Qualidade de vida em gestantes no contexto na Estratégia Saúde da Família

The pregnancy as a process in woman's life requires several biological, psychological, relational and socio-cultural changes for the preparation for motherhood. By modifying its capacity and, at the expense of these factors, it is observed that the physical, social and emotional problems experienced by women during pregnancy can affect their quality of life, especially related to health. It had as objectives of this research verifying the quality of life of women in the context of the Family Health Strategy in a municipality in Paraíba, in order to characterize the sociodemographic aspects, lifestyle habits, and obstetric care of pregnant women and to characterize the fields of quality of life of pregnant women according to the WHOQOL-bref. This is a descriptive exploratory study with cross-sectional and quantitative approach. The population consisted of 120 pregnant women in primary care in the municipality of Sousa-PB. Data collection occurred over a period of two months by the own master's degree student and two nursing students in applying a standard form about sociodemographic characteristics, and obstetric care and the WHOQOL-bref instrument. The data collected were organized into an electronic database of the Microsoft Excel application, coded, tabulated and presented in tables, charts and figures with their respective percentage distributions. Of the surveyed, the predominant were age group of 20 to 25 years, Catholic religion, with a steady partner, low education, no employment, wage income of 01 minimum wage. As for the data and obstetric care, almost all had never aborted and reported to the care received as excellent. The most frequent complaints were back pain and in lower abdomen. Regarding quality of life according to the WHOQOL-bref, dissatisfactions that predominated in the areas were in the physical pain and discomfort, sleep, rest, energy and fatigue. In the psychological domain, body image and appearance, memory, concentration and negative feelings. In the field of social relationships, sexual activity and the environment domain, the greatest dissatisfaction with facets scored: financial resources, leisure opportunities and transport. It is concluded that the quality of life of the users interviewed were deemed unsatisfactory for these facets, indicating that assistance to this target audience should be done comprehensively and holistically, in order to accommodate the affected facets to improve the quality of life pregnant women attended in primary care

Atenção à saúde mental na Estratégia Saúde da Família no Município de Parnamirim/RN: opinião dos profissionais, dos portadores de transtornos mentais e seus acompanhantes

This study aims to analyze and compare the opinion of professionals, managers and users about the mental health care in the Family Health Strategy (FHS). It is characterized as an Operations Research or Health System Research with a cross-sectional design and a descriptive quantitative nature. The study was developed from the application of the Opinion Measurement Scale allied to techniques of observation and structured interview in the city of Parnamirim / RN. The sample consists of 409 subjects, 209 professionals of the Family Health Strategy, 30 of the Oral Health Strategy, 19 of the Family Health Support Center, 24 directors of Basic Health Units, plus 68 users with mental disorders and 59 caregivers, respecting the ethical parameters of Resolution 196/96 of the National Health Council, trial registration number: CAAE 0003.0.051.000-11. Quantitative data were submitted to the Epi-info 3.5.2 for analysis. The network of mental health in Parnamirim involves the flow between the FHS, Psychosocial Care Centers, clinics and hospitals, having as main barriers the fragility of the referral and counter-referral system, of the municipal health conferences, of the FHS teams by the limitations in material and human resources as well as the population´s lack of acknowledge about the organization of the mental health network, issues that affect the integral attention. Even though the FHS professionals recognize the importance of their actions, they question their role in mental health care, experiencing difficulties in accessing psychiatric services (76.5%). Although most agree that the mentally ill is best treated in the family than in hospital (65.2%), the community health workers were the predominant category in the partial or total disagreement of this statement (40.8%), who is the professional in greater contact with the family. Nevertheless the caregivers miss the support of the FHS as the main focus of attention is on revenue control. The views of professionals, mental patients and caregivers converged in several statements, showing the main weaknesses to be focused by the mental health network of the city, as the perceptions that: (a) physical strength is needed to take care of mental patients for its tendency to aggression, requiring it to stay in the sanatorium for representing danger to society, (b) only a psychiatrist can help the person with emotional problems, (c) the user of alcohol and drugs does not necessarily develop mental illness, (d) the access barriers and doubts about the quality of psychiatric services, (e) caring of a mental health patient does not bring suffering to professionals. Therefore, the commitment to consensus building, monitoring and evaluation of the network are important mechanisms for an effective management system, reflecting in the importance of strengthening the health conferences and approximating different institutions. The results reinforce the importance of strengthening primary care through programs of continuing education focusing on the actions and functions of professionals in accordance with its competences and duties what contribute to the organization and response of mental health care, favoring user´s care and the promotion of family health

