-income settings. To evaluate the effectiveness of Learning Through Play Plus Dads (LTP + Dads), a nonspecialist-delivered psychosocial intervention, in improving symptoms of male postpartum depression compared to treatment as usual. This cluster randomized clinical trial was conducted in Karachi, Pakistan, between June 2018 and November 2019. Assessors were blind to treatment allocation. Participants were recruited from 2 large towns in the city of Karachi via basic health units. Fathers aged 18 years and older with a DSM-5 diagnosis of major depressive episode and a child younger than 30 months were recruited. Of 1582 fathers approached, 1527 were screened and 357 were randomized in a 1:1 ratio to either the intervention or treatment as usual; 328 were included in the final analysis. Data were analyzed from April to June 2022. LTP + Dads is a manualized intervention combining parenting skills training, play therapy, and cognitive behavior therapy. The intervention was delivered by community health workers via 12 group sessions over 4 months. The primary outcome was change in 17-item Hamilton Depression Rating Scale score at 4 months. Secondary outcomes included anxiety symptoms; parenting stress; intimate partner violence; functioning; quality of life; and child social, emotional, and physical health outcomes. Assessments were completed at baseline and 4 and 6 months postrandomization. Of the 357 fathers included (mean [SD] age, 31.44 [7.24] years), 171 were randomized to the intervention and 186 to treatment as usual. Participants randomized to the intervention demonstrated significantly greater improvements in depression (group difference ratio [GDR], 0.66; 95% CI, 0.47 to 0.91; P < .001), anxiety (GDR, 0.62; 95% CI, 0.48 to 0.81; P < .001), parenting stress (GDR, -12.5; 95% CI, -19.1 to -6.0; P < .001), intimate partner violence (GDR, 0.89; 95% CI, 0.80 to 1.00; P = .05), disability (GDR, 0.77; 95% CI, 0.61 to 0.97; P = .03), and health-related quality of life (GDR, 12.7; 95% CI, 0.17 to 0.34; P < .001) at 4 months. The difference in depression and parenting stress was sustained at 6 months. Children of fathers randomized to the parenting intervention had significantly greater improvements in social-emotional development scores (mean difference, -20.8; 95% CI, -28.8 to -12.9; P < .001) at 6 months. The psychosocial parenting intervention in this study has the potential to improve paternal mental health and child development in Pakistan. Further studies in other populations and with longer follow-up are warranted. ClinicalTrials.gov Identifier: NCT03564847.

Use of the value-focused thinking methodology to understand health care waste management under the perspective of occupational and environmental health

The increasing generation of healthcare waste has greatly accelerated the concern about its potential negative environmental and public health effects. In this sense, the application of decision-making methods and techniques at a strategic level has become increasingly indispensable for the management of health units. This article aimed to understand the challenges in healthcare waste management (HCWM), the main mechanisms of action and values. The Value-Focused Thinking methodology was used to evidence important gaps and propose improvements in the context of decision on occupational safety and environmental protection, leading to the creation of alternatives not seen previously and guaranteeing the good ideas would be converted into actions. The structure was developed by semi-structured questionnaires, observation lists and interviews, conducted to expose the values of the main stakeholders (managers, health professionals, and cleaning professionals) of 10 public health units selected in Caruaru (Brazil). As a result, the investigation evidenced four fundamental goals for the decision context: improvement in work and environmental safety; improvement in HCWM practices; improvement in resource management; strengthening of the stakeholder communication network. From the analysis of the attributes associated with the fundamental goals, it was possible to identify actions that should be implemented with a higher priority and, in the short term, aiming at obtaining positive results, especially in the management practices and the safe management of health waste. The study resulted from an investigation that awakened the participants about aspects little questioned in everyday life. Implementing actions to segregate and recycle materials, with data monitoring and sharing, will increase the population's trust and the environment's and professionals' safety. The alternatives derived from the VFT method consider the perspectives of key stakeholders in HCWM, helping decision-makers and policymakers develop more assertive and grounded management strategies.

Assessment of five-year data of high-risk pregnancies.

