Avaliação longitudinal do impacto da saúde bucal na estratégia saúde da família em Natal

As a result of the financial incentive provided by the GM / MS 1.444, since 2000, Brazil has experienced a substantial increase in the number of oral health services at the Family Health Strategy. There is, however, evidence that these teams have produced qualitatively different experiences which do not translate necessarily into improved quality of life and health. Thus, evaluative research of great importance. This study aims to assess the impact of the Family Health Strategy in oral health in a longitudinal perspective natalense the years 2006 and 2009. This is an intervention study whose design is a community trial in parallel, nearly randomized. The sample consisted of census tracts covered by oral health teams in the Family Health and the Traditional Model (Basic Health Units and non-FHS Program of Community Health Agents and areas not covered.) The sample was determined by drawing ten census tracts to form the experimental group and ten other sectors for the control group by pairing intentional based on socio-economic and geographic. To check the net effect of the intervention was performed multivariate analysis by Poisson regression. As a result of cross-sectional analysis of year 2009, it was found that the effects of the ESF in Natal were satisfactory only for the variables of injuries and for other purposes without and with negative impact on stock coverage reclaimers. However, the longitudinal analysis revealed that the ESB / ESF improved their performance in dealing with grievances, access and coverage of the type of actions and this fact is independent of age, sex and social and economic conditions. In other employees' words are related to the presence of the Family Health Strategy in the region. However it does not say that both models under study (the Family Health Strategy Model and Traditional) are different in terms of performance and it is pertinent to reflect on the need for further development of evaluation studies that use other approaches able to clarify the dynamics of the process whose results can come to the knowledge of the actors responsible for leading the ESF and encourage them to incorporate the assessment in their routine

A educação em saúde pública na práqtica cotidiana: atuação dos cirurgiões-dentistas do PSF de Natal-RN

Considering education a support to health promotion, care integration and citizenship formation,the purpose of this research was to analyze the perception of the oral surgeons from the Family Health Program of Natal-RN over education in health as well as their performance as educators based on their activities on the program. A qualitative study was accomplished by a semi-structured interview and a Free Association of Words Test with 80 oral surgeons from the Family Health Program of Natal-RN. The instruments were analyzed through the meaning analysis and the Central Nucleus of Vergès Theory. The results showed a lack of planning in health actions so there is no standardization on the educative practices done by the oral surgeons which mostly are focused on scholars. There was an agreement among the group according to the oral surgeons´ perception about education in health that education is related to its function of recall prevention ideas to the population. Most part of the context units analyzed by the professionals´ speech show the knowledge of education in health as an inadequate behavior change instrument of the individuals. An interesting point was a quotation cited by some professionals that included actual themes such as citizenship, motivation and life quality, put inside the speech of education in health. To the oral surgeons the biggest difficulties on the development of the educative actions are due to the lack of incentive by the Municipal Health Bureau and to the detachment and lack of valorization of the themes by the population. The oral surgeons consider themselves co-responsible for the formation of a population which is able to request its health. They also mention the knowledge about the need of the community participation on the planning of the Family Health Program actions. Finally, it is notable the need for more encouragement so the oral surgeons can be more capable and have more interest in applying education in health on the perspective of a new model in health, because once capable and stimulated they can awake the population to education importance as a great transformation instrument for people searching for a fair, equalitarian and citizeness society

Avaliação clínica da saúde bucal de crianças com neoplasias malignas atendidas no Hospital Infantil Varela Santiago em Natal-RN

The childhood cancer is characterized by a predominance of hematogenic and lymphatic system neoplasm, although a fTequency of the central nervous system tumors and sarcomas are widely common. Particularities of many childhood cancers and the adverses effect of the antineoplastic agents can change radically the oral environrnent and predisposes to the risk of oral complications. This study assessment clinically the oral health of 40 children on treatment for different types of malignant neoplasm with age range of O to 1S years old (Group I) and compared to 38 nonnal children in the same age range (Group lI). The results shown that nonnal patients had a gingival bleeding index (GBI) and caries experience minar than patients of Group lI, the visivel plaque index (VPI) was lightly higher in patients of Group 1. There was not difference statistically significant in the variables. Sixteen patients of Group I developed together 61 oral complications with predominance of mucositis, followed by spontaneous oral bleeding, candidiasis and xerostomy, that complication were most commons in patients with systemic neoplasm. Its was concluded that patients submitted to antineoplastic therapy with poor oral health had a higher risk to develop oral complications

