Limites e possibilidades do programa nacional de alimentação escolar enquanto estratégia de promoção da segurança alimentar e nutricional no municipio de Macaíba/RN

This dissertation aims to understand the importance of the National School Feeding as a strategy for ensuring the promotion of food and nutrition security in the municipality of Macaíba / RN, taking into account the implementation of the Law School Feeding, 11,947, 2009. The program was extended to all public basic education, youth and adults, in addition to ensuring that 30% of transfers from FNDE, were intended for the purchase of products from family farms. The survey was conducted with 160 students from public schools and farmers nesting Quilombo dos Palmares II, who produce on their land vegetables, fruits and cereals for their own consumption, for sale in local markets, in addition to providing for PNAE. The reciprocity between neighbors, such as mutual aid and sharing of common goods was noticeable in this group of farmers, since it was necessary to meet weekly deliveries of products to schools. As students, we applied a test of acceptability in two schools located in rural and in urban areas, to learn the opinion of ourselves in relation to school food consumed. It was concluded that to be most effective program in the region, there must be a better match in school menus, so that it can be attractive to students and to ensure greater use of fresh food, the main ingredient of same, practice of nutrition education in schools, to teach students the importance of food to health. In relation to local management, noted the need for adjustments bureaucratic as hiring staff for the departments, in order to be more agile in releasing payments to farmers, in addition to hiring assistants general services for schools, one Since the cooks exert dual role, the cooking while being responsible for cleaning the entire school environment. Government investments in the rural sector would be extremely valuable for farmers, since they need financial resources to purchase inputs, irrigation projects for gardens, availability of land for planting, transportation to facilitate the delivery of its products to schools and technical assistance more frequently

As práticas educativas na saúde da família: uma cartografia simbólica

This qualitative research aimed to understand the educational activities carried out in Family Health Units, of the municipality of Mossoró-RN. It was used symbolic cartography to organize and present data from reality. It started on the approach of Health Education and knowledge transformation practice, aiming at the development of autonomy and responsibility of individuals and healthcare, publicized by the appreciation of the interpersonal relations area established in services, such as educational emancipator practices contexts. Individual and collective interviews were realized, conducted with health professionals and users of ESF, about themes, activities, membership, the difficulties, the potential and the design of health education that permeate everyday Family Health Strategy. From what was apprehended, thematic maps were done with the analysis of educational practices of professionals belonging to the Family‟s Health. Links are built with the wires of conceptions of education reflected on themes and activities of family health teams. The storylines are rebinded by voices about the difficulties and the potential of educational processes for emancipator postures. For users, health education means proper care and information on disease prevention. Professionals understand that it is all information that is given to users, about health, social well-being, economic and general condition of human being as a way of preventing and treating disease. Mark printed on voices denote that activities and themes worked don‟t motivate users enough for their participation, being that physicians and dentists also get excluded themselves from educational practices. Elderly groups are those who get most involved with the activities. The size of the contained area and its seclusion from community make harder the access of users, as well as diminishing the quality of educational actions and links users-professionals. Therefore, the searching for medicines, medical consultations and wish to be well served are trademarks of voices from the users that interconnect with enlightening information and guidelines offered by professionals to users. It brings out practices that need to incorporate the social, the subjective and act with practices of prevention and health promotion, on the basis of lifestyles. The dialogical model, which needs to be approached since planning phase of health education actions could arouse interest of involved groups; promoting a relationship of dialogue and listening; discussing the local reality; stimulating practical methodological dialetics; promoting processes of deconstruction of concepts, values and attitudes, as more necessary than construction, using multiple languages. The defended thesis denotes paths to other studies aimed at understanding a dialogical template committed to exchanges of knowledge, and discover strategies that encourage formation of critical consciousness and the discovery of how is the training of new generations of healthcare professionals to belong to the project of society, in its technical, scientific, pedagogical, ethical, political and humanistic dimensions

O direito à saúde e a política nacional de atenção oncológica: uma análise a partir da crescente judicialização dos medicamentos antineoplásicos

