Work in health: sanitary surveillance of drugstores in Salvador (state of Bahia, Brazil)

A drugstore is an establishment of interest in health, from which medication is dispensed, namely the therapeutic technology most broadly used in the practice of medicine. The scope of this study is to describe and analyze the sanitary surveillance of drugstores. Based on the theory of working processes in healthcare, a case study was conducted on the sanitary surveillance of drugstores in Salvador (Bahia, Brazil), examining 2 analytical categories: agents and activities. Data were collected through observation, analysis of documents and interviews, and QSR N Vivo software was used for data processing. Personnel of the surveillance service were found to have varied professional and educational backgrounds, with limited experience in the sanitary surveillance of drugstores, and insufficient technical training for the performance of the tasks assigned. Deficiencies of a managerial nature were detected in the service. Its operation is primarily focused on granting drugstore licenses, prioritizing attendance to spontaneous demand, thereby configuring a technological model of intervention based on sanitary inspection. The findings revealed a need for updating the service and the adoption of technologies to enhance control of risk, given that technological evolution provides drugs that are increasingly more potent, with a concomitant rise in levels risk.     

Theoretical and conceptual considerations about the work in sanitary surveillance, as a specific field of the work in health

This paper discusses some of the theoretical-conceptual presupposes to the analysis of the work in sanitary surveillance in a social and historical perspective. As a work in health, the sanitary surveillance presents particularities that are inherent to the elements that are part of its process of work. These elements are inserted in the space of the production-consumption relationships, under the regulatory action of the State. The problematic of the work in sanitary surveillance occurs due to the specificities of its objects. It is identified in these objects a double dimension, at the same time as a "way of life" and "commodity". This confers to its working process a provisory and historical character, permeated by contradictions. The technical and social division of the work determines the organization of the working process in its "technical-scientific" and "political-administrative" organization, taking in account the necessity to guarantee the integrality in the actions of the health protection. It is expected that the sanitary surveillance should be organized and acting in several phases of the productive chain. It is identified and discussed the concepts of inter-dependence and inter-complementary as the principles to build the practices of sanitary control.     

Pharmacists' knowledge of sanitary legislation and professional regulations

OBJECTIVE: To characterize the profile of pharmacists employed as technical supervisors in drugstores and evaluate their knowledge regarding certain aspects of the legislation controlling drugstores and the profession in general. METHODS: Based on 175 drugstores in the city of Ribeir?o Preto, southeastern Brazil, 100 pharmacists/technical supervisors were randomly selected. Data collection was done by means of in-person interviews, and was guided by a questionnaire evaluating knowledge and attitudes. Data were processed and analyzed using Epi Info and Stata software. Associations were sought between dependent and independent variables using Pearson's chi-squared and Fisher's exact tests. RESULTS: Most pharmacists were women (64%), aged 22-29 years (47%), graduated approximately three years prior to data collection, trained to work in the pharmaceutical industry (36%) or in clinical analysis (29%). Pharmacist's knowledge of sanitary legislation was considered as insufficient for 28% of subjects, regular for 50%, and good for 22%. Low levels of knowledge were observed regarding the legal requirement for the presence of a pharmacist during the entire drugstore opening hours, pharmacists' attributions, sale of antibiotics, and penicillin administration. It was found that most professionals have difficulties handling the concepts of 'generic' and 'similar' drugs. Low level of knowledge was not associated with any of the independent variables, indicating that this is a generalized phenomenon, i.e., one present among pharmacists of all age groups and both sexes, irrespective of the time since graduation, institution attended, and modality of graduation, among others. CONCLUSIONS: We conclude that training in the field of drug pharmaceutical care, during undergraduate studies and, especially, during traineeship in pharmacies and drugstores is deficient. It is necessary to divulge information concerning sanitary legislation so that pharmacists may fully exert their profession, without risk of legal threats or hazard to the population.     

