Poder de agir e sofrimento: estudo de caso sobre Agentes Comunit��rios de Sa��de

Os Agentes Comunit��rios de Sa��de (ACS) possuem uma miss��o de grande import��ncia na implementa����o da Estrat��gia de Sa��de da Fam��lia: devem criar o v��nculo entre a popula����o e os servi��os de aten����o b��sica, combinando a����es de promo����o da sa��de, assist��ncia b��sica e preven����o. A equipe do Cerest de Piracicaba realizou, no per��odo de 2004-2006, an��lise ergon��mica do trabalho em uma unidade de sa��de de fam��lia cujos objetivos foram compreender a rela����o entre queixas de sofrimento e as condi����es de trabalho das ACS e propor medidas para modific��-las. Os resultados da AET mostram que, a despeito do engajamento visando resolver os problemas de sa��de das fam��lias, o limitado ���poder de agir��� das ACS, devido ��s limita����es da unidade e da rede de servi��os, expunham-nas a situa����es nas quais se encontravam incapazes de adotar a����es efetivas e nas quais n��o podiam se prevenir do sofrimento

Inspe����o sanit��ria em creches: uma proposta de roteiro de inspe����o

O trabalho apresenta um projeto de interven����o na realidade concreta das a����es de Vigil��ncia Sanit��ria, atrav��s da proposi����o de um roteiro para inspe����o destinado a creches. Os objetivos espec��ficos foram identificar os fundamentos jur��dicos, t��cnico-cient��ficos e sanit��rios que possam nortear a pr��tica de inspe����es sanit��rias em creches; elaborar uma proposta de roteiro que permita um processo de an��lise mais expl��cito, objetivo e homog��neo e discutir a contribui����o do instrumento proposto para a atividade de Vigil��ncia Sanit��ria, com base na literatura cient��fica pesquisada. Para a realiza����o do trabalho foi feita uma revis��o fundamentada em textos did��ticos e normativos das ��reas de educa����o e sa��de, legisla����o sobre Vigil��ncia Sanit��ria e Educa����o Infantil, outros roteiros j�� existentes e artigos da literatura cient��fica sobre agravos �� sa��de em crian��as que frequentam creches. O trabalho focaliza o conte��do da legisla����o espec��fica vigente e sua aplicabilidade na pr��tica da inspe����o sanit��ria em creches e baseia-se na Portaria - MS n. 321 de 26.05.1988. Este estudo apresenta um instrumento para avaliar a qualidade do atendimento nas creches sob o aspecto da promo����o da sa��de e sugere estudos posteriores de valida����o para o contexto, com a poss��vel inclus��o de um sistema de classifica����o para os padr��es de conformidade, por meio de uma metodologia estat��stica

Efetividade de programa de agentes comunit��rios na promo����o da sa��de bucal

OBJETIVO:Avaliar mudan��as em conhecimentos, atitudes e acesso/utiliza����o de servi��os odontol��gicos decorrentes de um programa de promo����o da sa��de bucal com agentes comunit��rios de sa��de. M��TODOS:Um projeto de capacita����o combinando ensino-aprendizagem, apoio e supervis��o, foi desenvolvido entre os meses de julho de 2003 a agosto de 2004. As mudan��as foram avaliadas por meio de entrevistas estruturadas em que participaram 36 agentes comunit��rios de sa��de e uma amostra de 91 mulheres e m��es, representativa de donas de casa com 25 a 39 anos de idade, alfabetizadas e residentes em domic��lios de tr��s a seis c��modos no munic��pio de Rio Grande da Serra (SP). Foram colhidos dados sobre conhecimentos de sa��de-doen��a bucal, pr��ticas e capacidades auto-referidas em rela����o ao auto-exame, higiene bucal, n��mero de residentes e de escovas dentais individuais e coletivas em cada domic��lio e acesso e uso de servi��os odontol��gicos. Por meio do teste t de Student pareado, foram comparadas as m��dias dos valores obtidos antes e depois do programa para cada um dos grupos estudados. As respostas foram analisadas adotando-se um n��vel de signific��ncia de 5%. RESULTADOS: Foram observadas diferen��as estatisticamente significativas para quest��es relativas ao conhecimento de sa��de bucal entre os agentes e entre as mulheres antes e depois da capacita����o (p<0,05). Desequil��brio entre o n��mero de escovas e de indiv��duos em cada fam��lia diminuiu. A freq����ncia da escova����o e do uso do fio dental se elevou depois da atua����o dos agentes. Os valores de auto-avalia����o da higiene bucal aumentaram. Modifica����o nas pr��ticas e capacidades auto-referidas mostrou significativa eleva����o da auto-confian��a. O acesso ao servi��o foi mais f��cil (p<0,000) e seu uso mais regular (p<0,000) entre mulheres. CONCLUS��ES: Houve mudan��as positivas na percep����o em rela����o a aspectos de sa��de bucal, na auto-confian��a e no acesso e uso de servi��os odontol��gicos. Tais mudan��as po

