Atividades preventivas realizadas pelos cirurgiões-dentistas do PSF de Natal-RN

Family Health Program (FHP) presents itself as a restructured model on basic cares besides having prevention practices and promotion in health as essential parts. According to that, the purpose of this study is to perceive which prevention practices in oral health are accomplished by the dentists from the FHP of Natal-RN as well as the way they have been developed, the knowledge basis to execute the procedure and the use of evaluation instruments by the dentists and by the Oral Health Co-Ordinator. A list of dentists participating on the FHP of Natal in March, 2006 (n= 91) was obtained so it was possible to formulate a structured interview. After excluding those with less than six months attending to the program, and considering the loss, eighty dentists got to be interviewed. It had questions about individual and group preventive procedures, sources of basement to develop the activities and to verify the impact and evaluation instruments. Besides that, an interview was made with the Oral Health Co-Ordinator about the evaluating process and the existence of a protocol as well as about document analysis in the Ambulatory Informations System Unique Health System (AIS-UHS), Information of Basic Care System and Pact of Recorder. The main individual activities consist on Oral Hygiene Orientation (87,5%) and Fluoridization (95%). Group activities remain at scholar groups acts(91,25%) being fluoridization done by 91,25% and educative activities by 86,25% mainly through speeches (61,25%).Orientations about oral cancer were detached on the aged group (39,96%)and hypertensive and diabetic group (19,51%), as well as integration with the health team was respectively 21,93% and 39,02%. Speeches and talk rounds are the main activities for aged, hypertensive and diabetics, and are also expressive to pregnant women. For pregnant women and babies group predominate hygiene and diet orientation. About the evaluation instruments 73,75% of the dentists do not consider their existence, despite 73,75% consider that actions have impact specially due to a increase of hygiene and decrease of caries index on the children. The main sources of basement are clinical experience (42,5%) and preparative courses (33,75%), only 7,5% mentioned population need and local reality. The Oral Health Co-Ordinator related the Attention Pact Recorder and records from the AIS - UHS as evaluation source but also detached the lack of epidemiologic surveying. She mentioned the increase of supervised brushing as a positive result and detached the hardness of the professional to act inside the family and as a team. The AIS-UHS records showed that fluoridization is more used individually and the supervised brushing is predominant as a group action, besides that educative activities at the Health Establishment predominate due to actions at the community. Facing the results, it was verified the act in different groups, special attention given to scholars, as well as focus the activities on caries giving less emphasis to other oral problems. Despite that, there was no epidemiologic instruments or data of the local reality to guide the actions and to be part of the planning and evaluation process

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

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

Nervos: rede de discursos e práticas de cuidado na atenção básica no município de Natal/RN

The Primary Health Care and one of its main strategies, the Family Health Strategy (ESF), are framed as the gateway to the Public Health System (SUS). Thus, most of the incident and prevalent health problems in the population attended should be solved at this level of care, including psychological suffering, and the so-called complaint of nerves. Nerves and nervous denote a complexity that is not always well comprehended by health workers, in such a way that the care to this kind of problem is usually inadequate. In this line of thought, the general objective of this study is to analyze the network of discourses and the care to the psychological suffering, expressed as nerves, in SUS daily Primary Health Care. Besides and more specifically, it aims at identifying the principles and guidelines of the Primary Health Care in mental health; to investigate health workers positioning before psychological suffering and complaints of nerves, and also analyze different actions and practices of care carried out in different Health Units towards complaints like nerves. Institutional Ethnography was the theoreticalmethodological perspective adopted for the work. This approach seeks to understand and analyze the institutional relationships in a particular context considering sociostructural influences and power relations, as well as daily discourses and practices. Based on interviews with health professionals, informal conversations and observations in six Health Units with ESF teams from different sanitary districts in Natal/RN, it was possible to check that the index of complaint of nerves is high. The referral to psychologists and psychiatrists, as well as the prescription of psychotropic drugs appear as the most common intervention at this level of care. In general, the participants complain that they have poor specialized knowledge about the theme of mental health. They face the problem of bad work conditions and the lack of institutional support, which make actions of illnesses prevention and health promotion even more difficult. Besides, there are different ongoing practices such as meetings for hypertensive and aged people, walk, visit, round-table discussions and community therapy. However, not all of these actions are aimed at the care of psychological suffering. It is observed that the Matrix Support, which is a methodological strategy of supervision and follow up forcases of mental health, hasn t been totally implemented in the municipal system, although it is a tool that has been used by psychologists in some Health Units in the city. It was also verified that the health care practices to the problem of nerves strongly depend on the professional s commitment with the PSF guidelines and on mental health policies, in addition to continued support, when available, from other professional who works as matrix supporter

Motivação para o trabalho: um estudo com os profissionais de saúde das unidades básicas de saúde do município de Natal RN

