Qualidade de vida no envelhecimento: situação dos idosos assistidos em unidades de saúde da família do município do interior paulista

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Saúde e desenvolvimento humano

Este livro está dividido em quatro seções. Na primeira, que trata da Sexualidade e Corporeidade, os temas apresentados abordam o conceito de corporeidade, gênero e a busca por serviços de saúde, a imagem corporal em mulheres com depressão e a política de redução de danos em situações de sexualidade e vulnerabilidade. Na segunda seção, Intercorrências no desenvolvimento infantil, os temas se referem ao desenvolvimento infantil, abordando os efeitos do chumbo e da escolaridade, as habilidades sociais de crianças com irmão com transtorno de espectro autístico ou com desenvolvimento típico, e a ocorrência de estresse e bullying em crianças em condição de sobrepeso e obesidade. A terceira seção, intitulada Adolescentes: maternidade, fatores de risco e de proteção aborda o tema da gravidez e maternidade da adolescência, as interações familiares de mães adolescentes e os fatores de risco e de proteção em adolescentes com transtorno mental. A quarta seção, intitulada Manejo de estresse e outros fatores em diferentes populações adultas, aborda o estresse em universitários com desordens temporomandibulares, em motoristas de ônibus urbano ou em pacientes com líquen oral

O transtorno mental na percepção de agentes comunitários de saúde na estratégia saúde da família

The Family Health Strategy facilitates user access to mental health actions. This study aimed to verify the community health agents’ perceptions of the Family Health Strategy about mental disorder. A qualitative study was conducted with 26 randomly selected community health agents, among the professionals of 13 units, which constitute the Family Health Strategy of Itapeva (SP). The community health agents responded to a personal information questionnaire and a semi-structured interview. Data were checked through content analysis. Stigmatizing perception of the mentally disturbed persons, lack of knowledge about the process of falling ill and the mental disorder evolution, and the unpreparedness to act in this population were observed. Capacitating agents enable them to contribute in a positive way to the effective functioning of a care net in mental health in the city.

Apoiador matricial: uma possibilidade de promover a interdisciplinaridade entre profissionais da saúde

This study aims to reflect the organization of the mental health services in primary care from a new organizational arrangement to health work, defined as Matrix Support (Campos, 1999), which aims to build technical and educational support in the relationship between health professionals from mental health professionals in the Family Health Strategy. The methodology used in the Matrix Support the “Wheel” method, which is mediated by a supporter who, through questions and reflections, points out possibilities for case discussions, promotes links between the health teams, discusses the concept of link between professionals and users, strengthens the co-responsability for the actions of health and tries to break the logic related with the services organized by referrals. So the wheels when they occur in health services enables the interdisciplinary, and through it, it is expected to talk about the complexity of the phenomena that surround each subject, so that they overcome the dichotomy between individual and collective, social and biological revealing new values to be incorporated into health practices. In front of this analysis that is theoric and conceptual, allied with the experience from a nursisn area professional that worked in this work method, can be concluded that this experience related here, eas strategic for the health care actions for strengthen based on the Unique Health system and Psych Rebuild principles.

Comparação de gastos com serviços de atenção básica à saúde de homens e mulheres em Bauru, São Paulo, 2010

OBJECTIVE: to compare expenditure on primary health care services for men and women in Bauru-SP, Brazil. METHODS: cross-sectional study with a sample composed of randomly selected health service users' aged ≥50 years. Healthcare expenditure over the last 12 months was analyzed and stratified into: medical consultations, exams, medication and overall expenditure. RESULTS: 707 women and 256 men were assessed. Women had higher overall expenditures than men (median: R$128.1 versus R$108.6; p-value=0.027). Comparing females and males, being female was associated with higher medical consultation expenditure (27.6% versus 18.4%, respectively p-value=0.005) and exams (27.1% versus 19.5%, respectively p-value=0.022). After statistical adjustments (smoking, socioeconomic status, physical activity and overweight), being female was still associated with higher exam-related expenditure (Odds Ratio= 1.47; 95% confidence interval: 1.01-2.14). CONCLUSION: women have higher expenditure related to exams than men. Female obesity was associated with medical consultation higher expenditure.

Redes de atenção à saúde para gestantes usuárias de álcool e/ou outras drogas

Pós-graduação em Saúde Coletiva - FMB

Vigilância à saúde de recém-nascidos de risco: elaboração de protocolo de organização de serviços para redução do óbito infantil

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Avaliação do uso de medicamentos psicotrópicos pelos pacientes de uma Unidade Básica de Saúde de um município de pequeno porte do Estado de São Paulo

Pós-graduação em Saúde Coletiva - FMB

Saúde bucal e uso dos serviços odontológicos em função do Índice de Necessidades em Saúde: São Paulo, 2008

A Secretaria Municipal de Saúde de São Paulo desenvolveu o Índice de Necessidades em Saúde (INS) para identificar áreas prioritárias para a oferta de serviços. Em 2008 realizou um Levantamento das Condições de Saúde Bucal. Pretende-se, neste estudo ecológico, analisar o perfil de saúde bucal em relação ao INS. As variáveis, estratificadas para as idades de 5, 12 e 15 anos, foram: porcentagem de indivíduos com dificuldade no acesso ao serviço odontológico; média do ceod e CPOD; prevalência da necessidade de extração e de livres de cárie. As informações foram analisadas para as 25 Supervisões Técnicas de Saúde (STS). Empregou-se o teste estatístico de covariância, o coeficiente de correlação de Pearson e o modelo de regressão linear. Observou-se uma correlação positiva entre maiores INS e a dificuldade de acesso aos serviços. Nas STS com maiores INS houve maior experiência de cárie, maior necessidade de exodontias e menor prevalência de livres de cárie. Reforça-se a necessidade de priorizar as áreas de privação social para melhorar a condição de saúde da população.

