Efeito de um resultado falso positivo da leitura da mamografia na n��o participa����o no rastreio do cancro da mama : estudo de coorte hist��rico de um rastreio de base populacional da regi��o de saúde do centro em Portugal

RESUMO - Introdu����o: O cancro da mama �� uma das principais causas de mortalidade por doença oncol��gica. O rastreio contribui para o aumento da sobreviv��ncia, mas apresenta riscos como a obten����o de um resultado falso positivo com efeitos controversos sobre a participa����o subsequente. M��todos: Realizou-se um estudo de coorte hist��rico (2006-2012) de 170.835 mulheres com 45-67 anos, eleg��veis para o programa de rastreio do cancro da mama da ARSC,IP. Calcularam-se as medidas de efeito de um falso positivo da leitura na n��o participa����o na volta consecutiva de rastreio do cancro da mama, e a associa����o entre o evento em estudo e factores sociodemogr��ficos, relacionados com o rastreio e com a anamnese, atrav��s de an��lise de regress��o de Poisson. Resultados: A incid��ncia de n��o participa����o foi 12,13%. A exposi����o a falso positivo da leitura aumentou 8,01% o risco absoluto de n��o participa����o. O falso positivo da leitura da mamografia revelou-se um factor de risco para a n��o participa����o (RRa=1,17; IC 1,10-1,25). O efeito protector da exist��ncia de participa����es anteriores foi superior ao efeito dos factores de risco identificados. Identificaram-se outros factores de risco e de protec����o. Discuss��o: De acordo com os factores de risco e de protec����o identificados recomendaram-se altera����es �� operacionaliza����o do programa de rastreio, a manuten����o das estat��gias adequadas e a realiza����o de estudos futuros para avaliar o efeito de outros factores n��o inclu��dos neste estudo. A comunica����o do risco associado a um resultado anormal da mamografia �� importante para diminuir a ansiedade consequente ao rastreio, devendo ser oferecidas interven����es que promovam a participa����o no rastreio.

Caracteriza����o da carga da doença arterial perif��rica dos membros inferiores : contributos para um melhor conhecimento do peso desta doença no internamento hospitalar

RESUMO - A doença arterial perif��rica (DAP) apresenta uma carga de doença significativa, afetando cerca de 3 a 10% da popula����o em geral e 15 a 20% dos indiv��duos com idade superior a 70 anos. A sua preval��ncia em Portugal foi estimada em cerca de 5,9% no continente; 6,6% na Regi��o Aut��noma dos A��ores (RAA) e 3,8% na Regi��o Aut��noma da Madeira (RAM). Para al��m da importante carga de doença, quer em termos epidemiol��gicos, quer econ��micos, a DAP confere aos seus portadores um risco cardiovascular agravado, sendo que os mesmos apresentam cerca do triplo do risco de mortalidade e de eventos cardiovasculares quando comparados com indiv��duos sem DAP. Tratou-se de um estudo observacional, transversal e descritivo tendo como base duas popula����es de estudo. A primeira �� referente aos hospitais do Servi��o Nacional de Saúde (SNS) com a val��ncia de cirurgia vascular e a segunda �� popula����o portuguesa com epis��dios de internamento por diagn��stico de DAP dos membros inferiores (MI) nos anos de 2013 e 2014 na totalidade dos hospitais do SNS. Atrav��s da an��lise dos resultados do question��rio procedeu-se �� descri����o de algumas das caracter��sticas dos servi��os e unidades de cirurgia vascular de sete hospitais do SNS; atrav��s da an��lise da base de dados dos GDH para os anos de 2013 e 2014 procedeu-se �� caracteriza����o do peso do internamento por DAP dos membros inferiores a n��vel nacional no mesmo per��odo. A DAP tem uma carga significativa e atendendo aos seus fatores de risco e hist��ria natural da doença, apresenta uma tend��ncia crescente durante os pr��ximos anos, representando por isso um enorme desafio para os sistemas de saúde. S��o, no entanto, necess��rios estudos mais aprofundados sobre o tema que permitam conhecer melhor o peso desta patologia e, de forma global, melhorar o planeamento, tendo por base a caracteriza����o quer do lado da procura (dados epidemiol��gicos e peso no internamento), quer da oferta (capacidade instalada).