Reception: possibility of reorganizing nursing care

The study analyzes reception as a strategy for reorganizing nursing care, identifying its presuppotions and mechanisms which make it possible to implement and qualifying potentialities of care. It uses the qualitive approach, giving priority to primary sources: questionnaires answered by managers, degree nurses, nursing auxilliares and doctors from the Municipal Health Office of Belo Horizonte. It was found that the nursing auxiliary is the main person carrying out this activity, followed by the degree nurse. The main activities are listening, screening and forwarding, with little focus on guidance. The actors emphasize team integration and the understanding of the work process as facilitating factors. The training and qualification of professionals was considered as one of the mechanisms to overcome difficulties. It reveals the failures of the structure of service for reception. The conclusion is that this practice suggests the need for the reorganization of the nursing work process in order to improve the quality of health care.     

Intersectorial actions for health promotion in Family Health Strategy: experiences, challenges, and possibilities

Qualitative study with the purpose of analyzing intersectorial actions for health promotion in the context of the Family Health Strategy, identifying experiences, facilitating and restricting factors to the process of building partnerships. Subjects were health managers and informers from social equipment in the territory covered by a local health service in Belo Horizonte/Minas Gerais, Brazil. The results indicate the existence of a wide social network. However, intersectorial health promoting actions are still incipient. Intersectorial actions are faced with the challenge of creating communication spaces that allow the resolution of complex problems. It is concluded that intersectorial actions constitute an innovative strategy which is still under construction, and the paths of which are still being unraveled.     

Action research: a useful method of promoting change in primary care?

BACKGROUND: Action research has been used successfully to promote change in disciplines other than medicine, but there are few examples of its use in primary care. OBJECTIVE: We aimed to discuss the benefits and difficulties of using action research in primary care using the example of child health surveillance provision in general practice. METHODS: Twenty-eight general practices were randomly allocated into two groups. Action research was used to promote change in 14 practices by facilitating practice meetings and by providing written feedback. The other 14 practices received written feedback alone. The two groups of practices were compared using the following: (i) semi-structured interviews with one health visitor and GP from each practice; (ii) observation of baby clinics; (iii) questionnaires to parents; and (iv) return rates of child health surveillance reviews from the personal child health record. RESULTS: All 14 practices in the action research arm of the study met as individual practice teams and decided to make changes to their provision of child health surveillance. Ten practices audited their child health surveillance as a result. More health visitors in the action research practices than in the comparison practices reported changes to child health surveillance, audit, communication and use of the personal child health record. The majority of health visitors and GPs thought involvement in the action research process was beneficial. However, we were unable to show a statistically significant difference between the two groups of practices in baby clinic provision, parent satisfaction or the return rate of child health surveillance reviews. CONCLUSION: Our study suggests that action research is a successful method of promoting change in primary care. However, measuring the impact of change is difficult.     

Perceptions on the quality of services relating to women's healthcare

The scope of this work is to identify the characteristics relating to the quality of women's healthcare services from the perspective of the sanitary vigilance professionals (Visa) and women's healthcare coordinators (CSM) in the municipalities. It is a study with a qualitative approach that was carried out using semi-structured interviews. Three Brazilian state capitals were selected and three individuals in each capital were interviewed, namely a Visa healthcare service chief, as well as a technician, and a CSM coordinator. The content analysis technique was adopted to organize the data and the answers were grouped into the healthcare service evaluation topics based on Donabedian's model, i.e. structure, processes, and outcomes. Visa workers reported aspects related to the structure of health services, such as equipment and qualified human resources more frequently. The Visa chief mentioned aspects related to structure and processes, such as prioritization in attendance. The CWH coordinator examined all three categories, especially processes. Analysis of interviews points to a potential distortion in evaluation by results. The study highlights the need for joint action between the surveillance and assistance sectors to improve the quality of services.     

社会因素对农村地区孕产妇死亡率的影响

[目的]了解影响农村地区孕产妇死亡率的社会因素,为政府制定降低孕产妇死亡率的策略和措施提供依据。[方法]利用全国妇幼卫生监测中心1996～2001年全国农村地区(共68个监测点)孕产妇死亡数据,及采用现况调查进行问卷调查获得相同地区的社会因素的资料,进行孕产妇死亡与社会因素之间关系的相关分析和多元回归分析。[结果]1996～2001年农村孕产妇死亡率由86.4/10万下降到61.9/10万,下降幅度为28.4%;农村孕产妇主要死亡原因以产科出血为主,产科出血死亡率由1996年的48.3/10万下降到2001年的33.0/10万;农村地区孕产妇死亡率与住院分娩率、孕产妇系统管理率、卫生技术人员数、妇幼卫生人员数、总床位数、现价国内生产总值、农村人均收入相关且有统计学意义。孕产妇死亡除受孕产妇自身因素影响外,还与卫生资源、妇幼卫生服务、经济发展水平等因素密切相关。[结论]减低农村地区孕产妇死亡率,应提高住院分娩率,加强孕产妇系统管理及医疗保健服务的利用,提高产科服务质量;加强对卫技人员的培训;加强交通通讯设施的建设。     

The senses of sanitary safety in the discourse of the National Health Surveillance Agency

The term sanitary safety (SS) appeared in the international debate mainly due to the emerging sanitary crisis, although its meaning has remained obscure. This paper aims to analyze the concept of SS brought into the Brazilian sanitary surveillance upon the creation of the National Health Surveillance Agency. An exploratory case study was undertaken with technical data analysis and semi-structured interviews with informants who had taken part in the process of formulating the body's institutional design. The following categories were analyzed: incorporation of the SS term into the institutional mission, the SS concept and SS mechanisms. The SS concept was analyzed in both institutional and technical discursive dimensions. The former elicits the sense of strategy, a reliable relationship and legitimacy whereas the latter shows the sense of an acceptable risk-benefit relationship from the perspective of individual and collective health protection and promotion. The SS concept was found to encompass health-related products, technologies and services, especially those designed for medical diagnosis and treatment, but environmental issues received little mention. The scope of the SS concept was shown to be widening to include the surveillance of hospital infection, drugs and blood.     

芦山地震灾区疫苗可预防传染病的初步风险评估

目的评估四川省芦山地震灾区疫苗可预防传染病的发生、传播风险,为灾后预防控制（防控）传染病提供有针对性的建议。方法采集2008—2013年4月20日灾区的传染病报告数据,进行回顾性疫情分析;收集疫苗接种率数据和免疫规划服务体系受损情况,分析地震灾害对灾区疫苗可预防传染病发生、传播可能产生的影响;对甲型肝炎（甲肝）等12种疫苗可预防传染病的发生和传播进行风险评估,并提出防控建议。结果芦山地震灾区2012年国家免疫规划疫苗实际接种率可能被高估。震后免疫规划服务体系遭受严重破坏,对疫苗可预防传染病发生、传播造成影响的因素主要有：安置点卫生条件差、疫源动物和媒介昆虫活动变化、人群流动性加大以及免疫规划服务可及性下降等。综合评估甲肝、流行性腮腺炎（流腮）在灾区传播的风险较高,其次麻疹、风疹和水痘易发生局部爆发疫情。结论震后灾区疫苗可预防传染病的防控,应开展甲肝疫苗和麻疹一流腮-风疹联合疫苗的群体性预防接种,做好水痘和流行性乙型脑炎等疫苗储备,加强疫苗可预防传染病的监测和报告,并尽快恢复常规免疫服务。     

Multidisciplinary cross-national studies: a commentary on issues of collaboration, methodology, analysis, and publication

Although multicenter studies proliferate in quantitative health and medical studies, few examples of similar multidisciplinary cross-national qualitative studies exist. In this article, the authors present a commentary on this type of study based on their involvement with two international projects. Issues include maintaining coinvestigators' participation in an international qualitative project with limited funding; difficulties in promoting collaboration in protocol development; factors inhibiting interest and enthusiasm; ethical concerns; issues of data recording, language, coding, and analysis; and implications for write-up and publication. Despite the difficulties and challenges posed at each stage of the process, the authors remain convinced of the value of these projects and provide recommendations for facilitating future multidisciplinary cross-national qualitative health projects.     

The Role of Practitioner Self-Efficacy,Training, Program and Workplace Factors on the Implementation of an Evidence-Based Parenting Intervention in Primary Care

This study examines factors affecting the implementation by primary care practitioners (nursing, education, allied health, and medical) of a brief parenting and family support intervention (the Primary Care Triple P—Positive Parenting Program) following professional training. It assesses the impact of prior experience, self-efficacy, program supports, program barriers, satisfaction with training, and workplace characteristics on reported extent of program use. The majority of practitioners (97%) reported using Triple P following training. Implementation was assessed as the proportion of cases seen who received the full program. Program supports (quality of format and materials) and barriers (management difficulties and lack of fit) impacted on practitioner self-efficacy, and higher self-efficacy was positively associated with implementation. Prior professional experience, satisfaction with training, and workplace factors were not significant predictors. These results highlight the importance of promoting practitioners’ sense of competence or mastery of a program for facilitating the implementation of evidence-based programs in primary care settings.     

