Logics of marginalisation in health and social care reform:integration, choice, and provider-blind provision

The period 2010–2013 was a time of far-reaching structural reforms of the National Health Service in England. Of particular interest in this paper is the way in which radical critiques of the reform process were marginalised by pragmatic concerns about how to maintain the market-competition thrust of the reforms while avoiding potential fragmentation. We draw on the Essex school of political discourse theory and develop a ‘nodal’ analytical framework to argue that widespread and repeated appeals to a narrative of choice-based integrated care served to take the fragmentation ‘sting’ out of radical critiques of the pro-competition reform process. This served to marginalise alternative visions of health and social care, and to pre-empt the contestation of a key norm in the provision of health care that is closely associated with the notions of ‘any willing provider’ and ‘any qualified provider’: provider-blind provision.

Effectiveness of the interventions in preventing the progression of pre-frailty and frailty in older adults:a systematic review protocol

REVIEW QUESTION / OBJECTIVE : The objective of this review is to identify the effectiveness of the interventions in preventing progression of pre-frailty and frailty in older adults. More specifically, the review questions are: - What is the effectiveness of interventions in preventing or reducing frailty in older adults? - How does effectiveness vary with degree of frailty? - Are there factors that influence the effectiveness of interventions? - What is the economic feasibility of interventions for pre-frailty and frailty? INCLUSION CRITERIA : Types of participants This review will consider studies that include older adults (female and male) aged 65 years and over, explicitly identified as pre-frail or frail by the researchers or associated medical professionals according to a pre-specified scale or index, and who have received health care and support services in any type of setting (primary care, nursing homes, hospitals). This review will exclude studies that: - Include participants who have been selected because they have one specific illness - Consider people with a terminal diagnosis only. - Types of intervention(s)/phenomena of interest: The clinical/medical component of the review will consider studies that evaluate any type of interventions to prevent the progression of pre-frailty and frailty in older adults. These interventions will include, but will not be limited to, physical activity, multifactorial intervention, psychosocial intervention, health and social care provision, and cognitive, nutrition or medication/medical maintenance and adherence focused interventions. The economic component of the review will consider studies that have performed any type of health economic analysis of ...

A follow-up outcome evaluation of independent living services for foster care youth

This study aimed to evaluate the effectiveness of the Independent Living (IL) program targeting foster youths to prepare them for effective adulthood. The study employed a pre-post, two-group comparative research design. The IL group was composed of 49 young adults who participated in the IL or SIL (subsidized IL) program prior to their emancipation from foster care (mean age, 20.6 years). The comparison was made up of 18 young adults who experienced foster care but never participated in the IL or SIL programs (mean age, 20.2 years). Data were collected via a mailed survey that included the Daniel Memorial Independent Living Assessment (DMILA) and an additional questionnaire developed by the researcher. The study also examined: (1) why youth in foster care do not participate in IL programs, (2) how participating youth evaluate IL services and what recommendations they make to improve services, and (3) the internal consistency of the DMILA. Results suggest that the DMILA assessment has mediocre reliability. IL program participation is associated with better educational, employment, income, housing, early parenting-prevention, transportation, anger control, criminal-prevention, and self-evaluation outcomes. However, IL participation is not associated with better social support, perceived parenting competence, substance abuse-prevention, sexual risk-prevention outcomes, increased knowledge in money management skills, job seeking and job maintenance skills, interpersonal skills, or lower depression. Results also suggest that the outreach activities of the IL program may be flawed. IL participants reported the IL program was doing best in educational preparation, criminal involvement prevention, and money management preparation and least well in parenting preparation, housing preparation, employment preparation, and substance abuse prevention. To improve services, youths recommended primarily that IL counselors develop closer relationships with youths, that IL training better address organizational skills, and that monthly subsidy be raised and SIL eligibility requirements softened. The study's political context and limitations are also discussed and implications are derived regarding prevention, intervention, outreach, mentorship, empowerment, cross-systems collaboration, and future research. ^

