2 research outputs found
Programa de promoção de atividade física no SUS: barreiras e facilitadores organizacionais
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Desportos, Programa de Pós-Graduação em Educação Física, Florianópolis, 2014.Objetivou-se analisar as barreiras e os facilitadores organizacionais para implantação de um programa de promoção da Atividade Física (AF) no Sistema Único de Saúde (SUS). Esta pesquisa experimental, com abordagem quanti-qualitativa do problema, analisou o programa de Mudança de Comportamento (MC) denominado  VAMOS  Vida Ativa Melhorando a Saúde , que foi aplicado em dois Centros de Saúde (CS) da Prefeitura Municipal de Florianópolis (PMF). A metodologia de avaliação adotada pelo VAMOS é o modelo RE-AIM (R=Reach/Alcance, E=Effectiveness/Efetividade, A=Adoption/Adoção, I=Implementation/Implementação e M=Maintenance/Manutenção). Neste estudo foram analisados somente o Alcance e a Adoção do programa em nível organizacional. Por questões didáticas as análises foram sistematizadas em dois momentos. No primeiro momento buscou-se verificar o potencial de alcance populacional e adoção organizacional do programa. Já, no segundo, o foco estava na investigação dos fatores influenciadores no alcance e na adoção do VAMOS. Participaram do estudo os profissionais de Educação Física (PEF) do Núcleo de Apoio a Saúde da Família (NASF) (n=7), profissionais que trabalhavam nos CS no período que o VAMOS foi aplicado (n=20) e profissionais ligados à gestão e coordenação de programas desenvolvidos na rede de Atenção Básica de Saúde (ABS) da PMF (n=2). Os dados referentes ao primeiro momento foram coletados no Instituto Brasileiro de Geografia e Estatística (IBGE), no Sistema de Informação da Secretaria de Saúde da PMF e na ficha diagnóstica aplicada aos idosos avaliados no baseline. Já para o segundo momento os dados foram coletados antes, durante e depois da intervenção, a partir das seguintes técnicas: entrevistas e grupos focais, com um roteiro pré-determinado. As falas foram gravadas e posteriormente transcritas. A análise do material coletado no momento 1 se deu por meio do software SPSS® versão 15.0, enquanto os dados do momento 2 foram analisados pelo software ATLAS-TI®, versão 5.0. Dentre os resultados, observou-se que a taxa de alcance do VAMOS foi de 15,2%, enquanto a adoção foi de 85,7% dos CS convidados a participar da pesquisa. As análises de representatividade entre os dois CS que desenvolveram o VAMOS demonstraram que no CS Barra da Lagoa a população masculina teve seu alcance limitado, todavia quanto às características sociodemográficas, condições de saúde e nível de AF não foram observadas diferenças significantes entre os idosos do CS Barra da Lagoa e do CS Santo Antônio. Quando verificado as barreiras para o alcance e a adoção, as principais reportadas foram: a falta de apoio da Equipe de Saúde da Família (ESF) e a sobrecarga de trabalho, respectivamente. Já em relação aos facilitadores o fator mais reportado para potencializar o alcance foi a ESF recomendar o programa, e para adoção, a organização ter interesse pelo programa e os PEF serem competentes. Conclui-se que as barreiras identificadas para implantação de um programa de promoção de AF estão relacionadas à aspectos como a sobrecarga de trabalho dos profissionais e a falta de entendimento de uma proposta inovadora, enquanto os facilitadores relacionam-se ao envolvimento e o interesse da ESF. A partir desses achados espera-se adequar essa proposta ao cotidiano das ESF, potencializando sua reaplicação em realidades semelhantes.Abstract : The aim of this study was to examine the barriers and facilitators organizational to implementation of a program to promote Physical Activity (AF) in the Unified Health System (SUS). This research experimental, with quantitative and qualitative approach to the problem, analyzed the program Behavior Change (MC) called 'VAMOS - Active Life Improving Health', which was applied in two Health Centers (CS) of Florianópolis. The evaluation methodology adopted by VAMOS is the RE-AIM model (R=Reach, E=Effectiveness, A=Adoption, I=Implementation and M=Maintenance). This study analyzed only the adoption and reach of the program at the organizational level. For didactic reasons the analyzes were compiled into two parts. At first we tried to verify the potential of population-wide and organizational adoption of the program. Already in the second, the focus was on investigating the factors that influence the reach and adoption of VAMOS. Participated in the study Professionals of Physical Education (PPE) of the Support Nucleus Family´s Healthy (NASF) (n=7), professionals working in the CS during the VAMOS was applied (n = 20) and professionals involved in the management and coordination of programs developed in the Basic Health Care Network (ABS) PMF (n= 2). The data for the first time were collected at the Brazilian Institute of Geography and Statistics (IBGE), at Information System of the Department of Health and in diagnostic record applied to elderly assessed at baseline. Already for the second time the data were collected before, during and after the intervention, from the following techniques: interviews and focus groups with a predetermined script. The discussions were recorded and later transcribed. The analysis of the material collected at first time occurred through the SPSS® software version 15.0, while the data from the second time were analyzed by ATLAS-TI® software, version 5.0. Among the results, it was observed that the rate range of the VAMOS was 15.2%, while adoption was 85.7% of CS invited to participate. Analyses of representation between the two CS who developed the VAMOS demonstrated that in Barra da Lagoa male population had limited range, however regarding sociodemographic characteristics, health status and level of AF no significant differences were observed between elderly Barra da Lagoa CS and Santo Antônio CS. When checked the barriers to reach and adoption, the main reported were: lack of support from Family Health Team (ESF) and work overload, respectively. In relation to the facilitators the factor most reported of potentiate reach was the ESF recommend the program, and for adoption, the organization has interest in the program and PEF are competent. We conclude that the barriers identified for implementation of a program for the promotion of AF are related to aspects as the workload of professionals and lack of understanding of an innovative proposal as facilitators relate to the involvement and interest of the ESF. From these findings it is expected adapt this proposal to daily of ESF, increasing its reapplied in similar situations
Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
No full textBACKGROUND: The number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, and highlight the most important messages for clinicians and neurologists. METHODS: GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugar-sweetened beverages). FINDINGS: In 2016, the global number of individuals who lived with dementia was 43·8 million (95% uncertainty interval [UI] 37·8-51·0), increased from 20.2 million (17·4-23·5) in 1990. This increase of 117% (95% UI 114-121) contrasted with a minor increase in age-standardised prevalence of 1·7% (1·0-2·4), from 701 cases (95% UI 602-815) per 100 000 population in 1990 to 712 cases (614-828) per 100 000 population in 2016. More women than men had dementia in 2016 (27·0 million, 95% UI 23·3-31·4, vs 16.8 million, 14.4-19.6), and dementia was the fifth leading cause of death globally, accounting for 2·4 million (95% UI 2·1-2·8) deaths. Overall, 28·8 million (95% UI 24·5-34·0) DALYs were attributed to dementia; 6·4 million (95% UI 3·4-10·5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages. INTERPRETATION: The global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide
