O Programa de Qualificação e Desenvolvimento do Agente Comunitário de Saúde na perspectiva dos diversos sujeitos envolvidos na atenção primária em saúde

The Development and Qualification Program for the Community Health Worker (CHW) was established by the Ministry of Health in order to invest in the Worker's professionalization. This article aimed to identify analyze, and understand the implications of the Development and Qualification Program concluded in 2009 by the School of Public Health of the State of Minas Gerais in the personal and occupational life of the CHWs and in the health care process. According to the viewpoint of the many subjects involved in Primary Health Care (PHC): CHWs, Family Health team, managers, teachers, and users of four primary health centers in a capital city of Southeastern Brazil. This study has a qualitative nature, using as techniques for information collection and documentary analysis interviews, focus group, and questionnaires. The collected information was analyzed by means of the subject discourse analysis technique and using the software SPSS, version 16. We conducted 14 focus groups with the Family Health Strategy units, 4 with CHWs, and 4 with users; 7 interviews, 4 with managers and 3 with teachers at the course. In the Worker's group, there is a predominance of women and a low turnover. In discourse analysis, it was found that the program under study brought favorable implications to the personal and professional life of CHWs and to APS. However, it needs to start being structured on the parameters of continued health education, in order to assure an approach that provides the permanent construction of strategies aimed to improve life and health conditions and achieve full citizenship.O Programa de Qualificação e Desenvolvimento do Agente Comunitário de Saúde (ACS) foi instituído pelo Ministério da Saúde visando investir em sua profissionalização. Este artigo teve por objetivo identificar, analisar e compreender as implicações do Programa de Qualificação e Desenvolvimento concluído em 2009 pela Escola de Saúde Pública do Estado de Minas Gerais na vida pessoal e laboral dos ACS e no processo de atenção à saúde, na visão dos diversos sujeitos envolvidos na Atenção Primária em Saúde (APS): ACS, equipe de Saúde da Família, gestores, docentes e usuários de 4 unidades básicas de saúde em uma capital da região Sudeste. Este estudo tem caráter qualitativo, utilizando como técnicas de coleta de informações a análise documental, entre-vistas, grupo focal e questionários. As informações coletadas foram analisadas por meio da técnica de análise do discurso do sujeito e utilizando o programa SPSS, versão 16. Foram realizados 14 grupos focais com as unidades da Estratégia Saúde da Família, 4 com ACS e 4 com usuários; 7 entrevistas, 4 com gestores e 3 com docentes do curso. No grupo dos ACS, há predomínio do sexo feminino e uma baixa rotatividade. Na análise do discurso, verificou-se que o programa investigado trouxe implicações favoráveis à vida pessoal e profissional do ACS e à APS. Contudo, é necessário estruturar o programa nos parâmetros da educação permanente em saúde, assegurando uma abordagem que propicie a construção permanente de estratégias voltadas à melhoria das condições de vida e saúde e à cidadania plena

Factors associated to the access to health services from the point of view of professionals and users of basic reference unit