Pr��ticas corporais: atividade f��sica e pol��ticas p��blicas de promo����o da sa��de

A promo����o da sa��de, entendida como estrat��gia de produ����o social de sa��de, deve articular e permear pol��ticas p��blicas que influenciem o futuro da qualidade de vida urbana. Esse grande desafio envolve arranjos intersetoriais na gest��o p��blica, empoderamento da popula����o, desenvolvimento de compet��ncias e habilidades, capacita����o, acesso �� informa����o, est��mulo �� cidadania ativa, entre outros, para que a popula����o reconhe��a seus problemas e suas causas, a fim de que ela possa advogar por pol��ticas p��blicas saud��veis. Para esse prop��sito, �� necess��rio que o governo operacionalize uma forma de gest��o p��blica que considere a melhoria nas condi����es de vida, de trabalho e de cultura, estabelecendo uma rela����o harmoniosa com o meio ambiente, com o corpo que envolva a participa����o social na cogest��o e na democracia. Nesse contexto, a inser����o de um programa de pr��ticas corporais/atividade f��sica direcionada �� popula����o deve estar fundamentada em uma concep����o da Promo����o da Sa��de apoiada em processos educativos que v��o al��m da transmiss��o de conhecimentos. Ela deve estar focada no enfrentamento das dificuldades, no fortalecimento da identidade e na incorpora����o de solu����es criativas e saberes saud��veis. Este artigo tem o objetivo de refletir sobre pol��ticas de promo����o da sa��de relacionadas ��s Pr��ticas Corporais/Atividade F��sica, al��m de apresentar um breve relato sobre o trabalho desenvolvido nessa ��rea no munic��pio de S��o Paulo

A advocacia em sa��de como uma estrat��gia para a promo����o da sa��de

O conceito de promo����o da sa��de vem sendo desenvolvido h�� aproximadamente trinta anos e j�� est�� sedimentado. Atualmente, torna-se muito importante elaborar estrat��gias para sua implementa����o. O presente artigo �� uma reflex��o sobre a pr��tica da advocacia em sa��de enquanto estrat��gia para a implementa����o dos princ��pios e diretrizes da promo����o da sa��de. O ponto de partida �� o questionamento sobre como conciliar os aspectos conceituais e metodol��gicos da promo����o da sa��de, considerados dentro de nossa realidade. A conclus��o principal aponta para uma proposta de desenvolvimento de uma " Advocacia em Promo����o da Sa��de."

Methods and Participant Characteristics of a Randomized Intervention to Promote Physical Activity and Healthy Eating Among Brazilian High School Students: The Saude na Boa Project

Background: A cross-cultural, randomized study was proposed to observe the effects of a school-based intervention designed to promote physical activity and healthy eating among high school students in 2 cities from different regions in Brazil: Recife and Florianopolis. The objective of this article is to describe the methodology and subjects enrolled in the project. Methods: Ten schools from each region were matched and randomized into intervention and control conditions. A questionnaire and anthropometry were used to collect data in the first and last month of the 2006 school year. The sample (n = 2155 at baseline; 55.7% females; 49.1% in the experimental group) included students 15 to 24 years, attending nighttime classes. The intervention focused on simple environmental/organizational changes, diet and physical activity education, and personnel training. Results: The central aspects of the intervention have been implemented in all 10 intervention schools. Problems during the intervention included teachers' strikes in both sites and lack of involvement of the canteen owners in schools. Conclusions: The Saude no Boa study provides evidence that public high schools in Brazil represent an important environment for health promotion. Its design and simple measurements increase the chances of it being sustained and disseminated to similar schools in Brazil.

Pr��ticas corporais e grande sa��de: um encontro poss��vel

Physical Activity produces health! When admitting the precocious veracity that the affirmation introduces, we reconstruct it in ideological dimension to put again the intentions of the physical activity on the scope of the health. To support this displacement, we search endorsement in the concept of Great Health forged in the philosophy of Nietzsche and of this concept we launch considerations about body practices to argue the care from physiological imperatives, worried about the vital necessities of the body. These possibilities only appear when it gave power to the meeting of the subject with himself and with the other - as operated in the body practices context. It is the quality of this meeting that allows trying the Great Health.

