O Serviço Residencial Terapêutico: cartografias de um híbrido no contexto da desinstitucionalização em saúde mental

This thesis seeks to uphold the idea that the therapeutic residential service, as hybrid device and recent process of deinstitutionalization in mental health, works as a problem producer while it also indicates challenges and potentialities in this process, the attention on mental health and on its own care production. To that end, we work with the prospect map with which we approach reality as the subjectivities production field which transformations and intensities are the major thought propellants. From this perspective, it was possible to produce three "purpose maps" from meetings with actors and groups involved with the TRS and the theoretical study carried out. On the first map we mapped the conditions of possibility of this device and its design in the midst of the process of institutionalization and health policies. We indicate on it the TRS configuration as a hybrid and we hassled its proposition as a means of "social rehabilitation" that can work as a social homogeneity mechanism. On a second map, we cartographied mental captures through images and ways historically built from madness presented in the biopolitical contemporary game and we indicated that the resistance to such catches should be built on a politic daily basis as important vectors of the institutionalization process in mental health. Finally, on a third map we mapped the carefulness produced in the TRS, by analyzing the transition psychiatric hospital - TRS and the caregivers´ team work. On this mapping, the care, for the weakness in the coresponsibility field, is reveled crossed by mental, disciplinary and normality elements, but it is also built in resistance born from links in the intersubjective field of the caring work. We conclude, then, that the TRS power and the deinstitutionalization process itself were in building and strengthening affective labor micro political networks of life and liberty producers

Impacto do trabalho em profissionais de Saúde Mental de serviços de saúde do município de Mossoró-RN, 2012

The Psychiatric Reform has brought profound changes in assistance to people affected by mental disorders and behavior. In this context, mental health workers have played decisive roles of great impact, acting driving the process. Objective: To evaluate the impact felt by working professionals, because of the daily work with people who have psychiatric disorders. Methodology: This is a search field, a quantitative approach, sectional, descriptive and applied. Data collection occurred through the Assessment Scale Impact of Working in Mental Health Services (IMPACT-BR) applied to mental health researchers city Mossoró - RN. Results: Participants in this study 87 professionals, mostly female married, which took charge of higher education, working on a single service, working in the area for more than six years, aged between 25 and 64 years. There were a low effect of overloading the professionals surveyed. Discussion: Our results corroborate findings in other surveys conducted previously, not identifying large impact load at work among professionals of mental health teams studied. Subscales studied the highest score was observed in measuring the impact of work on team functioning. It was observed that the greater age and duration of action, reduced the emotional impact at work, suggesting that the experience enhances safety in decisions made and the possibility of greater control over the demands of work. Final Thoughts: The work presented showed that the interactive relationships between professionals and users are not the causes of greatest impact in the workplace, although it revealed overload in relation to specific aspects such as: fear of being assaulted by a patient and the feeling of physical exhaustion the end of the workday. Further investigations should be conducted on this topic in order to contribute to the implementation of psychiatric reform proposed by advances both in terms of assistance to individuals and the quality of life in the work of the professionals involved

Superando a aridez do semi-árido: encontros entre saúde mental e saúde da família na formação de médicos no alto sertão paraibano

