<p>This phenomenological study explored the lived experiences of undergraduate community health nursing students at the University of the Western Cape&nbsp / who conducted a family health assessment learning task in communities during their clinical fieldwork placement.The population included the 2008&nbsp / semester two, third year undergraduate baccalaureus nursing students. These students completed their community health nursing modules at the end of the first semester. A total of nine (9) out of the eighty- nine (89) semester two students participated in this qualitative research study. The purposive and&nbsp / convenient sample consisted of those students who agreed to voluntarily participate in the research study. In-depth interviews were conducted with seven&nbsp / (7) female and two (2) male students to collect data. Field notes were taken and utilized to capture non-verbal communication of the participants. The focus&nbsp / f the researcher was to explore the lived experiences of students and not that of the family whom they interviewed. All interviews were audio recorded&nbsp / nd validated by participants after transcription, before any of the data was used for the data analysis process. The data collected was categorized into themes as guided by the systematic data analyses process according to Tesch&rsquo / s (1990) method, as cited in Creswell (2003). Saturation was tested&nbsp / after nine interviews and the researcher found that no new data emerged. The importance of the research study was to reflect on the exploration of the&nbsp / self-reported lived experiences of the third year community&nbsp / ealth nursing students while conducting the family health assessment learning task.&nbsp / </p>

The disappearance of the wetlands of Taiwan have reflected all kinds of biological drifting about aimlessly. We have to take action for protecting the wetlands, due to there are less than before. In the face of the wetlands that there are not much left, we must treasure and offer protection. The action that a lot of wetlands protection at present is going on. We need to invest more research and monitoring, and should investigate the state of wetland health that file, expect that can utilize limited resources more effectively during the process of protecting. This research expects to build the index system constructing out a set of Taiwan wetlands and assessing to the characteristic of the wetland of Taiwan. After consulting the domestic and international relevant index system, this research drafts preliminary wetland health assessment system. Through Delphi method, gathering opinions and suggestions from experts and scholars this research could set up the health assessment indicators of Taiwan artificial wetlands. Index system is divided into environment and management two general parts, and is categorized into six major indexes groups, including organism, water, soil, environment, management and social economy, amounts to 18 indexes. In the case of Zo-Zai Wetland Park, in Kaohsiung, Taiwan, we applied this index system to inspect the health degree of Zo-Zai Wetland Park and its index results. Assessing the result for being 'good' in health, and cause the unhealthy projects of wetland include restoration species grow up degree, the distribution of the invasive species, the water quality situation, the hydrology situation and the maintenance funds of the wetland . The whole but the speech, the continent Zo-Zai Wetland Park still belongs the health, but influence the wetland healthy factors still need to monitor continuously in order to maintain wetland health quality. This research hopes to diagnose the health state of the wetlands, through health assessment indicators system and regular wetland monitoring, Then designing the wetland follow-up planning and management strategies to result the wetlands¡¦ problems earlier. Finally, it hopes to help restoring the wetlands in Taiwan.

A review of diagnostic methods shows that new techniques are required that quantify system degradation from measured response. Information theory, developed by Claude E. Shannon, involves the quantification of information defining limits in signal processing for reliable data communication. One such technique considers information theory fundamentals forming an analogy between a machine and a communication channel to modify Shannon`s channel capacity concept and apply it to measured machine system response. The technique considers the residual signal (difference between a measured signal induced by faults from a baseline signal) to quantify degradation, perform system health assessment, and diagnose faults. Similar to noise hampering data transmission, mechanical faults hinder power transmission through the system. This residual signal can be viewed as noise within the context of information theory, to permit application of information theory to machines to construct a health measure for assessment of machine health. The goal of this dissertation is to create and study metrics for assessment of machine health. This dissertation explores channel capacity which is grounded and supported by proven theorems of information theory, studies different ways to apply and