Atención en domicilio de pacientes NANEAS: experiencia del hospital de niños Dr. Roberto del Río / Home care of NANEAS patients: experience of the children's hospital Dr. Roberto del Río

El avance de las tecnologías de soporte vital ha aumentado la sobrevida de niños con patologías y secuelas graves, categorizados como NANEAS (Niños y Adolescentes con Necesidades Especiales de Atención en Salud) de mediana y alta complejidad. En el Hospital de Niños Dr. Roberto del Río se organizó un equipo de atención para NANEAS en 2014, que realiza visitas domiciliarias desde 2015 a pacientes médicamente complejos. OBJETIVO: Caracterizar la población atendida en domicilio y la modalidad de atención. PACIENTES Y MÉTODO: Estudio retrospectivo descriptivo mediante revisión de registro clínico electrónico y ficha clínica de NANEAS atendidos en domicilio del 2015 al 2018. RESULTADOS: Se analizaron 581 visitas a 81 pacientes, mediana 8 años, 78% hombres, 64% institucionalizados, 78% con patología neurológica de base, 75% de alta y mediana complejidad según clasificación SOCHIPE. De las visitas, 71% fue en comunas rurales, la mediana de tiempo de viaje 60 minutos y de atención 26 minutos. Un 60% de las visitas se realizó a pacientes con dispositivos médicos. En un 99% asistió pediatra, 33% enfermera y 68% otro profesional, que en 61% correspondió al neuropediatra. CONCLUSIONES: La mayor proporción de pacientes atendidos son de alta y mediana complejidad, usuarios de dispositivos médicos y la mayoría con patología neurológica de base, por lo que resulta fundamental contar con un neurólogo en el equipo interdisciplinario. Las visitas se realizan principalmente a comunas distantes por la dificultad de traslado de estos pacientes. Esta modalidad de atención promueve una mejor calidad de vida para niños y niñas médicamente complejos y para sus familias.

The advancement of life support technologies has increased the survival of children with serious pathologies and sequelae, categorized as NANEAS (Children and Adolescents with Special Health Care Needs) of medium and high complexity. At the Hospital de Niños Dr. Roberto del Río, a care team for NANEAS was organized in 2014, which has made home visits to medically complex patients since 2015. OBJECTIVE: To characterize the population attended at home and the care modality. PATIENTS AND METHOD: Retrospective descriptive study by reviewing the clinical file of NANEAS patients seen at home in this period. RESULTS: 581 visits were analyzed in 81 patients, median 8 years, 78% men, 63% institutionalized, 78% with neurological diseases. 75% were of high and medium complexity according to the SOCHIPE classification. Of the visits, 71% were in rural places, median travel time 60 minutes and direct attention 26 minutes. 60% of the visits were made to patients with medical devices, 99% attended by a pediatrician, 33% a nurse and 68% another professional, who in 61% corresponded to the child neurologist. CONCLUSIONS: The highest proportion of patients seen are of high and medium complexity with medical devices and with underlying neurological pathology, so it is important to have a neurologist in the interdisciplinary team. Many of the visits are made in places distant from the hospital center due to the difficulty of transferring these patients. This modality of care promotes a better quality of life for medically complex children and their families.

Un plan protocolizado de rehabilitación domiciliaria tuvo mejores resultados que el tratamiento habitual en pacientes operados de prótesis total de rodilla: cohorte prospectiva / A protocolized home rehabilitation program had better outcomes than the usual care following total knee replacement: a prospective cohort study

Objetivo: comparar los resultados funcionales y de calidad de vida, y algunos indicadores de calidad y satisfacción, entre dos estrategias de cuidados posoperatorios de prótesis total de rodilla: 1) Cuidados protocolizados brindados por la Unidad de Rehabilitación del Hospital Italiano (URED) para pacientes que residen en CABA; 2) Cuidados habituales brindados por el sistema tercerizado de rehabilitación kinésica. Materiales y métodos: cohorte prospectiva de pacientes que fueron sometidos a una cirugía de reemplazo articular de la rodilla en el Hospital Italiano. Fueron evaluados mediante cuestionarios de funcionalidad y calidad de vida percibida, y goniometría, a los 45 días, por kinesiólogos entrenados. Resultados: se incluyeron 81 pacientes en el grupo de cuidados protocolizados y 28 en el de cuidados habituales. Se observaron diferencias estadísticamente significativas en todas las variables evaluadas y destacamos la relevancia clínica de que solamente el 2,43% de los pacientes atendidos en la URED continuaban usando andador a los 45 días frente al 35,71% de los que habían sido atendidos con los cuidados habituales (p = 0,004), así como la menor proporción de pacientes con déficit de flexión (2,47% vs. 46%, respectivamente; p < 0,001) y de extensión (18,52 vs. 75%; p < 0,001) en el mismo lapso, requisitos que son importantes para lograr una marcha funcional. Conclusión: un programa de rehabilitación domiciliaria protocolizada y supervisada por kinesiólogos entrenados mostró ser eficaz para una progresión más rápida hacia una marcha independiente con un menor riesgo de déficit de flexión o de extensión a los 45 días. (AU)

