Saúde Mental e enfermagem: em busca da integralidade na ESF

The present work shows an inquiry about the conceptions and practical work of the nursing professionals on the accompaniment of mental sick patients in the Family s Health Strategy, under the approach of the completeness in health. The justification of this research is given by bringing an special attention concerning the subjet to these professionals of health: the gradual abandonment of the traditional manicomial model leads to the insertion of mental patients in the community . The nursing professionals must be prepared to receive these patients in the basic net of health and contribute to help their adaptation and insertion in the social environment as citizen. In this context, considering the entire attention to the mental health, it is important to detach that the assistance to the patient must search his reinsertion in the community by providing programs that develops his sociability. This analytical study was developed using a qualitative approach and a thematic verbal history. Ten nurses of Nova Natal s Health of the Family Unit, of Felipe Camarão Mista s Unit and of Cidade da Esperança s Health Unit contributed for its development . The information was acquired through an instrument research that made possible the accomplishment of the interviews. These ones were set previously and counted on the assent of the participants. The interviews were recorded and analyzed in accordance with the pertinent literature concerning the subject. The aggregation of the information was then discussed. At this moment three thematic axles were defined dividing the categories of analysis. According to the results of the interviews, the practical procedure given to the patients with mental upheaval is resumed by the prescription of psicotroprics medicaments. It doesn t provide an accompaniment by the professionals of health, specifically, nurses, to the patients and their families. The lack of qualification and a multi-professional team emerged as one of the challenges for the implementation of practical procedures towards the patients with mental upheaval. Therefore, the results of this research show the necessity of transformations in the current scene of the mental health in the Family s Health Strategy. These changes can be reached by politics investments on the mental health area, not only financially but by providing human resources that should allow the professionals to exert the completeness procedures

Reinternações psiquiátricas no Rio Grande do Norte: implicações e impacto das novas estratégias de atenção à saúde mental

The Brazilian Psychiatric Reform based on the desinstitucionalization of the assistance, translated to the emphasis on community/territorial treatment and in the social inclusion of the mental suffering, promoted advances in the psychiatric restructuring. In the Rio Grande do Norte (RN), we can enumerate as advances of the Brazilian Psychiatric Reform the expansion of the mental health care chain and the implementation of some strategies that, together, aims to further the psychosocial attention of the individual with psych suffering and to reduce the indices of psychiatrics readmissions in the state. In the current Brazilian‟s mental health situation we were interesting in answered the following question: what the impact of the substitutes services‟ extension in the revolving door phenomenon? This search aims to analyze the revolving door phenomenon occurrences based on the news strategies of mental health care in the Rio Grande do Norte. This is a descriptive-exploratory study with a qualitative approach, oriented by the theoretical framework of critical-dialectical approach about the Brazilian Psychiatric Reform and using the thematic oral history as method of information collects. The search was realized on the Hospital João Machado (HJM), estate reference in psychiatric treatment, and the participants was 20 professionals that work on it. The collection of information had started after the approval of the UFRN Research Ethics Committee with the opinion number 216/2011 and CAAE number 0021.0.051.000-11 and was realized using the direct observation and semi-structured interview. The study‟s results were categorized in two categories and five subcategories of analysis. CATEGORY 1) Current situation of the mental health care chain in the RN, with the subcategories: 1.1 Impact of the new services of mental health care in the revolving door phenomenon in the RN; 1.2 Implications of the new services of mental health care in assisting user to the HJM; 1.3 Issues the permeate the mental health care chain in the RN. CATEORY 2) Main causes of the revolving door phenomenon in HJM, with the categories: 2.1 Family problems; 2.2 Lack of assistance after discharge from psychiatric hospital. In summary, we conclude that the extension of the mental health care chain contributed for the reduction of the psychiatrics re-hospitalization‟s indices in RN. However, we realized that territorial services of mental health care are not the only responsible for the revolving door phenomenon. Factors as family problems and the disarticulation of the assistance after the discharge from hospital influence on the perpetuation of hospitalizations and re-hospitalizations in the local scenario. To study the revolving door phenomenon that occur in the psychiatrics‟ assistance considering the news strategies of mental health care allowed us to approach the advances and challenges brought by the RPb and by the desinstitucionatization in the state, indicating the need for further discussions and problem-solving strategies of psychosocial care.

