Cerca de 222 mil pessoas vivem em situação de rua atualmente no Brasil . A história brasileira re... more Cerca de 222 mil pessoas vivem em situação de rua atualmente no Brasil . A história brasileira revela que essa população sempre esteve às margens das agendas governamentais, culminando na escassez de políticas públicas e no predomínio de ações repressivas, higienistas e de controle sobre esses sujeitos . É sabido, também, que a população em situação de rua (PSR) recebe, além das políticas públicas oficiais e das entidades religiosas, o auxílio e o apoio de entidades não-governamentais, de projetos de extensão universitária e vinculados a partidos políticos que possuem trajetória de luta em prol do acesso à moradia e ao trabalho, os quais não medem esforços na busca dos direitos dessa população, principalmente pelo direito a uma vida com dignidade. Com a criação do Sistema Único de Saúde (SUS) em 1988, e do Sistema Único de Assistência Social (SUAS) em 2005, a saúde passou a ser vista de forma ampla, sendo fomentada a criação de políticas voltadas para a promoção da saúde da população e incentivado o engajamento comunitário . A compreensão dos determinantes e condicionantes sociais no processo saúde-doença, por sua vez, ampliou a perspectiva de ação para além do setor sanitário e fortaleceu a necessidade do trabalho intersetorial e interdisciplinar, a partir da visão e interface de diferentes profissionais. No ano de 2009, a Política Nacional da População em Situação de Rua (PNPR) foi instituída no Brasil, fruto da articulação e luta por visibilidade e direitos desse público. A PNPR conceitua População em Situação de Rua como um grupo populacional heterogêneo, que tem em comum a pobreza extrema, vínculos familiares interrompidos ou fragilizados, ausência de moradia convencional regular, e uso de logradouros públicos e áreas degradadas como espaço de moradia . Além de estimular a participação popular, a PNPR tem como princípios o respeito à dignidade humana e suas
Este artigo apresenta discussão sobre o processo de produção e finalidade de um documentário, pro... more Este artigo apresenta discussão sobre o processo de produção e finalidade de um documentário, produto de uma pesquisa desenvolvida com pessoas em
Background: The crisis brought about by the COVID-19 pandemic brought a great connection with the... more Background: The crisis brought about by the COVID-19 pandemic brought a great connection with the population's level of trust in the governance of federative entities, in the intention of feeling supported and protected, whether at an individual or collective level. Here, we aimed to investigate the level of confidence of the Brazilian population in the governance of federative entities to combat COVID-19 and its associated factors. Methods: A cross-sectional survey was developed, applied to the general Brazilian population, with a validated instrument, and a hybrid application online and in the field. Convenience sampling was used for recruitment using the snowball technique. Multinomial logistic regression was applied. Results: The sample included 1,018 participants, with a mean age of 46.1 years, the majority being female (75.2%). Brazil has three levels of governance: the Federal, State, and Municipal Government. Residents in the Northeast and Central-West regions were more confident than those in the Southeast. The sources of information consulted by the participants were also associated with governance confidence. Conclusions: The study advanced knowledge by showing that trust in governance capacity is socially determined and is crossed by forces that can lead to dissent, reducing the level of trust, especially in the Federal Government.
Objective To identify the risk areas of deaths due to unspecified pneumonia and tuberculosis (TB)... more Objective To identify the risk areas of deaths due to unspecified pneumonia and tuberculosis (TB) in children, and to identify if there is a relationship between these events with higher TB incidence and social determinants. Methods Ecological study carried out in Brazil. All cases of TB or unspecified pneumonia deaths in children under 5 years of age reported between 2006 and 2016 were included and collected through Department of Informatics of the Unified Health System (Brazil's electronic database). The Spatial Scan Statistics was used to identify areas at higher risk of dying from this event. The spatial association was verified through the Getis-Ord techniques. The Bivariate Moran Global Index was used to verify the spatial autocorrelation between the two events. To identify the association of TB and pneumonia deaths with endemic areas of pulmonary TB and social determinants, four explanatory statistical models were identified. Results A total of 21 391 cases of pneumonia and 238 cases of TB were identified. Spatial scanning analysis enabled the detection of four clusters of risk for TB (relative risk, RR, between 3.30 and 18.18) and 22 clusters for pneumonia (RR between 1.38 and 5.24). The spatial association of the events was confirmed (z-score 3.74 and 64.34) and spatial autocorrelation between events (Moran Index:0.031 (p=0.001)). The zero-inflated negative binomial distribution was chosen, and an association for both events was identified with the TB incidence rate (OR 5.3, 95% CI 2.85 to 9.84; OR 6.63, 95% CI 5.62 to 7.81), with the Gini Index (OR 1.78, 95% CI 1.12 to 2.82; OR 4.22, 95% CI 3.63 to4.92). Primary care coverage showed an inverse association for both events (OR 0.10, 95% CI 0.67 to 0.17; OR 0.18, 95% CI 0.15 to 0.21) for pneumonia). Finally, a family that benefited from the Bolsa Família Programme had an inverse association for deaths from pneumonia (OR 0.81, 95% CI 0.52 to 1.25). Conclusions The results do not just contribute to reduce mortality in children, but mainly contribute to prevent premature deaths through identification of critical areas in Brazil, which is crucial to qualify health surveillance services.
