Itinerário da escola pública em Portugal (Séculos XIX-XX) : um olhar histórico à escola primária / elementar

La historia de la escuela es paralela y reflecte la cultura de la sociedad de cada época. Por eso, la escuela constituye un objecto historiográfico, por lo cual la conceptualización del sistema educativo, la escolaridad, las instituciones escolares, corresponden a un continuo evolutivo de perspectivas pedagógicas, discursos y políticas. Si el estado en el siglo XIX deja la esculea a la incumbência de los municípios enl siglo XX será él a incumbirse de su manutención económica (problemática de la descentralización y de la centralización). En términos historiográficos hay tres interrogaciones de la evolución de la escuela publica: el enunciado legislativo (proyectos de ley e reformas educativas), explicación pedagógica (realidad educativa de la época) y las condiciones generales e específicas de las escuelas (organización escolar), formación del profesorado y red escolar. La literatura y las teorías pedagógicas estaban mas cercanas a la realidade (insuficiências) de las escuelas que el ordenamiento de la política educativa (legislación). La política y la pedagogia ni sempre se han puesto de acuerdo. Todos los processos de investigación histórica son multidimensionales y complejos, en una base interdisciplinar, por lo cual los historiadores buscan comprendery explicar la realidade educativa y las instituciones escolares en su organización y evolución. En nuestro trabajo haremos un balance histórico e evolutivo de la escuela publica (instrucción pública) y de la escolaridad en el siglo XIX basta meados del siglo XX. Haremos una sumula histórica de la escuela primaria en Portugal en ese período histórico.

Doença inflamatória intestinal associada a colangite esclerosante primária : um fenótipo raro

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Exsudados algodoosos sentinela como manifestação primária de patologias sistémicas : descrição de um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Trombocitopenia imune primária crónica : palavra-passe incompleta

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Remineralização preventiva primária do esmalte através do sistema CPP-ACP

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

DIVERGÊNCIAS E CONVERGÊNCIAS ENTRE A COMUNICAÇÃO PRIMÁRIA E A COMUNICAÇÃO SECUNDÁRIA NA DIVULGAÇÃO DO CÂNCER DE MAMA

Este estudo investiga as convergências e as divergências na comunicação primária e na comunicação secundária do câncer de mama. Nós usamos um esquema interpretativo fornecido pela Análise de Enquadramento, Agenda Setting, Teoria do Aprendizado Social, Difusão de Inovações, Semiótica e conceito de Novidade na Ciência e no Jornalismo, para argumentar que cientistas e jornalistas comunicam as novidades da Ciência de modos diversos. Também tivemos como uma proposta secundária traçar um panorama histórico da Comunicação da Saúde, e sua evolução, considerando que a Comunicação empreendeu um esforço para legitimar um espaço de encontro com a Saúde, afirmando uma área de aplicação de teorias, princípios e técnicas comunicacionais, com o objetivo preciso de difundir e compartilhar informação, conhecimentos e práticas que contribuam para melhorar os sistemas de saúde e o bem-estar das populações. Através da análise dos dados de periódicos científicos e jornalísticos que divulgam o câncer de mama, nós encontramos apoio significante para nossas predições. As implicações destas diferenças entre a comunicação primária (interpares) e a comunicação secundária (público leigo) para a comunicação da saúde são discutidas, às vezes apresentando-se como convergências, às vezes como divergências. Quando bem esclarecidas e compreendidas, fazem avançar a Comunicação da Saúde, obtendo resultados positivos no bem-estar das populações, considerando que a origem das doen ças está, fundamentalmente, onde se entrelaçam o biológico e o social.(AU)

Avaliação do pré-natal na atenção primária à saúde no Rio grande do Norte: visão das usuárias

ABSTRACT This study aimed to evaluate the quality of prenatal Primary Care in Rio G rande do Norte, Brazil in 2012 under the program Improving Access and Quality of Primary Care. The study was cross - sectional, quantitative. Included 156 mothers of children under 2 years who received prenatal care at the health evaluated. We applied a ques tionnaire on profile, minimum queries, regularity of attendance, laboratory tests, vaccination, participation in educational activities, guidance received, clinical and obstetric procedures and prescription Ferrous sulphate and folic acid. The descriptive analysis of the criteria used Humanization Program Prenatal and Birth. The results showed that 92% of mothers had six or more visits; 85% with the same care was professional; 94% subsequent appointments scheduled. As for tests and procedures the percentage s were: Urine 98%; HIV - 96%; VDRL and 88%; 91% glucose; tetanus vaccination 93%; educational groups 56% with 36% participation, knowledge of the delivery location and 59% achievement breast exam 65%, 33% and preventive gynecological 43%; 98% supplemented wi th 96% Ferrous Sulfate and Folic Acid. It was concluded that there were advances in Rio Grande do Norte concerning assistance and there are weaknesses in the educational practices and conducting some minimal clinical examinations.

