OBJECTIVE Analyzing statements of health professionals from a Street Clinic regarding care of a homeless population with tuberculosis. METHOD This is a qualitative research, conducted in the central region of São Paulo at three basic health units in the period of November to December 2014. A semi-structured interview guideline was implemented for data collection and all interviews were recorded using a digital recorder. RESULTS Six health professionals were interviewed. According to the Discourse Analysis perspective, three discursive segments emerged: experiences on care in the streets; weaknesses inherent to the treatment process; and incentives as a means of maintaining sick people in treatment. CONCLUSION Caring for a the homeless population with tuberculosis constitutes a new and challenging experience. It involves difficulties in dealing with the reality of a miserable social context, a lack and inadequacy of services, as well as care limitations for treatment and treatment dropout, which reinforces multiresistance. However, the investigated Street Clinic teams seek to expand access to health and social care services to this population.
IntroductionLeprosy, or Hansen’s disease, remains a cause of preventable disability. Early detection, treatment and prevention are key to reducing transmission. Post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) reduces the risk of developing leprosy when administered to screened contacts of patients. This has been adopted in the WHO leprosy guidelines. The PEP4LEP study aims to determine the most effective and feasible method of screening people at risk of developing leprosy and administering chemoprophylaxis to contribute to interrupting transmission.Methods and analysisPEP4LEP is a cluster-randomised implementation trial comparing two interventions of integrated skin screening combined with SDR-PEP distribution to contacts of patients with leprosy in Ethiopia, Mozambique and Tanzania. One intervention is community-based, using skin camps to screen approximately 100 community contacts per leprosy patient, and to administer SDR-PEP when eligible. The other intervention is health centre-based, inviting household contacts of leprosy patients to be screened in a local health centre and subsequently receive SDR-PEP when eligible. The mobile health (mHealth) tool SkinApp will support health workers’ capacity in integrated skin screening. The effectiveness of both interventions will be compared by assessing the rate of patients with leprosy detected and case detection delay in months, as well as feasibility in terms of cost-effectiveness and acceptability.Ethics and disseminationEthical approval was obtained from the national ethical committees of Ethiopia (MoSHE), Mozambique (CNBS) and Tanzania (NIMR/MoHCDEC). Study results will be published open access in peer-reviewed journals, providing evidence for the implementation of innovative leprosy screening methods and chemoprophylaxis to policymakers.Trial registration numberNL7294 (NTR7503).
these professionals' words produce different meanings, which suggest that the practices of nursing professionals allow the patient to search for a cure, which is reinforced by incentives of a social nature, but permeated by the vicissitudes that are circumscribed in the ill person's everyday production conditions.
Objective:to investigate the planning pathways in the transfer of Directly Observed
Treatment of tuberculosis. Method:a qualitative study conducted using interviews and a semi-structured guide,
administered to five subjects who were among the coordinators and managers
of the tuberculosis control programs, and the secretary of health of a
municipality in the south of Brazil. Situational Strategic Planning and
Discourse Analysis of the French matrix were the theoretical and analytical
references used, respectively. Results:three reflexive axes were identified: weaknesses in the process of planning
the Directly Observed Treatment transfer, antagonism between planning and
daily requirements and formulation of planning and execution. Lack of
systematization regarding the planning and execution for transfer the
Directly Observed Treatment policy, demonstrates the fragility and
incipience of this activity, and the possibility of its non-existence. Conclusion:the urgent need for managers and coordinators to better appropriate the
theoretical framework for changing public policies, and the related planning
mechanisms, includes a proposal for reorganization and qualification of the
diffusion process, both practical-operative and political-organization.
Objectiveto discuss the right to health, incorporation into the legal instruments and the
deployment in practice in the National Health System in Mozambique.Methodthis is a documentary analysis of a qualitative nature, which after thorough and
interpretative reading of the legal instruments and articles that deal with the
right to health, access and universal coverage, resulted in the construction of
three empirical categories: instruments of humans rights and their
interrelationship with the development of the right to health; the national health
system in Mozambique; gaps between theory and practice in the consolidation of the
right to health in the country.ResultsMozambique ratified several international and regional legal instruments (of
Africa) that deal with the right to health and which are ensured in its
Constitution. However, their incorporation into the National Health Service have
been limited because it can not provide access and universal coverage to health
services in an equitable manner throughout its territorial extension and in the
different levels of care. Conclusionsthe implementation of the right to health is complex and will require mobilization
of the state and political financial, educational, technological, housing,
sanitation and management actions, as well as ensuring access to health, and
Objective: To analyze whether user-centered nursing practices in TB DOT are being carried out and are contributing to democracy. Method: A cross-sectional, exploratory, descriptive study with 123 nurses in three capital cities with high incidence of TB (Manaus-AM, João Pessoa-PB, Porto Alegre-RS) in Brazil. Data were collected from January to June 2014. Descriptive and multiple correspondence analyzes were used. Results: It was identified that the most user-centered care actions had scores below 50%, considered unfavorable to the exercise of democracy. In the analysis of the general user-centered practice score per municipality, Manaus and João Pessoa presented unfavorable results, and the municipality of Porto Alegre was partially favorable. Conclusion: The three municipalities need to advance in the implementation of user-centered practices in DOT, because their health system still has difficulties and challenges to overcome.
Resumo: O reconhecimento de que a melhoria da saúde da população depende do avanço das condições socioeconômicas é cada vez mais visível nos últimos anos, incentivando mudanças nas políticas nacionais e internacionais. Contudo, em vários países da África Subsaariana, se não todos, essa relação é inversamente proporcional. Assim, com este texto pretende-se refletir sobre a conexão existente entre saúde e desenvolvimento em Moçambique. Esta reflexão oferece uma compreensão sobre o crescimento econômico que se registra no país, porém com maior parte da população a viver em precárias condições e com uma multiplicidade de doenças evitáveis, demonstrando, também, que as políticas adotadas pelo país ainda não favorecem um caminhar conjunto da saúde e desenvolvimento. Essa situação requer que o país aplique políticas de redistribuição de renda e de atenção à saúde em populações mais carentes. Palavras-chave: saúde; desenvolvimento; pobreza.
OBJECTIVE To analyze the meanings produced in the Health Surveillance actions for tuberculosis control, carried out by healthcare professionals in Mozambique. METHOD Qualitative study using the theoretical and methodological framework of the French Discourse Analysis. RESULTS A total of 15 healthcare professionals with more than one year of experience in disease control actions participated in the study. Four discursive blocks have emerged from the analysis: tuberculosis diagnosis process; meeting, communication and discussion of treatment; local strategies for tuberculosis control; involvement of family and community leaders in the tuberculosis control. CONCLUSION The statements of the healthcare professionals suggest, as Health Surveillance actions, practices that include collecting sputum in the patient's home and sending it to the laboratory; deployment of the medical team with a microscope for tuberculosis testing; and testing for diseases that may be associated with tuberculosis. In this context, the actions of Health Surveillance for tuberculosis control involve valuing all actors: family, community leaders, patients and health professionals.
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