Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services.

Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

Introdução. A Iniciativa Hospital Amigo da Criança (IHAC) foi idealizada pela OMS e pelo UNICEF para promover, proteger e apoiar o aleitamento materno no âmbito hospitalar. Já a Rede Amamenta Brasil foi criada pelo Ministério da Saúde com o mesmo objetivo; porém, no âmbito da atenção básica. Objetivo. Avaliar a influência do apoio propiciado pelas maternidades e pelos locais de seguimento ambulatorial sobre o padrão de aleitamento materno de crianças menores de seis meses do Município de Ribeirão Preto SP. Métodos. Foram coletados dados referentes à caracterização das maternidades e à implementação dos Dez Passos para o Sucesso do Aleitamento Materno da IHAC mediante entrevista com o chefe do serviço de neonatologia de cada local. Informação sobre a Rede realização da Oficina de Trabalho em Aleitamento Materno foi fornecida pela Secretaria de Saúde do município. Características das crianças, suas mães, hospital de nascimento e local de seguimento ambulatorial foram obtidas com base no Projeto Amamentação e Municípios 2011. O efeito do fator de estudo sobre a amamentação exclusiva (AME) e predominante (AMP) foi avaliado mediante análise de regressão múltipla de Poisson com variância robusta. No modelo múltiplo foram incluídas como ajuste as variáveis que apresentaram p<0,20 na análise bruta e modificaram em mais de 10 por cento a razão de prevalência do fator de estudo. Resultados. Foram estudadas 916 crianças. A maioria (58,9 por cento ) nasceu de parto cesárea. A prevalência de AME foi de 33,2 por cento e de AMP, 16,3 por cento . Das sete maternidades do município, três são públicas e estão credenciadas na IHAC. Das 40 unidades de saúde, 15 realizaram a Oficina da Rede. O total de passos cumpridos por cada maternidade variou de 1 a 10, e somente um local cumpriu todos os passos. A prevalência de AME foi maior quando o passo relacionado ao não uso de bicos artificiais foi cumprido. A de AMP tendeu a aumentar quanto maior foi o número de passos cumpridos, e o passo referente a grupos de apoio à amamentação aumentou essa prevalência. O AME foi mais prevalente em locais que realizaram a Oficina da Rede. Conclusões. Cumprir maior número de passos mostrou tendência ascendente no aumento da prevalência de AMP. O passo 10 também aumentou essa prevalência, e o passo 9 aumentou a de AME. Este desfecho foi mais prevalente em locais que participaram da Oficina da Rede. Os achados deste estudo podem servir como subsídios para outras localidades incentivarem o aleitamento materno. / Introduction. The Baby Friendly Hospital Initiative (BFHI) was idealized by WHO and UNICEF to promote, protect and support breastfeeding in the hospital sphere. The Rede Amamenta Brasil was created by Ministry of Health with the same objective; however, in the primary health care sphere. Objective. To evaluate the influence of support offered by maternity hospitals and ambulatory attendance places on breastfeeding pattern in children less than six months in the city of Ribeirão Preto, SP, Brazil. Methods. Dates related to maternity hospitals characterization and implementation of IHACs Ten Steps to Successful Breastfeeding were collected during an interview with responsible doctor by the neonatology service of each place. Information about Rede Amamenta Brasil participation on Oficina de Trabalho em Aleitamento Materno was given by Citys Secretary of Health. Characteristics of children, their mothers, birth hospital and ambulatory attendance place were obtained by Projeto Amamentação e Municípios 2011. The effect of factor study on exclusive (EB) and predominant (PB) breastfeeding was evaluated by Poisson multiple regression analysis with robust variance. Variables with p<0,20 and that modified in more than 10 per cent prevalence ratio of factor study were included in the multiple model. Resultados. The number of studied children was 916. The most part (58.9 per cent ) was born by Cesarean delivery. The prevalence of EB was 33.2 per cent , and PB, 16.3 per cent . Among seven maternity hospitals of the studied city, three are public and accredited by BFHI. Among 40 primary care units, 15 made the Oficina da Rede. Total number of met steps for each maternity hospital range from 1 to 10, and only one place met all steps. The prevalence of EB was higher when step referred to no offer artificial teats or pacifiers was met. The prevalence of PB tended to increase when the number of met steps raised, and the step related to breastfeeding support groups increased this prevalence. The EB was more prevalent in places that realized the Oficina da Rede. Conclusions. Meeting higher number of steps showed ascendant trend on increasing prevalence of PB in children less than six months. The step 10 also increase this prevalence, and the step 9 increase the prevalence of EB. This outcome was more prevalent in places that participated of the Oficina da Rede. The findings of this study can be useful to other places encourage breastfeeding.