A prática do enfermeiro da atenção primária à saúde nas consultas ao paciente com tuberculose

This study aimed to analyze the practice of nurses regarding the development of the nursing process in the consultation to the patient with tuberculosis. This is a descriptive study with quantitative approach, performed with 60 nurses of the Primary units of the city of Natal, RN Health. The project was approved by the Ethics Committee of the Federal University of Rio Grande do Norte. To collect data, we used a structured questionnaire, developed from the "Consultation of Nursing," the Nursing Protocol for the Treatment of Tuberculosis Directly Observed in Primary Care, Ministry of Health. The instrument was subjected to pre- -test and contained questions regarding the elements used by the nurse in consultation with the patient with tuberculosis and an open question about the feasibility of implementing the Nursing Process in Primary Health Care. data collection was conducted between September and October 2014, in health units work of each participant. Data were analyzed using SPSS 20. The answers to the open question were analyzed for themes and quantified for analysis. With respect to the elements of nursing process used in consultation with the patient with tuberculosis, were on the history of nursing at the expense of survey nursing diagnosis, action planning, implementation and evaluation. Step in the history of nursing, however, the actions were toward complaints and symptoms of the disease (100% of the nurses always investigating). Social and cultural aspects involved in for tuberculosis, as stigma and difficulties in routine work, were less addressed by nurses (43.3% never investigated suffering stigma; 46.7% sometimes investigating changes in the work routine patient ). The physical examination was focused on measuring patient weight (100% held). To the understanding of nurses on the implementation of the nursing process Primary Health Care, favorable factors were identified, such as that this implementation can promote greater scientific basis for nursing (36.7%); and hindering aspects, such as the understanding that Primary Health Care is pervaded by bureaucratic issues and high demand (13.3%). Be established in consultation with the nurse fragmentations, since elements as identification of nursing diagnoses, action planning and evaluation were not made in full by the professionals. Highlights the need for continuing education for nurses who are included in Primary Health Care, seeking to maximize the autonomy of these professionals in developing a practice grounded in scientific knowledge

Travestis na atenção primária: o cuidado em saúde na cidade de Natal

Among the deviant a heteronormative ideal, transvestites are the ones that suffer abuse and discrimination. Have been found that health services often present themselves as places that maintains and reproduce such discrimination, which makes transvestites only sought medical care in the latter case. Based on the guidelines of the SUS and the National Humanization Policy as well as the inclusion and leadership of the users, we conducted a qualitative study seeking to understand the experience of transvestites in seeking health care within primary care in Natal-RN. We use as techno-methodological instruments in depth interview and workshop with use of "scenes". For interpretative analysis of the narratives we use to Hermeneutics-Dialectic. From the dialogue with the narrative we come to the following themes: 1) Understanding the meaning of being a transvestite; 2) The experience transvestite in search of health; 3) Transvestites and humanized health care. In the first point they reveal the daily struggle of transvestites between prejudice and the search for respect, as well as the meanings of being a transvestite, who appeared as: Being gay, being feminine, not transsexual and accept themselves as they are. In the second axis, expressed difficulties in access to and use of health services: the embarrassment by not using the social name; fear of going out during the day; the association of transvestites to HIV; and pain caused by discrimination from health professionals. It was also possible to identify simple demands such as illnesses from day to day, the demand for hormone therapy, which involves treatment needs as well as the vital need to have their rights XVII respected. The third axis, for the range of a humanized care identified that the respectful gaze guarantee their dignity and their right to health in a humane way, but it identified some necessary changes: Training of professionals, dialogue with the social movement, publicity campaigns and rapprochement with the transvestite. Finally, it is expected that the research will contribute to the field of knowledge know-how in health care transvestites, inside and outside of the university

O trabalho em equipe na atenção primária à saúde: situação de Portugal e do Brasil

