Avaliação das condicionalidades em saúde do Programa Bolsa Família

The programs of conditional cash transfer are widespread in developing countries in Latin America with emphasis on Brazil as a new paradigm in social p olicies for poverty eradication . Consist of transferring monetary funds from the government directly to poor families by fulfilling the condition alities on education and health . In health, even wi th variations between countries , conditionality targeting public pregnant women and children with a view to improving health indic ators maternoinfantil as growth , infant mortality and prenatal care. The objectives of this study are to compare the transfer progr am conditional Brazilian income , the Family and similar programs in Latin A merica in relation to it s effects on growth in children , and to evaluate the effect of Bolsa Família in the prevalence of use of services ( conditionalities ) of prenatal care in Brazilian health services whose teams joined the Programa de Acesso e Melhoria da Qualidade da Atenção Básica (PMAQ - AB) . For the first objective a systematic review , we selec ted ten articles between 1007 ( one thousand and seven ) found in the databases Embase , PubMed, Scopus , Scielo and Lilacs databases was performed . Articles are ob servational epidemiological studies of transverse descriptive and analytical types of cohort and case - co ntrol. For the second objective, for it is a prevalence study , a statistical analysis using Poisson regression with robust variance was performed to i nvestigate how the prevalence of compliance with conditionalities on health was influenced b y various explanatory variables . Ratios , crude and adjusted prevalence , with their respective confidence i ntervals of 95 % were estimated . The family joined the sch olarship program was considered as the main expo sure variable . Confounding variables were: maternal age , race / color, paid employment , marital status and region of residence . In d ata analysis software R 3.0.1 (RDevelopment Core Team 2013 ) was used . Rega rding the comparison of the Bolsa Família with other programs in Latin America , the review found similar results regarding the positive effect of income transfer in the nutritional status o f beneficiary children programs , and these effects are more evident in children under two years old and belonging to familie s of lower socioeconomic status . For the prevalence of conditionalities entres different groups of users of the Bolsa Família and nonusers results showed no statistically significant difference betwe en respondents (with children under two years ) registered and not registered in PBF on issues relating to: me et at least six prenatal visits , meet and participate in health education activities . It follows from side to increase minimum income for families in extreme poverty showed positive impact on children's health in Brazil and Latin America. The o ther is not confirmed in Brazil , an increase in conditionality expressed in use of primary care by the user s of the Bolsa Família services.

Os efeitos das queimadas na Amazônia em nível celular e molecular

The Amazon holds over half of the planet's remaining tropical forests and comprises the largest biodiversity in the world, accounting for approximately 60 % of the Brazilian territory. However, deforestation fires in the region causes serious problems to exposed human. The aim of this study was to evaluate the chemical compounds as well as the cellular and molecular effects after exposure to organic material extracted from particulate matter less than 10 µm (PM10) in the Amazon region. As for the chemical composition, n-alkanes analysis showed a prevalence of anthropogenic influence during the fires in the region. In addition, there was a predominance of monosaccharides from biomass burning markers. Also, the Polycyclic Aromatic Hydrocarbons (PAH) and their derivatives have also been identified in samples collected in the Amazon. By using the PAH concentrations was possible to calculate the BaP-equivalent and it was found that the dibenz(a) anthracene contributes with 83% to potential carcinogenic risk. As for the potential mutagenic risk, the benzo (a) pyrene is the HPA that has a major contribution in this analysis. It may be noted that the retene was the most abundant PAH. This compound was genotoxic and cause death by necrosis in the human lung cells. In biological tests, the data showed that organic PM10 is capable of causing genetic damage in both plant cells and in human lung cells. This damage cause an arrest in the G1 phase of the cell cycle exposed, increasing the expression of p53 and p21. Additionally, the PM10 caused cell death by apoptosis, increasing the foci of histone - H2AX. Given these results, it is important to emphasize the reduction and better control of biomass burning in the Amazon region thus improving the quality of health of the population being exposed. As clearly stated recently by the World Health Organization, the reduction of air pollution could save millions of lives annually.