Pregnancy is a natural physiological process, but certain conditions can increase the risk, leading to high-risk pregnancy. Several risk factors may cause high-risk pregnancy. The leading ones are chronic diseases, anemia, multiple pregnancies, premature rupture of membrane, preeclampsia, obesity, frequent pregnancy, and advanced maternal age. A total of 7,230 women with high-risk pregnancies followed up by the Unit of Women's and Reproductive Health of the Directorate of Public Health Services, Kayseri Provincial Directorate of Health between 2016 and 2020 were included in the study. Demographic data, pregnancy outcomes, and risk factors were recorded. The mean age was 27.62±6.55 years. The mean number of pregnancy follow-ups was 3.69±1.36. The mean number of follow-ups for Turkish pregnant women was 3.73±1.34 while it was 1.93±1.1 for foreign pregnant women. Binary logistic regression analysis was used to investigate the effect of risk factors on pregnancy outcomes. Pregnancies that did not result in live birth were associated with preeclampsia (OR=12.677), hypertension (HT) (OR=2.079), and cardiovascular disorders (OR=2.277). It was revealed that the number of follow-ups for high-risk pregnancies was low. In conclusion, we believe that increasing monitoring of high-risk pregnancies and developing follow-up models by health authorities will improve the quality of monitoring for high-risk pregnancies.

Underreporting of violence against women: an analysis of two data sources.

This article aims to estimate the underreporting of violence against women (VAW) in the Notifiable Diseases Information System (SINAN), based on data from the National Survey of Health (NSH), in Brazil and subnational units (SU). This work was an ecological study using SINAN and NSH, both from 2019. In SINAN, reports of sexual, physical, and psychological VAW, aged 18 years or older, were selected. In the NSH, women of the same age group who reported psychological, physical, or sexual violence, and who had sought health care due to consequences of the violence were selected. SINAN underreporting was calculated in reference to the NSH's estimated population, for Brazil and each SU. Underreporting of VAW in Brazil was 98.5%, 75.9%, and 89.4% for psychological, physical, and sexual violence, respectively. The North and Northeast states presented the lowest reporting rates among the states. VAW in Brazil is highly underreported by the health sector, showing the need for adequate training of health professionals to recognize situations of violence and raise awareness of the importance of reporting.

Development and validation of a new method by MIR-FTIR and chemometrics for the early diagnosis of leprosy and evaluation of the treatment effect

ObjectiveDevelop a new method for diagnosing leprosy and monitoring the pharmacological treatment effect of patients. Material and methodsPlasma samples from patients diagnosed with leprosy (n = 211) who had not yet received any pharmacological treatment were collected at a basic health unit in Brazil. After treatment, samples were collected from the same patients (n = 125). Plasma samples from healthy volunteers were also collected (n = 179) and used as a control group. All samples were analyzed by Fourier transform mid-infrared spectrophotometry (MIR-FTIR). The spectral data of the samples were subjected to chemometric analysis. Principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) were used to predict diagnosis and monitor pharmacological treatment. ResultsThe PCA model successfully distinguished among three sample classes: healthy individuals, pre-treatment leprosy patients, and post-treatment leprosy patients. The PLS-DA algorithm accurately classified healthy, treated, and diseased samples, facilitating both reliable diagnosis and treatment monitoring for leprosy. The model achieved a sensitivity of 97% to 100%, specificity of 100%, and accuracy ranging from 99% to 100%. Furthermore, when tested on plasma samples from patients with other conditions—renal failure (n=1032), hypertriglyceridemia (n=100), hypercholesterolemia (n=100), and mixed dyslipidemia (n=100)—the model correctly classified these as negative for leprosy, with diagnostic specificity between 93% and 96%. ConclusionThe MIR-FTIR technique combined with PLS-DA analysis proved to be a highly effective tool for screening leprosy patients and monitoring treatment outcomes. Given its low cost, this method could be easily implemented in laboratories across emerging and low-income countries.

Development and validation of a questionnaire (QSPC-Q) for assessment of quality and strengthening of primary care in Brazil.

The performance evaluation of services through instruments is relevant, as it can support thoughts, actions and political approaches to meet a social need. The objective of the article was to develop and validate the Quality and Strengthening of Primary Care Questionnaire (QSPC-Q) for professionals and users based on Starfield attributes and Donabedian pillars. A mixed sequential study was performed to develop the QSPC-Q. The test was applied to 149 doctors and 795 users of basic health units. Psychometric properties was assessed by testing internal consistency using Cronbach's alpha and exploratory factor analysis. Reproducibility od scale was assessed using intraclass cognitive and test-retest correlation. The final version of the follow-up consisted of 45 items aimed at physicians (Cronbach's alpha = 0.921) and 33 at users (Cronbach's alpha = 0.86); the intraclass respiratory capacity was 0.88. An exploratory factor analysis identified 13 factors associated with the pattern components. A short version with 29 items for professionals was also elaborated. Professional QSPC-Q (short and braided versions) and user QSPC-Q were valid.

Opportunities and lessons learned from a retrospective analysis of administrative billing data to understand the language profile of high-risk close contacts of COVID-19 cases in Ontario.

