OBJETIVOS: Investigar a incidência de prematuridade e de baixo peso ao nascer no município de Bento Gonçalves, Rio Grande do Sul, e identificar fatores associados, sensíveis à Atenção Primária à Saúde MÉTODOS: Amostra consecutiva de 540 puérperas que realizaram pré-natal em Bento Gonçalves, RS, entre agosto de 2009 e fevereiro de 2010. Visitou-se diariamente as puérperas no hospital ou no domicílio para a coleta de dados. Os preditores investigados contemplam variáveis sócio-demográficas e gestacionais. Associações com os desfechos foram estimadas utilizando o modelo de Regressão de Poisson Robusta. RESULTADOS: A incidência de baixo peso ao nascer foi de 11,2% e de prematuridade foi 14,3%. No modelo multivariável para o baixo peso permaneceram associadas as variáveis maternas: idade menor que 17 anos (RR=3,2; IC95%:1,51- 6,75), ter nascimento prévio de baixo peso (RR=4,1; IC95%:1,96-8,48), ter fumado na gestação (RR=2,1; IC95%:1,16-3,77) e ter hipertensão (RR=4,3; IC95%:1,94- 9,47). Como fator de risco de prematuridade permaneceram associadas significativamente após análise multivariada: idade menor de 17 anos (RR=2,7; IC95%:1,12-6,40), ter nascimento prévio de baixo peso (RR=2,8; IC95%:1,52-5,25), pré-natal na rede conveniada/particular (RR=2,2; IC95%:1,35-3,44), pré-eclâmpsia na gestação (RR=3,6; IC95%: 1,76-7,37). CONCLUSÕES: A incidência de prematuridade e de baixo peso ao nascimento aumentou, corroborando com a literatura nacional. Fortalecer os princípios da Atenção Primária em Saúde coloca-se relevante neste contexto, focando-se a atenção na gestante adolescente, medidas antitabaco e monitoramento das doenças hipertensivas, seria possível interferir nas taxas de prematuros e de baixo peso e, por conseguinte, alcançar a redução da mortalidade infantil. Porém, também se faz relevante discutir o papel da saúde suplementar e suas altas taxas de cesarianas. / OBJECTIVE: To investigate the incidence of prematurity and low birth weight in the municipality of Bento Gonçalves, Rio Grande do Sul, and to identify the associated factors that may be sensitive to Primary Health Care. METHODS: Consecutive sample of 540 postpartum women who received prenatal care in Bento Gonçalves, RS, between August 2009 and February 2010. Every day the mothers were visited in the hospital or at home for data collection. The predictors included socio-demographic and pregnancy variables. Associations with outcomes were estimated using robust Poisson regression model. RESULTS: The incidence of low birthweight was 11.2% and of prematurity was 14.3%. The variables associated with low birth weight were being younger than 17 years (RR=3.2; CI95%:1.51-6.75), history of previous low birth weight (RR=4.1; CI95%:1.96-8.48), smoking during pregnancy (RR=2.1; CI95%:1.16-3.77) and having hypertension (RR=4.3; CI95%:1.94-9.47). The variables associated with preterm birth in the multivariable model were being younger than 17 years (RR=2.7; CI95%:1.12- 6.40), history of previous low birth weight (RR=2.8; CI95%:1.52-5.25), prenatal care through the private system (RR=2.2; CI95%:1.35-3.44) and pre-eclampsia during pregnancy (RR=3.6; CI95%:1.76-7.37). CONCLUSIONS: The incidence of prematurity and low birth weight increased, according to national literature. Strengthening the principles of Primary Health Care may be relevant in this context, focusing on teen pregnancy. Tobacco control and monitoring of hypertensive diseases may reduce preterm and low birth weight incidences and therefore achieve the a reduction in infant mortality. However, it is also relevant to discuss the role of supplementary health on the high rates of cesarean.

