A Comprehensive Review on Long vs. Short Regimens in Multidrug-Resistant Tuberculosis (MDR-TB) Under Programmatic Management of Drug-Resistant Tuberculosis (PMDT).

This comprehensive review delves into the intricate landscape of multidrug-resistant tuberculosis (MDR-TB) treatment within the programmatic management of drug-resistant tuberculosis (PMDT) framework. MDR-TB poses a substantial global health threat, necessitating targeted approaches for effective management. The analysis explores the historical evolution, efficacy, safety profiles, and implementation challenges associated with long and short regimens. The findings underscore the importance of individualized clinical practices, considering patient-specific factors, and the need for ongoing monitoring within PMDT programs. Recommendations advocate for integrating advanced diagnostics, continuous surveillance, and training for healthcare professionals. The review concludes with a nuanced outlook on long versus short regimens, emphasizing a balanced approach and the imperative role of collaborative efforts in shaping the future of MDR-TB treatment. This synthesis contributes to the ongoing discourse, providing valuable insights for healthcare practitioners, policymakers, and researchers working toward optimizing outcomes for individuals afflicted with MDR-TB.

Mandatory immunization and vaccine injury support programs: A survey of 28 GNN countries.

BACKGROUND: Despite the proposed ethical link between mandatory immunization and Vaccine Injury Support Programs (VISPs), relatively few jurisdictions, even those with mandatory immunization, have implemented such programs. Although it may be assumed that individuals injured by a vaccine in a non-VISP country receive less support than in countries possessing such programs, the extent of the discrepancy is not clear; nor is the nature of any discrepancy. METHODS: In our 2018 survey of 28 Global NITAG (National Immunization Technical Advisory Group) Network (GNN) countries, we asked respondents about mandatory immunization and the availability of VISPs. Responses were supplemented with desktop research and review of scholarly literature for further information regarding VISP availability and details. RESULTS: Although only two of 14 (14%) surveyed jurisdictions with mandatory immunization had formal VISPs, responses from additional countries suggested the presence of less formal avenues of compensation for serious Adverse Events Following Immunization (AEFIs); similarly, we found five of 15 (33%) of countries without mandatory immunization had implemented formal VISPs, but another three such countries suggested similar informal methods of compensation. CONCLUSIONS: From our data, it is evident that at least some countries with mandatory immunization may discharge their (perceived or actual) ethical obligation to provide financial assistance to vaccine-injured individuals through more informal avenues rather than structured VISPs, although the extent and impact of this practice is by its nature difficult to assess. Further, the nature of VISPs may vary significantly from jurisdiction to jurisdiction, and simple VISP/non-VISP classification of jurisdiction may fail to capture nuance in support for AEFI victims in many jurisdictions. Future assessments of VISPs should consider the possibility of these more informal avenues of support for vaccine injuries.

The Association between a Novel Baby-Friendly Hospital Program and Equitable Support for Breastfeeding in Vietnam.

Background: Rates of early initiation of breastfeeding are low in Southeast Asia, despite evidence that increased initiation of early breastfeeding would lead to better long-term infant and child health and decrease inequities in long-term health and well-being. In response, a novel performance-based, baby-friendly hospital program designates hospitals that adhere to evidence-based early essential newborn care (EENC) and breastfeeding interventions as Centers of Excellence for Breastfeeding (COE). This study examined whether hospital participation in the program was associated with better breastfeeding outcomes. Methods: Hospitals (n = 28) were invited into the program in December 2018. Hospitals developed an improvement plan for promoting a breastfeeding-friendly environment and meeting the standards of the COE accreditation process and were enrolled on a rolling basis over the course of a year. Post-partum surveys were conducted with parents (n = 9585) from January 2019 through April 2020 to assess their breastfeeding and post-partum experience. Segmented regression models were used to assess how breastfeeding outcomes evolved before and after hospital enrollment in the COE program. Results: Enrollment was associated with a 6 percentage-point (95% CI: 3, 9) increase in the level of early initiation of breastfeeding, which continued to increase in the post-enrollment period, and a 5 percentage-point (95% CI: 2, 9) increase in the level of exclusive breastfeeding during hospital stay. We did not observe evidence that enrollment was immediately associated with receipt of lactation counseling or exclusive breastfeeding at survey time. Conclusion: The prevalence of early and exclusive breastfeeding increased after enrollment in the COE program, suggesting that the program has the potential to improve breastfeeding initiation rates and longer-term child health and well-being. Further research should be conducted to examine whether the program has an impact on the overall duration of breastfeeding.

