Atenção à saúde da pessoa idosa na estratégia saúde da família no município de Santo Antônio/RN: um estudo de caso

According to demographic estimates, by the year 2025 Brazil will be the sixth country in the world in number of elderly. For this reason, it is a purpose of public policies to help people to reach that age being healthier. The current health care model of health surveillance through the Family Health Strategy (EFS, in portuguese) is configured as a gateway into the care of the elderly in the Unified Health System (SUS, in portuguese). It is also an area of development of practices to promote health, prevention and control of chronic nondegenerative diseases. The aim of this study was to analyze the health care of the elderly provided by ESF professionals for the achievement of a full care. The study is descriptive case study with a quantitative approach, performed in the city of Santo Antônio/RN. The population included all health professionals, who are FHS members of the city that agreed to participate of the survey, a total of 80 professionals. Data were collected using a structured questionnaire, having mostly closed questions and divided into two parts: one containing sociodemographic information of health professionals and vocational training and the other, the activities carried on by the professionals in senior care, being analyzed from a database tabulated in a spreadsheet and discussed according to the descriptive statistics in tables, graphs and charts using frequencies, medians and values of central tendency. It was verified a predominance of professionals who finished highschool, mostly female, aged from 30 to 34 years old, with training completed in the last 10 years, without being graduated in the field of geriatrics or gerontology and mostly without training in gerontology. Family members and caregivers were the components of the social support network most identified by the professionals (66.3%).The elderly access to the Family Health Basic Unit was considered by83.8% of professionals as the most important factor that interferes in the activities of health care of the elderly. Considering the inclusion of the family in care: 98.8% of professionals consider the family as one of the goals of care, but 82.5% assist the family to know their role and participate in the care of the elderly, emphasizing that no professional makes use of tools for evaluating the functionality of the family. Regarding the actions taken to assist the elderly, 91.25% have home visits program to the elderly, 88.75% use the host program; 77.5% know the habits of life, cultural, ethical and religious values of the elderly, their families and their community ;51.25% complement the activities through intersectoral actions, 50%participate in groups of living with the elderly; 33.75% keeps track and maintain updated the health information of the elderly; 11.25% of the professionals perform the Single Therapy Planning (PTS, in portuguese) and few implement the actions to promote health according to PTS; there is a deficit in the number of professional categories in the identification and monitoring of the frail older people in their households. It is concluded that the health care of the elderly developed by ESF professionals differs among the professional categories. It was identified weaknesses in the promotion of an active and healthy aging and also in the establishment of an integrated and full care of the elderly. It is recommended the adoption of permanent educational activities by the City Management, initially for ESF professionals in the the perspective of the guidelines of the National Policy of Health Care for the Elderly and later to the other professionals that are part of the health care network of the elderly, at all levels of care in the city for the development of strategies and practices that promote the improvement of the quality of healthcare for the elderly, expecting concrete and effective results in terms of promoting health within Brazilian reality

Evidências de validação de um protocolo para assistência às pessoas com úlceras venosas em serviços de alta complexidade

