Impacto do Programa de Saúde da Família sobre indicadores de saúde bucal na população de Natal -RN

The aim of this study was to assess the impact of the Family Health Program (FHP) on a number of oral health indicators in the population of Natal, Brazil. The study is characterized as a quasi-random community intervention trial. The intervention is represented by the implementation of an Oral Health Team (OHT) in the FHP prior to the study. A total of 15 sectors covered by the FHP with OHT were randomly drawn and paired with another 15 sectors, based on socioeconomic criteria, not covered by the teams. A few sectors were lost over the course of the study, resulting in a final number of 22 sectors, 11 covered and 11 not covered. We divided the non-covered areas into two conditions, one in which we considered areas that had some type of assistance program such as the Community Agents Program (CAP), FHP without OHT, BHU (Basic Health Unit) or no assistance, and the other, in which we considered areas that had only BHU or no assistance. Community Health Agents (CHAs) and Dental Office Assistants (DOAs) applied a questionnaire-interview to the most qualified individual of the household and the data obtained per household were transformed into the individual data of 7186 persons. The results show no statistical difference between the oral health outcomes analyzed in the areas covered by OHT in the FHP and in non-covered areas that have some type of assistance program, with a number of indicators showing better conditions in the non-covered areas. When we considered the association between covered and non-covered areas under the second condition, we found a statistical difference in the coverage indicators. Better conditions were found in covered areas for indicators such as I have not been to the dentist in the last year with p < 0.001 and OR of 1.64 and I had no access to dental care with p < 0.001 and OR of 2.22. However, the results show no impact of FHP with OHT on preventive action indicators under both non-covered conditions. This can be clearly seen when we analyze the toothache variable, which showed no significant difference between covered and non-covered areas. This variable is one of the most sensitive when assessing oral health programs, with p of 0.430 under condition 1 and p of 0.038 under condition 2, with CI = 0.70-0.90. In the analysis of health indicators in children where the proportion of deaths in children under age 1, the rate of hospitalization for ARI (Acute Respiratory Infections) in those under age 5 and the proportion of individuals born underweight were considered, a better condition was found in all the outcomes for areas with FHP. Therefore, we can conclude that oral health in the FHP has little effect on oral health indicators, even though the strategy improves the general health conditions of the population, as, for example child health

O fazer do psicólogo no núcleo de apoio à saúde da família

The Brazilian Ministry of Health regulated in 2008 the Family Health Support Nucleus (FHSN) as a device for support and complementarity to the Family Health Strategy. The FHSN, through the matrix support, potentiates the Family Health teams on dealing with a great variety of demands and activities that are under their responsibilities. It is structured in teams of professionals from various health specialties, among which is the mental health. In preliminary studies we noticed that the psychologists have been the main representatives of mental health professionals at the FHSN from Rio Grande do Norte (RN-Brazil). On this scenario, this study intends to problematize the professional practice of the psychologists who work at the FHSN teams in RN, regarding how their work is done, discussing it under the perspective of collective health and the directions for the basic health care on Brazilian s health system. Still as a goal, in more specific ways: identify the forms of professional insertion of the psychologists in this field; characterize the work done by the psychologist at the FHSN (developed activities); and produce an analysis of the characteristics and limits of those actions, from theoretical and methodological references based on Marxian ontology. Were performed semistructured interviews with psychologists working in the oldest FHSN teams form RN. We conducted the analysis of the material following the blocks of information: determinants of the psychologist entry at the services, training for current practice; operation of FHSN; activities performed by FHSN team and the psychologist; joint actions; and limits of psychology practice in the FHSN. An important result, we observed the little articulation of practicing between the psychology and other professionals and teams, further indicating the prevalence of the traditional medical model (individual and outpatient) as guidance of their performance instead of the matrix logic that is the foundation of the proposed action for the FHSN. We also emphasize the potential of psychologists actions at the FHSN on contributing to the achievement of comprehensive care

