ALTERNATIVAS COMUNICACIONAIS A ESTRATÉGIA DE SAÚDE DA FAMÍLIA

O estudo exploratório de caso que teve como objetivo analisar o processo de comunicação utilizado pelos profissionais da Estratégia de Saúde da Família, na Unidade de Saúde de Maruípe, no município de Vitória, capital do Espírito Santo. Como amostra, escolhemos a Região de Maruípe, que possui o maior número de habitantes da capital, segundo dados do IBGE/2000 e em que a estratégia atinge toda a população. A coleta de dados se realizou pela aplicação de questionários estruturados com perguntas abertas, semiabertas e fechadas aos integrantes de duas equipes de Saúde da Família que, voluntariamente, decidiram participar da pesquisa. Foram aplicados dois tipos diferentes de questionários: um para oito Agentes Comunitários de Saúde e outro para treze membros da equipe. Os dados foram quantificados e analisados qualitativamente visando refletir sobre a importância da comunicação nas ações de promoção e prevenção da saúde, e sua relação com a atenção básica municipal e a redução do número de internações nos hospitais por causas básicas. Com base na teoria crítica, na teoria do agir comunicativo de Habermas e nos recentes estudos latino-americanos sobre a importância da comunicação como insumo na saúde, analisamos os instrumentos de comunicação utilizados pela equipe e a forma como essa comunicação se estabelece, a fim de traçar um protocolo de sugestões para minimizar os problemas de comunicação no desenvolvimento das ações.

Avaliação das condicionalidades em saúde do Programa Bolsa Família

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

A inserção do técnico em saúde bucal na estratégia saúde da família no estado do Rio Grande do Norte

An oral health technician is a profession in odontology whose own functions are defined in FEDERAL LAW NUMBER 11889, which can act for prevention, recovery and promotion of oral health. According to the web site, Of Primary Health Attention Department. Health Ministry Of Brazilian Federal Republic, you can see through historical cover, as regards Health Family Strategy that, in Rio Grande Do Norte, There are nowadays eight TSB equipments in use. Objective: The aim of this study is to find out the reasons of the inclusion of those technicians in public service, no matter the importance of this work. Method: It is about a quantitive study and a kind of exploring type, taking into account that there are not any similar previous ones. We divide it into two parts: as regards the first one, these technicians were registered in a map using the information of the Formation Schools and Class Counsel to know how and where they are. During the moment of this study, an application (or no application) of the mouth health equipments was done. They tried to discover in this process which elements contribute to the efficiency (or not) of this technical work done all together in equipment work. As regards the second part, the coordinators of Municipal Mouth Health answered to a survay that contained open and closed questions through telephone calls. The sample was defined by a raffle taking into account the work contained in municipalities. Results: There are 1053 technicians.94,3% of them are women, devided in all the health regions. As regards interview, 96,9% of oral health coordinators considered that it is very important to have an oral health technician in odontology. 92,2% would reccomend its inclusion in equipments related to mouth health, dealing to familly health . 76% have never talked before to the Health Secretary in this municipality. this spreading out could be related to financial resources and 51,6% mentioned the importance of improving the physical structure to make this spreading out possible. Conclusions: Oral Health technicians in Rio Grande Do Norte are not being adequatly used by public service, because they do not introduce themselves or act as Oral Health auxiliaries. It is important to increase concience about the importance of this category in odontology. we also say it is necesasary to invert money in a reform of the Basic Health Unities and the inclusion of these workers. On the other hand the role of the state and the public health militancy is questioned in the fulfilment of this process

Acolhimento prescrito x real: uma análise sobre as relações entre trabalhadores e usuários na estratégia saúde da família