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

Iniq��idade em saúde: uma extens��o das desigualdades sociais no sistema p��blico de saúde do Brasil (2003-2006)

This issue analises the unevenness in the brazilian system of public health care as an extension of socials inequities. It is a theoretical study based in a historical method, using empirical camp from academic, corporation and institution researchs, along the period 2002-2006. Equality and effectiveness in health systems are analitical basic cathegories grap in the root of the doctrine, principles and organization of the Unique Health System, in which sectorial actions are inserted. Discuss the estructural prodution and determined those inequalities through some social determiners of health system: income, land, food securitiy, nutritional situation, basic sanitation, epidemiological inequities and public management policy. Carry out a thematic review over health social production, it formlation and the goals of social policies, as well as the insertion of the equality principle in the assistance system, in the frame of the running public health regulations. It uses reflections that enlighted the correlation between the process of political-institutional actions and equity on health assistance. Analized the pertinency of sectorial reorganizational strategies on basic attendance, confronting the hipothesis that those strategies reinforce social inequities in health system, because it organize diferential assistance levels over not equal baselines. The results show up that social inequalities, even remaining, have had a small decrease; that the selectiviness of actual public policies and the duplication of the health system, increases the differences within and between the social classes and configures the assistance as inequal. The basic care system has great shortages that also appeares in middle and complex assistance levels. As conclusion, it remarks that the health assintance system, even with it integrality has limits; structural problems on material conditions of living and health system could not be reversed only with institutional legal arragements; by the contrary, in border conditions, these strategies produce policies that reinforce inequities, neglecting the equity principle of the system in which frame, they work. One patina of this tim

As pr��ticas educativas na saúde da fam��lia: uma cartografia simb��lica

This qualitative research aimed to understand the educational activities carried out in Family Health Units, of the municipality of Mossor��-RN. It was used symbolic cartography to organize and present data from reality. It started on the approach of Health Education and knowledge transformation practice, aiming at the development of autonomy and responsibility of individuals and healthcare, publicized by the appreciation of the interpersonal relations area established in services, such as educational emancipator practices contexts. Individual and collective interviews were realized, conducted with health professionals and users of ESF, about themes, activities, membership, the difficulties, the potential and the design of health education that permeate everyday Family Health Strategy. From what was apprehended, thematic maps were done with the analysis of educational practices of professionals belonging to the Family‟s Health. Links are built with the wires of conceptions of education reflected on themes and activities of family health teams. The storylines are rebinded by voices about the difficulties and the potential of educational processes for emancipator postures. For users, health education means proper care and information on disease prevention. Professionals understand that it is all information that is given to users, about health, social well-being, economic and general condition of human being as a way of preventing and treating disease. Mark printed on voices denote that activities and themes worked don‟t motivate users enough for their participation, being that physicians and dentists also get excluded themselves from educational practices. Elderly groups are those who get most involved with the activities. The size of the contained area and its seclusion from community make harder the access of users, as well as diminishing the quality of educational actions and links users-professionals. Therefore, the searching for medicines, medical consultations and wish to be well served are trademarks of voices from the users that interconnect with enlightening information and guidelines offered by professionals to users. It brings out practices that need to incorporate the social, the subjective and act with practices of prevention and health promotion, on the basis of lifestyles. The dialogical model, which needs to be approached since planning phase of health education actions could arouse interest of involved groups; promoting a relationship of dialogue and listening; discussing the local reality; stimulating practical methodological dialetics; promoting processes of deconstruction of concepts, values and attitudes, as more necessary than construction, using multiple languages. The defended thesis denotes paths to other studies aimed at understanding a dialogical template committed to exchanges of knowledge, and discover strategies that encourage formation of critical consciousness and the discovery of how is the training of new generations of healthcare professionals to belong to the project of society, in its technical, scientific, pedagogical, ethical, political and humanistic dimensions

Pol��tica de aten����o �� saúde do idoso em Mossor��/RN: potencialidades e possibilidades para promo����o do envelhecimento saud��vel no estado do Rio Grande do Norte