Saúde psíquica e condições de trabalho dos profissionais de saúde nos hospitais da Universidade Federal do Rio Grande do Norte

A tese se propôs a avaliar a relação entre saúde psíquica e condições de trabalho em dois hospitais da Universidade Federal do Rio Grande do Norte, a saber: Hospital Universitário Onofre Lopes e Hospital Universitário Ana Bezerra. Adotou como ponto de partida epistemológico a abordagem psicossociológica, considerando que a compreensão sócio-histórica do contexto é indispensável para entender os fenômenos em análise. As condições de trabalho e a saúde psíquica foram abordadas interdisciplinarmente, fundamentando a construção de um modelo compreensivo de saúde psíquica que orientou a investigação. O caminho metodológico utilizado foi a pesquisação. Essa foi desenvolvida, utilizando técnicas como análise documental, observação participante, entrevistas não estruturadas, grupo focal e aplicação de um protocolo de pesquisa composto pelo questionário de condições de trabalho, pelo Questionário de Saúde Geral (QSG-60), pela Escala de Bem-Estar Afetivo no Trabalho (JAWS-12) e por questões sociodemográficas. A análise dos resultados mostrou que os escores sintomáticos de saúde psíquica variam por hospitais e que a saúde psíquica sofre influência das condições de trabalho, sobretudo em aspectos referentes a três dimensões: condições físicas e materiais; processos e características do trabalho e o ambiente sociogerencial. Em referência à primeira dessas dimensões, destacaram-se a exposição aos riscos psicobiológicos e de acidentes, bem como as exigências de esforço físico. Na segunda dimensão, a complexidade das atividades e a responsabilidade implicada nas mesmas. E, na última, os fatores de organização da atividade, violência e ambiente conflitivo. Como a relação do indivíduo com seu contexto é dialética, os resultados encontrados corroboraram que quanto mais as condições de trabalho são desfavoráveis, maior a afetação da saúde psíquica e dos afetos com relação ao trabalho, repercutindo novamente no ambiente de trabalho. Portanto, ações de melhoria das condições de trabalho precisam ser estabelecidas para resultar, no efeito inverso, proporcionando o aumento dos afetos positivos e a redução dos sintomas psíquicos

O ambulatório de Saúde Mental no contexto da Reforma Psiquiátrica em Natal/RN

The years 1990 disclose the consolidation of the Brazilian Psychiatric Reform project, assumed as official politics by the Health Department, also stirring up discussions, lines of direction and new ways of care. Substitutive services to the psychiatric hospital as CAPS, conviviality centers, therapeutical residences and ambulatory clinics are implemented. This work analyzes the relations that the Specialized Ambulatory Clinic of Ribeira establishes to the services of Mental Health of the public system in the city of Natal/RN, as well as its adjustment to the proposal of the Psychiatric Reform. Through semi-structured interviews and observation, it was possible to gather data which allowed picturing a general characterization of the service: activities, technical group, joint with other institutions, daily routine organization. Such institution develops activities that surpass the traditional character of a clinic- in other words, the psychological/medical appointments - and it mainly greets the ones proceeding from CAPS and psychiatric hospitals. It offers group activities, psychiatric appointments, therapeutical workshops, sheltering and strolls, among others. The institution is composed by a multi-professional team of psychiatrists, psychologists, occupational therapists, nurse s aide and art-educator. The joint of this service with others that make part of the Mental Health Assistance network in Natal is incipient. Due to this fact, some actions and activities that could and should be developed together are just not. Although facing difficulties, the professionals of the Ambulatory Clinic of Ribeira are able to achieve good results and establish care in Mental Health that prioritize sheltering, listening and respect to the user s individuality. The Ambulatory Clinic of Ribeira is organized according to the paradigm of the Psychiatric Reform. Therefore, it offers an attention that stimulates the re-socialization of the users and the exercise of the citizenship and autonomy of those

