Dimensões da satisfação do paciente geriátrico com a assistência fisioterapêutica

Introdução: Os idosos constituem os maiores consumidores dos serviços de saúde, especialmente os de reabilitação, tornando imprescindível a avaliação da qualidade da assistência fisioterapêutica prestada. A satisfação do paciente tem sido considerada uma das melhores e mais eficazes formas de avaliar o cuidado e direcionar o provedor do serviço para suprir as necessidades e expectativas do paciente-cliente. O objetivo deste estudo foi investigar os principais aspectos (preditores) que contribuem para a satisfação do paciente geriátrico com o tratamento fisioterapêutico ambulatorial. Métodos: Trata-se de um estudo com enfoque epidemiológico, transversal e descritivo de cunho exploratório. Foi utilizado o instrumento de avaliação da satisfação do paciente com a fisioterapia, desenvolvido e validado para a população brasileira por Mendonça em 2007, com uma escala de satisfação do paciente composta por 23 itens. Os dados foram coletados na sala de espera de 29 clínicas de Fisioterapia da rede privada da capital do RN/Brasil e a amostra selecionada de forma não-probabilística constou de 221 pacientes com idade superior a 60 anos, que realizaram entre 5 e 60 sessões de fisioterapia onde os dados foram coletados, deveriam ser usuários de plano de saúde e ter condições cognitivas preservadas. Resultados: A análise fatorial indicou a existência de quatro fatores com autovalor maior que 1: interação pacienteterapeuta (7 itens) α = 0,901; acesso e atendimento de recepcionista e pessoal de apoio (8 itens) α = 0,888; ambiente físico e satisfação global (5 itens) α = 0,835; e conveniência (3 itens) α = 0,711. Os itens com maiores escores de satisfação completa foram os contemplados nos aspectos de interação paciente-terapeuta, especialmente o respeito e a gentileza do fisioterapeuta. As associações realizadas através do teste do Qui-quadrado e regressão logística binária entre a satisfação do paciente e as variáveis sócio-demográficas, percepção do estado de saúde e capacidade funcional demonstraram que a satisfação do paciente idoso associa significativamente com o sexo e estado civil. Os achados revelam que as mulheres mostram-se mais satisfeitas com a fisioterapia. Conclusão: Os aspectos interpessoais demonstraram ser preditores relevantes para assistência fisioterapêutica satisfatória, especialmente na população idosa que requer atenção além do suporte puramente técnico

As ações de controle da tuberculose na atenção primária à saúde: a visão do doente

Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health.

Quem é o doente? Um estudo sobre as vivências dos acompanhantes de pacientes adultos em hospital público no Rio Grande do Norte

The aim of this research is to reveal how caregivers have lived the experiences from adult patients admitted in a Rio Grande do Norte’s state hospital. This is a study where the use of the participant observation, associated with the use of interviews and informal conversations handled categories such as the mismatch between the prerogatives of Brazilian Health Care Policies (HumanizaSUS) and practices performed in hospitals, the relationships established between the caregivers and the other subjects of the research field, family relationships, permanence of women as caregivers, therapeutic itineraries, dramas, religiosity and secrets. To sew up it appears the role of a caregiver is more than emotional support or help, it is a complex act in several directions.

Crianças com infecções respiratórias agudas: como são cuidadas em casa?

Objetivou-se, neste estudo exploratório/descritivo, identificar conhecimentos e necessidades dos cuidadores da criança com Infecção Respiratória Aguda (IRA) através de uma amostra de 129 crianças atendidas no serviço de crescimento e desenvolvimento de uma unidade de saúde. Foram aplicados formulários junto aos cuidadores, em seu domicílio, nos meses de fevereiro e março de 2002. Os cuidadores eram do sexo feminino, a maioria jovem, com ensino fundamental incompleto e com renda de 1 a 2 salários. Em relação aos primeiros cuidados com a criança doente, 48,2% dos cuidadores procuram o médico, 36,6% medicam por conta própria e 13,2% utilizam fitoterápicos. Como medidas de prevenção contra pneumonia em crianças com IRA leve, os cuidadores utilizam medidas de senso comum e sabem reconhecer sinais de gravidade das doenças, por experiências anteriores, revelando uma lacuna do conhecimento dos principais sinais e sintomas de doenças graves do trato respiratório