A atenção primária à saúde é um importante cenário para o cuidado em saúde mental por suas características e pelo trabalho no território contribuir para a superação do modelo manicomial de atenção. Esta pesquisa partiu do questionamento sobre como acontece a atenção em saúde mental na atenção básica nas unidades em que se desenvolve a Residência de Medicina de Família e Comunidade em um município do sertão paraibano. Objetivou investigar as demandas de saúde mental e práticas de cuidado no contexto de ESF e da RMFC do município de Cajazeiras a partir do discurso dos profissionais ali inseridos e discutir estratégias de qualificação do cuidado em saúde mental nessa realidade. Utilizou-se abordagem qualitativa em que foram realizados grupos focais envolvendo profissionais de duas equipes da ESF e uma equipe de NASF. Os dados produzidos nos grupos foram analisados a partir do referencial da análise do discurso de inspiração foucaultiana. Como resultados evidenciou-se que os profissionais percebem a demanda em saúde mental na atenção básica principalmente na forma de sofrimento psíquico inespecífico e transtornos mentais graves. A atenção a essas pessoas não consegue superar a medicalização que é identificada por esses profissionais. A prática asilar persiste como alternativa para os casos de transtornos mentais graves, sendo limitada a incorporação do paradigma da desinstitucionalização como referencial para a prática profissional. Além disso, a relação com a rede de saúde encontra vários limites destacando-se a dificuldade de produção de continuidade e integralidade do cuidado. A partir disto, analisa-se a formação médica e sua capacidade de garantir o cuidado integral na atenção às demandas de saúde mental. No campo da pesquisa, dois modelos de formação se encontram. Os residentes participantes ou graduaram-se em Cuba ou em escola médica brasileira orientada pelas Diretrizes Curriculares Nacionais. Percebe-se então que a graduação, ao incorporar questões relativas à integralidade do cuidado, não é suficiente para gerar bons profissionais para o SUS. Considera-se necessário somar às mudanças na graduação a perspectiva da Educação Permanente em Saúde no mundo do trabalho, o envolvimento dos profissionais com a transformação das práticas de atenção à saúde e a construção da perspectiva da integralidade e da atenção psicossocial por dentro da Residência de Medicina de Família e Comunidade como importantes estratégias para a formação de médicos generalistas aptos para a atenção às demandas de saúde mental

Desnudando as condições para materialização da reforma psquiátrica em Natal/RN: para além da implantação dos serviços substitutivos em saúde mental

Esta pesquisa objetivou analisar a concretização da reforma psiquiátrica em natal, partindo de um dos serviços substitutivos que compõe a rede psicossocial deste município. A política de saúde mental tem passado por mudanças paradigmáticas, definindo como objetivo maior o processo de desistitucionalização. Redirecionando sua ação para os serviços substitutivos e não, mas o hospital psiquiátrico tradicional. Nesse cenário os Centros de Atenção Psicossocial (CAPS) se mostram estratégicos para materialização dos objetivos pretendidos pela reforma psiquiátrica. O estudo transcorre dentro da perspectiva materialista dialética. A presente pesquisa teve como lócus de investigação empírica o primeiro Centros de Atenção Psicossocial implantado em Natal/RN. A escolha por um serviço extra-hospitalar vai ao encontro de uma postura defendida pelo movimento de Reforma Psiquiátrica. Considerando o CAPS um serviço substitutivo estratégico em saúde mental para a efetivação da Reforma Psiquiátrica, neste sentido objetivamos apreender as contradições que marcam o processo de concretização da Reforma Psiquiátrica através da vivência dos usuários e de suas famílias, no interior de uma unidade integrante do novo modelo de atenção em saúde mental. Partimos do pressuposto de que os usuários e seus familiares são sujeitoschave no processo de reforma psiquiátrica, por vivenciarem em seu cotidiano as mudanças concretas realizadas, que acenam para um processo de re-inserção social, mas também, contraditoriamente, os limites e entraves desse processo

A CRONIFICAÇÃO NOS SERVIÇOS SUBSTITUTIVOS NA REDE DE SAÚDE MENTAL DE NATAL/RN

Brazilian Psychiatry Reform, through Psychosocial Care Strategy, has intended to build insane people care practices from community care services which contemplates the subjects complete lives. However, to change the traditional care ways demands the facing of a series of epistemological, political and cultural obstacles. One of the current challenges deals with patients aggravation processes, with management ways, with devices and with professionals, as well as with the assistance network. The purpose of this thesis was to investigate how these aggravation processes has been constituted in Natal mental healthcare network, understanding its effects in the work teams and patients. Theoretical and methodological perspective used was Institutional analysis was, subsidizing the usage of concept-tools as the implication analysis, selfmanagement and self-analysis, and restitution. The research was carried out at the Natal East Sanitary District Mental Healthcare Clinic, with the participation of technicians and patients. The research procedures were: literature and document research on the attendance and the analyzed theme; attendance registers analysis; participating observation of the institutional routine for three months and field log entries; talking groups, one with the team and one with the patients. Two main discussion points are shown: 1. The mental healthcare clinic organization logic and the intersector politics; 2. The work and management processes developed at the mental healthcare clinic. The analysis show diversity in the attended demands in the service, which has favored the patients aggravation, this device and the substitute network processes. The work processes are apart from the political sphere and from the managements processes. In this sense, we show the need to reevaluate the clinic device as well as the management models adopted in the Brazilian Psychiatry Reform context

