Produção de sentidos sobre a maternidade: uma experiência no Programa Mãe Canguru

Este artigo analisa, sob a perspectiva da relação entre a família e instituições de saúde, os sentidos produzidos sobre a maternidade em um programa de saúde neonatal desenvolvido na rede pública - o Programa Mãe Canguru. A partir de entrevistas e observações feitas com usuárias durante sua participação no programa, buscamos apreender como as práticas discursivas e não discursivas sobre maternidade e maternagem, difundidas nesse processo, se articulam com as experiências concretas dessas mulheres para produzir novas configurações subjetivas. Na interpretação dos dados, realizada através de análise do discurso, os aspectos mais significativos das falas das entrevistadas foram agrupados em quatro núcleos de sentido: família e religião; o impacto do nascimento prematuro; desconfiança e resistência nas relações com instituições e profissionais de saúde; e a experiência com o Programa Mãe Canguru. Ao final, procurou-se identificar as principais estratégias e formas de singularização utilizadas por essas mulheres ao atribuírem sentidos ao papel materno.

A educação permanente em saúde na ótica dos cirurgiões dentistas

This study aimed to examine the perception of dentist-surgeon about the Permanent Education in Health (PEH). It is characterized as a qualitative research with focus in the field of public health policies. It refers specifically to the development of Permanent Education policy in Health in the state of Rio Grande do Norte. They were participants of this research 42 dentist surgeons and 83.3% females and 16.7% males, participants in Specialization courses approved and agreed by the Permanent Education Center in Health (PEC-RN) in the period 2005 to 2007. These professionals are part of the Family Health Strategy (FHS), and 11.9% work in management at the central level and 88.1% are directly related to oral health care in the Basic Health Units of the Family, 30 cities in the state. Data collection was through a questionnaire, with questions that guided the research development and achieve the objectives proposed. The socio-demographic data were analyzed using the descriptive statistics and subjective content was subjected to content analysis by Bardin. The emerging categories from the textual material generated by respondents were: program content, methodological approach and concepts of Permanent Education in Health. The subjects surveyed reported that the program content is more comprehensive and directs to the reflection of everyday practices, with regard to the methodological approach, concern that occurs through discussion and reflection with dynamic, participative, varied and constructive activities, questioning and putting as the main focus. As for understanding of the concepts of the PEH, there was a consensus that define as education stable strategies which contributing to transform and improve the health workers to have the upgrade, improvement of practices, being based on everyday experience and taking into account the accumulation and renewal of these experiences. Therefore, results presented showed that there is a clear understanding of the subjects on the proposals and guidelines of the PEH. It was concluded that lack continuous access to the policies proposed by Ministry of Health involving health workers, managers, communities, through social control and the teaching-service integration and that they are worked within the health system and can classify all these segments of society favor the existence of a more participatory, effective, fair and better quality health service

Avaliação do programa de atenção à saúde do trabalhador: uma abordagem da atenção primária

The accelerated industrialization, coming with the Industrial Revolution, caused profound changes in the working world. These changes led to the households risks from work environment. Trying to assist comprehensively the health of workers, Brazil has a program of Health Care Workers in the Primary Care, and the Family Health Strategy is the main entrance for this system. The study sought to determine if the actions of the health care worker have been developed in primary care through the Family Health Strategy. This is a quantitative study with a methodological evaluation, focusing on normative assessment. The sample was formed by professionals from Team Family Health Strategy, in the municipalities of Pau dos Ferros, Caicó and Natal in Rio Grande do Norte state. The sample consists of 202 professionals (Doctors, Nurses, Assistant / Technician Nursing and Community Health Workers) in 52 Health Family Units from the 3 municipalities cited. The instrument used consists of a checklist, from Manual of Primary Care 5 - Family Health - Occupational Health, Ministry of Health. The data were analyzed describing the variables by its frequency and doing a classification of cities from the scores obtained by each. It was observed that the Family Health professionals know the program of health care worker, however do not know the Manual of Primary Care 5, which is a guidance tool. As a result of non-appropriation of the FHT professionals with worker health, these activities are not performed, mainly surveillance in occupational health and health education labor

A produção das desigualdades: análise da relação entre trabalho infantil e indicadores sociais