The 1988 Federal Constitution of Brazil by presenting the catalog of fundamental rights and guarantees (Title II) provides expressly that such rights reach the social, economic and cultural rights (art. 6 of CF/88) as a means not only to ratify the civil and political rights, but also to make them effective and practical in the life of the Brazilian people, particularly in the prediction of immediate application of those rights and guarantees. In this sense, health goes through condition of universal right and duty of the State, which should be guaranteed by social and economic policies aimed at reducing the risk of disease and other hazards, in addition to ensuring universal and equal access to actions and services for its promotion, protection and recovery (Article 196 by CF/88). Achieving the purposes aimed by the constituent to the area of health is the great challenge that requires the Health System and its managers. To this end, several policies have been structured in an attempt to establish actions and services for the promotion, protection and rehabilitation of diseases and disorders to health. In the mid-90s, in order to meet the guidelines and principles established by the SUS, it was established the Política Nacional de Atenção Oncológica PNAO, in an attempt to sketch out a public policy that sought to achieve maximum efficiency and to be able to give answers integral to effective care for patients with cancer, with emphasis on prevention, early detection, diagnosis, treatment, rehabilitation and palliative care. However, many lawsuits have been proposed with applications for anticancer drugs. These actions have become very complex, both in the procedural aspects and in all material ones, especially due to the highcost drugs more requested these demands, as well as need to be buoyed by the scientific evidence of these drugs in relation to proposed treatments. The jurisprudence in this area, although the orientations as outlined by the Parliament of Supreme Court is still in the process of construction, this study is thus placed in the perspective of contributing to the effective and efficient adjudication in these actions, with focus on achieving the fundamental social rights. Given this scenario and using research explanatory literature and documents were examined 108 lawsuits pending in the Federal Court in Rio Grande do Norte, trying to identify the organs of the Judiciary behave in the face of lawsuits that seeking oncology drugs (or antineoplastic), seeking to reconcile the principles and constitutional laws and infra constitutional involving the theme in an attempt to contribute to a rationalization of this judicial practice. Finally, considering the Rational Use of health demands and the idea of belonging to the Brazilian people SUS, it is concluded that the judicial power requires ballast parameters of their decisions on evidence-based medicine, aligning these decisions housing constitutional principles that the right to health and the scientific conclusions of efficacy, effectiveness and efficiency in oncology drugs, when compared to the treatments offered by SUS

O direito coletivo prestacional à saúde e o poder judiciário: a concretização do art. 196 da Constituição de 1988 pela via jurisdicional

During the ninth century, owing to the process of industrialization, new social conflicts were showed, forcing the Government not to remain inert. The necessity of answer to these new demands requires from the State some actions that assure the new economic, cultural and social rights, able to exceed the formal equality, according to the principles of redistributive equality and well-being. Among the social rights, the right to health is showed up, which is placed at the Universal Declaration of Human Rights and the International Treaty for the Economic, Social and Cultural Rights, as a necessary term to promote the dignity and the free development of the human personality. Under the Constitutional Law, it is clear that the implementation of the right to health, placed at the 6th article of the Brazilian Constitution, demands a government activity, which usually requires a provision of material goods, depending on budgetary resources. The Legislative and Executive Branches have a very important role in compliance with the constitutional regulations about the satisfactory offer of health care services, besides the correct use of the resources at this area. The adoption of public policies is the way of Government action to the planning and realization of this right. Though, some public policies are usually made apart from the social compromises, to the detriment of the basic social rights. The government has a discretionary competence to manage the health services. That is the reason it is necessary the control of the political choices, through the popular control, the extrajudicial control by the Account Courts, or the judicial review. Owed to the constitutionalization of social rights, the constitutional justice has a very relevant role, concerning to the constitutional jurisdiction, in a way the Judiciary Branch assume your position as a player that transforms the society. On the control of the public health policies, there is a cast of official instruments, judicial or not, to the guarantee of the collective right to the public health services, and to allow the citizens to reach the real implementation of the right to health

Dificuldades e/ou facilidades vivenciadas pelos profissionais que compõem a Estratégia de Saúde da Família