Morte como desafio afetivo para o profissional da saúde: ansiedade e sentimentos de quem lida com o paciente terminal com câncer

It is a Cross-sectional and multi-disciplinary study whose population selection was made by department of human resources (composed by a Manager, an Oncologist and a Psychologist) from the hospital where this research was realized. They also collaborated with important information about the work of that professionals in the hospital. We also counted on a Statistic who made study design calculating the sample and analyzing data. This research issued Evaluating health professionals anxiety levels who care for cancer terminally ill and their feelings about that work as well as identifying the factors which have influence on it. 100 health professionals from the Hospital which is a reference on cancer caring in Brazil situated in the city of Natal, state of Rio Grande do Norte, participated of this research. There was a sample loss of 21%. Data were collected through a questionnaire and State-Trait Anxiety Inventory (STAI). Results showed that 15% of the professionals have low State Anxiety levels, 70% Medium State Anxiety levels and 15% high State anxiety levels. The Number of Patients and Working in another Institution have interfered in the anxiety levels. Doctors and Nursing Assistants and Technicians have got the highest high State Anxiety percentage (25%). 73% of them declare to feel some sort of different behavior and/or feelings in caring for terminally ill. The most remarkable professionals feelings were Suffering and Sadness, and Terminally ill Children was the most difficult age group to care for. We conclude that work overload and having more than one job can interfere in professional stress levels and anxiety. Dealing with terminally ill, specially children one, can cause on the professionals psychological suffering. It s recommended the development of supporting and training strategies to reduce and/or to prevent Stress and Anxiety high levels

Análise de depoimentos de mulheres mastectomizadas sobre o câncer de mama

The breast cancer is the most incident neoplasia in Brazilian women, configure as important cause of female death in Brazil. Its magnitude is go to be consider as a disease that go out the biological and numerical, extending of the subjective dimension and interrelationships of society and socials experiences, to into in knowledge and practices. Linking of the growing older process, the breast cancer extend as social, economical and cultural dimensions, madding in plot of socials relationships, through that acquire mean. In the context of the high expectative of live and the high number of older age persons, consider that that the high number of years had lived correspond the exposition of this individuals to corporate of the ambientals aggressions and own processes of human constitution of natural wear, like as chronicle-degenerate disease, the example is cancer. In the perspective, we collected narratives of mastectomies women with 60 age or so, about the breast cancer, the body and the growing older process, had has as objectives to reflexes about relatives questions, the comprehension about cancer, like experience, had lived and mean in the context of action and interaction of mastectomies older women, and to comprehend like women interrelationships and respond the changes that grow up of the disease and the growing older process in the everyday of their lives. Through of the narratives. We know that the disease is an initial information that take a form through successives approximation between women with their reality, since the family from hospital institution. The breast cancer to be continue a disease who cause a lot of apprehension and fear, getting and changing the ill s live as marked form. Have dad the body and the growing older process genteels and redimensions by disease, women need to define news and multiples functions due to the contingency that the disease impose