User embracement has been proposed as a tool that contributes to humanize the nursing, to increase the users’ access to the services, to ensure the resolvability of claims, to organize the services and promote the strengthening of the links between them and the health professionals. In the city of Recife, this practice has been fomented by the municipal government and its implementation is guided by normative acts, with evaluation matrices and proposition of goals, based on a model created by the public administration. This study intended to analyze the relation between the prescribed user embracement and the real one and their interferences with the relations of reciprocity between workers and users in the health units of basic attention in Recife. Four units of the Family Health Strategy at the Sanitary District IV of the city of Recife – PE were taken as an investigation field. The investigation had a qualitative character, so, Interviews were performed involving professionals and users whose speeches were recorded by the voice digital mode and literally transcript. The obtained speeches were analyzed mostly through the Discourse of the Collective Subject methodological approach, being also used, but on a smaller scale, the technique of thematic analysis, in the dialogic way, with theoretical contributions and official documents related to the theme. The results pointed that in most of the health units the professionals execute the proposed protocols and consider that these have a positive influence for the working process in user embracement, however, factors such as the excessive demand, the physical structure of the units, little resolvability of the reference network, singularities of the units, among others, have appeared, hampering the accomplishment of the prescribed, creating, thus, a negative influence on the working process of the user embracement. The reciprocal relations have also suffered the influences of these factors, which made difficult, therefore, the circulation of gift. Meanwhile, other factors such as access, resolvability, sheltering attitude and responsabilization, potentiated the reciprocal exchange between professionals and users. The findings demand the prescriptive acts and the reciprocal relations of the user embracement to be directly influenced by the singularities present in each community, by the human variabilities and by factors connected to the structure and working process, so it shall be operated with caution in order to provide a real user embracement with quality

Práticas integrativas e complementares em Currais Novos/RN: uso de plantas medicinais?

The objective of this study is to investigate how the team of health professionals of the Family Health Strategies program and clients in Currais Novos/RN deal with the use (or not) of medicinal plants as one of the complementary and holistic practices in the Individual Health System (SUS in Portuguese). The research is carried out using a qualitative approach, applying semi-structured interviews, related to the proposed objective, as the instruments of data collection. The interviews applied to professionals and clients were based on questionnaires and were recorded, with their permission, then transcribed in a field diary. The subjects of the study were doctors, nurses, dentists and community health agents of the Family Health Strategies team, totaling 24 (twenty four) health professionals, as well as ten volunteers identified in the research as people who use medicinal plants for health care purposes. From this study, we verify the great importance that health professionals and clients attribute to the use of medicinal plants, as well as evidence that family tradition is the main vehicle for the dissemination of knowledge regarding their use. Most medicinal plants had popular indications similar of those used scientifically, however, 70% of the clients reported never having had medical health advice or encouragement to use medicinal plants in their treatments. Half of the group of professionals interviewed reported not feeling safe in prescribing medicinal plants; approximately 25% reported having received information on the subject during their undergraduate program. Expected outcomes of this study include instigating the implementation of treatment protocols by the health professionals, and broadening holistic care practices, as well as access to alternative therapeutic options, client participation, ultimately strengthening the link between primary care and Family Health Strategies

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

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

As ações em saúde mental nos Núcleos de Apoio à Saúde da Família - NASF

The National Police for Basic Care (PNAB), regulated by ordinance nº2488 from October 2011, restates the Family Health Strategy (ESF) as a priority to the expansion, consolidation and qualification of basic attention to health matters in Brazil. In order to bring it about, city counsellors along with other federal entities ought to ordinate their work process deepening principals, directions and fundaments of Basic Care (AB). Besides ESF, the new PNAB expatiates on the Family Health Support Centres (NASF), reaffirming their role on broadening the scope of basic care actions and their improvements, ratifying their ability to share knowledge and support Basic Care professionals. All this considered, the purpose of this work is to investigate how NASF is currently structured in João Pessoa and what has been achieved by it on what concerns to mental health. Its main objectives are to analyse the practices of mental health professionals that are part of NASF teams and if they differ from what has been developed by the other members of the teams; to discuss the articulation of NASF in managing mental health measures on what concerns to internal organisatio n and to the city health network; to identify strategies used to organise such measures on mental health in Basic Care. To reach such goals, individual interviews have taken place two city health managers and four of NASF professionals that participated on the Mental Health Office as representatives of their sanitary districts. Also a focal group formed by various supporters of NASF was created, contemplating the diversity of professional categories involved with the teams and sanitary districts. It was possible to identify in NASF, in João Pessoa, an organisation based by the matrix support in which both management and basic care demands reflect a series of actions developed alongside with ESF. Amongst such actions, matrixing, home visits and the Singular Therapeutic Project (PTS) stand out. These activities have been discussed on the focal group and integrate the daily work of all NASF supporters despite their professional categories. NASF presents itself as a powerful strategy to SUS proper qualification and support to strengthen Basic Care and broaden family health teams‟actions.

