Adherence to precautions for preventing the transmission of microorganisms in primary health care: a qualitative study

Background Health care associated infections (HAIs) are a source of concern worldwide. No health service in any country can be considered HAI risk-free. However, there is scarcity of data on the risks to which both patients and health workers are subject in non-hospital settings. The aim of this study was to identify issues that determine the adherence of professionals to precautions for preventing transmission of microorganisms in primary health care. Method This was a qualitative study, using focus groups of primary health care staff, in two Brazilian municipalities. The data were analysed using content analysis. Results Four focus groups were conducted with 20 professionals (11 community health workers, 5 nursing assistants and 4 nurses), and the analysed content was organized into four thematic categories. These categories are: low risk perception, weaknesses in knowledge, insufficient in-service training and infrastructure limitations. Participants expressed their weaknesses in knowledge of standard and transmission based precautions, mainly for hand hygiene and tuberculosis. A lack of appropriate resources and standardization in sharps disposal management was also highlighted by the participants. Conclusion The study points out the need to provide in-service training for professionals on the transmission of microorganisms in primary health care to ensure adequate level of risk perception and knowledge. Further recommendations include investment to improve infrastructure to facilitate adherence to precautions and to minimize the risk of disease transmission for both patients and health care workers

Análise situacional da rede cegonha com ênfase no nível terciário na macrorregião Centro-Norte/ Situational analysis of the rede cegonha with emphasis at the tertiary level in the Central-Northern macroregion

Introdução: A Rede Cegonha é uma estratégia político-assistencial nacional para ações materno e infantil, considerando os princípios de equidade, universalidade e integralidade. Contudo, essa estratégia depende da integração da atenção básica e a unidade hospitalar de referência como garantia de uma atenção à saúde progressiva, continuada e acessível a todos as mulheres, de acordo com a singularidade de cada usuária. Dessa forma, observa-se a importância da atenção terciária para a implantação da Rede Cegonha, já que envolve diversos aspectos desta política. Objetivo: Analisar situacionalmente a macrorregião Centro-Norte e município de Anápolis, e propor uma intervenção da Rede Cegonha no nível terciário, de acordo com os tópicos: descrição de cada município da região a partir de sua população e da sua distância ao município pólo, quantidade de partos em incidência e ocorrência, quantidade de leitos pediátricos, neonatais, adultos e salas de parto, comparar os resultados com as demandas e identificar o problema vinculado a essa análise situacional. Método: Trata-se de um estudo ecológico retrospectivo, com base na análise situacional de dados fornecidos pelo Sistema de Informações Hospitalares do SUS (SIH/SUS), Cadastro Nacional de Estabelecimentos de Saúde (CNES), Instituto Brasileiro de Geografia e Estatística (IBGE) e Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e Órteses/ Próteses e Materiais Especiais (OPM) do SUS (SIGTAP), com coleta de dados realizada no período de 31 de maio a 18 de junho de 2019. Resultados: Foram constatados ausência de organização e planejamento da rede, número insuficiente de leitos obstétricos, de leitos para Gestação de Alto Risco, de leitos de UTI pediátrica e neonatal, e de leitos pediátricos, ausência de Casa da Gestante, Bebê e Puérpera, ausência de habilitação do banco de leite, além de deficiência de profissionais capacitados para a rede de atenção e falta de capacitação de profissionais para realizar os registros de produção. Conclusão: A Rede Cegonha em seu nível terciário ainda necessita de grandes intervenções e melhorias em sua infraestrutura, capacitação e sistematização, para que possa suprir efetivamente as demandas da região analisada