Since 2004, Brazilian policy makers have been making some changes in the drug policies. It has pr... more Since 2004, Brazilian policy makers have been making some changes in the drug policies. It has prioritized a harm reduction perspective instead of a prohibitionist one. Nevertheless, this latter perspective also persists in some parts of the policies and strategies used to deal with this phenomenon in Brazil. This study aims to analyze the structure of the drug policies in Brazil. It is a documental search of Brazilian mental health legislation (laws, decrees, and ordinances) regarding alcohol and other drugs since 2001. The analysis focused on prevention, assistance, and supply control axes. There was a predominance of assistance, which focuses on development of treatment services. Documents have focused more on crack cocaine than on other drugs which have more impact on public health. Scientific evidence competes with partisan political issues and values and the opinions of different actors. The results suggest that it is necessary to have a solid scientific foundation, clearer technical operational aspects, and an evaluation strategy for mental health services to systematize and analyze the implemented policies.
Revista de Terapia Ocupacional da Universidade de São Paulo, Apr 1, 2011
* Este artigo é parte da Tese de doutorado intitulada "A organização dos serviços extra-hospitala... more * Este artigo é parte da Tese de doutorado intitulada "A organização dos serviços extra-hospitalares de saúde mental, o projeto terapêutico e a inserção da reabilitação psicossocial" apresentada à Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, cuja defesa pública e aprovação da mesma se deu em 04/10/2010.
FIORATI, R. C. The organization of extra-hospital mental health services, the therapeutic project... more FIORATI, R. C. The organization of extra-hospital mental health services, the therapeutic projects and integration of psychosocial rehabilitation. 2010. 242f. Doctoral Thesis
Intersectoral actions in decreasing social inequities faced by children and adolescents* Objectiv... more Intersectoral actions in decreasing social inequities faced by children and adolescents* Objective: to identify the evidence about the repercussion of intersectoral programs / actions / strategies in the reduction of social inequities experienced by children and adolescents in social vulnerability. Method: integrative review performed in the
Mycobacterium tuberculosis Determinantes sociales en salud Mortalidad Brasil r e s u m e n Objeti... more Mycobacterium tuberculosis Determinantes sociales en salud Mortalidad Brasil r e s u m e n Objetivo: Evaluar la magnitud de los determinantes sociales en áreas de riesgo para la mortalidad por tuberculosis en una ciudad de alta incidencia de esta enfermedad. Método: Estudio ecológico que recogió los casos de muerte por tuberculosis registrados entre 2006 y 2016 en la capital del Estado de Mato Grosso (Brasil). Los determinantes sociales se obtuvieron de las Unidades de Desarrollo Humano. Se utilizó la estadística de barrido para identificar las áreas de riesgo de muerte por tuberculosis. Se realizó un análisis de componentes principales para identificar dimensiones de determinantes sociales, y se aplicó regresión logística múltiple para verificar asociaciones entre las dimensiones de los determinantes sociales y el riesgo de muerte por tuberculosis. El error estándar se estableció en un 5% para todas las pruebas estadísticas. Resultados: Se registraron 225 muertes por tuberculosis en el periodo, distribuidas heterogéneamente en el espacio. Se identificó un conglomerado de riesgo para la mortalidad por tuberculosis, con un riesgo relativo de 2,09 (intervalo de confianza del 95% [IC95%]: 1,48-2,94; p = 0,04). Los determinantes sociales «bajo nivel escolar» y «pobreza» se mostraron asociados al riesgo de muerte por tuberculosis (odds ratio [OR]: 2,92; IC95%: 1,17-7,28). La renta presentó asociación negativa con el riesgo de muerte por tuberculosis (OR: 0,05; IC95%: 0,00-0,70). El valor de la curva ROC del modelo fue del 92,1%. Conclusiones: Los resultados confirman que el riesgo de muerte por tuberculosis es un problema asociado a los determinantes sociales. Las políticas de salud y los programas de protección social pueden contribuir a enfrentarse a este problema.
