O estudo teve como objetivo avaliar o efeito da expansao da cobertura da Estrategia Saude da Familia (ESF) sobre as internacoes por condicoes sensiveis a atencao primaria (ICSAP) em criancas menores de um ano. Trata-se de um estudo ecologico longitudinal com uso de painel de dados, cujas unidades de analise foram os 417 municipios da Bahia, Brasil, entre 2000 a 2012. Os dados foram obtidos dos sistemas de informacao em saude. A taxa de ICSAP foi o desfecho e a cobertura da ESF a exposicao principal. As covariaveis eram referentes as caracteristicas demograficas e socioeconomicas e disponibilidade de leitos pediatricos nos municipios. Foi realizada analise de regressao bivariada e multivariada para painel de dados, com resposta binomial negativa e modelos de efeitos fixos, utilizando como medida de associacao o risco relativo (RR), bruto e ajustado, com seus respectivos intervalos de confianca. Para controle de efeito de tendencia, os modelos foram ajustados pelo tempo. Entre 2000 e 2012, 248.944 ICSAP foram registradas em criancas menores de um ano, e a mediana das taxas municipais de ICSAP reduziu 52,5% no periodo, variando de 96,9 para 46,0 hospitalizacoes evitaveis por mil nascidos vivos. Apos o ajuste do modelo, a reducao das internacoes evitaveis se manteve nos diferentes niveis de cobertura da ESF. Este estudo demonstrou os efeitos da consolidacao da ESF nas ICSAP em menores de um ano, o que indica a importância do fortalecimento das acoes no âmbito da atencao primaria, com o intuito de oferecer assistencia resolutiva ao primeiro contato e evitar hospitalizacoes desnecessarias.

/pdf/efeito-da-estrategia-saude-da-familia-nas-internacoes-por-39rp7pnvxl.pdf

Efeito da Estratégia Saúde da Família nas internações por condições sensíveis à atenção primária em menores de um ano na Bahia, Brasil

This study aimed at determining the factors related to the duration of exclusive breastfeeding and to associate them to the scores of the Breastfeeding Self-efficacy Scale. 300 mother-baby binomials were studied, from the capital cities of the southern region of Brazil in 2012, using the Breastfeeding Self-efficacy Scale during postpartum period and with intervals from 15 to 120 days after delivery. The average of the score of breastfeeding was 36 points. The risk factors for breastfeeding were: hospitals which were not Child Friendly (p=0.002), schooling (≤ 8 years of study; p=0.004), and working mother (p=0.013). When evaluating the maternal breastfeeding after 120 days, the variables which were considered as protection factors  for breastfeeding were the maternal age of majority (p=0.039) and the score in the test of breastfeeding (p=0.046). The variables for the exclusive breastfeeding were the maternal age of majority and the score in the test of breastfeeding.

/pdf/exclusive-maternal-breastfeeding-and-the-breastfeeding-self-578fgst3lo.pdf

Exclusive maternal breastfeeding and the Breastfeeding Self-efficacy Scale

O estudo analisou a evolucao das equipes de saude da familia no Brasil, com base em dados secundarios do Ministerio da Saude sobre as equipes de saude da familia implantadas em dezembro de 2012 e 2015 no Cadastro Nacional de Estabelecimentos de Saude, segundo macrorregioes e portes populacionais dos municipios. Tambem foram analisadas internacoes por causas sensiveis a atencao primaria, com base no Sistema de Informacoes Hospitalares, tendo como referencia o ano de ocorrencia da internacao. Em 2015, mais de 70% dos municipios tinham aderido ao Programa Mais Medicos (quase 40% das equipes de saude da familia), assegurando a universalizacao em quase 100% dos municipios de menor porte populacional. Alem da expansao, que incluiu mais de vinte milhoes de habitantes, observou-se a substituicao de equipes antes implantadas, sugerindo reducao da rotatividade e fixacao dos profissionais, o que pode ter sido estimulado pelo financiamento do Ministerio da Saude, desonerando os municipios. Internacoes por causas sensiveis a atencao primaria reduziram-se ainda mais apos a implantacao do programa, sugerindo sua contribuicao na melhoria do acesso e desempenho da atencao primaria. Ainda ha importantes desafios, e o programa representa um esforco para se alcancar a universalidade no sistema.