Seafood processing in South Africa: a study of working practices, occupational health services and allergic health problems in the industry

The work practices, occupational health services and allergic health problems among workplaces which process seafood in Western Cape province of South Africa were examined. A cross-sectional study was conducted among 68 workplaces that were sent a self-administered postal survey questionnaire. Workplaces reporting a high prevalence of work-related symptoms associated with seafood exposure were also inspected. Forty-one (60%) workplaces responded to the questionnaire. The workforce consisted mainly of women (62%) and 31% were seasonal workers. Common seafoods processed were bony fish (76%) and rock lobster (34%). Major work processes involved freezing (71%), cutting (63%) and degutting (58%). Only 45% of workplaces provided an on-site occupational health service and 58% of workplaces conducted medical surveillance. Positive trends were observed between workplace size and activities such as occupational health service provision (P = 0.002), medical surveillance programmes (P = 0.055) and reporting work-related symptoms (P = 0.016). None of the workplaces had industrial hygiene surveillance programmes to evaluate the effects of exposure to seafood. Common work-related symptoms included skin rashes (78%), asthma (7%) and other non-specific allergies (15%). The annual prevalence of work-related skin symptoms reported per workplace was substantially higher for skin (0-100%) than for asthmatic (0-5%) symptoms. The relatively low prevalence of employer-reported asthmatic symptoms, when compared to epidemiological studies using direct investigator assessment of individual health status, suggests likely under-detection. This can be attributed to under-provision and under-development of occupational health surveillance programmes in workplaces with less than 200 workers. This is compounded further by the lack of specific statutory guidelines for the evaluation and control of bio-aerosols in South African workplaces.     

Value of the sanitary control of technological processes in the normalization of the environment

The article describes the experience gained in the work of the sanitary and epidemiological station (SES) on preventive sanitary surveillance at the stage of technological assignment for the converter refractory shop using coal-tar pitch. According to the demand of the SES, coal-tar pitch was excluded from the technology, thus it became possible to eliminate emission of polycyclic aromatic hydrocarbons, including benzo(a)pyrene. Participation of the SES authority in the development of technological assignment was regarded as the most effective method of preventive sanitary surveillance.     

Evaluation of epidemiologic surveillance practice in the public health service in Brazil]

The results of a process evaluation of the epidemiological surveillance activities in 948 health units, situated in 98 of the most populated cities of each State in the country are presented. The survey was conducted towards the end of 1985. The following aspects were analyzed: information system, data analysis, epidemiological investigation. Institutional insertion, vaccination activities, management aspects and capacitation of the health worker were considered as potential determinants of performance. Data were submitted to correspondence analysis and a process of ascendant hierarchical classification, using the statistical package "Systeme Portable Pour L' Analise de Données-SPAD". The performance pattern was not found to be homogeneous. Six different classes of epidemiological surveillance practice in the health units were observed. In 53.7% of the services visited, even the most elementary norms of activity were not complied with. The presence of vaccination activities in the health units was associated with better performance in epidemiological surveillance. The study points to the need to review the epidemiological surveillance model in use in Brazil. It is no longer acceptable to restrict the practice of epidemiology in health services to communicable diseases, now to manage programs and services without epidemiological information.     

Socio-political aspects of toxoplasmosis epidemic in Santa Isabel do Ivaí, Paraná State, Brazil

In 2002, due to a toxoplasmosis epidemic Santa Isabel do Ivaí, Paraná State, was the focus of sanitary investigations. Four hundred and twenty six individuals had serology suggestive of acute T. gondii infection (IgM reactor), considered the largest outbreak of toxoplasmosis ever reported in the world. This research was meant to identify actions carried out by the sanitation and health services sector at that time, highlighting the political conflicts that took place during the process and identifying the measures taken by the sanitary authorities during and after the epidemic period. This is an interdisciplinary study aimed at understanding major problems of public health like this one. The investigation was based on the contents of documents--press and institutional--and interviews. According to official data, the epidemic was caused by the contamination of one of the water reservoirs that supply the city. This research showed that political and social factors, as the party instability and the level of political dependence of local society, were largely responsible for the occurrence of the epidemic and for the difficulties faced by the health agents during such crisis.     

