Proposta de seminários para formação de teleconsultores sobre a Política Nacional de Atenção Integral às Pessoas com Doenças Raras no SUS

Ementa do curso online sobre a Política Nacional de Atenção Integral às Pessoas com Doenças Raras no Sistema Único de Saúde (SUS). Iniciativa do Programa Nacional de Telessaúde Brasil Redes, através da Secretaria de Gestão do Trabalho e Educação na Saúde (SGTES) do Ministério da Saúde, o curso envolveu parceria com as seguintes instituições: Sociedade Brasileira de Genética Médica, Serviço de Genética Médica do Hospital das Clínicas de Porto Alegre (HCPA), Departamento de Genética da Universidade Federal do Rio Grande do Sul, Núcleo de Telessaúde Técnico-Científico do Rio Grande do Sul (TelessaúdeRS/ UFRGS) e Rede Nacional de Ensino e Pesquisa (RNP). Desenvolvido no segundo semestre de 2014 e composto por seis módulos, o curso teve como objetivo principal qualificar teleconsultores atuantes em núcleos de telessaúde do Programa Nacional de Telessaúde Brasil Redes no tema doenças raras e, em especial, nas questões relacionadas aos procedimentos de encaminhamento de pacientes com doenças raras aos serviços especializados do SUS

Risk factors for default from tuberculosis treatment in HIV-infected individuals in the state of Pernambuco, Brazil: a prospective cohort study

BACKGROUND: Concomitant treatment of Human Immunodeficiency Virus (HIV) infection and tuberculosis (TB) presents a series of challenges for treatment compliance for both providers and patients. We carried out this study to identify risk factors for default from TB treatment in people living with HIV. METHODS: We conducted a cohort study to monitor HIV/TB co-infected subjects in Pernambuco, Brazil, on a monthly basis, until completion or default of treatment for TB. Logistic regression was used to calculate crude and adjusted odds ratios, 95% confidence intervals and P-values. RESULTS: From a cohort of 2310 HIV subjects, 390 individuals (16.9%) who had started treatment after a diagnosis of TB were selected, and data on 273 individuals who completed or defaulted on treatment for TB were analyzed. The default rate was 21.7% and the following risk factors were identified: male gender, smoking and CD4 T-cell count less than 200 cells/mm3. Age over 29 years, complete or incomplete secondary or university education and the use of highly active antiretroviral therapy (HAART) were identified as protective factors for the outcome. CONCLUSION: The results point to the need for more specific actions, aiming to reduce the default from TB treatment in males, younger adults with low education, smokers and people with CD4 T-cell counts < 200 cells/mm3. Default was less likely to occur in patients under HAART, reinforcing the strategy of early initiation of HAART in individuals with TB

How students perceive medical competences: a cross-cultural study between the Medical Course in Portugal and African Portuguese Speaking Countries

<p>Abstract</p> <p>Background</p> <p>A global effort has been made in the last years to establish a set of core competences that define the essential professional competence of a physician. Regardless of the environment, culture or medical education conditions, a set of core competences is required for medical practice worldwide. Evaluation of educational program is always needed to assure the best training for medical students and ultimately best care for patients. The aim of this study was to determine in what extent medical students in Portugal and Portuguese speaking African countries, felt they have acquired the core competences to start their clinical practice. For this reason, it was created a measurement tool to evaluate self-perceived competences, in different domains, across Portuguese and Portuguese-speaking African medical schools.</p> <p>Methods</p> <p>The information was collected through a questionnaire that defines the knowledge, attitudes and skills that future doctors should acquire. The Cronbach's Alpha and Principal Components Analysis (PCA) were used to evaluate the reliability of the questionnaire. In order to remove possible confounding effect, individual scores were standardized by country.</p> <p>Results</p> <p>The order of the domain's scores was similar between countries. After standardization, Personal Attitudes and Professional Behavior showed median scores above the country global median and Knowledge alone showed median score below the country global median. In Portugal, Clinical Skills showed score below the global median. In Angola, Clinical Skills and General Skills showed a similar result. There were only significant differences between countries in Personal Attitudes (p < 0.001) and Professional Behavior (p = 0.043).</p> <p>Conclusions</p> <p>The reliability of the instrument in Portuguese and Portuguese-speaking African medical schools was confirmed. Students have perceived their level of competence in personal attitudes in a high level and in opposite, knowledge and clinical skills with some weaknesses.</p

