Avaliação da terapia comunitária na atenção primária à saúde

A busca por um modelo democrático de saúde despertou a atenção do governo brasileiro para o estabelecimento de prioridades e estratégias, que impulsionaram a implantação do Programa de Saúde da Família (PSF), atualmente denominada Estratégia Saúde da Família (ESF), a fim de aproximar a equipe de saúde da comunidade e, assim, implementar ações de promoção da saúde e de prevenção do adoecimento. Nessa perspectiva a Terapia Comunitária (TC) emerge como uma tecnologia de cuidado voltada à saúde mental na Atenção Básica de Saúde. Desde 2007, a TC vem sendo desenvolvida no município de João Pessoa/PB por profissionais da ESF: enfermeiras, agentes comunitários de saúde, médicos, odontólogos, fisioterapeutas, nutricionistas, psicólogos, entre outros. O estudo teve como objetivos: avaliar a satisfação dos usuários em relação à TC na Atenção Básica no município de João Pessoa/PB; medir o nível de satisfação dos participantes da TC em relação a essa ferramenta do cuidado; identificar elementos importantes para a satisfação em relação à TC por parte dos usuários. Trata-se de um estudo avaliativo, transversal e observacional, realizado no período de maio a agosto de 2009. Utilizou-se como instrumento de coleta de dados a Escala de Avaliação da Satisfação dos Usuários com os Serviços de Saúde Mental Satis-BR, bem como um instrumento de perguntas complementares utilizado pelos terapeutas comunitários. Os resultados revelaram que dos 198 (100%) entrevistados, 105 (53%) verbalizaram satisfação e 93 (47%) muita satisfação nos encontros de TC, o que evidencia que a totalidade da amostra está satisfeita com a terapia. Os elementos importantes que concorreram para a satisfação dos usuários da TC foram: respeito, dignidade, escuta, compreensão, acolhimento, apoio nas necessidades e boas instalações dos locais onde ocorre a terapia. A TC vem fortalecendo o cuidado à saúde mental, por se constituir como uma tecnologia de prevenção e fortalecendo a porta de entrada para a rede de saúde mental e de apoio psicossocial. Conclui-se, portanto, que a TC vem se destacando como instrumento de inclusão da saúde mental na Atenção Básica no atendimento aos usuários do Sistema Único de Saúde

Cartografia da percepção de mês e profissionais sobre a atenção a saúde de crianças/adolescentes soropositivos no município de Natal

This study had as objective to identify to the perception of mothers and professionals of health on the attention to the health of HIV-Positive children/adolescents in the city of Natal-RN. It is a descriptive-exploratory study with quantitative and qualitative approach, carried through in the Giselda Trigueiro Hospital and in the State and Municipal Health Councils in Natal - RN, from march to december of 2005. The sample was composed by 56 participants, 33 mothers of children who use specialized assistance and 23 professionals. Data collection occurred with the application of a half-structuralized interview. Quantitative data were analyzed through descriptive statistics and qualitative data were submitted to content analysis. Prevailing categories in relation to the cartography of the attention to seropositive children and adolescents in Natal were: Organization and dynamics of the attention; Institutional management and human development; Control and prevention; other contexts of attention; relationship/communication team-patient and organization and functioning of the services. The profile epidemiologist of the children, adolescents and of the people/mothers, who take care of them with HIV/Aids, followed the evolution of the epidemic in the country and the world. It was verified that mothers need care and information; however they make a positive evaluation of the attendance they receive. It was also observed many gaps in the services of assistance, in which the researched group was attended, beyond imperfections in the communication between health professionals and users. The professionals recognize the advances that the politics represent for the assistance of people with Aids; however feel themselves limited by the precariousness of the system and the partner-economic conditions of the people. According to these data, it can be verified great challenges to go through in the context of integrality of the assistance to HIV positive children and adolescents in the city of Natal and in the improvement of the communication in the institution of reference

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.

