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.

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

Qualidade de vida no trabalho do enfermeiro da Atenção Básica à Saúde

OBJETIVOS: Apreender as concepções e experiências de enfermeiros sobre qualidade de vida e qualidade de vida no trabalho na Atenção Básica à Saúde. MÉTODOS: Estudo descritivo de abordagem qualitativa, realizado no interior paulista, Brasil, com oito enfermeiros cujos depoimentos foram submetidos à análise de conteúdo, na vertente temática. RESULTADOS: Os enfermeiros apresentaram concepções ampliadas sobre qualidade de vida e qualidade de vida no trabalho, em geral, apresentando-se satisfeitos quanto às mesmas. Entretanto, foram apontados entraves comprometedores da qualidade de vida dos profissionais no contexto estudado determinados, principalmente, pela falta/inadequação de recursos materiais, humanos e ambientais, bem como pelo processo de trabalho estabelecido. CONCLUSÃO: Embora haja o reconhecimento da satisfação em trabalhar na Atenção Básica à Saúde, os problemas apontados revelam a importância de se mobilizar maior atenção dos profissionais e gestores para o tema.

Desenvolvimento territorial e a política nacional de água em Moçambique: o caso do distrito de Chibuto

The development has been a phenomenon in constant discussion today, whose fundamental importance should be to promote the welfare of humanity. Thus, the development becomes an element that adds political, economic, social and environmental values . In Mozambique the development model adopted by the State prioritizes the economic dimension, in this case favoring the growth of capitalist structure production. Thus , the basic conditions for human survival still leaves much to be desired and the Mozambican population in general and the district of Chibuto , in particular , continue to face several difficulties to have access to such conditions, and the lack of potable water is a that most of the problems afflicting this population . The water was always a factor related to the socio-economic development of the population, where great civilizations and major economic marks were always influenced by water availability, and today this feature is present in all sectors of production. In Mozambique, much effort has been made by the government, national and international organizations to enhance and guarantee the supply of potable and drinking water, and despite all this effort, most of the population does not have access to this precious resource. In this sense, this work presents an analysis of the effects of the National Water Policy in the study area, analyzes the shortage of potable water in the district of Chibuto, discusses the design and development contained in the official discourse of the state and, opposes the idea of human development. For such issues that help to understand the phenomenon under study, such as territory, public policy and criticism of hegemonic conception of development are addressed. To make the desired approach, we performed a characterization of the District of Chibuto, addressing the issue of poverty, with a brief discussion of this concept, from different approaches, and analyze the impact of the PARPA (Action Plan for the Reduction of Absolute Poverty) in fighting poverty in Mozambique, and became a description of the scenario of poverty and vulnerability in Chibuto district with the construction of Territorial Human Development Index. Research also brings up a discussion about territory and technicization which describes the senary of the water supply system in the District and territorial dynamics of Chibuto, from the analysis and description of existing structures and other technical objects that structure the territory under study. Thus, it was found that the development should be summarized in the satisfaction of human needs, and should be the cornerstone of the new type of development that is intended for the purpose of triggering urgently actions to overcome or combat bleak misery suffered by the majority of inhabitants of the District of Chibuto

Capacitação de profissionais da atenção primária à saúde para educação em Diabetes Mellitus

Objective: To present the proposal of educational workshops on diabetes and a strategy of evaluation aimed at upgrading the professionals' performance in primary care. Methods: The workshops were implemented using participatory methodology, play techniques, experiences, and group dynamics, involving the participation of 85 health professionals from Units of Primary Care, in the city of Belo Horizonte, MG. The knowledge about the disease and the skills required for self-care were measured by applying specific instruments. The workshops were evaluated based on the instrument: developed for that purpose. Results: There were limitations in the knowledge of professionals about pathophysiology and the disease's complementary tests. The workshops helped to awaken the potential of professionals (reflection, criticism and creativity) necessary to change the educational process. It was considered a pedagogical strategy, easy to understand, interactive and playful. Conclusions: The workshops contributed to the planning of the educational process and the structuring of an evaluation model of practices of health and education promotion in diabetes.

Evolução da perda de peso entre indivíduos da fila de espera para a cirurgia bariátrica em um ambulatório multidisciplinar de atenção secundária à saúde

Objective: The objective of this study is to characterize the assistance and analyze patient's adherence to nutritional follow-up while in the waiting line for bariatric surgery in a multidisciplinary, secondary healthcare outpatient clinic. Methods: This retrospective study was based on the nutritional records of 59 patients subjected to bariatric surgery at the Hospital das Clinics de Botucatu, from 2001 to 2008. The population studied was distributed into 8 groups and analyzed according to follow-up duration. The analysis took into account the evolution of body weight and the number of follow-up visits in a given period. The Kruskal-Wallis test was used to compare data between groups while Spearman's coefficient was used to test correlations. Results: Among the 59 studied patients, 42 (71.2%) returned to the clinic at least once in six months. Of these, 67.8% lost weight while in the waiting line and 27.1% of them lost more than 10% of their body weight. The greatest weight losses in the preoperative period were found in the groups that had more than six months of nutrition follow-up. There was a mean delay of three months between return visits, which could have contributed to the low adherence to follow-up. Conclusion: The patients in the waiting line for surgery analyzed in this study presented low adherence to the long-spaced return visits. The greatest weight losses were observed in groups that had been followed for more than six months. This shows that, to achieve the desired weight loss and an adequate education process before surgery, at least six months of follow-up and regular visits are necessary.

La política nacional de desarrollo regional: experiencia reciente de la política regional en Brasil

Incluye Bibliografía

La política nacional de desarrollo regional del gobierno de transición: apreciaciones y dudas

Incluye Bibliografía

La sostenibilidad del desarrollo oceánico a partir de la Plataforma de Tlatelolco sobre el Medio Ambiente y el Desarrollo: opciones para la formulación de una política nacional en el área

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Hacia una política nacional de riego

Incluye Bibliografía

O Banco Mundial e a política nacional de recursos hídricos no governo FHC (1995-2002)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A questão regional e o BNDES: uma análise da conformidade entre a atuação do BNDES e a Política Nacional de Desenvolvimento Regional (PNDR)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Caracterização do processo de reciclagem do óleo lubrificante usado em postos de combustíveis e identificação de desafios frente à política nacional de resíduos sólidos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)