Tendência da mortalidade por Diabetes Mellitus no Paraná, Brasil, entre 1984 e 2014: regressão joinpoint / Trend in mortality from Diabetes Mellitus in the state of Paraná, Brazil, between 1984 and 2014: Joinpoint regression

O objetivo foi analisar a tendência da mortalidade por Diabetes mellitus (DM) no Paraná (Brasil) no período de 1984 a 2014, por meio de pesquisa analítica retrospectiva do Sistema de Informações sobre Mortalidade (SIM) quanto a notificações de DM como causa básica do óbito. Os dados foram digitados no software Microsoft Excel®. Foi utilizado o Jointpoint regression analysis para calcular a percentagem anual de mudança da taxa com intervalo de confiança de 95%. Entre o período de 1984 a 2014, ocorreram 60343 óbitos decorrentes do DM. No Paraná, observou-se que a taxa de mortalidade por DM no período analisado passou de 14,37/100000 habitantes para 29,27/100000 habitantes. A tendência da mortalidade de 1984 a 2000 foi crescente, mantendo-se estável a partir de 2000 a 2014. Um aspecto promissor foi a constatação da estabilização da taxa de mortalidade no período de 2000 a 2014, num contexto que verifica-se aumento progressivo do número de casos da doença.(AU)

The objective was to analyze the trend in Diabetes Mellitus (DM) mortality in the state of Paraná (Brazil) from 1984 to 2014. This is a retrospective analytical research on mortality from DM as a basic cause of death in Paraná, reported to the Mortality Information System (SIM). Data was entered in Microsoft Excel® software. Jointpoint regression analysis was used to calculate the annual rate change with a 95% confidence interval. Between 1984 and 2014, there were 60,343 deaths from DM. In Paraná, it was observed that the DM mortality rate in the analyzed period increased from 14.37/100,000 inhabitants to 29.27/100,000 inhabitants. The trend in mortality from 1984 to 2000 has been increasing, remaining stable from 2000 to 2014. A promising aspect was the stabilization of the mortality rate in the period from 2000 to 2014, in a context where there is a progressive increase in the number of cases of the disease. (AU)

Análise das práticas gerenciais na Atenção Primária à Saúde nos municípios de pequeno porte do norte do Paraná, Brasil / Analysis of management practices in primary health care in small-scale municipalities in the north of the state of Paraná, Brazil

O presente artigo tem como objetivo descrever as práticas gerenciais na atenção primária à saúde (APS) em 49 municípios de pequeno porte (até 20.000 habitantes) do norte do Paraná. Trata-se de um estudo de abordagem quantitativa, realizado em 2011, no qual foi aplicado questionário semiestruturado para 90 gerentes. Como resultado, as respostas da pesquisa apontaram que 85,6% realizavam reunião com a equipe; 77,8% conheciam metas e indicadores de saúde de 2010; 73,3% planejavam as ações; 70,0% realizavam reunião com a comunidade; 64,5% discutiam as metas e indicadores com os trabalhadores da unidade; 61,1% conheciam os indicadores de saúde de 2009; 61,1% realizavam avaliação das ações e serviços de saúde mais avaliação dos trabalhadores. Porém, a análise dos resultados permitiu observar distorções e/ou insuficiências em: reuniões de equipe e com a comunidade, participação relevante das comunidades, conhecimentos de indicadores, planejamento, avaliação das equipes e preparação dos gerentes. Em síntese, os gerentes padecem de precário profissionalismo e insuficiente preparação.

The scope of this article is to describe management practices in primary health care (PHC) in 49 small-scale municipalities (less than 20,000 inhabitants) in the north of the state of Paraná. The study conducted in 2011 adopts a quantitative approach with the application of a semi-structured questionnaire to 90 managers. The responses in the research revealed that 85.6% had meetings with the team, 77.8% knew about the health goals and indicators for 2010, 73.3% planned actions, 70% staged meetings with the community, 64.5% of the managers discussed the goals and indicators with the workers of the unit, 61.1% knew the health indicators for 2009 and 61.1% conducted evaluations of health actions and services and also evaluated the workers. However, analysis of the results made it possible to pinpoint distortions and/or failings in team and community meetings, relevant participation of the communities, knowledge of indicators, planning, evaluation of teams and training of the managers. The main conclusion is that the managers suffer from poor professionalism and insufficient training.

[Analysis of management practices in primary health care in small-scale municipalities in the north of the state of Paraná, Brazil]. / Análise das práticas gerenciais na Atenção Primária à Saúde nos municípios de pequeno porte do norte do Paraná, Brasil.

The scope of this article is to describe management practices in primary health care (PHC) in 49 small-scale municipalities (less than 20,000 inhabitants) in the north of the state of Paraná. The study conducted in 2011 adopts a quantitative approach with the application of a semi-structured questionnaire to 90 managers. The responses in the research revealed that 85.6% had meetings with the team, 77.8% knew about the health goals and indicators for 2010, 73.3% planned actions, 70% staged meetings with the community, 64.5% of the managers discussed the goals and indicators with the workers of the unit, 61.1% knew the health indicators for 2009 and 61.1% conducted evaluations of health actions and services and also evaluated the workers. However, analysis of the results made it possible to pinpoint distortions and/or failings in team and community meetings, relevant participation of the communities, knowledge of indicators, planning, evaluation of teams and training of the managers. The main conclusion is that the managers suffer from poor professionalism and insufficient training.

[Profile of Primary Health Care managers in small municipalities in the north of the state of Paraná, Brazil]. / Perfil dos gerentes de Atenção Primária à Saúde de municípios de pequeno porte do norte do Paraná, Brasil.