Perfis e práticas dos profissionais de saúde mental em dois hospitais psiquiátricos de grande porte

In the Brazilian network of psychosocial care, health professionals are important actors in the process of transformation of mental health public policies among various services. In the reality of psychiatric hospitals, one should understand the need to expand the debate about the current context of practices developed. This study aimed at analyzing the process of psychiatric reform and the mental health policy in the State of Rio Grande do Norte (RN) from the profiles and practices of higher-level professionals in two psychiatric hospitals. This is a cross-sectional and descriptive research, with quantitative and qualitative data, conducted in two psychiatric hospitals of RN. The universe of the target population was 95 professionals, taking into account the margin of error of 8%, non-response rate and the inclusion criteria: holding effective link with the institution by means of approval in public examination for, at least, six months, being state or municipal servant; having a minimum weekly workload of 20 hours in service; participating in care and/or activities with patients and families in a direct way. The final sample consisted of 60 professionals. The tool for data collection was a questionnaire with closed and semi-open questions about socioeconomic profile, and mental health policies, practices and training. Quantitative data were tabulated in the statistical software SPSS, and simple and bivariate statistics, chi-square type, was used for analysis by adopting the significance level with the value p<0,05. In order to analyze data, the content analysis of Bardin was used. The qualitative findings obtained with the semi-open questions in Analyse Lexicale par Context d'un Ensemble de Segments de Texte (ALCESTE) were grouped into four thematic axes: Professional action in mental health; Mental health training; Scenarios of psychiatric reform and psychiatric hospitals; Mental health policies and practices: challenges for professionals in hospitals. The profile of professionals has revealed the majority of women (89,7%), nurses (36,7%), aged 50-59 years (42,9%), weekly workload of 40 hours (52,4% ), time of completion of graduation from six to 15 years (57%), and 21,4% reported to have specialization in mental health. Regarding the practices developed in individual care, it was found an association between those who do not build or partially conducts the therapeutic project and those who conduct care related to observation and annotation. In family care, it was obtained care consultation during crisis; and, in group care, recreational activities. In the analysis of thematic axes, it was noted that, despite changes identified in the profiles and practices of higher-level professionals in care services for mental health, with the implementation of new public policies for this field, the findings indicate the confluence of asymmetries and divergences in the actions of the teams in psychiatric hospitals, difficulties in managing services, frequent readmissions, reduced quantitative of available services and equipment, high demand of users, disarticulation of the network of psychosocial care, and the very shortage of skilled human resources to compose these services. Accordingly, the evidenced scenarios partially outline the current political and ideological mismatch of the national process of psychiatric reform that denies the role of care actions conducted within hospitals, although it has not gone far enough with the creation of new services that justify the total extinction of this institution

A reforma psiquiátrica e a política de saúde mental do Rio Grande do Norte: papéis e funções de profissionais e gestores

