Interdisciplinary approach at the primary healthcare level for Bolivian immigrants with Chagas disease in the city of São Paulo.

BACKGROUND/METHODS: In a pioneering cross-sectional study among Bolivian immigrants in the city of São Paulo, Brazil, the epidemiological profile, clinical manifestations and morbidity of Chagas disease were described. The feasibility of the management of Chagas disease at primary healthcare clinics using a biomedical and psychosocial interdisciplinary approach was also tested. Previously, a Trypanosoma cruzi (T. cruzi) infection rate of 4.4% among 633 immigrants was reported. The samples were screened using two commercial enzyme-linked immunoassay (ELISA) tests generated with epimastigote antigens, and those with discrepant or seropositive results were analyzed by confirmatory tests: indirect immunofluorescence (IFI), TESA-blot and a commercial recombinant ELISA. PCR and blood cultures were performed in seropositive patients. RESULTS: The majority of the 28 seropositive patients were women, of whom 88.89% were of child-bearing age. The predominant clinical forms of Chagas disease were the indeterminate and atypical cardiac forms. Less than 50% received the recommended antiparasitic treatment of benznidazole. An interdisciplinary team was centered on primary healthcare physicians who applied guidelines for the management of patients. Infectologists, cardiologists, pediatricians and other specialists acted as reference professionals. Confirmatory serology and molecular biology tests, as well as echocardiography, Holter and other tests, were performed for the assessment of affected organs in secondary healthcare centers. The published high performance of two commercial ELISA tests was not confirmed. CONCLUSION: An interdisciplinary approach including antiparasitic treatment is feasible at the primary healthcare level for the management of Chagas disease in Bolivian immigrants. The itinerant feature of immigration was associated with a lack of adherence to antiparasitic treatment and was considered a main challenge for the clinical management of this population. This approach is recommended for management of the infected population in endemic and nonendemic areas, although different strategies are needed depending on the severity of the disease and the structure of the healthcare system.

Prevalence of Trypanosoma cruzi infection among Bolivian immigrants in the city of São Paulo, Brazil.

With the urbanisation of the population in developing countries and the process of globalisation, Chagas has become an emerging disease in the urban areas of endemic and non-endemic countries. In 2006, it was estimated that the prevalence of Chagas disease among the general Bolivian population was 6.8%. The aim of the present study was to determine the prevalence of Trypanosoma cruzi infection among Bolivian immigrants living in São Paulo, Brazil. This study had a sample of 633 volunteers who were randomly selected from the clientele of primary care units located in the central districts of São Paulo, Brazil. Infection was detected by two different ELISA assays with epimastigote antigens, followed by an immunoblot with trypomastigote antigens as a confirmatory test. The prevalence of the infection was 4.4%. Risk factors independently associated with the infection were: a history of rural jobs in Bolivia, knowledge of the vector involved in transmission, and having relatives with Chagas disease. Brazil has successfully eliminated household vector transmission of T. cruzi, as well as its transmission by blood transfusion. The arrival of infected immigrants represents an additional challenge to primary care clinics to manage chronic Chagas disease, its vertical transmission, and the blood derivatives and organ transplant programs.

Impacto do Programa Mais Médicos na atenção básica de um município do sertão central nordestino / The impact of the Program More Doctors in the basic atention in a north east location county

Tendo em vista os problemas inerentes à atenção primária a saúde, o Governo Federal implantou o Programa Mais Médicos para o Brasil em busca de melhoria na assistência e do acesso à atenção primária a saúde com vistas de proporcionar qualidade de vida aos usuários do Sistema Único de Saúde -SUS através da prevenção e promoção da saúde. Este estudo visou identificar os impactos causados pela implementação do Programa Mais Médicos em um município do sertão central nordestino. O estudo foi constituído a partir da análise estatística dos indicadores registrados no Sistema de informação da Atenção Básica SIAB. Os dados foram processados no software Stata®, na versão 11.0, onde, a partir da análise estatística descritiva, os resultados foram analisados e apresentados em tabelas. O estudo identificou que a partir da implementação do Programa Mais Médicos houve um aumento considerável no número de consultas e atendimentos realizados pelos médicos, tendo destaque os atendimentos prestados aos pacientes portadores de tuberculose e hanseníase e impacto nas solicitações dos exames complementares que sofreu uma queda bastante considerável. Outro ponto identificado é o aumento de visitas domiciliares. Pode se realizar uma análise de forma geral de melhoria dos indicadores da saúde no município depois do Programa Mais Médicos implantado segundo resultados estatísticos apresentados.

Because of problems in Brazil’s primary health care attention, the Federal Government created the Mais Médicos Program. This Program comprises a series of actions intended to better assistance in the segment of primary health care attention and have the great responsibility to promote the life quality of the Brazilian national health system (SUS) users, and became possible through the health promotion and prevention. This study aims at identifying impacts that come out with the Mais Médicos Program implementation in a north east location county, through the analysis of statistical indicators registered in the basicattention information system (SIAB). The data were processed by software Stata 11.0 and are shown as descriptive statistics and tables. The work identified an important increase in numbers of medical appointments, given a special emphasis in medical appointments to tuberculosis and hanseniase suffers, as well as a decrease number in extras exams solicitations. Another point identified that deserves merit is the demand of home visit by the doctor. In this way can be perform, in a general form, an improvement of health indicators in the county after the Mais Médicos Program based on real statistics results.

[Primary health care organization in the context of social exclusion/inclusion processes]. / Organização das práticas de atenção primária em saúde no contexto dos processos de exclusão/inclusão social.

This article reports on a primary health care and training center in São Paulo, Brazil, and the organization of its activities based on equity and positive discrimination. Operating in the city center of São Paulo, the policy aims to provide health services access to certain target groups (homeless, sex workers, and slum-dwellers). It also raises discussion on the various forms of social life found in downtown areas, mainly those of vulnerable groups lacking access to public goods and services. The experience demonstrates the feasibility of implementing health policies based on universal access.