O trabalho em equipe na atenção primária à saúde: situação de Portugal e do Brasil

Introdução: Na Atenção Primária à Saúde, nos contextos internacional e nacional, o trabalho em equipe tem sido reconhecido como estratégia decisiva para a organização de processos que visam à integralidade do cuidado, além de possibilitar melhorias na satisfação dos usuários com os serviços de saúde. Neste sentido, o objetivo, deste estudo, é analisar o trabalho em equipe na Atenção Primária à Saúde. Método: Trata-se de uma pesquisa em banco de dados secundários. Realizou-se três estudos: a) O trabalho em equipe na Atenção Primária à Saúde, em Portugal, pesquisa avaliativa, de natureza qualitativa, tipo estudo de caso descritivo, que representou um recorte dos resultados derivados da pesquisa integrada ao projeto “Implantação das Unidades de Saúde Familiar em Portugal”, que teve como procedimentos entrevistas semiestruturadas, roteiro de coleta de informações (check list) e análise documental. Foi realizada a estratégia de triangulação dos dados com análise de conteúdo; b) trabalho em equipe, acesso e qualidade na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 17202 profissionais e 65391 usuários. Utilizou-se entrevista estruturada, com análise estatística realizada pelas frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. c) satisfação dos usuários com o trabalho em equipe na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 65391 usuários. Realizou-se análise estatística das frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. Utilizou-se, ainda, o Teste X2 , com nível de significância de 5%; análise de regressão logística múltipla. O modelo final foi ajustado pelo teste de Hosmer/Lemeshow, o qual indicou um ajuste de 66%. Resultados: Sobre o trabalho em equipe na Atenção Primária à Saúde, em Portugal, destacou-se a formação das equipes de forma voluntária, por meio de afinidades pessoais, a existência de “carteira básica de serviços”, juntamente com x intervenções de vigilância, promoção da saúde e prevenção de doença, cuidados em situação de doença aguda, acompanhamento clínico de doença crônica e de patologia múltipla, cuidados domiciliares, interligação e colaboração em rede com outros serviços (cuidados hospitalares), sistemas informatizados nas unidades de saúde. Os dados revelaram dificuldades quanto ao atendimento domiciliar. No Brasil, foi destaque o processo de trabalho, com avanços relacionados a realização de planejamento e programação das ações e o apoio da gestão. Existência de território definido e de prontuários familiares. É destaque a agenda compartilhada e pactuada entre os profissionais. As equipes realizam acolhimento e reuniões, cujos temas, discutidos, giram em torno do processo de trabalho e planejamento. Os desafios, enfrentados, estão relacionados ao agendamento dos usuários; ao número de pessoas sob a responsabilidade das equipes; à existência de população descoberta nas áreas adscritas à Unidade de Saúde; à incipiência na ação intersetorial e ao pouco envolvimento da comunidade pelas equipes. Quanto aos fatores associados à satisfação do usuário foi marcante: a faixa etária; a escolaridade; a raça; se a falta de material prejudica o atendimento e se a equipe consegue marcar consulta para outros profissionais. Conclusões: Constatou-se o trabalho em equipe como elemento central no processo de mudança na Atenção Primária à Saúde, tanto no contexto de Portugal quanto no do Brasil, o qual ampliou o acesso e a qualidade na oferta de serviços de saúde e obteve, ainda, o reconhecimento social, mesmo que, em ambas as realidades, não tenha avançado na coordenação do cuidado e no estímulo à participação social. Os fatores, associados com a satisfação do usuário, estão relacionados diretamente ao cuidado prestado e refletem a expectativa, por parte do usuário, de resolução concreta de suas necessidades.