Venous ulcers are lesions resulting from chronic venous insufficiency, venous valvular abnormalities and venous thrombosis. Its occurrence has been growing with the increase in life expectancy of the world population. Considered as fundamental aspects in the approach to the person with venous ulcer care with the interdisciplinary approach, adoption of protocol-specific knowledge, technical skill, coordination between levels of care complexity of the Health System and active participation of patients and their families, a holistic perspective. The construction of a clinical protocol for people with venous ulcers can help professionals of high complexity services in patient assessment and the establishment of quality care in a systematic way and focused on the factors that interfere with wound healing. Thus, this study aimed to analyze the evidence of validation of a clinical protocol for people with venous ulcers treated at high-complexity services. This is a methodological study with a quantitative approach, developed in three stages: literature review, evidence of content validity and evidence of validation in the clinical context. Approved by the Federal University of Rio Grande do Norte Research Ethics Committee (Opinion: 147.452 and CAAE: 07556312.0.0000.5537). The literature review was conducted in August and September 2012, becoming the basis for the construction of the protocol. Then the evidence of content validity, which included 53 judges (experts) selected by the Lattes platform to evaluate the protocol items was performed. The judges were contacted by e-mail and rated the protocol via Google Docs . After analyzing the ratios obtained in this step, which reported kappa between 0.75 and 0.96 and between 0.80 and 0.98 IVC, and the suggestions of the judges, the protocol was adjusted and subjected to empirical evidence to validate the clinical setting at the University Hospital Onofre Lopes in Natal / RN. Evidence of validation in the clinical setting involved 4 judges who acted in pairs (paired) evaluated 32 patients with venous ulcers in the clinical context of high complexity. In both stages, we used the Kappa Index and Content Validity Index to analyze the responses of the judges. The parameters set as acceptable for these indices were: Kappa ≥ 0.61 and Content Validity Index > 0.80. Any evidence of content validity, as evidence of validation in the clinical context, the protocol items that have not reached Kappa and Content Validity Index established indices were excluded and some items were modified or added after suggestions. The process of content validation evidence and evidence of validation in the clinical setting allowed the improvement of the protocol for the care of people with venous ulcers initially proposed. The initial version of the protocol, built from the literature, contained 15 categories and 108 items; after evidence of content validity, remained the reduction to 15 categories with 91 items; the final version, clinically validated, is composed of the same 15 categories, 76 items. The protocol was validated in its content and in the clinical aspect, so we accepted the alternative hypothesis in the study. This protocol may contribute to the care system, allowing tailor behaviors and promote greater resolution in the treatment of people with venous ulcers in health services of high complexity

Atuação do enfermeiro no acompanhamento do crescimento e desenvolvimento da criança

The nurses assistance in monitoring the growth and development of children has been characterized mostly a service based on the biological dimension of illness, when in reality, the actions should be combined in the reorientation of care model of the Family Health Strategy. Thus, the research aimed to examine the role of nurses in the growth and development of children. This is an exploratory and descriptive, qualitative approach. The project was approved by the Ethics Committee of the Universidade Federal do Rio Grande do Norte under Opinion No. 191/2012. Data collection was developed in the Health Units from the city of Natal, RN, Brazil. Survey participants were nurses who worked in the Family Health Strategy for at least two years and who performed the monitoring of child growth and development in the health unit selected. Data were collected through an in-depth interview, and seized material from speeches was treated as categorical thematic analysis proposed by Bardin. This process revealed three themes, which were analyzed in the light of Relief Models and Process Work in Health and Nursing and discussed based on the findings literary. The results elucidated that nurses consider their performance satisfactory as it has favored the accession of mothers of children under one year nursing visits, contributing to the reduction of morbidity and mortality due to prevalent diseases, as well as the establishment of a connection between the professionals and mothers. It was shown that despite having a promotion and prevention with the use of lightweight technologies, the nurses also emphasized the care of mothers in complaints and signs and symptoms of children, followed by referrals to professionals in the unit or to other sectors. Furthermore, we found that the process of working nurses face challenges regarding the organizational structure of services and social situation of the family. Given these statements, it is observed that despite the strong interference from hegemonic health model in the performance of nurses, it is found that these professionals have been investing in promotion and prevention to injuries to children in care, with a focus on family context. Thus, nurses are embarking on making the reorientation of health care through the use of relational technologies, which has contributed to solving the integral care to the pediatric population

A formação de conceitos no ensino de graduação em enfermagem à luz da teoria da aprendizagem significativa