Encontros entre dança, subjetivação e saúde mental

Taking from starting point the contact with the experience of a dancing body language group at Centro de Atenção Psicossocial (CAPS) II in Fortaleza-CE, aiming to investigate the relationship between what we denominate dancing-dispositive and the process of de-institutionalization of insanity. Based in the philosophy of difference and in the cartographic perspective, we used the concept of dispositive in order to make visible the lines that compose it and the way they tangle in the production of different ways of subjectivation through another form of expression using the body. We followed two fortnight groups of body language recording the conversations that took place in the beginning and in the end of the activities. We also recorded our informal talks with the workshopper, with the psychiatrist responsible for the course of formation of artists of CAPS and the choreographer who was part of the artistic formation of the workshopper aiming to elucidate the body, dance and art conceptions which guided such work. Finally, we interviewed some technicians and we participated of a meeting of the team aiming to understand how that activity was perceived. We observed that the use of certain conception of dance in the field of mental health is in consonance with the the Phychiatric Reform, since it provides another way of dealing with the body, different from that produced by the contention and by the discipline. Nevertheless, we understood that there is a risk that, in some moments, the group being more a place of normalization than one of experimenting other ways of relating with yourself and with the others. We also noted that the dancing-dispositive appears as an important analyzer of the connections established at CAPS, indicating a need of the service to be more opened to the production of new care and harboring strategies, breaking the mental health facility logic of incarceration of life which still persists in the quotidian of that institution

A atuação do psicólogo no contexto das referências ambulatoriais em saúde mental de Aracaju - SE

Psychologists‟ insertion in mental healthcare ambulatory clinics occurred during the decade of 1980, in the context of the claims disseminated by sanitary and psychiatric reforms, of the formation of minimum mental healthcare teams and of the retraction of the private clinic. Historically, this migration had been accompanied by the importation of practices traditionally applied at the clinics. Furthermore, the lack of clear guidelines from the Health Ministery occasioned the opening of ambulatory clinics with diversified structures at each city. The objective of this dissertation was to study the practices of psychologists at mental healthcare ambulatory references at Aracaju-SE. Were interviewed psychologists of these services and managers of the municipal health secretary using a semi-structured interview guideline, in addition to the analysis of management reports. It was observed that the mental healthcare references had experienced substantial changes referred to its structures and operation, leading to a present framework of expansion and readjustment. It was realized that there is an effort by the psychologists to maintain individual and group assistance, using adjustments in the frequency of the sessions and in the focus of the activities. Besides the progresses, the relation with the psychiatrist still works basically through the medical record, blocking advances on joint discussions of the cases. Some advances toward the amplified clinic are notable, like the overcoming of the isolated usage of psychiatric diagnostic and the replacement of the line‟ criterion by the urgency one. Sheltering had become an interesting strategy on flux ordination, however the mismatch between offer and demand seems to be a matter which extrapolates the psychologists‟ sphere at the references. For this reason the narrow of the relation with family healthcare centers seems to be the major challenge to be faced by psychologists at mental healthcare ambulatory references