No description available.

Orientador: Helenice Bosco de Oliveira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T02:23:41Z (GMT). No. of bitstreams: 1 Rocha_MariaCecilia_M.pdf: 905094 bytes, checksum: e2815138228095ed2f6e30905b686046 (MD5) Previous issue date: 2003 / Resumo: Este trabalho foi realizado na rede SUS-Campinas-SP, em 2001 e investigou 410 casos diagnosticados de tuberculose. Numa primeira análise, foram descritas as seguintes variáveis: casos incidentes e retratamentos, sexo, teste antiHIV, idade, escolaridade, descoberta do diagnóstico, exames realizados (baciloscopia e cultura de escarro, raio X de tórax), hospitalização. O perfil epidemiológico evidenciou pacientes do sexo masculino, caso novo, teste antiHIV negativo ou não-realizado, adulto entre 25 a 44 anos, sintomático respiratório com exames compatíveis e a não-indicação para hospitalização. A partir deste grupo formou-se um subgrupo para descrever a demora diagnóstica. Para tanto, os critérios de inclusão foram residir em Campinas, ser maior de 15 anos, incidente na coorte de 2001, forma clínica pulmonar, teste antiHIV negativo, baciloscopia ou cultura de escarro positiva. Estudar a demora no diagnóstico da tuberculose teve como finalidade detectar elementos que permitarão criar subsídios para reflexão e implementação de políticas públicas voltadas ao controle da doença. O tempo decorrido desde a percepção de alguma sintomatologia, pela população de estudo,até a sua chegada ao serviço público de saúde para uma primeira assistência, denominou-se demora do paciente. O intervalo de tempo entre esta primeira assistência e o início do tratamento referiu-se à demora do serviço. A soma dos intervalos constitui a demora total. Os doentes ingressantes em serviços de saúde, para o tratamento de tuberculose pulmonar, contribuíram com informações antecedentes ao diagnóstico da doença, tais como: sintomatologia prévia, tempo decorrido do aparecimento dos sintomas até procurar assistência médica, tempo decorrido da primeira assistência ao início do tratamento e acesso aos serviços públicos de saúde, de Campinas. Conclui-se que a demora do paciente foi superior a três semanas e possui associação com o tempo de sintomatologia respiratória. Quanto à demora do serviço, superior a duas semanas, está associada ao número de serviços procurados pelo paciente, antes do tratamento. O município apresentou uma demora total superior a quatro semanas, o que sugere investir na busca de casos e educação em saúde, à comunidade / Abstract: This work was made in SUS ¿ Campinas, São Paulo in 2001, 410 diagnostic cases of tuberculosis were investigated. In the first analysis was described the following variations: incident cases and retreatments, sex, AIDS test, age, education, discovery of diagnostic physical examinations performed (bacillus tests, spittle culture, thorax, x-ray), hospitalization. The epidemic profile evidenced male pacients, nem cases, AIDS tests ¿ or not performed, adults within 25 to 44 years old, respiratory symptoms with compatible examinations and non- indication to hospitalization. From this group was made a sub-group to describe the delay of the diagnosis. Therefore, the inclusion criteria were: to live in Campinas, be over 15 years old, be part of the cohort in 2001 pulmonary health condition, AIDS test, bacillus test or positive spittle culture. The study of delay in the tuberculosis diagnostic was to detect the elements that could create subsidies to meditation and implantation of public politics to control this disease. The period since perception of the symptoms by the studied population to the arrival at the health public service for the first assistance was called delay of the pacient. The interval from the first assistance to the beginning of the treatment was called ¿ total delay¿. The pacients entered in health service for the treatment of pulmonary tuberculosis contributed with the following information before the diagnostic of the disease: previous symptoms, period form the first symptoms to the medical assistance, period form the first assistance to the beginning of treatment and admittance in the public health service in Campinas. It was concluded that the delay of the patient was over three weeks and is related to the period of respiratory symptoms. The delay of service over two weeks is related to number of services demanded by the pacients before the treatment. The county presented a total delay over four weeks; so it's necessary to invest in searches and education to the society comfort / Mestrado / Saude Coletiva / Mestre em Saude Coletiva