Introdução: Na Atenção Primária à Saúde, nos contextos internacional e nacional, o trabalho em equipe tem sido reconhecido como estratégia decisiva para a organização de processos que visam à integralidade do cuidado, além de possibilitar melhorias na satisfação dos usuários com os serviços de saúde. Neste sentido, o objetivo, deste estudo, é analisar o trabalho em equipe na Atenção Primária à Saúde. Método: Trata-se de uma pesquisa em banco de dados secundários. Realizou-se três estudos: a) O trabalho em equipe na Atenção Primária à Saúde, em Portugal, pesquisa avaliativa, de natureza qualitativa, tipo estudo de caso descritivo, que representou um recorte dos resultados derivados da pesquisa integrada ao projeto “Implantação das Unidades de Saúde Familiar em Portugal”, que teve como procedimentos entrevistas semiestruturadas, roteiro de coleta de informações (check list) e análise documental. Foi realizada a estratégia de triangulação dos dados com análise de conteúdo; b) trabalho em equipe, acesso e qualidade na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 17202 profissionais e 65391 usuários. Utilizou-se entrevista estruturada, com análise estatística realizada pelas frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. c) satisfação dos usuários com o trabalho em equipe na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 65391 usuários. Realizou-se análise estatística das frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. Utilizou-se, ainda, o Teste X2 , com nível de significância de 5%; análise de regressão logística múltipla. O modelo final foi ajustado pelo teste de Hosmer/Lemeshow, o qual indicou um ajuste de 66%. Resultados: Sobre o trabalho em equipe na Atenção Primária à Saúde, em Portugal, destacou-se a formação das equipes de forma voluntária, por meio de afinidades pessoais, a existência de “carteira básica de serviços”, juntamente com x intervenções de vigilância, promoção da saúde e prevenção de doença, cuidados em situação de doença aguda, acompanhamento clínico de doença crônica e de patologia múltipla, cuidados domiciliares, interligação e colaboração em rede com outros serviços (cuidados hospitalares), sistemas informatizados nas unidades de saúde. Os dados revelaram dificuldades quanto ao atendimento domiciliar. No Brasil, foi destaque o processo de trabalho, com avanços relacionados a realização de planejamento e programação das ações e o apoio da gestão. Existência de território definido e de prontuários familiares. É destaque a agenda compartilhada e pactuada entre os profissionais. As equipes realizam acolhimento e reuniões, cujos temas, discutidos, giram em torno do processo de trabalho e planejamento. Os desafios, enfrentados, estão relacionados ao agendamento dos usuários; ao número de pessoas sob a responsabilidade das equipes; à existência de população descoberta nas áreas adscritas à Unidade de Saúde; à incipiência na ação intersetorial e ao pouco envolvimento da comunidade pelas equipes. Quanto aos fatores associados à satisfação do usuário foi marcante: a faixa etária; a escolaridade; a raça; se a falta de material prejudica o atendimento e se a equipe consegue marcar consulta para outros profissionais. Conclusões: Constatou-se o trabalho em equipe como elemento central no processo de mudança na Atenção Primária à Saúde, tanto no contexto de Portugal quanto no do Brasil, o qual ampliou o acesso e a qualidade na oferta de serviços de saúde e obteve, ainda, o reconhecimento social, mesmo que, em ambas as realidades, não tenha avançado na coordenação do cuidado e no estímulo à participação social. Os fatores, associados com a satisfação do usuário, estão relacionados diretamente ao cuidado prestado e refletem a expectativa, por parte do usuário, de resolução concreta de suas necessidades.

História oral de vida de pessoas com úlcera venosa nos serviços de atenção primária à saúde