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

Saúde física e emocional de cuidadores da cidade de Santa Cruz-RN: perfil epidemiológico e fatores associados

Taking care for an impaired elderly is a hard and costly task that could affect directly the caregiver health. The purpose of this study was to evaluate the physical and mental health of elderly caregivers from the city of Santa Cruz-RN and analyze the potential correlated factors through an observational analytic design of a crosssectional. A multidimensional questionnaire was used to evaluation of the social demographics characteristics and those related to the care activity, as well as the caregivers´ physical and mental health. It was realized a descriptive analyze using frequency distribution and measures of the central tendency and dispersion to description of the caregivers. To verify the magnitude of the association between the variables was used the bivariate analysis through the Pearson and Spearman correlations and qui-square test. To evaluation of the association of the correlated factors to the adverse outcome with the caregivers´ physical and mental health was made a multivariate analysis by logistic binary regression and multiple linear regression models. The final sample was constituted by 304 persons, mostly women with a mean age of 50.3 ±16.8 years. The principal factors related to the physical health were age, stress and life satisfaction. Be a male caregiver, caring for a little while the elderly with cognitive deficit and not been spouse were related to worse mental health. Have worse physical health, high stress, depressive symptomatology, burden and low levels of satisfaction were also related to the mental health. After adjust through multiple linear regression was observed R2 values of R2=0,21 for Stress, R2 =0,17 for Depressive Symptomatology, R2 =0,21 for Burden and R2 =0,16 for Satisfaction. The attainment of the factors associated with caregiver´s health can help in the elaboration of specifics politics witch the goal is the integral attention to the elderly and his caregiver. The inability of continuous taking care could result in adverse outcomes such as institutionalization, impairment and death

Mulheres em situação de violência e atenção em saúde mental: um estudo no município de Natal (RN)

The present study aims to meet the attention given to women with mental health needs in specialized services for the fight against violence against women, as well as psychosocial care network in the municipality of NatalRN. It is a qualitative research characterized as research-intervention that took place in the year 2011. The study started in the Centre of Reference in which individual semi-structured interviews were carried out directed to the coaching staff and manager, in order to know the care offered in relation to the aforementioned clientele. From the Reference Centre were identified through analysis of registration records, the routes traversed by users through the network of psychosocial care and hospital network. After the identification of the same were visited two day-care Centers, two psychiatric hospitals, a basic health Unit and the local shelter. In these organizations was investigated the reception and procedures offered to users in situations of violence, the knowledge of policies for women and the coordination with the attention to women, through interviews with semi-structured individual scripts directed to professionals. The interviews were analyzed taking as starting point the theoretical framework of French Institutional Analysis, which includes the assumption of events analysers for the critical reading of dimensions introduced in the practices of care of the teams that took part in the study. The survey results revealed difficulties on the part of the same host of users with this profile, both in the face of violence as services in mental health services. This fact led to the lack of support under the guarantee of their rights, ceasing the possibilities of confronting the situations of violence, as well as in the context of mental health care

Satisfaçã dos Usuários e a qualidade da atenção primária à saúde no Rio Grande do Norte