It discusses the Health Care of the Elderly in the town of Mossor��, traversing the paths that discussed the history of health care, which has been altered by the new (con) formation and required adjustments of society which led the development and implementation of the National Health Care for the Elderly with the backdrop of the guiding principles of the Health System - SUS. The goals outlined were: To map the implementation of the policy of health care for the elderly in Mossor�� considering whether this is based on the principles and guidelines of the NHS and National Health Policy of the Elderly; Check if health promotion is seen as a strategy that favors the elderly mossoroenses the possibility of healthy aging; identify the discourse of the elderly about the aging process and the strategies you use to take care of your needs. Applies as a methodological strategy BOAS, complemented by interviews with twenty (20) elderly residents of Mossor�� with a view to understand the objective elements, and the political and subjective traits that express a regularity which marks the area of health care mossoroense elderly. The data were tabulated and the BOAS divided into nine sections for analysis. The speeches were transcribed seized and subjected to a thorough reading that allowed the visualization of issues that have been examined with theoretical and methodological support to the model proposed by Boaventura de Souza Santos (2006) designated this cosmopolitan reason being supported by three meta-sociological procedures, namely, the sociology of absences, the sociology of translation work and emergencies. It appears as a result the exclusion and discrimination of the elderly in different social settings, a condition that prevents them from being aware of their importance as citizens deserving of decent treatment and respect for the family, society and the government, when addressing health the elderly said the need to propose alternative models of care that has the paradigm of health promotion. We conclude that in these areas, meetings are held, to draw lines that were heterogeneous because they were built by the dissimilarities that engender incessantly and show that although we have advanced regarding the attention of the elderly in Mossor�� there is still a long way to go in order to meet the needs revealed by the elderly. It is suggested that the practice of trial-creation-differentiation, while highlighting the historical and procedural dimension, deconstructions and negotiations with collective effects. A democratic paradigm and analytical creeps: the constitution are moments of Health Care for the Elderly shaping a new landscape in the town of Mossor��.

O direito �� saúde e a pol��tica nacional de aten����o oncol��gica: uma an��lise a partir da crescente judicializa����o dos medicamentos antineopl��sicos

The 1988 Federal Constitution of Brazil by presenting the catalog of fundamental rights and guarantees (Title II) provides expressly that such rights reach the social, economic and cultural rights (art. 6 of CF/88) as a means not only to ratify the civil and political rights, but also to make them effective and practical in the life of the Brazilian people, particularly in the prediction of immediate application of those rights and guarantees. In this sense, health goes through condition of universal right and duty of the State, which should be guaranteed by social and economic policies aimed at reducing the risk of disease and other hazards, in addition to ensuring universal and equal access to actions and services for its promotion, protection and recovery (Article 196 by CF/88). Achieving the purposes aimed by the constituent to the area of health is the great challenge that requires the Health System and its managers. To this end, several policies have been structured in an attempt to establish actions and services for the promotion, protection and rehabilitation of diseases and disorders to health. In the mid-90s, in order to meet the guidelines and principles established by the SUS, it was established the Pol��tica Nacional de Aten����o Oncol��gica PNAO, in an attempt to sketch out a public policy that sought to achieve maximum efficiency and to be able to give answers integral to effective care for patients with cancer, with emphasis on prevention, early detection, diagnosis, treatment, rehabilitation and palliative care. However, many lawsuits have been proposed with applications for anticancer drugs. These actions have become very complex, both in the procedural aspects and in all material ones, especially due to the highcost drugs more requested these demands, as well as need to be buoyed by the scientific evidence of these drugs in relation to proposed treatments. The jurisprudence in this area, although the orientations as outlined by the Parliament of Supreme Court is still in the process of construction, this study is thus placed in the perspective of contributing to the effective and efficient adjudication in these actions, with focus on achieving the fundamental social rights. Given this scenario and using research explanatory literature and documents were examined 108 lawsuits pending in the Federal Court in Rio Grande do Norte, trying to identify the organs of the Judiciary behave in the face of lawsuits that seeking oncology drugs (or antineoplastic), seeking to reconcile the principles and constitutional laws and infra constitutional involving the theme in an attempt to contribute to a rationalization of this judicial practice. Finally, considering the Rational Use of health demands and the idea of belonging to the Brazilian people SUS, it is concluded that the judicial power requires ballast parameters of their decisions on evidence-based medicine, aligning these decisions housing constitutional principles that the right to health and the scientific conclusions of efficacy, effectiveness and efficiency in oncology drugs, when compared to the treatments offered by SUS

Tuberculose: conhecimentos, representa����es sociais e experi��ncias da doença na vis��o 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 Fam��lia (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

Câncer de mama: viv��ncia das usu��rias dos servi��os prestados pela Liga Norte Riograndense Contra o Câncer