/pdf/a-ampliacao-das-equipes-de-saude-da-familia-e-o-programa-3g69ot31lz.pdf

A ampliação das equipes de saúde da família e o programa mais médicos nos municípios brasileiros

Objetivou-se analisar as internacoes por condicoes sensiveis a atencao primaria (ICSAP) especificas em mulheres e os fatores que determinam ou influenciam a ocorrencia dessas internacoes (fatores socioeconomicos, sociodemograficos e controle de saude) por meio de um inquerito de morbidade hospitalar realizado com amostra de 429 mulheres internadas em hospitais conveniados ao Sistema Unico de Saude. O percentual de ICSAP foi 49,42% (n = 212), com destaque para as internacoes especificas do sexo feminino 19,35% (n = 83). Associaram ao risco de internar por CSAP: idade superior a 60 anos, baixa escolaridade, internacao previa, realizacao de controle regular de saude, falta de vinculo com a Estrategia Saude da Familia (ESF) e ser gestante. As causas evidentes foram as condicoes relacionadas a gravidez, ao parto e ao puerperio e as inflamacoes nos orgaos pelvicos femininos. Os resultados sugerem falhas no atendimento ambulatorial que deveria ser oportuno e resolutivo no contexto da saude da mulher.

/pdf/internacoes-sensiveis-a-atencao-primaria-especificas-de-31kzwq2630.pdf

Internações sensíveis à atenção primária específicas de mulheres

Teenagers face many new health concerns during adolescence. Although Adolescent Health Concerns (AHCs) do not represent a major public health problem like high risk behaviors, their existence is a threat to adolescent health and well-being (1). Examining the AHCs may increase our understandings of motivations that underlie specific behaviors (2) and in some cases the concerns and problems reported by adolescents precede the onset of high risk behaviors (3). In fact, health concerns represent all major issues affecting individual health. Health concerns differ by age groups, life stage, and a host of socio-economic and intrapersonal variables (2). When examining AHCs, it is important to identify their corresponding problems as evidenced by epidemiologic data so that appropriate policies and strategies to improve their health can be established (4). Despite the importance of examining the health concerns of adolescents, few comprehensive questionnaires design to systematically assess AHCs exist. A variety of tools have been used in different studies for studying AHCs (5–14). Due to lack of comprehensive and psychometrically sound questionnaires for assessing the AHCs in Iran, two options were available: create a new questionnaire, or translate and pilot test an existing questionnaire from its original language to Persian. While designing a new questionnaire is a time consuming process and requires considerable effort (15), using existing tools in different countries requires translation and cultural adaptation (16, 17). The process of translation and cultural adaptation of a tool is required when the tool is going to be used in a new language and culture (18). The purpose of this process is to obtain a different version of the original language equal for any of the target countries or cultures in terms of concept (19).

Considering that adolescents have concerns in all of their functional aspects including physical, mental and social dimensions, we found Adolescent Health Concern Inventory (AHCI) as the most comprehensive instrument; AHCI was developed and its Psychometric characteristics were examined by Weiler in 1990 in the United States of America (USA). It assesses the health concerns of adolescents, teachers’ beliefs about adolescents’ health concerns, and parents’ beliefs about adolescents’ health concerns. The three instrument forms contained identical core items of concerns, differing only with respect to the perspective from to which the subjects of the three study groups responded. Thus, for Form A: “a personal concern for myself”; Form B:”teenagers in our school have a concern”; Form C:”teenager(s) living in our home have a concern (6). This instrument have at least two possible applications: “(1) as a needs assessment instrument to determine the health concerns of adolescents and to determine teachers’ and parents’ beliefs about the health concerns of adolescents; and (2) as an instructional tool to be used by health educators and other health professionals for staff development programs”(6). Some changes (minor revisions) were made to the AHCI in 2005 by Weiler. In the present study, we report the psychometric characteristics of the adolescence form. The AHCI contains 150 items, grouped into 12 subscales: (1)Substance Use and Abuse (14 items); (2) Diseases and Disorders (17 items); (3) The Environment (11 items); (4) Consumer Health (7 items); (5) Human Sexuality (11 items); (6) Personal Health (13 items); (7) Nutrition (9 items); (8) Injury Prevention and Control (13 item); (9) Social Health (16 items); (10) Relationships (14 items); (11) Emotional Health (17 items); and (12) The Future (8 items). Responses are based on a check-off response option. Adolescents are instructed to check each item in the inventory that represented a personal concern. The scores are calculated based on the number of items chosen or checked within the inventory, with each item equaling one point. Thus, the total score of health concerns vary between 0 and 150 (2, 6).

AHCI was originally designed in English for use in the USA. Thus, in order to use the AHCI with Iranian adolescents for our own needs assessment purposes, we decided to translate the AHCI from the English version to Persian and then assess its cultural relevance, validity, and reliability to ensure that it would be culturally appropriate for our target population.

