Pneumonia and poverty: a prospective population-based study among children in Brazil

<p>Abstract</p> <p>Background</p> <p>Children in developing country suffer the highest burden of pneumonia. However, few studies have evaluated associations between poverty and pneumonia.</p> <p>Methods</p> <p>A prospective population-based study on pneumonia was carried out as part of the Latin America Epidemiological Assessment of Pneumococcus (LEAP study). Chest x-rays were obtained for children one to 35 months old with suspected pneumonia presenting to emergency care centers and hospital emergency rooms in Goiania, Brazil. Chest radiographs were evaluated according to WHO guidelines. Clustering of radiologically-confirmed pneumonia were evaluated using a Poisson-based spatial scan statistic. Associations between census socioeconomic indicators and pneumonia incidence rates were analyzed using generalized linear models.</p> <p>Results</p> <p>From May, 2007 to May, 2009, chest radiographs were obtained from 11 521 children with clinical pneumonia; 3955 episodes were classified as radiologically-confirmed. Incidence rates were significantly higher in very low income areas (4825.2 per 10⁵) compared to high income areas (1637.3 per 10⁵). Spatial analysis identified clustering of confirmed pneumonia in Western (RR 1.78; p = 0.001) and Southeast (RR 1.46; p = 0.001) regions of the city, and clustering of hospitalized pneumonia in the Western region (RR 1.69; p = 0.001). Lower income households and illiteracy were associated with pneumonia incidence.</p> <p>Conclusions</p> <p>In infants the risk of developing pneumonia is inversely associated with the head of household income and with the woman educational level. Areas with deprived socioeconomic conditions had higher incidence of pneumonia and should be targeted for high vaccination coverage.</p

Formação do Enfermeiro: desafios para a promoção da saúde La formación del enfermero: retos para la promoción de la salud Nurse training: challenges for health promotion

Estudo qualitativo, descritivo-exploratório, realizado em dois cursos de Enfermagem com o objetivo de analisar os referenciais de promoção da saúde na formação do enfermeiro. Foram entrevistados 19 coordenadores, docentes, estudantes e profissionais de serviços envolvidos na formação do enfermeiro. Os resultados indicam imprecisão conceitual entre promoção da saúde e prevenção de agravos na formação do enfermeiro. As concepções de promoção da saúde reveladas estão associadas a práticas que incidem sobre qualidade de vida sustentada em um conceito amplo e complexo de saúde e que são incipientes nos cenários da atenção à saúde. Conclui-se que a promoção da saúde é tomada como decisão política para mudança na formação do enfermeiro, explicitada nos projetos pedagógicos das instituições cenário do estudo. Entretanto, esta incorporação é incipiente e heterogênea quanto à formulação teórica, indicando a necessidade de ampliação dos espaços de análise conceitual nas relações que proporcionam a produção de saúde e do processo formativo.<br>Estudio cualitativo de tipo descriptivo y exploratorio realizado en dos cursos de enfermería con el objeto de analizar los puntos de referencia de la promoción de la salud en la formación del enfermero. Se entrevistaron a 19 coordinadores, profesores, estudiantes y profesionales de las áreas que participan en la educación y formación del personal de enfermería. Los resultados indican que existe vaguedad conceptual de la promoción de la salud y la prevención de agravamientos en esta formación. El concepto de promoción de la salud está asociado a prácticas de divulgación que se centran en la calidad de vida basada en un concepto amplio y complejo de la salud, incipientes en el ámbito de la asistencia de la salud. Se concluyó que la promoción de la salud se convierte en un instrumento de decisión política que permite realizar cambios en la educación de enfermería puesta de manifiesto en los proyectos de estudio de las instituciones que se enmarcan en esta investigación. Sin embargo, debido a su formulación teórica, esta incorporación es incipiente y heterogénea, confirmando que existe la necesidad de ampliar los espacios para el análisis conceptual dentro del círculo de relaciones que hacen aportes a la producción de la salud y al proceso de formación.<br>This was a descriptive/exploratory study of qualitative character carried out in two Nursing Schools in the State of Minas Gerais. The goal was to analyze the referential of nurses regarding health promotion. Nineteen course coordinators, faculty members, students and professionals of the health services involved in nurse training were interviewed. The results indicate a conceptual imprecision about health promotion and disease prevention. Revealed conceptions of health-promoting practices are associated to practices that affect the quality of life, which lies on a broad and complex concept of health, and are incipient in the current health care scenario. The conclusion is that health promotion is taken as political decision for a change in nurse training, as made explicit in the pedagogical projects of the institutions taking part in the study. However, such incorporation is incipient and heterogeneous in terms of its theoretical formulation, thus indicating the need for widening the space for a conceptual analysis in the relations that allow for the production of health and of a training process