Evaluation of pre-natal care from the perspective of different models in primary care

OBJETIVOS: avaliar a qualidade do cuidado pré-natal desenvolvido na atenção primária, comparando os modelos tradicional e Estratégia Saúde da Família. MÉTODO: estudo de avaliação de serviço, pautado nas políticas públicas de saúde. Os dados foram obtidos por meio de entrevista com gerentes, observação nas unidades de saúde e análise de prontuários de gestantes, selecionados aleatoriamente. Diferenças nos indicadores de estrutura e processo foram avaliadas pelo teste qui-quadrado, adotando-se p<0,05 como nível crítico, cálculo dos odds ratio e intervalos de confiança de 95%. RESULTADOS: foram evidenciadas estruturas semelhantes em ambos os modelos de atenção. Indicadores-síntese de processo, criados neste estudo, e os indicados pelas políticas públicas apontaram situação mais favorável nas Unidades de Saúde da Família. Para o conjunto de atividades preconizadas para o pré-natal, o desempenho foi deficiente em ambos os modelos, embora pouco melhor nas Unidades de Saúde da Família. CONCLUSÃO: os resultados indicam a necessidade de ações para melhoria da atenção pré-natal nos dois modelos de atenção básica no município avaliado.

The migration of health care workers in the Western Hemisphere: issues and impacts

Includes bibliography

Integration of Genomics in Cancer Care

Purpose: The article aims to introduce nurses to how genetics-genomics is currently integrated into cancer care from prevention to treatment and influencing oncology nursing practice. Organizing Construct: An overview of genetics-genomics is described as it relates to cancer etiology, hereditary cancer syndromes, epigenetics factors, and management of care considerations. Methods: Peer-reviewed literature and expert professional guidelines were reviewed to address concepts of genetics-genomics in cancer care. Findings: Cancer is now known to be heterogeneous at the molecular level, with genetic and genomic factors underlying the etiology of all cancers. Understanding how these factors contribute to the development and treatment of both sporadic and hereditary cancers is important in cancer risk assessment, prevention, diagnosis, treatment, and long-term management and surveillance. Conclusions: Rapidly developing advances in genetics-genomics are changing all aspects of cancer care, with implications for nursing practice. Clinical Relevance: Nurses can educate cancer patients and their families about genetic-genomic advances and advocate for use of evidence-based genetic-genomic practice guidelines to reduce cancer risk and improve outcomes in cancer management. © 2013 Sigma Theta Tau International.

Situation of unpaid work and gender in the Caribbean: The measurement of unpaid work through time-use studies

Includes bibliography.

Policies and care provision in Latin America: A view of regional experiences

This study identifies the key challenges facing the region in the domain of care provision. To that end it describes, analyses and discusses the concept of care, the rights approach and the public policies implemented in Latin America and the Caribbean on the social organization of care. The document describes care policies in the region generally, and it specifically analyses experiences of the social organization of care provision in four countries. In Chile, it studies the Chile Crece Contigo national child-care programme; in Costa Rica it reviews the National Care Network; in Ecuador, it analyses the recognition of unpaid reproductive work in the 2008 Constitution and the National Plan for Good Living; and in Uruguay it considers the National Care System.

Ethical Care of the Self and the Teacher in the Pedagogical Relationship: Reflections Based on the Latest Foucault

Our conception of education is that it is the responsible action whereby man becomes human, trains and faces the challenges that life and the world present, as man enters a larger, shared cultural tradition and thus joins the world. However such sharing implies that we must not just rely on tradition, but remain open to new ideas. It is essential for schooling to preserve a field where the art of living intersects with the world for which future generations are being prepared. It is in this field of intersection that this essay seeks to discuss Michel Foucault's thought, care of the self and the role played by others in the acquisition of ethical attitudes pertaining to one's conduct in life. Through reconstructing Foucault's ideas, we elaborate on the hypothesis that, before morally shaping students, teaching them values, or aiding in their skill acquisition in the sense prevailing in schooling today, it is important to understand the notion of care of the self (and how the notion implies interaction with others for effective care of the self). Care of the self is vital for thoroughly understanding the relationships between ethics and education in school. We particularly examine how Foucault's ideas and his analysis of the teacher's role in shaping the student's life conduct can help educators rethink pedagogical action in an ethical sense and find within it a certain openness to the formation of attitudes in educators and students

THE CARE NEEDS OF WOMEN INFECTED WITH THE HUMAN PAPILLOMA VIRUS: A COMPREHENSIVE APPROACH

This study is founded on the phenomenology of Martin Heidegger, with the objective to understand the care needs of women infected with the human papilloma virus. Participants were fourteen women who had been diagnosed with this infection. The guiding questions were: What is it like to have this diagnosis? Tell me your experience, from when you received your diagnosis until today. What has your health care been like? The questions revealed the theme - seeking care as solicitude - which showed the importance of the support of family and friends. The presence of the infection as the cause of marital conflicts and separation was another highlighted aspect. The statements showed that there was a sense of resignation after an unsuccessful attempt to find accurate and clear information in order to make assertive decisions. Health interventions for infected women must overcome the traditional models of care, including interventions for health promotion and prevention, with trained professionals who are sensitive to the subjective dimension.