Canadian Aboriginal communities and medical service patterns for the management of injured patients: a basis for surveillance

Growing attention has been placed on injury as a major public health problem which has served to highlight the need for relevant injury data for preventive purposes at the community level. In the case of reserve-based Aboriginal communities in Canada, available injury data, from large datasets, often has little or no relevance at the community level. In addition, the availability of local data is complicated by unique health service and community infrastructures. As such, a prerequisite to establishing injury surveillance requires an understanding of Medical Service Patterns (MSPs) for injured patients intrinsic to a community's health service infrastructure. In determining patterns, cultural and environmental contexts are integral to methodological considerations as historically, Canada's Aboriginal population has been 'controlled' by others in the areas of health, education and social services. The objective of the study was to investigate MSPs in a Canadian Aboriginal community, specific to the management of injured patients, for the purpose of identifying data sites, sources, and collectors. The method relied on a four-step qualitative process designed explicitly for the study community, comprising: (1) semi-structured interviews with key informants; (2) a flow diagram process; (3) focus group discussions; and (4) a summary matrix diagram. This methodology was later replicated with three additional pilot communities. Three major MSPs were identified from nine original patterns generated through the initial data collection process. MSPs were found to be most directly impacted by severity of injury and the proximity of health service providers. Data collection practices were inconsistent, sporadic and poorly coordinated. Data was exclusive to respective data sources and off-reserve documentation was not reported back to the community. MSPs identified key data sites, sources, and collectors relevant to the study population. In conclusion, the four-step qualitative methodology employed in the study was found to be reliable and feasible in identifying community MSPs. Empirical findings confirm the need to investigate MSPs in communities considering surveillance activities, as intra-national differences may be considerable given social inequalities, geographic uniqueness and cultural factors. The use of sophisticated methodologies may detract rather than promote collaborative efforts.     

安徽贫困地区已婚妇女妇科病现患情况 经期保健现况及相关因素分析

对安徽省某国际合作项目覆盖地区的2566名已婚妇女妇科病现患情况及经期保健现状做了描述,并就年龄、受教育水平、职业、家庭年收入、是否获得过妇女健康知识等因素对经期卫生的影响做了分析。结果显示,被调查地区经济、文化比较落后,已婚妇女妇科病患病率较高,子宫脱垂、尿瘘、阴道炎、宫颈糜烂、月经不调的患病率分别为3.0％、0.7％、30.3％、10.6％、36.9％。调查还显示,84．3％的育龄妇女月经时使用卫生纸（巾）,月经期间干重活、下水田、用脏水洗下身等不良卫生行为的发生率分别为69．4％、50．4％和7．1％。多因素Logistic回归分析发现,年龄、受教育水平、职业、是否获得过妇女健康知识等因素对经期卫生有影响。建议在发展经济、改善妇女生存环境的同时,在被调查地区开展妇科病普查普治工作和妇女的健康教育,以期提高妇女的健康水平。     

Personnel and their training as needed for controlling infectious diseases during the era between wars in Poland

Sanitary personnel, which were combating the epidemic of infectious diseases in Poland between the first and the second world war, consisted of doctors, sanitary inspectors, hygienists and disinfectors. With support of the Rockefeller Foundation for the first time the public health staff was fully trained. They were awarded travel scholarships to the United States of America. The Polish Hygiene School was inspired by Johns Hopkins School of Public Health. It was on integrated part of the State Hygiene Institute, which since 1924 started regulary to school the sanitary personnel. The course of lectures included a large range of subjects of public health and was adjusted to the Polish conditions. Through thirteen years of the specialist schooling the half the doctors employed in the public health service took part in them, all of the country doctors and the greater part of the middle personnel of the sanitary--epidemic service.     

江苏省保健食品生产企业卫生情况的调查与分析

为规范保健食品的生产,确保产品质量,对江苏省保健食品生产企业卫生情况进行了调查。结果发现提高从业人员素质,改善生产企业厂房设施与工艺流程布局。强化关键控制点管理是保健食品GMP实施的关键。