O acolhimento como promoção da saúde entre pacientes com câncer

Cancer has been affecting people all around the world; disregard sex, ethnicity or social class. Despite the fact it is not always deadly, to be diagnosed and treated of cancer brings a lot of physical, emotional and social suffering, specially for those with less economic resources. Considering the complexity of the problem, there has been perceived that medical treatment is not enough to support cancer patients. There is an increasing understanding about their necessity of integral care, supposed to be given by a multidisciplinary health care equip that can consider all the different aspects involved in the illness process. Everyone has a particular way of been ill or healthy, and gives different meanings to the experienced events. The starting point of the research was the contact with a called work `group of shelter', developed with cancer patients by a multidisciplinary health care equip working on the LIGA Norte Riograndense Contra o Câncer. The research goal is to identify meanings people give to the shelter they receive in the group and to understand the way they experience the disease. Considering it singularity of this process, one worked with individually half-structuralized interviews, carried through with nine patients of the chemotherapy clinics and suck, that they had passed for the experience of the group of shelter, having approached getting ill, the treatment, the shelter and the recreation of the psychosocial processes (or not) after all this process. It was chosen as focus of analysis the creation of psychosocial processes and production of felt of these social actors through its discourse analysis perspective, boarded in accordance with the following thematic axles: the experience of the cancer, the shelter and recreation of the psychosocial processes the life. It was found that shelter has an extensive meaning going beyond the the group and involving others besides the multidisciplinary health care equip, and being important to give each patient the best possible benefit. It was also identified the importance of other social actors, such as relatives, friends and neighbors; added of religious faith, mentioned by all interviewees. It is to be considered the recovering capacity shown by eight interviewees, demonstrated by changing the way of interacting with others, getting new values and behaviors, and demonstrating more wisdom. We can consider the possibility of making this strategy to become part of the everyday practices of others health services working with cancer patients, what we think can help to minimize their suffering

Práticas educativas e integralidade na saúde da família: um estudo etnográfico

Primary Health Care, especially in the family health strategy, it is expected that the joint assistance and actions of health promotion. The Ministry of health (BRAZIL, 2007) defines health education as an eyeshadow strategy of prevention and health promotion, based on reflective practices, which allow the user to their condition of historical, social and political subject, under the vision of an expanded clinic on the part of health professionals. In this sense, there are guidelines for it professionals to develop educational activities and that they can interfere in the health/disease process of the population, with a view to the development of autonomy of the subject. This research had as objective to understand in the light of the integrality of the care, as is the production of health education practices, within the framework of the family health strategy from ethnographic study in a family health unit (USF). The location of the research was the unit of USF Felipe Camarão II in West Health District, in the city of Natal, RN, Brazil, selected from preliminary mapping of educational practices deployed in units of health of the family of this municipality, based on criteria such as time-to-deployment of USF and sustainability of existing actions. Immersion in the field consisted of participant observation with journaling, held during the period of August 2012 to January 2013, in which she accompanied team work processes in clinical-welfare actions on the USF, in households and in educational activities of group character. The results presented in ethnographic description were analyzed based on the axes proposed by Ayres (2009) for identification of integrality in health practices:the axis of the needs; the axis of the purposes; the joint axis; and the axis of the interactionsThe evidence described from observation point the presence of each axle up health education practices developed by the teams, even incipient form, namely: articulation and appreciation of knowledge and practices of popular culture with local initiatives (Pastoril do Peixe Boi Encantado, Auto de Natal e Grupo Terapia e Arte); Clinical integration with health promotion actions and coordination of multidisciplinary knowledge, with professional-user link (course for pregnant women). However, a few challenges were identified to be faced in order to move forward in these practices in integral care: the need to break with the fragmentation of actions; strengthening teamwork; need for greater sustainability policy of collective actions; intersectoral work aimed at a better role of the State in the face of the health-disease process, adding to the action of individuals.The analysis produced from observation of the processes experienced indicates the need for a better recognition of local managers that actions similar to those that occur in the USF Felipe Camarão II enable advances in completeness as allows inclusion of actors involved in the processes of health work, and stimulate participation and shared responsibility in the fight for health-disease situations

Impacto da cárie precoce severa na infância na qualidade de vida relacionada à saúde bucal de pré-escolares sob privação social