O presente estudo tem por objetivo avaliar a satisfação dos usuários em relação à qualidade da Atenção Primária à Saúde no Rio Grande do Norte. Trata-se de Pesquisa Avaliativa observacional transversal, com abordagem quantitativa, a qual faz parte da Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ), da Universidade Federal do Rio Grande do Norte. Foram utilizados dados secundários de todas as entrevistas com usuários das equipes que participaram da Avaliação Externa do PMAQ no Estado do RN. A pesquisa foi realizada em 167 municípios do Estado do Rio Grande do Norte, na qual a população foi composta por 1.650 usuários. A amostra se deu por conveniência a partir dos seguintes critérios: usuários que estavam presentes na Unidade Básica de Saúde (UBS) para realizar qualquer tipo de procedimento e que consentisse em participar da avaliação. Foram excluídos os que tinham ido pela primeira vez na unidade e aqueles que não frequentaram há mais de 12 meses. A coleta dos dados foi realizada no período de setembro a novembro de 2013. Para tanto, foi elaborado um protocolo de pesquisa contendo as seguintes dimensões: organizacional, interpessoal e estrutural. Em relação à dimensão organizacional os resultados mostram que a marcação de consultas tem se configurado em empecilho ao acesso do usuário ao serviço de saúde, uma vez que se faz necessário para o atendimento, enfrentar filas, antes da abertura da unidade para pegar fichas. No tocante ao funcionamento da unidade, se destaca o fato dos usuários referirem que o horário de funcionamento da unidade atende à suas necessidades, apesar de funcionar 5 (cinco) dias por semana, a maioria das unidades permanece fechada no horário de almoço. Outro dado importante refere-se à coordenação do cuidado, cujos resultados apresentam diferenças maiores entre os usuários da região metropolitana e do interior do Estado em relação à Capital. Essa diferença se expressa principalmente em relação de marcação de consulta com outros profissionais especialistas. A dimensão interpessoal, no que diz respeito à categorias interação usuário-serviço-equipe e vínculo, demonstraram alguns avanços, contudo os melhores resultados foram observados em relação a satisfação com o cuidado, onde mais de 50% dos usuários se mostraram satisfeitos com o cuidado recebido nas unidades. Em contrapartida, o estudo mostrou que, na opinião de 56% dos usuários da capital, a falta de materiais e equipamentos influencia negativamente no cuidado. Por fim, o estudo contribuiu para reforçar a ideia de que a avaliação da satisfação dos usuários dos serviços de saúde pode ser uma ferramenta importante para subsidiar o processo de decisão compartilhada, de forma a se repensar as práticas profissionais, reorganizar o processo de trabalho desenvolvido, realocar recursos, readequar ações e redefinir objetivos que estejam coerentes com o projeto de saúde estabelecido

Adesão a um Programa de Triagem Auditiva Neonatal

A Triagem Auditiva Neonatal tem se efetivado mundialmente como meio para detecção precoce da surdez. Na Unicamp, desde 2002, os recém-nascidos na maternidade do Centro de Atenção Integral à Saúde da Mulher são agendados para a triagem auditiva no Centro de Estudos e Pesquisas em Reabilitação Prof. Dr. Gabriel Porto. No entanto, nem todos vêm para a triagem e alguns abandonam o processo de avaliação antes do diagnóstico. O objetivo desta pesquisa foi caracterizar as taxas de adesão de lactentes ao Programa de Triagem Auditiva Neonatal. Tratou-se de pesquisa que utilizou dados contidos nos prontuários dos lactentes que efetuaram a triagem no período de fevereiro a novembro de 2007. Permaneceram no alojamento conjunto do CAISM 2107 lactentes e vieram para a triagem 1310. Dentre aqueles que não passaram na triagem (92 lactentes), realizaram o exame de PEATE-A 73 lactentes. A adesão na primeira etapa da triagem foi de 62,17%, e na segunda, 79,34%. As taxas de adesão são inferiores às preconizadas pelo Joint Comittee on Infant Hearing e encontradas em alguns países desenvolvidos. No entanto, aproximam-se de outras experiências brasileiras de programas de triagem auditiva neonatal. O acompanhamento sistemático às famílias dos lactentes que não passaram na primeira avaliação e a conscientização destas sobre a detecção precoce da perda auditiva e suas consequências podem ter contribuído para o aumento da taxa de adesão na segunda etapa da triagem.

