Constituição cidadã e representações sociais: uma reflexão sobre modelos de assistência à saúde

Este artigo apresenta uma reflexão sobre o significado dos termos cidadania e saúde, abordando a Teoria das Representações Sociais como estratégia para implementação e avaliação dos modelos de assistência a saúde no Brasil. Na primeira parte, traçamos um breve histórico sobre a concepção de cidadania; na segunda, tratamos dos princípios de liberdade e igualdade pautados no pensamento de Kant; na terceira, evidenciamos a saúde como um direito do cidadão e um dever do estado; por fim, destacamos a Teoria das Representações Sociais como estratégia para avaliar e implementar os serviços de saúde prestados ao cidadão pelos modelos assistenciais de saúde em vigor no Brasil.

Políticas e tecnologias de gestão em serviços de saúde e de enfermagem

Objetivo: identificar se os enfermeiros do Brasil têm conhecimento das políticas e tecnologias de gestão nos serviços de saúde e enfermagem. Métodos: realizamos revisão integrativa da literatura, utilizando as bases de dados: LILACS, MEDLINE, SciELO, BDENF e PAHO e os descritores: gestão em saúde, tecnologia em saúde, tecnologia assistencial e enfermagem, incluindo as publicações nos idiomas português, espanhol e inglês. Resultados: A análise resultou em 11 referências completas, no período de 2003 a 2007. Constatamos que os enfermeiros possuem articulação nos serviços de enfermagem e competência técnica no exercício profissional, porém, apresentam-se frágeis politicamente, o que limita sua autonomia profissional e os torna ainda subordinados a outros profissionais. Conclusão: diante dos avanços e constantes mudanças no setor saúde, particularmente no nível organizacional e técnico-científico, torna-se imprescindível que o(a) enfermeiro(a) desenvolva suas habilidades políticas, gerenciais e de liderança com participação responsável e de forma interdisciplinar.

Prática diária dos agentes comunitários de saúde: dificuldades e limitações da assistência

This qualitative study aimed to identify difficulties experienced by Community Health Agents (CHA) in the course of daily practice of care. Data were collected from semi-structured interviews with twelve CHA from four Basic Health Units in a city of the state of São Paulo, Brazil. From an analysis of the speech of subjects, we found that the deficiency of health services, the workload of the nurses responsible for the team and the service rejection by users make it difficult to implement the health actions. This research emphasizes the limitations expressed by the health agents, and points towards the necessity of an evolving discussion of this theme, seeking strategies that enable the consolidation of community health principles.

The reasons of the nursing staff to notify adverse events

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

Anemia and hemoglobinopathies in pregnant women attended in a public hospital

Objectives: to identify the demographic profile and frequency of anemia and hemoglobinopathies, as a basis for future implementation of actions aimed at pregnant women in the public health domain. Method: this is a cross-sectional study developed with pregnant women attended in a university hospital at Mato Grosso do Sul, Brazil. Blood samples were collected for the erythrogram analysis for detection of anemia and selective and specific tests for abnormal hemoglobin. The patients regarded as indigenous and mentally ill, as well as inmates, were excluded from the research, as they represent a vulnerable population which needs a cohort different from that of the sample. For data collection, a particular questionnaire was used. The research was approved by the Ethics Committee of Universidade Federal de Mato Grosso do Sul (UFMS), under the Protocol 873/2006. Results: of the 215 pregnant women under study, 20% were adolescents; 36.3% had incomplete primary education; 53.0% were non-Caucasian; 43.3% were from Campo Grande, Mato Grosso do Sul, Brazil; and 21.1% were of European descent. 17.7% had some type of anemia and, in the evaluation of hemoglobinopathies, 4.7% of patients were detected with some abnormal hemoglobin, with the following frequencies: 3.3% with HbAS; 0.9% with HbAC; and 0.5% with intermediate β-thalassemia. Conclusion: the frequencies of anemia and hemoglobinopathy found in these pregnant women showed the importance of early diagnosis, revealing indicators able to provide a basis for preventive and assistance actions for adequate clinical monitoring, reducing maternal and neonatal morbimortality in the public health services. Descriptors: pregnant women; anemia; hemoglobinopathies; public health; nursing.