Referência e contra referência em saúde bucal: regulação do acesso aos centros de especialidades odontológicas

Objective Based on the system of reference and counter-reference and comprehensiveness in oral health care, we aimed to examine ways of refering users to Specialized Dental Care Centers (SDCC) and the interface between them and Primary Care. Methods This is a cross-sectional study carried out with users and dentists of SDCC in a metropolitan region of Northeast of Brazil. Analyses were descriptive, and the association test was done with chi-square. Results Six forms of entry to specialized service were identified: free demand (13.8 %) and reference by the Primary Care dentist (63.2 %) were most frequent. Users referred by the basic health unit dentist had more interest in making a counter-reference than the others (p<0.001, PR=4.65, 95 % CI: 2.74 to 7.91), while individuals without this referral had 1.49 times more difficulty obtaining care (95 % CI: 1.02 to 2.17). Referral procedures are a decisive factor for counter-references. However, the high demand for primary care services and the short supply these services can offer in the face of needs make SDCC performance difficult. Conclusion The analysis of oral health practices from the perspective of network modeling points to the service's need to establish protocols for regulation in a bid to improve access to and the quality of care provided.

Referência e contra referência em saúde bucal: regulação do acesso aos centros de especialidades odontológicas

Objective Based on the system of reference and counter-reference and comprehensiveness in oral health care, we aimed to examine ways of refering users to Specialized Dental Care Centers (SDCC) and the interface between them and Primary Care. Methods This is a cross-sectional study carried out with users and dentists of SDCC in a metropolitan region of Northeast of Brazil. Analyses were descriptive, and the association test was done with chi-square. Results Six forms of entry to specialized service were identified: free demand (13.8 %) and reference by the Primary Care dentist (63.2 %) were most frequent. Users referred by the basic health unit dentist had more interest in making a counter-reference than the others (p<0.001, PR=4.65, 95 % CI: 2.74 to 7.91), while individuals without this referral had 1.49 times more difficulty obtaining care (95 % CI: 1.02 to 2.17). Referral procedures are a decisive factor for counter-references. However, the high demand for primary care services and the short supply these services can offer in the face of needs make SDCC performance difficult. Conclusion The analysis of oral health practices from the perspective of network modeling points to the service's need to establish protocols for regulation in a bid to improve access to and the quality of care provided.

Impacto do Programa Saúde da Família sobre indicadores de saúde da criança em municípios de grande porte da região Nordeste do Brasil

The present study carried out in the context of the Baseline Studies of the PROESF was aimed at evaluating the impact of the Family Health Program (PSF) on indicators for child health in cities with more than 100,000 inhabitants in the Brazilian Northeast. Four cities were investigated. In each one, twenty censual sectors were selected randomly from areas covered by the PSF and compared with twenty sectors selected from areas not covered by the PSF on the basis of socioeconomic criteria. In most cases, no significant differences were found between the areas covered and not covered by the PSF. The only difference found was a significantly lower rate of hospital admissions due to diarrhea but this was on account of the Program of Community Health Agents. The PSF exerted no additional effect on the reduction of this indicator. It was also observed that the way by which the program is implemented in each city interferes directly in the results. Thus, there is no basis for considering the PSF per se ineffective or not differing from other programs with regard to its health care patterns. An evaluation of the PSF would necessarily have to include an analysis of the way the program is implemented and conducted in each case, besides considering its general socioeconomical and political characteristics.