During a public health emergency, it is vital to have access to data sources that can identify communities disproportionately affected and to ensure public health communications are meeting the needs of diverse populations. To explore how administrative billing data for language interpretation services could be used as an additional source of information to understand the language profile of high-risk close contacts of COVID-19 cases. A retrospective descriptive analysis was conducted using administrative billing data from Public Health Ontario's Contact Tracing Initiative from May 2020 to February 2022. Data from the Contact Tracing Initiative were utilized to identify drivers that could have influenced patterns in language interpretation requests. Trends were compared with community language profiles using 2021 Canadian Census data. Interpreters responded to 2,604 requests across 38,518 interpretation minutes and provided information in 50 different languages. The top five requested languages were French, Arabic, Spanish, Punjabi and Mandarin. Five distinct periods were identified of different language predominance including Spanish in spring/summer 2020, French in summer/fall 2020 and Arabic in spring 2021. Overall, these trends aligned with the language profile of health units contributing most submissions. Public health agencies could benefit from using existing secondary data sources to understand the language interpretation needs of their communities. This study also demonstrated how existing data sources could be used to help assess how communities are being disproportionately affected by public health emergencies and how this might change over time.

Tempe Drink Making Training, Physical Activity Education and Optimization of Madrasah Health Units for Madrasah Teachers in Manado

Masa remaja merupakan masa transisi dari anak-anak menuju dewasa. Masa remaja dapat menjadi salah satu indikator kesehatan pada usia dewasa. Pola konsumsi dan rendahnya aktivitas fisik pada remaja memicu terjadinya obesitas yang menjadi faktor risiko terjadi dislipidemia. Tempe mengandung protein yang berpengaruh terhadap perbaikan profil lipid. Modifikasi tempe menjadi minuman tempe membuat penyajian tempe lebih praktis dan disukai oleh remaja. Kegiatan ini bertujuan untuk meningkatkan peran guru madrasah dalam pencegahan dislipidemia pada remaja putri melalui pelatihan pembuatan minuman tempe, edukasi aktivitas fisik dan optimalisasi UKM. Guru adalah sosok yang langsung berhadapan dengan remaja yang merupakan peserta didik untuk mentransfer pengetahuan dan keterampilan dalam berperilaku hidup sehat. Selain itu, proses pemberian pendidikan kesehatan juga perlu ditunjang oleh sarana dan prasarana yang mumpuni yaitu melalui optimalisasi fungsi dan program-program UKM. Sebanyak 26 guru madrasah berpartisipasi pada kegiatan ini. Kegiatan ini dilakukan dengan beberapa tahap kegiatan yaitu penyuluhan mengenai dislipidemia dan potensi minuman tempe sebagai upaya pencegahan dislipidemia pada remaja putri dan dilanjutkan dengan pelatihan pembuatan minuman tempe. Selanjutnya, penyuluhan mengenai aktivitas fisik dan pelatihan optimalisasi fungsi UKM dan pengembangan media promosi kesehatan. Hasil kegiatan pengabdian masyarakat ini diharapkan dapat meingkatkan kualitas kesehatan remaja serta dapat diimplementasi dalam bentuk program berkelanjutan oleh para civitas akademik di madrasah.

Balance, Gait, Functionality and Fall Occurrence in Adults and Older Adults with Type 2 Diabetes Mellitus and Associated Peripheral Neuropathy.

Body balance is regulated by sensory information from the vestibular, visual and somatosensory systems, and changes in one or more of these sensory systems can trigger balance disorders. Individuals with type 2 Diabetes Mellitus (DM2) often present peripheral neuropathy, a condition that alters foot sensory information and can negatively influence balance and gait performance of these subjects. To evaluate and compare balance, gait, functionality and the occurrence of falls between individuals with and without a clinical diagnosis of DM2 with associated peripheral neuropathy. Cross-sectional study, which evaluated seventy individuals, thirty-five with and thirty-five without a clinical diagnosis of DM2, of both sexes and age range between 50 and 85 years, who were recruited from Basic Health Units of Serra Talhada, Pernambuco state, Brazil. The volunteers' balance was analyzed using the Berg Balance Scale, gait-related functional tasks were measured using the Dynamic Gait Index, functional mobility was assessed using the Timed Up and Go test and functionality was assessed using the Katz Index. The occurrence of falls was recorded by the volunteers' self-report. Individuals with DM2 demonstrated the worst performance in balance (p = 0.000) and in gait-related functional tasks (p = 0.000), slower functional mobility (p = 0.000) and worse functionality (p = 0.016) compared to the group without DM2, demonstrating significant differences for all analyzed outcomes. A greater occurrence of falls was observed in individuals with DM2, compared to those without the disease (p = 0.019). Individuals with DM2 demonstrated worse performance on balance, gait-related functional tasks, slower functional mobility and worse functionality compared to those without the disease. Individuals with DM2 had the highest occurrence of falls in this study.