SITUATIONAL ANALYSIS OF THE COVERAGE OF PRIMARY CARE OF THE STORK NETWORK IN THE CITY OF ANAPOLIS IN 2018

Objetivo: Este estudo visa abordar a Rede Cegonha em seus aspectos que envolvem a Atenção Primária em Saúde, com foco nos serviços de pré-natal de baixo risco, acolhimento da gestante e do bebê, humanização do parto do nascimento e vinculação da gestante à maternidade, no município de Anápolis, durante o ano de 2018. Método: Trata-se de um estudo retrospectivo descritivo com base na análise observacional através de dados fornecidos pelo sistema de dados registrados no Sistema de Informações Ambulatoriais do SUS (SIA/SUS), a partir do programa Tab para Windows – Tabwin, pelo Cadastro Nacional de Estabelecimentos de Saúde (CNES), no sistema de Informação e Gestão da Atenção Básica (e-Gestor AB) e por dados fornecidos diretamente na Secretaria Municipal de Anápolis. Resultados: Ao se analisar a cobertura da Rede Cegonha na cidade de Anápolis, levantou-se 35 estabelecimentos que realizam tal tipo de serviço e, dentre eles, 30 correspondem exclusivamente aos serviços prestados pela Atenção Primária, com uma cobertura de 56,10% da população para os serviços prestados pela ESF. Dentre 45.165 mulheres em idade fértil atendidas pela atenção primária, contabilizou-se 5.023 atendimentos de Pré-Natal, sendo destes 3.233 atendimentos por profissionais médicos. Quanto à situação de saúde, constatou-se problemas de subnotificação, ausência de equipamentos de pré-natal adequados, falta de capacitação e educação permanente da equipe multidisciplinar e precária captação de gestantes.  Conclusões: Mesmo sendo o Acolhimento e Acesso Pré-Natal difundido nacionalmente, constata-se uma precariedade e falha na efetividade de assistência às gestantes nessa base fundamental da Rede Cegonha, necessitando de intervenções estratégicas de imediato para a resolução efetiva do quadro situacional atual. Objective: This study aims to address the Stork Network in its aspects that involve Primary Health Care, focusing on low-risk prenatal services, care of pregnant women and babies, humanization of childbirth and linking pregnant women to maternity in the municipality of Anápolis in 2018.  Methods: This is a descriptive retrospective study based on observational analysis through data provided by the data system registered in the SUS Outpatient Information System (SIA / SUS), from the Tab for Windows program - Tabwin, by the National Register of Establishments (CNES), in the Primary Care Information and Management system (e-Manager AB) and data provided directly at the Anápolis Municipal Secretariat. Results: When analyzing the coverage of the Stork Network in the city of Anapolis, 35 establishments that perform this type of service were raised and, among them, 30 correspond exclusively to the services provided by Primary Care, with a coverage of 56.10% of the population to the services provided by the ESF. Among 45,165 women of childbearing age attended by primary care, there were 5,023 prenatal visits, of which 3,233 were attended by medical professionals. Regarding the health situation, there were problems of underreporting, lack of adequate prenatal equipment, lack of training and permanent education of the multidisciplinary team and poor recruitment of pregnant women.  Conclusions: Even though the Prenatal Acess and Reception is widespread nationally, there is a precariousness and failure in the effectiveness of assistance to pregnant women on this fundamental basis of the Stork Network, requiring immediate strategic interventions for the effective resolution of the current situation

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Psychosocial experiences of patients who completed the Treatment of Tuberculosis in the country of the state of São Paulo: A clinical-qualitative study.