Early childhood caries, especially in its severe form, which is characterized by an acute and aggressive nature, can have negative impacts on thequality of life of a child, due to effects such as difficulty in chewing, decreased appetite, weight loss, insomnia, changes in behavior and a decreased performance in school, among others. Moreover, the quality of life of the child`s family can also be affected, as the pain and discomfort caused by this type of caries result in loss of working days of parents, spending on dental treatments, changes in sleep patterns and stress. The aim of this study was to evaluate the impact of severe early childhood caries in the Oral Health-Related Quality of Life (OHRQoL) of public daycares`s preschool children through the Escala de Impacto da Saúde Bucal na Primeira Infância, a Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). A single calibrated examiner (kappa=1.0) evaluated, through the dmfs index, the oral health of 116 children aged between 3 and 5, which were included in one of three study groups: "caries-free", "not-severe early childhood caries" and "severe early childhood caries". The parents responded to ECOHIS, to assess their perception regarding the OHRQoL of their children, and a questionnaire on socioeconomic conditions. The OHRQoL was measured through the total scores and domains of ECOHIS. Descriptive analysis, Mann-Whitney test, Kruskal-Wallis test, chi-square test and Poisson multiple regression with robust variance were used. Among the children observed, 38.8% were caries-free, 27.6% showed not-severe early childhood caries and 33.6% showed severe early childhood caries. Regarding the total score of ECOHIS, severe early childhood caries had a greater negative impact on OHRQoL, compared to caries-free and not-severe early childhood caries groups (p <0.001). Regarding the child subscale, there was significant difference between the "severe early childhood caries" group and the other groups in all domains, except for theone of self-image / social interaction. In the family subscale domains, there was statistical significance between the severe early childhood caries and the caries-free groups in all domains (p <0.001), whereas between the "severe early childhood caries and not-severe early childhood caries groups there was a statistically significant difference only in the domain of parental anguish (p <0.001). Multivariate analysis showed that early childhood caries and the parent`s age were significantly associated to OHRQoL (p <0.05), independently of the other variables in the model. The presence of severe early childhood caries resulted in greater negative impact on OHRQoL (AdjPR= 6.016; 95%CI = 3.12 11.56; p<0.001), while older parents reported better OHRQoL (AdjPR = 0.603; 95%CI = 0.428 - 0.850; p = 0.004). The presence of severe early childhood caries had a negative impact on OHRQoL of preschool children and their families.

Produção e validação de um indicador de saúde bucal para idosos a partir de dados secundários do SB Brasil 2010

Dentre os vários aspectos da saúde do idoso, a saúde bucal merece atenção especial pelo fato de que, historicamente, nos serviços odontológicos, não se considera esse grupo populacional como prioridade de atenção. Por isso, se faz necessária a produção de um indicador multidimensional capaz de mensurar todas as alterações bucais encontradas em um idoso, facilitando a categorização da saúde bucal como um todo. Tal indicador representará um importante instrumento capaz de elencar prioridades de atenção voltadas à população idosa. Portanto, o estudo em questão propõe a produção e validação de um indicador de saúde bucal a partir dos dados secundários coletados pelo projeto SB Brasil 2010 referente ao grupo etário de 65 a 74 anos. A amostra foi representada pelos 7619 indivíduos do grupo etário de 65 a 74 anos que participaram da pesquisa nas 5 (cinco) regiões do Brasil. Tais indivíduos foram submetidos à avaliação epidemiológica das condições de saúde bucal, a partir dos índices CPO-d, CPI e PIP. Além disso, verificou-se o uso e necessidade de prótese, bem como características sociais, econômicas e demográficas. Uma análise fatorial identificou um número relativamente pequeno de fatores comuns, através da análise de componentes principais. Após a nomenclatura dos fatores, foi realizada a soma dos escores fatoriais por indivíduo. Por último, a dicotomização dessa soma nos forneceu o indicador de saúde bucal proposto. Para esse estudo foram incluídas na análise fatorial 12 variáveis de saúde bucal oriundas do banco de dados do SB Brasil 2010 e, também 3 variáveis socioeconômicas e demográficas. Com base no critério de Kaiser, observa-se que foram retidos cinco fatores que explicaram 70,28% da variância total das variáveis incluídas no modelo. O fator 1 (um) explica sozinho 32,02% dessa variância, o fator 2 (dois) 14,78%, enquanto que os fatores 3 (três), 4 (quatro) e 5 (cinco) explicam 8,90%, 7,89% e 6,68%, respectivamente. Por meio das cargas fatoriais, o fator um foi denominado dente hígido e pouco uso de prótese , o dois doença periodontal presente , o três necessidade de reabilitação , já o quarto e quinto fator foram denominados de cárie e condição social favorável , respectivamente. Para garantir a representatividade do indicador proposto, realizou-se uma segunda análise fatorial em uma subamostra da população de idosos investigados. Por outro lado, a aplicabilidade do indicador produzido foi testada por meio da associação do mesmo com outras variáveis do estudo. Por fim, Cabe ressaltar que, o indicador aqui produzido foi capaz de agregar diver sas informações a respeito da saúde bucal e das condições sociais desses indivíduos, traduzindo assim, diversos dados em uma informação simples, que facilita o olhar dos gestores de saúde sobre as reais necessidades de intervenções em relação à saúde bucal de determinada população

