Politics of Childbirth in Nepal

Nepal has been hailed as a global success in reducing the maternal mortality ratio from around 540 women dying per 100,000 births in 1996 to about 240 in 2016. The chapter will critically analyse two interventions implemented around 2005. First, we will look at the USAID-funded Nepal Family Health Program, through which oral misoprostol (to control bleeding after delivery) was launched across Nepal. Second, we will look at Aama Surakshya Karyakram (or mother programme), which was implemented to promote institutional delivery. These two programmes, despite aiming to address high maternal mortality ratio in Nepal, adopted very different approaches, reflecting ideological struggles on women’s agency and the politics of childbirth. The chapter concludes that the costs of these changes (such as the lack of resources or the commercialization of healthcare) have been overlooked in the claims of Nepal’s ‘success’.

Polypharmacy, inappropriate medication use and associated factors among brazilian older adults

Background Population aging is still an important worldwide phenomenon. Elderly people suffer from multiple chronic diseases that require the use of several drugs, and this demographic scenario fosters the increased prescription of multiple drugs, or Polypharmacy (PP) and Potentially Inappropriate Medication (PIM). Objective This study aimed to identify the prevalence rates and associated factors of PP and PIM in Brazilian older adults. Method The prevalence of PIM use and PP was estimated in a sample of 222 patients enrolled in the Family Health Program in Niterói, Brazil. Logistic regression models were used to analyze the data. Age and sex were kept in the models as potential confounding factors. Results PP and PIM use presented prevalence rates of 23.9 and 24.8%, respectively. PP was associated with body mass index, coronary heart disease, diabetes mellitus, and a number of comorbidities, whereas PIM use was associated with PP. Conclusion The prevalence rates of PP and PIM use found were lower than those reported in previous studies. This could be a result of differences in availability of drugs or prescribing habits. Multiple chronic diseases were associated with PP. These results suggest that more care should be taken in prescribing for the elderly population.

Knowledge of Heat-Related Illness First Aid and Self-Reported Hydration and Heat-Related Illness Symptoms in Migrant Farmworkers

Background: Outdoor workers are exposed to hot work environments and are at risk of heat-related morbidity and mortality. The purpose of this study was to evaluate the knowledge of migrant farmworkers about first aid for heat-related illness (HRI) symptoms. Methods: The authors recruited 60 migrant farmworkers out of 66 who were approached from vegetable farms in Georgia. They were workers who participated in the 2018 Farmworker Family Health Program (FWFHP). The authors surveyed the workers to assess demographics, prevalence of HRI symptoms, hydration practices, and knowledge of HRI first aid. Descriptive statistics for worker demographics, HRI symptoms, and hydration data were calculated, as were the percentages of correctly answered pilot questions. Findings: Of the 60 workers who chose to participate in this study, more than 50% incorrectly answered pilot questions related to their knowledge of HRI first aid. The two most common HRI symptoms reported were heavy sweating and muscle cramps. More than two thirds reported experiencing at least one HRI symptom during the workday. Mean liquid consumption within this sample was 72.95 oz per day, which is much less than the recommended 32 oz per hour. Conclusion/Application to Practice: Until larger structural change can occur to protect farmworkers, farm owners can prevent morbidity and mortality from inadequate hydration practices and working in high-heat conditions by providing migrant farmworkers with training in heat-related first aid. Appropriate heat-illness interventions should focus on first aid measures to reduce morbidity and mortality related to heat illness in farmworkers.

Cross-sectional observational study of the sleep disorders in subjects assisted in the Basic Health Units and Family Health Program in Divinopolis, Brazil – a protocol study