The Theory of Meaningful Learning (TML) described by David Paul Ausubel offers a proposal for the teaching strategies to provide a more active and effective student learning. The projection of the TML practice is demonstrated through the development of concept maps (CM) technique, created by Joseph Donald Novak, which presents as a strategy, method or schematic feature, which is an indicator to identify the cognitive organization of the knowledge acquired by students. The survey was conducted in the light of TML in relation to learning concepts involving students of undergraduate nursing in a public university in the state of Rio Grande do Norte. Thus, the study aimed to compare the concept learning of students of undergraduate nursing, when subjected to different forms of education, to point approaches that promote more effective and meaningful results. It was a quasi - experimental study with a qualitative analysis, conducted with students of the Undergraduate Nursing of the Universidade Federal do Rio Grande do Norte (UFRN), approved by the Research Ethics Committee/UFRN Certification of Presention for Ethics Appreciation (CPEA) in 11706412.3.0000.5537. The study took place at two different times and involved content on complications mediate postoperative surgical wound in the same discipline with students who attended the 5th semester of the degree course in Nursing. For the viability of data collection, in the second half of 2013, we used the technique of CM, to represent the concept of complications mediate postoperative surgical wound covered in the classroom. CM were built at a different time from that of the discipline, with the support of tutors and preceded by a brief description and explanation about the form of preparation and application. In this study were subjected, 31 students of undergraduate nursing, registered in the discipline of Integral Attention to health I. In the first stage, 18 students participated in the survey, they had the teaching intervention based on TML, and in the second stage, all students participated in the lesson provided curriculum with the responsible teacher of the subject, on the same issue occurred. At the end of each meeting, the students 11 developed concept maps with the aid of software Cmap Tools®. Data analysis happened upon the technique of content analysis, supported by a conceptual map "glass", previously developed by researchers and aid in the preparation of the categories in which the concepts found were classified. The study found that the teaching intervention based on TML with the help of CM, managed to develop in students a more expressive teaching learning process than just classroom curriculum with the traditional teaching method, and also that the association between the intervention motion teaching with the traditional method and the use of the technique of CM encourages the student the ability to articulate the various acquired knowledge as well as apply them in real situations

Assistência de enfermagem às urgências e emergências psiquiátricas no serviço de atendimento móvel de urgência em Mossoró-RN

This study aims to identify the concepts of professional nursing team on assistance in urgency and psychiatric emergencies in SAMU in Mossoró/RN, identifying the difficulties in implementing an emergency assistance to the user in psychiatric distress in this service and point strategies in pursuit of consolidation and expansion of comprehensive health care to the public. It is a descriptive research with qualitative and exploratory approach. The subjects were employees of the nursing staff of SAMU of that mentioned municipality. Semi-structured interviews are applied as tool for data collection. It was counted on the consent of the institution where the study was developed and approval by the Ethics Committee in Research of UFRN with CAAE No 17326513.0.0000.5537, besides signing the Informed Free Consent Term by the participants. Data analysis was done by means of thematic analysis proposed by Bardin. Thus , as a result of the research produced the following categories: mechanistic practice; dehumanization of care; need for qualification, barriers to assistance in urgency and psychiatric emergency and strategies in pursuit of comprehensive care, which proceeded in preparing two articles entitled "Nursing care to the emergency room and psychiatric emergencies in the mobile emergency care service" and "Barriers for emergency service and psychiatric emergencies in the mobile emergency care service". In the studied reality it was identified that nursing care offered to users in situations of urgency and psychiatric emergency is made based primarily on the use of chemical and physical restraints, as well as transportation to the general hospital, constantly using the police force support, which meets the guidelines of the Psychiatric Reform and thereby undermining the provision of an effective and humane care. This scenario is worsened by the lack of an organized network of services in mental health, where after the service the user is taken to a general hospital, considering that there is no ready or appropriate psychiatric emergency service as a Center of Psychosocial Care - CAPs III to reference it, thereby precluding the realization of a resolute and comprehensive care. Thus, it is concluded that nursing care is based on biologicist and medicine-centered model advocated by classical psychiatry, and that despite all the advances in psychiatric reform, still guides the mental health care, so the lack of service network organized in hierarchical and mental health, where the user in urgency and emergency service can be watched in full and the guidelines of the psychiatric reform can be realized in practice

O ensino de enfermagem gerontológica na formação do enfermeiro

At the current time of demographic changes in the world , it is observed that the health sector requires restructuring of its practices in caring for the elderly , in order to enable a comprehensive and humane care . In this sense, we identify the need for qualified professionals to assist the elderly and, therefore , it is important that training curricula are adequate to this reality . The study aims to analyze how it develops teaching gerontological nursing component in undergraduate nursing . This is a descriptive , exploratory study with a qualitative approach, in two higher education institutions in the city of Natal / RN . The population involved corresponded to the coordinators of graduate courses in nursing and teachers who teach content of health care for the elderly, a total of seven participants . The data collection instruments were used: a questionnaire containing questions related to the characterization of the participants and the teaching of gerontological nursing in undergraduate courses in nursing and a form with items of analysis for pedagogical projects . The results were presented descriptively in tables and analyzed from coming themes of the main themes of the instruments defined in: knowledge about the research participants , knowledge of teaching gerontological nursing component and knowledge of pedagogical projects , discussed under Resolution paragraph . 03 of 7/11/2001 , which establishes standards for the nursing program , the educational projects of educational institutions , the Theoretical Donald Shoon and thematically relevant literature . The results indicate that the majority of participants were female (four), all have graduate though , none of them stated in the qualification of aging or elderly health area; the organization of the contents of the component in the curriculum, workload theoretical- methodological and practical teaching strategies presented was heterogeneous and sometimes diverging at the same institution . On the definition of gerontological nursing component was identified that is not well defined along the pedagogical design of educational institutions surveyed . It was concluded that in the context of this study , teaching gerontological nursing is present in the course of nursing education, but needs reevaluation and updating in order to teach a wider range of driving and health practices

