Preenchimento do quesito raça/cor na identificação dos pacientes: aspectos da implementação em um hospital universitário / Filling out the race/skin color item in the patient identification form: aspects of its implementation in a university hospital

Resumo Após 13 anos da publicação da Política Nacional da Saúde Integral da População Negra (PNSIPN), o preenchimento do quesito raça/cor na identificação de pacientes permanece um desafio. Autores têm se debruçado sobre a necessidade de integrar os conhecimentos da ciência da implementação às políticas públicas. O objetivo deste artigo é descrever e analisar a implementação da coleta do quesito raça/cor feito pelos profissionais responsáveis pelo registro dos pacientes num hospital universitário do município de São Paulo. Estudo exploratório e descritivo, estruturado a partir de três constructos do Consolidated Framework for Implementation Research (CFIR): intervenção, cenário interno e características dos indivíduos. Resultados: a maioria dos registros do quesito raça/cor na instituição observada é feita por heteroidentificação. A partir dos constructos do CFIR, são identificados aspectos apontados como obstáculos ou facilitadores. A implementação da coleta do quesito raça/cor por autodeclaração, como previsto na PNSIPN e na Portaria 344/2017, ainda é incipiente e depende de mudanças, sobretudo organizacionais, que favoreçam sua efetivação.

Abstract Thirteen years after the publication of the National Policy for the Comprehensive Health of the Black Population (PNSIPN, Política Nacional da Saúde Integral da População Negra), filling out the race/skin color question in the patient identification form remains a challenge. Authors have focused on the need to integrate knowledge from the science of implementation into public policies. The aim of this article is to describe and analyze the implementation of the collection of the race/skin color item carried out by the professionals responsible for the registration of patients at a university hospital in the city of São Paulo. This was an exploratory and descriptive study, structured from three constructs of the Consolidated Framework for Implementation Research (CFIR): intervention, internal scenario and characteristics of individuals. Most records of race/skin color in the observed institution are made by heteroidentification. Based on the CFIR constructs, aspects identified as obstacles and facilitators are identified. The implementation of the collection of the race/skin color item by self-declaration, as provided for in the PNSIPN and in Ordinance n. 344/2017, is still incipient and depends mainly on organizational changes, which can favor its effectiveness.

Filling out the race/skin color item in the patient identification form: aspects of its implementation in a university hospital. / Preenchimento do quesito raça/cor na identificação dos pacientes: aspectos da implementação em um hospital universitário.

Thirteen years after the publication of the National Policy for the Comprehensive Health of the Black Population (PNSIPN, Política Nacional da Saúde Integral da População Negra), filling out the race/skin color question in the patient identification form remains a challenge. Authors have focused on the need to integrate knowledge from the science of implementation into public policies. The aim of this article is to describe and analyze the implementation of the collection of the race/skin color item carried out by the professionals responsible for the registration of patients at a university hospital in the city of São Paulo. This was an exploratory and descriptive study, structured from three constructs of the Consolidated Framework for Implementation Research (CFIR): intervention, internal scenario and characteristics of individuals. Most records of race/skin color in the observed institution are made by heteroidentification. Based on the CFIR constructs, aspects identified as obstacles and facilitators are identified. The implementation of the collection of the race/skin color item by self-declaration, as provided for in the PNSIPN and in Ordinance n. 344/2017, is still incipient and depends mainly on organizational changes, which can favor its effectiveness.

Após 13 anos da publicação da Política Nacional da Saúde Integral da População Negra (PNSIPN), o preenchimento do quesito raça/cor na identificação de pacientes permanece um desafio. Autores têm se debruçado sobre a necessidade de integrar os conhecimentos da ciência da implementação às políticas públicas. O objetivo deste artigo é descrever e analisar a implementação da coleta do quesito raça/cor feito pelos profissionais responsáveis pelo registro dos pacientes num hospital universitário do município de São Paulo. Estudo exploratório e descritivo, estruturado a partir de três constructos do Consolidated Framework for Implementation Research (CFIR): intervenção, cenário interno e características dos indivíduos. Resultados: a maioria dos registros do quesito raça/cor na instituição observada é feita por heteroidentificação. A partir dos constructos do CFIR, são identificados aspectos apontados como obstáculos ou facilitadores. A implementação da coleta do quesito raça/cor por autodeclaração, como previsto na PNSIPN e na Portaria 344/2017, ainda é incipiente e depende de mudanças, sobretudo organizacionais, que favoreçam sua efetivação.

Association between adductor pollicis muscle thickness, anthropometric and immunological parameters in HIV-positive patients.

BACKGROUNDS AND AIMS: Involuntary weight loss and muscle mass loss among HIV-positive patients are only detectable in late stages, leading poor life quality. The reduction of adductor pollicis muscle thickness (APMT) can be easily and earlier uncovered in those cases. The purpose was to estimate APMT and compare it with immunological and anthropometric parameters of HIV-infected people. METHODS: A crosssectional study was carried out in an University Hospital including 103 HIV-infected outpatients by subjective global assessment (SGA). Data were compared to APMT for the whole sample and between gender in univariate analysis. Besides that, simple correlation and multiple linear regression were done to check the APMT relation with gender, age, weight body, body mass index, arm circumference, CD4, CD8 and viral load. RESULTS: The APMT average values of the dominant hand (16.2 ± 4.2 mm) and non-dominant hand (14.8 ± 4.3 mm) were lower than in the healthy population. Through stratified analysis by gender, it was found significant difference in weight, arm muscle circumference, arm muscle area, triceps skinfold thickness and arm fat area (p < 0,01 for each). In any age group, men had significantly higher dominant and non-dominant APMT values than women (p < 0.001). Although the fair correlation among cited variables and APMT of both hands, there were no correlation and no difference between the genders in regards to immunological markers (CD4, CD8 and viral load). In a prediction model to APMT values, gender was determinant in multiple linear regression. CONCLUSIONS: In a well-nourished HIV sample by SGA with adequate CD4 counts, APMT measures of both hands were lower than in healthy people. In both hands, APMT were positively correlated with weight and male, regardless of other anthropometric data and immunologic factors.