This thesis studied the motivation to work among health professionals of the Basic Unities (BUH) in the health network of the city of Natal (RN). It was understood that the work motivation is a process. Then, the expectation theory was applied and motivation components (results of work, expectative, valence, instrumentality, and motivational force) were used to analyses. It s understanding the motivation as multifaceted phenomenon, the psycho sociological perspective was adopted. The research was developed in two phases: one with application of Work Motivation and Meaning Inventory (WMMI), and another with interview. In the first phases, the analysis of results revealed that the major factors contributing to increase the motivational force to health professionals in the BUH´s are: in valence, Self Expression and Personal Realization (VF2), Personal and Family Survival (VF3); in expectative, Self Expression and Work Justice (EF1), Safety and Dignity (EF2) and Responsibility (EF4); in instrumentality, Involvement (IF1) and Recognition and Economic Independence (IF4). In opposition, the factors that more contribute to reduce the motivational force are Wear and Dehumanization factors in valence (VF4), in expectative (EF3), and in instrumentality (IF4), behind the Work Justice Factor (IF2). Basing in content analysis of interviews, it was possible to associate by equivalence, the senses presented by health professionals with obtained results of first phase, indicating that the results of second phase corroborated and complemented those of first one. This possibility broadened the comprehension of the studied phenomenon. In speaking of the respondents, it was visible the presence of contents showing that they perceive the Health System and BUH´s in degradation. In the first phase, the participants´ instruction also predict the results in motivation, and in the interviews can be saw that the instruction is associated with the opportunities in outside of system. As work motivation is a process, the impact of personal and occupational characteristics tend to interact with contextual aspects. It was concluded the majority of health professionals present the moderated motivational force, but it was falling because they experience and perceive a degrading context with work condition increasingly unfavorable.

Estratégias de cuidado integral à saúde: os CAPS no processo de implementação do apoio matricial em Natal/RN

This study aims to analyzing the implementation of the Matrix Support proposal with professionals of Substitutive Services in Mental Health in the city of Natal/RN. The Matrix Support (MS) is an institutional arrangement which has been recently adopted by the Health Ministry, as an administrative strategy, for the construction of a wide care net in Mental Health, deviating the logic of indiscriminate follow-through changed by one of co-responsibility. In addition to this, its goal is to promote a major resolution as regards health assistance. Integral attention, as it is intended by the unique health system, may be reached by means of knowledge and practices interchange, establishing an interdisciplinary work logic, through an interconnected net of health services. For the accomplishment of this study, individual interviews of semi-structured character were used as instrument, with the coordinators and technical staff of the CAPs. The data collection was done in the following services: CAPS II ( East and West) and CAPS ad ( North and East), in the city of Natal/RN. The results point out that the CAPs to initiate of the discussion the process in the implementation of the MS aiming, to promote the reorganization and redefinition of the flow in the net, thus not acting in a fragmented way. Nevertheless, there is no effective articulation concerning the basic attention services, there is a major focus of the attention in mental health on the specialized services, little insertion in the territory and in the everyday life of the community

O médico diante da morte na urgência e emergência:reflexões sobre o ser médico

The literature pointed that the way which people deal with death have been changing along centuries, and nowadays what is realized it is that, each time more, the human being have difficulties to deal with death. Due to the fact that the main function of the physician is to save their patients lives; responsibility that is aggravated by the necessity of to take decisions quickly, once he need to deal with the unexpected situations of the urgency and emergency, many times these professional have to face of impotency and fail situations, when he lose a patient. The main goal of this study was to understand the experience of physicians that work in the urgency and emergency, in front of death. These questioning it justified by the fact of the physicians do not have, many times, a space to express their suffering and anguish about the issues related to death in their work routine, despite lifedeath question to be often present their everyday. It is still possible to verify in the literature, an appointment of the necessity of to include in the curriculum of Medicine courses, subjects that approach such questions. The method used was based on the existential-phenomenological perspective, using as instrument the participant observation, to the intent of understand the routine in the urgency and emergency context, and semi-structured interview. It was interviewed six physicians that work in the urgency and emergency of the most important hospital of public health system of Natal-RN. The results showed that the physicians reported pleasure in work in the urgency and emergency, despite of they presented stress and the difficulties that they deal with in the public system. Despite of the fact that the death to be considered as a phenomenon that make part of the physician s routine, sometimes, deals with these one is more difficult. Many times losses generate an impotency and guilty feeling, as well as questionings about their performance during the attempts to save lives. We verified, from this study, the importance of the existence of some kind of intervention in the emergency, in order to the physicians can elaborate the questions about death and die emerged in their work. We consider yet that this study corroborates and reiterates the discussions concerning the importance of this thematic to be approached in a more effective way, during the academic formation of these professionals, as well as, the importance of a larger investment from the part of Government in the urgency and emergency sector, in order to propitiate to these professionals a work that brings less harmful for their health

A psicologia e o programa de saúde da família :novas possibilidades, velhos dogmas?