This study is about the users' experiences of the services offered by League Against Câncer that are in treatment of breast cancer, focusing on how the health/illness process develops. It is distinguished, in this context, the National Politics of Health, approaching the sprouting, implantation and consolidation process of the Unified Health System and its shocks on the installment of health services to the low-income population as a legit right from Citizen Constitution. It has as an objective to analyze how the social-economic extract of these women intervenes with such process, the aspects who involve the cancer while a pathology, approaching the signals, symptoms, forms of prevention, diagnosis, among other aspects that configure themselves as important points to the understanding of these experiences, since the diagnosis, treatment and control phases. The research was carried out with 25 women, between the months of January and February of year of 2005. The used technique was the scriptstructured interview, whose universe was defined through intentional sample. The following distinguishes as a result of the research: The majority of the women has its origins on the interior of the state, possesses a familiar income from one to three minimum wages and didn't make any kind of prevention before diagnosis, currently make treatment, beyond other aspects. It becomes necessary posterior studies on this social problematic, with respect to the personal, professional, familiar and social daily behavior of these women. It is worth mentioning that the role of the social assistant in the developed work with these women, understanding all the impediments associated with such experiences, as well as giving information about the rights of the patients with cancer, conquered through the years

Doença como experi��ncia: as rela����es entre vulnerabilidade social e corpo doente enquanto fen��meno biocultural no estado do Par��

O estudo ora apresentado analisa a representa����o biossocial de pessoas com Anemia Falciforme (AF) no Estado do Par��, agravo entendido como um fen��meno biocultural por envolver aspectos evolutivos, gen��ticos, ambientais, socioecon��micos e culturais da viv��ncia cotidiana dos indiv��duos acometidos pela s��ndrome. A investiga����o aborda as sociabilidades de quarenta (40) interlocutores com AF, representando cerca de 10% dos pacientes em tratamento na Funda����o Hemopa (Bel��m), centro de referência em doenças hematol��gicas do Estado, englobando a sua situa����o de vulnerabilidade social, suas percep����es de Saúde e Doença, os tratamentos complementares (folk medicine), diagn��stico, estigmas, preconceitos, tabus e dificuldades de acesso e acessibilidade aos servi��os do SUS com os quais eles convivem rotineiramente. A metodologia compreensiva e a an��lise de conte��do revelam as experi��ncias pr��ximas dos sujeitos que diariamente convivem com as instabilidades da enfermidade. A viv��ncia da doença, elaborada atrav��s das rela����es sociais, conversas, percep����es e enredamentos familiares e extrafamiliares do grupo em quest��o, que em seu conjunto organiza sua vida social de modo sui g��neris, foram os principais dados revelados, considerando a dor f��sica e psicol��gica representada pelo corpo adoecido. O habitus em rela����o ao estilo de vida dos sujeitos �� um recorte que engloba a natureza ��tnico-racial da AF, ainda entendida como ���doença que vem do negro��� e que necessita ser desmistificada pelos profissionais de saúde que os assistem no dia-a-dia em ambulat��rios de todo o Estado. Concluo sugerindo que a AF �� uma doença que est�� atrelada aos Determinantes Sociais em Saúde, incorporando as diversas suscetibilidades dos interlocutores, que necessitam de maior sensibilidade pol��tica e dos setores de aten����o b��sica �� saúde para que as pessoas que compartilham as vicissitudes da AF possam ser inclu��das socialmente.

Saúde mental e trabalho na assistência social: viv��ncias de sofrimento ps��quico e estrat��gias de defesa dos(as) servidores(as) p��blicos(as) municipais da FUNPAPA em Bel��m/PA