Promoção da saúde: estratégias para a autonomia e qualidade de vida do sujeito com diabetes

O diabetes é uma doença crônico-degenerativa de grande prevalência na população mundial configurando-se enquanto sério problema de saúde pública. Por ser crônico exige dos sujeitos autocuidado e autogoverno longitudinal. A autonomia, por sua vez, é um direito fundamental e também um dos princípios da bioética mais discutidos na atualidade. Seu conceito é complexo e leva em conta a vida experimentada ao longo dos anos. Quando a discussão sobre autonomia se trata de diabetes, a dependência do outro e os conflitos no controle da doença, diante de novas regras e estilos de vida, nem sempre condizentes com os valores dos pacientes, torna-a fragilizada. Embora a autonomia seja claramente parte integrante do tratamento e alicerce para uma vida digna e de qualidade, observamos que os sujeitos se tornam ainda mais dependentes dos serviços de saúde, quando se deparam com o diagnóstico e não têm confiança para tomar suas próprias decisões diante da patologia limitadora. Por isso, há a necessidade dos serviços de atenção primária à saúde traçarem estratégias para promover a saúde desses sujeitos. Os Grupos de Promoção da Saúde são estratégias recentemente utilizadas para influenciar no nível de autonomia dos sujeitos, pois possibilitam, respeitando os limites éticos, a garantia de participação decisória no grupo, através de estratégias e treinamentos de habilidades com competências claramente definidas, que favorecem o empowerment e o protagonismo dos sujeitos. Desse modo, este trabalho objetiva identificar estratégias no âmbito da promoção da saúde na ESF, que contribuam para melhor autonomia e qualidade de vida dos sujeitos com diabetes mellitus, a partir de sua percepção. E, mais especificamente, analisar o perfil clínico e socioeconômico dos portadores de diabetes da ESF; identificar as experiências, necessidades e expectativas dos sujeitos com diabetes sobre autonomia, autocuidado e qualidade de vida; e realizar um levantamento em conjunto com os sujeitos com diabetes, sobre aspectos que sirvam de evidências para construção de propostas para implantação de um Grupo Estratégico de Promoção da Saúde GEPS, com foco na autonomia. Para isto, foi realizada uma pesquisa exploratória descritiva de abordagem qualitativa e quantitativa, com 65 sujeitos com diabetes acompanhados por uma Unidade de Saúde da Família do Município de Santa Cruz/RN. A pesquisa foi realizada em três etapas interdependentes: 1) coleta de dados clínicos e socioeconômicos, para o qual foi utilizado entrevista estruturada e análise retrospectiva dos registros feitos em seu prontuário; 2) a análise das experiências, necessidades e expectativas dos sujeitos sobre autonomia, autocuidado e qualidade de vida, que se utilizou de entrevista semiestruturada com 6 sujeitos, sendo 3 com mais e 3 com menos complicações autorreferidas e verificadas no prontuário; e 3) a construção coletiva de propostas para melhor autonomia e qualidade de vida dos próprios participantes do estudo, por meio de roda de conversa. Para a análise dos dados utilizamos software de estatísticas simples para os dados das questões fechadas de cunho quantitativo e os dados qualitativos foram analisados através da análise de conteúdo. Observamos que o perfil clínico e socioeconômicos dos sujeitos com diabetes aproximam-se das estatísticas nacionais, embora existam variáveis, como cor da pele, com variação significativa. A autopercepção dos sujeitos diante de algumas complicações divergem de registros encontrados em seu prontuário o que aponta uma possível desvalorização de queixas como hipoglicemia e disfunção sexual, como também baixa adesão ao tratamento por, muitas vezes, não terem suas opiniões valorizadas. As categorias encontradas: vida, qualidade de vida, diagnostico e enfrentamento do problema, autonomia, limites e dependência assim como as práticas coletivas de promoção da saúde, apontam para a necessidade de estratégias por meio de grupos que considerem as crenças e valores dos sujeitos, favoreçam sua emancipação e torne-os protagonistas de sua própria história e de seu processo saúde doença. A autonomia é fundamental para o exercício da cidadania efetiva. É por meio dela que os sujeitos transformam sua realidade e a si mesmo. A contribuição desta pesquisa consiste em identificar estratégicas que se propõe a potencializar a autonomia dos sujeitos, através dos GEPS, norteando a atuação dos profissionais na atenção primária à saúde, que deve sustentarse em ações de prevenção e promoção da saúde e também no incentivo à participação popular e protagonismo dos sujeitos