O cuidado humanístico como foco institucional: um estudo sobre empatia dos profissionais de saúde na área obstétrica

Empathy is a basic facilitating element of the therapeutic helping relationship and the humanization process in health care. The objectives of this study were to identify the empathy level of health professionals working in the obstetrical sector of a university hospital recognized for its humanistic care and the perceptions of the women under their care regarding the empathic behavior shown by these professionals during hospitalization. We conducted a quanti/qualitative study with 47 health professionals that worked in the obstetrical sector (13 obstetricians, 12 nurses, 22 nurse technicians) and an intentional sample of 101 women that received cared from these professionals during the study period. We collected data by means of the Jefferson Empathy Scale for Health Professioals (JEPS-HR) and the Patient´s Perception of Health Professional Empathy (PPHPE), and two additional open questions designed to obtain the subjective opinion about the empathic behavior during the care. We utilized thematic analysis for the data obtained through the open questions and descriptive and inferential statistics for the quantitative data. We identified five thematic categories that represent the aspects valued by the professionals in their relationship with the women under their care: emotional involvement, communication, warm environment, integral vision and technical/scientific knowledge. The mean score on the JEPS-HR reported for the health professionals was 120,40, being that the maximum possible was 140.The Cronbach Alpha for the JEPS-HR was 0,83, indicating an acceptable level of reliability for this population. We consider therefore, that these professionals presented an acceptable empathy level when compared to other populations observed with the JEPS-HR. The results also indicated that women had statistically significant (p ≤ 0,05) higher scores than men and that professionals with higher working hours tended to have lower scores in the empathy scale (r = -0,288; p ≤ 0,05). The analysis of the subjective responses of the women indicated that they were satisfied with the humanistic care provided by the professionals but they also point out the existence of some power relationships. There were no significant differences in the empathy level of the medical or nursing team perceived by the women who registered means of 41,90 and 41,20 respectively on the PPHPE. In view of these results and considering the relevance of the element of empathy for care based on humanistic values, we reiterate the importance of further in-service training for the health team of the hospital in focus, on the topics of empathy and global aspects of humanized care for the implementation of its mission

Efeito do processamento da soja integral sobre a energia metabolizável e a digestibilidade dos aminoácidos para aves

Essa pesquisa foi desenvolvida para se avaliar o valor nutricional da soja integral submetida a diferentes processamentos. Quatro ensaios de metabolismo foram conduzidos para determinar os coeficientes de digestibilidade da matéria seca (CDMS), do extrato etéreo (CDEE) e dos aminoácidos e os valores de energia metabolizável aparente e verdadeira da soja integral desativada (SID) e extrusada (SIE) e das misturas de farelo de soja com óleo degomado de soja (FSO) ou com óleo ácido de soja (FSOA). Nos ensaios um e dois, utilizou-se a metodologia tradicional de coleta total de excretas com pintos e galos, respectivamente. A metodologia da alimentação forçada com galos adultos intactos foi utilizada no ensaio três, e com galos cecotomizados, no ensaio quatro. Os CDMS e CDEE e a energia metabolizável determinados com galos foram superiores aos determinados com pintos. Os maiores valores de CDMS, CDEE e de energia metabolizável foram obtidos para FSO, seguidos pelos da SIE e FSOA, e os menores, para a SID. O processo de extrusão proporcionou melhores resultados no aproveitamento da gordura do grão de soja e, conseqüentemente, da energia. Entretanto, a digestibilidade dos aminoácidos não foi influenciada pelos processamentos. Os diferentes processamentos conferiram à soja integral características nutricionais que se distinguiram, principalmente quanto ao valor de energia metabolizável, que também variou com a idade das aves.

Hidrolisados protéicos de mucosa intestinal, levedura e proteína isolada de soja em dietas com leite em pó integral para leitões desmamados

Avaliou-se o efeito da substituição parcial do farelo de soja (FS) por hidrolisado protéico do conteúdo celular de levedura (HPCCL), proteína isolada de soja (PIS) ou hidrolisado protéico de mucosa intestinal de suínos (HPMIS) em dietas com leite em pó integral (LPI) sobre o desempenho, os níveis séricos de uréia e a incidência de diarréia em leitões desmamados. Foram utilizados 40 leitões desmamados aos 21 dias de idade (20 machos castrados e 20 fêmeas), distribuídos em delineamento em blocos ao acaso, com cinco tratamentos (dietas) e oito repetições. As dietas foram fornecidas em três fases, de acordo com a idade dos animais: fase pré-inicial 1 (21 aos 35 dias de idade): dieta à base de milho e farelo de soja (FS); dieta com 15,0% LPI; dieta com 15,0% LPI + 3,5% HPMIS; dieta com 15,0% LPI + 5,0% de PIS; dieta com 15,0% LPI + 5,0% HPCCL. Na fase pré-inicial 2 (36 aos 49 dias de idade), foi mantida a dieta à base de milho e farelo de soja e o LPI foi reduzido para 7,5% em todas as dietas, o HPMIS para 1,5%, a PIS para 4% e o HPCCL foi mantido em 5%. Na fase inicial (50 aos 70 dias de idade), foi mantida a dieta à base de milho e farelo de soja, o LPI foi retirado de todas as dietas e os animais que nas fases pré-inicial 1 e 2 foram alimentados com as dietas contendo LPI e LPI + HPMIS passaram a ser alimentados com a dieta à base de milho e farelo de soja; a PIS foi reduzida para 3% e o HPCCL para 2,5%. No período de 21 a 35 dias, a dieta LPI + PIS proporcionou maior ganho diário de peso e melhor conversão alimentar. Nas fases seguintes, não houve diferença no desempenho entre as dietas. Até cinco dias após o desmame, os animais alimentados com as rações FS e LPI + PIS apresentaram menor índice de diarréia. Os níveis séricos de uréia não foram influenciados pelas dietas. A utilização de PIS, HPMIS e HPCCL em dietas complexas contendo leite em pó pode consistir em alternativa biologicamente viável em dietas para leitões.

Otimização de forma aplicando B-splines sob critério integral de tensões

This work proposes a computational methodology to solve problems of optimization in structural design. The application develops, implements and integrates methods for structural analysis, geometric modeling, design sensitivity analysis and optimization. So, the optimum design problem is particularized for plane stress case, with the objective to minimize the structural mass subject to a stress criterion. Notice that, these constraints must be evaluated at a series of discrete points, whose distribution should be dense enough in order to minimize the chance of any significant constraint violation between specified points. Therefore, the local stress constraints are transformed into a global stress measure reducing the computational cost in deriving the optimal shape design. The problem is approximated by Finite Element Method using Lagrangian triangular elements with six nodes, and use a automatic mesh generation with a mesh quality criterion of geometric element. The geometric modeling, i.e., the contour is defined by parametric curves of type B-splines, these curves hold suitable characteristics to implement the Shape Optimization Method, that uses the key points like design variables to determine the solution of minimum problem. A reliable tool for design sensitivity analysis is a prerequisite for performing interactive structural design, synthesis and optimization. General expressions for design sensitivity analysis are derived with respect to key points of B-splines. The method of design sensitivity analysis used is the adjoin approach and the analytical method. The formulation of the optimization problem applies the Augmented Lagrangian Method, which convert an optimization problem constrained problem in an unconstrained. The solution of the Augmented Lagrangian function is achieved by determining the analysis of sensitivity. Therefore, the optimization problem reduces to the solution of a sequence of problems with lateral limits constraints, which is solved by the Memoryless Quasi-Newton Method It is demonstrated by several examples that this new approach of analytical design sensitivity analysis of integrated shape design optimization with a global stress criterion purpose is computationally efficient

Análise da magnetohidrodinâmica com transferência de calor em canais de placas paralelas via transformação integral