Capacidades estatais para implementação de políticas públicas em ambientes federativos: o caso do Programa Bolsa Família

This thesis aims to understand the extent to which state capacities of state governments explain the effectiveness of the implementation of Programa Bolsa Família (PBF) in the Northeast, adopting the implementation of the theory as the main theoretical lens and more specifically the concept of state capacity. Methodologically is a study of public policy evaluation, and categorized as a process of evaluation study or implementation. Given the specificity of the object is classified as a multi case study research covering the states of Sergipe, Rio Grande do Norte and Bahia. In addition to using secondary data, the study used semi-structured interviews with members of Intersectoral Committees responsible for the actions of PBF and the Cadastro Único at the state level, composed of representatives of the areas of the state government of Social Welfare, Education and Health. the main findings related to technical and administrative capacities and policies were found: infrastructure with weakness in human resources, technological and financial resources; intra-governmental coordination with boundaries between PBF and Unified Social Assistance System , and the actions of conditionality of health and Health Unic System Basic Attention; intergovernmental coordination carried out mostly by the distance limitations of displacement and incipient regional decentralization of actions; based monitoring in the municipalities of lower performance and from the parameters placed by the federal government and political capacities; representative political system is hardly accessed by instances of program management; minor social participation and low articulation with related issues advice to PBF; audit control by any outside agencies. The thesis concludes that depending on the capabilities found implementing weaknesses are not unique to the program's actions, but from the very institutional capacity of the systems in which it operates that are the Unified Social Assistance System, the Health Unic System and the Educational System. In other words limitations of their own state capacities of the state governments and the municipal governments of each territory, such as quantitative insufficiency and qualification of human resources, financial and institutional resources, lack instance promoting decentralization (Intergovernmental and intra-governmental) as well the weakness or absence of a network of local social services are also factors that explain the program management performance and state capabilities of arrangements formed by states and municipalities in the PBF, only to partially deal with the complexity of joints involving Implementation of the program with regard to inter and intra-governmental action.

Capacidades estatais para implementação de políticas públicas em ambientes federativos: o caso do Programa Bolsa Família

This thesis aims to understand the extent to which state capacities of state governments explain the effectiveness of the implementation of Programa Bolsa Família (PBF) in the Northeast, adopting the implementation of the theory as the main theoretical lens and more specifically the concept of state capacity. Methodologically is a study of public policy evaluation, and categorized as a process of evaluation study or implementation. Given the specificity of the object is classified as a multi case study research covering the states of Sergipe, Rio Grande do Norte and Bahia. In addition to using secondary data, the study used semi-structured interviews with members of Intersectoral Committees responsible for the actions of PBF and the Cadastro Único at the state level, composed of representatives of the areas of the state government of Social Welfare, Education and Health. the main findings related to technical and administrative capacities and policies were found: infrastructure with weakness in human resources, technological and financial resources; intra-governmental coordination with boundaries between PBF and Unified Social Assistance System , and the actions of conditionality of health and Health Unic System Basic Attention; intergovernmental coordination carried out mostly by the distance limitations of displacement and incipient regional decentralization of actions; based monitoring in the municipalities of lower performance and from the parameters placed by the federal government and political capacities; representative political system is hardly accessed by instances of program management; minor social participation and low articulation with related issues advice to PBF; audit control by any outside agencies. The thesis concludes that depending on the capabilities found implementing weaknesses are not unique to the program's actions, but from the very institutional capacity of the systems in which it operates that are the Unified Social Assistance System, the Health Unic System and the Educational System. In other words limitations of their own state capacities of the state governments and the municipal governments of each territory, such as quantitative insufficiency and qualification of human resources, financial and institutional resources, lack instance promoting decentralization (Intergovernmental and intra-governmental) as well the weakness or absence of a network of local social services are also factors that explain the program management performance and state capabilities of arrangements formed by states and municipalities in the PBF, only to partially deal with the complexity of joints involving Implementation of the program with regard to inter and intra-governmental action.