Descriptive and quantitative study, with the objective of review the positive and negative aspects experienced by professionals working in the Family Health Strategy (ESF) of Ceará-Mirim town, at Rio Grande do Norte state. The population included 190 healthcare professionals that integrate the family healthcare staff and the data-collection occurred in a meeting at their workplace, with the implementation of a questionnaire. Results were organized in Microsoft Excel spreadsheet software, with descriptive statistical analysis in tables, graphs and tables through frequencies, averages values and standard deviations. There is a predominance of females (n = 137) and higher rates in almost all professions, and higher average age (38.9%, SD = 7.8) and income wage (average = 10) in the medical category. Regarding the more developed activities, for physicians and nurses are the healthcare actions in the Unit, the oral hygiene for dentists, the immunization for auxiliary nurses (Aux-N), educational meeting for the dental office assistants (ACD), and home visitations to community-based health workers (ACS). About the easiness of work, 93.2% said to be presence of professionals with a personal profile in public healthcare; about the difficulties, 86.8% of professionals cited the unavailability of material, followed by salary range reported by nurses (80.9% ), dentists (80.0%), physicians (73.3%), ACS (83.1%), and Aux-N (90.5%). In relation to working conditions, the unavailability of materials was the most mentioned, with the exception of dentists who reported improvement in wages. We still identify among these difficulties: the drugs availability regarded as first grade obstacle by ACS and physicians, the type of contracts in second grade cited by the ACD and dentists and, in third grade, the salary range cited by dentists and auxiliary nurses. It is concluded that the difficulties and easiness faced by ESF professionals are divergent among themselves. For physicians and nurses, whose healthcare actions become directed to specific groups, the individual and the family, their difficulties relate to the unavailability of materials. For dentists, whose actions more quoted were topical application of fluoride and supervised toothbrush, their greatest difficulty is the salary range. As to the Aux-N, ACD and ACS, for all of them the unavailability of materials has hindered the implementation of their activities in ESF

Envelhecer entre pássaros e anjos: um estudo etnográfico sobre o processo saúde doença do idoso no contexto familiar

Study, a descriptive-like one, is guided by ethnographic principles which have analyzed the elderly within the familiar context in his/her process of health and aging, in the neighborhood called Felipe Camarão, located in the western administrative region of Natal, RN, a Northeastern city of Brazil. The participants are elders aging 61 to 84 years old, living in this referring neighborhood, whose majority is constituted of migrants from the rural region of the state of the RN, retired, including widows, widowers and married couples, with low school-educational degree. For the information gathering it was utilized a semi-structured interview, the participant observation and the field diary, being put into effect, in majority, in the houses and in the Family Health Unit, in a period between March and October of 2006. For the results discussion it was utilized an analysis of thematic content and the program ALCESTE (In Portuguese, Análise Léxica por Contexto de um Conjunto de Segmentos de Texto or Lexical Analysis by Context of a Set of Text Segments), which through have emerged two corpus: the corpus I, Family and the elderly, and corpus II, The elderly and the aging within society. The analysis of the results has permitted to conclude that the family, also used by the public policies as a strategy of their practices in health, it is a necessary base support for the elderly citizen in his/her process of aging and of health. The elders familiar contexts have allowed this study to identify the existence of minimal social conditions of life, of new rearrangements of the current families by means of the plurigenerational acquaintanceship and the active presence of the elderly woman as a maintainer of this family; also by means of conflicted relationships among one another but in a bearable level of acquaintanceship. Different conceptions about the aging and the elderly generate disagreement and divergency however the family support and help for the solving of these problems and the attention to health are proceeding from the family components. However, it is noticed that loneliness is something present in these elder s everyday lives. About the attention to health, in a basic level of it, it was noticed that there are still a lot of gaps, mainly concerning promotional and preventing actions, deserving a higher sensitization and effort by the local health institutions

Relatos de uma vivência interdisciplinar: educação, saúde e cidadania

This study addresses the interdisciplinary training in perspective for the Brazilian Health System (SUS) in view of graduation students in the areas of health of Federal University of Rio Grande do Norte s (UFRN) former students of the course Health and Citizenship (SACI). Emphasizes also the importance of commitment to social policies, particularly with those focused on the area of health. This is a case study with a qualitative approach. There was the lifting of data through documental research, from 14 portfolios of learning, which are weekly records of students from the respective discipline, corresponding to 2005.2 to 2007.2 semesters. From the analysis undertaken, inferred that the methodology problematizing, used by the discipline, enables students to understand that learning is not restricted to the confined university walls. It shows the health from a complex and concrete social reality, allowing students to an interdisciplinary dialogue in search of the transformation of this reality. It means an opportunity to interact with the dynamics of society in their area of activities, developing a relationship of solidarity in the formation of the citizen. Moreover, it was clear the direction of experienced interdisciplinary and recognized by students of various professions that make up the discipline. Thus, the SACI in preparation for construction of SUS, helps to form a new professional, more committed to the promotion and with a collective work in health