Introduction: Sleep disorders have a high prevalence in the general population being currently considered as a major public health problem. In the last four decades, scientific interest in sleep patterns has steadily grown. Such studies may contribute to a better understanding of the clinical course to explore potential therapeutic interventions. This study will aim to verify the prevalence of sleep disorders in subjects assisted at the Basic Health Units (UBS’s) and Family Health Program (PSF’s) in Divinópolis, MG, Brazil. Methods: This research will be an observational, cross-sectional study carried out by professors and students from the University of State of Minas Gerais - UEMG, Divinópolis Unit, with subjects recruited from the UBS’s and PSF’s in Divinópolis-MG, between March 2016 and December 2017. These subjects will be assessed clinically and respond to the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Berlin Questionnaire, SF-36 Quality of Life Questionnaire, evaluating the quality of sleep, presence of sleep disorders, excessive daytime sleepiness, risk for obstructive sleep apnea and quality of life. Discussion: Recently, sleep disorders were considered a global public health problem, affecting the quality of life of the population and influencing morbidity and mortality. The results of epidemiological studies are not only applicable in clinical practice but also in the planning and implementation of public policies and programs aimed at controlling sleep disorders and their impact on individuals and societies.

Ethnodirigid study of Medicinal plants used by the population assisted by the “Programa de Saúde da Família” (Family Health Program) in Marechal Deodoro - AL, Brazil

This study aimed to assess diagnosis of Unique Health System (SUS) users profile with regard to herbal medicine. This is a cross-sectional study with observational data collection conducted in the city of Marechal Deodoro, through a semi-structured questionnaire with questions related to socioeconomic data, use, and knowledge of medicinal plants and herbal medicines and satisfaction with the use of medicinal herbs (MH) and interactions of phytotherapeutic drugs (PD). Among the topics, 86.89% of users used herbal medicines often, especially lemon balm (Melissa officinalis L.). It was also observed that the plants are generally used as a sedative (21.74%) and as tea (87.84%). 82.32% of respondents claim to have acquired the knowledge of herbal medicine through a family member and 85.36% make use of medicinal plants without having received any information on the use of MH and PD. 61% of the plants described that coincided with the form of use and therapeutic properties found in the literature. With regard to satisfaction by treatment with MH and PD, it was found that 56.67% are satisfied. Therefore, it is necessary to pay attention to this aspect of usage, in order to avoid possible drug interactions or adverse reactions resulting from the incorrect use.

Knowledge and perceptions about generic drugs by users of PSF in triple borders

Background The Brazilian Ministry of Health, by the National Policy on Medication, Ordinance 3916 from October 30th 1998, reinforces the Law of Generics of February 1999 (Law No. 9787 from February 10th, 1999, aiming, among other things, to reduce the prices and make access to medications easier for population). Objective The main objective was to identify the level of knowledge of the population regarding generic drugs. Method Descriptive, quantitative study, with 520 users interviewed in four health care units that implemented the Brazilian Family Health Program. Such units represent four health districts in Foz do Iguaçu, PR, Brazil. Results Most of the interviewed know and/or have heard about generic drugs. For many people, the generic drug represents only a more affordable type of medication. Conclusion The need for health education to clarify the population’s questions was found, so they could identify and acquire their medication safely and with confidence.

Extensão universitária: Hanseníase na escola, em busca de um diagnóstico precoce

O projeto de extensão teve como objetivo desenvolver atividades educativas sobre hanseníase, visando o esclarecimento sobre sinais da doença e possível detecção de casos novos, de forma a avaliar a situação da hanseníase na população do ensino fundamental do município de Passos-MG. Foram selecionadas intencionalmente 10 escolas públicas com ensino fundamental da área urbana do município de Passos-MG no ano de 2018. Inicialmente realizou-se palestras aos discentes e docentes para inteirá-los a respeito da hanseníase e de seu tratamento. Em um segundo momento, por meio de uma triagem, selecionou-se os alunos que possuíam lesões de pele pigmentadas pelo corpo. Esses alunos, após autorização dos pais, foram convidados a realizar o exame dermatoneurológico e, aqueles com análise sugestiva para hanseníase, encaminhados à Estratégia de Saúde da Família. Participaram das palestras 329 docentes e 2.962 discentes, sendo que 305 discentes foram submetidos ao exame dermatoneurológico. Desses, seis casos foram sugestivos para hanseníase e encaminhados para a Estratégia de Saúde da Família. Notou-se grande desconhecimento por parte da população a respeito da doença, principalmente em relação à cura. A busca ativa de casos é um método importante para o controle da hanseníase. Palavras-chave: Hanseníase; Doença Infectocontagiosa; Relações Comunidade-Instituição Health students' perceptions on interdisciplinary work: experience at the outreach project smile on duty Abstract: The objective of the extension project was to develop educational activities about leprosy, aiming at the clarification of the disease symptoms and possible detection of new cases, to assess the leprosy scenario among elementary school students in the city of Passos, Minas Gerais state. Ten public elementary schools in the urban area of Passos were selected intentionally in 2018. Initially, lectures were held to students and teachers in order to brief them about leprosy and its treatment. At a second stage, students who had pigmented skin lesions on their bodies were selected through a screening. These students, after parental consent, were invited to undergo an exam dermato-neurological, and those with a suggestive analysis for leprosy were referred to the Family Health Strategy program. A total of 329 teachers and 2,962 students attended the lectures, and of these students, 305 underwent the exam dermato-neurological. Six cases were indicative of leprosy and committed to the Strategy of Family Health program. There was a significant lack of knowledge on the part of the population about the disease, mainly concerning the cure. Thus, active searching for cases is an essential method for leprosy control. demands, promoting their potential to work collectively and answer to the current demands of interdisciplinary healthcare. Keywords: Leprosy; Communicable Diseases; Community-Institutional Relations