Orientador: Carlos Alberto Gama Pinto / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T23:04:59Z (GMT). No. of bitstreams: 1 Lemes_AdrianadeAquinoeSaglietti_M.pdf: 3285990 bytes, checksum: 7b716f58eced266faa92b7fae2a972cc (MD5) Previous issue date: 2014 / Resumo: Devido à importância da Atenção Básica como uma das portas preferenciais de entrada no sistema de saúde, o trabalho realizado pela mesma está sendo alvo de estudos e discussões voltadas à qualidade de atenção à saúde que oferece ao cidadão, sendo importante para obter esta qualidade, a avaliação do acesso, a humanização nos cuidados realizados, a otimização de recursos utilizados e a participação comunitária nas áreas de abrangência, fatores fundamentais para que a Atenção Básica cumpra seu papel de ordenadora de cuidados na rede de atenção à saúde. Para que os pontos citados acima sejam efetivados, faz-se fundamental a presença do coordenador local nestas unidades, tanto nas UBS (Unidades Básicas de Saúde) tradicionais quanto nas de ESF (Estratégia de Saúde da Família), Com o objetivo de compreender as necessidades de formação para se exercer a função de coordenador local de unidades de saúde da Atenção Básica, realizamos uma pesquisa com os coordenadores das Unidades Básicas de Saúde e das equipes de Saúde da Família do Município de Piracicaba/SP. Para isso, nos utilizamos de revisão bibliográfica e estudo a respeito das necessidades de formação (teórica, técnica e prática) para se exercer esta função. Junto aos coordenadores locais de UBS, e visando compreender sua percepção sobre o tema, utilizamo-nos de uma combinação de métodos quantitativos e qualitativos, sendo que na parte quantitativa do trabalho, realizamos contato com 61 coordenadores locais de UBS tradicionais e de ESF, para preenchimento de questionário estruturado, com 78 questões desenhadas para respostas numa escala de 0 a 10 de valoração, que foi digitado em banco de dados construído em software livre, utilizando o Programa Epi Info for Windows Versão 3.5.1, do Centers for Disease Control (CDC) e Organização Mundial de Saúde (OMS). Na parte qualitativa da pesquisa, optamos por realizar um grupo focal, com 10 coordenadores locais de unidades de saúde, escolhidos intencionalmente. Ao final desta pesquisa, pretende-se mostrar a importância da formação em gestão de Saúde aos profissionais que atuam como coordenadores das Unidades de Atenção Básica, a fim de que impacte na dinâmica de trabalho da equipe, com consequente melhoria no serviço prestado ao usuário. Além disso, fomentar na Gestão Municipal, a necessidade de educação permanente para os coordenadores, visando a criação de espaços coletivos na cogestão em saúde / Abstract: Due to the importance of primary care as one of the preferred port of entry into the health system, the work of the same is being studied and discussions focused on the quality of health care that provides citizens, it is important to get this quality, assessing access to humanize the care provided, the optimization of resources used and community participation in catchment areas, essential for the Primary Care fulfills its role ordinator of care in the health care network factors. For the points mentioned above take effect , it is essential the presence of the local coordinator in these units, both in UBS (Basic Health Units) as traditional in the FHS (Family Health Strategy), In order to understand the training needs to act as the local coordinator of health facilities of primary care, we conducted a survey of the coordinators of the Basic Health Units and Family Health Teams of Piracicaba/SP. Therefore, we use in the literature and study on training needs (theoretical, technical and practical) to perform this function. With local coordinators UBS , and seeking to understand their perception about the topic, we use ourselves on a combination of quantitative and qualitative methods, and in the quantitative part of the study, conducted with 61 contact local coordinators traditional UBS and ESF for completing structured questionnaire with 78 questions designed to answer on a scale of 0 to 10 valuation, which was entered into a database built on free software, using Epi Info software version 3.5.1 for Windows, the Centers for Disease Control (CDC) and World Health Organization (WHO). In the qualitative part of the research, we decided to conduct a focus group with 10 local health unit coordinators, intentionally chosen. At the end of this research, is intended to show the importance of management training for health professionals who act as coordinators of Primary Care Units, so that impact on the dynamics of team work, with consequent improvement in the service provided to the user. Also, encourage the Municipal Management, the need for continuing education for engineers, aimed at creating collective spaces in the co-management in health / Mestrado / Política, Gestão e Planejamento / Mestra em Saúde Coletiva

Data were analyzed from the 1998-2004 Uniform Data System (UDS) to identify trends and predictors of financial performance (costs, productivity, and overall financial health) for health centers (HCs). Several differences were noted regarding revenues, self-sufficiency, service offerings, and urban/rural setting. Urban centers with larger numbers of clients, centers that treated high numbers of patients with chronic diseases, and centers with large numbers of prenatal care users were the most fiscally sound. Positive financial performance can be targeted through strategies that generate positive revenue, strive to decrease costs, and target services that are in demand.