Pesquisa desenvolvida nos anos 2012 e 2013 em Ribeirao Preto-SP, Brasil, junto a pessoas em situa... more Pesquisa desenvolvida nos anos 2012 e 2013 em Ribeirao Preto-SP, Brasil, junto a pessoas em situacao de rua e que teve como objetivo conhecer os fatores de ruptura dessas pessoas com o mundo do trabalho formal e com suas redes de suporte social, bem como, conhecer o cotidiano vivido nas ruas. Estudo etnografico com historias de vida filmadas e diario de campo como instrumentos de coleta de dados. A analise de dados foi realizada com base no referencial da Teoria da Acao Comunicativa de Habermas, a partir das comunicacoes gravadas nos videos de cada entrevista e dos relatos do diario de campo. Os resultados mostraram que iniquidades e vulnerabilidade social estao presentes ha geracoes passadas nas familias dessas pessoas e que o cotidiano e marcado por violencia e morte, pobreza e exclusao, rupturas das redes sociais e isolamento, uso de alcool e outras drogas e outras doencas socialmente determinadas.
Resumo O objetivo deste artigo é analisar o desfecho desfavorável do tratamento da tuberculose en... more Resumo O objetivo deste artigo é analisar o desfecho desfavorável do tratamento da tuberculose entre a população privada de liberdade segundo os determinantes sociais de saúde. Coorte retrospectiva realizada nos estados de Rondônia e São Paulo, Brasil, com detentos com tuberculose notificados entre 2008 e 2017. Os dados foram coletados do SINAN e do TB-WEB e analisados pelo risco relativo (RR), com intervalos de confiança (IC95%), testando a associação entre a variável dependente [desfecho desfavorável (óbitos por tuberculose e outras causas, assim como os abandonos, primários ou não) x favorável (cura)] e os determinantes estruturais e intermediários da saúde. Foram registrados 158 desfechos desfavoráveis em Rondônia e 2.227 em São Paulo. Para Rondônia, tal desfecho esteve associado a sexo masculino (RR 3,09; IC95% 1,03-9,27) e Aids (RR 2,46; IC95% 1,63-3,71). Em São Paulo, idade superior a 30 anos (RR 1,36; IC95% 1,26-1,47), Aids (RR 3,08; IC95% 2,81-3,38), alcoolismo (RR 1,54; IC...
Two studies were carried out in Ribeirao Preto, State of Sao Paulo, Brazil, in two extra-hospital... more Two studies were carried out in Ribeirao Preto, State of Sao Paulo, Brazil, in two extra-hospital mentalhealth services: one regional mental health outpatient clinic and one psychosocial care center. The purpose of thisresearch was to study the organization of the extra-hospital and therapeutic projects of these services, and theinclusion of psychosocial rehabilitation in such projects. The study was based on qualitative methodology and usedsemi-directive interviews and focal groups to collect data. Data analysis was based on the hermeneutic dialecticphilosophy of Jürgen Habermas according to the interpretative technique of reconstruction. Results indicated thatthese services are organized focusing on the clinical-psychiatric work, emphasizing the diagnosis, pathology andmedication treatment; while psychosocial actions have a secondary role in the therapeutic project. This articlediscusses part of this study in relation to the therapeutic activities and how they are implemented. The...
BACKGROUNDTuberculosis is the leading cause of global deaths from a single infectious agent. This... more BACKGROUNDTuberculosis is the leading cause of global deaths from a single infectious agent. This study aimed to identify areas of spatial and space-time risk for pulmonary tuberculosis, to identify areas with variation in the temporal tendency for this event, and to identify factors associated with the epidemiological situation in one municipality. METHODSAn ecological study carried out in Ribeirão Preto, São Paulo, Brazil. The population consisted of pulmonary tuberculosis cases reported in the Tuberculosis Patient Control System between 2006 to 2017. To check the behavior of tuberculosis over the period, the Seasonal Trend Decomposition using Loess decomposition method was used. Spatial and spatiotemporal scanning statistics were used to identify risk areas, and Spatial Variation in Temporal Trends (SVTT) was used to detect clusters with changes in the temporal trend. Finally, Pearson's chi-square test was performed to identify factors associated with the epidemiological situ...