This study arose from an interest in knowing the reality of mental health care in Rio Grande do Norte (RN) on the advances and challenges in the intersectoral agreements paths and consolidation of the Psychosocial Care Network (RAPS) from the state. Considering problematic and concerns were defined as objectives: Identify the knowledge of managers of Rio Grande do Norte on the National Mental Health Policy (PNSM) in the RN State; Describe the activities developed by health professionals in the individual service offered in the CAPS from RN; Understanding the relationship of managers’ knowledge on national mental health policy in professionals’ practice working in the the CAPS from the countryside. It is a descriptive study with a quantitative and qualitative approach, carried out in 30 CAPS from RN’s countryside, where 183 professionals answered a structured questionnaire with closed questions about the activities they do in individual care; and 19 mental health coordinators of municipalities and the state coordinator of RAPS were interviewed about their knowledge on the Mental Health Policy. Data were collected after approval by the Research Ethics Committee of the Federal University of Rio Grande do Norte, with the number 508.430 CAAE: 25851913.7.0000.5537 from August through October of 2014 in 26 municipalities with CAPS from the state. Quantitative data were tabulated and analyzed using a descriptive statistics aided by the software Statistical Package for the Social Scienses (SPSS) version 20.0. The qualitative data were prepared in a corpus and analyzed through software Analyse Lexicale par Contexte d’um Ensemble de Segments de Texte (ALCESTE) that allow to perform textual statistical analysis and categorization from their comments, submitted to Bardin content analysis. Five categories were generated approaching the managers’ knowledge, namely: Back to society: leadership and users’ role and autonomy; The gap between policy and practice; Barriers that affect the service; Structuring the Psychosocial Care Network; Multidisciplinary team: attribuitios and activities. The CAPS professionals’ ages ranged from 20 to 58 years, prevailing females, with 76.5% of the total, the majority were social workers (16.8%), psychologists (15.3%), nurses (14.8%) and nursing technicians (14.8%). The results showed precariousness in care associated with physical workload regard to high workload and low wages of the CAPS professionals' and, also, it was possible to observe a large involvement of professionals in care delivery, despite the difficulties encountered in services. It was found little knowledge in managers regarding the National Mental Health Policy having as causes of this reality the poor education and training of these professionals. The responses of professionals working in care reveals strong consistency with what is expected of a psychosocial care service. Points up as a thesis of this study that the psychiatric reform and mental health policy in Rio Grande do Norte is following a structural expansion process, but with precariousness of services from a still unprepared management to act in a psychosocial context.

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.

Cuidado psicossocial em saúde mental: estudo em assentamentos rurais do Rio Grande do Norte

Dwellers of agrarian reform settlements have a life conditioned by poor living and work conditions, difficulties accessing health programs, social assistance and other public policies and by this exacerbating their psychosocial and environmental vulnerability, which has an impact on their mental health. This research investigates the availability of support by the health and social assistance staff, regarding the demands of common mental disorders and alcohol abuse of dwellers of nine settlements in Rio Grande do Norte. Fifty three experts from different professional categories were interviewed individually or in groups. The results indicate that the workers suffer from poor working conditions, attributes of patrimonial heritage and welfare, which still survives in Brazilian social policies and particularly at local administrations of the countryside. The staffs have little knowledge of the local conditions and of the mental health needs, which has a negative impact on the reception and offered care. The implemented health care still corresponds to the biomedical logic, characterized by ethnocentrism, technicality, biology, cure, individualism and specialization, with little participation of the dwellers and disregarding the traditional knowledge and practices of local health care and by this not achieving the expected results. The psychosocial attendance is not well coordinated, presenting problems with the follow-up and continuity of care. The psychosocial mental health care in rural context has to face the challenge of the reorganization of the health care networks, the establishment of primary health care close to the people’s everyday life, building intersectional practices considering a health multidetermination and health education connected to these specific contexts. Due to the lack of knowledge of the specifics of the life conditions of the dwellers and the fragmentation of the psychosocial health care network, these staffs do not abide and are not ready to face the mental health needs in order to interfere with these health iniquities.

Cuidado psicossocial em saúde mental: estudo em assentamentos rurais do Rio Grande do Norte