Práticas educativas e integralidade na saúde da família: um estudo etnográfico

Primary Health Care, especially in the family health strategy, it is expected that the joint assistance and actions of health promotion. The Ministry of health (BRAZIL, 2007) defines health education as an eyeshadow strategy of prevention and health promotion, based on reflective practices, which allow the user to their condition of historical, social and political subject, under the vision of an expanded clinic on the part of health professionals. In this sense, there are guidelines for it professionals to develop educational activities and that they can interfere in the health/disease process of the population, with a view to the development of autonomy of the subject. This research had as objective to understand in the light of the integrality of the care, as is the production of health education practices, within the framework of the family health strategy from ethnographic study in a family health unit (USF). The location of the research was the unit of USF Felipe Camarão II in West Health District, in the city of Natal, RN, Brazil, selected from preliminary mapping of educational practices deployed in units of health of the family of this municipality, based on criteria such as time-to-deployment of USF and sustainability of existing actions. Immersion in the field consisted of participant observation with journaling, held during the period of August 2012 to January 2013, in which she accompanied team work processes in clinical-welfare actions on the USF, in households and in educational activities of group character. The results presented in ethnographic description were analyzed based on the axes proposed by Ayres (2009) for identification of integrality in health practices:the axis of the needs; the axis of the purposes; the joint axis; and the axis of the interactionsThe evidence described from observation point the presence of each axle up health education practices developed by the teams, even incipient form, namely: articulation and appreciation of knowledge and practices of popular culture with local initiatives (Pastoril do Peixe Boi Encantado, Auto de Natal e Grupo Terapia e Arte); Clinical integration with health promotion actions and coordination of multidisciplinary knowledge, with professional-user link (course for pregnant women). However, a few challenges were identified to be faced in order to move forward in these practices in integral care: the need to break with the fragmentation of actions; strengthening teamwork; need for greater sustainability policy of collective actions; intersectoral work aimed at a better role of the State in the face of the health-disease process, adding to the action of individuals.The analysis produced from observation of the processes experienced indicates the need for a better recognition of local managers that actions similar to those that occur in the USF Felipe Camarão II enable advances in completeness as allows inclusion of actors involved in the processes of health work, and stimulate participation and shared responsibility in the fight for health-disease situations

Avaliação das ações do Núcleo de Apoio à Saúde da Família (NASF) em Macaíba/RN

This research evaluated the contribution of the Support Center for Family Health (SCFH) in relation to its effect on the Family Health Units through perception of the Family Health Strategy (FHS) and SCFH professionals, in addition to the satisfaction of users in relation to that role. Data were collected in the public health services of the city of Macaíba-RN in 2012, through semi-structured questionnaire and non participant systematic observation and it counted as investigated subjects 272 individuals (60 FHS professionals, 12 SCFH professionals and 200 users representatives of 20 units). For analysis of the responses of the opened questions was used categorization process and, in relation to the observational method, that was based on checking the space organization, the characteristics of the participating subjects and the specific set of activities performed by SCFH teams through an observation guide. The results point to a good acceptance of the SCFH teams role by most FHS professionals who reported active participation in the health units routine, its integration activities to the FHS teams with resolving based health promotion actions. Regarding the SCFH professionals, they also reported positive contribution by participating actively in the units routine with integrated activities to the ESF teams and developing resolute actions. For users, the SCFH brought assurance services with better access to specialized, resolving and welcoming care. Systematic observation ratified data obtained by questionnaire. It was perceived the need to implement actions related to man`s health, to invest in expanding the number of the SCFH teams, the greater supply of medications, improving the regulatory process and planning together as a key strategy to promote a more effective integration between teams SCFH / FHS