Effect of an Integrated Healthcare Program for Korean Rural Older Adults: A Quasi-Experimental Study.

Studies have been conducted on the development of healthcare programs for older adults in rural areas, not only in Asia but also in Europe and the United States. However, these reports have been limited by largely non-comprehensive results, lack of demand surveys, or programs with no systematic development. The purpose of this study was to develop an integrated healthcare program for rural older adults and investigate the effects of the program. A nonequivalent control group pretest-posttest design was used. Subjects were aged over 65 and lived in the rural community. The integrated healthcare program involved 12 three-hour sessions over 12 weeks. Compared with the control group, the experimental group demonstrated significant differences in both upper extremities strengths (t = 2.74, p = 0.008; t = 2.03, p = 0.047), static balance (z = -2.38, p = 0.017), dynamic balance (t = -4.82, p < 0.001), loneliness (t = -3.02, p = 0.003), and role self-efficacy (t = 2.39, p = 0.020), but no differences for ego integration (t = 1.51, p = 0.137). To improve physical, mental, and social health of the rural older adults, we developed an integrated healthcare program. The program improved physical functions, loneliness, and role self-efficiency of the rural older adults. Therefore, it is recommended that healthcare professionals actively apply this program in primary healthcare institutes and elsewhere.

Innovative mental health initiatives in India: A scope for strengthening primary healthcare services.

Mental health burden is a major health concern worldwide. In the last few decades, we are witnessing innovations that are successfully addressing gaps in the mental health service delivery in Indian context. This is an opportune time to explore existing innovative mental health initiatives in the country and integrate viable interventions to primary healthcare facilities to strengthen public mental healthcare delivery. The descriptive review of literature on innovative mental health programs in India was carried out. The initial search from google scholar and PubMed database yielded 1152 articles, of which 1114 were excluded that did not meet inclusion criteria. Full texts of 38 articles were reviewed and finally 22 studies were included for the study. Based on the review, most innovations are broadly summarized into five categories: (1) quality improvement mental health programs; (2) community-based mental health programs; 3) non-specialist mental health programs, 4) mobile-technology based mental health programs, 5) tele-mental health programs. These promising innovations in treatment and care can be customized as per the context for scale up and integrated into the primary healthcare system through District Mental Health Programme. The innovative approach not only makes mental health services more accessible and affordable but also empowering in nature by encouraging community members in early detection, prevention of mental illness and appropriate treatment referral to existing primary health care services.

[Global Health Care]. / Global Health Care.

Global health data are changing rapidly and they show large regional differences. The incidence and mortality of infectious diseases can be reduced by successes in medical research, national health plans and large financial expenditure. In contrast, illnesses that are caused by unhealthy and changing environmental and living conditions are on the rise. The Global Health Care concept is a cross-sectoral master plan taking into account that worldwide health cannot be established by healthcare workers alone. It was designed to have a lasting impact on the cause of disease through global health programs, of which improved medical services, including essential surgical treatment need to play a key role.

Effect of an oral healthcare program on gingival health status in rural areas of South Korea.

INTRODUCTION: The purpose of this study was to analyze the effects of an oral health care program administered at rural public health subcenters on oral hygiene status and bleeding on probing (BOP) scores among Korean rural residents older than 40 years. METHODS: Residents older than 40 years living in two rural areas were allocated randomly by order of visit into an intervention group (n=23) and control group (n=23). Changes in plaque and BOP score were analyzed between the groups using repeated-measures ANOVA. Hierarchical multiple regression analysis was conducted to identify factors affecting changes in BOP score. RESULTS: The BoP score decreased by 22.87 in the intervention group and 0.27 in the control group between baseline and the eighth week (p<0.001). Multiple regression analysis showed that the change in BoP score (ΔBoP score) increased significantly with an increase in the reduction of the plaque (PHP) index (ΔPHP index) (t=-2.174, p<0.05) and increased significantly more in the intervention group than in the control group (t=2.143, p<0.05). CONCLUSIONS: Professional care and continuous oral health education for 8 weeks prior to scaling among adults older than 40 years living in rural environments resulted in a change in oral health behaviors and a substantial reduction in gingival bleeding.

Evaluación del impacto de un programa de atención de niños con asma grave / A program for children with severe asthma: Impact analysis

Introducción. El asma tiene un alto impacto en la salud pública pues causa un gran número de consultas a los servicios de emergencias y de internaciones. Si bien los programas de atención de niños con asma han demostrado ser muy eficaces para mejorar la evolución de la enfermedad, existe menos información sobre programas para niños con asma grave. Objetivo. Evaluar en forma comparativa el impacto del Programa de Atención de Niños con Asma Grave (PANAG). Métodos. Estudio longitudinal, pre-posintervención. Se comparó el número de exacerbaciones y de internaciones por asma grave en un grupo de pacientes bajo dos estrategias: seguimiento regular en un hospital público (período preintervención, 18 meses) y seguimiento bajo el PANAG (período posintervención, 18 meses). Durante el PANAG los pacientes recibieron en forma gratuita la medicación preventiva y se organizaron actividades educativas. Resultados. Se incluyeron 20 niños, 16 mujeres (80%) con un promedio de edad de 13,3 años (DE 3,8). Durante el período pre-intervención se observaron 59 crisis asmáticas y luego de la implementación del PANAG hubo 26. Esto representa una reducción significativa del 55% en el número de crisis asmáticas (p= 0,0002). Durante el período previo al PANAG se observaron 4 internaciones por asma. En el período posterior solo hubo una hospitalización. Conclusiones. El programa de atención de pacientes con asma grave es una estrategia eficaz para el control de esta patología. Es un modelo de atención factible en un hospital público.

Introduction. Asthma is a major economic burden to families and public healthcare since it leads to a large number of emergency room (ER) visits and hospital admissions. Whereas healthcare programs for children with asthma have proved to be very effective to improve the course of the disease, there is less information about programs for children with severe asthma. Objective. To comparatively analyze the impact of the Healthcare Program for Children with Severe Asthma (Programa de Atención de Niños con Asma Grave, PANAG). Methods. This was a longitudinal, pre- and postintervention study. Two approaches were used to compare the frequency of asthma exacerbations and hospital admissions due to severe asthma in a group of patients: regular follow-up in a public hospital (pre-intervention period, 18 months) and follow-up while participating in PANAG (post-intervention period, 18 months). During the Program, patients received preventive treatment free of charge; educational activities were also organized. Results. Twenty children were included, 16 (80%) out of the 20 were females, and the mean age was 13.3 years (SD 3.8). During the pre-intervention period 59 asthma attacks were recorded; after PANAG was implemented, they decreased to 26. This accounts for a significant reduction of 55% of asthma attacks (p= 0.0002). During the period previous to PANAG implementation, there were 4 asthma-related hospital admissions. In the period after the program implementation, there was only one hospital admission. Conclusions. The Healthcare Program for Patients with Severe Asthma is an effective strategy to manage this disease. This healthcare program is affordable to be used in a public hospital.

Evaluación del impacto de un programa de atención de niños con asma grave / A program for children with severe asthma: Impact analysis

Introducción. El asma tiene un alto impacto en la salud pública pues causa un gran número de consultas a los servicios de emergencias y de internaciones. Si bien los programas de atención de niños con asma han demostrado ser muy eficaces para mejorar la evolución de la enfermedad, existe menos información sobre programas para niños con asma grave. Objetivo. Evaluar en forma comparativa el impacto del Programa de Atención de Niños con Asma Grave (PANAG). Métodos. Estudio longitudinal, pre-posintervención. Se comparó el número de exacerbaciones y de internaciones por asma grave en un grupo de pacientes bajo dos estrategias: seguimiento regular en un hospital público (período preintervención, 18 meses) y seguimiento bajo el PANAG (período posintervención, 18 meses). Durante el PANAG los pacientes recibieron en forma gratuita la medicación preventiva y se organizaron actividades educativas. Resultados. Se incluyeron 20 niños, 16 mujeres (80%) con un promedio de edad de 13,3 años (DE 3,8). Durante el período pre-intervención se observaron 59 crisis asmáticas y luego de la implementación del PANAG hubo 26. Esto representa una reducción significativa del 55% en el número de crisis asmáticas (p= 0,0002). Durante el período previo al PANAG se observaron 4 internaciones por asma. En el período posterior solo hubo una hospitalización. Conclusiones. El programa de atención de pacientes con asma grave es una estrategia eficaz para el control de esta patología. Es un modelo de atención factible en un hospital público.(AU)