The International Labor Organization (OIT) estimates that there are around 118 million children subjected to child labor around the world. In Brazil, there are 3.5 million workers aged between 5 and 17. This exploitation practice constitutes a serious social problem, including of Public Health, since these workers are exposed to a wide range of risks, such as those related to health, physical integrity and even to life, which may cause them to become sick adults and/or interrupt their lives prematurely. Therefore, this research aims to investigate the relationship between the frequency of child labor in the age group of 10 to 13 years and some socio-economic indicators. It is a quantitative research in an ecological study whose levels of analysis are the Brazilian municipalities grouped in 161 regions, defined from socioeconomic criteria. The dependent variable of this study was the prevalence of child labor in the age group of 10 to 13 years. The independent variables were selected after a correlation between the 2010 Census of child labor in the age group of 10 to 13 years and secondary data had been conducted, adopting two main independent variables: funds from the Family Allowance Program (PBF) per 1,000 inhabitants and Funds from the Child Labor Eradication Program (PETI) per a thousand inhabitants. Initially, it was conducted a descriptive analysis of the variables of the study, then, a bivariate analysis, and the correlation matrix was built. At last, the Multiple Linear Regression stratified analysis was performed. The results of this survey indicate that public policies , like the Bolsa Familia Program Features per 1000 inhabitants and Resources Program for the Eradication of Child Labour to be allocated to municipalities with HDI < 0.697 represent a decrease in the rate of child labor ; These programs have the resources to be invested in municipalities with HDI > = 0.697 have no effect on the rate of child labor. Other adjustment variables showed significance, among these the municipal Human Development Index (IDH), years of schooling at 18 years of age, illiteracy at 15 years of age or more, employees without employment contract at 18 years of age and the Gini Index. It is understood that the child labor issue is complex. The problem is associated, although not restricted to, poverty, the social exclusion and inequality that exist in Brazil, but other factors of cultural and economic nature, as well as of organization of production, also account for its aggravation. Fighting child labor involves a wide intersectoral articulation, shared and integrated with several public policies, among them health, sports, culture, agriculture, labor and human rights, with a view to guaranteeing the integrality of the rights of children and adolescents in situation of labor and of their respective families

PET-saúde na percepção de estudantes: contribuições para a formação na área de saúde

This dissertation aimed to analyze the perception of students about (EPW Health) Education Program at Work for Health Training in the area of Health. It discusses the proposed theme from the perception of students graduating from the EPW- Health courses participants (dentistry, medicine, physiotherapy, nursing, nutrition, physical education) who have developed their school activities in family health units in the city of João Pessoa between 2009/2011.The program aims policies curricular changes as a potential route of contributions to training in healthcare. Attention is drawn to the new possibilities of working health training contextualized, ethically grounded, socially endorsed. It is pointed out in this process the need to adapt to the demands of professional profiles of SUS (Sistema Único de Saúde). This is an exploratory, descriptive study within a qualitative approach, conducted in the city of João Pessoa in the context of health care courses at the Federal University of Paraiba. The empirical material of this study was treated by the use of technical analysis "Categorical Content Theme" by Bardin. The results indicate prospects for promoting new practices and curricular changes, which highlights the EPW- Health, which has been presenting important experiences in teaching -community -service- with the inclusion of students in the municipal health network. We conclude that the path from collection to data analysis, corroborated with the literature to reaffirm the importance and urgency of change in educational processes with a view to greater proximity to the health needs and the SUS. The EPW- Health project is incipient and requires further investigation in terms of effective interdisciplinary and multidisciplinary character of its proposal

Avaliação da qualidade da atenção primária à saúde da criança no Rio Grande do Norte: visão das usuárias

The study aims to evaluate the quality of the work processes of the teams from the Family Health Strategy regarding the comprehensive health care for children, in the view of users in the state of Rio Grande do Norte. This is a cross-sectional observational evaluative research with quantitative approach. The primary data are part of the External Review from the Program of Improving Access and Quality of Primary Care (PMAQ) in 2012. 190 women were interviewed. The inclusion criteria was the presence in the clinic at the time of the survey, have attended the service in the last 12 months and be a mother or companion of a child up to two years old. A research protocol was developed in the dimensions of Growth and Development, Breastfeeding and nutrition, and health problems and its variables. The results revealed that mothers / companions who responded to the questionnaire 71% were aged between 18 and 35 years, 92.1% were literate, 96.3% had a monthly income and 62.6% received financial assistance from the government. As for the children, 39.4% were aged between 13 to 24 months. In promotion and prevention actions for children, 64.2% had consultation up to the 7th day of life, 91.1% underwent the screening test, 95.3% had a health handbook, 98.9% had a vaccine, 17.9% breastfed or breastfeed from 6 to 24 months. As for link and continuity of care, 86.8% of the children were accompanied by the same professional staff and 59.5% left with next consultation scheduled. In acute situations 42.4% of the children went to the health unit and 64% of these were attended. It is concluded that the actions involving prevention and health promotion of children in RN, are evaluated positively by the service users and meet the requirements of MS, as well as link and continuity of care. The weakness in access and reception of users is evident, indicating the need to adapt the service to the demand of health and planning actions to welcome all who seeks basic health unit-UBS