This study aims to analyze the users' access to health services in a Basic Reference Unit (UBR) in a municipality of the metropolitan area of Belo Horizonte, Minas Gerais. The semi-structured interviews and questionnaire were conducted with 15 health professionals and 38 users respectively. The interviews addressed the local service, the health team, the users and the health services delivery network's characteristics. The questionnaire addressed users' sociodemographic and health characteristics. The interviews and questionnaires results analysis were presented on structural (financing, coverage), relational (comprehension of the health-illness process) and operational (service organization) dimensions. In the structural dimension, it was observed that the health system underfunding is a difficulty to the health services access and to the Family Health Strategy (ESF) implementation. In the relational dimension, it was observed that the lack of alignment regarding the structure and the health system operational flow impact negatively on the relationship between health professional and user. On the operational dimension, the health professionals and users reported significant shortcomings, such as the ESF coverage, appointment scheduling, reception, geographical barriers, referral and counter referral. The information obtained in this study is important to understand the factors associated to the health services access for the subject population and to help the developing strategies to improve the access.O objetivo deste trabalho foi analisar o acesso de usuários de uma Unidade Básica de Referência (UBR) aos serviços de saúde de um município da região Metropolitana de Belo Horizonte, Minas Gerais. Foram realizadas entrevistas semiestruturadas com 15 profissionais de saúde e aplicado questionário semiestruturado a 38 usuários. As entrevistas abordaram características do atendimento local, da equipe de saúde, dos usuários e da rede prestadora de serviços de saúde. Os questionários abordaram características sociodemográficas e de saúde dos usuários. A análise dos resultados das entrevistas e questionários foi apresentada com base nas dimensões estrutural (financiamento, cobertura), relacional (compreensão do processo saúde-doença) e operacional (organização dos serviços). Na dimensão estrutural, verificou-se que o subfinanciamento do sistema de saúde constitui uma dificuldade para o acesso aos serviços de saúde e para a implantação da Estratégia Saúde da Família (ESF); na dimensão relacional, a ausência de alinhamento sobre a estrutura e os fluxos de funcionamento do sistema de saúde impacta negativamente na relação do profissional com o usuário; e na dimensão operacional, profissionais de saúde e usuários relataram importantes lacunas tais como cobertura da ESF, marcação de consulta, acolhimento, barreiras geográficas, referência e contrarreferência. As informações obtidas neste trabalho são importantes para compreender os fatores que influenciam o acesso aos serviços de saúde da população estudada e colaborar para o desenvolvimento de estratégias voltadas para melhoria do acesso

Vigilância da qualidade da água para consumo humano no âmbito municipal: contornos, desafios e possibilidades

The magnitude of drinking-water quality surveillance (DWQS) attributions in meeting its primary function of health protection, associated with the heterogeneity of Brazilian municipalities (demographic and epidemiological profile, human and financial resources), is an important challenge in implementing actions which are effective and sustainable at the local level. The study presents the experience in rolling out the national operation model for DWQS in a small municipality in Minas Gerais state. The paper whether the strategic and basic actions and the doctrinal, organizational and executive principles provided in the operation model were achieved and how they were accomplished. Also, certain strategies for confronting the challenges imposed by DWQS assignment were presented. The existence of a well prepared and measured professional team is a fundamental aspect in achieving the DWQS objectives. In addition, some procedures should have clear guidelines, such as the integrated analysis of information systems and analysis and health risk classification of water supplies. In conclusion, different challenges must be overcome to implement drinking-water quality surveillance at the local level and managers could experience some difficulties. Federal level managers should be aware of issues that require more detailed and specific treatment.A amplitude das atribuições da vigilância da qualidade da água para consumo humano (VQACH) associada à heterogeneidade dos municípios brasileiros (perfil demográfico e epidemiológico, recursos humanos e financeiros) impõe ao nível local de gestão o desafio de implementar com efetividade e sustentabilidade as ações previstas no modelo de atuação da VQACH. Tendo como cenário de estudo um município mineiro de pequeno porte, o trabalho apresenta desafios e possibilidades vivenciados durante a implementação do modelo. O atendimento às ações estratégicas e básicas e aos princípios doutrinários, organizacionais e executivos previstos no modelo de atuação foi verificado e as estratégias para o enfrentamento dos desafios impostos ao exercício da VQACH foram apresentadas. A conformação de uma equipe de profissionais em quantidade e qualidade compatíveis com as ações de VQACH foi aspecto fundamental, além da melhor explicitação de procedimentos como análise integrada dos sistemas de informação e análise e classificação do grau de risco à saúde das diferentes formas de abastecimento de água. O estudo permite adiantar aos gestores dos diferentes níveis de governo desafios e estratégias para contorná-los, bem como instrumentaliza a coordenação da VQACH no nível federal sobre questões que necessitam tratamento mais detalhado e específico