Teleconsultoria Off-line: uma arquitetura distribuída e compartilhada para sistemas heterogêneos

The Telehealth Brazil Networks Program, created in 2007 with the aim of strengthening primary care and the unified health system (SUS - Sistema Único de Saúde), uses information and communication technologies for distance learning activities related to health. The use of technology enables the interaction between health professionals and / or their patients, furthering the ability of Family Health Teams (FHT). The program is grounded in law, which determines a number of technologies, protocols and processes which guide the work of Telehealth nucleus in the provision of services to the population. Among these services is teleconsulting, which is registered consultation and held between workers, professionals and managers of healthcare through bidirectional telecommunication instruments, in order to answer questions about clinical procedures, health actions and questions on the dossier of work. With the expansion of the program in 2011, was possible to detect problems and challenges that cover virtually all nucleus at different scales for each region. Among these problems can list the heterogeneity of platforms, especially teleconsulting, and low internet coverage in the municipalities, mainly in the interior cities of Brazil. From this perspective, the aim of this paper is to propose a distributed architecture, using mobile computing to enable the sending of teleconsultation. This architecture works offline, so that when internet connection data will be synchronized with the server. This data will travel on compressed to reduce the need for high transmission rates. Any Telehealth Nucleus can use this architecture, through an external service, which will be coupled through a communication interface.

Fatores psicológicos preditores do grau de funcionalidade em idosos

A velhice pode estar associada ao sofrimento, aumento da dependência física, declínio funcional, isolamento social, depressão e improdutividade. No envelhecimento observam-se lentificação no processamento cognitivo, redução da atenção, dificuldades na retenção das informações aprendidas (memória de trabalho) e diminuição na velocidade de pensamento e habilidades visuoespaciais. Por outro lado, as que se mantêm inalteradas são: inteligência verbal, atenção básica, habilidade de cálculo e a maioria das habilidades de linguagem (Moraes, Moraes & Lima, 2010). O objetivo deste estudo é comparar funções executivas com grau de funcionalidade para averiguar em que medida estas variáveis predizem funcionalidade. Trinta idosos de três valências diferentes constituíram a amostra deste estudo. Os instrumentos de avaliação administrados foram os seguintes: Escala de Barthel, MontrealCognitiveAssessment (MoCA), Trail Making Test (TMT), Teste de Aprendizagem Audio-Verbal de Rey (RAVLT), Figura Complexa de Rey, Teste Stroop de Cores e Palavras (TSCP), DigitSpan, Escala Geriátrica de Depressão. Dos resultados obtidos destacam-se a existência de relações estatisticamente significativas entre a saúde mental e a funcionalidade. Quanto melhor é a saúde mental, maior é o grau de funcionalidade e os participantes do “Domicílio” possuem melhor saúde mental, atenção, planeamento e construção visuo-espacial do que os do “Centro de Dia”, e estes melhor do que os do “Lar”. A Organização Mundial de Saúde (OMS) destaca a capacidade funcional e a independência como fatores preponderantes para o diagnóstico de saúde física e mental na população idosa. Alguns autores indicam que a avaliação cognitiva deve ser sempre acompanhada de uma avaliação funcional e vice-versa.

Síndrome de Burnout y calidad de vida laboral en el personal asistencial de una institución de salud en Bogotá Colombia

El objetivo de este estudio fue describir el Síndrome de Burnout y la Calidad de Vida Laboral en el personal asistencial en una institución de salud de segundo nivel ubicada en Bogotá, y observar si existe relación entre estos constructos. Se aplicó el Inventario de Burnout de Maslach [MBI] y el Cuestionario de Calidad de Vida Profesional [CVP-35] a 62 participantes, pertenecientes a distintos campos del área de la salud. Los resultados indicaron que el 38,7% de los participantes presentaron severidad alta y moderada del síndrome, no obstante, con un nivel de realización personal alto, que unido a la fuerte motivación intrínseca encontrada, constituye un factor protector ante la alta carga laboral y el escaso apoyo directivo. El cansancio emocional correlacionó directamente con la carga laboral e inversamente con la motivación intrínseca. Se resalta la importancia de una eficiente gestión en las organizaciones de salud y la necesidad de una dirección más centrada en las personas a fin de garantizar su bienestar, lo que redundará en su calidad de vida y en la atención ofrecida.