Inserido no contexto das rela����es estabelecidas entre saúde mental e trabalho, este estudo tem por objetivo analisar as viv��ncias de sofrimento ps��quico dos servidores respons��veis pela execu����o dos servi��os socioassistenciais da rede de Prote����o Social da FUNPAPA, enfatizando as estrat��gias que desenvolvem para realizar o seu trabalho de forma a colocarem-se no ��mbito da ���normalidade���. Pautado nas contribui����es da psicodin��mica do trabalho e nos referenciais do campo da saúde do trabalhador, o enfoque te��rico-metodol��gico desta pesquisa consiste em uma abordagem qualitativa, cuja coleta de dados envolveu entrevistas individuais semi-estruturadas e observa����o participante. A an��lise dos dados, realizada atrav��s da t��cnica de an��lise de conte��do, apontou aspectos relacionados ��s condi����es de trabalho e �� organiza����o do trabalho atuando como desencadeantes de viv��ncias de sofrimento ps��quico, as quais se expressam em ansiedade, insatisfa����o, medo, t��dio, repugn��ncia, dentre outras manifesta����es. Os aspectos relacionados ��s m��s condi����es de trabalho que desencadeiam o sofrimento ps��quico dos servidores da FUNPAPA s��o: espa��o f��sico sem a adapta����o necess��ria para o atendimento dos usu��rios, equipamentos obsoletos e/ou com funcionamento defeituoso, escala de ve��culos irregular e condi����es ambientais insalubres devido �� infiltra����es constantes. Como elementos constituintes da organiza����o do trabalho que funcionam como determinantes do sofrimento ps��quico vivenciado pelos servidores da FUNPAPA podemos citar: o atendimento aos usu��rios, a capacita����o profissional inadequada ao trabalho que desenvolvem, a avalia����o de desempenho, a aus��ncia de reconhecimento social, o quantitativo reduzido de servidores, a rede socioassistencial deficit��ria e a impot��ncia diante dos limites da pol��tica de assistência social para fazer frente ��s demandas sociais postas a esses servidores. Para lidar com as viv��ncias de sofrimento ps��quico de modo a evitar a doença e a loucura esses servidores adotam estrat��gias de defesa de prote����o, incluindo: a racionaliza����o, a religiosidade, os la��os de confian��a e solidariedade, o absente��smo, a antecipa����o das f��rias, o investimento em atividades desenvolvidas fora da jornada de trabalho, o trabalho itinerante na comunidade e a busca de solu����es alternativas para tornar o ambiente f��sico o mais acolhedor poss��vel. Desta forma, a estrutura deste trabalho abrange tr��s momentos: a referência emp��rica, o aporte te��rico e a discuss��o dos resultados, respectivamente. Por ��ltimo, �� guisa de conclus��o, s��o apontadas algumas notas para subsidiar uma proposta de promo����o da saúde mental no trabalho.

Atravessando fronteiras: viagem rumo �� saúde tradicional

Esta tese possui como tema o estudo da saúde tradicional, traz a proposta de pesquisar os saberes e pr��ticas dos profissionais de saúde tradicional que utilizam t��cnicas corporais para tratar perturba����es e desconfortos restabelecendo a saúde aos atendidos. Trabalho de campo foi realizado no distrito de Icoaraci na cidade de Bel��m e na localidade de Chipai��, no munic��pio de Cachoeira do Arari, o qual faz parte do arquip��lago do Maraj��. Apresenta como objeto de estudo a constru����o social da pr��tica do profissional de saúde tradicional, como elemento m��gico-simb��lico e social de saúde nas regi��es trabalhadas. Foram selecionados oito profissionais de saúde tradicionais, quatro em cada localidade. Por meio de observa����es e entrevistas abertas o estudo busca aprofundar a medida curativa conhecida como ���puxa����o���, pr��tica pertencente ao Sistema Tradicional de A����o para a Saúde (STAS), discutindo as concep����es que dizem respeito a cren��as, mitos e representa����es simb��licas utilizadas para a constru����o do saber tradicional; a forma que s��o realizados os ritos e como tais pr��ticas levam �� constru����o social do profissional de saúde tradicional; as concep����es de saúde e doença na concep����o do STAS; e a rela����o das pr��ticas de cura com o sistema social. A an��lise tamb��m aborda a inter-rela����o dos ritos: puxa����o da m��e-do-corpo e puxa����o de barriga-cheia como exemplos de pr��ticas singulares do STAS, sua import��ncia na aten����o �� saúde da mulher e reflexo gerado no Sistema Ocidental de A����o para Saúde (SOAS).