Ações educativas com portadores de diabetes Mellitus através da educação popular em saúde

Popular Health Education in its emancipatory dimension refers to individuals and groups to exchange knowledge and experiences, allowing them to associate health to the outcomes of their living conditions. Under this view, health workers and health users are subjects of the educative process. Thus, this study aims to identify the key clinical and socio sanitary attributes and promote educational activities with patients with Diabetes Mellitus (DM) in a Family Health Care Unit of the Western Sanitary District, in the city of Natal / RN. It is an action research which uses the references of the Theory of Liberating Education, which is based on a problem-solving pedagogy and that values dialogue in the process of understanding oneself and the world. Thirty-six diabetics, who are residents of the area covered by the health care unit, and thirty health workers participated in the survey. Each group had an average of twelve participants, and the meetings took place at the Unit´s hall, using conversation wheels, group dynamics, life narratives, experiences telling, movie exhibition and discussions, music, knowledge telling, desires, limitations, beliefs and values socially constructed. Data collection took place during the second half of two thousand and thirteen through Free Word Association Technique (FWAT), recordings of conversation wheels, participative observation, group dynamics, testimonies, questionnaires, life narratives and photographs. The empirical material was organized and subjected to three analyzes: thematic content (Bardin), textual statistics analysis by software IRAMUTEQ (Ratinaud), and photographic analysis (Edmund Feldman). The data analyses originated words, expressions, categories, themes and creative situations showing that popular health education is in process of construction, but still very incipient in primary care. The National Policy on Popular Health Education shows us the necessary ways for the transformation of health practices and the build of a more shared and solidary society. The meetings could be place to reverse that normative logic that has been happening over the years in primary care, but that by itself is not enough. It is possible to conclude that the use of active practices, increasing of listening and training on Popular Health Education will enable changes in the scenario where users and health workers deal with diabetes mellitus. Thus we see the popular health education is being timidly incorporated to the educational process of the subjects involved in this study, and far away from the principles of participation, organization of political work, increase opportunities for dialogue, respect, solidarity and tolerance among different actors involved in addressing the health problems that are fundamental to the improvement in building healthy practices of primary care