A experiência da saúde coletiva na formação profissional: retrato da extensão universitária

The guidelines of National Curriculum for Dental courses highlights the necessity in providing for the professional the ability to analyze and assess community’s problems and needs, and to create solutions for the society. The continuing education may be considered a useful tool for the teaching and learning because it favors the diversification of learning environments, which allows the insertion of undergraduate and graduate students into the real scenarios. This current study aimed to assess the Public Health projects and programs of the UNESP – Araçatuba Dental School, by describing the interaction experiences between faculty and health services in the professional career development. Historical, documentary and descriptive searches were performed based on the faculty archives such as official documents, reports, databases from the Pro-rector of continuing education and published papers in the period between 1964 and 2011. The following experiences were noted: the Extra-Muro Dental Service (SEMO), established in 1964, that focused in providing dental treatment to the rural population, highlighted the social inclusion of discriminated society groups since that time. In 1972, this service was expanded to several specific populations living in the urban areas. In the '60s, many educational campaigns were performed as homemade water filter and construction of wells and septic tanks which demonstrate the concern with the determinants of healthdisease process. At that time, the campaign of fluoridation of public water supplies in several counties started as Araçatuba, Birigui, Penápolis, Guararapes, Valparaíso and so on. The Campaign of “Good Teeth” from the '70s became wider over time and it was transformed in the "Oral Health Education Program" and it was continuously developed in all public schools of Araçatuba and some neighboring towns, benefiting children aged from 6 to 10 years-old. Several epidemiological studies of caries, periodontal diseases, malocclusion and fluorosis were conducted in cooperation with local governments, and counted with the participation of undergraduate and graduate students. Pereira Barreto – SP was the precursor city in Brazil to carry out fluorosis study. Currently, 12 projects of Public Health from the Institution of Higher Education in the Pro-rector of continuing education are being developed. The concern in qualifying the human resources in health is confirmed with the development of training courses and workshops for professionals, highlighting the training for people enrolled in the Family Health program; Community Health Agent training - Solidarity University, and Municipal Health Counselors training. The Graduate Program in Social and Preventive Dentistry, created in 1993, has an important role to train several professionals for the Unified Health System, and provides education to create researchers, professors and administrators, and enucleates research groups in several Brazilian states. In all activities showed herein, a dynamic participation of undergraduate and graduate students has been observed, and several books, guidelines, articles, brochures and booklets have been published as a result of the continuing education activities.. It was concluded that different projects and programs have been developed by the Public Health of UNESP –Araçatuba Dental School, which allow the exchange of experience between the university and health services, and benefit all participants enrolled in these activities.

Pistas diretas para o tratamento de mordida cruzada posterior

The malocclusions are one focus of discussions in public health, due to which it is necessary to incorporate correction procedures that are inexpensive, easy to perform and which can be made in health services. Planas Direct Tracks meet such characteristics which make them advantageous for the crossbite correction. The aim of this study was to present a case in which correction of unilateral crossbite was performed with the resources available in a public clinic. This is a 6 year-old patient who presented functional unilateral crossbite in canines and posterior teeth. A cross decreased maxillary arch leading to a condition of unilateral posterior crossbite was detected. Occlusal adjustments were performed in canine and posterior teeth; however it was not enough to restore the occlusal balance. It was decided to prepare Planas Direct Tracks in canines, allowing functional balance, which prevented masticatory movement alteration during the growth phase and malocclusion correction. Controls were performed every six months to evaluate the patient's progress and whether or not new occlusal adjustments were necessary. Monitoring and treatment were conducted for 5 years, until stabilization of the permanent dentition ensuring treatment. It is concluded that Planas Direct Tracks were effective for the correction of unilateral posterior crossbite. So, it is essential to note that this procedure can be performed in public services.

Absentismo laboral por patología odontológica y médica en una industria de gran porte del sector mecánico y mueblero

Introduction: The current Brazilian legislation states that health services must be performed by the Specialized Service of Safety Engineering and Labor Medicine (SESMT). Objective: To analyze the dental and medical reasons for absenteeism, checking the interference of factors such as age, gender and position of the worker, and most of the reasons that led the employee to miss work. Material and methods: The research appears as a descriptive study with a quantitative approach. The dental and medical certificates and statements of attendance were analyzed, duly approved, lodged in a acrylic industry in the city of Araçatuba-SP, from January to July 2011. Results: Of the total number of certificates (n = 1841), only 103 (5.6%) were for dental reasons. Predominance of the age group of 20-29 years, males and with non-administrative function. The reasons most dental and medical certificates stated that led the workers to miss working days were "inclusive and impacted teeth" and "diarrhea and gastroenteritis of presumed infectious origin", respectively. As to factors related to absenteeism, there was a severity index of 2.83, 1.33 frequency and average duration of absences of 2.12. Conclusions: It is concluded that dental reasons had little weight on total absences due to illness that caused the temporary leave of the worker for a shorter period. The age and function variables influence the occurrence of work absenteeism.