Saúde da família: uma estratégia de mudança no processo de produção dos serviços de saúde

The purpose of this study is to analyze, from the point of view of nurses, changes that took place in the process of providing health services after the introduction of the Family Health Program (FHP). It is na investigation of qualitative nature that uses semi-structured interviews as a main empirical approach tool. Six nurses from the city of Caicó, Rio Grande do Norte, who were working with basic care before the introduction of the FHP, within basic care, were: adscription and ties with the community; hospitality and the humanizacion of care-giving; decrease in cases of inpatient treatment; strengthening of the prevention of injuries and health promotion; improvemente of health indicatiors, finally, actions that point towads meeting the principles of wholeness, equity and universality as a declaration of the Brazilian National Health Care System (SUS). Nevertheless, in spite of all recognizable positive aspects, the FHP has some weaknesses, such as: the difficulty posed by colletive work; the mismatch between professional education and the demands of the current health standard; a poor physical infrastructure of the Basic Health Units; a high heath staff turnover and precarious work conditions. In addition to this, some strategies that can be used to help improve the process of providing health services have been pointed out, such as, coordination between sectors, continuous education, making work conditions less precarious and improving the means whereby heathy service management is conveyed,Tthus, finally, we understand that the FHP does bring forward meaningful changes to the process of provinding health services to strengthen the Brasilian National Health Care System (SUS), in spite of the fact that it lies within a scenario of adversities that can be overcome through the collective endeavor of the several social actors

O homem na estratégia de saúde da família

The research aimed to understand the general perception of men about their health care in a health unit família. This is an exploratory and descriptive qualitative approach, developed at the Center for Health Dr Vulpiano Cavalcante in the City of Parnamirim / RN. Participated in the investigation 12 men enrolled in the Estratégia de Saúde da Família ESF (Family Health Strategy), in the age-group 20 to 59 years lived in the catchment area of one of the ESF teams unit above. Data were collected from July to August 2009, through structured interviews, which, after transcription have undergone a process of identifying meaning units, coded and categorized according to the precepts of content analysis according to Bardin. Following in the footsteps of this method, originated the following themes: "Revealing what motivates men to seek assistance in the Estratégia de Saúde da Família," "Expressing knowledge of the Estratégia de Saúde da Família ", "an opinion about the care health and relationship with the ESF. The analysis was processed according to the principles of symbolic interactionism as Blumer. To support the discussions were used literary themes about man in the context of public health policies and the man in the family and the influences of gender. These, when they had their properties and dimensions analyzed, raised the central category Man on the Estratégia de Saúde da Família . The results show that respondents have limited knowledge about the ESF, your actions turn to use the service when no obligation arising from discomforts and accuracy of care. Moreover, delivering the opinion of the care with your health, even need, but recognizing that do not perform self-care. Given this reality, we can conclude that the perception of the man about his health in the ESF permeates gender issues that influence their behavior toward disease prevention and health promotion. This situation requires that the professionals and managers of health initiatives for the inclusion of man in the actions of the ESF assistance starting from the understanding of their conceptions of health care.

Entre flores e espinhos: a atuação do técnico em enfermagem na estratégia saúde da família