A migração do cuidado em saúde: do hospital para o domicílio

This study is an analysis of opportunities and challenges of health assistance migration from hospitals to home care from the approach of the Domiciliary Internment Program (PID) in Natal / RN. The research aims to identify the ways that the multidisciplinary team act and know the stories of these professionals about the situation experienced in the transition between the instituting and instituted on home care modalities. PID has as a prior focus the elderly person in stable medical conditions, not to replace the hospital care, but to offer a therapeutic support turned to the exercise of their autonomy and coexistence with the situation of diseases. The home in their internal coexistence rules preserves own customs. As the hospital care migrates to the home care, it happens in the confrontation and rationality negotiation and becomes something new, that is going to be directed by an instituting dimension. In the view of New History, that suggests an interdisciplinary approach and interprets the problems on its time and from the technique of thematic oral history, it can be seen that working in interdisciplinary team is able to incorporate new values in the way of healthcare assistance, it longs for maintaining the maximum functional capacity of patients, it presents results as the prevention of diseases, costs reduction in connection with the Hospital Service, empowers and expands the possibilities for the patient recovery by aligning with the daily life and the opportunity of the patient being assisted by a multiprofessional team, interacting on the concrete reality. Therefore, PID is in line with the contemporary demands and as an instrument to be considered in the review of a wider concept of the health-disease process

Saúde Mental e enfermagem: em busca da integralidade na ESF

The present work shows an inquiry about the conceptions and practical work of the nursing professionals on the accompaniment of mental sick patients in the Family s Health Strategy, under the approach of the completeness in health. The justification of this research is given by bringing an special attention concerning the subjet to these professionals of health: the gradual abandonment of the traditional manicomial model leads to the insertion of mental patients in the community . The nursing professionals must be prepared to receive these patients in the basic net of health and contribute to help their adaptation and insertion in the social environment as citizen. In this context, considering the entire attention to the mental health, it is important to detach that the assistance to the patient must search his reinsertion in the community by providing programs that develops his sociability. This analytical study was developed using a qualitative approach and a thematic verbal history. Ten nurses of Nova Natal s Health of the Family Unit, of Felipe Camarão Mista s Unit and of Cidade da Esperança s Health Unit contributed for its development . The information was acquired through an instrument research that made possible the accomplishment of the interviews. These ones were set previously and counted on the assent of the participants. The interviews were recorded and analyzed in accordance with the pertinent literature concerning the subject. The aggregation of the information was then discussed. At this moment three thematic axles were defined dividing the categories of analysis. According to the results of the interviews, the practical procedure given to the patients with mental upheaval is resumed by the prescription of psicotroprics medicaments. It doesn t provide an accompaniment by the professionals of health, specifically, nurses, to the patients and their families. The lack of qualification and a multi-professional team emerged as one of the challenges for the implementation of practical procedures towards the patients with mental upheaval. Therefore, the results of this research show the necessity of transformations in the current scene of the mental health in the Family s Health Strategy. These changes can be reached by politics investments on the mental health area, not only financially but by providing human resources that should allow the professionals to exert the completeness procedures

Tuberculose: conhecimentos, representações sociais e experiências da doença na visão do portador