Purpose: Access to the full range of contraceptive options is essential to providing patient-centered reproductive health care. Women living in rural areas often experience more barriers to contraceptive care than women living in urban areas. Therefore, federally funded family planning clinics are important for ensuring women have access to contraceptive care, especially in rural areas. This study examines contraceptive provision, factors supporting contraceptive provision, and contraceptive utilization among federally funded family planning clinics in 2 Southern states. Methods: All health department and Federally Qualified Health Center clinics in Alabama and South Carolina that offer contraceptive services were surveyed in 2017-2018. Based on these surveys, we examined differences between rural and urban clinics in the following areas: clinic characteristics, services offered, staffing, staff training, policies, patient characteristics, contraceptive provision, and contraceptive utilization. Differences were assessed using Chi-square tests of independence for categorical variables and independent t-tests for continuous variables. Findings: Urban clinics had more staff on average than rural clinics, but rural clinics reported greater ease in recruiting and retaining family planning providers. Patient characteristics did not significantly vary between rural and urban clinics. While no significant differences were observed in the provision of long-acting reversible contraceptives (LARCs) overall, a greater proportion of patients in urban clinics utilized LARCs. Conclusions: While provision of most contraceptives is similar between rural and urban federally funded family planning clinics, important differences in other factors continue to result in women who receive care in rural clinics being less likely to choose LARC methods.

A cross-sectional household survey of maternal and child health was conducted in the Mount Frere health district of the Eastern Cape in August / September 1997. The aim was to describe key aspects of maternal and child health to inform the planning activities of the District Health Management Team (DHMT). A participatory process was followed, in order to develop research capacity within the district, and to facilitate interaction between health workers and the community. Methods: Structured questionnaires were used by local research trainees to gather data from each household on: • household demographics; • deaths in household since April 1994; • household access to water and sanitation; • children under five years; • children aged 5 to 15 years; • deliveries in the past 12 months; • knowledge of prevention and transmission of HIV/AIDS. Focus group discussions around the key findings were conducted with community members and clinic nurses to provide a qualitative component. Results: A high proportion of children under the age of 16, high household density, high unemployment, migrant labour, and absent mothers, are some of the defining demographic characteristics which affect the status of maternal and child health in the district. Access to health services is constrained by distance, lack of transport, and poor roads. Registration of births and deaths is poor, and the crude birth and death rates were found to be significantly higher than the " official" provincial rates. Tuberculosis, diarrhoea, trauma and homicide are notable features of the overall mortality profile, although the majority of deaths were classified "ill-defined / unknown". Diarrhoea and pneumonia accounted for half of all infant deaths. Eight out of ten deaths due to diarrhoea in under-fives occurred at home, but knowledge and use of oral rehydration solution is poor. Access to clean drinking water and sanitation is a major concern, with almost three quarters of homes using unprotected sources, a third more than 30 minutes' walk from the nearest source, and a half having no toilet. Areas of the district with particularly poor environmental health indicators were identified. Immunisation coverage among children 1-4 years is poor. Coverage for all vaccines except BCG falls well short of the national target of 90%, and fewer than 1 in 3 children was fully immunised with valid doses at the age of one year. Long intervals between doses and a high "dropout" rate between subsequent doses was observed. The road to health card (RTHC) could be produced for just over a half of under-five children. The proportion of home deliveries is high (45%), and traditional birth attendants (TBAs) therefore play an important role in this community. Nine out of ten mothers had attended antenatal clinic at least once, but almost half reported receiving no tetanus toxoid and no WR test for syphilis during their antenatal visits. More than a half of all mothers was using no family planning method at the time of the survey. Almost all 15-49 year-olds had heard about HIV/AIDS, but one in five did not know how HIV is transmitted, and a third did not know how it could be prevented. Recommendations: A detailed set of recommendations with action points for the DHMT was developed in a district workshop around the following key issues: 1. Improving access to health care, including road access, mobile clinic coverage, and waiting facilities for expectant mothers. 2. Promoting health in the community, by means of integration of health promotion into all health programmes, and more involvement of communities. 3. Improving the quality of care in the existing health facilities and services, including minimising missed opportunities for immunisation, and promoting home-made oral rehydration (sugar-salt) solution. 4. Improving the district health information system, especially the registration of vital events, and the provision of feedback to district health managers. 5. Identifying areas of further research, including the reasons for home deliveries, management of diarrhoea at home, and the use of traditional healers. Conclusion: The participatory research process that was used has helped to build research capacity in the district, to provide a deeper insight into community health problems, to highlight the value of health workers listening to the people they serve, to further collaboration between the disciplines, and to develop specific action plans. This is a process that should be followed in all research conducted in health districts.