Opiniões e atitudes dos médicos frente às ações promocionais da indústria farmacêutica

The pharmaceutical industry invests heavily in promoting their products, and studies suggest that these actions influence doctor’s prescribing. Therefore, this study aimed to analyze the opinions and attitudes of doctors when facing promotional activities of the laboratories. To this end, questionnaires were sent to doctors in Araraquara (SP) containing statements on the subject. Data analysis included study of the association by the chi-square. The results indicated that physicians relate to the propagandists (98%) by considering them useful (55%), but not as a main source update (86%). For 62% of them their prescriptions are not influenced by such relationships, while 24% disagree that doctors in general are influenced as well as new graduates (37%). The majority also disagrees that are influenced by amenities (86%) or free samples (70%) but only 38% believe their colleagues are not influenced by the samples. As for the ethics of these receipts, 57% considered to be appropriate when benefit patients, but only 32% while for personal use. The results show that doctors are vulnerable to the influences of marketing. Therefore, mechanisms and interventions are needed for prescribing drugs solely by criteria of effectiveness, safety, convenience and accessibility to the patient.

Acesso, segurança e uso de medicamentos por usuários

The present study aims to identify families who have stock and are making use of medications, as well as assess the conditions of storage, security and use of these drugs. The study was conducted in a city of São Paulo, the interviews were conducted in households enrolled in one of ten units of the Estratégia de Saúde da Família (ESF) that the city provides and the sample was defined by means of stratified random sampling (134households, IC 95%). Data collection was conducted through interviews with a semistructured questionnaire during the first half of 2011. We interviewed 118 (88.0%) households, of which 112 (95.0%) had medications that were stored n insecure or inadequate places in 75.4% of households, non-prescription self-medication was a common practice in 46 (47 4%) households, and lack of identification and security of medications stored was observed in 60 (53.6%) households. Most households had stock of medicines, which were done improperly or unsecure, or have specialties with lack of identification and security, which can lead to poisoning or e ineffective therapy. The Pharmaceutical Assistance under SUS lacks social initiatives, with actions directed for medications users, which can be supplied by the presence of the pharmacist in the ESF, essential for the promotion of racional use of medicines, that, through the Pharmaceutical Care, can identify, correct and prevent possible problems related to drugs.

Miedo e inseguridad de la gestante durante el trabajo de parto como motivos para la demanda de internación precoz

Objective. To identify reasons why women look for early health care attention at the end of pregnancy. Methodology. Qualitative study based in socio-existential phenomenology proposed by Alfred Schütz. Nine pregnant women who consulted to the maternity service without being in real labor were interviewed. Results. The following analysis categories emerged: Having different symptoms or signals from the ones they had felt or been informed about, not being able to identify real labor, fear to fetal complications for being close to the probable labor date, feeling calmer when being seen by professionals of the institution, lack of problem solving by other services of the health institution, fearing out of hospital delivery, imitating real labor, looking for tranquility in the idealization of labor and modifying behaviors to guarantee attention. Conclusion. Women are insecure and fear because of a fragmented health care, where they do not perceive themselves linked to the prenatal control program anymore, and at the same time they don’t find the health care assistance they want.

O princípio da integralidade no Sistema Único de Saúde (SUS): utopia?

The Brazilian Federal Constitution promulgated in 1988 created the concept of Social Welfare, which is based on the triad: Health, Social Security and Social Assistance. The Unified Health System (SUS) was then instituted. SUS is a conquest of a society that seeks social justice, integrality, equalitarian and universal access to health services. In the present essay, I succinctly discourse on the various meanings of integrality. I present the theoretical basis of complexity and transdisciplinarity by opposing to reductionism, aiming at showing that, by means of transdisciplinarity and intersectoriality, integrality can be achievable.

Acolhimento na percepção dos enfermeiros da atenção primária à Saúde

Objective: This paper is intended to explore how nurses working in primary health care perceive acceptance. Method: It is based on a qualitative study conducted through interviews with 21 nurses from eight municipalities in the State of São Paulo. A phenomenological approach was used in data analysis. Results: It was found that nurses' understanding of acceptance, at certain points in time, comes close to the principles and guidelines of the Unified Health System (SUS). Conclusions: Nursing professionals manifest difficulties with the structure, organization and management of health services and express actions and beliefs related to the traditional model of care. The various stakeholders need to join forces if acceptance is to be achieved.

Participação social nos conselhos de unidades de saúde

This exploratory and qualitative study sought to investigate how health service users? participation on the Councils of Health centers occurs in the municipality of Botucatu in São Paulo. Data was collected in September and October 2008 via interviews guided by a semi-structured script, administered to 9 service users who are members of the Council at four primary health care centers. After content analysis, three thematic categories emerged: Knowing the service user/councillor, The Health Centers? Council and Participation on the Council. The results show the unpreparedness and lack of knowledge of the councillors representing health service users on the subject of the role of the Councils and on public health policies, evidencing the need for actors from the health services to invest in guidance, consciousness-raising and preparation of citizens with critical ability to influence, guide, demand and question the health services? actions.

Avanços da informática em enfermagem no Brasil: revisão integrativa

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)