Pressure ulcers and nutritional deficits in elderly long-term care patients: Effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: (1) pressure ulcer wound healing (2) length of hospital stays, and (3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SID-12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

Pressure ulcers and nutritional deficits in elderly long-term care patients : effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: 1) pressure ulcer wound healing 2) length of hospital stays, and 3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SD=12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

Attitudes and behaviors of pre-adolescents with diabetes toward fat -modified foods

Fat modified foods are widely available and have the potential to help individuals with diabetes, including children, achieve a lower total fat and saturated fat intake. Sixty-three pre-adolescents (10-13 years) with insulin-dependent diabetes mellitus (IDDM or Type I), and 60 without diabetes (boys, n=54; girls, n=69) were tested to determine their beliefs and attitudes towards high-fat and reduced-fat foods. In addition, both children and parents were asked about the child's use of low fat foods i.e., how often the parent bought or encouraged their child to eat reduced-fat food; how strongly the doctor or dietitian promoted the use of reduced-fat foods, and the child's concern about dietary fat. In this study, preadolescents with diabetes were not more likely than those without diabetes to use fat-modified foods. Parental and health care practitioner encouragement is associated with greater use of these products by children.

Avaliação do pré-natal na atenção primária à saúde no Rio grande do Norte: visão das usuárias

ABSTRACT This study aimed to evaluate the quality of prenatal Primary Care in Rio G rande do Norte, Brazil in 2012 under the program Improving Access and Quality of Primary Care. The study was cross - sectional, quantitative. Included 156 mothers of children under 2 years who received prenatal care at the health evaluated. We applied a ques tionnaire on profile, minimum queries, regularity of attendance, laboratory tests, vaccination, participation in educational activities, guidance received, clinical and obstetric procedures and prescription Ferrous sulphate and folic acid. The descriptive analysis of the criteria used Humanization Program Prenatal and Birth. The results showed that 92% of mothers had six or more visits; 85% with the same care was professional; 94% subsequent appointments scheduled. As for tests and procedures the percentage s were: Urine 98%; HIV - 96%; VDRL and 88%; 91% glucose; tetanus vaccination 93%; educational groups 56% with 36% participation, knowledge of the delivery location and 59% achievement breast exam 65%, 33% and preventive gynecological 43%; 98% supplemented wi th 96% Ferrous Sulfate and Folic Acid. It was concluded that there were advances in Rio Grande do Norte concerning assistance and there are weaknesses in the educational practices and conducting some minimal clinical examinations.

Investigando o cuidado em equipe de enfermagem em uma UBS da cidade do Natal-RN

On the health area, care is seen as an important concept for professionals. Recently there is a trend, the epistemological point of view, to think carefully as category allowing discuss and re (thinking) practices of humane health care. The objective of this study is to investigate the understanding of care in nursing staff in a Basic Health Unit (BHU) in the city of Natal. The participants were two nurses and two nursing technicians working on the BHU of Guarapes district, located on the west side of Natal - RN. As Theoretical support for data interpretation, was used the concept of care taking, using Heidegger’s theories as reference, through Ayre’s ideas. This is a qualitative research using autobiographical as a methodology. The methodological strategy approach used were focus group and individual interviews. The data were discussed by three angles: knowledge (concepts and theories behind the practical model), technical (the way to do), and ethics (values that bases practices) by hermeneutics Gadamer's dialectic. The results showed the necessity to expand the discussion on care, in practice the understanding of care seems to get narrower concerns with technical success by professionals. The care, as a meeting between beings, the desired humanized care, seems to be understood in parts in theory, but also distances itself from reality in professional practice.

