Quality of child health care in the family health strategy

OBJECTIVE: to verify the quality of child health care in the Family Health Strategy (FHS) in a state capital of Northeastern Brazil. METHODS: a descriptive study using a quantitative approach was carried out in 2010 with 66 primary care (PC) teams represented by their doctors and nurses. The survey used part of the Evaluation for Quality Improvement of the Family Health Strategy² (AMQ), a self-rating instrument of the Brazilian Ministry of Health which evaluates the FHS actions and services and classifies them by the following quality-based standards of care: Elementary, undergoing development, Consolidated, Good or Advanced. RESULTS: 84.1% of the FHS-teams rated themselves as providing "Elementary" actions and services, and 47.7% of them considered that they provided "Advanced" ones. The health teams with less than four years of implementation rated themselves better. CONCLUSION: these findings suggest that most of the FHC-teams are providing care with an elementary standard of quality, and indicate that better quality child care is apparently delivered with by teams with less time of implementation

Qualidade da Atenção à Saúde da Criança na Estratégia Saúde da Família

AbstractObjective: to verify the quality of child health care in the Family Health Strategy (FHS) in a state capital of Northeastern Brazil. Methods: a descriptive study using a quantitative approach was carried out in 2010 with 66 primary care (PC) teams represented by their doctors and nurses. The survey used part of the Evaluation for Quality Improvement of the Family Health Strategy² (AMQ), a self-rating instrument of the Brazilian Ministry of Health which evaluates the FHS actions and services and classifies them by the following quality-based standards of care: Elementary, undergoing development, Consolidated, Good or Advanced. Results: 84.1% of the FHS-teams rated themselves as providing “Elementary” actions and services, and 47.7% of them considered that they provided “Advanced” ones. The health teams with less than four years of implementation rated themselves better. Conclusion: these findings suggest that most of the FHC-teams are providing care with an elementary standard of quality, and indicate that better quality child care is apparently delivered with by teams with less time of implementation.ResumoObjetivo: verificar a qualidade da atenção à saúde da criança pelas equipes da Estratégia Saúde da Família (ESF) em Capital do Nordeste do Brasil. Método: trata-se de um estudo transversal, descritivo, com abordagem quantitativa, realizado durante o ano de 2010, por meio de inquérito com os profissionais médicos e enfermeiros de 66 equipes da ESF de Maceió-AL, estratificadas por tempo de funcionamento em anos. Utilizou-se parte do instrumento de auto-avaliação denominado Avaliação para Melhoria da Qualidade da Estratégia Saúde da Família (AMQ) do Ministério da Saúde, especificamente as questões referentes às ações e atividades realizadas no campo de atenção à “saúde da criança”, dentro da dimensão “atenção à saúde”. Resultados: os padrões elementares de qualidade foram encontrados em 84,1% das ações realizadas. Os padrões considerados avançados apresentaram o menor percentual de conformidade entre todas as equipes (47,7%). Quanto ao tempo de implantação da ESF, as equipes com menos de quatro anos tenderam a relatar melhores padrões de qualidade. Conclusões: os achados sugerem que as ações de saúde da criança estão sendo realizadas em melhor conformidade nas equipes com menos tempo de implantação, e que a grande maioria das equipes ainda estão atendendo a padrões considerados menos avançados em termos de qualidade

Retrospective clinical and epidemiological analysis of scorpionism at a referral hospital for the treatment of accidents by venomous animals in Alagoas State, Northeast Brazil, 2007-2017

Scorpionism has a high incidence rate in Brazil. It is considered a serious public health problem mainly in tropical and subtropical regions around the world. The number of scorpion accidents have increased over the years and the highest frequencies have been reported mainly in the Brazilian Northeast region. Therefore, in this study we report a retrospective clinical and epidemiological analysis of scorpion stings from 2007 to 2017 in Alagoas State, Northeast Brazil, at a referral hospital for assistance and treatment of accidents by venomous animals. During the analyzed period, the referral hospital treated 27,988 cases, and an increase in the number of cases has taken place over the years. The highest frequency of scorpion stings was observed in females, and the age range most affected was from 20 to 29 years old. The most stung body site was the foot, followed by finger, toe or hand. Regarding the severity, most severe cases were reported in children up to 4 years old (69.4%) and 50% of the total cases treated with serotherapy corresponded to patients in this age range. Interestingly, it was also found that the occurrence of systemic manifestations and the severity of the cases were significantly associated with pediatric patients. In this way, this study highlights the scorpionism as an environmental public health problem in Alagoas State, Northeast Brazil, as well as the need to intensify the epidemiological surveillance and educational campaigns to prevent and control scorpion accidents throughout the year

Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study.