Tuberculosis (TB) is a curable disease, however, is still a stigmatized disease. People with TB suffer from the disease, not only by clinical manifestations, but also with prejudice, embarrassing situations and even a self-discrimination that contribute to social isolation. This study aimed to analyze the psychosocial experiences of patients who were treated for TB in São Carlos - SP. A clinical-qualitative methodology was used as it seeks the meanings assigned by subject. 15 people who had completed TB treatment were studied as participants, the definition of the sample is given by the criteria of saturation. A data collection method, semi-directed interviews recorded on digital media were and were later transcribed and analyzed. Data analysis was based on the method of thematic content analysis as proposed by Bardin. Two thematic units were determined: Obstacles to cure TB and Psychosocial Experiences from the treatment. In the first thematic unit sub-categories that were listed: difficulties in diagnosis and supervised treatment. In the second thematic unity sub-categories that were listed: suffering in the face of disease, the impact on family and social context, the support of the health service and its effects after treatment. There is the thematic unity "obstacles to cure TB" that patients have difficulties in identifying the disease and health services sojourn until this diagnosis, patients suffer from adverse drug reactions; supervised treatment was identified as a facilitator for the completion of treatment, because they feel taken care of by the team and also as an obstacle to change the daily routine due to frequent displacement of health facilities. In the unit "Living resulting psychosocial treatment" found that the disease still causes distress to patients for fear of transmission, they are also victims of prejudice and fear of death. Suffering is also caused by stigmatizing, prejudicial actions in society. Family and health team offer support to patients and were essential to the completion of treatment. However, friends and colleagues keep away from them because of the fear of contagion and / or prejudice. The lack of knowledge about the disease and its mode of transmission are present in the statements of interviewees, which can still reproduce the stigma of the disease. The absence from work during treatment may be due to health conditions and also to minimize the constraints. It is concluded that health professionals should be aware of the repercussions that the treatment of TB leads the patient to minimize the obstacles that the disease causes in the patient's life. For this to happen the professional should allow sharing moments of anguish, suffering, psychosocial and biological changes so that the treatment is completed with fewer obstacles.Financiadora de Estudos e ProjetosA tuberculose (TB) é uma enfermidade curável, entretanto, ainda é uma doença estigmatizada. Os indivíduos com TB sofrem com a doença, não apenas pelas manifestações clínicas, mas também pelo preconceito, situações constrangedoras e até por uma auto-discriminação. Tais fatores contribuem para o isolamento social do paciente. Este estudo teve como objetivo analisar as vivências psicossociais de pacientes que foram tratados de TB no município de São Carlos - SP. Utilizou-se a metodologia clínicoqualitativa, uma vez que se buscam os significados atribuídos pelos sujeitos. Fizeram parte do estudo 15 pessoas que haviam concluído o tratamento de TB. A definição da amostra se deu pelos critérios de saturação. Como método para coleta de dados, ou foram utilizadas entrevistas semi-dirigidas, gravadas em mídia digital as quais foram posteriormente transcritas e analisadas. O tratamento dos dados baseou-se no método de análise de conteúdo - modalidade temática - conforme proposto por Bardin. Foram nomeadas duas unidades temáticas: Obstáculos para a Cura da TB e Vivências Psicossociais Decorrentes do Tratamento. Na primeira unidade temática, foram elencadas as sub-categorias: as dificuldades para o diagnóstico e o tratamento supervisionado. Já na segunda unidade temática, foram consideradas as sub-categorias: o sofrimento frente a doença; as repercussões no contexto familiar e social; o apoio do serviço de saúde e repercussões após o tratamento. Verifica-se, na unidade temática, Obstáculos para a cura da TB , que os doentes enfrentam dificuldades na identificação da doença e peregrinam pelos serviços de saúde até obterem esse diagnóstico. Os pacientes sofrem com as reações adversas dos medicamentos. O tratamento supervisionado foi apontado ora como um facilitador para a conclusão do tratamento, em decorrência de os pacientes se sentirem cuidados pela equipe, ora como obstáculo por alterar a rotina diária devido ao deslocamento freqüente às unidades de saúde. Na unidade, Vivências psicossociais decorrentes do tratamento , constatou-se que a doença ainda provoca sofrimento nos doentes pelo medo da transmissão, do preconceito e, também, da morte. O sofrimento também é decorrente de ações preconceituosas e estigmatizantes presentes na sociedade. Os familiares e a equipe de saúde oferecem suporte para os pacientes e são imprescindíveis para a conclusão do tratamento. No entanto, amigos e colegas de trabalho se afastam por medo do contágio e/ou por preconceito. A falta de conhecimento sobre a doença e sobre sua forma de transmissão estão presentes nas falas dos entrevistados, os quais ainda reproduzem o estigma da doença. O afastamento do trabalho, durante o tratamento, pode ser em decorrência das condições de saúde ou também para minimizar os constrangimentos. Conclui-se que os profissionais de saúde devem conhecer as repercussões que o tratamento da TB tem na vida do doente para minimizar os obstáculos que a doença acarreta. Para isso, deve-se possibilitar momentos de compartilhamento das angústias, sofrimentos, alterações psicossociais e biológicas para que o tratamento seja concluído com menos obstáculos