Condições de trabalho e saúde psíquica de servidores técnico-administrativos da UFRN

Unfavorable working conditions constitute one of the factors that may contribute to cause psychic suffering and behavioral disorders in workers. This research aimed to characterize the working conditions public servant technical- administrative , specifically the auxiliaries and assistants in administration of the Federal University of Rio Grande do Norte – UFRN, Natal, Brasil, as well to identify the incidence of psychic suffering in this group of public servants. As a strategy, we chose a case study of multi-method type, descriptive with quantitative and qualitative sequential steps. For this, it initially performed desk research by surveying epidemiological data for these public servants working in central campus, to identify the major diseases presented in the period from January 2011 to June 2014. Then, we proceeded to diagnostic step of the aspects related to work, by applying online and in loco of Working Conditions Survey (already validated by Borges et al., 2013a) in 11 sectors selected according to the following criteria: high number of workers public servants and major and minor percentage of absences for health care for ICD-F (according to records of Sector of Workers Health Care - DAS). In the treatment of the data the spreadsheet editor software Microsoft Office Excel and statistical SPSS Statistical Package for Social Sciences were used and made qualifying type of content analysis of open questions. Applied to this study 174 public servants and the results show a predominance of absenteeism due to mental or behavioral disorders (ICD F), musculoskeletal diseases (ICD M) and respiratory system (ICD J). Among the factors that were significant are the working hours (contractual and legal); Physical Effort (M = 2.59) and workspace (M = 2.58) - physical and material conditions; encouraging collaboration (M = 3.5) - processes and characteristics of the work; and participation (M = 1.78) - social-management environment. Therefore, it infers the existence of a relationship between these factors and some of the reasons for absenteeism reported by participants. It is suggested the expansion of this research with studies involving other professionals (including scholarship workers and contractors) and specific sectors.

Síndrome de Burnout : um estudo com guias de turismo regional em Natal-RN

Burnout is a psychological syndrome triggered in response to continuous exposure to interpersonal stressors. It is considered a multifactorial construct, which is commonly characterized by three dimensions: emotional exhaustion, dehumanization, and lack of personal accomplishment.This study aimed to verify if the three characteristics of burnout (exhaustion, lack of dehumanization and personal accomplishment) are present in people working as guides Tourism in Natal - RN. It is a descriptive and quantitative study. 109 subjects were surveyed. Data collection was done through the use of questionnaires, the instrument used was the characterization of the Burnout Scale (ECB) created and validated in Brazil by Trocoli and Tamayo (2000). In order to analyze data we used descriptive statistics, analysis of core measures, exploratory and confirmatory factor analysis, reliability analysis, cluster analysis, multiple discriminant and Spearman correlation. Factor analysis identified four factors that explain 58.3% of the total variance. Those factors were named exhaustion, deception, avoidance, and dehumanization. The reliability of the instrument, as measured by Cronbach's Alpha was 0.918, which is considered excellent reliability. The 109 subjects were grouped into three cluster, which had the deception, avoidance, and dehumanization as discriminant. It is possible to conclude that the characteristics of burnout syndrome are present in the studied population where 19 people are on the high level of burnout, moderate in 32 and 56 in the light. The correlations between socio-demographic variables studied and the dimensions of burnout, were few and weak. The variable leave for health reasons in the study appeared to be related to feelings of exhaustion and avoidance behavior appeared related to younger individuals and who work only in the activity of Receptive Tourism Guide. Verification of the incidence of burnout in individuals surveyed suggest the need to adopt intervention strategies are individual, organizational and / or combined

Representações sociais sobre o acidente de trabalho em saúde

The aim of the present study was to identify the representational elements of workrelated accidents in the health field, as well as investigate their most frequent occurrences at a university hospital, seeking to understand the cognitive, affective and social elements subjacent to the work process involved in health. The analysis focused on 470 middle and senior support staff of this hospital, based on the theoretical-methodological support of the Social Representations Theory. A combination of the following instruments was used for data collection: a free wordassociation test, a questionnaire, an interview and a field journal. Evoc 2000 software was used to identify representational structure. Chi-square and Mann-Whitney tests, at a significance level of 5%, were performed to verify the association between the independent variables and the occurrence of work accidents. In addition, thematic content analysis and lexicographic analysis by ALCESTE software program were used to understand textual content. It was observed that social representations of work-related accidents in the health area are centered in the contamination category, while the categories of prevention and professional unpreparedness are found peripherally. There was a significant association between the existence of multiple employment, the use of personal protective equipment (PPI) during work, job satisfaction and the occurrence of work accidents. The conclusions indicate that perforating-cutting occupational accidents predominated in the hospital and that the representations of the subjects intertwined, with a traditional discourse of work accidents strongly present in Occupational Health. It is therefore suggested that certain subjective aspects related to culture, in terms of controlling work accidents, such as: management, process, organization and the increasing precariousness