Fatores influenciadores da participação pública na tomada de decisão ambiental :o caso do programa de combate ao caramujo gigante (Achatina fulica) em Parnamirim/RN

The aim of this work is to investigate the factors which influence people s participation in the enviromental decision, in Parnamirim, Rio Grande do Norte, from the vision of the residents of that area, approaching the Plan of Control/Eradication of the African s Huge Snail (Achatina Fulica),with the jointly work of IBAMA and Municipal Town Hall of Parnamirim .The applied methodology consists of a research (Survey kind) including 395 interviews by people who live in that county, with minimum age of 18, within an universe of 124.690 residents. The choice of the county was due to a detection (made by IBAMA technicians and reported in a Technical Report) -which showed that the dangerous Snail is already spreading in 14 of 17 districts of the county-, as well as the support given by Parnamirim s Town Hall, with the implementation of the Plan Control/Eradication of the African s Huge Snail, widely known as Day C . The research tools used in that research consists of questionnaires with all sorts of questions. The results show us that most of the residents were feeling threatened by the presence of the animal as well as having had a little participation in the fight against the animal. It also shows us that residents believe that organizations (Town Hall, IBAMA and Local Community) involved are able to solve the problem and believe that the amounts which organization are supposed to take 89,4 %, 87,6% and 80,8%, in that order. As we check the results, we notice in 95%, the variety of threaten and frequency reunion and participation level

O psiquiatra na atenção psicossocial: entre o luto e a liberdade

No Brasil, vemos surgir, a partir da década de setenta, diversas propostas inovadoras no campo da atenção à saúde mental. A partir de então, multiplicam-se no país ambulatórios de psicologia e psiquiatria, hospitais-dia, residências terapêuticas e diversos núcleos/centros de atenção psicossocial. Transformados em política pública, os centros de atenção psicossocial espalham-se pelo país, preconizando um atendimento ambulatorial, interdisciplinar e de orientação territorial. Geralmente formado sob os auspícios de um grande hospital, o psiquiatra que se propõe a trabalhar, a partir da ótica psicossocial, imerso em uma pequena cidade, vê-se exposto às diversas contradições e ilogicidades do discurso psiquiátrico clássico. Os variados saberes locais são uma ameaça ao saber psiquiátrico medicamente constituído. Respostas, antes fáceis no interior do hospital, têm variadas implicações no território e adquirem uma complexidade para a qual o psiquiatra não se encontra preparado. Assim, este trabalho tenta demonstrar a dissonância entre essas duas espécies de psiquiatria: a clássica (afinada com a biologia, com a normatividade e com a instituição) e a psicossocial (que se volta para respostas localmente construídas e que se afina com o homem, em uma dimensão muito além do seu corpo).

Estratégias midiáticas na aprendizagem do tema DST/AIDS: ações em rede para reduzir vulnerabilidades de adolescentes e jovens da comunidade de Mãe Luiza, Natal-RN