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T16:48:42Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_GabrielaBohrerBolsson.pdf: 1963924 bytes, checksum: 3b44b6e46447fb592b5ee730cecf6db1 (MD5) / Made available in DSpace on 2018-08-22T16:48:42Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_GabrielaBohrerBolsson.pdf: 1963924 bytes, checksum: 3b44b6e46447fb592b5ee730cecf6db1 (MD5) Previous issue date: 2017-12-07 / Objective: The purpose of the present study was to verify the factors that affect the quality of life related to oral health (HRQoL) of pregnant women, attended at the Basic Health Units and Family Health Strategies, in the municipality of Santa Maria, Rio Grande do Sul. South. Material and Method: The study design was of a cross-sectional type, of which 100 pregnant women participated in this study. Information regarding the QVRSB of pregnant women was collected through the Oral Health Impact Profile (OHIP-14). Data related to biological characteristics, socioeconomic factors and social support were obtained through a semi-structured questionnaire. Results: Descriptive analysis showed that the mean gestation time was 27.6 weeks; 75.8% of the participants were single and only 21.2% had a family income less than two minimum wages. In addition, the majority of pregnant women were in the age group between 20 and 30 years of age, with the mean age being 24.6 years. Still, 53% declared themselves white and 55% did not work. Regarding clinical dental conditions, most of the pregnant women had depth of probing (PS) ≥ 3mm and clinical insertion level (NIC) ≥ 3mm and the mean CPO-S was 12.77 (SD: 15.16). Regarding the impact on the HRQoL, the mean OHIP-14 score was 2.5 (dp: 1.3), with the domains most affected: disability followed by the domain of psychological discomfort and social disability. After the Poisson-adjusted analysis, it was observed that pregnant women older than 40 years were 47% more likely to report an impact on the HRQoL compared to those <20 years of age. White women showed a lower impact on the QVRSB when compared to black, brown or indigenous women. In addition, women with more than 8 years of schooling have a protective factor when compared to those with less schooling. Regarding social support, pregnant women who never or almost never had someone to give information had a greater impact on the quality of life related to oral health. Clinical data on caries and periodontal disease did not have an impact on HRQoL in the sample evaluated. Product: As a product of this Master's Dissertation, didactic material was built, based on a virtual learning technology, about prenatal dentistry and its importance for the pregnant woman and her baby. Conclusion: health education is essential to prenatal dentistry, since the quality of life related to the oral health of the pregnant woman will have repercussions on her general health and that of her baby. / Objetivo: O propósito do presente estudo foi verificar os fatores que que impactam na qualidade de vida relacionada a saúde bucal (QVRSB) de gestantes, atendidas em Unidades Básicas de Saúde e Estratégias de Saúde da Família, do município de Santa Maria, Rio grande do Sul. Material e Método: O delineamento do estudo foi do tipo transversal, sendo que 100 mulheres grávidas participaram desta pesquisa. Informações a respeito da QVRSB das gestantes foram coletados através do Oral Health Impact Profile (OHIP-14). Dados relacionados as características biológicas, fatores socioeconômicos e apoio social foram obtidos mediante questionário semiestruturado. Resultados: Através da análise descritiva observou-se que a média de tempo de gestação foi de 27,6 semanas, 75,8% das participantes eram solteiras e apenas 21,2% apresentavam renda familiar menor que dois salários mínimos. Além disso, a maior parte das gestantes estavam na faixa etária entre 20 a 30 anos de idade, sendo a média de idade 24,6 anos. Ainda, 53% declararam-se da cor branca e 55% não trabalhavam. Sobre as condições clínicas dentárias, a maior parte das gestantes apresentou profundidade de sondagem (PS)≥ 3mm e nível de inserção clínica (NIC) ≥ 3mm e a média do CPO-S foi de 12,77 (dp: 15,16). Quanto ao impacto na QVRSB a média do resultado do OHIP-14 foi de 2,5 (dp: 1,3), sendo os domínios mais afetados: incapacidade seguido pelo domínio de desconforto psicológico e inabilidade social. Após a análise ajustada de Poisson observou-se que gestantes com mais de 40 anos apresentaram 47% maior probabilidade de relatar um impacto na QVRSB quando comparadas com aquelas < de 20 anos de idade. Mulheres brancas demostraram menor impacto na QVRSB quando comparadas com as negras, pardas ou indigenas. Além disso, mulheres com mais de 8 anos de estudos apresentam um fator de proteção quando comparadas com aquelas com menos escolaridade. Referente ao apoio social, gestantes que relataram nunca ou quase nunca possuir alguém para lhe dar informação apresentaram maior impacto na qualidade de vida relacionada à saúde bucal. Os dados clínicos observados sobre cárie e doença periodontal não impactaram na QVRSB na amostra avaliada. Produto: Como produto desta dissertação de mestrado, foi construído material didático, apartir de uma tecnologia virtual de aprendizagem, sobre o pré-natal odontológico e sua importância para a gestante e seu bebê. Conclusão: a educação em sáude é essencial ao pré-natal odontológico, visto que qualidade de vida relacionada a saúde bucal da gestante repercutirá na sua saúde geral e na de seu bebê.