Antioxidant capacity of Brazilian fruit, vegetables and commercially-frozen fruit pulps

Several epidemiological and research studies suggest that a high intake of foods rich in natural antioxidants increases the antioxidant capacity of the plasma and reduces the risk of some kinds of cancers, heart diseases, and stroke. These health benefits are attributed to a variety of constituents, including vitamins, minerals, fiber, and numerous phytochemicals, such as flavonoids. Thus, in addition to measuring the composition of the usual macronutrients and micronutrients, it seems important to also measure the antioxidant capacity of foods. For this purpose, 28 foods including fruits, vegetables and commercially-frozen fruit pulps were analyzed for antioxidant capacity. The antioxidant capacity of the foods varied from 0.73 to 19.8 mu mol BHT equiv/g. The highest values were observed for wild mulberries (19.8 mu mol BHT equiv/g), acai fruit pulp (18.2 mu mol BHT equiv/g) and watercress (9.6 mu mol BHT equiv/g). The antioxidant capacities are only indicative of the potential of the bioactive compounds; however, these data are important to explore and understand the role of fruit, vegetables and other foods in health promotion. (C) 2009 Elsevier Inc. All rights reserved.

Exposure to contaminated water: perceptions and practices in a neighborhood in the city of Manaus, Brazil

Objective. To investigate the modes of water supply and the perception concerning the problems caused by this water among residents of a neighborhood without public supply of water, settled in an area previously used as a garbage dump in the city of Manaus, Brazil. Methods. One hundred and sixty-two semi-structured household interviews were conducted. In addition, a focal group with teachers from a local public school and a meeting with residents were held. The instruments employed focused on the perception and modes of water use and on the process of exposure to chemical contaminants through water. Results. Untreated well water was used by most families. This water was considered to be ""good"" by 64.8% of the individuals interviewed. Most residents (88.3%) declared knowledge about the garbage dump. Of these, 77.6% stated that the garbage dump caused health and environmental problems. However, qualitative analysis of the responses revealed that the residents were not aware of contamination by chemical elements or of the consequences of such contamination. The activities carried out with teachers revealed that they were partially aware of the problem, but did not design interventions to address the issue. In a meeting with neighborhood residents, the presence of social activism concerning the problem was identified, but it did not extend beyond the neighborhood or reach governmental spheres. Conclusions. The study identified a situation of critical exposure that tends to be maintained as a result of misperceptions and lack of social mobilization. The dissemination of research results to teachers and residents was useful to empower subjects.

Comparison of surveys used to measure physical activity

Objective: To compare the level of agreement in results obtained from four physical activity (PA) measurement instruments that are in use in Australia and around the world. Methods: 1,280 randomly selected participants answered two sets of PA questions by telephone. 428 answered the Active Australia (AA) and National Health Surveys, 427 answered the AA and CDC Behavioural Risk Factor Surveillance System surveys (BRFSS), and 425 answered the AA survey and the short International Physical Activity Questionnaire (IPAQ). Results: Among the three pairs of survey items, the difference in mean total PA time was lowest when the AA and NHS items were asked (difference=24) (SE:17) minutes, compared with 144 (SE:21) mins for AA/BRFSS and 406 (SE:27) mins for AA/IPAQ). Correspondingly, prevalence estimates for 'sufficiently active' were similar for AA and NHS (56% and 55% respectively), but about 10% higher when BRFSS data were used, and about 26% higher when the IPAQ items were used, compared with estimates from the AA survey. Conclusions: The findings clearly demonstrate that there are large differences in reported PA times and hence in prevalence estimates of 'sufficient activity' from these four measures. Implications: It is important to consistently use the same survey for population monitoring purposes. As the AA survey has now been used three times in national surveys, its continued use for population surveys is recommended so that trend data ever a longer period of time can be established.

Print versus website physical activity programs: A randomized trial

Mediated physical activity interventions can reach large numbers of people at low cost. Programs delivered through the mail that target the stage of motivational readiness have been shown to increase activity. Communication technology (websites and e-mail) might provide a means for delivering similar programs. Randomized trial conducted between August and October 2001. Participants included staff at an Australian university (n=655; mean AGE=43, standard deviation, 10 years). Participants were randomized to either an 8-week, stage-targeted print program (Print) or 8-week, stage-targeted website (Web) program. The main outcome was change in self-reported physical activity.

Prevention of child behavior problems through universal implementation of a group behavioral family intervention.

The aim of this mental health promotion initiative was to evaluate the effectiveness of a universally delivered group behavioral family intervention (BFI) in preventing behavior problems in children. This study investigates the transferability of an efficacious clinical program to a universal prevention intervention delivered through child and community health services targeting parents of preschoolers within a metropolitan health region. A quasiexperimental two-group (BFI, n=804 vs. Comparison group, n=806) longitudinal design followed preschool aged children and their parents over a 2-year period. BFI was associated with significant reductions in parent-reported levels of dysfunctional parenting and parent-reported levels of child behavior problems. Effect sizes on child behavior problems ranged from large (.83) to moderate (.47). Positive and significant effects were also observed in parent mental health, marital adjustment, and levels of child rearing conflict. Findings are discussed with respect to their implication for significant population reductions in child behavior problems as well as the pragmatic challenges for prevention science in encouraging both the evaluation and uptake of preventive initiatives in real world settings.