Objective: to compare functionality and quality of life, and some indicators of patient satisfaction, between two postoperative rehabilitation care following total knee replacement: 1) Protocolized care provided by the Italian Hospital Rehabilitation Unit for patients who live in CABA; 2) Usual care provided by the outsourced rehabilitation system. Materials and methods: prospective cohort of patients who underwent total knee replacement at the Italian Hospital were evaluated using questionnaires of functionality and quality of life at 45 days. Results: 81 patients were included in the protocolized care group and 28 in the usual care group. Statistically significant differences were observed in all the variables evaluated, highlighting clinical relevance that only 2.43% of the patients treated by the URED continued using the walker at 45 days vs 35.71% of those who had been treated with the usual care (p = 0.004); as well as the lower proportion of patients with flexion deficit (2.47 vs. 46%, respectively; p < 0.001) and extension (18.52 vs. 75%; p < 0.001) at the same time. Conclusion: a home protocolarized rehabilitation program supervised by a physical therapist proved to be effective for a quicker progression to an independent walk with lower risks of flexion or extension deficits at 45 days. (AU)

RDQA - Relatório Detalhado do Quadrimestre Anterior da Secretaria de Saúde do Estado do Tocantins [1º Quadrimestre de 2020] / RDQA - Detailed Report for the Previous Quadrimester of the Tocantins State Health Department [1st Quadrimester of 2020]

O Relatório Detalhado do Quadrimestre Anterior (RDQA) apresentam os resultados alcançados com a execução da PAS a cada quadrimestre e orientam eventuais redirecionamentos. Eles têm a função de comprovar a aplicação de todos os recursos do Fundo de Saúde. É instrumento indissociável do Plano e de suas respectivas Programações, sendo a principal ferramenta para subsidiar o processo de monitoramento e avaliação da gestão. Tem seu modelo padronizado pela Resolução nº 459 do Conselho Nacional de Saúde - CNS, de 10 de outubro de 2012, publicada no DOU de 21/12/2012, conforme dispõe o Parágrafo 4º do Artigo 36 da Lei Complementar nº 141/2012. A Programação Anual de Saúde (PAS) é a referência de execução das ações e serviços públicos em saúde, cujo processo de sua gestão é demonstrado no Relatório de Gestão: a cada quadrimestre no RDQA e ao final do exercício no Relatório Anual de Gestão (RAG).

The Detailed Report for the Previous Quadrimester (RDQA) presents the results achieved with the execution of the PAS every four months and guides any redirections. They have the function of proving the application of all the resources of the Health Fund. It is an inseparable instrument of the Plan and its respective Programs, being the main tool to support the process of monitoring and evaluation of management. Its model is standardized by Resolution No. 459 of the National Health Council - CNS, of October 10, 2012, published in the DOU of 12/21/2012, as provided in Paragraph 4 of Article 36 of Complementary Law No. 141/2012. The Annual Health Program (PAS) is the benchmark for executing public health actions and services, whose management process is demonstrated in the Management Report: every four months in the RDQA and at the end of the year in the Annual Management Report (RAG) ).

El Informe Detallado del Cuatrimestre Anterior (RDQA) presenta los resultados obtenidos con la ejecución del PAS cada cuatro meses y orienta las redirecciones. Tienen la función de acreditar la aplicación de todos los recursos del Fondo de Salud, instrumento inseparable del Plan y sus respectivos Programas, siendo la principal herramienta de apoyo al proceso de seguimiento y evaluación de la gestión. Su modelo se encuentra estandarizado por la Resolución No. 459 del Consejo Nacional de Salud - CNS, de 10 de octubre de 2012, publicada en el DOU de 21/12/2012, según lo dispuesto en el numeral 4 del artículo 36 de la Ley Complementaria No. 141/2012. El Programa Anual de Salud (PAS) es el referente para la ejecución de acciones y servicios de salud pública, cuyo proceso de gestión se demuestra en el Informe de Gestión: cuatrimestral en el RDQA y al final del año en el Informe Anual de Gestión (RAG) ).

Le rapport détaillé du quadrimestre précédent (RDQA) présente les résultats obtenus avec l'exécution du PAS tous les quatre mois et guide les éventuelles réorientations. Ils ont pour fonction de prouver l'application de toutes les ressources du Fonds de la Santé, instrument indissociable du Plan et de ses Programmes respectifs, étant le principal outil d'appui au processus de suivi et d'évaluation de la gestion. Son modèle est normalisé par la résolution n ° 459 du Conseil national de la santé - CNS du 10 octobre 2012, publiée au DOU du 21/12/2012, comme prévu au paragraphe 4 de l'article 36 de la loi complémentaire n ° 141/2012. Le Programme Annuel de Santé (PAS) est la référence pour la mise en œuvre d'actions et de services de santé publique, dont le processus de gestion est démontré dans le rapport de gestion: tous les quatre mois dans le RDQA et en fin d'année dans le rapport annuel de gestion (RAG) ).

Fatores associados a emergências médicas domiciliares em idosos brasileiros / Factors associated with household medical emergencies in elderly brazilians