(Em defesa dos) Cuidados Paliativos na Atenção Primária à Saúde

One of the basic principles of the Brazilian Public Health System (SUS) is integral assistance, which considers the integrality of the individual, of service and care, which should necessarily include end of life care. Our aim was to analyze the work process of health professionals at the Family Health Strategy / Primary Care that already cared for people in the dying process to propose viable contributions to the Public Health area as regards the implementation of Palliative Care in Primary Care. We present data referring to the following themes: Singular Therapeutic Project (PTS); death quality as PTS goal (work purpose); the team's ways of doing (bonding as a pact condition). Eleven health professionals (four nurses and seven physicians) linked to the Family Health Strategy (ESF) of Campinas (São Paulo) participated on this research. From the interviews, data analysis followed the Socio-Historical Psychology theoretical and methodological approach. The professionals' activity was analyzed in articulation with the specificities of caring for people in the dying process. We found that action planning in health is oriented by the Singular Therapeutic Project (PTS), with an emphasis in social diagnosis and the need of a bond for attaining a pact. It is understood that the purpose of health professionals' activity is to promote dignity and life quality in the dying process, but integral care should include not only individual and family care, but also the defence of full human development during all phases of life.

Ações da vigilância alimentar e nutricional em serviços de atenção básica à saúde de Botucatu-SP e município pertencentes à DRS VI

Pós-graduação em Alimentos e Nutrição - FCFAR

Avaliação das práticas e conhecimentos de profissionais da atenção primária à saúde sobre vigilância do desenvolvimento infantil

O objetivo desta pesquisa foi avaliar os conhecimentos e práticas relacionados à vigilância do desenvolvimento da criança de 160 profissionais que atuam na atenção primária à saúde, no Município de Belém, Pará. Foram selecionados 40 médicos e 40 enfermeiros de Unidades Municipais de Saúde (UMS), e 40 médicos e 40 enfermeiros do Programa da Família Saudável (PFS). Na avaliação dos conhecimentos por meio da aplicação de teste objetivo, o percentual de acerto foi de 63,7% para médicos das UMSs, 57,3% para médicos do PFS, 62,1% para os enfermeiros do PFS e 54,3% para enfermeiros das UMSs. Na avaliação das práticas, apenas 21,8% das mães informaram que foram indagadas sobre o desenvolvimento dos seus filhos, 27,6% que o profissional perguntou ou observou o desenvolvimento da sua criança e 14,4% que receberam orientação sobre como estimulá-las. Concluímos que médicos e enfermeiros da atenção primária no Município de Belém apresentam deficiências nos conhecimentos sobre desenvolvimento infantil e que a vigilância do desenvolvimento não é realizada de forma satisfatória, sendo necessárias sensibilização e capacitação dos profissionais para esta prática.

Compreender o trabalho na Atenção Primária à Saúde para desenvolver ações em Saúde do Trabalhador: o caso de um município de médio porte

INTRODUCTION: Attention in Worker's Health (WH) integrality incites expansion of Primary Health Care (PHC) actions. So, it is necessary to understand the work carried out at PHC units and its possibilities to subside WH plans and procedures aiming at workers' health integral attention. OBJECTIVE: To present PHC workers' perception concerning WH actions performed in health care units of a mediumsized municipality in the state of São Paulo. METHODOLOGY: data collected through a 20 question-self-assessment questionnaire prepared by the researcher, using descriptive analysis of closed questions and content analysis of open questions. RESULTS: 45% of all workers answered the questionnaire. All health units in the municipality and all the professional categories part of the PHC teams were enclosed. The answers indicated that the PHC personnel, when providing assistance to users, take their jobs into consideration, and that some actions concerning worker's health are carried out at health care units. The respondents also pointed out that their difficulties to perform these actions are much more related to aspects of the system organization and management, than to the particularities of the worker's health area. CONCLUSION: The study indicates that health care worker's working condition is an important issue for the implementation of PHC worker's health actions

Gestão da atividade física no SUS: o processo de inserção do Programa de Exercícios Físicos em Unidades de Saúde no município de Rio Claro-SP : um estudo de caso

Pós-graduação em Ciências da Motricidade - IBRC