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-08T13:48:33Z No. of bitstreams: 1 Monica Simoes da Motta Duarte.pdf: 4646820 bytes, checksum: 1952095a931878a44ea2044ea87ff0e6 (MD5) / Made available in DSpace on 2015-12-08T13:48:33Z (GMT). No. of bitstreams: 1 Monica Simoes da Motta Duarte.pdf: 4646820 bytes, checksum: 1952095a931878a44ea2044ea87ff0e6 (MD5) Previous issue date: 2011 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Apesar de a literatura existente apontar diversas vantagens às instituições de saúde que aderem aos programas de acreditação, observa-se que poucas instituições, principalmente públicas do Estado do Rio de Janeiro, conseguiram percorrer esse caminho de trabalho contínuo de sensibilização, envolvimento, liderança efetiva da direção, perseverança e uma mudança cultural organizacional significativa para alcançarem a acreditação. Diante desta assertiva, selecionou-se como objeto de estudo o processo de acreditação em uma instituição de saúde da rede pública do Estado do Rio de Janeiro. Traçou-se os seguintes objetivos: caracterizar uma instituição de saúde acreditada da rede pública do Estado do Rio de Janeiro; descrever os caminhos percorridos por esta instituição para ser acreditada e discutir os benefícios institucionais obtidos por esta instituição de saúde acreditada. Um estudo exploratório, descritivo, com abordagem qualitativa, método de estudo de caso, cujo cenário foi o HEMORIO. Utilizou-se como fonte de evidência a documentação referente ao processo de gestão da instituição e entrevistas semi-estruturadas com doze profissionais administrativos e de saúde que trabalham na instituição e acompanharam o processo de acreditação. A coleta de dados ocorreu entre os meses de janeiro a setembro de 2011. Os dados obtidos foram analisados através do método de análise de conteúdo temática, emergindo seis categorias: categoria I: o caminhar da instituição para a acreditação; categoria II: as reações dos profissionais no enfrentamento da acreditação; categoria III: os resultados do processo de acreditação na instituição; categoria IV: a escolha e os custos do tipo de processo de acreditação; categoria V: a acreditação nas instituições de saúde da rede pública e categoria VI: o usuário e a acreditação. Concluiu-se que o caminhar para a acreditação no HEMORIO não foi uma tarefa fácil, vários fatores foram relevantes, alguns obstáculos existiram nesta trajetória, mas os benefícios foram bem expressivos, propiciando visibilidade institucional. Foi evidenciado tanto nos clientes internos quanto externos orgulho em trabalhar e se tratar no Instituto. Cabe ressaltar ser imprescindível aos gestores das demais instituições de saúde compreenderem que este processo os levará a fornecer uma assistência à saúde mais segura, com qualidade e livre de riscos aos usuários. / Although literature points out several advantages to the health institutions that adhere to accreditation programs, it is noted that few institutions, mainly public of Rio de Janeiro State, were able to walk this path of continuous awareness, involvement, direction leadership, perseverance and a significant organizational culture change to achieve accreditation. In view of this assertive, was selected as object study the process of accreditation in a health public institution of Rio de Janeiro State. Traced the following objectives: characterize an accredited institution of public health in Rio de Janeiro State; describe the paths taken by this institution to be accredited and discuss the benefits obtained by this health institution accredited. It was an exploratory and descriptive research, qualitative method of case study, which was in HEMORIO scene. Used as a source of evidence documentation related to the institution management and semi-structured interviews with twelve health and administrative professionals who work at the institution and followed the accreditation process. Data collection occurred during the months of January and September of 2011. The obtained data were analyzed using thematic content analysis, emerging six categories: category I: the institution walk for accreditation; category II: the professionals reactions in dealing with accreditation; category III: the accreditation process results in the institution; category IV: the choice and the costs of the type of accreditation process; category V: the accreditation in health public institutions and category VI: the user and the accreditation. It was concluded that the move towards accreditation in HEMORIO was not an easy job, several factors were relevant, there were a few obstacles in this path, but the benefits were very expressive, providing institutional visibility. It was evidenced proud in both internal and external customers to work and to treat at the Institute. It is essential to emphasize to managers of other health institutions understand that this process will take to provide a safer health care, with quality and free of risk to users.