Inequalities in public water supply fluoridation in Brazil: An ecological study

Background. The literature is scarce on the social and geographic inequalities in the access to and implementation of the fluoridation of public water supplies. This study adds knowledge to the Brazilian experience of the chronic privation of water and wastewater policies, access to potable water and fluoridation in the country. Thus, the aim of this study was to verify possible inequalities in the population's access to fluoridated drinking water in 246 Brazilian municipalities. Methods. The information on the process of water fluoridation in the municipalities and in the macro region in which each municipality is located was obtained from the national epidemiological survey which was concluded in 2003. The data relating to the human development index at municipal level (HDI-M) and access to mains water came from the Brazilian Human Development Atlas, whilst the size of the population was obtained from a governmental source. The Fisher exact test (P < 0.05) was employed to identify significant associations between the explanatory variables and their ability to predict the principal outcomes of interest to this study, namely the presence or absence of the water fluoridation process in the municipalities as well as the length of time during which this measure has been implemented. Linear regression was used to observe the associations between the relevant variables in a multivariate environment. Results. The results clearly showed that there is a relationship between municipalities with larger populations, located in more socio-economically advantaged regions and with better HDI-M, and where fluoridation is both present and has been implemented for a longer period of time (started before 1990). Conclusion. The findings suggest that the aim of treating water with fluoride may not be being adequately achieved, requiring more effective strategies so that access to this measure can be expanded equitably.81Hart, J.T., The inverse care law (1971) Lancet, 1 (7696), pp. 405-12. , 4100731Victora, C.G., Vaughan, J.P., Barros, F.C., Silva, A.C., Tomasi, E., Explaining trends in inequities: Evidence from Brazilian child health studies (2000) Lancet, 356 (9235), pp. 1093-98. , 10.1016/S0140-6736(00)02741-0 11009159Basting, R.T., Pereira, A.C., Meneghim, M.C., Evaluation of dental caries prevalence in students from Piracicaba, SP, Brazil, after 25 years of fluoridation of the public water supply (1997) Rev Odontol Univ São Paulo, 11 (4), pp. 287-92. , 10.1590/S0103-06631997000400010Lawrence, H.P., Sheiham, A., Caries progression in 12 to 16-year-old schoolchildren in fluoridated and fluoride-deficient areas in Brazil (1997) Community Dent Oral Epidemiol, 25 (6), pp. 402-11. , 10.1111/j.1600-0528.1997.tb01730.x 9429812Pereira, A.C., Mialhe, F.L., Bianchini, F.L.C., Prevalence of caries and dental floozies in scholars from cities with different fluoride concentrations in drinking water (2001) Rev Bras Odontol Sade Coletiva, 2 (1), pp. 34-9For Disease Control, C., Prevention, Achievementsin Public Health, 1900-1999: Fluoridation of drinking water to prevent dental caries (1999) Morbidity and Mortality Weekly Report, 48 (41), pp. 933-40For Disease Control, C., Prevention, Ten great public health achievements -United Sates, 1900-1999 (1999) Morbidity and Mortality Weekly Report, 48 (12), pp. 241-3. , 10220250American Health Organization, P., XV Directing Council of the Pan American