Impacto da estratégia saúde da família com equipe de saúde bucal sobre indicadores de saúde bucal: análise em municípios do nordeste com mais de 100 mil habitantes

This study examined in municipalities of Northeast of Brazil with more than one hundred thousand people who incorporation of Oral Health Teams (OHT) into the Family Health Strategy (FHE) the possible impact on oral health indicators. Sought to answer whether implementation OHT brought the best indicators of health problems and coverage, compared to areas without coverage by the FHE through a community trial in parallel, quasi-randomized. In each of the municipalities surveyed were 20 census tracts, 10 were located in areas covered by oral health teams in the ESF and 10 industries in areas not covered. The final sample consisted of 59.221 individuals. We compared oral health indicators related to health problems, access to services and coverage of oral health actions. The analysis strategy was based on the calculation of prevalence ratios and confidence intervals, adjusted for confounding factors through Poisson regression with robust variance. It also has measured the association between an indicator of social inequality for comparison between areas. The best results are associated with indicators of access and coverage of oral health actions at the expense of the indicators of health problems, suggesting a possible maintenance of a traditional model of practice yet. The results also suggest a possible effect of a specific policy in the area of primary care on inequality in access. From the discussions presented throughout this work, we can see that the impact analysis of public policy, obtained by comparing areas with and without the intervention, not only captures the effect on the target population, but other dimensions of organization service and therefore should be understood as one of the analytical possibilities related to the management

Avaliação do conhecimento e de habilidades clínicas em saúde sexual e reprodutiva na graduação de medicina

No Brasil, a despeito das conquistas obtidas a partir da implantação do Sistema Único de Saúde e dos avanços legais e institucionais na atenção a diversos problemas relacionados ao gênero, a incorporação de temas relacionados aos direitos humanos, sexuais e reprodutivos no contexto da formação profissional em saúde permanece deficiente. Este trabalho teve como objetivos avaliar a inserção da temática saúde sexual e reprodutiva no currículo do curso de graduação em Medicina, por meio do emprego de avaliações de conteúdo cognitivo, procedimental e atitudinal. Trata-se de estudo de intervenção educacional envolvendo alunos do internato do curso de Medicina da UFRN. Foram utilizados os seguintes métodos avaliativos: prova escrita, exame clínico objetivo estruturado (OSCE) e Mini-CEX. Como variáveis explicativas foram consideradas o sexo, idade e participação prévia no componente curricular optativo Saúde Reprodutiva . A avaliação do processo constou da aplicação de questionários de satisfação e entrevistas acerca dos métodos avaliativos utilizados. Considerando os três métodos avaliativos empregados, 183 estudantes participaram do estudo, com média de idade de 24,5 ± 2,2 anos, sendo 52,5% do sexo masculino e 47,5% do sexo feminino. No contexto geral, observamos concordância entre os desempenhos dos estudantes nas avaliações de conteúdo cognitivo, procedimental e atitudinal. A participação dos estudantes no componente curricular eletivo Saúde Reprodutiva mostrou-se associada com melhor desempenho em algumas dimensões da avaliação cognitiva e na avaliação com o Mini-CEX, em relação às competências de anamnese, profissionalismo e qualidades humanísticas, relação médico paciente e desempenho global. A análise da fidedignidade entre os avaliadores na avaliação com o método OSCE mostrou-se adequada (alfa de Cronbach superior a 70%) em relação ao desempenho global e aos aspectos técnicos das competências avaliadas, observando-se baixa confiabilidade na avaliação da comunicação médico-paciente. O presente trabalho constitui-se numa experiência educacional inovadora e pioneira no âmbito da educação médica brasileira no que tange à inserção da temática de saúde sexual e reprodutiva na graduação, sugerindo-se um impacto positivo da iniciativa na formação do médico generalista na UFRN. A avaliação de conhecimentos, habilidades e atitudes em saúde sexual e reprodutiva na graduação de Medicina mostrou-se factível, com alta concordância entre os diferentes métodos empregados. Os métodos OSCE e Mini-CEX podem ser aplicados ao contexto da saúde sexual e reprodutiva, possibilitando a avaliação de competências clínicas relevantes para a formação do médico generalista e que habitualmente não são contempladas nas avaliações rotineiramente realizadas na graduação

