Biomedical subjects

Hillegonda Maria Dutilh Novaes

Publications and source records attributed to Hillegonda Maria Dutilh Novaes.

9 recordsLinked to original sources

PubMed2006

[Prevalence of common mental disorders in a population covered by the Family Health Program (QUALIS) in São Paulo, Brazil].

The prevalence of common mental disorders has increased in many countries. Cases are often not identified and adequately treated because traditional health care services are rarely prepared to deal with this problem. The Family Health Program (FHP) has been implemented in Brazil since 1995-1996 and provides a new primary health care model with the potential for better care for these patients. This study investigates common mental disorders prevalence according to FHP coverage and associated socio-demographic factors. A large health and health care survey was conducted from January to March 2001 in areas partly covered by the FHP in a peripheral area of the city of Sao Paulo and included common mental disorders screening in 2,337 individuals > 15 years of age. There was no significant difference in common mental disorders prevalence according to FHP. Common mental disorders prevalence was significantly higher among females (PR = 1.34), elderly (PR = 1.56), and individuals with lower income (PR = 2.64) or less schooling (PR = 2.83). Common mental disorders was associated with indicators of social disadvantage, implying the need to focus on specific health problems and risk groups to improve the impact of care.

Adolescent↗

PubMed2006

[Validation of birth certificates based on data from a case-control study].

The information recorded on birth certificates was validated with data from a perinatal mortality case-control study, obtained from home interviews of mothers and hospital records for cases (early neonatal deaths) and controls. Sensitivity, specificity, and concordance were calculated for all variables and their estimated and real prevalence. The completeness of birth certificates was lowest for mother's parity and presence of congenital anomalies (records without information range from 23% to 31% for cases and controls). Birth certificates correctly identified low birth weight and type of delivery for cases and controls. Birth certificates showed high sensitivity and specificity to detect preterm births within cases. The number of preterm births was underestimated at 30.8% of the controls and 2.9% of the cases. Low maternal education was two times greater on birth certificates than in the mother's interview, for cases and controls. Completeness of birth certificates was higher in controls, but data quality was better in cases.

Birth Certificates↗

PubMed2006

[From production to evaluation of health systems technologies: challenges for the 21st century].

The study analyzes factors and processes identified in the literature that determine the patterns of production, use and assessment of the health care technologies, which are part of the "medicalization" of contemporary societies. We also evaluate the scientific and technological public and health care policies proposed during the 1990s in developed and developing countries to enhance the impact of scientific and technological development on population health. Problems facing these policies were identified, as were the challenges to be overcome in the twenty-first century.

Biomedical Technology↗

PubMed2005

[Health services utilization in areas covered by the family health program (Qualis) in Sao Paulo City, Brazil].

OBJECTIVE: The Family Health Program (FHP) is a strategy for reorganizing the healthcare attendance system within the Brazilian National Health System. The objective of the study was to assess whether there had been changes in the utilization profile of the healthcare services following implementation of the program, and to identify factors associated with any changes observed. METHODS: Data on service utilization and demand for attendance were analyzed by means of two cluster-based population samples, representing areas covered (n=1865) and not covered (n=2036) by the FHP, in two districts of the municipality of Sao Paulo. The data formed part of a population survey carried out in 2001. Statistical methods for cluster analysis were used. RESULTS: In the area covered by the FHP, no statistically different prevalence ratios (PR) according to schooling and income levels were observed for service utilization. In the area not covered by the FHP, service utilization was positively associated with greater schooling and income. Among individuals with illnesses, the demand for attendance in the area covered by the FHP was higher (higher PR) among those with severe physical limitations. In the area not covered, the PR was higher among those with greater schooling and lower among those who were inactive (unemployed or retired). CONCLUSIONS: In the areas studied, for the population covered by the FHP, income and schooling levels did not constitute factors that significantly differentiated the utilization profile of the healthcare services and the demand for attendance. This indicates that the program may be contributing towards greater equity under these conditions.

Adolescent↗

PubMed2005

Adverse events and death in stroke patients admitted to the emergency department of a tertiary university hospital.