O objetivo do estudo consiste em analisar os fatores associados à vivência de emergências domiciliares por idosos brasileiros. Estudo de caráter transversal, quantitativo, com fonte de dados secundária ­ Pesquisa Nacional de Saúde ­ 2013. A amostra foi composta por indivíduos com 60 anos ou mais (n = 23.815). A variável desfecho foi nomeada "Emergência domiciliar" e foram incluídas 56 variáveis independentes. Os dados foram tratados, e posteriormente foi realizada redução de dimensionalidade no software Waikato Environment for Knowledge Analysis. As variáveis fortemente associadas com situações de emergência domiciliar foram analisadas através da regressão logística para mensurar a intensidade da ligação. Os achados apontam que as situações de emergência domiciliar envolvendo idosos têm maior probabilidade de acontecer quando o indivíduo precisou ser internado nos últimos 12 meses (OR = 7,02), teve dificuldade em ir ao médico sozinho (OR = 2,10), autopercebeu-se em situação negativa de saúde (OR = 2,00), teve dificuldade em administrar as próprias finanças (OR = 1,71), teve dificuldade de sentar-se ou levantar-se de uma cadeira (OR = 1,67), deixou de realizar qualquer atividade habitual por motivo de saúde (OR = 1,66), procurou o mesmo médico ou serviço de saúde quando precisou de atendimento (OR = 1,34) e teve frequência superior a quatro consultas médicas nos últimos 12 meses (OR = 1,39). A interpretação dos presentes achados compõe uma importante base para o planejamento e desenvolvimento de ações preventivas e promotoras de saúde. (AU)

The objective of the study is to analyze the factors associated with the experience of household emergencies by Brazilian elderly. Cross- -sectional, quantitative study with secondary data source ­ National Health Survey ­ 2013. The sample consisted of individuals aged 60 years or over (n = 23,815). The outcome variable was named "Household emergency", 56 independent variables were included. The data were processed, then the dimensionality reduction was performed in the Waikato Environment for Knowledge Analysis software. The variables strongly associated with home emergency situations were analyzed through logistic regression, to measure the intensity of the connection. The findings indicate that home emergency situations involving the elderly are more likely to occur when the individual had to be hospitalized in the last 12 months (OR = 7.02), had difficulty going to the doctor alone (OR = 2.10), self-perceived negatively their health (OR = 2.00), has difficulty managing their own finances (OR = 1.71), has difficulty sitting or getting up from a chair (OR = 1.67), has failed to perform any usual activity (OR = 1.66), had sought the same physician or health service when they needed care (OR = 1.34) and had a frequency of more than four medical visits in the last 12 months (OR = 1.39). The interpretation of the findings presents an important basis for the planning and development of preventive and health promotion actions. (AU)

Atenção domiciliar na estratégia saúde da família: perspectivas de idosos, cuidadores e profissionais / Home care in the family health strategy: perspectives of the elderly, caregivers and professionals

A Atenção Domiciliar (AD) é uma ação potente para ampliar a integralidade na Estratégia Saúde da Família (ESF) e torna-se necessária devido ao crescente número de idosos dependentes de cuidado no domicílio. Assim, objetivou-se analisar as perspectivas dos idosos, familiares/cuidadores e profissionais da ESF sobre a AD. Esta pesquisa é de abordagem qualitativa do tipo exploratória, o campo de pesquisa foi a ESF do município de Sobral, Ceará. Os sujeitos do estudo foram 28 profissionais da ESF, 13 idosos e 13 familiares/cuidadores. A coleta de informações foi através de entrevista semiestruturada e grupo focal, que ocorreram entre setembro de 2014 e março de 2015; a análise se deu pela codificação temática. Foram identificados os tópicos semelhantes e específicos de cada grupo, emergindo-se quatro temáticas, a saber: a) percepções e sentimentos sobre a AD ao idoso na ESF; b) o apoio/suporte oferecido às famílias de idosos com comprometimento funcional pelas equipes da ESF; c) AD ao idoso na ESF: fatores facilitadores e limitantes; e d) as contribuições da estrutura física do domicílio para o cuidado do idoso dependente. Relatou-se a parceria da equipe multiprofissional, a fragilidade do apoio/suporte à família e a relação de dependência, na qual os papéis dos responsáveis pelo cuidado não estão bem definidos, sendo necessário potencializar a autonomia e corresponsabilização. Assim, identificou-se a necessidade de sensibilização dos profissionais e gestores sobre a relevância e especificidades do cuidado domiciliar ao idoso e cuidador, exigindo um perfil profissional e competências que devem ser desenvolvidas no ambiente de trabalho através de processos de educação permanente. (AU)

The Home Care (HC) is a powerful action to increase the integrality in the Family Health Strategy (FHS), and is necessary due to the increasing number of elderly people dependent on care at home. Thus, the objective was to analyze the perspectives of the elderly, family/caregivers, and FHS professionals about HC. This research has a qualitative exploratory approach, the field of research was the FHC of the city of Sobral, Ceará. The subjects of the study were twenty eight ESF professionals, thirteen elderly, and thirteen family members/caregivers. The data was collected through semi-structured interviews and focus groups, and occurred between September 2014 and March 2015; the analysis was based on thematic coding. The similar and specific topics to each group were identified, leading to the emergence of four themes, namely: a) perceptions and feelings about HC to the elderly in FHS; b) the support/backup offered to the families of elderly people with functional impairment by the FHS teams; c) HC to elderly in FHS: facilitating and limiting factors; and d) the contributions of the infrastructure of the home to the care of the dependent elderly. The research results reported the partnership of the multiprofessional team, the fragility of support/backup to the family and the relationship of dependence, in which the roles of those responsible for care are not well defined and it becomes necessary to enhance autonomy and co-responsibility. Thus, it was possible to identify the need to sensitize professionals and managers about the relevance and specificities of home care to the elderly and caregivers, requiring a professional profile and skills that must be developed in the work environment through permanent education processes. (AU)

Cuidadores de idosos e tensão excessiva associada ao cuidado: evidências do Estudo SABE / Caregivers of elderly and excessive tension associated to care: evidence of the Sabe Study