Youngsters and teenagers are still a very vulnerable group of DST/AIDS. In order to combat this vulnerability the community intervention project being developed in Mãe Luiza neighborhood in the city of Natal-RN, entitled Strengthening Community Action Network for Prevention in HIV/AIDS: knowledge and Intervene emerged, popularly known as Project Viva Mãe Luiza. The project develops workshops of educomunication whose approach involves the DST/AIDS subject with the following media: video, photography, and theater playbook. This research integrates the activities of the project and has as main objective to investigate how strategies and practices of media communication developed in Project Viva Mãe Luiza through workshops of educomunication, assisted learning for the prevention of DST/AIDS and contributed to the reduction of vulnerability to DST/AIDS among adolescents and young participants of the project residents of Mãe Luiza community. The methodological basis was based on intervention research, with the technique of gathering daily field data, literature and documentary, in-depth interviews and ethnographic observation. The qualitative analysis was based on the monitoring of video workshops, photography, theater and primer, respectively, crossed by transverse to the prevention of DST/AIDS, conducted between June 2012 and December 2013 issues. Interviews with eight multipliers, aiming to understand their perceptions of vulnerability, prevention, multiplication and use of media that were part of the project were conducted. The analyzes show that learning workshops educomunication community health repercussions both in the development of individual skills in communication as changing perceptions about the vulnerabilities to which they are exposed, the awareness about prevention at the individual and differentiated actions multiplication in the community

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

Impacto do Programa de Saúde da Família sobre indicadores de saúde bucal na população de Natal -RN

The aim of this study was to assess the impact of the Family Health Program (FHP) on a number of oral health indicators in the population of Natal, Brazil. The study is characterized as a quasi-random community intervention trial. The intervention is represented by the implementation of an Oral Health Team (OHT) in the FHP prior to the study. A total of 15 sectors covered by the FHP with OHT were randomly drawn and paired with another 15 sectors, based on socioeconomic criteria, not covered by the teams. A few sectors were lost over the course of the study, resulting in a final number of 22 sectors, 11 covered and 11 not covered. We divided the non-covered areas into two conditions, one in which we considered areas that had some type of assistance program such as the Community Agents Program (CAP), FHP without OHT, BHU (Basic Health Unit) or no assistance, and the other, in which we considered areas that had only BHU or no assistance. Community Health Agents (CHAs) and Dental Office Assistants (DOAs) applied a questionnaire-interview to the most qualified individual of the household and the data obtained per household were transformed into the individual data of 7186 persons. The results show no statistical difference between the oral health outcomes analyzed in the areas covered by OHT in the FHP and in non-covered areas that have some type of assistance program, with a number of indicators showing better conditions in the non-covered areas. When we considered the association between covered and non-covered areas under the second condition, we found a statistical difference in the coverage indicators. Better conditions were found in covered areas for indicators such as I have not been to the dentist in the last year with p < 0.001 and OR of 1.64 and I had no access to dental care with p < 0.001 and OR of 2.22. However, the results show no impact of FHP with OHT on preventive action indicators under both non-covered conditions. This can be clearly seen when we analyze the toothache variable, which showed no significant difference between covered and non-covered areas. This variable is one of the most sensitive when assessing oral health programs, with p of 0.430 under condition 1 and p of 0.038 under condition 2, with CI = 0.70-0.90. In the analysis of health indicators in children where the proportion of deaths in children under age 1, the rate of hospitalization for ARI (Acute Respiratory Infections) in those under age 5 and the proportion of individuals born underweight were considered, a better condition was found in all the outcomes for areas with FHP. Therefore, we can conclude that oral health in the FHP has little effect on oral health indicators, even though the strategy improves the general health conditions of the population, as, for example child health

Influência do tratamento periodontal sobre os níveis da proteína c-reativa ultrassensível em pacientes com insuficiência renal crônica em fase de prétransplante

The present study evaluated the influence of non-surgical periodontal treatment on the levels of C- reactive protein (hsCRP) in patients with chronic renal failure (CRF) in pretransplant. We conducted a controlled and randomized trial to evaluate the periodontal condition and plasma concentrations of hsCRP, albumin and transferrin in 56 dialysis patients divided into two groups: experimental and control. The study was conducted at the dental clinic of Family and Community Health s Unit (USFC), located in Onofre Lopes University Hospital (HUOL), Federal University of Rio Grande do Norte (UFRN), from December 2010 to November 2011. Severe periodontitis was the type of periodontal disease more common, affecting 78.6% of patients. Periodontal conditions, evaluated through the means of probing depth, clinical attachment level, bleeding index and plaque index, proved to be uniform for both groups at the initial examination. There were no differences in levels of inflammatory markers between the two groups. The analysis of the concentrations of hsCRP allowed classifying study participants as at high risk of developing cardiovascular disease. After completion of periodontal treatment in the experimental group, there was a statistically significant reduction of the mean of all periodontal parameters assessed; however this improvement of periodontal health was not accompanied by changes in the levels of hsCRP, albumin and transferrin in the evaluation time. Given this, the periodontal treatment did not promote the reduction of systemic inflammatory burden and risk of cardiovascular complications in patients with CRF