Introduction. Asthma is a major economic burden to families and public healthcare since it leads to a large number of emergency room (ER) visits and hospital admissions. Whereas healthcare programs for children with asthma have proved to be very effective to improve the course of the disease, there is less information about programs for children with severe asthma. Objective. To comparatively analyze the impact of the Healthcare Program for Children with Severe Asthma (Programa de Atención de Niños con Asma Grave, PANAG). Methods. This was a longitudinal, pre- and postintervention study. Two approaches were used to compare the frequency of asthma exacerbations and hospital admissions due to severe asthma in a group of patients: regular follow-up in a public hospital (pre-intervention period, 18 months) and follow-up while participating in PANAG (post-intervention period, 18 months). During the Program, patients received preventive treatment free of charge; educational activities were also organized. Results. Twenty children were included, 16 (80%) out of the 20 were females, and the mean age was 13.3 years (SD 3.8). During the pre-intervention period 59 asthma attacks were recorded; after PANAG was implemented, they decreased to 26. This accounts for a significant reduction of 55% of asthma attacks (p= 0.0002). During the period previous to PANAG implementation, there were 4 asthma-related hospital admissions. In the period after the program implementation, there was only one hospital admission. Conclusions. The Healthcare Program for Patients with Severe Asthma is an effective strategy to manage this disease. This healthcare program is affordable to be used in a public hospital.(AU)

A configuração do trabalho da enfermeira na atenção ao idoso na Estratégia de Saúde da Família / The configuration of the work of nurses in care of the elderly in the Family Healthcare Strategy

Este artigo teve como objetivo descrever a configuração do trabalho da enfermeira com o idoso na Estratégia de Saúde da Família (ESF), destacando as ações nas quais se concentram a sua atuação. Caracterizou-se como um estudo exploratório-descritivo de natureza qualitativa que teve como informantes enfermeiras que atuam na ESF do município de Florianópolis/SC. As informações foram coletadas por meio da entrevista narrativa e os resultados foram submetidos à técnica de Análise de Conteúdo, originando três categorias temáticas e suas respectivas subcategorias: O cuidado individual: a consulta de enfermagem com o idoso; O cuidado coletivo: a atuação em grupos; e, O Cuidado no domicílio: a visita como espaço de atuação. Os resultados mostram que o trabalho da enfermeira na promoção da saúde do idoso na ESF vem estruturando-se com as demandas que emergem no cotidiano da população, apresentando algumas contradições em relação ao modelo de atenção em curso, situação que a coloca diante do desafio de revisar suas práticas e repensar os modos de operar o trabalho na atenção ao idoso, com vistas a desenvolver instrumentos e metodologias fundamentados em conhecimentos políticos e socialmente instituídos no intuito de conquistar e demarcar seu espaço de atuação no campo da saúde coletiva.

The scope of this article was to describe the configuration of the work of nurses with the elderly within the Family Healthcare Strategy, highlighting the actions in which their activities are concentrated. It involved an exploratory-descriptive study of a qualitative nature, in which the informants were nurses working in the FHS in Florianópolis in the state of Santa Catarina. Data were collected through narrative interviews and the results were subjected to content analysis, resulting in three thematic categories and their subcategories: individual care: nursing consultation with the elderly; collective care: working in groups; home care: the visit as the scope of activity. The results revealed that the work of nurses in promoting the health of the elderly in the FHS is being structured in accordance with the day-to-day demands that arise in the population, resulting in some contradictions regarding the current model of care. This situation leads to the challenge of reviewing practices and rethinking ways of working to care for the elderly, striving to develop tools and methodologies based on politically and socially established know-how in order to gain and demarcate their sphere of action in the field of health.

Avaliação da qualidade do programa Saúde da Família em municípios do Ceará: uma abordagem multidimensional / Evaluation of the quality of Family Healthcare program in municipalities of Ceará: a multidimensional approach

Com o intuito de responder às necessidades dos sistemas locais de saúde, este estudo avaliou a qualidade da atenção das equipes do Programa Saúde da Família (PSF) em Municípios do Ceará (Brasil) adotando um modelo de análise multidimensional fundamentado nas elaborações teórico-metodológicas de dois importantes autores conhecidos em nível internacional: Avedis Donadedian e John Øvretveit. Do primeiro autor, foram utilizadas as três abordagens da qualidade, ou seja, a estrutura, o processo e os resultados. Do segundo autor, foram adotadas as três dimensões da qualidade: qualidade percebida pelos pacientes, qualidade técnica definida pelos profissionais e qualidade na perspectiva gerencial. O estudo foi realizado em dez municípios do Estado. Embora com diferentes nuances e ênfase, os informantes entrevistados (médicos e enfermeiros das equipes, coordenadores do PSF, secretários de saúde e usuários) identificaram um conjunto de aspectos referentes à estrutura e ao processo do serviço, que deveria qualificar o PSF. Como resultado final do estudo, os pesquisadores apresentam um conjunto de dimensões e indicadores de qualidade, segundo a perspectiva dos diversos atores envolvidos.