BACKGROUND Psychological morbidity is commonly experienced by people with a spinal cord injury (S... more BACKGROUND Psychological morbidity is commonly experienced by people with a spinal cord injury (SCI), but whether it is associated with occupational role transitions in is unknown. OBJECTIVE To analyze whether anxiety or depression symptoms are independently associated to increased likelihoods of role transitions in adults with SCI. METHODS Cross-sectional study; multivariate analysis using a heteroscedastic Dirichlet regression. PARTICIPANTS Thirty persons with traumatic SCI. MEASURES Role Checklist (e.g. role transitions: dependent variables) and Beck's Depression Inventory and State-Trait Anxiety Inventory (independent variables), adjusted for socio-demographic, functional, and injury-level confounders. RESULTS Greater depression symptoms independently increased the likelihood of occupational role transitions, either for roles loss [adjusted Odds Ratio (AOR): 1.04; 95% confidence interval (CI):1.009-1.080] or roles gain [AOR: 1.07; 95% CI:1.02-1.13], as opposed to continued o...
Journal of infection in developing countries, 2020
INTRODUCTION Brazil is in the 19th position of priority countries for the control of TB/HIV coinf... more INTRODUCTION Brazil is in the 19th position of priority countries for the control of TB/HIV coinfection, so we aimed to analyze the social and health services contexts that are associated with TB/HIV coinfection in São Paulo state. METHODOLOGY Ecological study conducted in 645 cities of the state. The study population consisted of 10,389 new cases of TB/HIV coinfection in state residents between 2010 and 2015. The variables and indicators used in the study were collected from secondary sources. To identify the factors associated with the occurrence of TB/HIV coinfection cases, generalized additive models for location, scale and shape were used. The best distribution model was defined from the lowest Akaike information criterion value. RESULTS There was an association between the occurrence of coinfection and the diagnosis of TB after death and greater treatment default. There was also an association with greater coverage of nurses and Family Health Strategy, which comprises Primary ...
Cerca de 222 mil pessoas vivem em situação de rua atualmente no Brasil . A história brasileira re... more Cerca de 222 mil pessoas vivem em situação de rua atualmente no Brasil . A história brasileira revela que essa população sempre esteve às margens das agendas governamentais, culminando na escassez de políticas públicas e no predomínio de ações repressivas, higienistas e de controle sobre esses sujeitos . É sabido, também, que a população em situação de rua (PSR) recebe, além das políticas públicas oficiais e das entidades religiosas, o auxílio e o apoio de entidades não-governamentais, de projetos de extensão universitária e vinculados a partidos políticos que possuem trajetória de luta em prol do acesso à moradia e ao trabalho, os quais não medem esforços na busca dos direitos dessa população, principalmente pelo direito a uma vida com dignidade. Com a criação do Sistema Único de Saúde (SUS) em 1988, e do Sistema Único de Assistência Social (SUAS) em 2005, a saúde passou a ser vista de forma ampla, sendo fomentada a criação de políticas voltadas para a promoção da saúde da população e incentivado o engajamento comunitário . A compreensão dos determinantes e condicionantes sociais no processo saúde-doença, por sua vez, ampliou a perspectiva de ação para além do setor sanitário e fortaleceu a necessidade do trabalho intersetorial e interdisciplinar, a partir da visão e interface de diferentes profissionais. No ano de 2009, a Política Nacional da População em Situação de Rua (PNPR) foi instituída no Brasil, fruto da articulação e luta por visibilidade e direitos desse público. A PNPR conceitua População em Situação de Rua como um grupo populacional heterogêneo, que tem em comum a pobreza extrema, vínculos familiares interrompidos ou fragilizados, ausência de moradia convencional regular, e uso de logradouros públicos e áreas degradadas como espaço de moradia . Além de estimular a participação popular, a PNPR tem como princípios o respeito à dignidade humana e suas
Este artigo apresenta discussão sobre o processo de produção e finalidade de um documentário, pro... more Este artigo apresenta discussão sobre o processo de produção e finalidade de um documentário, produto de uma pesquisa desenvolvida com pessoas em
Background: The crisis brought about by the COVID-19 pandemic brought a great connection with the... more Background: The crisis brought about by the COVID-19 pandemic brought a great connection with the population's level of trust in the governance of federative entities, in the intention of feeling supported and protected, whether at an individual or collective level. Here, we aimed to investigate the level of confidence of the Brazilian population in the governance of federative entities to combat COVID-19 and its associated factors. Methods: A cross-sectional survey was developed, applied to the general Brazilian population, with a validated instrument, and a hybrid application online and in the field. Convenience sampling was used for recruitment using the snowball technique. Multinomial logistic regression was applied. Results: The sample included 1,018 participants, with a mean age of 46.1 years, the majority being female (75.2%). Brazil has three levels of governance: the Federal, State, and Municipal Government. Residents in the Northeast and Central-West regions were more confident than those in the Southeast. The sources of information consulted by the participants were also associated with governance confidence. Conclusions: The study advanced knowledge by showing that trust in governance capacity is socially determined and is crossed by forces that can lead to dissent, reducing the level of trust, especially in the Federal Government.