Fatores associados à doença pulmonar em idosos

OBJETIVO: Investigar a prevalência de doença pulmonar referida entre idosos segundo características sociodemográficas, econômicas, estilo de vida, mobilidade física e condições de saúde. MÉTODOS: Trata-se de um estudo transversal, de base populacional, do qual participaram 1.957 idosos (60 anos ou mais). As informações foram coletadas por meio de entrevistas. Os participantes foram selecionados a partir de amostragem probabilística, estratificada, por conglomerados e obtida em dois estágios em seis municípios do Estado de São Paulo, no período de 2001 a 2002. Foram utilizadas estatísticas descritivas, testes de associação pelo chi2, razões de prevalência e intervalos de confiança de 95%. A análise ajustada foi conduzida por meio de regressão de Poisson. RESULTADOS: Dos entrevistados, cerca de 7% referiram doença pulmonar. Não houve associação entre doença pulmonar referida e vacinação contra influenza. A partir da análise ajustada foi possível identificar os seguintes fatores independentemente associados à referência da doença: tabagismo (RP=2,03; IC 95%: 1,39-2,97); uso de medicamentos (RP=2,05; IC 95%: 1,11-3,79); auto-avaliação do estado de saúde atual como ruim ou muito ruim (RP=1,89; IC 95%:1,20-2,96); e depressão, ansiedade ou problemas emocionais (RP=1,86; IC 95%: 1,11-3,10). CONCLUSÕES: Os achados do presente estudo reforçam a importância das doenças respiratórias em idosos, particularmente em grupos mais vulneráveis, justificando medidas preventivas e assistenciais específicas.

Influências ambientais na saúde mental da criança

Objetivo: Apresentar uma revisão atualizada sobre a influência ambiental na saúde mental da criança, os principais fatores de risco e medidas práticas para intervenção pelo pediatra. Fontes dos dados: Foram utilizadas para a revisão as principais bases de dados, MEDLINE, Psyclit e Lilacs, livros técnicos e publicações relevantes na área de desenvolvimento e promoção da saúde mental da criança e adolescente. Síntese dos dados: As crianças estão expostas a múltiplos riscos, entre os quais o de apresentarem uma alta prevalência de doenças, o de nascerem de gestações desfavoráveis e/ou incompletas e o de viverem em condições socioeconômicas adversas. Tal cadeia de eventos negativos faz com que essas crianças tenham maior chance de apresentar problemas emocionais. Os resultados negativos no desenvolvimento e comportamento são produzidos pela combinação de fatores de risco genéticos, biológicos, psicológicos, e ambientais, envolvendo interações complexas entre eles. Os fatores mais fortemente associados com a saúde mental da criança são o ambiente social e psicológico, influenciando mais do que as características intrínsecas do indivíduo. O efeito cumulativo de risco é mais importante na determinação de problemas emocionais da criança do que a presença de um estressor único, independente de sua magnitude. Conclusão: Os fatores ambientais tem um papel importante na gênese dos problemas emocionais da criança e é papel do pediatra através de uma prática clínica adequada a identificação e intervenção precoce nos fatores de risco para o desenvolvimento desses distúrbios.