BACKGROUND: The microcephaly epidemic, which started in Brazil in 2015, was declared a Public Health Emergency of International Concern by WHO in 2016. We report the preliminary results of a case-control study investigating the association between microcephaly and Zika virus infection during pregnancy. METHODS: We did this case-control study in eight public hospitals in Recife, Brazil. Cases were neonates with microcephaly. Two controls (neonates without microcephaly), matched by expected date of delivery and area of residence, were selected for each case. Serum samples of cases and controls and cerebrospinal fluid samples of cases were tested for Zika virus-specific IgM and by quantitative RT-PCR. Laboratory-confirmed Zika virus infection during pregnancy was defined as detection of Zika virus-specific IgM or a positive RT-PCR result in neonates. Maternal serum samples were tested by plaque reduction neutralisation assay for Zika virus and dengue virus. We estimated crude odds ratios (ORs) and 95% CIs using a median unbiased estimator for binary data in an unconditional logistic regression model. We estimated ORs separately for cases with and without radiological evidence of brain abnormalities. FINDINGS: Between Jan 15, 2016, and May 2, 2016, we prospectively recruited 32 cases and 62 controls. 24 (80%) of 30 mothers of cases had Zika virus infection compared with 39 (64%) of 61 mothers of controls (p=0·12). 13 (41%) of 32 cases and none of 62 controls had laboratory-confirmed Zika virus infection; crude overall OR 55·5 (95% CI 8·6-∞); OR 113·3 (95% CI 14·5-∞) for seven cases with brain abnormalities; and OR 24·7 (95% CI 2·9-∞) for four cases without brain abnormalities. INTERPRETATION: Our data suggest that the microcephaly epidemic is a result of congenital Zika virus infection. We await further data from this ongoing study to assess other potential risk factors and to confirm the strength of association in a larger sample size. FUNDING: Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations

Anestesia neuroaxial comparada à anestesia geral para procedimentos na metade inferior do corpo: revisão sistemática de revisões sistemáticas

JUSTIFICATIVA E OBJETIVOS: As revisões sistemáticas organizam dados da literatura, combinando os resultados dos estudos publicados com o objetivo de resolver conflitos na área do conhecimento médico descrevendo as intervenções. O relato inadequado das revisões sistemáticas pode prejudicar sua credibilidade e interferir na qualidade de seus resultados. O objetivo deste estudo foi determinar a frequência de revisões sistemáticas de boa qualidade que comparam a anestesia neuroaxial com a anestesia geral para procedimentos na metade inferior do corpo. MÉTODO: Revisão sistemática de revisões sistemáticas, com variável primária sendo a frequência de revisões sistemáticas de boa qualidade. As informações foram analisadas a partir dos seguintes bancos de dados: LILACS (janeiro de 1982 a dezembro de 2010), PubMed (janeiro de 1950 a dezembro de 2010), Cochrane Database of Systematic Review e Database of Abstracts of Reviews of Effects (volume 10, 2010), e SciELO (em dezembro de 2010). A qualidade das revisões sistemáticas foi determinada pelo Overview Quality Assessment Questionnaire. O cálculo do tamanho da amostra demonstrou ser necessária a análise de 8 revisões sistemáticas, considerando que a frequência de revisões sistemáticas de boa qualidade foi de 5%, a precisão absoluta de 15% e o nível de significância de 5%. RESULTADOS: Foram identificados 1.995 artigos. O processo de seleção eliminou 1.968 artigos. Foram lidos 27 artigos de revisões sistemáticas na íntegra, foram excluídos 9 devido à incompatibilidade com os critérios de inclusão, e 8 eram publicações duplicadas. Dez revisões sistemáticas foram analisadas quanto a sua qualidade. A frequência de revisões sistemáticas de boa qualidade foi de 40% (4/10; IC 95% 9,6 a 70,4%). CONCLUSÃO: A frequência de revisões sistemáticas de boa qualidade foi de 40%