Objective To identify the risk areas of deaths due to unspecified pneumonia and tuberculosis (TB)... more Objective To identify the risk areas of deaths due to unspecified pneumonia and tuberculosis (TB) in children, and to identify if there is a relationship between these events with higher TB incidence and social determinants. Methods Ecological study carried out in Brazil. All cases of TB or unspecified pneumonia deaths in children under 5 years of age reported between 2006 and 2016 were included and collected through Department of Informatics of the Unified Health System (Brazil's electronic database). The Spatial Scan Statistics was used to identify areas at higher risk of dying from this event. The spatial association was verified through the Getis-Ord techniques. The Bivariate Moran Global Index was used to verify the spatial autocorrelation between the two events. To identify the association of TB and pneumonia deaths with endemic areas of pulmonary TB and social determinants, four explanatory statistical models were identified. Results A total of 21 391 cases of pneumonia and 238 cases of TB were identified. Spatial scanning analysis enabled the detection of four clusters of risk for TB (relative risk, RR, between 3.30 and 18.18) and 22 clusters for pneumonia (RR between 1.38 and 5.24). The spatial association of the events was confirmed (z-score 3.74 and 64.34) and spatial autocorrelation between events (Moran Index:0.031 (p=0.001)). The zero-inflated negative binomial distribution was chosen, and an association for both events was identified with the TB incidence rate (OR 5.3, 95% CI 2.85 to 9.84; OR 6.63, 95% CI 5.62 to 7.81), with the Gini Index (OR 1.78, 95% CI 1.12 to 2.82; OR 4.22, 95% CI 3.63 to4.92). Primary care coverage showed an inverse association for both events (OR 0.10, 95% CI 0.67 to 0.17; OR 0.18, 95% CI 0.15 to 0.21) for pneumonia). Finally, a family that benefited from the Bolsa Família Programme had an inverse association for deaths from pneumonia (OR 0.81, 95% CI 0.52 to 1.25). Conclusions The results do not just contribute to reduce mortality in children, but mainly contribute to prevent premature deaths through identification of critical areas in Brazil, which is crucial to qualify health surveillance services.
Since 2004, Brazilian policy makers have been making some changes in the drug policies. It has pr... more Since 2004, Brazilian policy makers have been making some changes in the drug policies. It has prioritized a harm reduction perspective instead of a prohibitionist one. Nevertheless, this latter perspective also persists in some parts of the policies and strategies used to deal with this phenomenon in Brazil. This study aims to analyze the structure of the drug policies in Brazil. It is a documental search of Brazilian mental health legislation (laws, decrees, and ordinances) regarding alcohol and other drugs since 2001. The analysis focused on prevention, assistance, and supply control axes. There was a predominance of assistance, which focuses on development of treatment services. Documents have focused more on crack cocaine than on other drugs which have more impact on public health. Scientific evidence competes with partisan political issues and values and the opinions of different actors. The results suggest that it is necessary to have a solid scientific foundation, clearer technical operational aspects, and an evaluation strategy for mental health services to systematize and analyze the implemented policies.
Revista de Terapia Ocupacional da Universidade de São Paulo, Apr 1, 2011
* Este artigo é parte da Tese de doutorado intitulada "A organização dos serviços extra-hospitala... more * Este artigo é parte da Tese de doutorado intitulada "A organização dos serviços extra-hospitalares de saúde mental, o projeto terapêutico e a inserção da reabilitação psicossocial" apresentada à Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, cuja defesa pública e aprovação da mesma se deu em 04/10/2010.