Nutrição social no Brasil: [mais] uma estratégia biopolítica?

Inspirés par la « méthode » artisanat intellectuel propose par le sociologue Wright Mills, notre étude porte sur la formation du champ de pratiques discursives et non discursives (Michel Foucault) de la nutrition sociale dans le contexte de la société brésilienne dans lequel s insère le champ de la santé. Le travail empirique s épuise sur une source de documents normatifs de ce champ et s oriente à vérifier et à comprendre comment le praticien de la nutrition émerge dans le scènario des pratiques de la santé au Brésil à partir du milieux du 20ème siècle, tout en construisant son « regime de vérité » fondé dans des processus biopolitiques du champ de la médecine sociale. Nous avons relié deux phénomènes: a) l émergeance du champ biomédical de la nutrition comme une instance biopolitique, en approchant cette formation à l'histoire de la médecine sociale, depuis ses débuts européens jusqu'au contexte brésilien ; b) les pratiques discursives et non discursives du champ de la nutrition lequel est compris dans le Sistema Único de Saúde (SUS - Système Unique de Santé) brésilien. La démarche de recherche comprend l'élaboration et analyse d'une archive composée de publications qui contiennent l'Histoire du praticien de la nutrition au Brésil et des publications officielles disponibles dans le site web « Política Nacional de Alimentação e Nutrição » (Politique Nationale d'Alimentation et de Nutrition) lesquelles sont considérées comme des guides d actions des praticiens de la nutrition sociale dans le Sistema Único de Saúde (SUS). Le concept de biopouvoir, décrit par Michel Foucault entre 1974 et 1979, et la notion de biopolitique, dans son sens réinterprété et mis à jour par Giorgio Agamben, Antônio Negri et Michael Hardt, ont fourni le support théorique de cette recherche

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

Avaliação da capacidade para o trabalho do servidor público: um estudo de caso em uma instituição federal de ensino superior

The ability to work, considered as resulting from a dynamic process between the individual resources in relation to their work, influenced from various factors such as sociodemographic, lifestyle, aging process and requirements of work. Aiming analyze the ability to work in a population of public servants, the study analyzed 132 public servants volunteers of the infrastructure sector, in a Federal Institution of Higher Education of the state of Rio Grande do Norte, Northeast, Brazil. Data were collected through a questionnaire called the Index of Capacity for Work - ICT. The variable analysis was done by using descriptive statistics of means, standard deviations, median minimum and maximum values of the scores of quantitative variables. The joint analysis of the variables was performed by multiple linear regression. The server had low capacity to work 11 (8.33%), moderate 31 (23.48%), good 54 (40.91), and Great 28 (21.21). Multiple regression analysis, adjusted for age, sex, education, age started to work, length of service, current capacity and full of disease, showed that best explained the variation of the CTI were age, current capacity and full of disease. The survey showed that 75% of the servers showed ICT below 43, so capacity low, moderate or good and only 25% of respondents had the CTI servers over 43 points, so great capacity for work. According to the recommendations of FIOH - Finnish Institute of Occupational Health, for servers that have these scores be implemented whose objective is to restore the ability to work which is low, improving the capacity for moderate work, support the capacity for the good work and maintain the ability to work great. Therefore, we recommend that the ICT is implemented in other units of the IFES survey in the perspective of achieving a real situation of all its servers, enabling the implementation of these measures as necessary to promote recovery and health of its employees.