Uso de drogas ilícitas e de medicamentos psicotrópicos sem prescrição: um inquérito epidemiológico transversal em amostra populacional da região metropolitana de São Paulo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A relação sujeito-objeto e a unidade afetivo-cognitiva: contribuições para a psicologia e para a educação

The relationship between affective-emotional problems and school learning is present in areas of Psychology and Education. In the present study, of theoretical and bibliographic characteristics, we investigated elements that might confirm the thesis of the historicity of cognitive and affective processes, giving to these processes a social and symbolic connotation . Through the Historic-Cultural Psychology we approached the subject-object relationship and affective-cognitive unit proposing to overcome the subjectivist and organicist thinking. The study suggested the importance for us to (re) think the relationships that the subject establishes with the environment, the role of knowledge and practical conditions of life and education. Besides, it highlighted the activity as a main category in the constitution of needs and motives, as well in the formation of desires and the objectification of them. In this way, it enhances the learning and promotes the development, considering that the formation of subjectivity in each subject is the effect of an educative process that shall be object of study of both Psychology and Education.

O surgimento das práticas de assistência à saúde mental da criança inspiradas na psicanálise no início do século XX através da obra de Durval Bellegard Marcondes

Psychoanalysis was introduced in Brazil since 1920 contributing to the appearance of new practices of health care for the child. Therefore, the present article aims to discuss the link between psychoanalysis and practices focused on children's mental health that emerged from the 1930s through the work of Durval Marcondes, a pioneer in the dissemination and use of psychoanalysis in Brazil. A historical research was held from a survey on Durval Marcondes’s work and the team led by him confined in the epigraph theme. It was found from that work that the link between mental hygiene, new school and psychoanalysis developed a pioneering service of care to children with school problems based on the diagnostic evaluation and guidance of parents and teachers. It is concluded that this work introduced the differentiation between children with cognitive and emotional problems and provided the foundations of psychoeducational and psycodiagnostic interventions.

Obsessive-compulsive symptoms in medical students: prevalence, severity, and correlates

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

Superdotados acompanhados em serviço especializado: características clínicas, sociodemográficas e qualidade de vida

Pós-graduação em Saúde Coletiva - FMB

Does body mass index in childhood predict restraint eating in early adolescence?

The aim of this study was (1) to examine whether childhood BMI is a significant predictor of restrained eating in preadolescents, (2) to investigate gender differences in restrained and emotional eating, and (3) to determine whether emotional problems, and body esteem were related to eating problems of preadolescents. In this longitudinal study with two measurement points, data from 428 children (50% female) were used. At time 1 (t1) children were on average 5.9 years old. BMI was assessed using objective measures. At time 2 (t2) participants were 12 years old. The adolescents and their parents completed questionnaires assessing restrained and emotional eating, body esteem, emotional problems, and BMI. Multiple regression analysis showed that restrained eating was significantly predicted by t1 BMI, by change in BMI between t1 and t2, and t2 body esteem. Emotional eating was, as expected, not predicted by t1 BMI, but associated with t2 body esteem and t2 emotional problems. Gender was not a significant predictor. The stability of BMI between childhood and preadolescence and its ability to predict restrained eating suggests that it is important to start prevention of overweight, body dissatisfaction and disordered eating at an early age

Ordinary Families -Extraordinary Care Giving

Children with severe emotional problems often have multiple needs that require disparate services including child welfare, juvenile justice, health, mental health, substance abuse, and mental retardation (Stroul, 1996). However, the primary care giving responsibilities for these youngsters still remain with their families. It is the family who shelters and clothes them; provides guidance, affection, recreation, nurturing; gets them to appointments with doctors and therapists and to school dayin- and-day-out, year after year (Lourie, 1995). Despite the invaluable and irreplaceable care provided by families, they are often maligned by a system which characterizes them as having their own problems and inadequacies. The purpose of this research is to learn more about the strengths of families who care for children with severe emotional disabilities (SED). This exploratory descriptive study made use of focus groups attended by parents who are caring for such children. In order to improve services to these families, it is important that we understand how the notion of strengths play out in their everyday lives. Observations are made about the care giving plan, which all families devise in the course of caring for their child with special needs. Implications for paid professionals who serve these families are offered by presenting a model for putting family care givers at the hub of the service provision wheel.