FIORATI, R. C. The organization of extra-hospital mental health services, the therapeutic project... more FIORATI, R. C. The organization of extra-hospital mental health services, the therapeutic projects and integration of psychosocial rehabilitation. 2010. 242f. Doctoral Thesis
Intersectoral actions in decreasing social inequities faced by children and adolescents* Objectiv... more Intersectoral actions in decreasing social inequities faced by children and adolescents* Objective: to identify the evidence about the repercussion of intersectoral programs / actions / strategies in the reduction of social inequities experienced by children and adolescents in social vulnerability. Method: integrative review performed in the
Mycobacterium tuberculosis Determinantes sociales en salud Mortalidad Brasil r e s u m e n Objeti... more Mycobacterium tuberculosis Determinantes sociales en salud Mortalidad Brasil r e s u m e n Objetivo: Evaluar la magnitud de los determinantes sociales en áreas de riesgo para la mortalidad por tuberculosis en una ciudad de alta incidencia de esta enfermedad. Método: Estudio ecológico que recogió los casos de muerte por tuberculosis registrados entre 2006 y 2016 en la capital del Estado de Mato Grosso (Brasil). Los determinantes sociales se obtuvieron de las Unidades de Desarrollo Humano. Se utilizó la estadística de barrido para identificar las áreas de riesgo de muerte por tuberculosis. Se realizó un análisis de componentes principales para identificar dimensiones de determinantes sociales, y se aplicó regresión logística múltiple para verificar asociaciones entre las dimensiones de los determinantes sociales y el riesgo de muerte por tuberculosis. El error estándar se estableció en un 5% para todas las pruebas estadísticas. Resultados: Se registraron 225 muertes por tuberculosis en el periodo, distribuidas heterogéneamente en el espacio. Se identificó un conglomerado de riesgo para la mortalidad por tuberculosis, con un riesgo relativo de 2,09 (intervalo de confianza del 95% [IC95%]: 1,48-2,94; p = 0,04). Los determinantes sociales «bajo nivel escolar» y «pobreza» se mostraron asociados al riesgo de muerte por tuberculosis (odds ratio [OR]: 2,92; IC95%: 1,17-7,28). La renta presentó asociación negativa con el riesgo de muerte por tuberculosis (OR: 0,05; IC95%: 0,00-0,70). El valor de la curva ROC del modelo fue del 92,1%. Conclusiones: Los resultados confirman que el riesgo de muerte por tuberculosis es un problema asociado a los determinantes sociales. Las políticas de salud y los programas de protección social pueden contribuir a enfrentarse a este problema.
Pesquisa desenvolvida nos anos 2012 e 2013 em Ribeirao Preto-SP, Brasil, junto a pessoas em situa... more Pesquisa desenvolvida nos anos 2012 e 2013 em Ribeirao Preto-SP, Brasil, junto a pessoas em situacao de rua e que teve como objetivo conhecer os fatores de ruptura dessas pessoas com o mundo do trabalho formal e com suas redes de suporte social, bem como, conhecer o cotidiano vivido nas ruas. Estudo etnografico com historias de vida filmadas e diario de campo como instrumentos de coleta de dados. A analise de dados foi realizada com base no referencial da Teoria da Acao Comunicativa de Habermas, a partir das comunicacoes gravadas nos videos de cada entrevista e dos relatos do diario de campo. Os resultados mostraram que iniquidades e vulnerabilidade social estao presentes ha geracoes passadas nas familias dessas pessoas e que o cotidiano e marcado por violencia e morte, pobreza e exclusao, rupturas das redes sociais e isolamento, uso de alcool e outras drogas e outras doencas socialmente determinadas.
Resumo O objetivo deste artigo é analisar o desfecho desfavorável do tratamento da tuberculose en... more Resumo O objetivo deste artigo é analisar o desfecho desfavorável do tratamento da tuberculose entre a população privada de liberdade segundo os determinantes sociais de saúde. Coorte retrospectiva realizada nos estados de Rondônia e São Paulo, Brasil, com detentos com tuberculose notificados entre 2008 e 2017. Os dados foram coletados do SINAN e do TB-WEB e analisados pelo risco relativo (RR), com intervalos de confiança (IC95%), testando a associação entre a variável dependente [desfecho desfavorável (óbitos por tuberculose e outras causas, assim como os abandonos, primários ou não) x favorável (cura)] e os determinantes estruturais e intermediários da saúde. Foram registrados 158 desfechos desfavoráveis em Rondônia e 2.227 em São Paulo. Para Rondônia, tal desfecho esteve associado a sexo masculino (RR 3,09; IC95% 1,03-9,27) e Aids (RR 2,46; IC95% 1,63-3,71). Em São Paulo, idade superior a 30 anos (RR 1,36; IC95% 1,26-1,47), Aids (RR 3,08; IC95% 2,81-3,38), alcoolismo (RR 1,54; IC...