Made available in DSpace on 2014-08-20T13:58:02Z (GMT). No. of bitstreams: 1 Tese ANDREA DAMASO BERTOLDI.pdf: 917303 bytes, checksum: 19c1b54f40d00e53bc200fe01be17bd0 (MD5) Previous issue date: 2006-06-21 / The utilization of medicines is an important indicator of health and well-being. In addition to its pharmacological role, medicines often assume a symbolic function. The access to medicines, particularly among low-income families, is an important health challenge, due to the high impact of expenditures with health, and specifically with medicines, on the family budget. The objective of this study was to evaluate medicine access and utilization in a population covered by the Family Health Program (PSF) in the city of Porto Alegre, Brazil. It was detected that 55% of the individuals interviewed (N=2988) used at least one medicine in the 15 days prior to the interview. Using the same recall period, only 4% of the subjects reported failing to use a needed medicine. Among the medicines used, 42% were purchased, 51% were provided for free by the PSF and 7% were obtained by other sources. Almost 90% of the medicines prescribed by PSF physicians were provided for free. Another focus of this thesis was to evaluate knowledge and utilization of generic drugs in a population-based sample of adults living in the city of Pelotas, Brazil. Only 4% of the medicines used were generics. Although the theoretical knowledge on generic drugs was satisfactory, almost half of the subjects incorrectly classified a similar medicine as generic in a simulation using pictures. This thesis also contains a literature review on methodologies applied in household studies on medicine utilization. Out of the 54 papers which fulfilled the review inclusion criteria, most were carried out in Europe or North America, used cross-sectional designs, collected data using interviewers, and requested the presentation of the packaging of the medicines used. The recall period of 15 days was the most frequently used. Data presented in this thesis allow us to conclude that the frequency of medicine use is high, although the utilization of generic drugs is very low, probably due to the existence of cheaper medicines in the market. The access to medicines in a population covered by the PSF in Porto Alegre was high in quantitative terms. / A utilização de medicamentos é um importante indicador de saúde e bem-estar. Além do seu papel farmacológico, o medicamento possui, muitas vezes, uma função simbólica. O acesso aos medicamentos, principalmente pelas parcelas mais pobres da população, é um importante desafio na área de saúde, tendo em vista o grande impacto dos gastos com saúde, e especificamente com medicamentos, no orçamento familiar. O objetivo do presente estudo foi avaliar o acesso aos medicamentos e sua utilização em uma população assistida pelo Programa Saúde da Família (PSF) na cidade de Porto Alegre. Constatou-se que 55% dos indivíduos entrevistados (N=2988) utilizaram pelo menos um medicamento nos 15 dias que antecederam a entrevista. Utilizando-se o mesmo período recordatório, apenas 4% dos indivíduos relataram ter deixado de usar algum medicamento que era necessário. Entre os medicamentos utilizados, 42% foram comprados, 51% foram distribuídos gratuitamente pelo PSF e 7% foram obtidos de outras formas. Quase 90% dos medicamentos prescritos por médicos do PSF foram fornecidos gratuitamente. Outro objeto de estudo desta tese foi avaliar o conhecimento e utilização de medicamentos genéricos em uma amostra populacional de adultos residentes na cidade de Pelotas, RS. Apenas 4% dos medicamentos utilizados pela população eram genéricos. Embora o conhecimento teórico sobre medicamentos genéricos