Preventive Intervention as Means of Clarifying Direction of Effects in Socialization: Anxious-Withdrawn Preschoolers Case

An indicated preventive intervention research program integrating attachment, attributional, and behaviorist perspectives was conducted to test the hypothesis that parent-child relationship disturbances directly effect the child's adjustment to the preschool. Anxious-withdrawn preschool children and their mothers were divided equally into treatment and control groups, and assessed on maternal self-report of parenting stress, behavioral ratings of mother-child interaction, and teacher ratings of the children in the preschool classroom. Results showed significant changes in the treatment group: mothers in the treatment group moderated their level of control to a more appropriate, less intrusive level, while children in the treatment group showed an increase in cooperation and enthusiasm during a problem solving task with mother. Teacher-rated social competence and anxious-withdrawn behavior indicated improvement, although only the former was significant. The demonstration of effects of this home intervention for the mother on the child's behavior in the preschool confirm the transactional model underlying this study and demonstrate the utility of a parent-child interaction training component for the prevention of behavioral-emotional problems in young children.

The illness experiences of African Americans residing in an inner city community, Houston, Texas

This dissertation documents health and illness in the context of daily life circumstances and structural conditions faced by African American families living in Clover Heights (pseudonym), an inner city public housing project in the Third Ward, Houston, Texas. Drawing from Kleinman's (1980) model of culturally defined health care systems and using the holistic-content approach to narrative analysis (Lieblich, Tuval- Mashiach, & Zilber, 1998) the purpose of this research was to explore the ways in which social and health policy, economic mobility, the inner city environment, and cultural beliefs intertwined with African American families' health related ideas, behaviors, and practices. I recruited six families using a convenience sampling method (Schensul, Schensul, & LeCompte, 1999) and followed them for fourteen months (2010–2011). Family was defined as a household unit, or those living in the same residence, short or long-term. Single, African American women ranging in age from 29–80 years headed all families. All but one family included children or grandchildren 18 years of age and younger, or children or other relative 18 years of age and older. I also recruited six residents with who I became acquainted over the course of the project. I collected data using traditional ethnographic methods including participant-observation, archive review, field notes, mapping, free-listing, in-depth interviews, and life history interviews. ^ Doing ethnography afforded the families who participated in this project the freedom to construct their own experiences of health and illness. My role centered on listening to, learning from, and interpreting participants' narratives, exploring similarities and differences within and across families' experiences. As the research progressed, a pattern concerning diagnosis and pharmacotherapy for children's behavioral and emotional problems, particularly attention-deficit hyperactivity disorder (ADHD) and pediatric bipolar disorder (PBD), emerged from my formal interactions with participants and my informal interactions with residents. The findings presented in this dissertation document this pattern, focusing on how mothers and families interpreted, organized, and ascribed meaning to their experiences of ADHD and PBD. ^ In the first manuscript presented here, I documented three mothers' narrative constructions of a child's diagnosis with and pharmacotherapy for ADHD or PBD. Using Gergen's (1997) relational perspective I argued that mothers' knowledge and experiences of ADHD and PBD were not individually constructed, but were linguistically and discursively constituted through various social interactions and relationships, including family, spirituality and faith, community norms, and expert systems of knowledge. Mothers' narratives revealed the complexity of children's behavioral and emotional problems, the daily trials of living through these problems, how they coped with adversity and developed survival strategies, and how they interacted with various institutional authorities involved in evaluating, diagnosing, and encouraging pharmaceutical intervention for children's behavior. The findings highlight the ways in which mothers' social interactions and relationships introduced a scientific language and discourse for explaining children's behavior as mental illness, the discordances between expert systems of knowledge and mothers' understandings, and how discordances reflected mothers' ‘microsources of power’ for producing their own stories and experiences. ^ In the second manuscript presented here, I documented the ways in which structural factors, including gender, race/ethnicity, and socioeconomic status, coupled with a unique cultural and social standpoint (Collins, 1990/2009) influenced the strategies this group of African American mothers employed to understand and respond to ADHD or PBD. The most salient themes related to mother-child relationships coalesced around mothers' beliefs about the etiology of ADHD and PBD, ‘conceptualizing responsibility,’ and ‘protection-survival.’ The findings suggest that even though mothers' strategies varied, they were in pursuit of a common goal. Mothers' challenged the status quo, addressing children's behavioral and emotional problems in the ways that made the most sense to them, specifically protecting their children from further marginalization in society more so than believing these were the best options for their children.^