The Chronic Venous insufficiency is characterized as a set of physical changes including how most serious complication of venous ulcers, characterized by irregular and progressive loss of continuity of the skin. The occurrence of venous ulcers in people with chronic venous insufficiency generates dependence on them with health services, with long-term treatments that cause limitations and high-impact changes, affecting their quality of life, affecting the physical, psychological, social, cultural and spiritual as an important public health problem. This study aimed to describe the experience of having a venous ulcer, in the scenario of primary health care services to Health, which includes Primary Care Units and Family Health Strategy in the city of Natal / RN, based on the life histories of users. This is a qualitative study, exploratory and descriptive, with the Oral History of Life as a methodological framework. From the ponto zero was the recruitment of participants who formed the network, totaling six employees, of both sexes and aged between 57 and 79 years. After approval by the Research Ethics Committee - UFRN under the Protocol 653 788/2014 and CAAE 30408014.0.0000.5537 was held data collection, between the months of July and August, through interviews, using identification and characterization of the instrument employees and open questions. Interviews were recorded, transcribed, transcriadas and returned to employees for a conference. The narratives were subjected to Content thematic analysis technique, according to Bardin, allowing the construction of three themes that encompass categories, namely: Axis I - Perspectives on the changes: the impact wound in social relations (changes with ulcer venous, venous ulcer and social and family relationships); Axis II - Brands in body and soul: the story of being hurt (conceptions of the body injured; therapeutic itinerary in primary care services); and Axis III - Reconstruction of being hurt: coping mechanisms (redefinition of the wounded body, resilience to chronic wound). The impact of having a chronic venous ulcer generates impact of physical, psychological and social order. As aspects related to changes after the appearance of venous ulcers, survey participants reported the presence of pain, physical limitations, psychological distress, social and emotional isolation, incapacity, aesthetic discomfort and dependency on health services; the family was the aspect thatshowed no significant change after the occurrence of wound for most participants, an ally in the therapeutic process as a support network. The redefinition of the body and the wound are the main coping mechanism of chronic condition. The services in the Primary Care Network play a fundamental role in the rehabilitation of patients with venous ulcers, although there are difficulties in accessing appropriate treatment and need for expanded services, with permanent professional training of health teams and providing the resources managers to strengthen the comprehensive care of people with venous ulcers in Health Primary Care.

Promoção da alimentação saudável na atenção primária à saúde: contribuição para construção coletiva do saber-fazer

The recognition of the food as determinant and health-disease process etching requires new explanations and interventions of the food and nutrition policy action and demand health care model based on the completeness of the actions and focused on health promotion. This study, characterized as research-action of interventionist character, sought to develop strategies to support the transverse insertion of healthy eating promotion in professionals practices a core of support for the health of the family and a family health strategy Unit in the city of Natal, capital of Rio Grande do Norte, from the analysis of perceptions and work processes of these teams. Several methodological strategies were adopted: Dialectical Hermeneutical Circle, direct observation, reflective and Thematic Meetings Workshop "Rethinking the educational practices for promoting healthy eating". For data logging, search diaries - SD were used and moments. The analysis of procedural form occurred in conjunction with research participants, in constant movement of reflection-action-reflection, based on hermeneutics-dialectic. About the results, in relation to the promotion of health, showed the following insights: health promotion and disease prevention-related harms; health promotion related to quality of life and well-being, in its various dimensions; health promotion as a responsibility of the State; health promotion related to the actions of health education; health promotion as an expression of efficaciousness and accessibility to health services. Regarding healthy nutrition, predominated the perceptions relating to nutritional aspects. With regard to food and nutritional education - FNE, it was observed a predominance of perception of FNE as information, guidance and knowledge transfer for changes of dietary practices. As regards the working process, it was observed that among the actions for health promotion, educational activities predominate, such as lectures, conversations, groups that mostly occur in fragmentary form, without joint planning teams, varying according to the professionals and the moment of work in which they are carried out. The results pointed to the need for reorganization of the work processes, in the context of intra-and intersectoral coordination and the construction of new technologies, such as: Health project of the territory – HPT, Unique Therapeutic Project- UPT, Expanded Clinic and educational practices, Shared with active teaching and learning methodologies. From the results we believe that it is necessary to "thought reform", from changes in vocational training and strengthening of the permanent education spaces, whereas the complexity that involves feeding, food and nutrition education and health promotion. The reformation of thought must be articulate and closely tied to the production of knowledge and practices that encourage intersectoral approach, the transversality, dialogue and democratic and supportive attitude, based on the collective construction of know-how. We hope that this study can contribute with reflections and initiatives that encourage building practices that promote healthy eating in primary health care, in terms of completeness of the care and the attainment of food security and nutrition.