Health Organization - Resolutions, 1964, , http://www.paho.org/English/GOV/CD/ftcd_15.htm(2003) The World Oral Health Report 2003, , http://www.who.int/oral_health, Geneva: WHOMcDonagh, M.S., Whiting, P.F., Wilson, P.M., Sutton, A.J., Chestnutt, I., Cooper, J., Misso, K., Kleijnen, J., Systematic review of water fluoridation (2000) BMJ, 321 (7265), pp. 855-9. , 11021861 10.1136/bmj.321.7265.855Bratthall, D., Hänsel-Petersson, G., Sundberg, H., Reasons for the caries decline: What do the experts believe? (1996) Eur J Oral Sci, 104 (4 PART 2), pp. 416-22. , 10.1111/j.1600-0722.1996.tb00104.x 8930592Narvai, P.C., Dental caries and fluorine: A twentieth century relation (2000) Cinc Sade Coletiva, 5 (2), pp. 381-92. , 10.1590/S1413-81232000000200011Peres, M.A., Fernandes, L.S., Peres, K.G., Inequality of water fluoridation in Southern Brazil - The inverse equity hypothesis revisited (2004) Soc Sci Med, 58 (6), pp. 1181-9. , 10.1016/S0277-9536(03)00289-2 14723912Peres, M.A., Antunes, J.L.F., Peres, K.G., Is water fluoridation effective in reducing inequalities in dental caries distribution in developing countries? (2006) Sozial und Präventiv Medizin, 51 (5), pp. 1-9Peres, K.G., Bastos, J.R., Mrdo, L., Relationship between severity of dental caries and social and behavioral factors in children (2000) Rev Saude Publica, 34 (4), pp. 402-8. , 10973161Maltz, M., Barbachan Silva, E.B., Relationship between caries, gingivitis and fluorosis and the socioeconomic status among school children (2001) Rev Saude Publica, 35 (2), pp. 170-6. , 11359204Moysés, S.J., Desigualdades em Sade Bucal e Desenvolvimento Humano: Um ensaio em preto, branco e alguns tons de cinza (2001) Rev Bras Odontol Sade Coletiva, 1 (1), pp. 7-17Patussi, M.P., Marcenes, W., Croucher, R., Sheiham, A., Social deprivation, income inequality, social cohesion and dental caries in Brazilian school children (2001) Soc Sci Med, 53 (7), pp. 915-25. , 10.1016/S0277-9536(00)00391-9 11522137Antunes, J.L.F., Frazão, P., Narvai, P.C., Bispo, C.M., Pegoretti, T., Spatial analysis to identify differentials in dental needs by area-based measures (2002) Community Dent Oral Epidemiol, 30 (2), pp. 133-42. , 10.1034/j.1600-0528.2002.300207.x 12000354Peres, M.A., Peres, K.G., Antunes, J.L.F., Junqueira, S.R., Frazão, P., Narvai, P.C., The association between socioeconomic development at the town level and the distribution of dental caries in Brazilian children (2003) Rev Panam Salud Publica, 14 (3), pp. 149-57. , 10.1590/S1020-49892003000800001 14653902Antunes, J.L.F., Narvai, P.C., Nugent, Z.J., Measuring inequalities in the distribution of dental caries (2004) Community Dent Oral Epidemiol, 32 (1), pp. 41-8. , 10.1111/j.1600-0528.2004.00125.x 14961839Antunes, J.L.F., Peres, M.A., De Campos Mello, T.R., Waldman, E.A., Multilevel assessment of determinants of dental caries experience in Brazil (2006) Community Dent Oral Epidemiol, 34 (2), pp. 146-152. , 10.1111/j.1600-0528.2006.00274.x 16515679Narvai, P.C., Frazão, P., Roncalli, A.G., Antunes, J.L.F., Dental caries in Brazil: Decline, polarization, inequality and social exclusion (2006) Rev Panam Salud Publica, 19 (6), pp. 385-93. , 10.1590/S1020-49892006000600004 16968593Projeto, S.B., Brasil, Condiçes de sade bucal da população brasileira 2002-2003. Resultados principais (2004) Brasília-DF: Ministério da Sade, Secretaria de Atenção Sade, Departamento de Atenção Básica, Coordenação Nacional de Sade BucalCarmichael, C.L., Rugg-Gunn, A.J., French, A.D., Cranage, J.D., The