calculate channel capacity in practical industry settings, and creates methods to assess and pinpoint degradation by applying the channel capacity based measures to signals. Channel capacity is the maximum rate of information that can be sent and received over a channel having a known level of noise. A measured signal from a machine consists of a baseline signal exemplary of health, intrinsic that contaminates all measurements, and signals generated by the faults. Noise, the difference between the measured signal and the baseline signal, consists of intrinsic noise and "fault noise". Separation between fault and intrinsic (embedded in the measurement) noise shows channel capacity calculations for the machine require minimal computational efforts, and calculations are consistent in the presence of intrinsic white noise. Considering the response average or DC component of a signal in the channel capacity calculations adds robustness to diagnostic results. The method successfully predicted robot failures. Important to system health assessment is having a good baseline response as reference. The technique is favorable for industry because it applies to measurement data and calculations are done in the time domain. The technique can be used in semi-conducting industry as a tool monitoring system performance and lowering fab operating cost by extending component use and scheduling maintenance as needed. With a window running average channel capacity the technique is able to locate the fault in time. / text

<p>This phenomenological study explored the lived experiences of undergraduate community health nursing students at the University of the Western Cape&nbsp / who conducted a family health assessment learning task in communities during their clinical fieldwork placement.The population included the 2008&nbsp / semester two, third year undergraduate baccalaureus nursing students. These students completed their community health nursing modules at the end of the first semester. A total of nine (9) out of the eighty- nine (89) semester two students participated in this qualitative research study. The purposive and&nbsp / convenient sample consisted of those students who agreed to voluntarily participate in the research study. In-depth interviews were conducted with seven&nbsp / (7) female and two (2) male students to collect data. Field notes were taken and utilized to capture non-verbal communication of the participants. The focus&nbsp / f the researcher was to explore the lived experiences of students and not that of the family whom they interviewed. All interviews were audio recorded&nbsp / nd validated by participants after transcription, before any of the data was used for the data analysis process. The data collected was categorized into themes as guided by the systematic data analyses process according to Tesch&rsquo / s (1990) method, as cited in Creswell (2003). Saturation was tested&nbsp / after nine interviews and the researcher found that no new data emerged. The importance of the research study was to reflect on the exploration of the&nbsp / self-reported lived experiences of the third year community&nbsp / ealth nursing students while conducting the family health assessment learning task.&nbsp / </p>

SAMMANFATTNING                                                                                             Syftet med interventionsstudien var att undersöka om ROAG (revised oral assessment guide) munbedömningsinstrument förbättrade sjuksköterskor bedömning av cancerpatienters munhälsa på en palliativ vårdenhet. Metoden hade en kvasiexperimentell design med en journalgranskning före och efter en intervention. Interventionen bestod av en kortare utbildning av munhälsa samt införandet av ROAG munbedömningsinstrumentet. Resultatet visade att både bedömningar och åtgärder av munhälsan har ökat statistiskt signifikant jämfört med före interventionen på den palliativa vårdenheten, resultatet visar också att det inte alltid finns rätt koppling mellan symtom och åtgärd. Slutsats ROAG munbedömningsinstrument är ett bra verktyg för sjuksköterskor att använda för att bedöma munhälsan på en palliativ vårdenhet, men det räcker inte bara med ROAG munbedömningsinstrument utan det behövs kontinuerlig utbildning för att förbättra bedömningar och åtgärder . / ABSTRACT The purpose of the intervention study was to investigate whether ROAG (Revised oral assessment guide) improved nurses’ estimation of cancer patients’ oral health at a palliative care unit. The method was of a quantitative design with a quasi-experimental survey. Medical records were studied before and after an intervention, which consisted of a brief lecture on oral health and an introduction of ROAG. The results show significant increase in both assessment and measure of oral health after the intervention at the palliative care unit compared to before the intervention. The result also shows that the link between symptom and action does not always correspond to each other.   In conclusion, ROAG oral assessment is a great instrument for nurses to evaluate oral health at a palliative care unit, although it is not enough. Continuous education is required to improve evaluation and intervention.