Cooperação em sagüis comuns callithrix jacchus: condições e restrições

The cooperative behavior is no longer a dilemma for the theory of evolution, since there are models that explain the evolution of this behavior by means of natural selection at the individual level. However, there have been few studies on the proximal factors that interfere with cooperative behavior. In the study of the influence of cognition on cooperation, many authors have been interested in situations in which individuals decide whether to act cooperatively and select partners with different qualities to cooperate. Of the factors studied, we highlight the need for understanding the apparatus and communication between partners to the occurrence of cooperation. Recently, highlight is the proposal that the ability to cooperate would be greater in species with cooperative breeding system. Thus, the common marmoset (Callithrix jacchus) is a New World monkey which stands as a valuable species for this type of study because it presents cooperative actions in nature, such as sharing food and protection of the community territory. Our experiment investigated whether common marmosets unrelated females (n = 6) were able to cooperate using an electrical and a mechanical apparatus, if this cooperation is a byproduct of individual actions or involve social attention, if it occurs inter-individual variation in the use of devices and formation of roles (producer / scrounger) in dyads. We use the number of rewards obtained by animals (Ratio of Correct Pulls) as indicators of cooperation and glances for partners (Ratio of Correct Glances) as indicators of social attention and communication. The results indicate that the type of apparatus was not a constraint for the occurrence of cooperation between the marmosets, but still has not been verified formation of roles in the dyads. The performance of animals in the two devices showed a large variation in the learning time, not having relationship with the performance in the tests phase. In both devices the level of social glances at control phases were casually correlated with any other phase, but the data showed that there was not social attention, that is, the monkeys realized that they gave food to the partners, but the partners did

Nervos: rede de discursos e práticas de cuidado na atenção básica no município de Natal/RN

The Primary Health Care and one of its main strategies, the Family Health Strategy (ESF), are framed as the gateway to the Public Health System (SUS). Thus, most of the incident and prevalent health problems in the population attended should be solved at this level of care, including psychological suffering, and the so-called complaint of nerves. Nerves and nervous denote a complexity that is not always well comprehended by health workers, in such a way that the care to this kind of problem is usually inadequate. In this line of thought, the general objective of this study is to analyze the network of discourses and the care to the psychological suffering, expressed as nerves, in SUS daily Primary Health Care. Besides and more specifically, it aims at identifying the principles and guidelines of the Primary Health Care in mental health; to investigate health workers positioning before psychological suffering and complaints of nerves, and also analyze different actions and practices of care carried out in different Health Units towards complaints like nerves. Institutional Ethnography was the theoreticalmethodological perspective adopted for the work. This approach seeks to understand and analyze the institutional relationships in a particular context considering sociostructural influences and power relations, as well as daily discourses and practices. Based on interviews with health professionals, informal conversations and observations in six Health Units with ESF teams from different sanitary districts in Natal/RN, it was possible to check that the index of complaint of nerves is high. The referral to psychologists and psychiatrists, as well as the prescription of psychotropic drugs appear as the most common intervention at this level of care. In general, the participants complain that they have poor specialized knowledge about the theme of mental health. They face the problem of bad work conditions and the lack of institutional support, which make actions of illnesses prevention and health promotion even more difficult. Besides, there are different ongoing practices such as meetings for hypertensive and aged people, walk, visit, round-table discussions and community therapy. However, not all of these actions are aimed at the care of psychological suffering. It is observed that the Matrix Support, which is a methodological strategy of supervision and follow up forcases of mental health, hasn t been totally implemented in the municipal system, although it is a tool that has been used by psychologists in some Health Units in the city. It was also verified that the health care practices to the problem of nerves strongly depend on the professional s commitment with the PSF guidelines and on mental health policies, in addition to continued support, when available, from other professional who works as matrix supporter