RESUMO: Introdução: A presença de múltiplas doenças e agravos crônicos pode ocasionar a incapacidade funcional do idoso, o qual poderá requerer a necessidade de ajuda de outra pessoa. A prestação de cuidados diários e ininterruptos pode gerar no cuidador situações estressoras, levando-o a sobrecarga. Objetivo: Descrever o perfil sociodemográfico e assistencial dos cuidadores de idosos e analisar os fatores associados à tensão excessiva associada ao cuidado. Métodos: Trata-se de um estudo transversal, parte do Estudo Saúde, Bem-Estar e Envelhecimento (SABE), realizado no município de São Paulo, no ano de 2010, com 362 cuidadores. A tensão excessiva associada ao cuidado foi avaliada pela escala de Zarit, e considerou-se ausência de sobrecarga pontuação inferior a 24 pontos e presença de sobrecarga os escores ≥ 24 pontos. Utilizou-se regressão de logística hierárquica para analisar os fatores associados à tensão dos cuidadores familiares. Resultados: A maioria dos cuidadores era familiar (91,5%), do sexo feminino (75,4%), com média de idade de 53,9 anos (desvio padrão - DP ± 15,5), casado (65,3%), residente no mesmo domicílio do idoso (68,2%). Um terço deles apresentou sobrecarga de cuidado, que foi associado à idade (odds ratio - OR = 1,04; p = 0,001), ao relato de disfunção familiar (OR = 5,60; p = 0,000) e à prestação de cuidado contínuo (OR = 2,78; p = 0,030). Conclusão: Os dados revelam a necessidade de políticas públicas que incluam as necessidades e o suporte aos cuidadores, em especial, os familiares, a fim de melhorar sua qualidade de vida e a sua prestação de cuidados às pessoas idosas.

ABSTRACT: Introduction: Multiple illness and injury classes can cause a functional disability of the elderly, or the right to seek help from another person. Caregiving can be generated without the caregiver functions, leading to burden. Objective: to describe the sociodemographic and care profile of caregivers of the elderly and to analyze the factors associated with excessive stress regarding care. Method: This is a cross-sectional study, part of the SABE (Health, well-being and aging) Study, carried out in the city of São Paulo in 2010, with 362 caregivers. The excessive stress associated with care was evaluated by the Zarit Scale, and the load was found to be less than 24 points and the presence of burden was considered, with scores ≥ 24 points. Hierarchical Logistic Regression was used to analyze the factors associated with the stress of family caregivers. Results: Most of the caregivers were family members (91.5%), being female (75.4%), mean age 53.9 years (SD ± 15.5), married (65.3%), lived in the same household with the elderly (68.2%). One-third of them presented burden, which was associated with age (OR = 1.04, p = 0.001), family dysfunction (OR = 5.60, p = 0.000), continuous care (OR = 78, p = 0.030). Conclusions: The data reveal the need to maintain their needs and support to caregivers, especially their relatives and their sources of life and their debts.

Unmet need for assistance with activities of daily life among older adults in Brazil

ABSTRACT OBJECTIVE To estimate the proportion of unmet need for personal assistance for basic and instrumental activities of daily life and to evaluate socioeconomic inequalities related to the unmet need among community-dwelling Brazilian older adults. METHODS This was a cross-sectional study with data from the last National Health Survey in Brazil. Unmet need was considered as the presence of at least one unmet need for basic or instrumental activities of daily life among individuals reporting the need for assistance. Logistic regression models were used to assess the correlates and probabilities of unmet need. RESULTS The proportion of unmet need was 18% and 7.1% for basic and instrumental activities of daily life, respectively. Unmet need was significantly related to living arrangements and socioeconomic status. Individuals in the first quintile of wealth status had about 50% higher probability of having an unmet need. A family member was the most prevalent type of caregiver. CONCLUSIONS Long-term care policy is needed to reduce the proportion of unmet need, especially among socioeconomically disadvantaged groups. Future studies should address the availability, training, and remuneration of caregivers, as those are an indispensable labor force in an aging society.

Vivências de graduandos e fisioterapeutas no contexto domiciliário à pessoa idosa fragilizada / Experiences of undergraduates students of physical therapy in the residence of frail elderly patient

Este estudo é oriundo de investigação qualitativa, assentado em multitécnica e se propõe a conhecer as vivências de graduandos e profissionais fisioterapeutas no cuidado domiciliário à pessoa fragilizada e sua família. Foi realizado em quarto instituições de ensino superior do estado da Bahia, com 43 participantes, sendo 28 graduandos e 15 fisioterapeutas. Os dados foram triangulados e compreendidos à luz da análise de conteúdo. Os resultados evidenciaram que o ambiente domiciliar é, por vezes, um espaço desconhecido da vivência acadêmica dos graduandos e profissionais fisioterapeutas, pois expressam sentimentos de insegurança e medo para atuarem nesse contexto por carência na formação acadêmica. Destacam a necessidade de reformulação dos componentes curriculares à inserção do processo formador ao contexto comunitário-domiciliar mais proximal, cujos saberes os potencializam de referências teórico-práticos sobre família, envelhecimento e comunidade. (AU)

This study is based on qualitative research based on multi technics and aims to know the experiences of undergraduate and professional physiotherapists in the home care of the frail person and his/her family. It was held in four institutions of higher education in the State of Bahia with 43 participants, of which 28 were undergraduates and 15 physiotherapists. The data were triangulated and understood in light of the content analysis. The results showed that the home environment is sometimes an unknown area of the academic experience of undergraduates and physiotherapists who express feelings of insecurity and fear to act in this context due to lack of academic training. They emphasize the need to reformulate the curricular components to the insertion of the formation process into the more proximal community-domicile context, whose knowledges empower them with theoretical-practical references on family, aging and community. (AU)