Background Many trials in the USA, Canada, Europe and Australia have attempted to evaluate the effectiveness of preventive in-home health assessment and home care programs for older people. Trials have differed widely in their processes, including the dependence levels of subjects, assessment components and locations (clinic/home), intensity of case management (frequency of contact, length of follow-up period, scope of interventions) and methods of case management (telephone/visits). Preventive programs use valuable health resources and, although there has been inconclusive evidence of their effectiveness, programs combining preventive in-home health assessment and home care for older people have been introduced into public policy in Australia and internationally. Ongoing research is therefore essential in order to identify the positive benefits for older people, and establish their effectiveness with regard to health resource utilisation. Purpose The purpose of the study was to maintain the health status of older people living alone in the community by implementing a preventive health assessment and follow-up home care program. Research Design An experimental group was compared with a control group using a cluster randomised controlled trial methodology. Health outcomes were measured pre and post intervention, including health perception, functional ability, psychosocial status, client satisfaction, and health resource utilisation. Population and Sample The population for this study consisted of people aged 75 years and over who lived alone in Independent Living Units within managed retirement facilities, and who were highly independent in their activities of daily living. The final sample totalled 124, comprising of an experimental group (n=61) and a control group (n=63). The sample resided in South East Queensland. Intervention The intervention for the study "A Community Preventive Health Model for over 75s Living Alone" comprised of five major elements: 1) targeting before health and/or social crisis, and while community care needs were low; 2) linking clients with a community nurse; 3) comprehensive health assessments and identification of needs; 4) introduction of basic health care and community services and referrals if required; and 5) case management by three-monthly telephone contact. Assessments and case management were carried out by experienced community care registered nurses, and case management was performed for a one year period. The control group received health assessments and phone calls similar to the experimental group for data collection purposes, and to balance the risk of a Hawthorne effect due to regular contacts with participants. However all aspects of case management were omitted from all episodes of contact with the control group. For ethical reasons control group participants were supplied with a summary of their health assessment results to share with their GP if they wished. Data Collection and Instruments Measures of health perception, functional ability and psychosocial status occurred at two points (baseline and after 12 months). Measures of health resource utilisation, mortality and client satisfaction were measured after twelve months. A combination of several widely-used, valid and reliable instruments, as well as some newly developed data collection tools, were used to measure health outcomes. Data Analysis Independent group t-tests and Chi-square tests were used to examine for baseline differences between the experimental and control groups, and also to analyse health resource utilisation data at Time 2. A series of ANCOVA tests were applied to test the remaining hypotheses, so that the effects of Time 1 scores and potential confounding variables could be incorporated into the analyses. Results The experimental group and control group were homogenous at baseline for all demographic variables and all major outcome variables. The intervention model was applied for one year, with 66% (n = 40) in the experimental group having at least one unmet need identified and appropriate interventions undertaken. Only a small proportion of interventions (16%) were recorded as not being followed through by clients, and the majority (59%) resulted in needs being met or problems resolved. Results showed no benefits were gained from the program after one year for experimental group participants for the outcomes of health perception, functional ability, psychosocial status, health resource utilisation and mortality. However, the experimental group did show a statistically significantly higher level of satisfaction with care. Conclusions Comprehensive assessments performed by Registered Nurses with expertise in gerontology resulted in the identification of previously undetected unmet needs. When comprehensive assessment was combined with low intensity case management for a one year period, higher levels of client satisfaction with care were achieved. Therefore a model involving Registered Nurses with advanced knowledge and experience in aged care, working in collaboration with General Practitioners and community service organisations, could have considerable benefits in identifying unmet needs and improving client satisfaction. However, no client benefit was detected for quality of life outcomes, nor was a reduction in health resource utilisation found. This result from an Australian cohort is consistent with findings from many other international trials (Van Haastregt et al., 2000). It is possible that methodological issues are masking the effect of the intervention. Are we measuring appropriate outcomes? Are we expecting long-term outcomes in short time frames? Are we applying the model appropriately across a diverse older population? Further research to explore these questions is recommended for the future.