Análise da atividade de trabalho profissional de gerentes de hotel à luz da abordagem da ergonomia

This Masters degree dissertation presents a research that aims at analyzing the activities regarding within a hotel managers work in Natal/RN - Brazil, This Masters degree dissertation presents the research that aims at analyzing the activities regarding the hotel managers work in Natal / RN - Brazil, performing diagnosis of their activities and relating the aspects that impact the quality and productivity of hotel services and managers occupational health. This research is characterized as a case study with a qualitative approach, taking the method of Ergonomic Work Analysis which is the analysis of the managers work activity as a reference to the focus; and combining the use of observational and interactional methods. Ergonomics and macroergonomics are used in this study not only to understand the physical, cognitive and organizational constraints of the manager s duties, but also to characterize the work organizational architecture and design of that hotel. High workload, accumulation of tasks and diversion of functions performed by managers were noticed, increasing thereby the physical and psychological suffering for them. It was found that the activity of managers is characterized by the ambivalence of power, limited autonomy, cooperation, interdependence between managers and the fear of incompetence. It was also noticed that managers devote more time to the day job (37%), another time to sleep (30%), while only 33% of the rest of the day are meant for activities like taking care of health, family, social life and study. Although there are few studies addressing the health and safety of hotel managers, this research revealed that 84% of the surveyed hotel managers complain of musculoskeletal pain which 50% are obese and are 100% sedentary. It was also observed that managers adopt unsuitable postures for carrying out the work activities that contribute to becoming injured or work-related musculoskeletal disorders in the near future. Ergonomic measures were recommended as an investment in the skills and the training of managers, encouraging cooperative work, appropriateness of workload, limiting overtime, preserving the enjoyment of breaks during work and weekly holidays, changing the layout of the work sector , usage of communication technology to prevent displacement, compensatory physical activities, furniture adaptation, among others

Relação das condições socioeconômicas com as condições de saúde bucal em capitais brasileiras

Despite the improvement of Brazilian s living conditions in recent decades, this improvement occurred in a polarized way between groups of better social position. Then, there is still a health inequity´s panorama in Brazil which encompasses the oral health state. This panorama instigated the attainment of this ecological study that aimed to evaluate the relationship of socioeconomic conditions, and public health policies with oral health status in Brazilian capitals. Thus, we performed factor analysis and linear regression using oral health indicators collected from SB Brasil 2010, of socioeconomic conditions from Brazilian Census 2010 and related to water´s supply fluoridation from SISAGUA. Factor analysis with indicators of living conditions revealed two common factors, economic deprivation and socio-sanitary condition. Economic deprivation showed statistically significant positive correlation with DMFT 12 years (p= 0,03) and mean missing teeth (p = 0,002) and negative correlation with caries-free population (p=0,012). Socio-sanitary negatively correlated with DMFT (p <0,0001) and a positive correlation with caries-free population (p = 0.002). Fluoridated water had a significant association with DMFT (p <0,0001), mean missing teeth (p <0,0001) and caries free population (p <0.0001). Multiple linear regression analysis for the DMFT of capital was estimated by socio-sanitary condition and fluoridation, adjusted by economic deprivation, whereas the model for the mean missing teeth was estimated only by fluoridation and economic deprivation, and finally the model the rate for the population free of caries in Brazilian capitals was estimated by economic and socio-sanitary status adjusted fluoridated water supply. Therefore, factors related to living conditions and public policies are intrinsically linked to tooth decay issues. Thus, actions, beyond dental care assistance, must be development to impact positively in social and economic conditions, especially, between the most vulnerable populations

Reflexões sobre a política de descentralização em saúde: uma análise a partir do Hospital Monsenhor Walfredo Gurgel em Natal (RN)