The scope of this article was to establish the profile of Primary Health Care (PHC) managers in 49 small municipalities (up to 20,000 inhabitants) in the north of the state of Paraná. A semi-structured questionnaire was applied to 90 managers in a quantitative-based study. For statistical analysis the EpiInfo 3.5.1. program was used. The results of the manager profile showed that 91.1% were women, 83.3% nurses, 50% aged 21 to 30 years and 75.6% with specialization. Concerning the entry into employment, 70% were through public exam/selective test. Regarding professional experience, 40% had worked professionally for more than 5 years, 43.4% had been involved in PHC up to 5 years and 32.2% had been in the current primary health care unit for less than 1 year. Regarding specific training for performing a managerial role, 71.1% had not taken any courses; only 23.3% reported having taken a management course, though 37.7% had already acted as managers. The conclusion reached is that there is a lack of professionalism, training and institutionalization of the position for the performance of this function.

Perfil dos gerentes de Atencao Primaria a Saude de municipios de pequeno porte do norte do Parana, Brasil / Profile of Primary Health Care managers in small municipalities in the north of the state of Parana, Brazil

O presente artigo teve por objetivo caracterizar o perfil dos gerentes da atenção primária à saúde (APS) em 49 municípios de pequeno porte (até 20.000 habitantes) do norte do Paraná. Trata-se de um estudo de abordagem quantitativa no qual foi aplicado questionário semiestruturado para 90 gerentes. Para análise estatística, utilizou-se o programa EpiInfo 3.5.1. O resultado do perfil dos gerentes apontou para 91,1% do sexo feminino, 83,3% enfermeiros, 50,0% com idade predominante entre 21 e 30 anos e 75,6% com especialização. Quanto ao ingresso no emprego, em 70,0% foi por meio de concurso público/teste seletivo. Em relação à atuação profissional, 40,0% atuavam há mais de 5 anos, 43,4% estavam inseridos na APS há mais de 5 anos e 32,2% na atual unidade básica de saúde há menos de 1 ano. Sobre treinamento específico para desempenho da função gerencial, 71,1% não fizeram nenhum curso, somente 23,3% relataram ter feito curso de gestão, mas 37,7% já atuaram como gerentes. Conclui-se que falta profissionalização, capacitação e institucionalização do cargo para o desempenho desta função.

The scope of this article was to establish the profile of Primary Health Care (PHC) managers in 49 small municipalities (up to 20,000 inhabitants) in the north of the state of Paraná. A semi-structured questionnaire was applied to 90 managers in a quantitative-based study. For statistical analysis the EpiInfo 3.5.1. program was used. The results of the manager profile showed that 91.1% were women, 83.3% nurses, 50% aged 21 to 30 years and 75.6% with specialization. Concerning the entry into employment, 70% were through public exam/selective test. Regarding professional experience, 40% had worked professionally for more than 5 years, 43.4% had been involved in PHC up to 5 years and 32.2% had been in the current primary health care unit for less than 1 year. Regarding specific training for performing a managerial role, 71.1% had not taken any courses; only 23.3% reported having taken a management course, though 37.7% had already acted as managers. The conclusion reached is that there is a lack of professionalism, training and institutionalization of the position for the performance of this function.

Aspectos associados à amamentação e desmame em crianças atendidas no programa bebê-clínica em Bandeirantes-PR / Breastfeeding and weaning related aspects in children attended at the “bebê-clinica” program in Bandeirantes–PR

O aleitamento materno, alimento natural, de fundamental importância para a saúde materno-infantil e para o espaçamento das gestações, encontra dificuldades em sua prática. O presente estudo propõe avaliar as razões e analisar quais são os mitos e fatos que contribuem para o desmame antes dos seis meses de idade. O objeto de estudo foi composto por crianças que participam do Programa Preventivo- Educativo Bebê-Clínica, realizando o levantamento do prontuário de cada criança, que foram amamentados no peito no período de zero a seis meses de idade totalizando uma amostragem de 143 prontuários. O questionário buscava informações relacionadas a progenitora tais como: idade, paridade, estado civil, atuação profissional, escolaridade, raça, renda familiar, inclusão em programa social e histórico da gestação. A promoção do aleitamento materno deve ser vista como uma ação prioritária para a melhoria da saúde e da qualidade de vida das crianças e de suas famílias. As estratégias de promoção da amamentação devem variar de acordo com a população, sua cultura, seus hábitos, suas crenças, sua posição sócio-econômica, entre outras características. No entanto, é de fundamental importância em qualquer estratégia a conscientização da importância do aleitamento materno.

Breastfeeding and weaning related aspects in children attended at the “bebê-clinica” program in Bandeirantes – PR / Aspectos associados à amamentação e desmame em crianças atendidas no programa bebê-clínica em Bandeitantes-PR

Maternal breastfeeding, natural food, fundamentally important to maternal-child’s health and for the pregnancy delay, finds difficulties in it’s practice. The present study purposes evaluating the reasons and analyzing what are the myths and facts that contribute to weaning before six months of age. Study’s object was composedby children who participate from the Educative-Preventive Program “Bebê-Clínica” (Baby-Clinic), by surveying each child’s handbook, that were breastfed in a period from zero to six months of age, in a total 143 handbooks. The questionnaire searched information related to the mother, such as: age, parity, civil status, professional actuation, race, family income, social programs participation and pregnancy historic. Breastfeeding promotion must be seen as a major action to improve children and its family health and life quality.