effect of fluoridation upon the relationship between caries experience and social class in 5-year-old children in Newcastle and Northumberland in 1987 (1980) Br Dent J, 149 (6), pp. 163-7. , 10.1038/sj.bdj.4804479 6931610Bradnock, G., Marchment, M.D., Anderson, R.J., Social background, fluoridation and caries experience in 5-year-old population in the West Midlands (1984) Br Denl J, 156 (4), pp. 127-31. , 10.1038/sj.bdj.4805287 6584119Jones, C.M., Taylor, G.O., Whittle, J.G., Evans, D., Trotter, D.P., Water fluoridation, tooth decay in 5 years olds, and social deprivation measured by the Jarman score: Analysis of data from British dental surveys (1997) BMJ, 315 (7107), pp. 514-17. , 9329305Riley, J.C., Lennon, M.A., Ellwood, R.P., The effect of water fluoridation and social inequalities on dental caries in 5-year-old children (1999) Int Dent J, 28 (2), pp. 300-5. , 10342695Congresso Nacional, Brasil., Lei Federal no. de 19/09/1990 (1990) Diário Oficial da União 20 Set, p. 18055Morgenstern, H., Ecological studies (1998) Modern Epidemiology, pp. 459-80. , Baltimore: Lippincot Williamns & Wilkins Rothman K, Greenland S(2000) Informaçes de Sade: População Residente, , http://w3.datasus.gov.br/datasus/datasus.php?area= 359A1B379C6D0E0F359G23HIJd6L26M0N&VInclude=./site/infsaude.php, Departamento de Informática do Sistema nico de Sade (DATASUS)(2003) Atlas Do Desenvolvimento Humano No Brasil, Versão 1.0.0, , Programa das Naçes Unidas para o Desenvolvimento Brasília: PNUDLallo, R., Myburgh, N.G., Hobdell, M.H., Dental caries, socio-economic development and national oral health profiles (1999) Int Dent J, 49, pp. 196-202. , 10858754Baldani, M.H., Narvai, P.C., Antunes, J.L.F., Cárie dentária e condiçes scio-econômicas no Estado do Paraná, Brasil, 1996 (2002) Cad Sade Pblica, 18 (3), pp. 755-63. , 10.1590/S0102-311X2002000300024Qizilbash, M., On the Measurement of Human Development (2002) UNDP, , http://hdr.undp.org/docs/training/oxford/presentations/ Qizilbash_HDIcritique.pdfBurt, B.A., Fluoridation and social equity (2002) J Public Health Dent, 62 (4), pp. 195-200. , 10.1111/j.1752-7325.2002.tb03445.x 12474623For Disease Control, C., Prevention, Recommendation focusing fluoride to prevent and control dental caries in the United States (2001) Morbidity and Mortality Weekly Report, 50 (14), pp. 1-42Griffin, S.O., Jones, K., Tomar, S.L., An economic evaluation of community water fluoridation (2001) J Public Health Dent, 61 (2), pp. 78-86. , 10.1111/j.1752-7325.2001.tb03370.x 11474918Bleicher, L., Frota, F.H.S., Fluoretação da água: Uma questão de política pblica - O caso do Estado do Ceará (2006) Cin Sade Coletiva, 11 (1), pp. 71-8Frias, A.C., Narvai, P.C., Arajo, M.E., Zilbovicius, C., Antunes, J.L.F., Custo da fluoretação das águas de abastecimento pblico, estudo de caso -Município de São Paulo, Brasil, período de 1985-2003 (2006) Cad Sade Pblica, 22 (6), pp. 1237-46. , 10.1590/S0102-311X2006000600013Congresso Nacional, Brasil., (1974) Lei Federal No. 6.050, 3, p. 107. , Brasília: Departamento de Imprensa Nacional Atos do Poder Legislativo. 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A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Programa de Desenvolvimento Gerencial 2009

Evento de divulgação do programa de desenvolvimento gerencial do Superior Tribunal de Justiça, contando com a palestra “Quando decorei todas as respostas, mudaram as perguntas” de José Augusto Pereira das Neves, realizada em 24 de abril de 2009