Resumo A recente mudança de modelo da atenção primária à saúde para estratégia de Saúde da Família, com foco centrado no usuário e na territorialização foi o momento ideal para implantação do Projeto AcolheSUS em uma Unidade Básica de Saúde (UBS) da Região Central de Brasília, Distrito Federal. A equipe de servidores da UBS realizou o diagnóstico situacional da unidade e o planejamento estratégico situacional, com o objetivo de reorganizar o serviço a partir da problematização e com foco nos processos de trabalho. Com o AcolheSUS houve aumento do número de cadastros individuais realizados pelas equipes de 135 para 3.525, o número de atendimentos de enfermagem aumentou em 193,7% e o número de procedimentos realizados por enfermeiros teve um acréscimo 121,2%. O percentual de residentes da área adstrita que procuravam a unidade básica de saúde durante o processo de mudança de modelo de atenção era 71% do total e alcançou 90,5% após o AcolheSUS. A média mensal de usuários acolhidos e classificados foi de 1.099,8. A construção conjunta de protocolos sólidos e o ajuste de processos de trabalho contribuíram para a melhoria na oferta de serviços e propiciaram maior acesso do usuário à unidade de saúde.
Background Tungiasis is a neglected disease caused by Tunga penetrans that can be complicated by secondary infections and local tissue destruction. Adequate treatment is important, especially in vulnerable populations; potential treatment options proposed range from surgical extraction to the use of oral and topical medications. We aimed to perform a systematic review to assess the efficacy of topical, oral and surgical interventions for the treatment of tungiasis. Methodology/Principal findings The present review is registered in PROSPERO (CRD42021234741). On September 1, 2020, we searched PubMed, EMBASE, Scopus, Web of Science, Science Direct, Scielo and LILACS BVS. We included clinical trials and longitudinal observational studies that evaluated any topical, systemic or mechanical treatment for tungiasis. We used the Revised Cochrane Risk of Bias (RoB) Tool for Randomized Trials for clinical trial analysis. Qualitative and quantitative descriptive syntheses were performed. Our search strategy resulted in 3376 references. Subsequently, 2568 titles/abstracts and 114 full texts were screened. We finally included 19 articles; 9 were classified as clinical trials. Two and 3 articles presented low and some RoB, respectively, according to the tool. Only two articles tested the efficacy of oral medications (niridazole, ivermectin), with discouraging results. Six clinical trials evaluated topical products for the treatment of tungiasis; 2 evaluated dimeticone-based compounds and reported positive results in lesion reduction and cure. None reported significant adverse reactions. Surgical extraction was evaluated only in observational studies. Conclusions/Significance We conclude that, although surgical extraction is the most commonly used treatment, there is sufficient evidence supporting the use of occlusive agents, especially manufactured dimeticone-based products.
BackgroundA paramount factor in the control of neglected tropical diseases from both medical and social aspects is education. New strategies must be constantly pursued to test and provide educational information related to diseases affecting vulnerable populations. We applied the Q method as a model to measure educational neglect based on the burden of disseminated tungiasis.MethodsUsing a saturation method for sample size calculation, we recruited students and healthcare professionals to evaluate and classify 27 statements related to the prevention, control and treatment of tungiasis. After quantitative analysis, the Q method was applied based on the paired use of the centroid method and Varimax rotation, and 4 factors were extracted representing the main sets of viewpoints among the participants.ResultsWe included 119 healthcare professionals with different academic degrees. Statements classified by specialists with a + agreement were also classified as a + agreement by most of the participants. However, we detected 5 important disagreements related to the topical treatment of tungiasis and control of the disease in the environment and animals. The Q method showed that almost no consensus was detected for four statements. The classification of each statement was not related to the participants' academic degree.ConclusionsThere is significant educational neglect related to tungiasis prevention and treatment in healthcare sciences in Brazil. We conclude that the Q method may be an interesting strategy alone or associated with quantitative strategies for detecting educational limitations related to neglected diseases. In countries where neglected diseases are endemic, a detailed study evaluating the quality of education related to these diseases must be prioritized.
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