Tuberculosis is considered one of the most ancient human diseases, cases were registered 3900 years before Christ, and it is currently regarded as a serious public health problem in the world due to several factors such as income mismanagement, precarious standard of life and some sort of prejudice comprised by the word tuberculosis. Taking this into consideration, it was developed a descriptive and exploratory study aiming at analyzing the social representations of tuberculosis made by its patient from the Unidades de Saúde da Família (Family Health Units a public health program) in Campina Grande City PB, in relation to the decentralization of the policies that administrate the disease. It was interviewed 34 tuberculosis patient that were being treated from 2007 to 2008. The age group of the interviewees varied from 10 to 60 years old, but most of them were between 36 and 60 years old (58,8%, n=20), some were young adult and adult (21 35 years old), with 11 (32,3%) respondents, and, less frequent, children and teenagers (11 20 years old), with 03 (8,8%) participants. Data was collected through semi-structured interview. The questions that guided the research were elaborated based on the operational recommendations of DOTS strategy; that is: access to laboratory examinations; medication guarantee; directly observed treatment. Besides that, the experiences of the patient were considered in their relation with the family and the different social groups. The analysis of the discursive material was submitted to the Analyse Lexicale par Context d un Ensemble de Segments de Texte software - ALCESTE 4.7. Data interpretation showed five categories for the social representations of the tuberculosis patient that participated in DOTS strategy: 1) the accessibility of the health assistance service; 2) the patient perspective of the disease; 3) the change in the operation of the productive life; 4) the signals and symptoms of the tuberculosis disease; 5) the rearrangement and mechanisms used to face the disease. The Central Nucleus reveals that tuberculosis is a transmissible disease that can be prevented by people through educational practices, health promotion, active search for symptomatic respiratory and control of the carriers communication; these mechanisms should be incorporated to the routine of all participants of the family health groups. The Intermediate Elements, based on quotidian life, as well as the individual experiences of the tuberculosis patient, reveals prejudiced attitude and beliefs that lead to isolation and restriction of interpersonal relationship. Peripheral Elements were constituted by themes that showed the patient feelings of indignation because of the social barriers they had to face in the Family Health Units during the treatment. These elements demonstrate a negative perspective of the representation concerning the accessibility, i.e. inadequate structure of the health service; long distance to the Health Centre, this factormakes it difficult for the patient to continue the treatment; scheduling delay; and limited service regarding other requests (doctor, dentist etc). One expects to contribute for the construction of a new perspective of the health question between the different agents who make the assistencial institutions and formation of professionals, either in central or local scope

Serviço de atendimento móvel de urgência (SAMU) e a assistência às urgências psiquiátricas

The objective of this work which is characterized as an applied research, with a qualitative exploratory approach and has case study character has been the analysis of the conceptions and dealings of health professionals of SAMU in Natal RN about the attendance of psychiatric urgencies. The information was collected between the months of March and April of 2010, by means of semi-structured interviews, performed with 24 health professionals integrating of SAMU-Natal as well as the usage of direct observation technique, performed in the institution's medical regulation room. Both the number of professionals involved in the interviews and the bringing about of the observations, were determined by saturation methods in qualitative research's information collecting. The interviews and observations were transcribed and submitted to contents analysis technique , more specifically, to thematic analysis, which made possible to reach the deepest levels, that go beyond what has simply been manifest in the speech of the interviewed, getting to the relations among the categories and social structures of the issue of the research. Keeping this in mind, three analysis categories have been built, namely: conceptions and concepts of psychiatric urgencies shared by health professionals in SAMU-Natal; attendances to psychiatric urgencies in SAMU-Natal; and the Brazilian Psychiatric Reformation under the view of the SAMU-Natal's health professionals. Reflection about the analyzed information revealed discussions pertaining to the stigma and prejudice on mental illness, and also, pointed out to some hindrances which impair the attendance to individuals in mental suffering in SAMU-Natal. The interviewed health professionals' conceptions on the individual in psychical crisis involve concepts of unpredictability, aggressiveness and risk, stigmatizing elements and historically associated to the social hazard ideology and need for mentally sicks' segregation. The predominance of these conceptions, seen in health professionals speech, had identifiable reflexes on assistance to psychiatric demands performed by SAMU-Natal, namely: indiscriminate request for military police's presence during psychic crisis intervention, neglect about occasions that involve mental health patients, as well as repetitive assisting practice directed on physical contention, and transportation to psychiatric hospital. Associated to it, the professionals have shown distorted and reductionist understanding about Brazilian Psychiatric Reformation, and, in the majority, haven't lent credibility to present model of attention to mental health, based on psycho-social treatment, pointing their speech to a need for psychiatric patient's internment. In this sense, we notice that the hospital-centered and excluding model conceived by classical psychiatry still remains alive in these health professionals' mentality as a reference to psychiatric urgency's assistance. Therefore, the research revealed a sequence of elements, that make us think about the challenges that health sector and society must face to realize Brazilian Psychiatric Reformation's principles and guidelines