As ações em saúde mental nos Núcleos de Apoio à Saúde da Família - NASF

The National Police for Basic Care (PNAB), regulated by ordinance nº2488 from October 2011, restates the Family Health Strategy (ESF) as a priority to the expansion, consolidation and qualification of basic attention to health matters in Brazil. In order to bring it about, city counsellors along with other federal entities ought to ordinate their work process deepening principals, directions and fundaments of Basic Care (AB). Besides ESF, the new PNAB expatiates on the Family Health Support Centres (NASF), reaffirming their role on broadening the scope of basic care actions and their improvements, ratifying their ability to share knowledge and support Basic Care professionals. All this considered, the purpose of this work is to investigate how NASF is currently structured in João Pessoa and what has been achieved by it on what concerns to mental health. Its main objectives are to analyse the practices of mental health professionals that are part of NASF teams and if they differ from what has been developed by the other members of the teams; to discuss the articulation of NASF in managing mental health measures on what concerns to internal organisatio n and to the city health network; to identify strategies used to organise such measures on mental health in Basic Care. To reach such goals, individual interviews have taken place two city health managers and four of NASF professionals that participated on the Mental Health Office as representatives of their sanitary districts. Also a focal group formed by various supporters of NASF was created, contemplating the diversity of professional categories involved with the teams and sanitary districts. It was possible to identify in NASF, in João Pessoa, an organisation based by the matrix support in which both management and basic care demands reflect a series of actions developed alongside with ESF. Amongst such actions, matrixing, home visits and the Singular Therapeutic Project (PTS) stand out. These activities have been discussed on the focal group and integrate the daily work of all NASF supporters despite their professional categories. NASF presents itself as a powerful strategy to SUS proper qualification and support to strengthen Basic Care and broaden family health teams‟actions.

Impacto da Estratégia Saúde da Família com equipe de saúde bucal sobre a utilização de serviços odontológicos

PEREIRA, C. R. S. et al. Impacto da estratégia saúde da família com equipe de saúde bucal sobre a utilização de serviços odontológicos. Cad. Saúde Pública, v. 25, n. 5, p.985-996. Maio, 2009. ISSN 0102-311X.

Impacto da Estratégia Saúde da Família com equipe de saúde bucal sobre a utilização de serviços odontológicos

PEREIRA, Carmen Regina dos Santos et al. Impacto da Estratégia Saúde da Família com equipe de saúde bucal sobre a utilização de serviços odontológicos. Cadernos de Saúde Pública, Rio de Janeiro, v. 25, n. 5, p. 985-996, maio 2009.

Avaliação das capacitações de Hanseníase: enfermeiros opinião de médicos e enfermeiros das equipes de saúde da família

MORENO,Cléa Maria da Costa,ENDERS,Bertha Cruz, SIMPSON, Clélia Albino. Avaliação das capacitações de Hanseníase: enfermeiros opinião de médicos e enfermeiros das equipes de saúde da família. Revista Brasileira de Enfermagem, Brasília, v.61,n.esp.p. 671-5.2008.

Violência intrafamiliar contra a criança: intervenção de enfermeiros da estratégia saúde da família

Objetivou analisar a atuação dos enfermeiros da Estratégia Saúde da Família frente à violência intrafamiliar contra a criança, visando identificar ações de prevenção do problema. Pesquisa descritiva e exploratória de cunho qualitativo, cujos dados foram analisados conforme análise de conteúdo. Participaram do estudo 14 enfermeiros da Estratégia de Saúde da Família do município de Mossoró-RN. Dados coletados utilizando-se questionário semiestruturado. As ações de promoção à saúde são atividades educativas desenvolvidas após detecção de casos. O medo de represálias do agente agressor, a sobrecarga de trabalho, a falta de apoio dos gestores e a dificuldade para a materialização da interdisciplinaridade, intersetorialidade e integralidade da atenção foram mencionadas como barreiras ao enfrentamento do problema

A representação social do cuidado no Programa Saúde da Família na cidade do Natal