It is about a study of an exploratory/descriptive type with a qualitative approach whose aim was to analyze the actuation of nursing technicians in Family Health Strategy (FHS), taking into consideration the defined attributions by the Ministry of Health (MH). Thus, it was sought to identify what activities they carry out, the difficulties encountered, what contributed to their professional performance, and what vision they have about FHS and about themselves in the context. Based on the assumption that the practice of Nursing Technician is not still geared to completeness and that the developed actions by this professional are predominantly individual and curative. We know that FHS proposes the work organization as a team, with territory definition, prioritization of promotion actions, protection and recovery of the individual/family/community health, choosing as a central point the establishment of entails between the professionals and the same ones. However, the team work pass through interdisciplinary, tying and competence, starting making the difference in the way of thinking and doing health. To the accomplishment of this study were interviewed twenty one Nursing Technicians of Family Health Units from Sanitário Oeste district in Natal-RN, using semistructured instrument. From the analysis, three empiric categories emerged: starting from the first, The reality of a dream: what FHS is for the Nursing Technician, we obtained two classifications: one inherent to the own conception they have about FHS, nominated The realization of a dream in the possible and another that corresponds to what they think about FHS, while project that doesn't take place fully, denominated of The beauty of a dream that doesn't take place. The second category was The FHS: a dream built in the daily of Nursing Technician treats of the day by day information of that professional; the activities they perform and how those are established. This created three other items, to know: The role of a Nursing Technician: a project that became routine; The pre-determined role of a Nursing Technician: the scale as factor of (non-)autonomy; and, Knowledge about the practice in FHS: challenges that are presented to the role of Nursing Technician. The third category, denominated of Charms and disenchantment in the beginning of a new practice, it is related to the facilities or difficulties in professional's actuation and how he sees himself in the context. From it emerged the "flowers" and the "thorns" found on the construction of a dream, which gave this study the title. The results indicate that, being considered the characteristics of researched professional category, it becomes fundamental the resizing of labor relations in FHS, being imperative that new glances is conducted, so that the way as those Nursing Technicians interacts with the families can become compatible, together with the team, as well as to return the attention for their possibilities and limits in face of the work process in FHS. Besides, it is necessary changes in the professional formation, so that it can guarantee the conceptual bases in the construction of new practices, seeking to answer to the model of current attention.

Repercussões da terapia comunitária no processo de trabalho na estratégia saúde da família: um estudo representacional

The Community Therapy (CT) is in a practice of therapeutic effect and may also be considered as a technology takes care of the therapeutic procedure group, whose purpose is to promote health, prevent illness, developed within primary care in mental health. In this study we sought to understand the social representations of health professionals who work with the Community Therapy, on use of the Family Health Strategy (FHS) in the city of Joao Pessoa. This is a field research with a qualitative view Moscovician Theory of Social Representations, held with seven professionals of the FHS, therapists of Community Health District II. The empirical data were obtained by carrying out two thematic therapies in April 2009, which were wheeled CT. It was used as a technique for analyzing the collective subject discourse, and the data presented through graphs, charts, maps, pictures and graphics and arranged in three stages: Subjects of the study, characterizing the study participants; Social Representations of Therapist Community presenting and discussing the social representations of therapists community studied on CT, and Consequences of Community Therapy at the Family Health Strategy, discussing the meanings attributed by the study participants about changes in FHS. Meanings were attributed to the CT by the therapists studied originated from the speeches, songs, drawings and constructed, and that presented by schematic illustration show the relation between the representations: life, listening, faith / light, change, transformation. The web, symbol of CT, appeared on the images constructed by the representatives of the study and represents the formation of bonds that allows the construction of social support networks that strengthen relationships among community. In the study, proved by professionals who have the meanings about the changes in the work process from the introduction of CT, and shown that the change took place within a more welcoming attitude on the part of professionals, the relationship between Team members had no significant changes, explained by the low compliance of team members to the CT in relation to the user front, the bond was strengthened, and this involved strengthening the role of the therapist community. It is recognized, thereby transforming the character of CT in building links with users, requiring, however, that the team is viewed as offering therapeutic services, not the professional therapist. Therefore, the CT for being a new phenomenon in health services and community belonging, it fits like a novelty which affects the construction of a representation dispute. Still, can contribute to the reorganization of mental health care in line with the new model of mental health care advocated by the Psychiatric Reform.

Atenção à saúde mental na Estratégia Saúde da Família no Município de Parnamirim/RN: opinião dos profissionais, dos portadores de transtornos mentais e seus acompanhantes