The model of attention to health has been suffering alterations due to the difficulty faced to put into practice its universal, democratic and institutional layout. Since the movement of Sanitary Reform, which focused in the demands of a new health context and the process of work in the area of health, one seeks uninterruptedly, to find a way which leads to the execution of the principles of SUS. Despite having tried, the model of Sanitary Vigilance centered within the work of a multi-professional team has shown fragmentation and little adequacy to the necessity of health in the population. Whilst inserting himself in the field of health, the psychology professional has taken with him his clinic way of attending to individuals being one more in the team to act in a de-contextualised and little critical way. In virtue of this framework, the Ministry of Health invests in the Family Health Program as a new guide in the health system, restructuring the basic attention at a new logic of action. In this way, the municipality of Natal-RN implants, in the year 2002, the PSF in the Northern Sanitary District, a context in which professional teams are created where there is not an inclusion of a psychologist. Consequently, this professional is excluded of his work space in the previous Basic Unities of Health. This piece of work constitutes in the investigation of the implementation and instrumentalization of the Northern Sanitary District PSF of Natal-RN, having as its objective to analyze the implications of this execution for the structuring of the health network services and more specifically the alterations that this implementation could be making to the practice of the Psychology Professionals, emphasizing its advances, obstacles and limitations. To make this work feasible it was necessary to search for data and information from the implementation and execution of the PSF in the DSN, carrying interviews from a semi-structured guide, with 21 institutional actors (members of the team, coordinators and directors of the unities and psychologists)

Humanização hospitalar, ambiente físico e relações assistenciais :a percepção de arquitetos especialistas

The creation of the Humanization Program of Hospital Care and the increasing number of academic works and journal articles that discuss more humane practices in the health care services express the emphasis given to the theme in Brazil. In these discussions, however, it is not usual to find reference to architecture as a relevant factor in the humanization of hospitals, even though it is known that the physical structure of the building may help the recovering of the patients; elements such as gardens, the use of colors and open spaces may soften the impact caused by the hospital routine on patients. Considering the contribution the architectural project may bring to the humanization of hospitals, the aim of this study was to verify how the architects perceive the hospital humanization process. Besides having searched for subsides in informal interviews with health professionals, in visits to hospitals and in related seminars, the study was based on semi-structured interviews with architects of Natal, Rio Grande do Norte, who are specialists in this kind of projects. The content analysis of the interviews showed that physical space and attendance are essential to the humanization process. Those professionals see two humanization tendencies: while private hospitals have the structural physical appearance considered as humanized, public hospitals emphasize the humanization in attendance, fact that illustrates the contradictions in Brazilian health system. The interviewees consider the post-occupancy evaluation of the building as a learning exercise that contributes to new projects, but surprisingly they do not mention the patients opinion as part of it. Two annoying facts have emerged from the interviews, as also seen in preliminary stages of the study: rare are the works that focus on the person-environment relationship, and the definition of humanized hospital environments is still broad and inaccurate. This suggests the need of new studies in order to better understand how the two factors shown in this study attendance and physical space interact towards a true hospital humanization

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

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

A humanização da saúde no cotidiano de usuários da estrategia saúde da família

This research assumes that for changes in health practices directed to an integral care, is crucial humanization, participation and autonomy of service users. In this sense, the research had investigated the issue of humanization involving users of the Family Health Strategy (FHS) in city of Mossoró, having as objectives: to analyze the perceptions of users on humanization in the production of health care in daily of Family Health Strategy, from these perceptions, identify elements featuring humanized and non-humanized in everyday practices related to production of health care; relate perceptions of users about humanization with the notions of extended clinic and social participation present in the National Humanization Policy (NHP); identify difficulties and potentialities in the production of health care from the perspective of humanization. It was a qualitative approach to data collection and it was used the methodology of Network Analysis of Everyday Life (NAEL), which allowed the questioning of health practices through an interactive discussion involving participants subjected. The analysis of data through the technique of content thematic analysis was performed and the results were interpreted related the Extended Clinic references and the users participation, related with the Gift Theory discussed by Marcel Mauss. The results indicated senses humanization linked to affection, reciprocity and honesty, highlighting as essential to humanized practices the trust, bonding, listening, dialogue and accountability. Were also mentioned other elements related to the organization of health services such as access and good functioning of the health services. The difficulties and potentialities show structural deficiencies of the health system and changes in the labor process. The participation of users deconstructing and reconstructing concepts remainder humanization in the production of health care is a key factor for the sedimentation of what is proposed in the HNP. Using the privileged space of the FHE to create more active people and understanding their needs and demands, is possible path to build a participative management