Orientador: Marli Teresinha Cassamassimo Duarte / Resumo: Introdução: O Subsistema Nacional de Vigilância Epidemiológica em Âmbito Hospitalar visa aumentar a sensibilidade e oportunidade na detecção de doenças de notificação compulsória (DNC) e, assim, possibilitar a adoção, oportuna, de medidas de controle, possibilitando a interrupção da cadeia de transmissão de doenças entre a população. Tendo-se em vista a importância de estudos avaliativos para o aprimoramento do sistema e a escassez de estudos nesta área, propôs-se a presente pesquisa que teve por objetivo descrever e avaliar a rede dos NHE do Estado de São Paulo, do ponto de vista de estrutura, com enfoque nos recursos humanos, e de processo. Método: Trata-se de estudo transversal, que incluiu 34 dos 41 NHE do Estado de São Paulo. Os dados foram obtidos de julho de 2017 a janeiro de 2018 por meio de questionário eletrônico e analisados com base nas Portarias 183/2014 GM/MS e 204/2016 GM/MS e no Guia de Vigilância Epidemiológica, segundo referencial de avaliação de Donabedian (1980), considerando-se estrutura e processo. Para a avaliação de estrutura foram selecionados 4 indicadores relacionados à composição e capacitação das equipes e para o processo, 4 indicadores relativos à organização e gestão do processo de trabalho e 7 referentes às atribuições previstas nas legislações. Os dados foram analisados por meio de estatística descritiva. Resultado: A maioria (73,5%) dos coordenadores eram mulheres, tinham 30 a 59 anos (64,7%) e a totalidade ensino superior completo. Dentre os... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The Hospital - based Epidemiological Surveillance Subsystem aims t o increase sensitivity and opportunity in the detection of notifiable diseases through the timely adoption of control measures, enabling the interruption of the chain of transmission of diseases among the population. Considering the importance of evaluati ve studies for the improvement of the System and the scarcity of studies in this area , the purpose of the present study was to describe and evaluate the network of the NHE of the State of São Paulo, from the point of view of structure, focusing on human re sources, and process. Method: This is a cross - sectional study, which included 34 of the 41 NHE's in the State of São Paulo. The data were obtained from July 2017 to January 2018 by means of an electronic questionnaire and analyzed based on Ordinances 183/2 014 GM/MS and 204/2016 GM/MS and on the Guide of Epidemiological Surveillance, according to the Donabedian evaluation referential (1980), considering structure and process. For the evaluation of the structure, 4 indicators related to the composition and qu alification of the teams and for the process 4 indicators related to the organization and management of the work process and 7 related to the attributions provided in the legislations were selected. Data were analyzed using descriptive statistics. Outcome: The majority (73.5%) of the coordinators were women, were between 30 and 59 years old (64.7%) and the entirety of them had complete higher educati... (Complete abstract click electronic access below) / Mestre

Submitted by Érica Morais Cardozo null (emcardozo2011@gmail.com) on 2018-03-24T13:13:07Z No. of bitstreams: 1 Érica Morais Cardozo.pdf: 2652982 bytes, checksum: d9a59adbc5d992b3d4090265c73c5fe8 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-26T17:11:08Z (GMT) No. of bitstreams: 1 cardozo_em_me_bot.pdf: 2430125 bytes, checksum: 1a361a43401419b1400df023f26ad381 (MD5) / Made available in DSpace on 2018-03-26T17:11:08Z (GMT). No. of bitstreams: 1 cardozo_em_me_bot.pdf: 2430125 bytes, checksum: 1a361a43401419b1400df023f26ad381 (MD5) Previous issue date: 2018-03-01 / Introdução: O Subsistema Nacional de Vigilância Epidemiológica em Âmbito Hospitalar visa aumentar a sensibilidade e oportunidade na detecção de doenças de notificação compulsória (DNC) e, assim, possibilitar a adoção, oportuna, de medidas de controle, possibilitando a interrupção da cadeia de transmissão de doenças entre a população. Tendo-se em vista a importância de estudos avaliativos para o aprimoramento do sistema e a escassez de estudos nesta área, propôs-se a presente pesquisa que teve por objetivo descrever e avaliar a rede dos NHE do Estado de São Paulo, do ponto de vista de estrutura, com enfoque nos recursos humanos, e de processo. Método: Trata-se de estudo transversal, que incluiu 34 dos 41 NHE do Estado de São Paulo. Os dados foram obtidos de julho de 2017 a janeiro de 2018 por meio de questionário eletrônico e analisados com base nas Portarias 183/2014 GM/MS e 204/2016 GM/MS e no Guia de Vigilância Epidemiológica, segundo referencial de avaliação de Donabedian (1980), considerando-se estrutura e processo. Para a avaliação de estrutura foram selecionados 4 indicadores relacionados à composição e capacitação das equipes e para o processo, 4 indicadores relativos à organização e gestão do processo de trabalho e 7 referentes às atribuições previstas nas legislações. Os dados foram analisados por meio de estatística descritiva. Resultado: A maioria (73,5%) dos coordenadores eram mulheres, tinham 30 a 59 anos (64,7%) e a totalidade ensino superior completo. Dentre os 34 NHE analisados, 27 foram classificados, com base no