Los factores asociados con el desarrollo neurológico en los niños de 6-18 meses presentes en guarderías públicas de la ciudad de João Pessoa, Paraíba, Brasil

Submitted by Regiane Silva ([email protected]) on 2018-08-27T18:52:33Z No. of bitstreams: 1 Fatores associados ao desenvolvimento neuropsicomotor em crianças de 6-18.pdf: 202007 bytes, checksum: 58e36dc8f47ba01ff697539224af2c30 (MD5)Approved for entry into archive by Regiane Silva ([email protected]) on 2018-08-29T14:58:11Z (GMT) No. of bitstreams: 1 Fatores associados ao desenvolvimento neuropsicomotor em crianças de 6-18.pdf: 202007 bytes, checksum: 58e36dc8f47ba01ff697539224af2c30 (MD5)Made available in DSpace on 2018-08-29T14:58:11Z (GMT). No. of bitstreams: 1 Fatores associados ao desenvolvimento neuropsicomotor em crianças de 6-18.pdf: 202007 bytes, checksum: 58e36dc8f47ba01ff697539224af2c30 (MD5) Previous issue date: 2015Universidade Federal da Paraíba, João Pessoa, PB, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Universidade Federal de Alagoas, Maceió, AL, Brasil.O estudo objetivou verificar a prevalência de alteração no desenvolvimento neuropsicomotor em lactentes inseridos nas creches públicas de João Pessoa, Paraíba, Brasil, e analisar fatores associados ao desenvolvimento infantil. Realizou- se um estudo seccional com o censo de crianças entre 6 e 18 meses de vida inseridas nas creches. O desenvolvimento infantil foi avaliado pelo Teste de Triagem de Denver II. Variáveis de natureza biológica, materna, social, demográfica e relativas à creche foram investigadas através de questionário e formulário. As associações foram ajustadas por regressão logística. A prevalência de alteração no desenvolvimento foi 52,7%. Associou-se à alteração no desenvolvimento a criança ter mais que 12 meses de idade (RC = 4,3), o parto vaginal (RC = 4,4), a fototerapia (RC = 7,9) e a creche não ter apoio da Estratégia Saúde da Família (RC = 2,9). Os achados sugerem que o desenvolvimento infantil é o reflexo das condições familiares, bem como da assistência recebida pelos serviços de educação e saúde.This study aimed to determine the prevalence of altered neurodevelopment in children in public daycare centers in João Pessoa, Paraíba State, Brazil, and to analyze factors associated with child development. A cross-sectional study was conducted in a sample of children 6 to 18 months of age enrolled in daycare. Child development was assessed by the Denver II Screening Test. Biological, riables were studied with a questionnaire and form. Associations were adjusted using logistic regression. Altered development was present in 52.7% of the children and was associated with age > 12 months (OR = 4.3), vaginal delivery (OR = 4.4), neonatal phototherapy (OR = 7.9), and daycare centers not supported by the Family Health Strategy (OR = 2.9). The findings suggest that child development reflects the family’s conditions and the care received from educational and healthcare services.El objetivo del estudio fue determinar la prevalencia de desarrollo neurológico alterado en los bebés presentes en guarderías públicas en João Pessoa, Paraíba, Brasil, y analizar los factores asociados con el desarrollo del niño. Se realizó un estudio transversal con el censo de los niños entre 6 y 18 meses de vida que se encontraban siendo cuidados en guarderías. El desarrollo se evaluó mediante la Prueba de Detección de Denver II. Variables biológicas, maternas, sociales, demográficos y relacionadas con el cuidado de niños se investigaron mediante un cuestionario. Las asociaciones se ajustaron mediante regresión logística. La prevalencia de un desarrollo anormal fue de un 52,7%. Asociado a un cambio en el desarrollo de los niños que tienen más de 12 meses de edad (OR = 4,3), parto vaginal (OR = 4,4), fototerapia (OR = 7,9) y no contar con el apoyo de una guardería en el ámbito de estrategia de salud familiar (OR = 2,9). Los resultados sugieren que el desarrollo infantil es un reflejo de las condiciones de la familia y el cuidado que recibe servicios de educación y salud