The aim of this study was to learn about the social representations of the care provided by the Family Health Program (FHP) in the city of Natal, Brazil and determine how these representations guide the daily actions of doctors, dentists, nurses, nurse s assistants and oral health assistants during the work process. In this sense, we used the theoreticalmethodological approach to the Theory of Social Representations. For data collection, we used the following instruments: a two-part questionnaire, where the first part recorded sociodemographic data and the second part was adapted to the free word association technique (FWAT), which was applied to 90 professionals belonging to 18 FHP units. Interviews were also used as collection instruments. These were based on inductive stimuli and on direct observations of 30 of these professionals. After a superficial reading of the material, we constructed a corpus from which ten categories emerged. To analyze FWAT we used lexicographic analysis, combining frequency and the mean order of responses. The interviews and sociodemographic variables were analyzed using content analysis and descriptive statistical analysis, respectively. The study showed that the central nucleus of the social representation in question is composed of the elements attention, receptivity and love, revealing that the subjects have different understandings of the FHP care process and that the knowledge accumulated in this respect is supported by an approximate vision of the meaning of care. However, traditional elements with trivializing connotations about care predominate, which compromises the development of strategies to overcome traditional practices. In the set of analyses, we were able to capture the invariance of a contradiction: on one hand, professionals know and affirm the importance of providing care for FHP patients; on the other, the experience of daily practice translates into the negation of this concept. In this contradictory context, professionals build gradual and successive syntheses that allow them to act and affirm themselves by associating information from their academic formation, structured knowledge acquired in other experiences, values and symbols of their daily routine. Thus, they shape and reshape themselves, according to what is concretely and specifically required, at the same time both plural and multiple. The composition of the central nucleus indicates that any measure that intends to modify attitudes that is, the daily actions of FHP professionals with respect to care must take into account and give priority to the debate about the redefining of the semantic fields of the central nucleus (love/attention/receptivity and humanization), especially those of love and attention

Avaliação do cuidado na estratégia saúde da família em metrópoles do nordeste brasileiro

Objective: To evaluate the implementation of the Family Health Strategy (FHS) in Brazilian cities of the Northeast, expanding coverage, analyzing the progress, challenges and innovations. Methods: Multicentric Evaluation Research, Studies Baselines in urban centers, using as a case study method. Selected cases of Aracaju, being capital, advanced coverage with extended team, and Fortaleza, capital coverage incipient and minimal staff. In Fortaleza, purposive sample of 11 Units Primary (APS), 03 managers, 53 professionals and 109 users. In Aracaju, 09 units of APS, 02 managers, 36 professionals, and 90 users. Structured interviews for managers, and structured to professionals and users. Descriptive analysis focusing on the political and institutional dimensions, organization and comprehensive care. Results: There was consensus that the ESF is the preferred port users and acts as inducing changes in care. In the case of Fortaleza, the specificities were: care protocols and community activities aimed at chronic conditions (100%) , with greater participation of doctors and nurses (93%) ; conjunction with more complex services, but the teams reported difficulties with the examination center and experts, the long waits and poor access to local services were the main difficulties reported by users., As innovative practice, the therapeutic group of elderly caregivers mentioned by respondents; There was intersectoral initiatives and teams 87 % of users have participated in meetings about health problems. In the case of Aracaju, care protocols were directed to the lines of care and formulated locally, 85 % coverage of the population with FHS counterpart local financing; employees hired by public tender; 70 % of teams with expertise in public health center for continuing education acting; democratization in management; access technologies, welcoming and computerization in different integrated networks, and evaluation matrix. Conclusions: The ESF has promoted access to health care and inclusion of disadvantaged populations. Different perceptions and practices in the organization of care, with distinct trajectories of reorganization. In the case of Fortaleza, predominance of model programs valuing older, with evidence of advances in care practices and teamwork, but restricted to primary care practices and incipient in public policy perspective. In Aracaju, had network integration with technologies related to the family, in which the ESF is consolidated as public policy. It can be argued that the XII APS expanding coverage, exhibited efficacy, despite the challenges inherent to the different degrees of implementation