número total de notificações e de leitos hospitalares, em notificadores de pequeno porte, 5 de médio e 2 de grande porte. A vigilância epidemiológica (VE) era realizada predominantemente por enfermeiros nos serviços de pequeno e médio porte e por médicos naqueles de grande porte. A maioria dos serviços (64,7%) estava sob a coordenação de médicos e a totalidade dos NHE realizava busca ativa de agravos de notificação compulsória por meio de várias estratégias, sendo a triagem de exames laboratoriais (96,8%) e visita às unidades de internação (90,3%) as mais empregadas. A maioria (74,2%) dos NHE não dividia os agravos de notificação compulsória entre os membros da equipe, suas equipes reuniam-se rotineiramente para discussão de casos (77,4%) e 45,2% deles não possuía instrumento de comparação entre o número de fontes de dados consultadas e o total de notificações produzidas. Apenas 24,1% dos núcleos elaboravam relatório trimestral com perfil de morbidade e mortalidade hospitalar dos agravos de notificação compulsória. A maioria dos serviços teve processo classificado como adequado em relação às atribuições esperadas (21) e na organização e gestão do processo de trabalho (27). Entretanto, quanto à estrutura, apenas 19 classificaram-se como adequados. Conclusão: a avaliação da rede de NHE do Estado de São Paulo, de modo geral, mostrou-se favorável quanto ao processo e, apesar da análise de estrutura ter sido menos favorável, tendo em vista que 15 NHE foram classificados como parcialmente adequados, a maioria destes tinha processo adequado. Este estudo aponta a necessidade de adequação de parte dos NHE quanto à constituição e carga horária da equipe e sugere discussão junto às equipes do importante papel da produção de relatórios analíticos e emprego de instrumentos de gestão do processo de trabalho, oportunizando visibilidade da complexidade das práticas de VE e, assim, sensibilização de gestores e profissionais da assistência. / The Hospital - based Epidemiological Surveillance Subsystem aims t o increase sensitivity and opportunity in the detection of notifiable diseases through the timely adoption of control measures, enabling the interruption of the chain of transmission of diseases among the population. Considering the importance of evaluati ve studies for the improvement of the System and the scarcity of studies in this area , the purpose of the present study was to describe and evaluate the network of the NHE of the State of São Paulo, from the point of view of structure, focusing on human re sources, and process. Method: This is a cross - sectional study, which included 34 of the 41 NHE's in the State of São Paulo. The data were obtained from July 2017 to January 2018 by means of an electronic questionnaire and analyzed based on Ordinances 183/2 014 GM/MS and 204/2016 GM/MS and on the Guide of Epidemiological Surveillance, according to the Donabedian evaluation referential (1980), considering structure and process. For the evaluation of the structure, 4 indicators related to the composition and qu alification of the teams and for the process 4 indicators related to the organization and management of the work process and 7 related to the attributions provided in the legislations were selected. Data were analyzed using descriptive statistics. Outcome: The majority (73.5%) of the coordinators were women, were between 30 and 59 years old (64.7%) and the entirety of them had complete higher education. Of the 34 NHE analyzed, 27 were classified based on the total number of reports and of hospital beds in s mall notifiers, 5 medium and 2 large. The Epidemiological Surveillance was predominantly performed by nurses in small and medium - sized services and by physicians in large ones. Most of the services (64.7%) were under the coordination of physicians and all the NHE carried out an active search for disease compulsory notification through several strategies, being the screening of laboratory tests (96.8%) and visits to hospitalization units (90.3%) the most employed. The majority (74 .2%) of NHE did not share d isease compulsory notification among team members, their teams routinely met for case discussion (77.4%) and 45.2% did not have a comparison tool between the number of data sources consulted and the total number of notifications produced. Only 24.1% of the centers produced a quarterly report with a hospital morbidity and mortality profile of disease compulsory notification. Most of the services were classified as adequate in relation to the expected tasks (21%), and in the organization and management of the work process (27%). However, regarding structure only 19 were adequate. Conclusion: the evaluation of the NHE network in the state of São Paulo, in general, was favorable and although the structure analysis was less favorable, considering 15 NHE classifie d as partially adequate, most had an adequate process. This study points out the need for adequacy of the NHE regarding the constitution and workload of the team and suggests discussion with the teams about the important role of the production of analytica l reports and the use of work process management tools, giving visibility to the complexity of Epidemiological Surveillance practices and thus raising the sensitivity of managers and care professionals.