Percepção e realidade da política de atenção à saúde do idoso nas equipes de profissionais do programa de saúde da família do estado da Paraíba

Investigar os fatores relacionados á percepção que os profissionais das equipes do Programa de Saúde da Família (PSF) possuem frente à realidade da política de atenção à saúde do idoso nas Unidades Básicas de Saúde dos municípios litorâneos do Estado da Paraíba. Trata-se de um estudo observacional descritivo com uma amostra constituída por 120 profissionais de saúde de três categorias distintas (enfermeiro, médico e odontólogo), sendo 104 respondentes como profissionais e 16 respondentes como coordenadores de equipes. A coleta de dados foi realizada através de um questionário auto-aplicável de avaliação fechada e de questões de múltiplas escolhas. Os dados foram processados e armazenados no Programa Estatístico SPSS versão 15.0 e analisados à luz da estatística descritiva. Os resultados indicaram que os profissionais tiveram dificuldade em perceber a realidade da política integral e integrada de saúde do idoso junto aos serviços de saúde em que atuam. O estudo revelou ainda a necessidade de uma definição de estratégias para qualificação dos profissionais garantindo à atenção integral à saúde do idoso sob uma nova visão de atuação

Avaliação da qualidade da assistência a pessoas com úlceras venosas atendidas na estratégia saúde da família

A úlcera venosa constitui importante problema de saúde pública, gera repercussão social, econômica e mudanças nos hábitos de vida, dor, sofrimento, acarretando diminuição da qualidade de vida. O estudo objetivou avaliar a assistência prestada às pessoas com úlceras venosas atendidas pela Estratégia Saúde da Família. É um estudo analítico, transversal e quantitativo, realizado com 59 pessoas com úlceras venosas, atendidas em 36 unidades da Estratégia Saúde da Família. O estudo obteve aprovação do projeto de pesquisa pelo Comitê de Ética da Universidade Federal de Alagoas. Para a coleta dos dados utilizou-se instrumento testado, entrevista, exame físico e informações dos prontuários. Os dados foram organizados em planilha do Microsoft Excel 2007, exportados e analisados em software estatístico por meio de estatística descritiva e inferencial, considerando nível de significância estatística de ρ-valor < 0,05. As pessoas com úlcera venosa eram do sexo feminino (71,2%), ≥ 60 anos (67,8%) e estavam em tratamento > 1 ano (69,5%). Possuíam tempo de lesão > 6 meses (64,4%), dor na úlcera/membro (86,4%) e leito com ≤ 30% de granulação/epitelização (78,0%). A qualidade da assistência foi ruim (< 5 aspectos positivos) em 57,6% (ρ=0,000) e os aspectos que mais interferiram foram as seguintes inadequações: profissional que acompanha/realiza curativo (ρ=0,002, coeficiente de contingência (CC) =0,458, razão de chance (RC) =13,9), produtos nos últimos 30 dias (ρ=0,038, cc=0,334, RC=7,3) e acesso a consulta com angiologista (ρ=0,041, cc=0,305, RC=4,1). Os aspectos clínicos que contribuíram para o aumento do tempo de assistência foram: tempo de lesão >6 meses (ρ<0,001), dor (ρ=0,043), recidiva (ρ<0,001); nos aspectos assistenciais: inadequação dos produtos com 83,1% (ρ=0,036). Essas características dificultaram a cicatrização tecidual, prolongando o tempo de tratamento das lesões,que podem ter contribuído para a cronicidade das úlceras