The process of decentralization of health policy in Brazil has evolved throughout the second half of the twentieth century, advancing by leaps and bounds in the last two decades. The various public institutions have assumed the function of responding to a growing demand for medical care and hospital. Monsenhor Hospital Walfredo Gurgel - H.M.W.G. fits into this context as an institution par excellence-oriented service the demand for medium and high complexity. This paper presents some questions about the process of decentralization and devolution occurred in Brazil. To do so is a brief historical background and politics, showing the concepts of reform and counter-reform and how the processes mentioned in the Country Correlates develop local social development of the decentralization process and discusses the modifications in policies social intervention in recent decades and the state health policies. Presents the implementation of a Health System in Brazil and the state showing how the decentralization of health policy occurs in Rio Grande do Norte. Finally, it explores the role of H.M.W.G. in health policy in RN. For this, portrays the institution and is located within the decentralized structure of health policy in the state and capital. An analysis of the demand for hospital care and the budget situation is realized at the close of work, correlating the role of HMWG with the decentralization of health policy in Brazil and Rio Grande do Norte. The methodology used for the preparation of this work was based on documentary research, systematic nonparticipant observation, field diary and analysis of data, documents and content. This set shows a quantitative and qualitative methodology that strips the institution, enabling the understanding of their role, boundaries, threats and opportunities

Serviço Social Audit Saúde no SUS/RN: projeto ético político profissional e de reforma sanitária

Health policies in Brazil, the decentralization of SUS management responsibilities for the three spheres of government has driven the creation and regulation of the audits of health services in the National Audit Office, this is a trend of neoliberal policies imposed by international bodies like the World Bank and IMF to peripheral countries characterized by productive restructuring and reforming the state focuses on the presence of two competing projects in the area of health: Health Sector Reform Project which is based on the democratic rule of law with the assumption of health as social right and duty of the State in defending the extension of the conquest of rights and democratization of access to health care guaranteed through the public financing strategies and the effective decentralization of decisions pervaded by social control and privatized Health Project which is based on the state minimum, with a reduction in social spending or in partnerships and privatization, stronger nonprofit sector, subject to capitalist interests, is made effective through strategies targeting health policy and refilantropização actions. In this context, the present study is an analysis on the work of social audits of public health in infants from a qualitative and quantitative approach, embodied by the critical method of dialectical Marxist social theory that enabled us to unveil the characterization, the demands, challenges and outline the profile of Social Work in teams inserted audits of SUS in RN, but also provided evidence to demonstrate the prospects and possibilities of this area of activity of social workers. It was also found that through the audit work that the state fulfill its role as bureaucratic and regulator of health services with efficiency, effectiveness and economy. Yet, paradoxically, the audits of SUS may provide a vehicle for enforcing rights and ensuring the fundamental principles contained in the project of health reform, because it can be configured in a space of political struggle as representing a new field of knowledge production that needs to be appropriate for a theoretical critic able to redirect the social interests in favor of the user. From this perspective, it is concluded that the work of social audits of public health in infants despite the social relevance that prints, as they constitute an activity study of reality and its transformation proposition requires a transformative political action guided the discussion Marxist theory holds that the ethical project professional politician of Social Work

As condições de trabalho na área de saúde e o processo de adoecimento da (o) assistente social

The requirements in the world of work in the contemporary impact on quality of life, health workers in their relations with users and other professionals of the healthcare team. Given this reality, this study discusses the working conditions in health and disease process of (a) having social goals as analyze the implications of working conditions in the disease (the) social workers in state hospitals Metropolitan Region Christmas (NMR); identify the main diseases affecting social workers in hospitals in the SESAP NMR and reveal the relationship between the disease processes of social and working conditions in hospitals in the state NMR. The research was guiding questions to reveal how to configure the work, conditions of work and of the disease process (the) social worker. To grasp the socioeconomic profile of (the) social workers, the characterization of the work, duties and responsibilities in the sociooccupational, factors that interfere with the disease process of (the) social workers of RMN, and actions and investments Policy on Occupational Health RN correlating to illness today is that we set for the unveiling of the movement of the object of study through the methodological approach with documentary research aimed at literature review; extensive direct observation correlated to real life observation and application of 66 (sixty-six) questionnaires. The data from the closed questions were treated using the Statistical Package for the Social Sciences (SPSS). The open questions were transcribed and then analyzed the light of theoretical work on the subject. The research reveals that social workers are subject to conditions and labor relations precarious illness causing health problems because some of these professionals, among them are: stress, allergies and skin conditions or, Read / WMSD among other diseases. Thus, we understand the need for debates about the relationship work (the) social worker and worker health before the contradictions of capital also present in public health services