O estudo objetivou avaliar as características organizacionais e de desempenho dos serviços de saúde no acesso dos doentes para o tratamento da tuberculose no município de Campina Grande PB. Método: pesquisa avaliativa, de abordagem quantitativa que utilizou o desenho de estudo seccional ou transversal, tendo como quadro teórico as dimensões da Atenção Primária em Saúde, proposta por Starfield (2002). Para coleta de dados foi utilizado um instrumento Primary Care Assessment Tool (PCAT), elaborado por Starfield (2000). Adaptado e validado para o Brasil por Almeida e Macinko (2006). Adaptado para a atenção à tuberculose por Villa e Ruffino-Netto (2006). Participaram do estudo 106 doentes que receberam tratamento da TB no período de julho/2006 a agosto/2007. A análise de dados foi realizada em quatro etapas: caracterização dos sujeitos do estudo, análise de freqüência, construção de indicadores e análise de variância, análise de confiabilidade do questionário. Resultados: dos 106 doentes, 83,96% realizaram tratamento auto-administrado e 16,03%, tratamento supervisionado (TS); 42,45% são do sexo feminino e 57,54% do sexo masculino, com 20,75% sem escolaridade e 57,54% com baixa escolaridade. Quanto à variável durante o tratamento faltou medicamento para a TB, os valores médios para os indicadores do PSF/PACS foi de 4,71 e desvio-padrão, dp = 0,58 e para AMBRF média de 4,95 e dp de 0,25 configurando que as médias de respostas se encontram muito próximas ao escore 5 que corresponde à categoria nunca. Não foram observados diferenças entre os indicadores das diferentes unidades PSF/PACS e AMBRF. Para a variável conseguiram consulta no prazo de 24 horas as médias obtidas pelos indicadores das unidades PSF/PACS (4,34) e AMBRF (3,86) não foram consideradas significativamente diferentes. Com relação a perder o turno de trabalho ou compromisso para consultar os dados mostram que as médias obtidas pelos indicadores das unidades PSF/PACS (3,12) e AMBRF (2,59) não foram considerados estatisticamente significantes. Para a variável aguardar mais que 60 minutos para o atendimento, os indicadores das unidades PSF/PACS (3,34) e AMBRF (2,97), não foram considerados estatisticamente significantes. Quanto às variáveis doentes de TB necessitam utilizar transporte motorizado para consultar, pagar pelo transporte e fazer tratamento perto da sua casa, os indicadores utilizar transporte motorizado PSF/PACS (4,68) e AMBRF (1,31), pagar pelo transporte para consultar PSF/PACS (4,68) e AMBRF (1,73), fazer tratamento perto de casa PSF/PACS (4,43) e AMBRF (1,13) foram considerados estatisticamente significantes. Para a variável visita domiciliar, os indicadores visita domiciliar PSF/PACS (2,53) e AMBRF (1,19) foram considerados estatisticamente significantes. Os coeficientes do Alpha de Cronbach não padronizados e padronizados foram, respectivamente, 0,7275 e 0,7075, com base nos 8 (oito) itens do questionário. Conclusão: Apesar do município ter 85 equipes de PSF, o TS foi incorporado ou assumido apenas por uma pequena fração dos profissionais das equipes do PSF como uma estratégia de tratamento. Embora o tratamento da TB seja disponibilizado pelo serviço público de saúde, ainda representa um custo econômico para o doente de TB em função da necessidade de deslocamento até o serviço de saúde, bem como a perda do turno de trabalho para ser consultado / The aim of the present study was to assess the performance and organizational characteristics of health services providers in terms of patients access to tuberculosis treatment in Campina Grande, PB. Method: It is a, transversal, or cross sectional evaluation-like study using a quantitative approach based on Starfields (2002) theory on the dimensions of Health Primary Care. An instrument designed by Starfield (Primary Care Assessment Tool), which was later adapted and validated for use in Brazil by Almeida and Macinko (2006) was used for data collection. The same tool was then adapted by Villa and Ruffino Netto (2006) to be used for TB attention. One hundred and six patients who received TB treatment from July 2006 to August 2007 participated in the study. Data analysis was performed in four steps: characterization of the participants of the study; frequency analysis; construction of indicators and variance analysis; and questionnaire confidence analysis. Results: Out of one hundred and six patients, 83.9% received self-administered treatment and 16% received supervised treatment; 42.45% of the patients were female and 57.54% were male; 20.75% had no education and 57.54% had low educational levels. In relation to the variable no TB medication available during treatment the mean values for PSF/PACS indicators were 4.71 and the deviation pattern was dp = 0.58 and for AMBRF indicators the mean values were 4.95 and the deviation pattern was 0.25 , meaning that the answers averages were close to score 5.0, which corresponded to the category never. No differences between the different PSF/PACS and AMBRF units indicators were found. As for the variable got an appointment in twenty