Dwellers of agrarian reform settlements have a life conditioned by poor living and work conditions, difficulties accessing health programs, social assistance and other public policies and by this exacerbating their psychosocial and environmental vulnerability, which has an impact on their mental health. This research investigates the availability of support by the health and social assistance staff, regarding the demands of common mental disorders and alcohol abuse of dwellers of nine settlements in Rio Grande do Norte. Fifty three experts from different professional categories were interviewed individually or in groups. The results indicate that the workers suffer from poor working conditions, attributes of patrimonial heritage and welfare, which still survives in Brazilian social policies and particularly at local administrations of the countryside. The staffs have little knowledge of the local conditions and of the mental health needs, which has a negative impact on the reception and offered care. The implemented health care still corresponds to the biomedical logic, characterized by ethnocentrism, technicality, biology, cure, individualism and specialization, with little participation of the dwellers and disregarding the traditional knowledge and practices of local health care and by this not achieving the expected results. The psychosocial attendance is not well coordinated, presenting problems with the follow-up and continuity of care. The psychosocial mental health care in rural context has to face the challenge of the reorganization of the health care networks, the establishment of primary health care close to the people’s everyday life, building intersectional practices considering a health multidetermination and health education connected to these specific contexts. Due to the lack of knowledge of the specifics of the life conditions of the dwellers and the fragmentation of the psychosocial health care network, these staffs do not abide and are not ready to face the mental health needs in order to interfere with these health iniquities.

Matriciamento em saúde mental: atuação de núcleos de apoio à saúde da família

In the context of break with psychiatric hospitals, the Brazilian Psychiatric Reform is a historical process of reformulation of knowledge and mental health practices. In this way, the Centers of Support for Family Health (NASF) have been acting in the supply of matrix support in mental health. So, the present research aims to analyze the actions which the NASF is taking for the matrix support in mental health in the city of Natal/RN. This is a kind of research descriptive, exploratory and qualitative. The data collection, was made by a direct observation of the professional pratices and semi-structured interviews with health professionals NASF's. The Data were analyzed according to thematic analysis technique, with the support of the content analysis method, which is a way to investigate clusters of meanings which make up the communication of the investigated object. Three analytical categories were organized by this method, whose titles were inspired in two theories in the health field called “Health to Paidéia” and “Expanded Clinic”. The name of the categories are: 1. “Mental illness in brackets: working dimensions of the Centers of Support for Family Health interfaces with the concrete subject”, which is about the work process of NASF; 2. “Freedom and engagement in the arrangement of matrix support in mental health”, which explore the matrix support limitations in mental health in Natal/RN from the professionals interviewed at the NASF’s; 3. “Between the desire and interest: influence of expert orientation in mental health in Psychosocial Care Network” (RAPS), which is related to matrix support in mental health, as an organizational arrangement responsible to ensure intersectoral and comprehensive care, strategies inside of context of the constitution of RAPS. We can extract and say that the actions of NASF teams in the brazilian city called Natal/RN, still not part of a structured link with health care networks, as happens with the absence of discussions and lack of professionals in the matrix support. In addition, there is a difficulty to do an specialized orientation in mental health because of the lack of human resources in this area and of the insufficient number of the replacement services for psychiatric hospital pratices, bringing up the discussion about the consolidation and expansion of RAPS in fact investigated.

Articulação entre saúde mental infanto-juvenil e atenção básica em Natal-RN: limites e possibilidades

In the case of Brazilian Psychiatric Reformation, mental health juvenile reveals itself as a great challenge, with major gaps in terms of needs, services and actions on mental illness in children and adolescents. This research is a qualitative study of descriptive and exploratory, having to analyze the actions and practices of mental health juvenile articulated between the Psychosocial Care Center juvenile (Caps i) and the basic care in Natal-RN, and specific, identify the limits and possibilities for an important precedent of the care network. After submission to the Research Ethics Committee (CEP) of the University Hospital Onofre Lopes (HUOL) of the Federal University of Rio Grande do Norte (UFRN) obtained approval contained in opinion number 777.067 / 2014. For the data collection, it was initially carried out a documentary research in the Municipal Health Department of Christmas about the phenomenon under study, and subsequently, applied semi-structured interviews with the subjects of the research, which were workers Caps i of Natal-RN. The analysis was woven as the thematic analysis technique, understood within the method of content analysis. The results and discussions were organized by categories and subcategories, namely: CATEGORY 1: Limits and weaknesses in the linkage between the Caps i and basic care, with the subcategories: 1.1 Lack of specialized services and devices articulators in network, 1.2 The diversity of situations in the demand juvenile assisted; CATEGORY 2: possibilities for an effective network, with the subcategory: 2.1 Intersectoral collaboration as a strategy for solving attention. The analysis revealed that the integration and coordination of mental health services juvenile and primary care in the city of Natal-RN, has incipient initiatives and/or inadequate for the resolvability intersectoral, where the devices of attention to health involved cannot establish bonds effective and long-lasting in the perspective of co-responsibility and sharing of care. On the other hand, it appears that the existing shares and practiced, configure an exercise in approximation to the dialog between mental health juvenile and basic care. It is highlighted that the shared care and the establishment of intersectoral collaboration within and outside of the health sector is possibility of facilitating the necessary dialog between the services and professionals involved, thus, enabling a better prospect of resolvability of the Network of Psychosocial Care for the youth in reality being investigated.