tenha sido satisfatório, quase metade dos entrevistados confundiu um medicamento genérico com um similar em uma simulação utilizando fotografias. Esta tese também contém uma revisão da literatura sobre metodologias empregadas em estudos domiciliares sobre utilização de medicamentos. Entre os 54 artigos que preencheram os critérios de inclusão da revisão, a maioria foram realizados na Europa ou América do Norte, utilizaram delineamento transversal, coletaram dados com entrevistadores, e solicitaram a apresentação das embalagens dos medicamentos utilizados. O período recordatório utilizado com maior frequência foi o de 15 dias. Os dados desta tese permitem concluir que a frequência de uso de medicamentos é elevada, embora a utilização de medicamentos genéricos seja muito baixa, provavelmente pela existência de outros medicamentos mais baratos no mercado. O acesso aos medicamentos em uma população atendida pelo PSF em Porto Alegre foi alto em termos quantitativos.

Cartas al editor

This exploratory study sought to identify factors which motivate individual participation in volunteer services for the Long-Term Ombudsman Program of the Volunteer Center of Riverside County.

Patient-centredness and patient empowerment have been gaining importance in health policy and society already since the 1990s (Fumagalli et al. (2015), Castro et al. (2016)). For example, increasing patient empowerment has been one of the declared national health objectives in Germany since 2003 because patient orientation and participation provide important impulses for a demand-oriented and efficient design of healthcare systems and services (Bundesministerium für Gesundheit (2018)). A transition is taking place from an institution-based view of care provision to a more patient-based view that considers patients as co-managers of their individual care process and well-being (Kayser et al. (2019)). This transition also encompasses the developments towards integrated care1, i. e. a closer coordination between inpatient, outpatient and home care services, broadening the traditional focus from acute care to better integrate healthpromoting, preventive and post-treatment or palliative services as part of the whole continuum of care across sector boundaries (Minkman (2012), World Health Organization (2016), Expert Group on Health Systems Performance Assessment (2017)). These developments are particularly relevant for patients with long-term, chronic diseases or multimorbidities as their needs are often more complex and not exclusively medically determined (Smith and O’Dowd (2007), Hujala et al. (2016)).

The main topic of this diploma thesis is support of informal caregivers taking care for dying loved ones or loved ones with life-threatening illness in the home environment. The theoretical partis focused on informal carers, the quality of life of informal carers, the quality of life of dying people and quality of life of people with life-threatening diseases, death and the stages of coping with death. It also deals with hospice and palliative care, their forms, methods and uses. The practical part is focused on the analysis and evaluation of questionnaires filled out by informal carers. The aim of my diploma thesis is to point out the need to help informally caring for dying loved ones or loved ones with life-threatening illnesses. Within the practical part of this thesis, it was intended to map helpful and, conversely, deficit types and ways of support. These outputs can then be the basis for improving the quality of support and services for informal carers caring for a loved one in the home environment. Keywords Informal care, formal care, hospice care, palliative care, quality of life, death.