Iniciação docente na educação infantil: cenários de uma cultura profissional

This paper focalizes the initial teacher socialization in the Infantile Education from the acknowledgement about that as a phase of a professional life cycle on distinguish of other steps in the teachers’ carrier. It is based on the studies of sociological and anthropological mark with the comprehension that the professional reality is equally constructed by daily practices of social interactions in the work environment. It aims understanding how the initial process of professional culture building of beginners in the infantile education occurs under a view toward to the organizational and dynamics aspects of the teacher activity (events, interactions, practices, wisdoms, tensions and dilemmas). This investigation assuming the orientations of an ethnographic type approach has been developed in a Municipal Center of Infantile Education (Centro Municipal de Educação Infantil) in the city of Natal, with daycare and pre-school. The participant subjects are four female teachers with less than five years in Infantile Education career. It has used a participant observation and a semi-structured interview in the data building that had interpreted through a content analysis and sources triangulation. It delineates three dimensions to the professional culture scenarios: the personal and formative profile of the subjects, the school daily and the teacher work management. The multiform character of the finds evidences that the professional culture of the novice teachers has been constituted from the confrontation with different situations of unpredictably in their emotions, routines and pedagogical and administrative difficulties, simultaneously to the dilemmas of child care and educate. The solitude feeling has been generating from the institutional and scholar organization, which offers no material and pedagogical conditions to the peers collaboration and discussion. Finally it means that teaching in the Infantile Education must been based on an expanding network relations, been indispensable to the beginners the support and orientation related to doubts, wistfulness and expectations as means of socializing and redefining their teaching practice

Um estudo sobre o perfil sexual e reprodutivo das adolescentes de um serviço de referência no município de Natal/RN

Adolescence is seen as a phase of life marked by a series of physical and behavioral changes, which leads to certain risk situations, such as early sexual activity, pregnancy and the occurrence of sexually transmitted diseases. Based on this statement, this research aimed generally: meet the sexual and reproductive adolescents of a reference service in Natal profile. Specifically describe the socioeconomic, sexual and reproductive individual and family characteristics of the population in question, but also verify possible association between pregnancy and age of onset of sexual activity with the socioeconomic aspects. The sectional study conducted in the database from the records of 463 adolescents seeking care in a referral center in Sexual and Reproductive Health in the period March 2011 to June 2012. The data collected were subjected to analysis by Excel 2007 and Statistical Package for Social Sciences (SPSS) 17.0. For data analysis, descriptive statistics, with absolute numbers and percentages was used, and its presentation by means of distribution and frequency tables. Results showed that the parents of these adolescents (65.7% - father; 57.8% - mother), had primary education; family income less than two minimum wages (66.2%); any type of chemical dependency in the family (33.5%) and presence of domestic violence (20.6%). A higher probability of pregnancy was verified when the mother had only primary education (26.3%), persons other than the father or mother contributed to family income (33.3%) and (26%) when there was substance abuse in the family early onset of sexual activity was observed when the mother had primary education (57.3%), persons other than the father or mother contributed to family income (63.1%) and the use of drugs / alcohol as a problem family (67.6%). It was concluded that such vulnerabilities appear as a reflection of the low social status of these young people, aggravated by emotional inheritance that is offered to every individual from birth. These findings may perhaps, support public health surveillance policies for adolescents in several areas

Ações de cuidado nas relações intrageracionais em crianças em acolhimento institucional