Translation is the most common method of preparing questionnaires for cross-cultural application (20). The process of questionnaire translation provides cultural adaptation. With a good translation, one can receive similar feedbacks by completing the questionnaire from different samples (21). The purpose of cultural adaptation is also to ensure compatibility between the reference version and new versions regarding face and content validity (22). As a result of cultural and linguistic differences, terms, concepts, directions, questions, of the translated instrument may have different meanings. Paying careful attention to the process of translation and cultural adaptation will ensure the validity and reliability of the instrument (16). There are no agreement upon uniform steps for culturally translating and adapting health promotion materials and measures. For instance, WHO recommends four steps for translation (19), while Beaton suggests six steps including initial translation, synthesis of the translations, back translation, expert committee, test of the pre-final version, submission of documentation to the developers/ coordinating committee for appraisal of the adaptation process (22). Wild recommends ten steps including forward translation, reconciliation, back translation, back translation review, harmonization, cognitive debriefing, review of cognitive debriefing, results and finalization, proof reading, and final report (23). We used a combination of approaches of Beaton and Wild in the process of translation and cultural adaptation (22, 23).

This study aimed to assess the validity and reliability of the Persian version of the questionnaire (i.e., the AHCI-P) to evaluate adolescent concerns in the Iranian population. Therefore, this report describes the process and principles used in the translation and cultural adaptation of the AHCI, and presents the psychometric properties resulting from a pilot study for the first time in Iran.

/pdf/psychometric-properties-of-the-adolescent-health-concern-li49vv9h8d.pdf

Psychometric Properties of the Adolescent Health Concern Inventory: The Persian Version

Introducao: Realizou-se uma pesquisa em municipios da Regiao de Saude de Sao Miguel do Oeste no estado de Santa Catarina, sobre Internacoes por Condicoes Sensiveis a Atencao Primaria, consideradas como um problema de saude publica. A Lista Brasileira de Internacoes por Condicoes Sensiveis a Atencao Primaria elenca doencas que nao deveriam gerar internacoes, e sim, ter resolubilidade na Atencao Primaria. Objetivos: Caracterizar o perfil das Internacoes por Condicoes Sensiveis a Atencao Primaria e outras variaveis no Sistema Unico de Saude de municipios de abrangencia da Regiao de Saude de Sao Miguel do Oeste / SC. Metodologia ou Descricao da Experiencia: A pesquisa foi realizada no Sistema de Informacao Hospitalar-SUS (SIH-SUS) que gerencia as autorizacoes de internacoes hospitalares ocorridas no pais (DATASUS, 2012) no âmbito do SUS. Atraves do SIH-SUS disponibilizados pelo site do DATASUS foi realizada coleta de dados das ICSAPs dos municipios de Bandeirante, Barra Bonita, Belmonte, Descanso, Guaraciaba, Sao Miguel do Oeste e Paraiso. Os dados foram coletados no periodo de Agosto 2009 a Julho de 2010 conforme as variaveis: sexo, faixa etaria, media de permanencia, valor do total gasto e numero de internacoes das ICSAPs. Resultados: Destacaram-se cinco patologias com maior numero de internacoes. Dentre elas encontrou-se a asma, diabetes mellitus, diarreia e gastroenterite, insuficiencia cardiaca e pneumonia. O municipio de Belmonte apresentou um total de 205 internacoes, dentre as internacoes ocorridas 9% foram por ICSAP, em Descanso 755 pessoas estiveram internadas e dentre elas 12% foram por ICSAP, em Paraiso das 266 internacoes 17% foram por ICSAP, em Sao Miguel do Oeste das 2.662 internacoes, 22% foram por ICSAP, em Bandeirante das 246 internacoes, 20% foram por ISCAP, no municipio de Barra Bonita no total de 191 internacoes 19% (foram por ICSAP e em Guaraciaba das 987 internacoes ocorridas 28% foram por ICSAP. Conclusao ou Hipoteses: As ICSAP geram internacoes que poderiam ser prevenidas com acoes oportunas em tempo adequado. Considerando que o estudo analisou somente cinco das setenta e quatro patologias descritas na Lista Brasileira, estima-se que tenha ocorrido no periodo, um numero ainda maior de internacoes por ICSAP. Espera-se que os resultados obtidos, reforcem a importância das acoes desenvolvidas na Atencao Primaria.

/pdf/internacoes-por-condicoes-sensiveis-a-atencao-primaria-47dzcini4i.pdf

Internações por condições sensíveis à Atenção Primária

The objectives of this study were to carry out cross-cultural adaptation of the HIV/AIDS-Target Quality of Life Instrument for Portuguese and to observe its psychometric properties. Translations, translations synthesis, back translation, analysis by a committee of specialists, pre-final version test, studies of validity and reliability of the final version were carried out. Psychometric properties were evaluated by the administration of the Brazilian version in 50 consecutive HIV positive patients, from the DST/HIV/AIDS municipal ambulatory of Sao Miguel do Oeste, Santa Catarina State. The internal consistency was observed by a-Cronbach. The reliability was estimated using the intraclass correlation coefficient and Bland-Altmann diagram. The validity was observed comparing the scores of the questionnaire with the WHOQOL-HIV-Brief through the Spearman rank correlation coefficient. The results pointed out to a-Cronbach of 0.893. The correlations obtained were 0.934 for inter-interviewer and 0.977 for intra-interviewer. The correlation with WHOQOL-HIV-Bref was 0.824. It was concluded that the cross-cultural adaptation process was successful and the adapted questionnaire demonstrated good psychometric properties.