Trajetória de vida de ex-portadores de hanseníase com histórico asilar

Hansen's disease, despite significant advances regarding the diagnosis, treatment and control still carries an immense burden of stigma as a result, mainly of its socio-historical marked by prejudice and isolation of patients, translated by suffering, abandonment and psychosocial problems. Thus, the study set out to rescue the life stories of former leprosy patients with a leprosarium history; recovering the life trajectory stories of these former patients and to identify common factors to these life stories. Exploratory-descriptive study with a qualitative approach, using the Life History Research Methodology. The sample was composed by twelve former leprosy patients who lived while undergone treatment in the Colony Hospital St. Francisco de Assis, located in Natal, Rio Grande do Norte. The network was composed without considering sex and age limit, patients that lived in the Colony Hospital for at least six months and who agree to participate freely in the study. The subjects with special physical needs (hearing) or mental disabilities and those who do not agree to participate were excluded. A semi-structured interview was used to data collection, the interviews were recorded in the household context of individual, residents in neighborhoods Felipe Camarão, Km 6 and Jardim America, more precisely at Nova Vida village, all located in that district. The data collected were subjected to the technique of thematic content analysis. This study had obtained an appropriate consent of the UFRN Research Ethics Committee under the protocol No. 016/2010. After extensive and careful readings of life stories we identified three themes that guided the data analysis: behavioral stages, social exclusion and, stigma and prejudice. Thus, it is clear that the practice of compulsory confinement of patients in nursing homes and the mythical image of Hansen's disease as being ugly and deformed, contributed to solidifying the historical stigma surrounding the disease and its patients, raising in society and family attitudes and feelings of exclusion, prejudice and fear. Moreover, there are remarkable stories in the lives of these interviewed reporting suffering, denials, anger that reverberate to this day, affecting negatively the social and family reintegration of these individuals. As a result, we see the need for managers and local health professionals, especially nurses, rethink existing strategies for social rehabilitation of the patient and ex-leprosy patient aiming to suppression unjust and harmful stigma rooted in image and stories of these individuals

Educação em saúde em hanseníase: estratégia na educação básica, Parnamirim/RN

Leprosy is an ancient disease that still stands as a public health problem worldwide, especially in the considered developing countries. Of these, Brazil still has large areas of endemicity. The disease remains high among those younger than 15 years old. In this group, the national index achieves 0.6 every 10 000 inhabitants and reaches 2 in the North and Midwest of Brazil. Therefore, the plan of the Ministry of Health is to prioritize the fight against disease in critical areas, providing early diagnosis and timely treatment, especially for patients under 15 years old. This research aimed to: identify the knowledge of students from three schools of basic education in Parnamirim/RN about the risk of getting ill in leprosy; conduct them health education on this topic. An exploratory-descriptive study with quantitative and qualitative nature. Data collection consists of two steps: questionnaire and health education on leprosy. The study was approved by the Research Ethics Committee (REC) of UFRN through the opinion nº 204/2009. Quantitative data obtained were organized, categorized, typed and submitted to the Microsoft Office - Excel for quantitative analysis with simple percentage. Qualitative data were subjected to a content analysis according to Bardin. The sample consisted of 164 students of basic education, most of which is: 1st year of high school, from 11 to 15 years, in the afternoon shift, female gender, skin color white and residents in the municipality of Parnamirim/RN. Still, each student living with four people curiously did not respond in relation to occupation of the father. But the same answered their mother as a housewife and a family income of one to less than four minimum wages. There have been significant results compared the performance of health education in leprosy. Initially, students possessed little knowledge about leprosy. Subsequent to health education, most knew the answer about the disease, transmission, cause, where to get help in case of suspicion of leprosy and the need for the people who lives with leprosy patients to also seek for help, the understanding about if it is treatable or not. Content analysis has established the following themes: axis I, what I do not know about leprosy: cure, fear and prejudice. Axis II, what I know about leprosy, we identified: cure, effectiveness of health education and social exclusion in the past. It is considered the scope of the proposed objectives by matching the effectiveness of health education on leprosy in basic education in Parnamirim/RN; emphasizes, therefore, the importance of understanding the knowledge of public school students. It is expected of them to detect early cases of leprosy in their communities; encourage adherence to treatment as quickly as possible; prevent disability; reduce the stigma surrounding the disease.