O adolescente em conflito com a lei e a escola: criminalização e inclusão perversa

This study aims to identify the relation between adolescents in conflict with the penal law, who were convicted to assisted freedom (a socio-educative measure applied by the Juvenile Justice system as a sanction to adolescent offenders), and the school. The research was developed in the Community-based Assisted Freedom Program of Pastoral do Menor , in Fortaleza (capital city of Ceará State, Brazil). The study has engaged 21 adolescents, eight program professionals, three members of the Center for Defense of Child Rights in Ceará, five teachers and eight school principals and education managers from the schools attended by the adolescents in the neighborhoods of Pirambu, Tancredo Neves, Jardim Iracema e Bom Jardim. It intends, based on dialectical and historical method, to define the investigated adolescents as persons with a very singular insertion into the social structures of neoliberal capitalism. Their adolescence is subject to consumerism appeals, to the limits imposed by these appeals and to perverse ways of insertion in the system, such as criminalization, segregation and marginalization. It reveals that the school attended by the adolescents reproduces such conditions of insertion. At the same time, these conditions are elements of identity, by which the adolescents are characterized.

Significados de família para crianças em abrigo

This research explores the meanings of family for institutionalized children. It identifies, more specifically, how the relationship between the child and his/ her family is. The field work was developed at a municipal shelter in Natal/RN, which houses children aged between 7 and 11 years old. The subjects of research consisted of three children: two boys and one girl. Besides age-group criterion, which facilitates the use of oral language and the procedures, we took into consideration another selection criterion: children whose family configurations were similar. In order to achieve the objectives, we used toys, pictures, collages and semi-structured interviews. Data were examined under the Thematic Content Analysis, with three thematic categories previously chosen: Configuration of geographic area, family composition and family s internal dynamics. Among the results, we highlight that, for children, the concept of family is based essentially on existence of affection ties, regardless of kinship. Through this study, we hope to contribute to the discussion on the rights of institutionalized children, concerning their need of experiencing family life and living in community

Gênero, trabalho e saúde mental entre trabalhadoras rurais assentadas na região do Mato Grande Potiguar

The lack of studies aimed at the mental health of the rural population, the social, economic, familial and emotional impact that mental disorders produce and the vulnerability that women have in this context, lead us to believe in the need to investigate the mental health demands of female rural workers, in order to subsidize the development of more effective and culturally sensitive public health programs and policies that take into account the specificities of this population. The present study aims to investigate the prevalence of common mental disorders (CMD) and the possible factors associated with the emergence of such disorders among women living in a rural settlement in Rio Grande do Norte. This survey has a quantitative and qualitative character with an ethnographic approach. As methodological strategies, we made use of an adapted version of the socio-demographic and environmental questionnaire prepared by The Department of Geology/UFRN s Strategic Analysis Laboratory to evaluate the quality of life of the families from the rural settlement and the mental health screening test Self-Reporting Questionnaire (SRQ-20) to identify the prevalence of CMD in adult women from the community. Complementing the role of methodological tools, we use the participant observation and semi-structured interviews with women who presented positive hypothesis of CMD attempting to comprehend the crossings that build the subjective experience of being a woman in this context. The results point to the high prevalence of CMD (43.6%) and suggest the link between poverty, lack of social support, unequal gender relations and the occurrence of CMD. We also verified that the settled women do not access the health network to address issues relating to mental health and that the only recourse of care offered by primary health care is the prescription of anxiolytic medication. In this context, the religiosity and the work are the most important strategies for mental health support among women