We evaluated the quality of the Family Healthcare Program of Ceará (Brazil) by adopting a multidimensional model based on the theoretical assumptions of two important scholars, both well-known at an international level, namely Avedis Donadedian and John Øvretveit. We adopted the well-known approaches to the quality of healthcare of the first author: structure, process and outcome. Of the latter, we adopted the three dimensions of quality: quality perceived by patients, by professionals and by managers. The research was conductedten municipalities of the State of Ceará. Even though different nuances and emphases were used, the informants (physicians, nurses, coordinators of family healthcare teams, municipal secretaries of health and users) some aspects responsible for the improvement of the quality of Family Healthcare were identified. As a final result the study highlight a range of dimensions and quality indicators according to the perspective of the different actors involved in the study.

Acolhimento no Programa Saúde da Família: revisão das abordagens em periódicos brasileiros / The relationship between healthcare personnel and patients (user acceptance) regarding the family healthcare program: a review of approaches in Brazilian journals / Aceptación en el programa salud de la familia: repaso de los enfoques en revistas brasileñas

Trata-se de uma revisão sistemática de literatura acerca do tema "Acolhimento no Programa de Saúde da Família-PSF" com o objetivo de identificar e analisar as diferentes abordagens em estudos selecionados em periódicos brasileiros. Utilizou-se a Biblioteca Virtual em Saúde a partir do argumento de busca "acolhimento" AND "saúde da família", perfazendo, no final da busca e dos refinamentos, um escopo de 39 artigos. Os estudos foram sistematizados segundo as dimensões do acolhimento no PSF. Compreenderam-se as dimensões do acolhimento em cinco categorias: 1. Acolhimento: desafios à produção do cuidado; 2. Acolhimento: práticas inovadoras que fortalecem o cuidado no PSF; 3. Acolhimento: dispositivo para a consolidação da integralidade; 4. Acolhimento: ação produtora de educação em saúde, adesão terapêutica e qualidade de vida; 5. Acolhimento: inclusão social, dignidade e respeito. O acolhimento evidencia-se enquanto uma tecnologia leve de grande impacto na promoção à saúde que estreita o vínculo, fortalece o PSF, mobiliza a sensibilidade dos trabalhadores da saúde, requerendo uma ação reflexiva, o desenvolvimento ético e solidário para escutar e dialogar, gerando satisfação dos profissionais e dos usuários. O acolhimento possibilita que o PSF torne-se a porta de entrada preferencial, contribuindo significativamente para construção e consolidação dos princípios do Sistema Único de Saúde.(AU)

This literature review was aimed at identifying and examining approaches to healthcare personnel's relationships with patients (user acceptance/reciprocal understanding) regarding the family health program (FHP) in selected studies in Brazilian journals. The virtual health library (biblioteca virtual em saúde - BVS) was searched, using the terms "user acceptance" (acolhimento) AND "family health" (saúde da família), giving 39 papers by the end of the search and its refinements. The studies were systematized by considering "user acceptance" in the FHP. User acceptance/reciprocal understanding fell into five categories: challenges when providing healthcare, innovative practices strengthening FHP healthcare, devices for consolidating reciprocal understanding, action producing health education, adhesion to therapy and quality of life, and social inclusion, dignity and respect. Health personnel's relationships with patients was manifest as a high-impact, soft technology approach for promoting healthcare by strengthening bonds. It strengthened the FHP, promoted health workers' sensitivity, requiring reflective action and the development of ethics and solidarity to listen to each other and promote dialogue, thereby generating satisfaction among healthcare service personnel and users. Reciprocal understanding enables the FHP to become the preferential gateway for providing healthcare and thus contribute significantly towards constructing and consolidating the principles of Brazil's national health system, the unified healthcare system (Sistema Único de Saúde).(AU)