Two studies were carried out in Ribeirao Preto, State of Sao Paulo, Brazil, in two extra-hospital... more Two studies were carried out in Ribeirao Preto, State of Sao Paulo, Brazil, in two extra-hospital mentalhealth services: one regional mental health outpatient clinic and one psychosocial care center. The purpose of thisresearch was to study the organization of the extra-hospital and therapeutic projects of these services, and theinclusion of psychosocial rehabilitation in such projects. The study was based on qualitative methodology and usedsemi-directive interviews and focal groups to collect data. Data analysis was based on the hermeneutic dialecticphilosophy of Jürgen Habermas according to the interpretative technique of reconstruction. Results indicated thatthese services are organized focusing on the clinical-psychiatric work, emphasizing the diagnosis, pathology andmedication treatment; while psychosocial actions have a secondary role in the therapeutic project. This articlediscusses part of this study in relation to the therapeutic activities and how they are implemented. The...
BACKGROUNDTuberculosis is the leading cause of global deaths from a single infectious agent. This... more BACKGROUNDTuberculosis is the leading cause of global deaths from a single infectious agent. This study aimed to identify areas of spatial and space-time risk for pulmonary tuberculosis, to identify areas with variation in the temporal tendency for this event, and to identify factors associated with the epidemiological situation in one municipality. METHODSAn ecological study carried out in Ribeirão Preto, São Paulo, Brazil. The population consisted of pulmonary tuberculosis cases reported in the Tuberculosis Patient Control System between 2006 to 2017. To check the behavior of tuberculosis over the period, the Seasonal Trend Decomposition using Loess decomposition method was used. Spatial and spatiotemporal scanning statistics were used to identify risk areas, and Spatial Variation in Temporal Trends (SVTT) was used to detect clusters with changes in the temporal trend. Finally, Pearson's chi-square test was performed to identify factors associated with the epidemiological situ...
BACKGROUND Psychological morbidity is commonly experienced by people with a spinal cord injury (S... more BACKGROUND Psychological morbidity is commonly experienced by people with a spinal cord injury (SCI), but whether it is associated with occupational role transitions in is unknown. OBJECTIVE To analyze whether anxiety or depression symptoms are independently associated to increased likelihoods of role transitions in adults with SCI. METHODS Cross-sectional study; multivariate analysis using a heteroscedastic Dirichlet regression. PARTICIPANTS Thirty persons with traumatic SCI. MEASURES Role Checklist (e.g. role transitions: dependent variables) and Beck's Depression Inventory and State-Trait Anxiety Inventory (independent variables), adjusted for socio-demographic, functional, and injury-level confounders. RESULTS Greater depression symptoms independently increased the likelihood of occupational role transitions, either for roles loss [adjusted Odds Ratio (AOR): 1.04; 95% confidence interval (CI):1.009-1.080] or roles gain [AOR: 1.07; 95% CI:1.02-1.13], as opposed to continued o...
Journal of infection in developing countries, 2020
INTRODUCTION Brazil is in the 19th position of priority countries for the control of TB/HIV coinf... more INTRODUCTION Brazil is in the 19th position of priority countries for the control of TB/HIV coinfection, so we aimed to analyze the social and health services contexts that are associated with TB/HIV coinfection in São Paulo state. METHODOLOGY Ecological study conducted in 645 cities of the state. The study population consisted of 10,389 new cases of TB/HIV coinfection in state residents between 2010 and 2015. The variables and indicators used in the study were collected from secondary sources. To identify the factors associated with the occurrence of TB/HIV coinfection cases, generalized additive models for location, scale and shape were used. The best distribution model was defined from the lowest Akaike information criterion value. RESULTS There was an association between the occurrence of coinfection and the diagnosis of TB after death and greater treatment default. There was also an association with greater coverage of nurses and Family Health Strategy, which comprises Primary ...
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Papers by Regina Fiorati