Desempenho dos serviços de atenção primária do município de Natal/RN para o diagnóstico e controle da tuberculose

Tuberculosis (TB) is one of the most important health problems being faced worldwide. In Brazil, the responsibility for the actions of to diagnosis and control of this disease was transferred to the municipalities within the Primary Health Care (PHC), aiming at improvement in epidemiological indicators, requiring reorientation of the practice of family health teams and requiring methodologies to analyze the extent to which components of the PHC are being achieved. Thus, this study aims to analyze the performance of primary care services in the city of Natal-RN for the diagnosis and control of TB, from the perspective of health professionals (doctors and nurses). The study is descriptive, cross-sectional and quantitative. Data collection was conducted from March to July 2011 and involved 121 health professionals working in 52 health units (family health unit, basic health unit and mixed units). The instrument is structured based on the Primary Care Assessment Tool (PCAT), validated and adapted to assess attention to TB in Brazil, and includes questions regarding the Structure and Process components of health services. For quantitative analysis, it was constructed indicators, whose response patterns are followed according to the Likert scale between one and five, which meant the degree of preference relation (or agreement) of the claims. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. With regard to inputs and equipment, the units had satisfactory condition for form (  = 4.26), consultation (  = 4.02) and basic basket (  = 4.24); regular condition to pot (  = 3.56) and unsatisfactory conditions for transportation tickets (  = 1.50) and sputum smear microscopy (  = 2.42) and X-rays (  = 1.07). In relation to actions, there was satisfactory development for those focused on the individual patient. Actions aimed at the collective level, as the search for respiratory symptoms (RS), monitoring of contacts and guidelines for the community ranged from regular to unsatisfactory (  = 3.16 -  = 1.34). With regard to training, 94,2% received training to identify RS. As regards the time for diagnosis, the median time elapsed between the identification of RS and the beginning of treatment it was 22 days. In relation to the difficulties faced by professionals in the diagnosis of TB, 56,2% reported that they are related only to health services, especially for the failure in the rearguard laboratory and in the specialized services reference, the lack of human and material resources and low performing an active search. The professionals perceive the performance of diagnosis and control of TB, permeated with limitations and barriers to organizational and operational character of various sizes, emerging the need for effective coordination of various sectors and key stakeholders of TB care, to adoption of a new intersectoral strategies that aim to increase the responsiveness of the PHC, providing the best performance in service delivery to the user, family and community, and ensuring effective action and resolving the needs of this population group.

Atenção à saúde mental na Estratégia Saúde da Família no Município de Parnamirim/RN: opinião dos profissionais, dos portadores de transtornos mentais e seus acompanhantes