Imagen Corporal y Calidad de vida de mayores incluidos en un programa de Rehabilitación Cardiaca

La mayor parte delas personas que conviven con algún tipo de enfermedad, tienden a adoptar un mayor número de hábitos saludables, pudiendo crear nuevas maneras de ver la vida y a sí mismos. El objetivo de este estudio fue verificar la relación entre índices de calidad de vida y percepción de la imagen corporal de los pacientes incluidos en un programa de rehabilitación cardiovascular en Florianópolis-Brasil. La muestra estuvo compuesta por 24 sujetos varones con una edad de 62 ± 1,3 años, portadores de Enfermedad Arterial Coronaria. Para evaluar la calidad de vida, se utilizó el cuestionario Minnesota Living With Heart Failure Questionnaire (MLHFQ) y para identificar el grado de descontento de la muestra con la imagen corporal, se aplicó el cuestionario de Stunkard y Sorensen (1993). El análisis de las pruebas fue hecho a través de un programa de estadísticas utilizando para tal fin, el software SPSS 11.0. El grado de asociación entre variables fue estudiado a partir del test de Kendall. Se verificó que cuanto mayor es el IMC y la silueta actual, mayor el grado de insatisfacción con la imagen corporal. Los síntomas emocionales también parecen estar correlacionados significativamente con un deseo de obtener una menor silueta corporal y con indicadores de menor calidad de vida (r= 0,474 y r= 0,735; p mayor 0,05). Los síntomas físicostambién se encuentran correlacionados de manera significativa con los síntomas emocionales. Estos resultados sugieren que las variables referentes a la calidad de vida poseen un peso significativo en la imagen corporal y la satisfacción con ésta, parece correlacionar con una menor cantidad de problemas emocionales y en un mejor afrontamiento de la enfermedad. Los programas de rehabilitación cardiovascular que implementan actividad física en los hábitos diarios se muestran adecuados como herramienta para la mejora de dichas dolencias en esta fase post aguda

Imagen Corporal y Calidad de vida de mayores incluidos en un programa de Rehabilitación Cardiaca

La mayor parte delas personas que conviven con algún tipo de enfermedad, tienden a adoptar un mayor número de hábitos saludables, pudiendo crear nuevas maneras de ver la vida y a sí mismos. El objetivo de este estudio fue verificar la relación entre índices de calidad de vida y percepción de la imagen corporal de los pacientes incluidos en un programa de rehabilitación cardiovascular en Florianópolis-Brasil. La muestra estuvo compuesta por 24 sujetos varones con una edad de 62 ± 1,3 años, portadores de Enfermedad Arterial Coronaria. Para evaluar la calidad de vida, se utilizó el cuestionario Minnesota Living With Heart Failure Questionnaire (MLHFQ) y para identificar el grado de descontento de la muestra con la imagen corporal, se aplicó el cuestionario de Stunkard y Sorensen (1993). El análisis de las pruebas fue hecho a través de un programa de estadísticas utilizando para tal fin, el software SPSS 11.0. El grado de asociación entre variables fue estudiado a partir del test de Kendall. Se verificó que cuanto mayor es el IMC y la silueta actual, mayor el grado de insatisfacción con la imagen corporal. Los síntomas emocionales también parecen estar correlacionados significativamente con un deseo de obtener una menor silueta corporal y con indicadores de menor calidad de vida (r= 0,474 y r= 0,735; p mayor 0,05). Los síntomas físicostambién se encuentran correlacionados de manera significativa con los síntomas emocionales. Estos resultados sugieren que las variables referentes a la calidad de vida poseen un peso significativo en la imagen corporal y la satisfacción con ésta, parece correlacionar con una menor cantidad de problemas emocionales y en un mejor afrontamiento de la enfermedad. Los programas de rehabilitación cardiovascular que implementan actividad física en los hábitos diarios se muestran adecuados como herramienta para la mejora de dichas dolencias en esta fase post aguda