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

ANÁLISE COMPARATIVA DO CONHECIMENTO, ATITUDES E PRECONCEITOS DE UNIVERSITÁRIOS DOS CURSOS DE PEDAGOGIA, EDUCAÇÃO FÍSICA E MEDICINA EM RELAÇÃO À EPILEPSIA

Epilepsy is a chronic disorder of the central nervous system, most frequently characterized by abnormal electrical impulses in the brain. It is the oldest recorded neurological disease and has been surrounded by myths, mistaken beliefs and preconceptions. Three professionals work with epileptic patients on a daily basis: teachers, physical educators and physicians . This study aimed to analyze and compare the level of knowledge, preconceptions and attitudes of undergraduate students in the courses of Pedagogy, Physical Education and Medicine, future professionals who will deal with epileptic patients. This descriptive observational study was conducted with 286 university undergraduates of both sexes (women 99/34.6% and men 187/65.4%) from the first to fourth year of Pedagogy, Physical Education and Medicine courses at the Universidade Estadual Rio Grande do Norte (UERN), with mean age of 23 years. A validated and adapted 17-question questionnaire, divided into nine knowledge-based questions, five related to preconceptions and three on attitudes, was applied. Results allowed elaboration of a manuscript entitled Comparative Analysis of Knowledge, Attitude and Preconceptions in University Undergraduates of Pedagogy, Physical Education and Medicine Courses in Relation to Epilepsy. The findings of this article show that knowledge of epilepsy in the three groups is very satisfactory. The low level of preconception indicates that educational or clarifying information is being transmitted, albeit by television, a layman s information vehicle, which has undoubtedly contributed to reducing the stigma of epilepsy through educational information. Results also suggest a lack of knowledge on how to act during a seizure, especially in education professionals. Although there are limitations in our sample, the relevance and contribution of this study is to call attention to the importance and need for these future professionals to be informed and learn correct attitudes with respect to epilepsy during their academic formation. This is essential at a time when the disease is being brought out of the shadows. This research was supported by the Office of the Dean of Teaching, and Deans of Pedagogy, Physical Education and Medicine at UERN. The research was made possible by the multidisciplinary interaction among a physical educator, child neurologist and statistician, all contributing to achieving the aims set out here

Capacidade antioxidante in vitro e avaliação da toxicidade aguda in vivo de extratos de folhas de Licania rígida Benth., Licania tomentosa (Benth.) Fritsch e Couepia impressa Prance (Chrysobalanaceae)

Licania rigida Benth., Licania tomentosa (Benth.) Fritsch, and Couepia impressa Prance (Chrysobalanaceae family) plants have long been used medicinally by the people from Northeastern Brazil. Crude extracts and infusions of these plants have been applied in the treatment of several conditions such as diabetes and rheumatism, degenerative diseases with involvement of reactive oxygen species (ROS). The aim of this study was to evaluate the aqueous, ethanolic, and hydroethanolic leaves extracts antioxidant capacity of these species, using several in vitro assay systems (reducing power, DPPH● scavenging, the β-carotene linoleate model system and lipid peroxidation inhibition in rat brain homogenate, using thiobarbituric acid reactive substances - TBARS). The oral acute toxicity of aqueous extracts was also evaluated in vivo. Results revealed that these extracts possess a potent reducing power and DPPH scavenging ability, as well as the ability to prevent TBARS formation in rat brain homogenate in a concentration-dependent manner. Regarding in vivo oral acute toxicity of the aqueous species extracts, no toxic effects were observed upon evaluating physiological, hematological and biochemical parameters. The presence of high levels of phenolics and flavonoids was determined mainly in the ethanol extract. However, the C. impressa hydroethanolic extract, fractionated with hexane, chloroform and ethyl acetate for analysis by NMR 1H, showed more efficient results than the reference antioxidant Carduus marianus. The classes of organics compounds were determined were phenolics in the fraction of ethyl acetate and terpenes in chloroform and hexane fractions. The ethil acetate fraction had the highest content of flavonoids and increased scavenging capacity of DPPH●, possibly by the presence of phenolic compounds. Therefore, a detailed investigation of the phytochemical composition and in vivo study of the C. impressa hydroethanolic extract is suggested to characterize the active compounds of the species

Família e TV: mais que dominação e subordinação.