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

O trabalho dos assistentes sociais no âmbito hospitalar: as particularidades da sua inserção no Hospital Universitário Onofre Lopes (HUOL), em Natal/RN/

This study aimed to analyze the work of social workers at the Hospital Universitário Onofre Lopes (HUOL), with the analytical approach the contracting process with the HUOL with the National Health System (SUS), which is set from 2004. Thus, this study sought in times of state reform, restructuring and tension between enlargement / reduction of social and labor rights, understanding the limits and possibilities of social work in HUOL, analyzing how these determinations bounce in the practice of social workers included in the collective process of health work. From a theoretical and methodological historical and dialectical materialism, we conducted literature search, in which developed book report and readings of texts, articles, books that focus on the central categories of the study, namely: Work, Social Work, Health, Health Reform , Project ethical and professional politician. Operationalized also a documentary research, on the Brazilian Public Health Policy, (SUS) and of the Education, as well as research field in which we conducted interviews with 11 social workers, employees packed the HUOL. We conclude that social workers did not participate in the discussion process of contracting the HUOL with the Municipal Health Secretariat of Natal, RN, manager of health and full resetting of user access, via reference setting - counter-referral services provided by the hospital brought the main demands on Social Work guidance regarding the functionality of SUS, and the social intervention in the struggle to guarantee such access. However, the data show that the expansion of demands that require the intervention of the social worker at HUOL is not associated with quantitative growth of these professionals need. Such conditions inflect the possibilities of materialization of the professional ethical-political project, even though that these professionals worry and seek the intellectual improvement, quality of service and to guarantee the social rights of users in the professional practice everyday

O trabalho dos assistentes sociais nos hospitais universitários Onofre Lopes (HUOL) e Hospital Ana Bezerra (HUAB) da UFRN: os desafios da formação permanente

This paper discusses the process of training social workers in the environment of University Hospitals- UH s. These hospitals provide space for professional education aiming to achieve a critical and purposeful professional performance. As environments for training, producing knowledge and providing essential services to the public, these hospitals require all members of the healthcare team to have a continued education. Understanding that training has to be a priority and conceived as constant pursuit for update through the interaction of Teaching, Researching and EPO ( Education and Public Outreach). These dimensions provide approximations and domain of theoretical and methodological, giving special importance to understanding the social reality, a sine qua non condition to the work of the Social Service professional. The main goal of the research was to comprehend how the continuous professional education of the social worker occurs and it s relation with the articulations involving Teaching, Researching and EPO, as significant elements for the job of the social workers in the Hospital Universitário Ana Bezerra and Hospital Universitário Onofre Lopes/UFRN. The research was conducted through a literature review, documentary and field inquiries with semistructured interviews including the group of 09 (nine) social workers from the aforementioned hospitals, taking as a reference the quantitative and qualitative approach to analyze mediations that stand between the subject and the social context. The results indicate that social workers in these university hospitals have their insertion beyond the care provided to patients in performance in the areas of education through preceptorship to undergraduate students and social work residents in and extension projects with low insertion in area of research. We note that there is a recognition of the importance of a continuous education, indicating that the qualification of social worker is essential in transforming their daily professional practice to better monitor, critically explain the peculiarities of public health in its everyday showing of how unequally access is provided to the users of the public health system

As diretrizes da política pública de saúde bucal e suas inflexões nos serviços da Clínica Odontológica da UFRN

The crisis that the Brazilian State have been crossing throughout the last decades has revealed intense oscillations in the the way of life of the population reality. In the health area, specifically of buccal health, new alternatives of attending to demands for odontological services have been increasing from the 1990 decade. The research had as objective to analyze the demand of the services of the clinic-school of odontology of the UFRN to identify the socio-economic profile of the users and the inflections of the standards of the National Politics of Buccal Health. The methodology is based on a dialectic perspective and a quali-quantitative boarding. It was used as instrument of data collection forms with open and closed questions, applied to two distinguished groups of citizens: 53 users of the services and 12 pupils of 9th and 10th term of the Odontology Course. The results reaffirm that, with the aggravation of the crisis of SUS (Sistema Único de Saúde- Single Health System) grow the difficulties of accessing the odontological services of the users majority. The subjects of the research make use of a regular socio-economic condition, with high school, own house, formal bond to labor and monthly medium income between 1 and 2 minimum wages. The conclusive analyses point to the selective and exculpatory character of the buccal health right, mainly, those users who find themselves in situation of extreme poverty and social vulnerability. Immediate and of lesser cost odontological assistance is what it s aimed, but the standards praised in the Public Politics of Buccal Health walk in another direction, requiring a bigger strongness of the formation bases and implementation of the programmatical actions since the academic field until the effectiveness of Politics of Buccal Health as a right while as a right to attention and care

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