Habilidad de cuidado y sobrecarga en cuidadores familiares de personas con enfermedad crónica / Ability of care and care burden in family caregivers of people with chronic illness

Introducción: la sobrecarga del cuidador ha mostrado ser una variable que se relaciona con factores como el género, funcionalidad del receptor de cuidados, el tiempo dedicado al cuidado, entre otros. Objetivo: determinar si existe relación entre sobrecarga de cuidador y habilidad de cuidado en cuidadores familiares de personas con enfermedad crónica no transmisible y comparar dicha relación en las regiones de Colombia. Métodos: estudio de abordaje cuantitativo, correlacional, la muestra fue de 2040 cuidadores de personas con enfermedad crónica de las regiones Andina, Pacífica, Caribe y Amazonia en Colombia. Los datos fueron recolectados en el Inventario de Habilidad de Cuidado de Nkongho y la escala de sobrecarga del cuidador de Zarit. El estadístico de elección fue el coeficiente Rho de Spearman. Resultados: en Colombia y en las regiones de Amazonia y Pacífico se observa una correlación negativa débil, pero estadísticamente significativa (p<0,01). En la región Caribe, se observa una correlación negativa moderada y estadísticamente significativa (p<0,01). En la región Andina, no existe relación alguna entre la habilidad de cuidado y la sobrecarga del cuidador. Conclusiones: se observó un relación débil pero estadísticamente significativa entre la habilidad de cuidado y la sobrecarga del cuidador en Colombia y sus regiones, excepto en la región Andina. Intervenciones en el fortalecimiento de la habilidad de cuidado podrían demostrar utilidad para disminuir la sobrecarga del cuidador(AU)

Introduction: Caregiver burden has proved to be a variable that is related to gender factors, the functionality of the care recipient, the time spent on care, among others. Additional research to determine if the burden of care is related to the caring ability of the family caregiver is required. Objective: To determine the correlation between burden of care and caring in family caregivers of people with chronic illness and to compare that relationship in the different regions of Colombia. Methods: Quantitative study, with a correlational approach. The sample included 2040 caregivers of people with chronic illness of the Andean, Pacific, Caribbean and Amazon regions in Colombia. Informed consent process was performed. Data were collected with the Caring Ability Inventory of Nkonghoy and with the Zarit Caregiver Burden Interview. The statistical approach was done with the Spearman Rho test. Results : In Colombia and in its Amazonic and Pacific regions, a weak negative statistically significant correlation (p <0.01) was observed. In the Caribbean Region, a moderate and statistically significant negative correlation (p <0.01). In the Andean region, no connection between the ability of care and caregiver burden was found. Conclusion: A weak but statistically significant relationship between the ability of care and caregiver burden was found in Colombia, except in the Andean region were no correlation was founded. Interventions in strengthening the ability of care, could be useful in decreasing caregivers burden with care(AU)

Impacto de la medicina familiar en la provincia de Granma, Cuba: actualización con datos de 2012 / Impact of family medicine in the province of Granma, Cuba: an update with 2012 data

Introducción: en el marco de la actualización del modelo económico cubano, el papel que juegan los recursos humanos para mejorar la calidad de la atención médica es fundamental para comprender las transformaciones que se vienen aplicando en el sector. La provincia oriental de Granma no escapa a dichos cambios, ni a la búsqueda constante de calidad de vida de sus pobladores, rescatando los conceptos fundacionales de la medicina familiar. Objetivo: describir para la comunidad científica el impacto de la medicina familiar, como especialidad del sistema de salud en la provincia de Granma durante el año 2012. Análisis: el artículo presenta un estudio descriptivo de algunos indicadores como el uso de la tecnología en la atención primaria de salud, actividades específicas de la medicina general integral, comportamiento de las consultas y visitas domiciliarias realizadas en el primer nivel de atención, así como del trabajo de grupo provincial de medicina general integral y la formación de especialistas. Conclusión: es importante considerar el impacto de los indicadores de la medicina familiar en la provincia de Granma durante 2012, entre los que destacan 100 por ciento de cobertura del plan médico y enfermera de la familia por medio de 28 policlínicos y 371 consultorios, perfeccionamiento del servicio médico social rural, incremento de la totalidad de consultas en atención primaria de salud, de visitas a terreno e ingreso en el hogar, disminución de consultas en las guardias de los policlínicos universitarios y uso racional de los medios diagnósticos.

Introduction. As part of the Cuban economic model reforms, the role of human resources in improving the quality of care is essential in understanding the changes that have been implemented in healthcare. The Eastern province of Granma is not immune to these changes, nor to the ongoing pursuit of quality of life for its residents based on the foundational concepts of family medicine. Aim. To describe the impact of family medicine as a specialty on the health system in the province of Granma in 2012. Analysis. The article describes indicators such as the use of technology in primary health care, activities of general medicine, trends in consultations and home visits at the primary care level as well as the provincial working group of general medicine and specialist training. Conclusion. It is important to consider family medicine indicators in the province of Granma in 2012, among which: 100 percent coverage by family doctors and nurses provided by 28 secondary centers and 371 out-patient clinics, improvement of rural social healthcare, increase of all consultations in primary health care, field visits and household access, a decrease in the number of visits to the emergency services of university clinics, and rational use of diagnostic tests.