https://www.scielosp.org/pdf/csc/2011.v16suppl1/1357-1362/pt

[Transcultural adaptation of the HIV/AIDS-Target Quality of Life for HIV/AIDS for the evaluation of patients quality of life]

Introducao: A Organizacao Mundial da Saude (OMS) orienta a utilizacao do leite materno como fonte de alimento nos primeiros meses de nascimento da crianca e esta orientacao tem sido incentivada no Brasil. Na esfera municipal, geralmente as acoes que contemplam o incentivo ao aleitamento materno sao realizadas pelos profissionais que compoem as equipes da Estrategia Saude da Familia (ESF). Objetivos: Este artigo sintetiza os resultados de uma pesquisa que foi realizada no mes de abril de 2012 e que teve como objetivo geral identificar a compreensao de gestantes do municipio de Sao Jose do Cedro no estado de Santa Catarina, sobre o aleitamento materno exclusivo. Metodologia ou Descricao da Experiencia: No periodo de realizacao da coleta dos dados existiam 81 gestantes cadastradas no Sistema de Informacao da Atencao Basica – SIAB/2012 no municipio. A pesquisa foi realizada com uma amostragem de 12 gestantes na faixa etaria de 18 a 35 anos de idade. Utilizou-se como tecnica uma entrevista semi-estruturada de forma individual e que seguiu um roteiro com perguntas abertas e fechadas. O projeto de pesquisa foi apresentado e aprovado pelo Comite de Etica em Pesquisa (CEP) da Universidade do Oeste de Santa Catarina(UNOESC). Resultados: Os resultados da pesquisa demonstraram que algumas entrevistadas possuem internalizados tabus culturais, expressados atraves do medo, receio ou vergonha de amamentar. Dentre as entrevistadas 9 (nove) terao o primeiro filho, 2 (duas) terao o segundo filho e 1(uma) tera o 3o filho, sendo assim, apenas as 3 (tres) gestantes que ja tiveram filhos possuem experiencia com a amamentacao. Dentre as que tiveram experiencia, uma amamentou por 4 meses, a segunda por seis meses e a terceira nao informou. Conclusao ou Hipoteses: As equipes da ESF realizam reunioes mensais com as gestantes, contudo, percebeu-se a necessidade de intensificar campanhas informativas e de conscientizacao sobre a importância do aleitamento materno, percebeu-se que ha pouca procura na Unidade de Saude para informacoes complementares apos o nascimento da crianca sobre a prioridade do alimento materno exclusivo.

/pdf/aleitamento-materno-exclusivo-2yh4dpvk0s.pdf

Aleitamento materno exclusivo

This study aimed to perform a subjective evaluation of the sleep quality of truck drivers in the extreme western region of Santa Catarina. For this purpose, a questionnaire was used to evaluate the participants' profile and two other questionnaires to measure the degree of sleepiness (Epworth Scale) and Pittsburgh sleep quality index. The sample consisted of 179 truck drivers, all of them male, aged between 21 and 65 years; 77.65% married and 22.34% single; 72.6% have children, with an average of two children per participant. As for the professional profile, 75.9% of the interviewees work as wage earners and 24.1% as freelancers. The type of route covered, in most cases, is long distance, representing 66%, and 34% being short distance routes. Regarding the educational level, 53.5% of the participants have elementary education; 42.4% high school and 3.9% were graduates. Overweight or obesity was identified in 59.80% of the interviewees. About sleep quality, 22.5% reported sleeping less than 5 hours daily; 35.1% from 5h to 6h; 29.0% from 6h to 7h; 12.8% sleep more than 7 hours. On the Epworth Sleepiness Scale, 67.0% presented no sleepiness; 27.3% presented mild degree of somnolence; 5.5% had moderate degree of somnolence. Regarding the Pittsburgh Sleep Quality Index, it was verified that 55.8% presented subjective poor sleep quality. The results suggested that lifestyle and poor habits can negatively influence the health of these professionals.

/pdf/quality-of-the-sleep-of-truck-drivers-that-travel-in-the-2i0kc60s3w.pdf

Ana Maria Martins Moser

Papers

Internações por condições sensíveis à Atenção Primária

[Transcultural adaptation of the HIV/AIDS-Target Quality of Life for HIV/AIDS for the evaluation of patients quality of life]

Aleitamento materno exclusivo

Quality of the sleep of truck drivers that travel in the region of the extreme-west of Santa Catarina

A saúde na fronteira seca Brasil-Argentina