The main goal of the present work is related to the dynamics of the steady state, incompressible, laminar flow with heat transfer, of an electrically conducting and Newtonian fluid inside a flat parallel-plate channel under the action of an external and uniform magnetic field. For solution of the governing equations, written in the parabolic boundary layer and stream-function formulation, it was employed the hybrid, numericalanalytical, approach known as Generalized Integral Transform Technique (GITT). The flow is sustained by a pressure gradient and the magnetic field is applied in the direction normal to the flow and is assumed that normal magnetic field is kept uniform, remaining larger than any other fields generated in other directions. In order to evaluate the influence of the applied magnetic field on both entrance regions, thermal and hydrodynamic, for this forced convection problem, as well as for validating purposes of the adopted solution methodology, two kinds of channel entry conditions for the velocity field were used: an uniform and an non-MHD parabolic profile. On the other hand, for the thermal problem only an uniform temperature profile at the channel inlet was employed as boundary condition. Along the channel wall, plates are maintained at constant temperature, either equal to or different from each other. Results for the velocity and temperature fields as well as for the main related potentials are produced and compared, for validation purposes, to results reported on literature as function of the main dimensionless governing parameters as Reynolds and Hartman numbers, for typical situations. Finally, in order to illustrate the consistency of the integral transform method, convergence analyses are also effectuated and presented

Análise técnica e econômica do processo de obtenção de espaguetes com adição de farinha de trigo integral e farinha de linhaça

This work studies the fabrication of spaghetti through the process at high temperatures through the use of flour added to flour and flaxseed meal, with the aim of evaluating the final product quality and estimate the cost of production. The values of moisture, ash, protein, wet gluten, gluten index, falling number and grain of flour and mixtures to test to be the possible use in mass manufacturing and technological criteria for compliance with current legislation. Spaghetti noodles type were manufactured by adding 10% and 20% flour and 10% and 20% flaxseed meal with performance of physical-chemical, sensory and rheological properties of the products. Further analysis was performed on the product acceptance and estimation of production cost in order to create subsidies to enable the introduction of products with greater acceptance and economic viability in the market by the food industry. On the rheology of the product test was cooking the pasta, specifying the volume increase, cooking time and percentage of solid waste. In the sensory evaluation was carried out the triangular test of product differentiation with 50 trained judges and acceptance testing by a hedonic scale with evaluation of the aspects color, taste, smell and texture. In defining the sensory profile of the product was performed with ADQ 9 judges recruited and trained at the factory, using unstructured scale of 9 cm, assessing the attributes of flavor of wheat, flax flavor, consistency, texture of raw pasta, raw pasta color and color of cooked pasta. The greater acceptance of product quality was good and the pasta with 20% flour, 10% followed by the full product, 10% and 20% flaxseed characterized the average quality of the criterion of loss analysis of solids, together with mass full commercial testing. In assessing the estimated cost of production, the two products more technologically feasible and acceptable (20% whole and 10% flaxseed) were evaluated in high temperature processes. With total cost of R $ 4,872.5 / 1,000 kg and R $ 5,354.9 / 1,000 kg respectively, the difference was related to the addition of lower inputs and higher added value in the market, flour and flaxseed meal. The comparative analysis of cases was confirmed the reduction in production time (10h), more uniform product to the drying process at high temperature compared to conventional

Saúde física e emocional de cuidadores da cidade de Santa Cruz-RN: perfil epidemiológico e fatores associados

Taking care for an impaired elderly is a hard and costly task that could affect directly the caregiver health. The purpose of this study was to evaluate the physical and mental health of elderly caregivers from the city of Santa Cruz-RN and analyze the potential correlated factors through an observational analytic design of a crosssectional. A multidimensional questionnaire was used to evaluation of the social demographics characteristics and those related to the care activity, as well as the caregivers´ physical and mental health. It was realized a descriptive analyze using frequency distribution and measures of the central tendency and dispersion to description of the caregivers. To verify the magnitude of the association between the variables was used the bivariate analysis through the Pearson and Spearman correlations and qui-square test. To evaluation of the association of the correlated factors to the adverse outcome with the caregivers´ physical and mental health was made a multivariate analysis by logistic binary regression and multiple linear regression models. The final sample was constituted by 304 persons, mostly women with a mean age of 50.3 ±16.8 years. The principal factors related to the physical health were age, stress and life satisfaction. Be a male caregiver, caring for a little while the elderly with cognitive deficit and not been spouse were related to worse mental health. Have worse physical health, high stress, depressive symptomatology, burden and low levels of satisfaction were also related to the mental health. After adjust through multiple linear regression was observed R2 values of R2=0,21 for Stress, R2 =0,17 for Depressive Symptomatology, R2 =0,21 for Burden and R2 =0,16 for Satisfaction. The attainment of the factors associated with caregiver´s health can help in the elaboration of specifics politics witch the goal is the integral attention to the elderly and his caregiver. The inability of continuous taking care could result in adverse outcomes such as institutionalization, impairment and death