According to the Statute of Children and Adolescents (1990) children and adolescents are conceived as subjects of rights, with absolute priority and development peculiar condition. Thus, if these rights were violated or threatened, will be applied protection measures. Within these measures, in that Statute, the foster institutional is proposed, with transitional and exceptional character. When the child goes out from family and community life, and she is upheld in an institution, the child is placed in a new development context, therefore, with new people, new places, and new relationships. According with Socio-Historical Psychology, theoretical support of this study, each context presents specific demands of socialization that influence child development and her subjectivity is constituted through the relations that the subject establishes in each context. These contexts bring challenges and proposals for the child and she needs to respond these. Then, whereas he is in relation to the other, in this moment, the subject is constituted, the interactions established during the foster institutional will be of paramount importance to the child. Among these interactions, we can cite situations involving aspects of moral development, specifically those that can ask (or not) the exercise of the virtues. About the intersection between these actions can then arise care actions beyond those involving the attending of an emerging need. The objective of this study is to investigate the presence of relation everyday permeated by care actions among children in foster institutional. For the scope of the objective three children were participated, with three years old and in foster care measure. The research is qualitative and the procedure for building the corpus was, mainly, the participant observation. Procedures with video and history in books were also used as supplementary procedures. The analysis of the corpus was made through Thematic Content Analysis, the episodes were grouped into analysis categories pre-and post-established. The preestablished were care actions related to body care, care actions related to socio affective aspects, and care actions related to body care and socio affective aspects simultaneously. The two post-established categories were dismemberment of the preceding categories, called care actions developed in child-child interaction, without the intervention of an adult, and care actions developed in child-child interaction, with direct intervention of the educator. The analysis indicated that in the everyday interaction between foster children, they identify the physical and emotional needs of each other foster member, and they are willing to help them in whatever way they can, emphasizing the importance of play and playful moments like mediators about these interactions. The care actions observed are based on children´s concepts and interpretations made from their experiences and largely refer to maternal care. The condition of being away from their family life can be an element that enables these actions. Finally, this study reaffirms the importance of designing the foster institution as a socialization and care space. It follows the importance of valuing and strengthening the positive aspects that arise in the relationships established by the children in this context, including the care actions, the research objective, which are components of the subjectivity of these children

A prática do enfermeiro da atenção primária à saúde nas consultas ao paciente com tuberculose

This study aimed to analyze the practice of nurses regarding the development of the nursing process in the consultation to the patient with tuberculosis. This is a descriptive study with quantitative approach, performed with 60 nurses of the Primary units of the city of Natal, RN Health. The project was approved by the Ethics Committee of the Federal University of Rio Grande do Norte. To collect data, we used a structured questionnaire, developed from the "Consultation of Nursing," the Nursing Protocol for the Treatment of Tuberculosis Directly Observed in Primary Care, Ministry of Health. The instrument was subjected to pre- -test and contained questions regarding the elements used by the nurse in consultation with the patient with tuberculosis and an open question about the feasibility of implementing the Nursing Process in Primary Health Care. data collection was conducted between September and October 2014, in health units work of each participant. Data were analyzed using SPSS 20. The answers to the open question were analyzed for themes and quantified for analysis. With respect to the elements of nursing process used in consultation with the patient with tuberculosis, were on the history of nursing at the expense of survey nursing diagnosis, action planning, implementation and evaluation. Step in the history of nursing, however, the actions were toward complaints and symptoms of the disease (100% of the nurses always investigating). Social and cultural aspects involved in for tuberculosis, as stigma and difficulties in routine work, were less addressed by nurses (43.3% never investigated suffering stigma; 46.7% sometimes investigating changes in the work routine patient ). The physical examination was focused on measuring patient weight (100% held). To the understanding of nurses on the implementation of the nursing process Primary Health Care, favorable factors were identified, such as that this implementation can promote greater scientific basis for nursing (36.7%); and hindering aspects, such as the understanding that Primary Health Care is pervaded by bureaucratic issues and high demand (13.3%). Be established in consultation with the nurse fragmentations, since elements as identification of nursing diagnoses, action planning and evaluation were not made in full by the professionals. Highlights the need for continuing education for nurses who are included in Primary Health Care, seeking to maximize the autonomy of these professionals in developing a practice grounded in scientific knowledge

Amélia Duarte Machado, a Viúva Machado: a esposa, a viúva e a lenda na Cidade do Natal (1900-1930)