Perfil do idoso dependente de cuidado domiciliar em comunidades de baixo nível socioeconômico de Porto Alegre, Rio Grande do Sul / Profile of the elderly individual dependent on home care in low socioeconomic level communities in Porto Alegre in the state of Rio Grande do Sul

O estudo estimou a prevalência de cuidado domiciliar e identificou o perfil demográfico, socioeconômico, comportamental e de saúde dos idosos dependentes. O delineamento transversal e representativo das comunidades Restinga e Extremo Sul, de Porto Alegre (RS), incluiu 638 idosos. O cuidado domiciliar foi definido pela resposta positiva à questão: "O(a) Sr.(a) tem alguém aqui na sua casa para cuidar do(a) Sr(a)?". A prevalência de cuidado domiciliar encontrada foi de 25,4% (IC95%: 22,0; 28,8). Filhos(as) e esposos(as) foram responsáveis pela maioria do cuidado domiciliar prestado a idosos (40,7% e 37,0%, respectivamente). Homens, indivíduos sem companheiro(a), fisicamente inativos, com idade avançada, menor escolaridade e maior nível econômico, incapacidade funcional e que foram hospitalizados no último ano caracterizaram o perfil do idoso dependente. A alta prevalência de cuidado domiciliar serve de subsídio para políticas públicas destinadas a idosos. Dentre todas as características avaliadas, a incapacidade funcional, esteve mais fortemente associada ao cuidado domiciliar.

The scope of this study was to estimate the prevalence of home care and to identify the demographic, socioeconomic, behavioral and health profile of dependent elderly individuals. The cross-sectional and representative delineation of the communities of Restinga and Extremo Sul in Porto Alegre in the State of Rio Grande do Sul included 638 elderly individuals. Home care was defined as a positive answer to the following question: "Do you have someone here in your home to take care of you?" The prevalence of home care was 49.5% (95% CI: 44.5; 54.5). Children and spouses were responsible for the majority of home care (40.7% and 37%, respectively). Men, unaccompanied and physically inactive individuals, of advanced age, lower educational level, higher economic level, functionally disabled and who had been hospitalized in the last year characterized the profile of the dependent elderly individual. The high prevalence of home care can serve as input for health services for the elderly. Among all the characteristics, functional disability was the one most closely associated with home care.

Método Mãe Canguru: uma investigação da prática domiciliar / Mother Kangaroo Method: an investigation about the domestic pratice

Estudo descritivo, inserido na abordagem quantitativa, com o objetivo de conhecer a prática domiciliar do Método Mãe Canguru. Os dados foram coletados a partir da aplicação de um questionário aos pais dos recém-nascidos prematuros que estiveram internados em um hospital universitário, em São Luís (MA), no período de maio a agosto de 2005. De acordo com os dados encontrados, 100 por cento das famílias receberam ensinamentos e orientações no hospital; sendo que em 53,3 por cento dos casos apenas a mãe foi orientada. Os benefícios do trabalho educativo desenvolvido pela equipe foram confirmados na prática domiciliar, com 93,3 por cento das mães realizando adequadamente a posição canguru, onde 86,7 por cento dos bebês encontravam-se ligeiramente vestidos, 86,7 por cento delas amamentando tecnicamente correto e 86,7 por cento sem fazer uso de qualquer tipo de adereços. 46,7 por cento das mães permanecem de cinco a oito horas/dia com o bebê nesta posição e 66,7 por cento identificaram as tarefas do lar como principal obstáculo da prática. Em relação ao seguimento ambulatorial neonatal, 63,3 por cento das mães identificaram a falta de recurso financeiro para cobrir as despesas com o transporte como principal fator de dificuldade. Os dados obtidos demonstram que o apoio da rede familiar e da equipe de saúde parece ser o melhor caminho para garantir a extensão do cuidado em domicílio.

This is a descriptive study, within uantitative approach, aiming at acquiring knowledge regarding the domestic practice of Mother Kangaroo Method. Data were collected from a survey for the parents of prematures hospitalized in a University Hospital in São Luís, Maranhão State, from May to August, 2005. According to the findings, 100 percent of the families received training and guidance in the hospital and only in 53.3 percent of the cases the mothers were guided. The benefits of the education works developed by the team were confirmed by domestic practice with 93.3 percent of the mothers performing the kangaroo position correctly, where 86.7 percent of the babies were slightly dressed, 86.7 percent of the mothers were breast feeding technically in a correct manner and 86.7 percent without any other items being used. 46.7 percent of the mothers stay 5 to 8 hours/day with their babies in this position and 66.7 percent identified house tasks as the principal obstacle of the practice. Regarding neonatal walk-in unit follow-up 63.3 percent of the mothers identified the lack of financial recourses to pay for transportation as the main difficulty factor. The data obtained show that the support from the family network and the health team seem to be the best way to guarantee the extension of domestic care.