Ziel der vorliegenden Masterarbeit ist die Entwicklung von Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ im Klinikum Mutterhaus. Damit soll ein Instrument entwickelt werden, das patientenbezogene Dienstleistungen der Krankenhausapotheker an der intersektoralen Schnittstelle im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit messen und bewerten kann. Schwachstellen und Verbesserungspotentiale über den Verantwortungsbereich der Apotheke hinaus sollen identifiziert und in einen kontinuierlichen Verbesserungsprozess eingebracht werden können. Methodik: Zur Entwicklung der Qualitätsindikatoren wurde ein mehrstufiges Verfahren gewählt. Zunächst wurden die Qualitätsziele des Prozesses definiert und eine Prozessanalyse durchgeführt. Die Literaturrecherche auf nationaler und internationaler Ebene gab Anhaltspunkte zur Ableitung von Qualitätsindikatoren. Basierend auf der Prozessanalyse und der Literaturrecherche wurden Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ entwickelt. Anhand einer retrospektiven Datenerhebung wurden die entwickelten Qualitätsindikatoren auf ihre Aussagekraft und Eignung geprüft. Der Prozess wurde mit Hilfe der Qualitätsindikatoren gemessen und bewertet. Schlussfolgerung: Mit Hilfe von fünf Qualitätsindikatoren-Sets kann der Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ umfassend untersucht werden. Die entwickelten Qualitätsindikatoren sind geeignet, die pharmazeutische Dienstleistung im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit zu messen und zu bewerten. Sie ermöglichen die Evaluation des Prozesses und zukünftiger Verbesserungsmaßnahmen. Anhand der Qualitätsindikatoren wird zukünftig ein Monitoring der Dienstleistung möglich sein. / Purpose: The aim of this thesis is the development of quality indicators for the process "recommendations of the pharmacy to continue patient’s medication" at Klinikum Mutterhaus. An instrument is to be developed that can measure and rate the patient-related services of the hospital pharmacist at the intersectoral interface in terms of quality target in medication safety. Weaknesses and potential improvements should be identified and incorporated into a continuous improvement process. Methods: A multistage process is selected for the development of the quality indicators. First, the quality objectives of the process are defined and a process analysis is performed. A literature review on national and international level shall provide evidence for the derivation of quality indicators. Based on the process analysis and the literature review the quality indicators for the "Recommendations of the pharmacy to continue patient`s medication” are developed. In a retrospective data collection, the developed quality indicators are tested for their validity and suitability. The process is finally measured by the quality indicators and evaluated. Conclusion: With the help of five quality indicator sets the process "recommendations of the pharmacy to continue patient’s medication" can be fully investigated. The developed quality indicators are suitable to measure and evaluate the process in terms of the quality target medication safety. So the evaluation of the process and future improvements are possible. On the basis of the quality indicators a monitoring of the process can be established in the future.

Der Beitrag untersucht auf der Grundlage neuer primärärztlicher Befunde die Versorgungsqualität bei der hinsichtlich Chronizität und Arbeitsausfall schwerwiegendsten Angsterkrankung, der Generalisierten Angststörung. Neben einer knappen Einführung in das Störungsbild werden die an über 20 000 Patienten in 558 Hausarztpraxen gewonnenen Kernbefunde der GAD-P-Studie (Generalisierte Angst und Depression in der Primärärztlichen Versorgung) zusammengefasst und Ansatzpunkte zur Verbesserung der Versorgungsqualität dieses selten adäquat behandelten Störungsbildes diskutiert. Insbesondere wird auf die zentrale Bedeutung einer sichereren diagnostischen Erkennung als Voraussetzung für therapeutische Verbesserungen hingewiesen. In Ergänzung zur Verbesserung bestehender Weiterbildungsangebote wird auf Arzt- und Patientenebene der breitere Einsatz bestehender Screeningverfahren, die Nutzung krankheitsspezifischer Patientenratgeber, sowie eine breitere Öffentlichkeitsarbeit zur Information über dieses bislang vernachlässigte, häufig chronisch verlaufende Krankheitsbild empfohlen. / Based on new empirical findings in a large-scale primary care study, the quality of care for the most chronic and debilitating anxiety problem, generalised anxiety disorder, is examined. Following a brief introduction of this disorder, the core findings of the GAD-P study (generalised anxiety and depression in primary care) with more than 20,000 patients of 558 family doctor practices are summarised and measures to improve the quality of care of patients with generalised anxiety disorder, a disorder which is rarely adequately treated, are discussed. This paper particularly emphasises the standard use of time-efficient diagnostic screening instruments, because improved recognition and diagnosis is the prerequisite for appropriate treatment. Further the role of the media to increase awareness of this disorder as well as patient education materials to improve compliance and to enhance treatment outcome effects are highlighted.