Diferenciais de mortalidade adulta por nível de escolaridade no Brasil e regiões

The study of mortality by various differentials has been an important tool to guide public health policies, due to better describing the events of deaths in a population. This research aims to seek disparities in mortality according to educational level, sex and adulthood in large Brazilian regions and consequently for Brazil as a whole. A vast literature has shown that people with more education tend to have lower risk of death. Studies on inequalities in mortality by level of education in Brazil are still very specific and has still known very little about Brazil about mortality according to educational level, due to lack of information about the well-filled school in the records of deaths arising from the Mortality Information System (MIS) of the Ministry of Health. This data source has shown improvement in the coverage of sub reports in the last decade, however, it has still perceived negligence in completing the question regarding schooling of death (about 30% of registered deaths in 2010 to Brazil, Given this scenario, this work contributes to the national literature on the behavior of adult mortality differentials having as proposed, using data from the new variable mortality of the 2010 Census (CD 2010), assuming the characteristics of education of the head the household for deaths occurring in the same. It is therefore considered that the probability of mortality is homogeneous within the household. Events of deaths were corrected only for the records come from households where the head possessed levels of schooling and Instruction Elementary Education No Incomplete and Primary Education and Secondary Education Complete Incomplete through the Generations Extinct Adjusted method. With deaths already corrected, probabilities of death were calculated between 15 and 60 years life, as well as tables by sex and level of education to all regions of Brazil. No que se refere às probabilidades de morte por idade, nas idades entre 15 e 60 anos as maiores probabilidades seguem um gradiente, maior probabilidade para os menos escolarizados. Results corroborate the literature, the more educated the population is, the greater the life expectancy. In all Brazilian regions, life expectancy of the female population is greater than that of men at all levels of schooling. With respect to probabilities of death by age between the ages of 15 and 60 years the most likely follow a gradient, most likely to the least educated. At older ages (from 70 years), this behavior has presented another pattern, the lowest level of education has the lowest odds in the regions, North, Northeast, South and Midwest, except in the Southeast region

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 educação interprofissional como abordagem para a reorientação da formação profissional em saúde

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

Influência da radiação ionizante natural no açude do boqueirão (RN): avaliação de risco saúde/ambiente

The contamination of water bodies with toxic substances causes a decrease in water quality, representing a risk to public health. In this context, human activities are generally seen as the main sources of water degradation. However, elements found naturally in the environment can also compromise water quality. Thus, the Boqueirão‘s dam, located in the municipality of Parelhas (RN, Brazil), was chosen as area for the development of this study, as its geological region is rich in the emission of natural ionizing radiation that produces byproducts like lead and Radon. Moreover, the area has a strong human influence that enhances the risks of pollutant discharge in this body of water.Thus, the objectives of this study were centered (i) in the analysis of risk perception in the city of Parelhas (RN/Brasil) due to the use of the water from the Boqueirão Dam; and (ii) in the assessment of water quality in the Dam using methods that quantify, mainly, heavy metals and radiation levels, as well as these toxics potential of inducing mutations on genetic material. The analysis of risk perception showed that the population in the city of Parelhas can perceive a risk in using the water from the dam and that they can recognize factors that influence the water quality. Regarding the second objective, the set of data point to the contamination of the Dam by heavy metals, as well as levels of radioactive parcicles and Radon – also present in high concentrations in outdoor air and on soil. Thus, it is possible to infer that the population residing in this area is subjected to injuries caused by exposure to natural and anthropogenic contamination. Our findings corroborate with the perception of the population regarding the risks associated with the use of the Dam for several types of activities. It is expected that the information gathered in this study can substantiate activities and future researches in this semiarid region in the Rio Grande do Norte/Brazil. Also, that the set of data can enable a better understanding of the specific toxicological scenario of risk found for the population and the effect of the contamination for the biota, which aids the development of a future risk assessment and a consequent management of this local issue.

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.

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.

Mestrado profissional em saúde da família: o curso sob a perspectiva dos mestrandos

Professional masters were created in Brazil in the 1990s in response to social changes in the world of work and aim to train high-level professionals with own profile for various activities of society and the productive sector. They are up in more innovative mode of graduate studies in Brazil, and therefore lack of legitimacy of their identity, which raises the need for discussions to get further information and outline the characteristics of this postgraduate modality. You want to build new understandings about their peculiarities starting from the perspective of students from the Professional Masters in Health Net Northeast Family Training in Family Health, and not only according to the similarities and differences with the academic master. This study aims to understand the meanings attributed by masters training in that course. This is a qualitative, exploratory study. The subjects are 100 students in training in 2013, distributed among the six institutions nucleation Network Northeast Training in Family Health. To collect information desk research was conducted in institutional records of all students, as well as interviews. We interviewed 15 students, distributed in the six nucleation institutions. Information obtained through recorded interviews were transcribed and resulted in two analytical corpus subsequently submitted to Alceste © 4.9 software for identification of semantic classes. It can be concluded that the course provided a redefinition of professional practices in the Family Health Strategy, considering the organizational context of primary care in the Northeast and the specifics of the health work. Even before the student body difficulties related to ownership of research methods, and the very active methodology of problem-based learning, the course effectively contributed to the improvement of work processes in primary care, valuing teamwork and allowing the acquisition of new scientific knowledge.