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Epidemiologic surveillance and drinking water quality surveillance. Challenges for the municipality. Case study in Barbacena Minas Gerais state

A relação entre qualidade da água e a ocorrência de agravos já é bastante conhecida. Nesse sentido, a distribuição de água segura para consumo humano, isto é, que atenda ao padrão de potabilidade estabelecido pela legislação e que não ofereça risco à saúde, é fundamental para a manutenção da saúde da população. Na atuação da vigilância em saúde ambiental relacionada à qualidade da água para Consumo Humano, preconiza-se, com respaldo legal na Portaria MS no 518/2004, o desenvolvimento de estudos de avaliação de risco que integrem as informações levantadas pela própria Vigilância em Saúde Ambiental relacionada à qualidade da água para consumo humano, pela vigilância epidemiológica e as fornecidas pelos responsáveis pelo controle da qualidade da água. O presente estudo objetivou demonstrar o potencial de desenvolvimento, no âmbito do município, das atribuições da Vigilância Ambiental em Saúde relacionada à Qualidade da Água para Consumo Humano, procurando, a partir da perspectiva de avaliação de risco, identificar perigos relacionados ao abastecimento de água e demonstrar a existência de associação entre os perigos identificados e a ocorrência de doenças diarréicas na população. Foram utilizados dados secundários relativos ao período de março de 2002 a março de 2004, disponibilizados pelo Departamento Municipal de Água e Esgoto (DEMAE), referentes ao monitoramento da qualidade da água tratada e distribuída por cinco diferentes sistemas de abastecimento e dados disponibilizados pelo Departamento Municipal de Saúde Pública (DEMASP), referentes às condições de saneamento e ocorrência de diarréia em crianças menores de dois anos cadastradas no Programa Saúde da Família (PSF). Os dados epidemiológicos trabalhados se referiram a seis regiões sanitárias de atuação do PSF no distrito sede de Barabacena (Carmo, Funcionários, Grogotó, Santa Cecília, Santa Efigênia e Vilela) e a três distritos pertencentes ao município (Correia de Almeida, Padre Brito e Senhora das Dores). Os sistemas de abastecimento estudados foram denominados ETA I e ETA II, responsáveis pelo abastecimento do distrito sede, ETA III, ETA IV e ETA V que abastecem respectivamente os distritos Correia de Almeida, Padre Brito e Senhora das Dores. Os pontos de coleta das amostras utilizadas neste estudo foram os reservatórios de distribuição localizados junto às ETAs e pontos das redes de distribuição. Os dados foram trabalhados a partir de técnicas de epidemiologia descritiva e de testes estatísticos de correlação. Dados referentes ao monitoramento da água foram utilizados para identificação e categorização de perigos associados ao abastecimento de água para cada sistema estudado, tendo como referência o Manual de Procedimentos de Vigilância em Saúde Ambiental relacionada à Qualidade da Água para Consumo Humano, com modificações. Com relação às condições de saneamento básico, o município de Barbacena apresentou, de maneira geral, boa cobertura, sendo as regiões sanitárias Carmo e Vilela e o distrito Senhora das Dores os que apresentaram os menores percentuais de acesso a esses serviços. Todos os sistemas de abastecimento analisados apresentaram problemas no atendimento ao plano mínimo de amostragem e no atendimento ao padrão de potabilidade preconizado pela legislação. Considerando os perigos identificados, foi proposta uma categorização dos sistemas de abastecimento estudados: apenas a ETA II foi considerada como em situação de perigos menores ou inexistentes, enquanto todos os outros sistemas foram categorizados em situação de alerta máximo, perigos acentuados (ETA I, ETA III, ETA IV, ETA V). Os resultados indicam a necessidade de um monitoramento mais adequado da qualidade da água e de ajustes no controle operacional do tratamento da água. A prevalência de diarréia em crianças menores de dois anos durante o período de estudo alcançou os maiores valores na região Funcionários (7,79%) e no distrito Senhora das Dores (4,12%). Não houve diferença estatisticamente significativa entre a ocorrência de diarréia nas regiões sanitárias e nos distritos (c2 = 3,19; p = 0,074). Não detectamos comportamento sazonal na ocorrência de diarréia em nenhuma das regiões estudadas, o que provavelmente se deve ao curto período de estudo, que pode ter comprometido a análise temporal dos dados. As análises de correlação entre a ocorrência de diarréia entre crianças menores de dois anos e variáveis relacionadas à qualidade da água demonstraram resultados inconstantes, o que não exime a água distribuída da responsabilidade pela transmissão de agravos, haja vista os nítidos problemas de controle da qualidade da água