Avaliação da terapia comunitária na atenção primária à saúde

A busca por um modelo democrático de saúde despertou a atenção do governo brasileiro para o estabelecimento de prioridades e estratégias, que impulsionaram a implantação do Programa de Saúde da Família (PSF), atualmente denominada Estratégia Saúde da Família (ESF), a fim de aproximar a equipe de saúde da comunidade e, assim, implementar ações de promoção da saúde e de prevenção do adoecimento. Nessa perspectiva a Terapia Comunitária (TC) emerge como uma tecnologia de cuidado voltada à saúde mental na Atenção Básica de Saúde. Desde 2007, a TC vem sendo desenvolvida no município de João Pessoa/PB por profissionais da ESF: enfermeiras, agentes comunitários de saúde, médicos, odontólogos, fisioterapeutas, nutricionistas, psicólogos, entre outros. O estudo teve como objetivos: avaliar a satisfação dos usuários em relação à TC na Atenção Básica no município de João Pessoa/PB; medir o nível de satisfação dos participantes da TC em relação a essa ferramenta do cuidado; identificar elementos importantes para a satisfação em relação à TC por parte dos usuários. Trata-se de um estudo avaliativo, transversal e observacional, realizado no período de maio a agosto de 2009. Utilizou-se como instrumento de coleta de dados a Escala de Avaliação da Satisfação dos Usuários com os Serviços de Saúde Mental Satis-BR, bem como um instrumento de perguntas complementares utilizado pelos terapeutas comunitários. Os resultados revelaram que dos 198 (100%) entrevistados, 105 (53%) verbalizaram satisfação e 93 (47%) muita satisfação nos encontros de TC, o que evidencia que a totalidade da amostra está satisfeita com a terapia. Os elementos importantes que concorreram para a satisfação dos usuários da TC foram: respeito, dignidade, escuta, compreensão, acolhimento, apoio nas necessidades e boas instalações dos locais onde ocorre a terapia. A TC vem fortalecendo o cuidado à saúde mental, por se constituir como uma tecnologia de prevenção e fortalecendo a porta de entrada para a rede de saúde mental e de apoio psicossocial. Conclui-se, portanto, que a TC vem se destacando como instrumento de inclusão da saúde mental na Atenção Básica no atendimento aos usuários do Sistema Único de Saúde

Qualidade de vida do servidor da Universidade Federal do Rio Grande do Norte em condição crônica de saúde