A saúde ambiental e os resíduos de serviços de saúde nos três níveis de complexidade do Sistema Único de Saúde - SUS

The environmental management in the health establishments is a reality still little explored in the health sector in Brazil, especially concerning its wastes. The management of wastes of health services is established in the valid legislation through the National Council of Environment and Sanitary Vigilance Agency (358/2005 and 304/2004 respectively). The present work is about a descriptive work about the environmental health in the health services. The used criterion was to diagnose the environmental management in twelve establishments of health inserted in the three levels of complexity of the Unique Health System (Sistema Ùnico de Saúde SUS). Among the sub criteria used the waste management is the one of bigger concern. The one referring to the water quality is considered good. The analysis of data reveals that 66% of the establishments got a poor environmental ranking, 17% critical and 17% appropriate, showing that the health establishments in the three levels of complexity of the SUS need urgent structural, environmental and educational interventions

A mineração artesanal e de pequena escala em pegmatitos e cerâmica no município de Parelhas, região do Seridó/Rio Grande do Norte

The working conditions, occupational health, occupational illness and workers quality of life, usually referring to the artisanal activities and the workers with a poor professional support. Because this reality is still present in locals without good infrastructure of social and economic attention, there is a need for a broad knowledge of problems related to the productive processes that include features of unsanitary and unhealthy. Despite the intense process of industrialization promoted by globalization and the growth of developing nations like Brazil, the activities of artisanal and small-scale mining are still suffering from the marginalization of their production processes and their workers. This dissertation deals with the description of mineral-based activities (MBA), especially the activities related to production processes of extraction and processing of red pottery and minerals in pegmatites in Parelhas city, Seridó, Rio Grande do Norte, which are conducted by small mining companies or artisanal miners. The study of the work process was based on direct observation, photographic documentation, ergonomics, health and occupational safety analysis, interviews and structured questionnaire with workers of the two activities. The results indicate the need for improvement in both workplaces (red pottery and pegmatites), adaptation of workers to safety standards specific to the workplace, more attention and care related to ergonomics and occupational safety, greater importance to economic and social relations among performed activities, workers and firms of mineral branch and better and greater integration of social policies, supported by different sectors of society with the intention of transforming the current social, cultural, labor and education situation

Lugar, saúde e informação: os círculos de informação da atenção básica do SUS no contexto na disputa pelo conceito de saúde

Through the analysis of the informational activity at the primary care of SUS at the scale of places, this dissertation has as central objective to observe the dispute for the concepts of health and sickness, in the ambit of Brazilian Health Movement, featuring, on one hand, the clinic, biomedical or flexnerian line hegemonic, scientifically restrict and the primary frame of references for the Brazilian health politics and on the other hand a multiplicity of new proposals and critic thoughts to the current model, which have , as common characteristic, the worry with a territorial way of thinking the health context, therefore beyond the biological processes. On the first chapter we jut out with details these scientific and ideological movements, on a wider way, but also on the specificities of the public health s information politics. On the second chapter we analyze the downward health information circle at the basic care, observing the operational processes of the information s technical systems SIAB and e-SUS. On the third and last chapter, we give references to think about an upward health information circle, centered on the places, ruled by the notions of autonomy, organic solidarity and communicational density. It would possess, as method s primary horizon, the local organization of production and managing of information through the work of the Health Community Agent, privileging therefore the urgency of the most contingent needs of the people in theirs every day s life