detectados nos sistemas de abastecimento estudados. O esforço empreendido na sistematização dos dados de monitoramento da água distribuída permitiu a construção de um bom histórico sobre o controle da qualidade da água para consumo humano. A proposição e aplicação de uma metodologia de avaliação de sistemas de abastecimento de água considerando a identificação e categorização de perigos associados e incorporando importantes elementos da Avaliação de Risco trouxe subsídios importantes para a atuação da Vigilância junto aos responsáveis pelo abastecimento de água.The relation between drinking water quality and diseases occurrence is already well known. In this sense, supplying safe water, that is, which matches the standards established by the legislation and does not represent any human health risk, is crucial to ensure the population s health. Amongst the activities of the Environmental Surveillance related to drinking water quality, the brazilian legislation points to the development of risk evaluation studies, getting together information obtained by the surveillance health services (Environmental and Epidemiological) and those obtained form the water suppliers (water quality control). The present study aimed to demonstrate the potential for fully developing, in local basis, the Drinking Water Quality Surveillance duties, trying from a risk evaluation perspective, to identify drinking water related hazards and demonstrate the association between the identified hazards and the occurrence of diarrhea diseases. The data used in this study included (March 2002 to March 2004): (i) treated water quality of five water supply systems monitored by the Barbacena Municipal Water and Sewage Department (DEMAE) (ii) sanitary conditions and diarrhea occurrence amongst children under two years old recorded in the Family Health Program (PSF), and available from the Municipal Public Health Department (DEMASP). The epidemiological data referred to six sanitary regions covered by the PSF (Carmo, Funcionários, Grogotó, Santa Cecília, Santa Efigênia e Vilela) and, from three districts (Correia de Almeida, Padre Brito and Senhora das Dores). The water supply systems studied were named (i) ETA I and ETA II in the main district; (ii) ETA III, ETA IV and ETA V, supplying the districts of Correia de Almeida, Padre Brito and Senhora das Dores, respectively. The water sampling sites were the distribution reservoirs located next to the water treatment plants (ETAs) and points along the distribution network. The data treated using descriptive Epidemiology techniques and correlation statistical tests. Also, the data were used to identify and classify associated hazards to each water supply sistems studied based on the Manual de Procedimentos de Vigilância em Saúde Ambiental relacionada à Qualidade da Água para Consumo Humano, with modifications. In general, Barbacena showed a good sanitary infrastructure (water supply and sanitation), being the sanitary regions of Carmo de Vilela and Senhora das Dores those with less services coverage. None of the water supply systems fully matched the minimal sampling requirements or attended the water drinking standards establish by the brazilian legislation. Based on the obtained results, a ranking of the water supply health related hazards is proposed. Only ETA II system was classified as of low hazard, whereas all the others would be in a category of high hazard (ETA I, ETA III, ETA IV, ETA V). The results pointed out the need for a better water quality monitoring and treatment control. The diarrhea prevalence amongst children under two years old during the studied period reached higher values in the Funcionários region (7,79%) and in the Senhora das Dores District (4,12%). There was no statistically significant difference between the diarrhea occurrence in the sanitary regions and in the districts (c2 = 3,19; p = 0,074). No seasonal pattern was detected in the diarrhea occurrence in any of the regions studied, probably due to the short study period. The results of the correlation analyzes between diarrhea occurrence amongst children under two years old and water quality variables were not much consistent. However it does not exempt the water supply from the possibility of diseases transmission, given the detected problems of water quality control problems. Finally this work demonstrates the powerful possibilities of treating together the water quality and epidemiological datas obtainable from the Health Surveillance and Water Supply Services, including a proposal for the classification of water supply system health related hazards. It is hoped that such a proposal can be further tested and eventually validated as a useful tool for the day to day Water Quality Surveillance activities.Escola de Saúde Pública do Estado de Minas Gerai