This study aims to analyze and compare the opinion of professionals, managers and users about the mental health care in the Family Health Strategy (FHS). It is characterized as an Operations Research or Health System Research with a cross-sectional design and a descriptive quantitative nature. The study was developed from the application of the Opinion Measurement Scale allied to techniques of observation and structured interview in the city of Parnamirim / RN. The sample consists of 409 subjects, 209 professionals of the Family Health Strategy, 30 of the Oral Health Strategy, 19 of the Family Health Support Center, 24 directors of Basic Health Units, plus 68 users with mental disorders and 59 caregivers, respecting the ethical parameters of Resolution 196/96 of the National Health Council, trial registration number: CAAE 0003.0.051.000-11. Quantitative data were submitted to the Epi-info 3.5.2 for analysis. The network of mental health in Parnamirim involves the flow between the FHS, Psychosocial Care Centers, clinics and hospitals, having as main barriers the fragility of the referral and counter-referral system, of the municipal health conferences, of the FHS teams by the limitations in material and human resources as well as the population´s lack of acknowledge about the organization of the mental health network, issues that affect the integral attention. Even though the FHS professionals recognize the importance of their actions, they question their role in mental health care, experiencing difficulties in accessing psychiatric services (76.5%). Although most agree that the mentally ill is best treated in the family than in hospital (65.2%), the community health workers were the predominant category in the partial or total disagreement of this statement (40.8%), who is the professional in greater contact with the family. Nevertheless the caregivers miss the support of the FHS as the main focus of attention is on revenue control. The views of professionals, mental patients and caregivers converged in several statements, showing the main weaknesses to be focused by the mental health network of the city, as the perceptions that: (a) physical strength is needed to take care of mental patients for its tendency to aggression, requiring it to stay in the sanatorium for representing danger to society, (b) only a psychiatrist can help the person with emotional problems, (c) the user of alcohol and drugs does not necessarily develop mental illness, (d) the access barriers and doubts about the quality of psychiatric services, (e) caring of a mental health patient does not bring suffering to professionals. Therefore, the commitment to consensus building, monitoring and evaluation of the network are important mechanisms for an effective management system, reflecting in the importance of strengthening the health conferences and approximating different institutions. The results reinforce the importance of strengthening primary care through programs of continuing education focusing on the actions and functions of professionals in accordance with its competences and duties what contribute to the organization and response of mental health care, favoring user´s care and the promotion of family health

Papéis e funções dos profissionais dos serviços e política de saúde mental em Natal (RN)

A assistência psiquiátrica e as políticas de atenção à saúde mental passaram por diversas transformações, marcadas ora por avanços, ora por retrocessos centrados no estigma, desinteresse e preconceito que ainda permeiam a sociedade e o senso comum. Este estudo objetivou analisar o processo de reforma psiquiátrica e a política de saúde mental do Município de Natal/RN a partir dos papéis e funções dos profissionais de nível superior dos serviços substitutivos em saúde mental. Trata-se de uma pesquisa analítica, transversal, com dados quantitativos e qualitativos, realizada nos sete serviços substitutivos de saúde mental de Natal, entre os meses de março a agosto de 2013, após aprovação do estudo pelo Comitê de Ética em Pesquisa da Universidade Federal do Rio Grande do Norte, Parecer nº 217.808, CAAE: 10650612.8.1001.5537, em 01 de março de 2013. A amostra por conveniência compôs-se por 65 profissionais de nível superior das equipes de saúde mental. Utilizou-se um questionário com questões fechadas e semiabertas sobre o perfil socioeconômico, as políticas, as práticas e a formação em saúde mental. Tabularam-se e submeteram-se as respostas das questões fechadas do questionário no programa estatístico SPSS versão 20.0, analisando-os por meio de estatística descritiva, com a formulação de gráficos e tabelas. Para verificar o nível de significância, adotando-se p-valor<0,05, optou-se pela aplicação dos testes qui-quadrado e exato de Fisher. Submeteram-se os dados das questões semiabertas ao software ALCESTE e à luz da análise de conteúdo de Bardin. O perfil dos participantes caracterizou-se por maioria do sexo feminino (79%), faixa etária de 36 a 55 anos (52%), média de 42 anos, carga horária de 40 horas semanais (62%), tempo de conclusão da graduação de 6 a 15 anos (57%), trabalhavam na área de saúde mental há menos de 10 anos (72%) e na instituição pesquisada há 5 anos ou menos (52%). Da amostra estudada, 86% atendiam grupos de usuários, 97% realizavam atendimento individual, 94% observavam o comportamento do paciente, 92% realizavam atendimento familiar, utilizando, principalmente, a abordagem cognitiva (28%). Os dados qualitativos originaram cinco categorias: Formação acadêmica e atuação em saúde mental; Ausência de capacitação e supervisão em saúde mental; Dificuldades da prática profissional nos serviços substitutivos de saúde mental; Trabalho em equipe: entre acertos e conflitos; Política Nacional de Saúde Mental: uma realidade ainda distante. Detectou-se adequabilidade dos papéis e funções dos profissionais quanto ao tempo de trabalho na saúde mental e na instituição pesquisada; no atendimento e atividades individuais; na promoção de ações visando à autonomia do paciente; no atendimento em grupo de pacientes; e, em parte, à família/familiar dos portadores de transtorno mental, havendo inadequação quanto ao atendimento aos grupos de familiares (52.3%), à formação especializada em saúde mental (69.2%; p=0,02) e às dificuldades de trabalho nos serviços (87.7%). Evidenciou-se adequação nos papéis e nas funções d esenvolvidas pelos profissionais nos serviços substitutivos em saúde mental de Natal, embora convivendo em seu cotidiano com inúmeras dificuldades encontradas no desenvolvimento de suas práticas profissiona is frente às condições de trabalho