Private and Public Dental Care in the City of Sao Paulo in the First Decade of the XXI Century

Two concomitant movements occur in the first decade of the XXI century within the private and public dental services in Brazil: the entrance of oral health on the agenda of political priorities of the federal government and the vigorous growth of additional dental care. We analyzed the occurrence of these phenomena in the city of Sao Paulo, by seeking information in official documents and electronic databases in the Municipality of Sao Paulo, the Ministry of Health and National Health Agency (ANS), and also in scientific literature. During the studied period - January 2000 to December 2009 - and with basis on indicators such as coverage of First Consultation Program and Dental coverage Population Potential, percentages were found that characterize low public assistance and a situation far short of the constitutional principle of universal access to dental care. The growing number of beneficiaries of additional services through exclusively dental coverage insurance plans and other types of private insurance plans in the same period was significant, accounting for a major expansion of population coverage in this mode of care. It was found that, compared to the overall national framework, the city of Sao Paulo offers poor access to public dental care, with reduced supply of services to adults and aged people. Furthermore, considering the limitations of market additional services to provide dental care to all Brazilians, it reinforces the need for continuity and expansion of Brasil Sorridente, which is the programmatic expression of the National Oral Health Politics.

THE KNOWLEDGE ABOUT COMMUNICATION STRATEGIES WHEN TAKING CARE OF THE EMOTIONAL DIMENSION IN PALLIATIVE CARE

The aim of this qualitative study was to investigate existing knowledge and the use of communication strategies in emotional care for patients receiving palliative care in Brazil. It was performed from August, 2008, to July, 2009, with 303 health professionals who worked or had frequent contact with patients receiving palliative care, using a questionnaire. Data was submitted to descriptive and analytical statistical treatment. The professionals reported not knowing about communication strategies, showing a significant difference (p-value 0.0011) in comparing subjects with and without previous training in palliative care, showing that those who had received proper training know/use more communication strategies when providing care for their patients on an emotional level. The strategies most often cited were: careful listening, verbal reaffirmation of care, using open questions, and affective touch. We conclude that there is little knowledge and poor use of communication strategies among health professionals in towards the emotional care of patients receiving palliative care.

HEALTH EDUCATION IN THE CARE TO CLIENTS OF THE BLOOD GLUCOSE SELF-MONITORING PROGRAM

This article reports, in a systemized and analytical way, the experience of an Outreach Program in the period between 2010 and 2011. The study focused on health education interventions as strategies to improve the adherence of individuals with insulin- dependent diabetes mellitus (IDDM), clients of a blood glucose self-Monitoring program. In addition, we intended to contribute to the reorganization of the program's working processes in the unit. Health education strategies were used in both educational groups and home visits, thus permitting the provision of care that was more individualized. Data regarding the clients were organized on a spreadsheet and in files for the Family Health teams, which made it easier to identify the patients, including those who were absent, helping to decentralize the care. By using health education strategies, we intended to contribute to a more comprehensive and emancipatory care of the clients, aimed at a continuous reflection of the workers regarding their practices.

Family Health Support Centers: challenges and opportunities from the perspective of primary care professionals in the city of Sao Paulo, Brazil

Family Health Support Centers (NASF) were created in Brazil to increase the case-resolution capacity of primary healthcare. Prior to their implementation in the West Side of the city of Sao Paulo, Brazil, a series of workshops were held for primary healthcare professionals to prepare a proposal for such centers. Hermeneutic analysis was used to study the transcribed material. The thematic categories were: role, constitution, and functioning of the NASF, relationship with family health teams, and interdisciplinarity. The participants' expected the NASF to be an empowering device for comprehensiveness of care, intervening in an existing culture of unnecessary referrals while fostering linkage with other levels of care. The participants also expected the NASF to contribute to the discussion on health professionals' training and stimulating reflection with policy-makers on health indicators based exclusively on the number of consultations. These indicators fail to reflect the impact on the services' activities and the quality of care offered to the population in the coverage area.

Palliative care in the home: perceptions of nurses in the Family Health Strategy

OBJECTIVE: To understand the perception of nurses from the Family Health Strategy in relation to palliative care in the home. METHODS: A descriptive, exploratory study with a qualitative approach conducted with nine nurses from the Family Health Strategy of the municipality of Lavras - MG. Semi-structured interviews were conducted and data were subjected to content analysis. RESULTS: The various dimensions of care in the home context were identified, along with the performance and limitations of nurses in the care of the patient and his family at end of life. The capacity to establish a bond, by the proximity to people who receive their care, is a remarkable point of the action of these nurses with patients and families in end of life situations. CONCLUSION: The nurses consider the patient and his family as the unit of care, they have the opportunity to share solidarity, experiences and learning, not only from a professional standpoint, but above all, from a human one.

The quality of primary care in a country with universal health care coverage

Standard indicators of quality of care have been developed in the United States. Limited information exists about quality of care in countries with universal health care coverage.

Impact of Various Insurance Types on Level and Appropriateness of Health Care Consumption

The goal of this study was to examine the extent to which insurance type, or method of care management, impact the appropriate delivery of health care. Previous studies indicate a relationship between insurance type and patterns of consumption but do not directly link the incentives or disincentives inherent in each plan with trends inconsumption of health care. This study explores how different types of health insurance coverage affect the location, the degree, and the frequency of health care consumption in order to gain insight into which plans promote appropriate delivery and consumption ofcare.