ABSTRACT
O estado do Amazonas abrange municípios ribeirinhos que, devido a suas peculiaridades, são um desafio para organização da Atenção Primária à Saúde (APS). Este estudo objetivou avaliar os atributos essenciais de integralidade e longitudinalidade da APS da mulher em idade reprodutiva em três municípios amazônicos, pois doenças preveníveis pela APS apresentam alta incidência nessa população. Esta é uma pesquisa transversal, de caráter exploratório e abordagem quantitativa, que utilizou o instrumento Avaliação da Atenção Primária (PCATool) Versão Adulto para entrevistar 857 mulheres. Os resultados foram insatisfatórios na avaliação dos dois atributos, longitudinalidade e integralidade, com diferenças significativas entre os municípios. Na avaliação da APS sobre questões de relevância epidemiológica para saúde da mulher amazônica os resultados demonstraram que os serviços de assistência pré-natal e a realização de exame preventivo para o câncer de colo de útero estavam disponíveis para cerca de 90% das mulheres. O aconselhamento para testagem de HIV foi relatado por mais de 60% das mulheres entrevistadas. Assim, este estudo identificou limites e desafios da Atenção Primária a Saúde da mulher nesses municípios, reforçando a importância de processos avaliativos como instrumentos de melhor gerenciamento das políticas públicas em saúde.
The State of Amazonas has riparian municipalities that, due to their peculiarities, are a challenge for the organization of Primary Health Care (PHC). This study aimed to evaluate the integral attributes and longitudinality of PHC to Women's Health in reproductive age in three municipalities of the state, because diseases preventable by PHC are present at high incidence in this population. This is a cross-sectional, exploratory and quantitative study that used the Primary Care Assessment Tool (PCATool) instrument - Adult version - to interview 857 women. The results were unsatisfactory in the evaluation of the two attributes, longitudinality and Integrality, with significant differences between the municipalities. In the PHC evaluation on issues of epidemiological relevance for the health of Amazonian women, the results showed that prenatal care and preventive examination for cervical cancer were available for about 90% of the women. Counseling for HIV testing was reported by more than 60% of the women interviewed. Therefore, this study identified the limits and challenges of Primary Health Care for Women in these municipalities, reinforcing the importance of evaluation processes as tools for better management of public health policies.
Subject(s)
Primary Health Care , Women's Health , Integrality in Health , Health Evaluation , Continuity of Patient Care , Health ManagementABSTRACT
PURPOSE: The aim of this study was to investigate the influence of the TNF -308 G/A polymorphism in the promoter region of the tumor necrosis factor-α gene on the susceptibility and severity of rheumatoid arthritis (RA) in individuals from the Brazilian Amazon. METHODS: A total of 323 individuals-192 healthy controls without arthritis and 131 individuals suffering from arthritis-were genotyped for this polymorphism using a methodology based on PCR-RFLP. RESULTS: The frequency of the A allele (TNF2) in rheumatoid arthritis sufferers was not significantly higher than in the controls (p=0.926; OR=0.97; confidence interval 0.54-1.76). However, using a logistic regression model, when the patients were stratified according to whether the manifestations were preponderantly articular or systemic, there was a strong association between the TNF2 allele and systemic arthritis (p=0.001; OR=5.89; confidence interval=1.98-17.5) as well as the use of anti-TNF immunotherapy (p=0.023; OR=1.10; confidence interval=1.00-1.14). The main factors that were found to influence the risk of extra-articular disease were age greater than or equal to 60 years (p=0.008; OR=4.06; confidence interval=1.45-11.38), disease duration greater than 10 years (p=0.031; OR=3.10; confidence interval=1.11-8.63) and positive rheumatoid factor (p=0.035; OR=2.07; confidence interval=1.05-4.09). CONCLUSIONS: These results suggest that the TNF2 allele is associated with the more serious forms of the disease in individuals from the Brazilian Amazon but not with a risk for developing RA.