Validity and limitations of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1)

OBJECTIVE: To study the concurrent validity of the Brazilian Composite International Diagnostic Interview 2.1 using as gold standard the clinical diagnoses based on the ICD-10 criteria and the Longitudinal, Expert, All Data (LEAD) procedure. METHOD: The sample was composed of 185 subjects selected at psychiatric hospitals, psychiatric outpatient units, the community, and primary care services. These individuals were intentionally selected according to 9 diagnostic groups. Instruments: Composite International Diagnostic Interview (CIDI-core) version 2.1 (paper-and-pencil) administered by 16 trained interviewers. Analysis: concurrent validity of diagnoses of the Composite International Diagnostic Interview 12-month. RESULTS: Values found for sensitivity and specificity in each diagnosis were: alcohol-related disorders (79.5%/97.2%); psychoactive substance-related disorders (77.3%/100%); schizophrenia and other psychotic disorders (28.6%/93.9%); manic episode and bipolar affective disorder (38.9%/96.4%); depressive disorder (82.5%/ 93.8%); phobic-anxiety disorder (80.6%/93.5%); obsessive-compulsive disorder (18.2%/98.9%); somatoform disorder (41.7%/90.8%); eating disorder (45.5%/100.0%). CONCLUSION: The Composite International Diagnostic Interview proved to be valid for diagnoses of alcohol-related disorders, psychoactive substance-related disorders, depressive disorder and phobic-anxiety disorder. The probable explanations for the poor performance for the other diagnoses were: necessity of some clinical judgement by the lay interviewer; difficulty to use the Probe Flow Chart; interviewees' difficulty of understanding; and lack of mechanisms to certify the veracity of the information.OBJETIVO: Validação concorrente da versão brasileira do Composite International Diagnostic Interview 2.1, utilizando como padrão ouro o diagnóstico médico baseado nos critérios diagnósticos da CID-10 e critérios Longitudinal, Experts Clinicians, All Data (LEAD). MÉTODO: Amostra composta por 185 indivíduos procedentes de hospitais psiquiátricos, ambulatórios de especialidades psiquiátricas, serviços comunitários e atenção primária à saúde, selecionados intencionalmente segundo nove grupos diagnósticos. Instrumentos: CIDI 2.1 (lápis e papel), versão para diagnósticos ao longo da vida, aplicado por 16 entrevistadores treinados. Análise: validade concorrente dos diagnósticos do Composite International Diagnostic Interview no último ano. RESULTADOS: Os valores encontrados de sensibilidade e especificidade foram: transtornos decorrentes do uso de álcool (79,5%/97,2%); transtornos decorrentes do uso de substâncias psicoativas (77,3%/100%); esquizofrenia e outros transtornos psicóticos (28,6%/93,9%); episódio maníaco e transtorno afetivo bipolar (38,9%/96,4%); transtorno depressivo (82,5%/93,8%); transtorno fóbico-ansioso (80,6%/93,5%); transtorno obsessivo-compulsivo (18,2%/98,9%); transtorno somatoforme (41,7%/90,8%); e transtorno alimentar (45,5%/100,0%). CONCLUSÃO: O Composite International Diagnostic Interview mostrou-se válido para os diagnósticos de transtornos decorrentes do uso de álcool e substâncias psicoativas, transtorno depressivo e transtorno fóbico-ansioso. As prováveis explicações para o pior desempenho nos demais diagnósticos foram: necessidade de algum julgamento clínico do entrevistador leigo; dificuldade no manuseio do Diagrama de Especificação de Resposta; dificuldade de compreensão dos entrevistados; e falta de mecanismos para atestar a veracidade das informações