Water for human consume and acute diarrhea disease in Viçosa-MG: space-time distribution and social representation

Um estudo descritivo foi realizado com o intuito de caracterizar os casos de doença diarreica aguda e a qualidade da água distribuída em localidades cobertas pelo Programa Saúde da Família, no período de janeiro de 2006 a dezembro de 2008, no município de Viçosa-MG. O estudo foi enriquecido com a integração entre as metodologias quantitativa e qualitativa e com a utilização de diferentes ferramentas de análise, a exemplo da análise espaço-temporal dos casos de doença diarreica aguda e da teoria psicossocial da representação social, no esforço para conhecer a percepção da população a respeito da água que consomem. Houve concentração dos casos de doença diarreica aguda nos trimestres correspondentes ao inverno e maior incidência na faixa etária de menores de 1 ano, sendo o plano de tratamento mais recomendado A, o que indica a pouca gravidade dos casos. A análise espaço-temporal demonstrou concentração dos casos de doença diarreica aguda nas localidades de Nova Viçosa e Nova Viçosa-Posses. Os dados de qualidade da água distribuída estavam, de modo geral, em conformidade com o padrão de potabilidade preconizado pela legislação, o que sugere que outros parâmetros e, ou, critérios deveriam ser levados em consideração pela Vigilância da Qualidade da Água para Consumo Humano. A utilização, por exemplo, de banco de dados sobre reclamações e queixas feitas pela população ao responsável pelo controle da qualidade da água demonstrou ser uma alternativa viável. Os resultados do estudo qualitativo demonstraram a objetivação da água pelo indivíduo em parâmetros físicos e microbiológicos, associados a características organolépticas, evidenciando a primordial importância do conhecimento da percepção do indivíduo e de suas demandas em relação à água que consome, no sentido de direcionar tomadas de decisão e ações que visem garantir o consumo de água segura pela população.A descriptive study was carried out to characterize acute diarrhea disease and quality of water distributed in localities covered by the Family Health Program, from January 2006 to December 2008 in Viçosa-MG. The study included the integrated quantitative and qualitative methodologies and the use of different analysis tools, such as the space-time distribution analysis for acute diarrhea cases and the psychosocial theory of social representation, attempting to obtain an insight on the perception the population had about the water consumed. There was a concentration of cases of acute diarrhea disease in the three winter months and a higher incidence in the under 1-yearold age range, with treatment A being the most recommended, indicating the little gravity of the cases. The time spatial distribution analysis showed concentration of the cases of acute diarrhea disease in the localities of Nova Viçosa and Nova Viçosa-Posses. The data on the quality of the water distributed were in general in compliance with the drinking water standard recommended by the legislation, suggesting that other parameters or criteria be taken into account by the Water Quality Surveillance for Human Consumption. The use, for instance, of a data bank of the complaints made by the population to the professional in charge of water quality control was shown to be a viable alternative. The qualitative study results showed that the population classified water based on physical and microbiological parameters, associated to organoleptic characteristics, stressing the foremost importance of knowing the individual's perception and his /her water consumption demands, aiming at decision-making processes and actions to guarantee safe water consumption by the population.Escola de Saúde Pública do Estado de Minas Gerai