Sistemas de saúde e percepção de barreiras para admissão e aderência em programas de reabilitação cardíaca: estudo comparativo

Além da elevada prevalência de doenças cardiovasculares (DCV), iniquidades regionais no acesso aos serviços de saúde e subutilização de programas de reabilitação cardíaca (PRC) ainda são marcantes no cenário brasileiro. Objetivo: Esse estudo visou descrever e comparar barreiras para uso de PRC em usuários de diferentes sistemas de saúde e níveis de atendimento em um estado brasileiro. Métodos: Participantes de PRC e pacientes elegíveis de enfermarias e ambulatórios foram pareados pelos sistemas de saúde que utilizavam e responderam a Escala de Barreiras para Reabilitação Cardíaca (EBRC). Os testes U de Mann-Withney e Kruskal Wallis foram usados para comparar barreiras entre os sistemas de saúde e entre níveis de atendimento, respectivamente. Resultados: Cento e quarenta (87%) pacientes participaram do estudo. A média total dos itens da escala foi 1,98±0,48 e diferiu apenas entre participantes de PRC e pacientes internados (p<0,05). Algumas barreiras de acesso, necessidades percebidas e comorbidades/estado funcional foram maiores no sistema público do que no privado (p<0,05). A falta de conhecimento sobre PRC (3.75±1.66) e a falta de referência médica (2.32±1.53) destacaram-se no domínio necessidades percebidas, que teve o maior escore médio da amostra (2.31±0.71). Conclusões: Barreiras de acesso e necessidades percebidas foram maiores para usuários de serviços públicos. Viagens e trabalho foram barreiras maiores para participantes de PRC, enquanto para pacientes internados e ambulatoriais as maiores barreiras foram necessidades percebidas. Logo, a disseminação de PRC e estratégias para referência de elegíveis devem ser estimuladas em ambos os sistemas de saúde e níveis de atendimento.In addition to the high prevalence of cardiovascular disease (CVD), regional iniquities in access to health services and underutilization of cardiac rehabilitation programs (CRP) are still significant in the Brazilian scenario. Objective:This study aimed to describe and compare barriers to the use of CRP in users of different health systems and levels of care in a Brazilian state. Methods: CRP participants and eligible inpatients and outpatients were matched by the health systems they used and responded to the Cardiac Rehabilitation Barriers Scale (CRBS). Mann-Whitney U and Kruskal Wallis tests were used to compare barriers in health systems and levels of care, respectively. Results: One hundred and forty (87%) adults with heart disease participated in the study. The total mean score of barriers on the scale was 1.98 ± 0.48 and only differed between CRP participants and inpatients (p<0.05). Some access barriers, perceived needs and comorbidities/functional status were higher in the public services than in the private services (p <0.05). Lack of knowledge about CRP (3.75 ± 1.66) and lack of medical referral (2.32 ± 1.53) were the major barriers in the perceived needs domain, which had the highest average score in the sample (2.31 ± 0.71). Conclusions: Access barriers and perceived needs were greater among users of public services. Travel and work were greater barriers for CRP participants, while for inpatients and outpatients the largest were perceived needs. Therefore, the dissemination of CRP and implementation of strategies for eligible referral should be encouraged in both health systems and levels of care

Atendimento fisioterapêutico em uma unidade de terapia intensiva neonatal

This study aims to describe the physical therapy assistance and the results of the outreach project “Estima Vida” designed for neonates of a Neonatal Intensive Care Unit. It is an experience report carried out with quantitative data obtained through activities developed in the project. It included chest physiotherapy and early stimulation. For data collection, it was used the Silverman Andersen Bulletin, the Brazelton Scale and the Infant Pain Neonatal Scale. The sample consisted of 64 newborns, the majority of them were male (62.5%), born by abdominal birth (60.94%), at term (50%) and were admitted with the diagnosis of respiratory distress syndrome (46.88%). It was noticed a statiscally significant increase in pain (p=0,004), respiratory discomfort (p=0,000) and behavioral changes (p=0,014). It was possible to conclude that the project provided an effective assistance to the neonates, considering their respiratory distress and behavioral state.O presente estudo tem por objetivo caracterizar a assistência fisioterapêutica e a repercussão proporcionada pelo projeto de extensão EstimaVida na condição de vida de neonatos admitidos em uma Unidade de Terapia Intensiva Neonatal. Trata-se de um relato de experiência realizado através de dados quantitativos obtidos acerca das atividades desenvolvidos no Projeto. O atendimento incluía fisioterapia respiratória e estimulação precoce. Para a coleta de dados, foi utilizado o Boletim de Silverman-Andersen, Escala de Brazelton e Escala Neonatal InfantPain. A amostra foi composta por 64 neonatos, sendo a maioria do sexo masculino (62,5%), nascidos de parto abdominal (60,94%), a termo (50%) e com diagnóstico de síndrome do desconforto respiratório (46,88%). Observou-se um aumento estatisticamente significativo da presença de dor (p=0,004), desconforto respiratório (p=0,000) e alteração do estado comportamental (p=0,014). Desse modo, conclui-se que a atuação do Projeto proporcionou uma assistência efetiva para os neonatos, considerando a condição de desconforto respiratório e estado comportamental

Barriers to and facilitators of populational adherence to prevention and control measures of COVID-19 and other respiratory infectious diseases: a qualitative evidence synthesis

Aims: To summarise the evidence on barriers to and facilitators of population adherence to prevention and control measures for coronavirus disease 2019 (COVID-19) and other respiratory infectious diseases. Methods: A qualitative synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Cochrane Effective Practice and Organization of Care: Qualitative Evidence Synthesis. We performed an electronic search on MEDLINE, Embase and PsycINFO from their inception to March 2023. Results: We included 71 studies regarding COVID-19, pneumonia, tuberculosis, influenza, pertussis and H1N1, representing 5966 participants. The measures reported were vaccinations, physical distancing, stay-at-home policy, quarantine, self-isolation, facemasks, hand hygiene, contact investigation, lockdown, infection prevention and control guidelines, and treatment. Tuberculosis-related measures were access to care, diagnosis and treatment completion. Analysis of the included studies yielded 37 barriers and 23 facilitators. Conclusions: This review suggests that financial and social support, assertive communication, trust in political authorities and greater regulation of social media enhance adherence to prevention and control measures for COVID-19 and infectious respiratory diseases. Designing and implementing effective educational public health interventions targeting the findings of barriers and facilitators highlighted in this review are key to reducing the impact of infectious respiratory diseases at the population level