Atenção à saúde de pessoas em situação de rua: estudo comparado de unidades móveis em Portugal, Estados Unidos e Brasil / Health care of people in homelessness: a comparative study of mobile units in Portugal, United States and Brazil

Resumo O trabalho descreve e analisa o quadro legal e normativo que orienta o uso de unidades móveis em Portugal, Estados Unidos e Brasil, que buscam melhorar o acesso e a continuidade dos cuidados em saúde de pessoas em situação de rua. Utilizou-se a análise comparada, por meio de revisão bibliográfica e documental relacionando três categorias: contexto (demográfico, socioeconômico e epidemiológico), sistema de serviços (acesso, cobertura, organização, gestão e financiamento) e as unidades móveis especificamente (concepção, modelo de atenção e financiamento). A análise fundamentou-se na teoria da convergência/divergência entre os sistemas de saúde, pela perspectiva da equidade em saúde. A melhoria do acesso, a abordagem do uso abusivo de substâncias psicoativas, busca ativa e trabalho multidisciplinar mostrou-se comuns aos três países, com potencial para reduzir as iniquidades. As relações com a atenção primária, uso de veículos e o tipo de financiamento são consideradas de maneira divergente nos três países, influenciando o maior ou menor alcance da equidade nas propostas analisadas.

Abstract This paper describes and analyzes the legal and normative framework guiding the use of mobile units in Portugal, United States and Brazil, which seek to improve access and continuity of care for people in homelessness. We used a comparative analysis through literature and documentary review relating three categories: context (demographic, socio-economic and epidemiological), services system (access, coverage, organization, management and financing) and, specifically, mobile units (design, care and financing model). The analysis was based on the theory of convergence/divergence between health systems from the perspective of equity in health. Improving access, addressing psychoactive substances abuse, outreach and multidisciplinary work proved to be common to all three countries, with the potential to reduce inequities. Relationships with primary healthcare, use of vehicles and the type of financing are considered differently in the three countries, influencing the greater or lesser extent of equity in the analyzed proposals.

Análise da implantação do sistema de atendimento pré-hospitalar móvel em cinco capitais brasileiras / Analysis of the implementation of a mobile pre-hospital treatment system in five Brazilian state capitals

Apresentamos descrição e análise da implantação do sistema de atendimento pré-hospitalar móvel (Serviço de Atendimento Móvel de Urgência - SAMU). O texto é parte de uma pesquisa denominada Análise Diagnóstica de Implantação da Política Nacional de Redução de Acidentes e Violências. Estudamos a história recente da implantação, organização, recursos humanos, materiais e equipamentos do SAMU em cinco capitais (Curitiba - Paraná; Recife - Pernambuco; Brasília - Distrito Federal; Manaus - Amazonas; Rio de Janeiro) que apresentam elevadas taxas de morbimortalidade por causas externas. Trabalhamos em quatro fases, cada qual agregando ciclos exploratórios, de trabalho de campo e de análise, triangulando dados quantitativos e qualitativos. Os resultados mostram que a implantação do SAMU constitui, hoje, um avanço do setor saúde e da sociedade. É preciso ainda completar a implantação de várias portarias quanto a veículos, pessoal e equipamentos; intensificar a articulação do pré-hospitalar móvel com as unidades de saúde; enfatizar informações geradas nesse subsistema visando ao melhor planejamento das ações; manter e promover a alta qualificação dos profissionais do SAMU. Este serviço veio oficializar, padronizar e regular um subsistema fundamental para salvar vidas.

The article presents a description and analysis of the implementation of a pre-hospital treatment system (SAMU) as part of the research project Diagnostic Analysis of the Implementation of a National Policy for the Reduction of Violence and Accidents. Implementation and organization of the SAMU service, together with the related materials, human resources, and equipment, was studied in five Brazilian State capitals with high morbidity and mortality rates from external causes: Curitiba (Paraná), Recife (Pernambuco), Brasília (Federal District), Rio de Janeiro, and Manaus (Amazonas). The study involved four phases, each developing exploratory and analytical cycles, combined with fieldwork, triangulating quantitative and qualitative data. Implementation of the pre-hospital treatment system is now a key health sector asset. Further necessary steps include: comprehensive legislation covering vehicles, personnel, and equipment; closer networking between mobile units and healthcare facilities; focus on information generated in this sub-system, thus facilitating planning; and maintaining and upgrading high qualifications for SAMU crews. The service is officially establishing, standardizing, and regulating a sub-system that is crucial for saving lives.

Development of community-based speech therapy model: for children with cleft lip/palate in northeast Thailand.

BACKGROUND: Surgical treatment can reduce disfigurement for children born with cleft lip/palate, however, most children are left with speech and language problems. This creates a new problem as speech and language services is limited. OBJECTIVE: To combine the principles of Community-Based Rehabilitation (CBR), Primary Health Care (PHC) and institutional medical approaches for reaching and treating speech disordered children with cleft lip and/ or palate in remote area. MATERIAL AND METHOD: The authors conducted the study from participatory workshops for development of a Community-Based Model. RESULTS: Community-Based Speech Therapy Model for children with cleft lip/palate was established based on healthcare system. CONCLUSION: Model can be implemented among children with cleft lip/palate for further process in Northeast and other areas of Thailand as well as developing countries where there is a limitation of speech therapy.

Chronic disease control and compliance--the HOPE worldwide Jamaica experience

HOPE worldwide Jamaica has provided mobile curative and preventative services to fourteen rural government clinics since 1994. The patient records of 1,091 chronic disease patients, aged >30 years between January and December 1999 were reviewed. They were all above 30 years of age with an average age of 64 years; 81were female and 60were hypertensive, 16diabetic and 24had both diabetes and hypertension. There were 2,390 visits for hypertension, with an average of 2 visits per patient. Thirty-four per cent of patients had BP of < or = 140/90 mmHg while 43had BP <160/ 95 mmHg. Compliance was defined as daily consistency in taking prescribed medication. Forty-four per cent of hypertensives were non-compliant at the time of their visit. Anti-hypertensive treatment included thiazide diuretics (65), reserpine (50), ACE inhibitors (30) and alpha-methyldopa (5). There were 1,129 visits for diabetes, with an average of 2 visits per patient. Twenty-four per cent of diabetic patients were controlled to fasting blood glucose FBG levels of <6.7 mmol/l and 38controlled to (FBG) levels <8 mmol/l. Thirty per cent of diabetics were non-compliant at the time of their visit. The most frequently used oral hypoglycaemic agents were metformin (78), glyburide (43) and chlorpropamide (30). Fourteen per cent of diabetics were on treatment with insulin 70/30 (12) and lente insulin (2). Electrocardiograms (ECG) were done on 24(n=267) of patients in the previous two years. Thirty-six per cent had evidence of left ventricular hypertrophy and 15had evidence of ischaemic heart disease. The level of blood pressure and blood glucose control is inadequate, despitethe provision of regular monitoring, surveillance and improved access to pharmaceuticals. It is perceived that poor socioeconomic conditions, lack of education, cultural beliefs, in addition to other factors, continue to militate against improved compliance and control.