Pediatric dentistry content in civil service examinations in the state of paraíba: how is this specialty being addressed?

This research study aimed at evaluating the content related to pediatric dentistry addressed in civil service examinations in the state of Paraíba through the analysis and classification of questions. Questions related to pediatric dentistry addressed in civil service examinations for the dentist position in the Family Health Program, held in the state of Paraíba, between the years 2001 and 2017 were evaluated. Across the state, 107 civil service examinations were identified and, when applying the exclusion criteria, 9 identical tests were found, consequently, being removed, totaling 98 examinations. After the analysis, 3,949 questions were obtained and only 54 questions were related to pediatric dentistry, representing 1.36% of total questions. The questions were classified according to the topic and the cognitive level according to the BLOOM's revised taxonomy. Results showed that topics related to oral rehabilitation and surgical management, including questions regarding anesthesia, surgery, pulp therapy, endodontic treatment, operative and restorative dentistry, dental materials, traumatic injuries and prosthesis/rehabilitation corresponded to 42% of the questions. The most prevalent cognitive domains were recall and analyze, corresponding to 45% and 29%, respectively. Thus, questions concerning oral rehabilitation and surgical management were the most addressed in civil service examinations, in which the domains remember and analyze were predominant. There were no questions requiring complex cognitive domain such as assessing and creating.

Integrating priorities of disadvantaged parents and professionals for community family health

Background Health inequalities persist, and policymakers, researchers and practitioners seek for effective ways to positively impact the health of disadvantaged people. Researchers point to a multi-component program with an integral design including various perspectives and involving different stakeholders. Few studies address the perspectives on health of disadvantaged people themselves. This study describes what parents in a socially disadvantaged situation and professionals working in that community perceived as 1) priority aspects to improve family health 2) barriers and facilitators for health behaviour changes 3) important health program activities. Methods Design: Community-based participatory action research. 10 parents participated in 6 panel meetings. 46 professionals received 4 panel meetings summaries. 18 parents and 25 professionals responded to questions in (panel) meetings and consultation by phone and e-mail. Results (preliminary) 1) Parents’ top priorities for improving health were: less stress related to finances and communication with related organizations, followed by a safe place for kids to meet. Of the program financers’ aims (reducing tobacco, alcohol use and overweight) reducing overweight got relatively most support of parents. 2) Parents perceived their family financial situation as barrier to behaviours reducing stress and overweight. 3) Program activities related to reducing stress got more support from parents and professionals than activities related to reducing overweight. Conclusions Insight in the perspectives of disadvantaged parents and professionals resulted in a program plan supported by them, aiming to reduce stress and overweight. Most participating parents and professionals committed themselves to invest time in program activities execution. Key messages Disadvantaged parents perceived reducing stress related to finances as top priority to improve family health. They perceived family finances as barrier to behaviours reducing stress and overweight. Community-based participatory action research with disadvantaged parents and professionals can result in an integrated family health program plan with stakeholder support.