Se trata de un repaso de la literatura sobre el tema "Aceptación en el Programa de Salud de la Familia - PSF" con el objetivo de identificar y analizar los diferentes enfoques de los estudios seleccionados en periódicos brasileños. Se utilizó la Biblioteca Virtual en Salud a partir del argumento de búsqueda "acolhimento" (aceptación) AND "saúde da família" (salud de la familia), llegando, al final de la búsqueda y del perfeccionamiento, a un alcance de 39 artículos. Los estudios se organizaron teniendo en cuenta las dimensiones de aceptación en el PSF. Se consideraron las dimensiones del aceptación dentro de cinco categorías (1) Aceptación: desafíos en la producción del cuidado; (2) Aceptación: prácticas innovadoras que fortalecen el cuidado en el PSF; (3) Aceptación: dispositivo para la consolidación de la integralidad; (4) Aceptación: acción productora de educación en salud, adhesión terapéutica y calidad de vida; (5) Aceptación: inclusión social, dignidad y respeto. El aceptación surge como una tecnología simple de gran impacto en la promoción de la salud que estrecha el vínculo. Fortalece el PSF, moviliza la sensibilidad de los trabajadores de la salud, lo que requiere una acción reflexiva, el desarrollo ético y solidario para escuchar y dialogar, que conllevan la satisfacción de los profesionales y de los usuarios. El aceptación permite que el PSF se vuelva puerta de entrada principal, lo que contribuye significativamente a la construcción y consolidación de los principios del Sistema Único de Saúde (Sistema Único de Salud).(AU)

Desenvolvimento de indicadores para avaliação de serviço público de odontologia / Development of indicators for evaluating public dental healthcare services

The objective of this article is to describe and analyze the development of indicators used to identify strengths and deficiencies in public dental healthcare services in the municipality of Cambé, Paraná. The methodology employed was a historical-organizational case study. A theoretical model of the service was developed for evaluation planning. To achieve this, information was collected from triangulation of methods (interviews, document analysis and observation). A matrix was then developed which presents analysis dimensions, criteria, indicators, punctuation, parameters and sources of information. Three workshops were staged during the process with local service professionals in order to verify whether both the logical model and the matrix represented the service adequately. The period for collecting data was from November 2006 through July, 2007. As a result, a flowchart of the organization of the public dental health service and a matrix with two-dimensional analysis, twelve criteria and twenty-four indicators, was developed. The development of indicators favoring the participation of people involved with the practice has enabled more comprehensive and realistic evaluation planning.

O objetivo do presente artigo é descrever e analisar o desenvolvimento dos indicadores utilizados para se identificar fortalezas e deficiências de serviço público de odontologia no município de Cambé, Paraná. A metodologia usada foi o estudo de caso histórico-organizacional. Para o planejamento da avaliação foi desenvolvido o modelo-lógico do serviço. Para tanto, foram coletadas informações a partir da triangulação de métodos (entrevistas, análise documental e observação). Na sequência, foi desenvolvida uma matriz que apresenta dimensões de análise, critérios, indicadores, pontuações, parâmetros e fontes de informações. Três oficinas de trabalho foram realizadas com profissionais do serviço local visando melhor adequação do modelo-lógico e da matriz à realidade do serviço. O período de coleta de dados foi novembro de 2006 a julho de 2007. Como resultado, obteve-se um fluxograma da organização do serviço de odontologia e uma matriz com duas dimensões de análise, doze critérios e vinte e quatro indicadores. O desenvolvimento dos indicadores, privilegiando a participação dos sujeitos envolvidos com a prática, proporcionou o planejamento de uma avaliação abrangente e realista.

Aleitamento materno exclusivo entre profissionais de um Programa Saúde da Família / Exclusive breastfeeding among professionals in a Family Healthcare Program

A amamentação é uma estratégia importante de sobrevivência infantil. Assim, vêm sendo desenvolvidas estratégias de sensibilização, especialmente direcionadas aos profissionais de saúde. O estudo objetivou identificar a frequência e o período de aleitamento materno exclusivo entre profissionais de um Programa Saúde da Família da cidade do Recife, Pernambuco, Brasil. Trata-se de um estudo transversal descritivo, envolvendo 37 mulheres, mães de crianças <5 anos, funcionárias do Programa Saúde da Família, do Distrito Sanitário IV do Recife, entre setembro e novembro de 2006. De 37 profissionais, duas foram excluídas por recusa, resultando em 35 efetivamente entrevistadas. A mediana do aleitamento materno exclusivo foi de quatro meses. Comparando-se as profissionais que amamentaram exclusivamente ou não, foi encontrado que as mulheres que amamentaram exclusivamente por > 4 meses não tiveram dificuldades para amamentar (p=0,027). Foi encontrada uma tendência à significância quanto ao uso de chupeta em crianças no grupo de mulheres que não amamentaram exclusivamente (p=0,051). Conclui-se que as dificuldades encontradas na amamentação entre as profissionais de Programa Saúde da Família estudadas e o uso de chupeta por seus filhos merecem destaque, por se tratar de um grupo que serve de modelo para a população.

Breastfeeding is considered an important strategy for survival in infancy. Consequently, strategies have been developed mainly directed towards health professionals. The scope of the study was to identify the frequency and duration of breastfeeding among professionals of a Family Health Program in the city of Recife, Pernambuco, Brazil. It is a transversal descriptive study conducted between September and November 2006 involving 37 workers and mothers of under-five's in the Family Health Program of the IV Sanitary Health District of Recife. Of the 37 professionals, two refused to participate and were therefore excluded, meaning that 35 were effectively interviewed. The mean duration of breastfeeding was four months. Comparing the workers who breastfed exclusively with those that did not, it was found that mothers who breastfed exclusively for > 4 months, had no difficulties with breastfeeding (p=0.027). A tendency of statistical significance was found in relation to the use of pacifiers among children whose mothers did not breastfeed exclusively (p=0.051). The difficulties found during breastfeeding among the workers of the Family Health Program of the IV Sanitary Health District and the use of pacifiers among their children are problems that deserve attention, due to the fact that they represent a group that serves as a model for the community.

O cuidado de grávidas e bebês no contexto do Programa de Saúde da Família: um estudo etnográfico / Caring for pregnant women and babies in the context of the Family Healthcare Program: an ethnographic study / El cuidado de grávidas y bebés en el contexto del Programa de Salud de la Familia: un estudio etnográfico

Este trabalho pretende contribuir para a discussão conceitual sobre o cuidado a partir de uma abordagem etnográfica com grávidas e bebês em um bairro popular de Salvador atendido pelo Programa de Saúde da Família. Realizamos entrevistas e observação participante. Com base na análise de duas situações - a descoberta da gravidez com a decisão de levá-la adiante e o aleitamento - comparamos a perspectiva dos profissionais com a dos usuários. Argumentamos que, para ambos, o cuidado envolve a construção permanente de projetos de pessoa. Enquanto os profissionais centram suas intervenções nas mulheres, buscando dar orientações e aplicar rotinas planejadas, os usuários fazem referência a comportamentos espontâneos que respondem a demandas práticas e onde a corporalidade da experiência é central. As diferenças entre profissionais e usuários são relacionadas não apenas com características subjetivas, mas com as posições sociais que ocupam.

This study aims to contribute towards the conceptual discussion on care from an ethnographic approach among pregnant women and babies in a low-income district of Salvador who were attended within the Family Healthcare Program. We conducted interviews and participant observation. Based on analysis of two situations - discovery of pregnancy with the decision to take it further, and breastfeeding - we compared the professionals' and users' perspectives. We argue that for both, care involves continuing construction of projects of the person. While professionals focus their interventions on the women, seeking to give guidance and apply planned routines, users make reference to spontaneous behavior that responds to practical demands and in which embodied experience is central. The differences between professionals and users relate not only to subjective characteristics but also to the social positions that they occupy.

Este trabajo pretende contribuir para la discusión conceptual sobre el cuidado a partir de un planteamiento etnográfico con grávidas y con bebés en un barrio popular de la ciudad de Salvador, estado de Bahia, Brasil, atendido por el Programa de Salud de la Familia. Hemos realizado entrevistas y observación participante. Con base en el análisis de dos situaciones - el descubrimiento de la gravidez con la decisión de llevarla a buen término y la lactancia -comparamos la perspectiva de los profesionales con la de los usuarios. Argumentamos que para ambos, el cuidado incluye la construcción permanente de proyectos de persona. Los profesionales centran ls intervenciones en las mujeres tratando de dar orientaciones y aplicar rutinas planeadas, los usuarios hacen referencia a comportamientos espontáneos que responden a demandas prácticas y donde la corporalidad de la experiencia es central. Las diferencias entre profesionales y usuarios se relacionan no sólo con las características subjetivas sino con las posiciones sociales que ocupan.