Avaliação do acesso aos serviços de reabilitação física para vítimas de acidentes de trânsito: caminhos para melhoria da qualidade do sistema de saúde

The Physical Rehabilitation services (PR) are of fundamental importance in combating the global epidemic of Traffic Accidents (TA). Considering the numerous physical and social consequences of the survivors, quality problems in access to PR are a hazard to recovery of victims. It is necessary to improve the management of quality of services, assessing priority dimensions and intervening in their causes, to ensure rehabilitation available in time and suitable conditions. This study aimed to identify barriers to access to rehabilitation considering the perception of TA victims and professionals. The aim is also to estimate the access to rehabilitation and their associated factors. This is a qualitative and quantitative study of exploratory nature developed in Natal / RN with semi-structured interviews with 19 health professionals and telephone survey to 155 victims of traffic accidents. To explore barriers to access the speeches were transcribed and analyzed using the Alceste software (version 4.9). During the interviews used the following guiding question: “What barriers hinder or prevent access to physical rehabilitation for victims of traffic accidents?”. The names of classes and axes resulting from Alceste was performed by ad hoc query to three external researchers with subsequent consensus of the most representative name of analysis. We conducted multivariate analysis of the influence of the variables of the accident, sociodemographic, clinical and assistance on access to rehabilitation. Associations with p <0.20 in the bivariate analysis were submitted to logistic regression, step by step, with p <0.05 and confidence interval (CI) of 95%. The main barriers identified were: “Bureaucratic regulation”, “Long time to start rehabilitation”, “No post-surgery referral” and “inefficiency of public services”. These barriers were divided into a theoretical model built from the cause-effect diagram, in which we observed that insufficient access to rehabilitation is the product of causes related to organizational structure, work processes, professional and patients. Was constructed two logistic regression models: “General access to rehabilitation” and “Access to rehabilitation to public service”. 51.6% of patients had access to rehabilitation, and 32.9% in public and 17.9% in the private sector. The regression model “General access to rehabilitation” included the variables Income (OR:3.7), Informal Employment (OR:0.11), Unemployment (OR:0.15), Perceived Need for PR (OR:10) and Referral (OR: 27.5). The model “Access to rehabilitation in the public service” was represented by the “Referral to Public Service” (OR: 23.0) and “Private Health Plan” (OR: 0.07). Despite the known influence of social determinants on access to health services, a situation difficult to control by the public administration, this study found that the organizational and bureaucratic procedures established in health care greatly determine access to rehabilitation. Access difficulties show the seriousness of the problem and the factors suggest the need for improvements in comprehensive care for TA survivors and avoid unnecessary prolongation of the suffering of the victims of this epidemic.

Conhecimentos alternativos e ecologia dos saberes: o difícil diálogo do sistema de saúde oficial

Le present travail a pour objectif, discuter le dialogue entre deux des formes de penser le processos santé-maladie: la médécine traditionnelle et celle scientifique. Et cette dernière représentée par le Système Unique de Santé, particulièrement par une Équipe de Santé de la Famille. Partant du questionnement “quel est le rôle de chaque système de santé dans les problèmes sanitaires ainsi que dans la prévention des maladies?”, il s‟agit de vérifier si l‟ ”Écologie des Savoirs” discutée par Santos (2007) a été appliquée dans les deux manières de penser et pratiquer les politiques de santé; tenant em compte que chacune d‟elles ayant son champ de possibilites et d‟impossibilités agit directement sur le quotidien des aires géographiques concernés par la recherche: le District de São João do Abade dans le Municipe de Curuçá/PA et l‟Équipe de Santé de la Famille Abade localisée dans ce même district. Cette étude fut réalisée à partir d‟instruments de collecte de données comme la recherche de terrain, l‟observation directe et les interviews semi-structurés (HAGUETTE, 1997) e apports théoriques à partir de certains des concepts clés les plus utilisés par les Épistémologies du Sud où nous mettons en relief l' “Écologie des Savoirs” (Santos, 2007); le “travail de Traduction” (SANTOS, 2008); la “Sociologie des Absences et la Sociologie des Émergences” (SANTOS, 2004); le concept de “Santé-Maladie” (MINAYO, 1988); ainsi que les discussions autor des “Savoirs de la Tradition” (ALMEIDA, 2010; RAMALHO et ALMEIDA, 2011). La stratégie “Santé de la Famille fut pensée à travers la vision de Guedelha (2008) et Vilar et al. (2011) où à partir de cette dernière la discussion sur le concept de “Médécine Communautaire” (DONNANGELO e PEREIRA, 1976) comme recours importante dans la recherche de l‟ “Écologie des Savoirs” dans la Stratégie Santé de la Famille a été possible.