Política de transferência de renda e desenvolvimento local: o programa Bolsa família no município de Pedra Grande/RN

The Family Scolarship Program while public politics of intersectorial form developed by Social Development Department and Famine Combat having with partner the Education Department and Health Department inaugurate in the country a new integrity way of the public politics, reinforcing a precept of 2004 Social Protection National Politics (PNAS 2004) that places the social protection while allied to the social and human development. The research INCOME TRANSFER AND LOCAL DEVELOPMENT: the family scolarship program in Pedra Grande-RN municipally had as aim to avaluate the permanent Family Scolarship Program as a possible element in local development of Pedra Grande-RN municipally understood as capacity expansion and improvement of life quality from its users. For this means we elaborate specifically the families` socio-economical profile; we avaluate the program repercussion in these families` lives; we analyse in which proportion occurred the capacity expansion and improvement of life quality of the users. The methodologic process was constituted by: literarture review about Income Transfer, Social Vulnerability, Development and Public Politics Avaluation to the criation of a theoric picture analysis. The documental research joined to the Social Development Department and Famine Combat of Pedra Grande Municipally Hall to obtain of the aims, program goals, and the profile of users. And finally, carrying out the interviews with the managers and experts of the Municipally Program and focal groups with the users to avaluate the permanent of the Program starting by the points of view of those ones. It was verified that the program expand the capacity (food, consumer goods and services, bank services access and wages) and improvement in life quality of the users. Nevertheless, there are deficiencies in coming with conditionality and from the use of resources the by families users

QualiAB: desenvolvimento e validação de uma metodologia de avaliação de serviços de atenção básica

Este artigo apresenta o desenvolvimento, validação e utilização de uma metodologia de avaliação da qualidade dos serviços de atenção primária do Sistema Único de Saúde (SUS), o Questionário de Avaliação da Qualidade de Serviços de Atenção Básica (QualiAB). Destina-se aos serviços de atenção básica, organizados segundo diferentes modelos de atenção, incluindo a Saúde da Família. Contém 50 indicadores sobre oferta e organização do trabalho assistencial e programático e 15 sobre gerenciamento, na forma de questões de múltipla escolha, autorespondidas via web pela equipe local do serviço. Confere a cada resposta valor zero, um ou dois; a média geral atribui ao serviço um grau de qualidade expresso pela distância do melhor padrão correspondente à média dois. Foi construído por processo de consenso interativo, que incluiu metodologias qualitativas, teste-piloto, aplicação em 127 serviços, validação de construto e confiabilidade. Respondido, em 2007, por 598 (92%) dos serviços de 115 municípios paulistas, mostrou bom poder para discriminar níveis de qualidade. Adotado em 2010 como parte de um programa de apoio à Atenção Básica da Secretaria de Estado da Saúde de São Paulo, foi respondido por 95% (2.735) dos serviços de 586 municípios (90,8% do Estado). Os resultados foram encaminhados aos municípios. O QualiAB fornece uma avaliação válida, simples e com a possibilidade de retorno imediato para gerentes e profissionais. Mostrou factibilidade, aceitabilidade, bom poder de discriminação e utilidade para auxiliar a gestão da rede de atenção básica do SUS em São Paulo. A experiência indica aplicabilidade nas redes de atenção básica do Brasil.

Atenção odontológica no Programa de Saúde da Família de Campos dos Goytacazes

Durante décadas, a política de saúde bucal no Brasil foi centrada na prestação de assistência à doença, e ainda hoje grande parcela da população brasileira não tem acesso a cuidados odontológicos. Pela Portaria nº 1.444, de 28 de dezembro de 2000, o Ministério da Saúde estabelece incentivo financeiro para a reorganização da atenção à saúde bucal aos municípios. Insere-se, assim, a Odontologia no programa e, conseqüentemente, a possibilidade de ampliar e reorientar a atenção odontológica no Brasil. Dentro desse contexto, este estudo teve por objetivo avaliar a situação da equipe de saúde bucal inserida no Programa de Saúde da Família (PSF) do município de Campos dos Goytacazes - RJ, em 2002. Os resultados demonstraram algumas limitações na inclusão e funcionamento da Odontologia no PSF da cidade. A atenção odontológica deve ser inserida no PSF, atendendo aos princípios básicos do Plano de Reorganização das Ações de Saúde Bucal na Atenção Básica, proposto pelo Ministério da Saúde, e à consolidação do Sistema Único de Saúde.