This work analises the social relationship between Television and the Family though the resignification of individuals about Television messages and the speeches that they make about Family. Firstly, the objective is to understand if the principles, values and beliefs constructed and communicated (repassed) inside the Family filter the messages from the Mass Media. Secondly, if there still exists a family culture able to forge identity against so many cultural exchanges. Thirdly, what the function of this identity in the production of senses is. In session 1 and 2, a general approach about the dissemination of Mass Media in Society and the pertinence of the work is presented. Session 3 is about the method used: a qualitative research, with thirteen families from Natal-RN, situated in the Middle Class. The theorical base is considered in the fourth session where the reference to the evolution of the Family is made, with enphasis on the Middle Class and some theories that analyze the pheomenom of the Mass Media , specially in the second half of twentieth century. In session 5 and 6, the research data is presented and analyzed. Finally, in the last session, as a conclusion it can be said that the value of the Family as emotional support is reforced by the speeches and practices that interfere in the signification procces, singular aspects, as well as the social repertoire constructed per si and by institutions (including the family) moreover, mediative message is assimilated by the receiver and becomes understood inside the learned speeches during the receiver‟s history of life, although these messsages are also components in the construction of these repertoire.

Aqui, todo mundo é da mesma família : parentesco e relações étnicas entre os ciganos na cidade alta, Limoeiro do Norte CE

This study aims to understand how facing a context of Constant interaction whit the local population, the gypsies family Alves dos Santos, neighborhood residentes in uptown, Limoeiro do Norte Ce, maintain a sense of ethnic belonging. To that end, I analyze both the social relations between Gypsies and non-gypsies community, as it is from the contact that the social boundaries are delineated, as the discourses and social representations that are used to qualify them from stigma. So, I found that grounded in the notion of family, gypsies are seen as a group, searching the history / past nomadic origing and blood common elements that underlie its condition, and the language a cultural trait that makes it possible to establish objective distinctions among gypsies and other community residentes, becoming thus a diacritical mark.

Mulher chefe de família, na cidade de Aracaju:dominação e poder

The research was focada in the feminine head of family, the City of Aracaju and its impacts in the nuclear familiar nucleus. Considering that, the papers of the men are in general, not valued and rewarded that the papers of the women in almost all the cultures. The women generally load the responsibility to take care of of the children and the domestic work, while the men traditionally are born with the responsibility to support the family. However, we find changes in this mainly north-eastern scene and, where through quantitative research, already one evidenced that they are majority as family support, therefore, we observe the construction of social identities of the women family heads and uncurling of the adaptativos aspects, the existing mechanism between domination and power, in the familiar nucleus. The impacts in the family if had change in the social relation for them to be family heads. One is about qualitative research that has left of the construction of a theoretical landmark, analyzing given of bibliographical sources and from interviews with women family heads, power to observe the forms of joints in the nuclear families, as they deal with the power to decide power, the financial power, the fragility, the domination and the influences of the traditional models. Analyzing the familiar relations between the woman, the children and the spouse, searching the excellent questions for the briefing of the thematic one, demystifying the dichotomy between the mother/wife and woman head of family in the residential environment