The research project examines representations elaborated about Amelia Duarte Machado, images that were built in a particular space: the Natal City. Amelia, one mossoroense that has a simple life, stated a luxurious life after marrying with a rich Portuguese merchant Manuel Machado, in 1904. She led a life of society lady, lived in a sumptuous residence, traveled to Europe, attending the Theatre the city and took care of the social image of her husband, opening the doors of your home to promote dinners and receptions. Experienced the changes occurring in Natal in the first three decades of the twentieth century, when the initiative of a political and intellectual elite of the city began to incorporate bourgeois values and to provide a technical framework focused on the improvements brought by the Industrial Revolution. In 1934, with her husband's death, took over the family business. Besides the widow, also became an enterprising woman. The widow Amelia Machado also became the target of suspicion of the population, rumors about his life. From there emerges a frightening figure in Natal, a being that captured and ate the liver of children, the papa-figo of Natal City, the Widow Machado. In this research, we relate different images that circulated about this woman, who was society lady, dashing widow and papa-figo, articulating these representations with the discourse on female circulating in Natal from 1900 to 1930 yet will raise hypotheses about the creation of the Legend of the Widow Machado

Travestis na atenção primária: o cuidado em saúde na cidade de Natal

Among the deviant a heteronormative ideal, transvestites are the ones that suffer abuse and discrimination. Have been found that health services often present themselves as places that maintains and reproduce such discrimination, which makes transvestites only sought medical care in the latter case. Based on the guidelines of the SUS and the National Humanization Policy as well as the inclusion and leadership of the users, we conducted a qualitative study seeking to understand the experience of transvestites in seeking health care within primary care in Natal-RN. We use as techno-methodological instruments in depth interview and workshop with use of "scenes". For interpretative analysis of the narratives we use to Hermeneutics-Dialectic. From the dialogue with the narrative we come to the following themes: 1) Understanding the meaning of being a transvestite; 2) The experience transvestite in search of health; 3) Transvestites and humanized health care. In the first point they reveal the daily struggle of transvestites between prejudice and the search for respect, as well as the meanings of being a transvestite, who appeared as: Being gay, being feminine, not transsexual and accept themselves as they are. In the second axis, expressed difficulties in access to and use of health services: the embarrassment by not using the social name; fear of going out during the day; the association of transvestites to HIV; and pain caused by discrimination from health professionals. It was also possible to identify simple demands such as illnesses from day to day, the demand for hormone therapy, which involves treatment needs as well as the vital need to have their rights XVII respected. The third axis, for the range of a humanized care identified that the respectful gaze guarantee their dignity and their right to health in a humane way, but it identified some necessary changes: Training of professionals, dialogue with the social movement, publicity campaigns and rapprochement with the transvestite. Finally, it is expected that the research will contribute to the field of knowledge know-how in health care transvestites, inside and outside of the university

O processo de inserção dos psicólogos na assistência social em Natal/RN no período de 1972-2003

Since the rules of the National Social Assistance (PNAS) and the Unified Social Assistance System (SUAS) in 2004/2005 the psychologist action as an essential professional teams in the services offered in this field. Althoug, there are indications of psychologists who worked on the assistence prior this time. This insertion had not systematized in the literature, not allowing the establishment of records of this linear trajectory. The objective of this paper is investigate the entrance and a psychologist working in social care services in Natal / RN , as well as the activities undertaken by them in the period 1972-2003 . This temporal boundary is justified because Natal initiate to have a psychologist from 1972 to 2003 was immediately prior to the landmarks of the 2004/2005 year. The research was divided into two stages: documentary and oral history. The first was through the consultation of 86 monographs of the Sector Documentation Social Service Department of the Federal University of Rio Grande do Norte , its intend identify what were the services that characterized the health care field and evidence of the presence of psychologists in these spaces. In the second stage, interviews with psychologists who worked 13 trailers to social assistance in order to investigate its performance, activities undertaken, the insertion process in the area, among other things were done. The material analysis was based on themes from a historical perspective. The results point to three major areas of integration of psychologists : in child exceptionality in which psychologists were linked to Brazilian Legion Social Assistance (LBA); the field of the minor through the State Foundation for the Well Being of Minors (center), and occupying positions of management and coordination in some welfare programs.