Os novos quixotes da psicologia e a prática social no âmbito do terceiro setor

A pesar del cuadro crítico de la pobreza y desigualdad social en que vivimos en el país, las perspectivas actuales apuntan para el fin del Estado Interventor y para la reducción del gasto público destinado a las políticas sociales. Con el enjugamiento del estado, el Tercer sector está encargado de pacificar la cuestión social, reduciéndola al ámbito del deber moral. Convocado al compromiso social, el psicólogo también empieza a trabajar en la frontera de la exclusión, sin cuestionar la finalidad y las implicaciones políticas del nuevo escenario. El objetivo de este trabajo es investigar la práctica social del psicólogo, en el ámbito del tercer sector , buscando el análisis que hace del nuevo campo de trabajo, así como las estrategias utilizadas en el enfrentamiento de la pobreza. Para la investigación, fueron realizadas 20 (veinte) encuestas semiestructuradas con psicólogos que actúan en instituciones del tercer sector . Las encuestas fueron analizadas cualitativamente, a la luz de la perspectiva gramsciana de sociedad civil y emancipación humana, bien como de los preceptos de la Psicología Comunitaria y Intervención Psicosocial. Utilizamos como base de análisis, todavía, el Método Comparativo Constante. Los resultados fueron agrupados en tres ejes: quien son los nuevos quijotes de la Psicología, las demandas del Tercer Sector y las estrategias utilizadas por el psicólogo en el Tercer Sector . La perspectiva defendida en este trabajo es la de que en el campo de las intervenciones sociales, y más acentuadamente en el Tercer Sector , los psicólogos serían nuevos quijotes , actuando con buena voluntad, con grandes sueños de transformación, pero realizando acciones que no parten de una lectura crítica y adecuada de la realidad, no percibiendo sus posibilidades reales y sus límites de actuación. Finalmente, defendemos que se debe buscar, con la inserción profesional; mejorar la calidad de vida y el bienestar, a través de una intervención proactiva, buscando el desarrollo, la organización y la emancipación de las personas, grupos y comunidades

O turismo de base local como um possível indutor de desenvolvimento rural: uma análise da realidade e das potencialidades no distrito de dondo-moçambique

The current debate on rural development focuses on the territorial approach, recognizing the multifunctional character of rural areas. Emphasize the use of endogenous forces, the need of implement policies which valorize local specificities, the participation of social actors in revitalization of rural areas. In this context tourism enters as a means to induce a new dynamic to rural areas, since the activity is regarded as a channel for the upgrading of the natural and cultural resources and the rural way of life. This study focuses on local-based tourism as a promoter of rural development, giving an analysis of the social reality and potential for this tourism in the district of Dondo. In it, is proposed to analyze the potential for development of local-based tourism in the district of Dondo, assessing the extent to which local reality enables the inclusion of the community in the management of local tourism resources. For this, was showed the inclusion of local-based tourism in the current context of rural development, was identified and organized systematically the factors that influence the implementation of local-based tourism in the study area and was verified as far as possible the study area corresponds to the constraints identified, showing how local-based tourism can best been encouraged. Was adopted a qualitative methodological approach to both the procedures and data processing, but also by critical approach, using bibliographical research, semi-structured interviews that fell on the group of public administrators who work in tourism and community leaders. The critical analysis was based on the principles of sustainability o Sachs particular ecological, social, cultural, economic, space, beyond the analysis of political and institutional aspects. The survey results show that the district of Dondo has a potential for implementing a model of tourism development on a local basis, since it is rich in natural and cultural research, benefits from good network accessibility in the context of the market in the region, the population live according to their habits and customs and value their identity. There is also a good cooperation between community members, although not in tourism, a fact which is observed through the lever of community participation in associations, cooperatives, working in areas such as agriculture, fishing, environment, civic education etc. It also has public funding sources to augment or stimulate local investment. Despite obstacles such as inexistence of policies and local plans for tourism development, lack of awareness of tourism, lack of basic infrastructure, as well as equipment and facilities to support tourism, the results shows that these problems can be solved through a public commitment from both government, and community through a joint planning and participation