Avaliação da qualidade de vida relacionada à saúde de cortadores de cana-de-açúcar nos períodos de entressafra e safra

OBJETIVO: Avaliar a qualidade de vida relacionada à saúde de cortadores de cana-de-açúcar. MÉTODOS: Estudo longitudinal em uma usina sucroalcooleira no Oeste do estado de São Paulo de abril (final da entressafra) a outubro (final da safra) de 2010. Foram avaliados 44 cortadores de cana-de-açúcar tabagistas e não tabagistas em três períodos: ao final da entressafra, no fim do terceiro mês de safra e no final da safra. A qualidade de vida relacionada à saúde foi avaliada pelo questionário Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Foram realizados análise de variância para medidas repetidas e teste de Friedman para comparar a qualidade de vida entre os períodos. Utilizou-se o teste de Goodman para identificar a frequência dos trabalhadores cujo escore aumentou nos períodos de safra em comparação com a entressafra (respondedores positivos), considerando-se as variáveis qualitativas dos domínios do SF-36. RESULTADOS: Ao final da entressafra, 23% dos trabalhadores desistiram do trabalho; 27% eram tabagistas. Houve decréscimo significativo no domínio vitalidade no final da safra em comparação com a entressafra. Os desistentes apresentaram maior escore no domínio aspecto social em relação ao grupo que permaneceu no trabalho. Não houve diferença na qualidade de vida relacionada à saúde entre tabagistas e não tabagistas. No entanto, observou-se maior percentual de respondedores positivos entre não tabagistas nos domínios aspecto físico, social e emocional nos três meses de safra e nos domínios estado geral de saúde e aspecto social nos seis meses de safra, quando comparados aos tabagistas. CONCLUSÕES: A qualidade de vida relacionada à saúde em cortadores de cana-de-açúcar mostrou-se diminuída após o período de safra no domínio vitalidade. Os trabalhadores que permaneceram na safra são os que apresentaram piores aspectos sociais, o que mostra a necessidade de promoção de políticas assistencialistas de saúde a essa população específica, principalmente durante a safra canavieira.

Capacitação no Programa de Saúde da Família: divergências sobre o conceito de visita domiciliar nas equipes de Presidente Epitácio, São Paulo

O Programa de Saúde da Família (PSF) tem por intenção - e mérito - mudar o foco da atenção à saúde centrada no médico e na cura das doenças, para uma atenção centrada na promoção da saúde e prevenção de doenças por meio de uma equipe multidisciplinar. Para atingir esse objetivo, tem na prática de trabalho da visita domiciliar um dos instrumentos fundamentais para o entendimento da totalidade dos condicionantes que afetam a vida do cidadão. Neste artigo, discutem-se os conceitos de visita domiciliar com que operam as três principais categorias de trabalhadores do PSF - médicos, enfermeiros e agentes comunitários - , assim como sua relação com a formação no curso básico. A metodologia se baseia na técnica do discurso do sujeito coletivo a partir das entrevistas aplicadas. Concluímos que a falta de uniformidade sobre o conceito de visita domiciliar pode interferir na proposta de mudança do modelo de atenção à saúde. O artigo tece ainda considerações sobre as distintas concepções de visita domiciliar e sua relação com a organização do trabalho no interior das equipes.