The study aimed to analyze the influence of chronic health conditions (CHC) on quality of life (QOL) of UFRN servers assaulted by CHC. It is a descriptive and cross-sectional study with prospective data and quantitative approach, accomplished in the ambulatory clinic of the Department of Server Assistance (DSA) of the Pro-Rectory of Human Resources, during three months. The sample was composed by accessibility, totaling 215 people, being 153 active and 62 inactive servers, in chronic health condition. The data were collected through the application of the sociodemographic characterization, health, environmental and laboral form, the Medical Outcome Study 36-Item Short Form (SF-36). The study was evaluated by the HUOL Ethics Committee (CAAE no. 0046.0.294.000.10), obtaining assent. The results were analyzed in the SPSS 15.0 program through the descriptive and inferential statistics. It was identified servants predominantly male (59,1%), under 60 years old, married or in stable union, Catholics, brown color, living in the capital and residents in own home. Regarding labor issues, there was a predominance of active servers technical-administrative with intermediate and medium level positions and small proportion of docents. Among the CHC, the non-communicable diseases - NCDs (95.8%) had a higher frequency, followed by persistent mental disorders - PMDs (18.6%) and, finally, the continuous and structural physical deficiency - CSPD (16.9 %). The QOL of servers was considered good, with a mean score of 72.5 points in the total score, with the most affected domains: physical (59.1), general health (66.2), bodily pain (66.3) and functional aspects (72.0). The mental health dimension (76.5) had a better average than the physical dimension (68.0 points). It was found that the decrease in QOL scores is significant statistically related to higher number of CHC (ρ <0.001), with no statistical significance regarding the functional situation (p = 0.259). The administrative technicians of elementary, primary, secondary levels and docents had the worst QOL scores. After the correlation analysis of CHC with the domains and dimensions of the SF-36, there was statistically significant, negative and weak correlation of the domains: functional aspect (ρ = 0.002, r = -0.207), physical aspects (ρ = 0.007; r = -0.183), vitality (ρ = 0.002, r = -0.213), social function (ρ = 0.000, r = -0.313), emotional aspects (ρ = 0.000, r = -0.293), mental health (ρ = 0.000 , r = -0.238), physical health dimension (ρ = 0.002, r = -0.210) and mental health dimension (ρ = 0.000, r = -0.298). The presence of PMD isolated or together, contributed to a lower SF-36 scores, being the domains variation of mean significant, except for bodily pain, general health and physical aspects. By correlating the categories of CHC and QOL, there was a weak correlation (r ≤ -0.376) and significant (ρ ≤ 0.011), mainly related to the NCD, PMDs and NCD + PMD, affecting the mental health, social function, emotional aspects, vitality and functional aspect domains. Front of the results, it was concludes that the servers quality of life is influenced by the CHC. Thus, it was inferred that the presence of CHC causes a negative effect on quality of life, leading the active and inactive servers to exposure their overall life activities and work over the years, due to the morbidity affected, mainly related to NCDs and PMDs. Descriptors: Quality of life. Chronic disease. Occupational Health. Nursing

Repercussões da terapia comunitária no processo de trabalho na estratégia saúde da família: um estudo representacional

The Community Therapy (CT) is in a practice of therapeutic effect and may also be considered as a technology takes care of the therapeutic procedure group, whose purpose is to promote health, prevent illness, developed within primary care in mental health. In this study we sought to understand the social representations of health professionals who work with the Community Therapy, on use of the Family Health Strategy (FHS) in the city of Joao Pessoa. This is a field research with a qualitative view Moscovician Theory of Social Representations, held with seven professionals of the FHS, therapists of Community Health District II. The empirical data were obtained by carrying out two thematic therapies in April 2009, which were wheeled CT. It was used as a technique for analyzing the collective subject discourse, and the data presented through graphs, charts, maps, pictures and graphics and arranged in three stages: Subjects of the study, characterizing the study participants; Social Representations of Therapist Community presenting and discussing the social representations of therapists community studied on CT, and Consequences of Community Therapy at the Family Health Strategy, discussing the meanings attributed by the study participants about changes in FHS. Meanings were attributed to the CT by the therapists studied originated from the speeches, songs, drawings and constructed, and that presented by schematic illustration show the relation between the representations: life, listening, faith / light, change, transformation. The web, symbol of CT, appeared on the images constructed by the representatives of the study and represents the formation of bonds that allows the construction of social support networks that strengthen relationships among community. In the study, proved by professionals who have the meanings about the changes in the work process from the introduction of CT, and shown that the change took place within a more welcoming attitude on the part of professionals, the relationship between Team members had no significant changes, explained by the low compliance of team members to the CT in relation to the user front, the bond was strengthened, and this involved strengthening the role of the therapist community. It is recognized, thereby transforming the character of CT in building links with users, requiring, however, that the team is viewed as offering therapeutic services, not the professional therapist. Therefore, the CT for being a new phenomenon in health services and community belonging, it fits like a novelty which affects the construction of a representation dispute. Still, can contribute to the reorganization of mental health care in line with the new model of mental health care advocated by the Psychiatric Reform.