Representa����es sociais sobre a Aids e a Terapia Anti-Retroviral: influ��ncias no tratamento de pessoas vivendo com HIV/Aids

Com o advento da Terapia Anti -Retroviral, a Aids assumiu caracter��sticas de doença cr��nica, em especial nos pa��ses onde o acesso aos medicamentos �� efetivamente garantido. O Brasil �� tomado como modelo por possuir um programa que tem dado boas respostas �� epidemia. Em novembro de 1996, foi promulgada, pelo Sistema Único de Saúde (SUS), a lei que disp��e sobre a obrigatoriedade do acesso gratuito a todos os que necessitarem de medicamentos anti -retrovirais. Os resultados obtidos com o tratamento ��� a redu����o progressiva da carga viral e a manuten����o e/ou restaura����o do funcionamento do sistema imunol��gico ��� t��m sido associados a benef��cios marcantes na saúde f��sica das pessoas soropositivas e permitido que elas retomem e concretizem seus projetos de vida. Por��m, o acesso universal aos medicamentos que possibilita o tratamento para portadores do HIV gratuitamente ainda enfrenta problemas de ades��o. Em uma compreens��o mais restrita, ades��o pode ser definida como o comportamento de uma pessoa ��� tomar rem��dio, seguir uma dieta ou fazer mudan��as no estilo de vida ��� que corresponde ��s recomenda����es da equipe de saúde. Nesse contexto, esse estudo se prop��e a analisar as representa����es sociais de sujeitos soropositivos sobre o tratamento anti-retroviral e suas implica����es no processo de ades��o a este tratamento, caracterizando as imagens e os sentidos que estes sujeitos soropositivos que aderiram ou n��o aderiram �� terapia anti -retroviral possuem sobre este tipo de tratamento e as implica����es na sua vida, destacando as objetiva����es e as ancoragens que comp��em suas representa����es sociais. A metodologia foi pautada nas formula����es te��ricas sobre pesquisa qualitativa, priorizando -se a entrevista no enfoque do M��todo de Explicita����o do Discurso Subjacente (MEDS), realizadas na Unidade de Referência em Doenças Infecciosas e Parasit��rias Especiais (UREDIPE), vinculada �� Secretaria de Estado de Saúde do estado do Par�� (SESPA) e no Hospital Universit��rio Jo��o de Barros Barreto (HUJBB), mais especificamente na Clinica de Doenças Infecciosas e Parasit��rias (DIP).

Câncer gastrointestinal: dificuldades para o acesso ao diagn��stico e tratamento

O câncer do trato gastrointestinal tem sua import��ncia no perfil de mortalidade do Brasil, estando entre os dez mais incidentes do pa��s. A detec����o precoce garante uma melhor qualidade de vida para os doentes oncol��gicos, por��m frequentemente estes chegam aos centros de tratamento em fase avan��ada da doença. O estudo objetiva investigar as dificuldades de acesso ao diagn��stico e tratamento para os pacientes com câncer gastrointestinal atendidos pelo Sistema Único de Saúde. Com este intuito, realizou-se uma pesquisa observacional descritiva e sob a forma de um question��rio foram coletados dados de pacientes em tratamento em dois hospitais p��blicos de Bel��m, no per��odo de mar��o a junho de 2013. Preencheram os crit��rios de inclus��o 122 pacientes que foram agrupados em diferentes trajet��rias de atendimento. Al��m disso, foram tamb��m obtidas informa����es registradas nos prontu��rios desses pacientes. A an��lise dos dados demonstrou que o diagn��stico da doença em 68,1% foi realizado pelo m��dico generalista; a maior dificuldade, nessa fase, foi o acesso ao diagn��stico gerando gastos com exames, pois a maioria dos pacientes (68,9%) n��o realizou exames especializados atrav��s do Sistema Único de Saúde, mas com recursos pr��prios. Nos centros/ unidades de referência em oncologia, as dificuldades relatadas por 56 pacientes come��am com a marca����o da consulta m��dica, ocorrendo demora do agendamento pela institui����o para 94,6% desses doentes. A falta de leito para interna����o foi apontada como o maior entrave (54.4%) para iniciar a terap��utica cir��rgica, particularmente para o câncer g��strico e de c��lon e reto. A an��lise das trajet��rias percorridas pelos doentes, desde o inicio dos sintomas at�� o atendimento na unidade de referência, revela que o diagn��stico da doença em 50% dos pacientes ocorreu somente ap��s 10 meses do inicio dos sintomas, e o tratamento iniciou s�� depois de 90 dias do diagn��stico. O tempo que os pacientes permanecem sintom��ticos sem um diagn��stico impacta negativamente no progn��stico. Nesta pesquisa, os casos de câncer g��strico e de c��lon e reto foram diagnosticados tardiamente (est��dio IV e IIIB) e, por conseguinte o tratamento n��o ocorreu no prazo desej��vel.