four hours, the averages obtained from the PSF/PACS (4.34) and AMBRF (3.86) indicators were not considered significantly different. In relation to missing a work shift due to the medical appointment data show that the averages obtained from the PSF/PACS (3.12) and AMBRF (2.59) were not statistically significant. Regarding the variables Tb patients have to use motor vehicle, pay for transportation, and receive treatment near their homes, the indicators use motor vehicle (PSF/PACS=4.68 and AMBRF = 1.31), pay for transportation (PSF/PACS = 4.68 and AMBRF =1.73), and receive treatment near their homes (PSF/PACS = 4.43 and AMBRF= 1.13) were considered statistically significant. In relation to the variable home visit, indicators both from the PSF/PACS units (2.53) and AMBRF (1.19) were considered statistically significant. Standardized and non-standardized Chronbachs Alpha coefficients based on the eight items in the questionnaire were 0.7275 and 0.7075, respectively. Conclusion: Although the city has eighty five PSF health teams, only a mall number of health professionals have actually incorporated ST as a treatment strategy. Besides, even though TB treatment is available in the public health services providers it still represents an economic cost to the TB patient because they have to use motor vehicle transportation and miss a work shift in order to go to the health units

Objetivo: Avaliar a presença e a extensão dos atributos da Atenção Primária à Saúde (APS) e o grau de afiliação do usuário em Unidades de Saúde da Família (USF) a partir da experiência das mães/cuidadores. Método: Estudo quantitativo, transversal, com dados coletados em todas as 56 equipes de Saúde da Família, da zona urbana de Juazeiro do Norte, CE. Mediante entrevista no domicílio com 317 mães/cuidadores, utilizou-se o instrumento PCATool-Brasil (versões Infantis) e um roteiro com questões relacionadas aos aspectos socioeconômicos e caracterização clínica da criança. Realizou-se análise univariada com a descrição de medidas de tendência central e de dispersão e, posteriormente, os atributos de APS foram analisados em relação às variáveis econômicas e sociais. Realizou-se também dicotomização das variáveis e assim construção de tabelas de contingência com aplicação do teste qui-quadrado de associação. Resultados: Na avaliação da APS, na perspectiva dos cuidadores, o grau de afiliação indicou que 57,1% deles utilizam o mesmo serviço de saúde para o atendimento das crianças, sendo o enfermeiro a pessoa que melhor conhece sua criança. Os subitens do atributo Acesso de primeiro contato (utilização do serviço e acessibilidade) apresentaram escore baixo, como também a Longitudinalidade, apesar de alguns itens avaliados dentro desse atributo apresentarem valores elevados de escore. Coordenação (integração de cuidados) foi outro atributo que revelou baixo escore. Coordenação (sistema de informação) apresentou escore elevado. A Integralidade da atenção (serviços disponíveis) obteve baixo escore. No que diz respeito à Integralidade (serviços prestados), obteve-se elevado escore. Orientação Familiar apresentou o menor escore de todos os atributos avaliados pelo PCATool neste estudo. Da Orientação Comunitária, somente o item \"visita domiciliar\" obteve escore acima do corte. Desse modo, os escores Essencial e Geral obtiveram valores médios classificados como baixos na avaliação dos cuidadores de menores de um ano. Na fase analítica, verificou-se associação entre as variáveis sociodemográficas \"receber auxílio do Bolsa Família\" e \"histórico de aborto\" e o desfecho diarreia, tendo- se que a Bolsa Família (OR=0,51; IC95%:0,31-0,85) foi encontrado como fator de proteção para os episódios de diarreia, enquanto que o histórico de aborto foi chance para esse desfecho (OR=2,25; IC95%:1,15-4,38). Também se buscou associação entre as variáveis sociodemográficas e o desfecho pneumonia e as variáveis que explicaram esse desfecho foram \"não acesso ao abastecimento de água na rede pública\" e ainda \"não utilização dos serviços de Atenção Primária à Saúde\"; as crianças nessas condições apresentaram mais chances de serem internadas em algum momento por pneumonia. Conclusão: A avaliação da assistência à saúde da criança no âmbito da Estratégia Saúde da Família evidenciou pouca presença e extensão dos atributos da APS, embora o município disponha de alta cobertura de ESF. Nessa perspectiva, apesar de a ESF ser um cenário preferencial para as ações de promoção à saúde e prevenção de agravos e de se constituir como porta de entrada para os serviços, nesta investigação, não alcançou uma assistência à criança com ênfase na integralidade do cuidado. Além disso, o modelo de assistência sem foco na família e sem participação da comunidade configura, ainda, a execução de práticas assistenciais tradicionais, voltadas para um modelo que pouco permite ampliar o olhar para quem se cuida. Como limitações, tem-se a ocorrência de movimento grevista no período de coleta de dados, momento no qual as famílias tiveram dificuldades de acesso aos serviços