Saúde do trabalhador: entre os dispositivos legais e as práticas efetivas

The health worker is seized in this research beyond the mere applicability of legal devices concerning the legislation of Labor, in order to be established correlations with activities alluding to the public power in the ambit of State of Rio Grande do Norte (RN). This dissertation is an cutting of analysis circumscribed in the research, "Accidents at work: law, citizenship and justice," of the Grupo de Estudos Seguridade Social e Trabalho (GESTO) of Universidade Federal do Rio Grande do Norte (UFRN). The overall goal turned to apprehend and relate contradictory elements inherent compliance of Occupational Health and Safety (OHS) in the supermarket which showed the highest occurrence of legal violations recognized by the Labor Justice of RN in the period between 2006 and 2008 . The specific objectives turned to identify, from the condemnatory sentences, violations inherent in the protective direction of the OH & S legislation; analyze the relationship of health damages to workers at the supposed recognition of rights claimed in condemnatory sentences and correlate violations inherent in the legislation OSH impacts on the health of workers, from data contained in expert reports. The justification for perform the research backed up, among other factors, in the fact that class of activity has been presented as the most recurrent in condemnatory sentences, since it chose to focus the analysis on documentary evidence from the supermarket which showed greater expression in relation to violations of the OSH legislation. From a qualitative perspective, the methodological approach was based on content analysis of thirteen condemnatory sentences, handed down by the potiguar labor justice, and three expert reports from a large supermarket in the city of Natal/RN. Aftermaths are evidenced relating to the cyclical processes of reorganization of capital, demanding requirements for labor organizations whose strategies for survival include identifying mechanisms to extract as much of the work force. Structural determination and ideological context that puts into question the historical achievements of workers, for example the legal devices aimed at preventing workplace accidents, expressed in this research as relativized, showing limitations of reach, as was inferred the indemnities, by material and moral damages, arising from Work-Related Musculoskeletal Diseases (MSDs'S), recognized by the laborite judiciary

Fatores associados à diferença clinicamente significativa da qualidade de vida relacionada à saúde após condicionamento físico em pacientes com DPOC

OBJETIVO: Investigar os fatores associados à diferença clinicamente significativa da qualidade de vida (DCSQV) após condicionamento físico em pacientes com DPOC. MÉTODOS: Trinta e cinco pacientes foram submetidos a 12 semanas de condicionamento físico, envolvendo treinamento de força e exercício aeróbio leve. Composição corporal, teste incremental e de endurance em esteira, teste de caminhada de seis minutos, força muscular periférica, PImáx, baseline dyspnea index (BDI) e Saint George's Respiratory Questionnaire (SGRQ) foram avaliados antes e após o treinamento, e suas alterações (Δ) foram calculadas. A DCSQV foi definida como a redução > 4% no escore total do SGRQ. Os pacientes que responderam ao treinamento, apresentando DCSQV, foram alocados no grupo respondedores (R; n = 24), e os demais pacientes foram alocados no grupo não-respondedores (NR; n = 11). RESULTADOS: Os seguintes resultados foram significativamente maiores no grupo R que no grupo NR (p < 0,05): VEF1 (1,48 ± 0,54 L vs. 1,04 ± 0,34 L), VEF1/CVF (47,9 ± 11,7% vs. 35,5 ± 10,7%), PaO2 (74,1 ± 9,7 mmHg vs. 65,0 ± 8,9mmHg) e ΔBDI [mediana (interquartil); 2,0 (0,0-3,5) vs. 0,0 (0,0-1,0)]. Houve correlação significativa (p < 0,01) de ΔSGRQ-sintomas (r = 0,44), ΔSGRQ-atividade (r = 0,62) e ΔSGRQ-total (r = 0,60) com ΔBDI. Após regressão logística, apenas ΔBDI foi selecionado como determinante da DCSQV. CONCLUSÕES: A DCSQV após o condicionamento físico está associada principalmente à redução da dispneia nos pacientes com DPOC. Portanto, são necessárias estratégias de tratamento visando interromper o ciclo dispneia-sedentarismo-dispneia nesses pacientes.