OBJECTIVES: To identify the occurrence of adverse events in stroke patients presenting to the emergency department of a tertiary university facility, and to disclose the categories of adverse events associated with death. METHODS: This matched case-control study enrolled 468 patients admitted with stroke to the emergency department from March 1996 to September 1999. The cases comprised 234 consecutive deaths and the controls 234 discharged patients, matched for primary diagnosis and admission period. Adverse events, detected by chart review, were classified according to the degree of severity, immediate causes, and professional category. The association with death was analysed by conditional logistic regression. RESULTS: Adverse events totaled 1218 and occurred in 295 patients: 932 events (76.5%) in 170 cases and 286 (23.5%) in 125 controls. Major adverse events equaled 54.1% of all events (659 episodes): 538 events in 143 cases and 121 in 65 controls. Diagnostic or therapeutic procedures and nursing activities accounted for 55.2% of events. Nursing (38.4%) and medical (31%) adverse events represented the most common related professional categories. A significant association with death was found for major adverse events, medical adverse events, and nosocomial infections, with adjusted odds ratio estimates of 3.74 [95% confidence interval (CI) 1.64-8.54], 3.71 (95% CI 1.61-8.53), and 3.22 (95% CI 1.21-8.59), respectively. CONCLUSION: Adverse events, mostly severe, predominated among deceased patients, resulting mainly from diagnostic or therapeutic procedures and nursing activities. In spite of limitations concerning the observational retrospective nature of this study, we found that severe adverse events, medical adverse events, and nosocomial infections were significantly associated with death in stroke patients.

Adolescent↗

PubMed2004

[Research in, about, and for health services: an international panorama and questions for health research in Brazil].

Health systems and services are important determinants of health conditions and quality of life. Health services research is a multidisciplinary area aimed at deepening and widening knowledge on the area in specific contexts and focusing on system accessibility, impact, and performance and conditions and quality of health care in order to contribute to decisions by policy-makers, managers, and health professionals. This article analyzes the main characteristics and trends in recent output in the international literature and discusses several key questions for health services research in Brazil.

Bibliometrics↗

PubMed2004

[Evaluation of the prenatal care program in Curitiba, Paraná, Brazil: a cohort study of primigravidae].

A prenatal care program was evaluated to measure its effectiveness and impact. In 1999 a new prenatal care program was introduced in Curitiba, Paraná State, Brazil, in health services under the Unified National Health System, introducing organizational changes in order to enhance accessibility, increase the number and distribution of prenatal visits, and ensure minimum necessary procedures. To evaluate how these changes were assimilated in routine practice, a cohort study was proposed in a sample of 660 primigravidae randomly selected among women enrolled in the program before the 20th week of gestation, from March to August, 2000. Two home visits and consultation of maternity cards or patient records during prenatal and hospital care were performed. The results indicate good accessibility and professional adherence to the protocol, but problems still remain with initiating care before the end of the first trimester and adequate distribution of consultations. According to the study criteria, adequate care was found for only 38.6% of the women, pointing to the complexity of factors that influence adequate prenatal care.

Brazil↗

PubMed2004

[Compliance with technical standards for radiological protection at radiation therapy services in São Paulo State, Brazil].

Radiation therapy services provide essential therapeutic procedures for cancer, one of the main causes of population morbidity and mortality. Despite their importance in the health system and their potential risks due to the use of ionizing radiation, there are few studies on such services. We evaluated compliance with technical standards for radiological protection in radiation therapy services in Sao Paulo State, Brazil. Forty-nine services were studied in 2000 through interviews with technical staff. Typologies of performance profiles focusing on structure and process variables were constructed and services compared. Important differences were observed in the services' positions in the health care system, level of complexity, and geographic distribution, with better average performance in structural conditions but very inadequate performance in patient protection, indicating the need for more effective health surveillance.

Brazil↗

PubMed2003

Clinical and epidemiological features of AIDS/tuberculosis comorbidity.

UNLABELLED: Considering the relevance of AIDS/tuberculosis comorbidity worldwide, especially in Brazil, this study was developed to describe the clinical and epidemiological features of the comorbid cases identified from 1989 to 1997 by the epidemiology service of the Hospital das Clínicas of the Universidade de São Paulo. METHODS: Databases containing information on all identified AIDS/tuberculosis cases cared for at the hospital were used to gather information on comorbid cases. RESULTS: During the period, 559 patients were identified as presenting with AIDS/tuberculosis comorbidity. Risk behavior for AIDS was primarily heterosexual contact (38.9%), followed by intravenous drug use (29.3%) and homosexual/bisexual contact (23.2%). Regarding clinical features, there were higher rates of extrapulmonary tuberculosis when compared to tuberculosis without comorbidity. There was an increase in reporting of AIDS by ambulatory units during the period. Epidemiologically, there was a decrease in the male/female ratio, a predominance in the 20 to 39 year-old age group, and a majority of individuals who had less than 8 years of schooling and had low professional qualifications. CONCLUSIONS: High rates of AIDS/tuberculosis cases at our hospital indicate the need for better attention towards early detection of tuberculosis, especially in its extrapulmonary form. Since the population that attends this hospital tends to be of a lower socioeconomic status, better management of AIDS and tuberculosis is required to increase the rates of treatment adherence and thus lower the social costs.

AIDS-Related Opportunistic Infections↗