This study aims to analyze and compare the opinion of professionals, managers and users about the mental health care in the Family Health Strategy (FHS). It is characterized as an Operations Research or Health System Research with a cross-sectional design and a descriptive quantitative nature. The study was developed from the application of the Opinion Measurement Scale allied to techniques of observation and structured interview in the city of Parnamirim / RN. The sample consists of 409 subjects, 209 professionals of the Family Health Strategy, 30 of the Oral Health Strategy, 19 of the Family Health Support Center, 24 directors of Basic Health Units, plus 68 users with mental disorders and 59 caregivers, respecting the ethical parameters of Resolution 196/96 of the National Health Council, trial registration number: CAAE 0003.0.051.000-11. Quantitative data were submitted to the Epi-info 3.5.2 for analysis. The network of mental health in Parnamirim involves the flow between the FHS, Psychosocial Care Centers, clinics and hospitals, having as main barriers the fragility of the referral and counter-referral system, of the municipal health conferences, of the FHS teams by the limitations in material and human resources as well as the population´s lack of acknowledge about the organization of the mental health network, issues that affect the integral attention. Even though the FHS professionals recognize the importance of their actions, they question their role in mental health care, experiencing difficulties in accessing psychiatric services (76.5%). Although most agree that the mentally ill is best treated in the family than in hospital (65.2%), the community health workers were the predominant category in the partial or total disagreement of this statement (40.8%), who is the professional in greater contact with the family. Nevertheless the caregivers miss the support of the FHS as the main focus of attention is on revenue control. The views of professionals, mental patients and caregivers converged in several statements, showing the main weaknesses to be focused by the mental health network of the city, as the perceptions that: (a) physical strength is needed to take care of mental patients for its tendency to aggression, requiring it to stay in the sanatorium for representing danger to society, (b) only a psychiatrist can help the person with emotional problems, (c) the user of alcohol and drugs does not necessarily develop mental illness, (d) the access barriers and doubts about the quality of psychiatric services, (e) caring of a mental health patient does not bring suffering to professionals. Therefore, the commitment to consensus building, monitoring and evaluation of the network are important mechanisms for an effective management system, reflecting in the importance of strengthening the health conferences and approximating different institutions. The results reinforce the importance of strengthening primary care through programs of continuing education focusing on the actions and functions of professionals in accordance with its competences and duties what contribute to the organization and response of mental health care, favoring user´s care and the promotion of family health

O conhecimento e as atitudes das famílias de pacientes em tratamento em tuberculose na atenção primária à saúde

This study thus sought to examine knowledge about TB and attitudes of patients families in disease treatment in Primary Health Care in Natal- RN. To this end, a cross-sectional study was undertaken through a questionnaire with families of patients diagnosed with TB and follow up by APS from Natal. The study subjects were recruited from a non-probabilistic way, by convenience, contemplating a sample of 50 families. Among the criteria considered for inclusion of subjects, older than 18 years were considered, as well as residing with the TB patient and in Natal and availability to participate in the research. Data collection was performed by own researcher and an assistant, through a questionnaire with families of patients diagnosed with TB following the double independent digitalization of data. In the analytical phase, was initially conducted an exploratory phase and univariate data, with description of the position measurements (mean, median, mode) and dispersion (confidence interval and standard deviation). In bivariate analysis, it was conducted an intersection of dependent variables of knowledge e and changes of attitude dichotomous, with each of the independent variables, using contingency tables and calculating the chi-square test and, when appropriate, the Fisher exact test. In 2x2 tables, calculated the odds ratio (OR) with confidence intervals of 95% (95% CI). From the selected sample, 43 (86%) subjects were female, average age and median respectively of 46.64 and 46.50 years, 25 (50%) had elementary school. The knowledge expressed by family members about TB was considered satisfactory. However, the lack of interest of the family (54%) in seeking information about tuberculosis; the wrong way of reply in relation to the organism causing the disease (64%); the water content (62%) and contaminated food (54% ) as a means of spreading TB was a weakness identified in the investigation. Regarding the time of transmission, 90% of respondents indicated not know or answered wrong. From investigated independent variables, only two were associated with lack of knowledge of TB, and they did not have religion (OR: 0.146, 95% CI: 0.027 to 0.800) and income below 1, 7 minimum wages (OR: 0.155, 95% CI: 0.029 to 0.813). Thus they seem to exercise a protective effect on this outcome. As for the changes in attitude, most of the found variables had no association with statistical significance, except no internet access (OR: 0.212, 95% CI: 0,048-0, 935). Most attitudes were positive in relation to TB patient. Results have demonstrated weaknesses in TB care, which has taken on a more individual and welfare character. Data not only express health outcomes produced by health services, but also the political and social situation of the families that are affected by TB