Apoio social e síndrome da fragilidade em idosos residentes na comunidade

Introduction: The frailty in the elderly is the result of a complex interplay between many social and clinical factors involved in its genesis. Although there is an understanding of its association with increased risk of adverse clinical outcomes, still it is unclear whether this syndrome can be aggravated due to lack of social support. So, the objective of this study was to analyze the association between social support and frailty syndrome in elderly community residents. Materials and methods: Observational analytical cross-sectional study, with a sample of 300 elderly living in the city of Natal-RN. Were collected informations about socialdemographic, economics and physical health data. The Social support was assessed by the status of cohabitation; marital status; contact frequency and diversity rate; received and given attendance frequency rate; and Map Minimum Relations of the Elderly. The frailty was assessed using the following criteria: unintentional weight loss, weakness, low physical activity, exhaustion and Slowness. To observe any possible associations, we performed the Pearson chi-square test, the Student t test and multivariate analysis using binary logistic regression, adopting a significance level of 5%. Results: It was observed that there were no associations of frailty with the social support variables, except for housekeeping mode (p = 0.046) of the MMRI. For the sociodemographic, economic, physical health and social support data, only age (p <0.001), sedentary lifestyle (p = 0.002) and poor perceived health (p = 0.001) were the ones that remained in the logistic regression model, with strong association for the presence of frailty. Conclusion: Among the variables related to social support, only to help with housekeeping was significantly associated with frailty. However, more studies need to be developed to characterize the social vulnerability, as well as health services need to recognize the importance of social support as an integral part of care for the elderly

Os Centros de Especialidades Odontológicas como suporte da atenção básica: uma avaliação na perspectiva da integralidade

The public dental services in Brazil were limited, practically, to the basic care, so that the specialized services acted, up to 2002, no more than 3,5% of the total of clinical procedures. That lower offer reveals the difficulty of continuity of the attention, that is, the comprehensiveness in the assistance, particulary, the reference and counter-reference system. Brasil Sorridente search to supply those needs when proposing Speciality Dental's Centers(CEOs Centros de Especialidades Odontológicas, Brazil) to compose the services of average complexity. In 2005, Ministry of Health enabled the three CEOs of Natal, located in the North II, East and West Sanitary Districts. This investigation evaluated the implantation of these CEOs, as support of the family health care teams, in the perspective of organization of the services in assistencial nets in Natal/RN. It was a study of evaluation, with qualitative approach and some quantitative data as contribution. Dentists, users and managers were interviewed to identify and to understand their perceptions, relationships and experiences in the daily of the services. The conceptual base that orientated the investigation was the principle of comprehensiveness, in its operational sense of the hierarchization in health attention levels. The collection of data was done with documental research, direct observation and semi-structured interview. The analysis was accomplished by triangulation of the extracted content from the used techniques and sources of interviewed groups depositions, looking for theoretical-conceptual support in specific bibliography. The results pointed aspects that go away from the comprehensiveness like: low resolution of problems in the basic net; little valorization of the space in the health units; traditional models of access to health services, insufficient offer for some specialties, compromising the reference and counter-reference system; practices centered in procedures in the CEO; bureaucratic directions from basic care to the specialized service; disintegrated and disjointed system among levels of attention; disrespect to the municipal protocol. On the other hand, there is an approach of compreensiveness in situations like: increase of the access and covering in the Family Health Strategy (ESF Estratégia Saúde da Família, Brazil); larger approach between professional and user; tendency to the quantitative and qualitative growth of specialized actions; punctual initiatives of relationships among levels; existence of protocol to guide professionals