Os rumos do fundo público no capitalismo contemporâneo: uma análise sobre o financiamento da Política de saúde no estado do Rio Grande do Norte

This work analizes the financing of Health Policies on the state of Rio Grande Do Norte, starting at the presumption that SUS is “Bombarded” by fiscal ajustments, as a neoliberal strategy to face capital crises.The trafectory of the financing of SUS demands the comprehension of two principles which are, in essence, contradictory: the “principle of universatility”, which is caracterized by the uncompromising defence of the fundaments of the Sanitary Reform, and the “principle of containment of social costs”, articulating the macroeconomic policy that has being developed in Brazil since the 1990s and which substantiantes itself on the 2000s.This last defends the reduction of the social costs, the maintanance of primary surplus and the privatization of public social services. Considering these determinations, the objective of this research constitues in bringing a critical reflection sorrounding the financing of the Health Policies on the state of Rio Grande do Norte, on the period from 2004 to 2012.Starting from a bibliografic and documentary research, it sought out to analyze the budget planning forseen on the Budget Guideline Law (LDO) and on the Multiannual Plans (PPA), investigating the reports of the Court of Auditors of the State of RN and gathering information about expenses with health, available on the System of Information About Public Budgeting in Health (SIOPS).The Analises of the data obtained, in light of the theoretic referece chosen, reveals trends in the public budget setting for health on the State of Rio Grande do Norte, which are: a tiny share of investment expenditure on health, when compared to other expenses, the amount used in daily fees and advertising; the high expense in personnel expenses, especially for hiring medical cooperatives;the strong dependence of the state on revenue transferences from the Union; the aplication of resources in actions of other nature considered as health, in exemple of the expenditures undertaken by the budgeting unit Supplying Center S/A (CEASA) on the function of health and subfunction of prophylactic and therapeutic and on the Popular Pharmacy program. Since 2006, expenses refering to Regime Security Servers (RPPA) on the area of health also have being considered as public actions and services in health for constitutional limit ends, beyond the inconsistencies on the PPAs with the actions performed efectively.

Influência da paridade, do tipo de parto e do nível de atividade física sobre a musculatura do assoalho pélvico em mulheres na pós-menopausa