Telessaúde como ferramenta de apoio à atenção primária à saúde: um olhar sobre as teleconsultorias em cardiologia

In order to qualify Primary Health Care in Brazil, the Ministry of Health implemented the Brazilian Telehealth Program to provide health support (telecare) and permanent health education (tele-education). In this respect, one of the primary services offered is teleconsultation. As part of the national expansion of the program, a local Telehealth Center, called Telehealth/RN, was created in Rio Grande do Norte state. The aim of this study was to describe the implementation of cardiological teleconsultations at Telehealth/RN, and analyze the characteristics of the teleconsultations in cardiology requested. Formative Second Opinions in cardiology, available at the web site of the Brazilian Telehealth Program, were also examined. This is a quantitative study with a descriptive, observational design. A total of 56 Formative Second Opinions in cardiology were identified, a majority related to hypertension (29%), focused on treatment support (30%), and requested by doctors (59%). At Telehealth/RN, 47 teleconsultations in cardiology were carried out, a majority also related to hypertension (50%), requested by community health workers (45%) and focused directly on treatment (52%). Cardiological teleconsultation, implemented at the Telehealth/RN in April 2014, is a practical and efficient strategy capable of ensuring health services and reaching those who live in remote areas. Knowing the demand for teleconsultations is extremely important, given that they provide the information needed to correct existing inadequacies related to care, management and/or education, as well as providing the basis for public policies that meet the demands of teleconsultation.

Residência multiprofissional, desafios e compromissos na reorientação da formação para o SUS: um estudo na atenção primária

The Health Multiprofessional Residency Program of the Federal University of Rio Grande do Norte (PRMS/UFRN) adopts as guiding keystones the learning process of in-service teaching, the interdisciplinary multiprofessional work and the compliance with the principles and guidelines of the Brazilian Unified Health System (SUS). Although PRMS/UFRN have been idealized with a focus on hospital care, the training process in the insertion of residents in the Primary Health Care (PHC) has an important role because they need to experience all levels of care, taking into account that the educational process through work proposed by the Residence is based on the comprehensiveness of health care. In light of the foregoing, the present research has sought to elucidate the insertion of these residents in PHC services, through a qualitative approach of case study, where data collection was held in two different moments: firstly, a questionnaire was accomplished, through an semi-structured script, with the residents of PRMS/UFRN, Natal Campus; subsequently, the focus group technique was accomplished with a group of nine residents, and data were analyzed from the categorical thematic content analysis. From the process of empirical categorization, categories and subcategories were raised, among which, the positive aspects and potentialities of insertion of residents in PHC. We detected the articulation of actions for promoting, preventing and recovering health; training in comprehensiveness of health care, multiprofessional activities and activities aimed at doing the integration among teaching-service-community. Regarding the difficulties found in this experience, we dealt with the organization and planning of rotation activities, the preceptorship, the process of work found in the Basic Health Units (BHU), in addition to factors external to educational practice, such as the issue of safety within these communities. Accordingly, with this situational diagnosis, we became able to realize that residents have identified the importance of this rotation for their vocational training, since these are inserted in post-graduate programs in hospital care. As an immediate product of this study, we will present a report that will provide a space for discussion and assessment of this rotation by the coordination bodies of PRMS/UFRN, in order to seek organizational and pedagogical adaptations, besides the proposition of qualification courses for the actors involved with this process, aiming the implementation of improvements in the rotation of PHC toward the qualified training of professionals for SUS.

Análise do perfil de encaminhamento da atenção primária para pré-natal de alto risco: desafios para o ensino de competências em saúde materno-infantil

OBJECTIVE: to identify a profile of the main causes of inappropriate referrals from primary care to specialized services, as strategy for the curriculum development of core competencies related to maternal health. METHODS: a cross-sectional study was performed using document analysis of all referrals of pregnant women from primary care to the high-risk pregnancy service, state of Rio Grande do Norte, Brazil. All pregnant women referred from June to December 2014 (n = 771) were included. According to their causes the referrals were categorized as adequate, inadequate or inconclusive. RESULTS: a total of 188 referrals were classified as inadequate (24.4%) and 93 inconclusive (12.1%) totalizing 36.5% of inappropriate referrals. The main causes identified in these inappropriate referrals were: low-risk pregnancy (12.8%), unconfirmed hypertension (12.1%), risk of abortion (8.9%), teenage pregnancy (7.1%) , toxoplasmosis (5.3%), Rh incompatibility (4.6%) and urinary tract infection (4.3%). These data contributed to the formulation of the following products: 1) a continuing education program for health professionals working in primary care, undergraduate students and residents; and 2) development of a virtual platform to support professionals who need to refer patients to high-risk pregnancy service. CONCLUSION: the results of this study are relevant in the current context of education of health professionals, with potential for positively impact not only in the development of skills related to maternal health in undergraduate and graduate education, as well as contributing for improvement of the health care of the population.