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

Família e TV: mais que dominação e subordinação

This work analises the social relationship between Television and the Family though the resignification of individuals about Television messages and the speeches that they make about Family. Firstly, the objective is to understand if the principles, values and beliefs constructed and communicated (repassed) inside the Family filter the messages from the Mass Media. Secondly, if there still exists a family culture able to forge identity against so many cultural exchanges. Thirdly, what the function of this identity in the production of senses is. In session 1 and 2, a general approach about the dissemination of Mass Media in Society and the pertinence of the work is presented. Session 3 is about the method used: a qualitative research, with thirteen families from Natal-RN, situated in the Middle Class. The theorical base is considered in the fourth session where the reference to the evolution of the Family is made, with enphasis on the Middle Class and some theories that analyze the pheomenom of the Mass Media , specially in the second half of twentieth century. In session 5 and 6, the research data is presented and analyzed. Finally, in the last session, as a conclusion it can be said that the value of the Family as emotional support is reforced by the speeches and practices that interfere in the signification procces, singular aspects, as well as the social repertoire constructed per si and by institutions (including the family) moreover, mediative message is assimilated by the receiver and becomes understood inside the learned speeches during the receiver s history of life, although these messsages are also components in the construction of these repertoire

Avaliação do programa saúde da família no Rio Grande do Norte

The Family Health Program implemented in Brazilian municipalities from 1994 represents today the most promising proposal to promote important changes in municipality`s health systems, to allow universal access to health care, comprehensiveness, equity and to promote social control, achievements provided by the health reform process and incorporated to the Unified Health System principles. However, many are the challenges imposed to the Family Health Program so that it can cause these advances. In this study, we aimed to answer the following research question: what are the results of the Family Health Program in relation to beneficiaries at small, medium and large municipalities? The hypothesis that guided this work was that the variation in levels of achievement/results (strict, impacts and effects) of the Family Health Program is related to the size of the municipalities. Therefore, our general aim was to evaluate the results of the Family Health Program in municipalities at Rio Grande do Norte, Brazil. And as specific objectives, to measure strict results, effects and impacts of the Program, from the criteria of efficiency and effectiveness on the beneficiated population, and to measure the Program`s impact on the organization of municipality`s health system. This is an impact assessment research, developed from multiple case studies with quanti-qualitative approach. The study included small municipalities (Acari and Taipu), midsize (Canguaretama and Santa Cruz) and large (Natal and Mossoró). The individuals chosen to the research were users/beneficiaries of the Program and health professionals. Data analysis was performed using descriptive statistics and content analysis compared from the Program`s logical /theoretical model. The results obtained in relation to the principles evaluated (universality, comprehensiveness and community participation) presented that municipalities show different results, although not directly related to the size, but related with characteristics of the Program`s implementation form in each municipality and the arrangements made for its operationalization. The positive effect that generated significant change in people`s lives has been linked to the increase of access and to the decrease of geographic barriers. However, to the municipal health system, regarding the changes desired by the Program, it was not observed a positive impact, but a negative impact related to the increase of barriers for the user to access other levels of the health system

Nas sombras da família coelho: a dinâmica de uma dominação política

As one of the most important cities in the state of Pernambuco, Petrolina is settled in the Pernabucanian backwoods, a place that still holds its own traditions and manners. Petrolina s economy is mainly based on primary activities. It s politics is run by Family groups which preserve themselves and remain in power, using the clientelism, which could be said as a give and get practice. That means that the suffrage is a currency to exchange benefits. The present study analyses facts occurred in the political history of the Coelho s Family, which still dominates the local Politics. They persist as heirs of the old system of Coronelism that is maintaining their power structuring a political machine, which is able to make them unbeatable for over fifty years. Despite of a family internal division, it benefits all of them, directly or indirectly. Based on empirical observation, we set a brief historical of the Coelho s family facts, in order to demonstrate the range of their power through the ancestry, which is to say we ve described the local political labyrinths. Our metodological choices were driven by the comprehensive sociology, through the Weberian ideal types, in order to find the answers for the historical, social and political conformation of the facts, in consonance with the reality. According to that, we ve studied the Coelho s political trajectory from 1968 to 2012, considering the election periods. Commonplace: where a new generation becomes active subjects on a new apprenticeship, moral and intellectual. After all, they are all family heirs