Avaliação da atenção à saúde da criança no contexto da Saúde da Família no município de Teixeiras, Minas Gerais (MG, Brasil)

Este estudo tem como objetivo analisar a atenção à saúde da criança pelo Programa de Saúde da Família (PSF) do município de Teixeiras, MG, Brasil. Foi aplicado um questionário a 161 mães de crianças menores de dois anos. Utilizou-se um sistema de escores específicos para análise das dimensões de estrutura, processo e resultado e seus respectivos atributos, classificando o município nos cenários incipiente, intermediário e avançado. Configurou-se, na síntese, um cenário intermediário (49,6%) para o PSF, caracterizado por uma atenção à saúde da criança fragmentada, mas com avanços na organização da atenção para este grupo. Foram consideradas incipientes as instalações físicas, a qualidade do cuidado no controle da diarréia e das infecções respiratórias, a participação comunitária e a intersetorialidade. Os avanços estiveram relacionados ao acolhimento realizado pelo programa, no entanto, as atividades preventivas e promocionais do PSF demonstram que o programa surge como um suporte do hospital e mais um local de atendimento médico. A atuação do PSF na atenção a saúde das crianças distancia-se da proposta de reorientação do modelo assistencial hegemônico, pela qual foi criado, dificultando estratégias na prevenção de doenças e na promoção da saúde.

A visita domiciliar na formação de médicos: da concepção ao desafio do fazer

Desde 2003, desenvolve-se a Interação Universidade Serviço Comunidade (IUSC) na graduação médica de uma universidade pública do interior de São Paulo, Brasil, a partir da necessidade de vivências na Atenção Primária, visando à integralidade do cuidado. A visita domiciliar (VD) destacou-se como possibilidade para o estudante refletir sobre determinantes sociais do processo saúde-doença; desenvolver habilidades comunicacionais, prática educativa dialógica e vínculo com a comunidade; ampliar o raciocínio clínico e contribuir para a compreensão e resolução dos problemas familiares. O objetivo deste estudo foi investigar essa proposta da VD na formação médica, utilizando pesquisa documental. Contextualizou-se o desenvolvimento da VD na IUSC, sua importância, abrangência e desafios para sua legitimação e incorporação como prática pertinente à formação médica. Concluiu-se que a VD pode fortalecer e ampliar vínculos, compromissos, e favorecer a comunicação, contribuindo para a mudança da educação médica no Brasil.

Multiplicadores reflexivos: Uma experiância do Instituto Familiae junto ao Grupo de Assistância em Transtornos Alimentares (GRATA) do HC-FMRP-USP

This article describes the Reflecting Practitioners Program developed by Instituto Familiae at GRATA (Grupo de Assistência em Transtornos Alimentares) placed at the Clinical Hospital of the Faculty of Medicine of Ribeirão Preto - University of Sao Paulo (HC-FMRP-USP). The aim of this program was to take care of the caretakers - the GRATA interdisciplinary team - through the development of their reflecting ability, the appropriation of their own resources and the support on constructing alternative histories and on solving situations defined by them as problematic. Thirteen monthly meeting had been carried out among Familiae members and GRATA interdisciplinary team. The changes described by the participants had occurred through sessions developed with interdisciplinary pairs and through the development of their capacity to construct more comfortable positions - as members of the team and in the relationship among professional/client/ family. This triad became to be seen by the team through its resources and abilities, instead of its flaws and lacks. As a result, horizontal relationships could be privileged instead of hierarchical ones.

Estudo da distribuição dos casos de Diabetes Mellitus em Presidente Prudente - SP

The main causes of illness and consequent death in patients affected by Diabetes Mellitus are the long-term complications. Depression can make it harder to control the level of glucose in the blood, as well as intensifying and worsening the clinical complications, thus reducing the quality of life. The aim of this study was to estimate the incidence of Diabetes Mellitus in Public Health Clinic in Presidente Prudente (SP) in patients enrolled in the Hiper-Dia Program. From October 2003 to July 2004, a descriptive survey was carried out. Data were obtained from doctor's records of 50 diabetes patients and also their answers to a specific questionnaire. The majority of the patients were female, had not completed elementary school, with a family income below five minimum wages, a nationally-defined amount related to the poverty line. It was observed that 24% of the patients had depression and 76% never followed a controlled diet. Pharmacological treatment was prescribed for 82% of the patients. Twenty-eight patients were receiving psyicological treatment, together with oral hypoglycemic agents. The glycated hemoglobin was measured in 68%. The association between depression and submission to treatment was not significant. No statistical association was found between the psychologically assisted patient's group and glucose control (p= 0.40), diet control (p= 0.37) and physical activities (p= 0.77). It was concluded that 24% patients had depression and the majority not under diet control, but 82% were under pharmacological treatment.

Políticas de población: un manual para formuladores de políticas y planificadores

Incluye Bibliografía