de saúde no município, o que pode ter avaliado negativamente os dados. Identificou-se também grande número de cuidadores que indicaram outros serviços da rede assistencial como referência para o cuidado da criança. Esse achado parece fragmentar ainda mais a assistência infantil e ter contribuído para que os atributos da APS fossem mal avaliados. Nesse sentido, os resultados desta investigação, de caráter avaliativo da APS, devem ser discutidos com as instâncias de decisão, com profissionais da rede de saúde e com a comunidade, visto que podem contribuir como ferramentas que orientem as políticas municipais voltadas à assistência da criança. Entendemos que avaliar o cuidado integral à saúde da criança no âmbito da ESF seja apontar caminhos capazes de fortalecer as práticas de saúde e qualificar, ainda mais, a atenção dispensada à criança e sua família / Objective: To evaluate the presence and extent of the attributes of Primary Health Care (PHC) and the degree of user membership in the Family Health Units (FHU) from the experience of mothers / caregivers. Method: Quantitative and cross-sectional study, with data collected in all 56 family health teams, in the urban area of Juazeiro do Norte, CE. Through interviews at home with 317 mothers / caregivers, we used the PCATool-Brazil instrument (Infant version) and a script with questions related to socioeconomic and clinical characterization of the child. We conducted univariate analysis with a description of measures of central tendency and dispersion and subsequently APS attributes were analyzed in relation to economic and social variables. It held also dichotomization of variables and so building contingency tables with application of chi-square test of association. Results: In the evaluation of PHC, from the perspective of caregivers, the degree of affiliation indicated that 57.1% of them use the same health service for the care of children, and the nurse is the person who best knows their child. The sub-items of the first contact Access attribute (using the service and accessibility) had low score, as well as Longitudinality, although some items within this attribute presented high values of score. Coordination (integration of care) was another attribute that showed low score. On the other hand, Coordination (information system) showed a high score. Comprehensive care (available services) got low score; on the contrary, Comprehensive care (services offered) obtained high scores. Family Guidance had the lowest score of all attributes assessed by PCATool in this study. For the Community Guidance, only the item \"home visit\" had a score above the cut. Thus, the Essential and General scores mean values obtained were classified as low in the evaluation of children caregivers. In the analytical phase, there was an association between sociodemographic variables \"receiving aid from government\" and \"abortion history\" and diarrhea outcome, and that the family allowance (OR = 0.51; 95% CI:0.31-0.85) was found as a protective factor for episodes of diarrhea, while abortion history was chance for this outcome (OR = 2.25; 95% CI:1.15-4.38). In addition, we sought association between sociodemographic variables and pneumonia outcome, and the variables that explain this outcome were \"no access to water supply in the public system,\" and \"non-use of primary health care services\"; children in these conditions were more likely to be hospitalized at some point by pneumonia. Conclusion: The evaluation of child health care in Family Health Strategy (FHS) showed little presence and extent of the attributes of PHC, although the municipality available high coverage of this strategy of care. From this perspective, although FHS be a preferred scenario for the actions of promotion of health and disease prevention and to establish itself as the gateway to the services, this research has not achieved a childcare with an emphasis on comprehensive care. In addition, the unfocused care model in the family and no community participation sets also running traditional care practices focused on a model that allows little broaden perspectives for those who was cared. As limitations, there is the occurrence of strike movement in the period of data collection; families probably had difficulties in accessing health services in the municipality, and they may have negatively assessed the services. There were also identified a large number of caregivers who indicated other services delivery networks as a reference for child care. This finding seems to further fragment the child care and have contributed to the attributes of the PHC were poorly evaluated. In this sense, the results of this research should be discussed with decision-makers, health and community network professionals, as they can contribute as tools to guide municipal policies aimed at child care. We understand that evaluate the comprehensive care of children under FHS is able to point out ways to strengthen health practices and qualifying even more the attention which is paid to children and their families