Preparo dos pais de recém-nascido prematuro para alta hospitalar: uma revisão bibliográfica / The preparedness of the parents to take care of a premature child after the hospital discharge: a literature review / Preparación de los padres para el alta hospitalar del recién nacido prematuro: una revisión bibliográfica

Este estudo foi motivado pela constatação de que os profissionais de Unidades de Cuidado Intensivo Neonatal nem sempre sededicam ao preparo do familiar para cuidar do recém-nascido prematuro no domicílio. Teve como objetivo identificar osprocedimentos empregados, pelo enfermeiro, para o preparo do familiar para a alta hospitalar do prematuro. Realizou-selevantamento bibliográfico em bases de dados internacionais, entre 1998 e 2008, cujos 10 textos úteis foram lidos na íntegra edos quais foram extraídos os focos principais de abordagem. Verificou-se que, no País, as iniciativas de envolvimento do familiarno cuidado intra-hospitalar ainda são incipientes e carecem de implementação de estratégias que assegurem a independência dofamiliar no cuidado do bebê no domicílio, enquanto, no exterior, a preocupação com este procedimento é mais presente.Proporcionar momentos de reflexão sobre o papel do enfermeiro na assistência ao familiar do prematuro é a finalidade destetexto.

Costo de hospitalización domiciliaria como alternativa de la hospitalización institucional: periodo enero-diciembre de 2007 / Cost of home care as alternative institutional hospitalization: period January-December 2007

Objetivo: Valorar el costo del servicio de hospitalización domiciliaria en comparación a la hospitalización institucional, teniendo en cuenta el perfil epidemiológico y los días estancia. Métodos: Estudio descriptivo, retrospectivo, longitudinal, realizado con pacientes pertenecientes a una compañía de seguros con productos como pólizas de salud y medicina prepagada, que hicieron uso del servicio de hospitalización domiciliaria e institucional en el período comprendido entre enero - diciembre del año 2007. Resultados: Se encontró que el costo de la hospitalización domiciliaria es el 18% del total del costo de la hospitalización institucional. Se evaluó la diferencia por perfil epidemiológico y por número de días estancia. Conclusiones: La hospitalización domiciliaria es una opción para disminuir el costo de la atención y permite la recuperación del paciente en su entorno.

Objective: To evaluate the cost of hospital at home compared to hospital institution, taking into account the epidemiological profile and the days stay. Methods: A retrospective, longitudinal, conducted with patients of an insurance company with products like health insurance and prepaid-medicine, which made use of hospital and institutional home for the period January to December of 2007. Results: We found that the cost of home hospitalization is 18% of the total institutional cost of hospitalization. The difference was evaluated by epidemiological profile and number of days stay. Conclusions: The home care is an option to reduce the cost of care and allows the recovery of the patient in his environment.

O cuidado domiciliar de idosos acometidos por acidente vascular cerebral: cuidadores familiares / La atención domiciliaria a ancianos afectados por accidente vascular cerebral: cuidadores familiares / Home care of elderly people affected by stroke: family caregivers

Propõe-se identificar os cuidados desenvolvidos pelos cuidadores/familiares de idosos acometidos por acidente vascular cerebral. Estudo do tipo descritivo e estatístico, realizado com 8(100 por cento) idosos e seus cuidadores/familiares acompanhados em um Centro de Saúde situado em Fortaleza-CE. A entrevista ocorreu no domicílio dos idosos, no período de outubro a novembro de 2007. Quanto à caracterização predominante dos idosos, 5(62,5 por cento) eram mulheres; a idade variou de 65 a 86 anos; 4(50 por cento) eram casadas, 6(75 por cento) representavam a principal fonte de renda e 4 (50 por cento) eram analfabetos. Referente aos cuidadores/familiares, todos eram do sexo feminino; houve uma variação na faixa etária de 18 a 65 anos; 4 (50 por cento) eram casadas e 4(50 por cento) residiam no domicílio do idoso. Todas cuidadoras preparavam a alimentação, controlavam o horário da medicação e sempre acompanhavam as consultas. A maioria das cuidadoras não recebeu explicações sobre os cuidados a serem realizados no domicílio. Torna-se fundamental o desenvolvimento de ações educativas voltadas para os idosos e seus cuidadores.

The purpose of the study is to identify the kind of care offered by caregivers/relatives of elderly people who have suffered a cerebrovascular accident. This descriptive and statistical study involved eight elderly people and their caregivers/relatives attending a clinic in Fortaleza, Ceará State. The elderly people –interviewed at home during October and November 2007 – were all 65 to 86 years old: 5 (62.5 percent) were women, 4 of them (50 percent) married; 6 (75 percent) represented the main source of household income (pension) and 4 (50 percent) were illiterate. The caretakers were all women aged from 18 to 65; four were married and four lived in the same house as the elderly person. All prepared meals, controlled the medication schedule and were always present during medical appointment. 5 (62,5 percent) had no instruction about the procedures to be followed at home. It is extremely important to undertake educational measures for the elderly and their caregivers.

El objetivo fue dentificar las atenciones hechas en el domicilio por los cuidadores/ familiares de ancianos acometidos por accidentes vascular cerebral. Estudio descriptivo y estadístico, hecho con 8 (100 percent) ancianos y sus cuidadores/ familiares acompañados en un Centro de Salud de la ciudad de Fortaleza-CE-Brasil. La entrevista ocurrió en el sitio de los ancianos, en el periodo de octubre a noviembre de 2007. Cuanto a la caracterización de los ancianos, 5 (62,5 percent) eran mujeres; la edad varió de 65 y 86 años; 4 (50 percent) eran casadas, 6 (75 percent) representaban la principal fuente de renta de la casa y 4 (50 percent) no eran alfabetizadas. Referente a los cuidadores familiares, todos eran del sexo femenino; hubo una variación en la franja etaria de 18 a 65 años; 4 (50 percent) eran casadas y 4 (50 percent) cuidadoras moraban en el sitio del anciano. Todas las cuidadoras realizaban el preparo de la alimentación, controlaban la hora de la medicación y siempre acompañaban las consultas. La mayoría de los familiares no recebieron explicaciones sobre la enfermedad y sobre las atenciones a seren hechas en el sitio. Se hace fundamental el desarrollo de acciones educativas para los ancianos y sus cuidadores.