The post-menopause stage is characterized by hormonal and organic alterations of ovarian failure. One of the most important of these is muscles alterations of the pelvic floor (MPF). According to current literature, in young women gynecological and obstetric factors, as well as lifestyles and habits influence that loss of function. However, there is still uncertainty about the influence of those variables in the MPF functions in post-menopause women. Thus, this study aimed at seeing if there is an influence from number of births, the type of birth and the level of physical activity on the MPF of post-menopause women. Another objective of this study was to compare MPF force in women who had had vaginal births with those who had been subjected to cesarean sections, those with different levels of physical activity and those with artificial and natural menopause in the initial and latter stages. Furthermore, the test of muscular force was compared to perineometry. Using observational, analytical and transversal observations, 100 women in the post-menopausal stage of life, between the ages of 45 and 65, were examined. They were divided according to the menopausal stage into three groups: women who had undergone hysterectomies, those in the initial stages of postmenopause and those in the late stage of postmenpause. The patients were questioned about social, demographic, gynecological and obstetric factors. All the volunteers were submitted to a physical examination where their height and weight were measured to arrive at the corporal mass index and their waist measurements were taken. The evaluation of the pelvic floor was conducted with muscular force tests and perineometry. These results were analyzed with statistical description and ANOVA statistical tests, multiple regression and Kolmogorov-Smirnov evaluations. The results showed homogeneity with regard to social demographic and anthropometric characteristics among the women in the final test sample (n=85). It was also seen that most of the women in all three groups were married (p=0.51) and catholic (p=0.13). The average per capital income varied between $R585.47 (+/-466.67) and $R1,271.83 (+/-1,748.95), with no significant difference between the groups (p=0.05). The G>6 group presented an average age between 58.95 (+/-3.96) which was significantly greater that the G<6 group´s average age (53.21+/- 3.88) (p=0.000). There was no difference between the groups´ anthropometric characteristics of weight (p=0.32), height (p=0.72) and corporal mass index (p=0.34), nor in the waist measurements (p=0.33). Furthermore, no significant difference was noted in the MPF function of women who had had normal births, cesarean sections or a combination of the two (TFM p=0.897; perineum measurement p=0.502). Likewise, no differences were seen in the MPF function of women who had one, two to three or four or more births (TFM p=0.28, perineum measurement p=0.13). Finally, no difference was perceived among those with different levels of physical activity (TFM p=0.663; perineum measurement p=0.741). Therefore, we found that the type of delivery, number of births and physical activity had no influence on the muscular function of the pelvic floor among the women studied. It is believed that decline in muscular function in post-menopause women is fundamentally related to the process of aging.

Serviços-escola de psicologia do Rio Grande do Norte: formação profissional e política pública de saúde em debate

The Psychology University Services is stablished normatively as an indispensable equipment to the recognition of the graduation courses of psychologists by the Brazilian Education Ministery. The Public Healthcare Policies (Universal Health System/SUS) constitutes itself as a input field of the professional category, but shows huge challenges in the formation of these professionals. The objective of this work is to analyse the functioning of the Psychology University Services (SEP) and the Superior Educational Institutions from Natal, understood as important formation devices to attend the actual demands of the psychologist's work on SUS. For this, it sought a) characterize the psychological practices developed in the SEP; b) relate the National Curricular Lines of Direction of the psychology courses to the skills and competences developed in the SEP to the performance on the public healthcare policies; c) mapping ways of including the SEP in the network designed by the healthcare policy. Interviews were performed with 13 academic supervisors, 8 field supervisors and technicians of superior level (TNC), along with 9 managers, being for of the Psychology University Services and 5 of the graduation programs. Questionnaires were also applied to 57 interns and 24 graduates. Besides that, two conversation circles were performed with the faculty and technician members from two of the Educational Institutions that were participating of the research, as well as a workshop with students and psychologists, promoted by the CRP 17. We observed that most part of the faculty members and managers know the DCN and comprehend that the formation is in process of change in what concerns to the extension of the formation to the performance of the psychologists in various contexts. However, most part of the TNC don't know about them. Moreover, the results point to the predominance of the assisting model based on the traditional clinic psychology, although the articulation with the public healthcare and social assistance networks can already be timidly visualized. Different modalities of practices in theses Psychology University Services were also detected, such as conversation groups, thematic workshops, organizational consultancies, team meetings with the interns and TNS in a daily basis, matriciament in mental health, therapeutic monitoring, among others. Yet, the SEP in Rio Grande do Norte are still isolated from the other courses that perform in the healthcare area and also from the services that compose the public healthcare and public policies.

Levantamentos epidemiológicos em saúde bucal: análise da metodologia proposta pela Organização Mundial da Saúde

Epidemiological surveys are important for obtaining information on the prevalence and etiology of mouth diseases, since the data collected permit health actions to be planned, performed, and assessed. Methodological uniformity is necessary, however, to maintain reproductibility, validity, and reliability, and to allow national and international comparisons. The initiative of the World Health Organization (WHO) as an advisor in ongoing surveys has been extremely useful, stimulating standardization in all countries. In 1991, a Portuguese version of the 1987 third edition of Oral Health Surveys - basic methods, an instruction manual for performing epidemiological surveys, was published and became a reference for many parts of Brazil and the World. The present analysis found conflicting points in relation to the sample size, calibration of the examiners, and criteria for evaluating oral health and treatment needs. In conclusion, due to the dynamic characteristics of scientific knowledge and, considering the regional differences in relation to the development of oral diseases, we recommend that proposals for standardizing surveys be checked periodically. Other important issues may have not been detected in this analysis, urging a thorough discussion within the dentistry community as a whole.