A política de humanização e a estratégia saúde da família: visões e vivências

This study approaches the topic of humanization in health that involves the set of policies implemented by the Ministry of Health in Brazil. Its aims are directed towards a reflection on the guiding theoretical and organizing axes of the National Humanization Policy (NHP) and their repercussions on municipal health policy of Natal, Brazil; an analysis of the results of the policy at the local level; knowledge of the views and experiences of the humanization agents in the daily work process and identification of the main challenges of the policy. The empirical field of investigation was the Family Health Strategy (FHS) of the city of Natal. The assumption of the study is that the FHS has produced local experiences with potentialities that must not be wasted, in which there are difficulties and discrepancies between the real and proposed model. The contradictions and challenges in the social and political context of Brazil in the early XXI century and their consequences in the field of health reflect anti-utilitarian aspects anchored strongly in the theoretical concepts of Boaventura de Sousa Santos about the sociology of privations and emergencies as well as of the work of translating. The predominantly qualitative approach collects some complementary quantitative data. The study procedures used were the following: bibliographic research; documental research; interviews; and direct observation. Interpretation of the information obtained was based on documental analysis and on the symbolic cartography of the social representations. Cartographic evidence suggests that practices still take place under dehumanizing conditions that compromise the quality of care given. However, there is a movement aimed at changing the work process that has been strengthening the link and widening the measures developed, incorporating new directions in diversity, integrality and solidarity. The map drawn shows a reality manifested by explicit intentions in a political agenda, by concrete solutions marked by an assortment of difficulties and expressed in the words of the agents and by latent clues identified in successful local experiences, posing many challenges for the consolidation of the proposed changes

As práticas educativas na saúde da família: uma cartografia simbólica

This qualitative research aimed to understand the educational activities carried out in Family Health Units, of the municipality of Mossoró-RN. It was used symbolic cartography to organize and present data from reality. It started on the approach of Health Education and knowledge transformation practice, aiming at the development of autonomy and responsibility of individuals and healthcare, publicized by the appreciation of the interpersonal relations area established in services, such as educational emancipator practices contexts. Individual and collective interviews were realized, conducted with health professionals and users of ESF, about themes, activities, membership, the difficulties, the potential and the design of health education that permeate everyday Family Health Strategy. From what was apprehended, thematic maps were done with the analysis of educational practices of professionals belonging to the Family‟s Health. Links are built with the wires of conceptions of education reflected on themes and activities of family health teams. The storylines are rebinded by voices about the difficulties and the potential of educational processes for emancipator postures. For users, health education means proper care and information on disease prevention. Professionals understand that it is all information that is given to users, about health, social well-being, economic and general condition of human being as a way of preventing and treating disease. Mark printed on voices denote that activities and themes worked don‟t motivate users enough for their participation, being that physicians and dentists also get excluded themselves from educational practices. Elderly groups are those who get most involved with the activities. The size of the contained area and its seclusion from community make harder the access of users, as well as diminishing the quality of educational actions and links users-professionals. Therefore, the searching for medicines, medical consultations and wish to be well served are trademarks of voices from the users that interconnect with enlightening information and guidelines offered by professionals to users. It brings out practices that need to incorporate the social, the subjective and act with practices of prevention and health promotion, on the basis of lifestyles. The dialogical model, which needs to be approached since planning phase of health education actions could arouse interest of involved groups; promoting a relationship of dialogue and listening; discussing the local reality; stimulating practical methodological dialetics; promoting processes of deconstruction of concepts, values and attitudes, as more necessary than construction, using multiple languages. The defended thesis denotes paths to other studies aimed at understanding a dialogical template committed to exchanges of knowledge, and discover strategies that encourage formation of critical consciousness and the discovery of how is the training of new generations of healthcare professionals to belong to the project of society, in its technical, scientific, pedagogical, ethical, political and humanistic dimensions