Self-medication: initial treatments used by patients seen in an ophthalmologic emergency room

OBJECTIVE: This study seeks to identify practices of self-medication in the treatment of ocular emergencies. We examine patients' use of both homemade preparations and manufactured products before seeking specialized care. MATERIALS AND METHODS: We conducted a cross-sectional analytic survey of consecutive patients seen in the ophthalmology emergency room of a teaching hospital. RESULTS: The sample included 561 subjects, 51.3 percent males and 48.7 percent females, with a mean age of 39.8 years. Prior to seeking emergency care, 40.5 percent reported self-medicating; 29.4 percent used a homemade preparation (13.9 percent referred to an industrialized product like boric acid as a homemade preparation), and 11.1 percent used a manufactured product. The most frequently used products included a boric acid solution (53.3 percent), a normal saline solution (35.7 percent), herbal infusions (6.1 percent) and breast milk (4.8 percent). Viral conjunctivitis was the most frequent diagnosis (24.4 percent), followed by the presence of a corneal foreign body (7.4 percent). No significant differences were found in the self-treatment of ocular injuries according to gender (p = 0.95), level of education (p = 0.21) or age (p = 0.14). In addition, self-medication practices were not related to the medically judged severity of the condition. CONCLUSION: Patients often attempt to treat conditions that require ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products include boric acid, normal saline, leaf infusions and breast milk. This behavior occurs independently of educational level, gender, age or the nature of the ocular condition. Self-medication is a culturally driven practice that is used even in cases of acute ocular injuries.

Adaptação de instrumento para dimensionar horas diárias de assistência de enfermagem residencial / Adaptacion de instrumento para medir horas diarias de atención de enfermería domiciliaria / Adaptation of an instrument for the measurement of daily hours for nursing care at patient's home

O Therapeutic Intervention Scoring System Intermediate: TISS-Intermediário foi traduzido para a língua portuguesa e adaptado para estabelecer horas diárias de assistência domiciliar. O processo de modificação do instrumento, desenvolvido através da Técnica Delphi, teve como participantes 16 enfermeiros, que atuam em empresas de assistência domiciliar e determinam horas diárias de assistência de enfermagem para pacientes na residência, após a hospitalização. Ao término do estudo obteve-se um instrumento com 104 itens, para ser no futuro validado clinicamente. Tal instrumento ajudará enfermeiros a estender cuidados de enfermagem a pacientes em casa, após a alta hospitalar, especialmente na tomada de decisões relativas à avaliação dos pacientes.

The Therapeutic Intervention Scoring System Intermediate: TISS-Intermediate, was translated into Portuguese and adapted to establish the number of hours daily of home care. The adaptation process of the instrument, developed with the Delphi Technique, used 16 nurses, who work in home care service providers and helped in calculating the number of nursing care hours for patients at their home after a period of hospitalization. At the end of the study, a 104 item-instrument was obtained for future clinical validation. This instrument will help nurses to extend nursing care to patients in their homes after they are discharged from hospitals, especially in regard to their decision-making concerning patient assessment.

El Therapeutic Intervention Scoring System Intermediate: TISS-Intermedio, fue traducido para el idioma portugués y adaptado para establecer las horas diarias de asistencia en el domicilio. Dieciséis enfermeros participaron del proceso de modificación del instrumento desarrollado a través de la Técnica Delphi. Esos enfermeros actúan en empresas de atención a domicilio y determinan las horas diarias de atención de enfermería a los pacientes en su domicilio después del alta. Al término del estudio se obtuvo un instrumento con 104 items para ser validado clínicamente.Tal instrumento ayudará a los enfermeros a extender sus cuidados de enfermería a pacientes que se encuentran en casa, después del alta hospitalario, especialmente en la toma de decisiones relacionadas con la evaluación de los pacientes.

Acute lower respiratory infections in rural Bangladeshi children: patterns of treatment and identification of barriers.

A study conducted in rural Bangladesh examined the patterns of health seeking behavior, mothers' recognition of symptoms, the perceived causes and barriers to timely treatment of acute lower respiratory infections (ALRI). A total of 194 children under 5 years of age suffering from ALRI in an intensive maternal child health and family planning area was prospectively followed. About 62% of the mothers sought allopathic treatment for their children within 24 hours of case detection. No treatment of any kind was sought in 45 (23.2%) cases. Most of the mothers could recognize the different symptoms of ALRI. Cold was reported as the most common cause of ALRI. No significant difference was observed in the reported symptoms or perceived cause of the disease between those who sought no treatment and those who sought allopathic, homeopathic, spiritual or combined treatments. Failure to recognize severity followed by work loss were the most common reasons identified for not seeking any medical care. Whether or not a mother sought allopathic treatment was not associated with the child's age, sex, mother's age, mother's education, duration of illness, birth order, housing type or distance from the health center. The study indicates the potential value of giving parents clear guidelines on recognition of severity of symptoms of ALRI and motivating them to seek treatment quickly when these symptoms present. Health service providers should be aware of the heavy work loads which rural women have and the severe time constraints which deter them from seeking timely treatment from the appropriate sources.