The epidemiology and impact of persistent Campylobacter infections on childhood growth among children 0–24 months of age in resource-limited settings

Campylobacter is the leading cause of bacterial gastroenteritis worldwide. It is generally associated with an acute gastrointestinal infection causing a self-limiting diarrheal episode. However, there is evidence that persistent/recurrent carriage of Campylobacter also occurs. In hyperendemic settings the epidemiology and consequences of persistent Campylobacter enteric infections is poorly studied. Risk factors for and growth consequences of persistent Campylobacter infections detected by polymerase chain reaction (qPCR) were evaluated with data from the MAL-ED birth cohort study in children 0-24 months of age between November 2009 and February 2012. A persistent Campylobacter infection was defined as three or more consecutive Campylobacter positive monthly stools. Across all study sites, 45.5% (781/1715) of children experienced at least one persistent Campylobacter episode. The average cumulative duration of days in which children with persistent Campylobacter were positive for Campylobacter spp. was 150 days (inter-quartile range: 28-236 days). Children who experienced a persistent Campylobacter episode had an attained 24-month length-for-age (LAZ) score that was 0.23 (95% (CI):-0.31,-0.15) less than children without a persistent Campylobacter episode. Among children who had at least one episode of Campylobacter over a 3-month or 9-month window, persistent episodes were not significantly associated with poorer 3-month weight gain (-28.7g, 95% CI:-63.4g, 6.0g) but were associated with poorer 9-month linear growth (-0.134cm 95% CI:-0.246,-0.022) compared to children with an episode that resolved within 31 days. Persistent/recurrent Campylobacter infection is common among children and has a measurable negative impact on linear growth in early childhood. Funding for this study was provided by the Bill and Melinda Gates Foundation (OPP1066146 and OPP1152146), the National Institutes of Health United States (R01AI158576 and R21AI163801 to MNK and CTP; K43TW012298 to FS; K01AI168493 to JMC; GOL was supported by K01AI145080. This research was also supported in part by USDA-ARS CRIS project 2030-42000-055-00D. The funders had no role in study design, study implementation, data analysis, or interpretation of the results.

Impacto da farmácia verde de Ipatinga – MG na redução das prescrições de Benzodiazepínicos em unidades de saúde pública.

Phytotherapy as a therapeutic alternative is the context of the study on Anxiolytic Herbal Medicines in the reduction of Benzodiazepine prescriptions (BZDs). The verification was developed from the analysis of the quantity dispensed with BZDs compared to the dispensing of anxiolytic Herbal Medicines from the Green Pharmacy of Ipatinga - MG. The data correspond to the dispensations, year-on-year from 2013 to 2019, in ten Health Units with phytotherapy. Clonazepam 2.5 mg/ml and Diazepam 10 mg are BZDs. Lavender Tincture, Chamomile, Holy Grass, Passion Fruit and Melissa; correspond to anxiolytic Herbal Medicines. From 2013 to 2017, the dispensation of anxiolytic herbal medicines increased by an average of 12.686% while BZD prescriptions reduced by an average of 6.957%. The trend was interrupted with the ban of the Green Pharmacy by the health surveillance, in August 2018. The objective is to verify the impact of anxiolytic Herbal Medicines in the reduction of BZDs prescriptions in Health Units with phytotherapy in Ipatinga - MG, within the Scope of SUS.

Liderazgo del Personal de Enfermería en Unidades de Primer Nivel de Atención en Comunidades Indígenas

Leadership is one of the functions of the nursing professional, which equips nurses with the necessary qualities to manage resources, make decisions, and lead a team. When these functions are conducted in primary care units within Indigenous populations, nursing staff may face specific sociocultural and geographical barriers. Aim: to identify the leadership functions applied by nursing staff in health units in Indigenous populations. Methods: community case study following an ethnographic approach through semi-structured interviews with nursing staff and users, participant observation, and the use of field diaries. Results: specific leadership functions performed by nursing staff were identified, as well as some of the barriers they face, such as inadequate communication related to the native language, lack of community support networks, gender role gaps, and geographical barriers. Conclusions: the role of the nursing professional as a leader in primary care units is crucial; however, there are sociocultural and geographical barriers that limit these functions, making it essential to develop strategies to reduce these barriers.