Dificuldades e/ou facilidades vivenciadas pelos profissionais que compõem a Estratégia de Saúde da Família

Descriptive and quantitative study, with the objective of review the positive and negative aspects experienced by professionals working in the Family Health Strategy (ESF) of Ceará-Mirim town, at Rio Grande do Norte state. The population included 190 healthcare professionals that integrate the family healthcare staff and the data-collection occurred in a meeting at their workplace, with the implementation of a questionnaire. Results were organized in Microsoft Excel spreadsheet software, with descriptive statistical analysis in tables, graphs and tables through frequencies, averages values and standard deviations. There is a predominance of females (n = 137) and higher rates in almost all professions, and higher average age (38.9%, SD = 7.8) and income wage (average = 10) in the medical category. Regarding the more developed activities, for physicians and nurses are the healthcare actions in the Unit, the oral hygiene for dentists, the immunization for auxiliary nurses (Aux-N), educational meeting for the dental office assistants (ACD), and home visitations to community-based health workers (ACS). About the easiness of work, 93.2% said to be presence of professionals with a personal profile in public healthcare; about the difficulties, 86.8% of professionals cited the unavailability of material, followed by salary range reported by nurses (80.9% ), dentists (80.0%), physicians (73.3%), ACS (83.1%), and Aux-N (90.5%). In relation to working conditions, the unavailability of materials was the most mentioned, with the exception of dentists who reported improvement in wages. We still identify among these difficulties: the drugs availability regarded as first grade obstacle by ACS and physicians, the type of contracts in second grade cited by the ACD and dentists and, in third grade, the salary range cited by dentists and auxiliary nurses. It is concluded that the difficulties and easiness faced by ESF professionals are divergent among themselves. For physicians and nurses, whose healthcare actions become directed to specific groups, the individual and the family, their difficulties relate to the unavailability of materials. For dentists, whose actions more quoted were topical application of fluoride and supervised toothbrush, their greatest difficulty is the salary range. As to the Aux-N, ACD and ACS, for all of them the unavailability of materials has hindered the implementation of their activities in ESF

Prática do enfermeiro do Programa Saúde da Família PSF na promoção da saúde do adolescente

Attention to the health of adolescents, based on paradigm flexneriano, needs to be overcome. Since the International Conference of Ottawa (1986), the literature is developing a discussion of the promotion of health, based on the paradigm of social production in health, suggests a design to overcome the health care traditional practices. Program Health of the Family PSF has this purpose to transmute the model of existing assistance, where the nurse is an essential element to the work done in the program. Around this context, it is our purpose to analyze the practice of nurse of the PSF for the promotion of health of adolescents, produced by a search of descriptive quantitative approach with the inclusion of qualitative data. Interviews were conducted with 9 nurses 3 units of health of the family USF, Mossoró-RN and applied questionnaires with 74 teenagers aged between 15 and 19 years old, with some nearby public schools where USF operate these nurses. The quantitative descriptions were transformed on tables, pictures and graphics using the program Excel (Microsoft) and the qualitative were worked through the technique of analyzing the content of Bardin (2004). The review was realized using the reference to promote health brought by the study. The results show that the most common problems that happen with teenagers are the drugs (33,8%), pregnancy (27,0%) and political problems-socio-economic-cultural issues (24,3%). Adolescents are spontaneous demand and rarely seek the USF. The actions presented by the nurses as, lectures and groups, are nothing comparing to the macro-problems presented by adolescents, and verticalized irregular. The nurses know the promotion of health generally, not explaining how operate it from its daily practice. Concluded that the practice of nurse of the PSF has not yet reach the promotion of health of the adolescent, being necessary to scheduling modules on the subject to continuous training of teams, professionals from USF, as well as teachers and other staff of schools, giving space to the participation of academic. The discussions should be socialized with the community to discuss possibilities of confrontation of the problems, which also require socio-structural changes. This research can contribute as work-diagnosis, which experienced the reality of care in nursing PSF to a specific group