Homens, masculinidade e violência: estudo em serviços de atenção primária à saúde

Há poucos estudos sobre homens abordando violência como evento não fatal. Contribuindo nessa direção, descrevem-se as prevalências da violência psicológica, física e/ou sexual sofridas por homens, detalhando-se nestes tipos a perpetrada contra parceiras. Trata-se de estudo transversal realizado com 789 homens de 18 a 60 anos, dos quais 775 com alguma parceria íntima na vida, selecionados por ordem de chegada em dois serviços de atenção primária na cidade de São Paulo. Foram investigadas as características sociodemográficas e as violências mencionadas, examinadas ainda quanto a sobreposições e à percepção de havê-las sofrido ou perpetrado. As prevalências de violências sofridas na vida foram de 79% para qualquer tipo e por qualquer agressor; 63,9%, 52,8% e 6,1% respectivamente para psicológica, física e sexual. Para violências perpetradas contra a parceira na vida, temos 52,1% qualquer tipo e 40%, 31,9% e 3,9%, respectivamente, para violência psicológica, física e sexual. Nas sofridas e nas perpetradas, a psicológica é a de maior taxa exclusiva, seguida da física. Quanto aos agressores, conhecidos é o principal agressor, seguido de familiar, estranhos e parceira íntima. Na relação entre sofrer por suas parceiras e perpetrar, 14,2% dos casos são sobrepostos e 81,2% somente perpetraram. Conclui-se que, embora nas violências relativas às parceiras íntimas os homens sofram muito menos do que perpetrem, os dados mostram que eles se envolvem em muitas situações de violência, de grandes magnitudes e sobreposições, quer como vitimas ou agressores, reiterando estudos sobre masculinidade. Este conjunto complexo de situações também deve ser considerado nos serviços básicos de saúde.

Análise do desempenho dos serviços prestados através das organizações sociais de saúde no estado do Rio de Janeiro

A partir de 2012, o Governo Estadual do Rio de Janeiro através da Secretaria de Estado de Saúde passou a adotar o modelo de gestão com base em Organizações Sociais de Saúde (OSS), a fim de melhorar os serviços prestados pelas Unidades de Saúde sob sua responsabilidade, ou seja, ampliar a cobertura de atendimento, melhorar o desempenho e reduzir custos. Desde junho de 2014, 80% das Unidades Estaduais de Saúde já eram gerenciadas por Organizações Sociais. O modelo de OSS foi criado com o intuito de publicizar serviços de relevância pública, até então prestados pelo Estado, mas que passaram a ser considerados não exclusivos do mesmo, a fim de alcançar maior eficiência. Nesse contexto, a presente pesquisa tem o objetivo de analisar o desempenho dos serviços prestados através das OSS contratualizadas pelo Estado do Rio de Janeiro (ERJ). Para tanto foi realizada uma contextualização sobre o processo de implementação e acompanhamento dos contratos de gestão na Secretaria de Estado de Saúde do Rio de Janeiro, bem como uma pesquisa documental com o levantamento dos indicadores quantitativos e qualitativos pactuados e os recursos de custeio utilizados, resultando na elaboração de ficha técnica de todos os contratos de gestão. As análises tiveram como foco a evolução dos indicadores quantitativos dos contratos de gestão no ano de 2012 até o 1º semestre de 2015, bem como o desempenho medido pela correlação de resultados de produtividade obtidos com base em indicadores quantitativos. Os resultados encontrados mostram que 80 % dos contratos de gestão de Hospitais Emergência, 75 % dos Hospitais Especializados e 92 % das Unidades de Pronto Atendimento atingem ou superam o grau de desempenho esperado pela SES quanto ao cumprimento do indicador Produção Hospitalar no ano de 2015, com ampliação da oferta de serviços especializados através das OS. Já para o cumprimento do indicador Produção Serviços Auxiliares de Diagnose e Terapia os resultados são 60 % para Hospitais Emergência e 25 % para Hospitais Especializados. Uma das conclusões possíveis e que cabe à SES/RJ, aprimorar sua função regulatória com a efetiva utilização da serie histórica de informações para a construção de indicadores compatíveis com o perfil das suas Unidades. Como sugestão para futuros estudos, aponta-se a possibilidade de realizar a mensuração da eficiência dos contratos de gestão do ERJ através da técnica envoltória de dados que correlaciona um número maior de indicadores qualitativos para verificação da eficiência.

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.

A articulação entre a estratégia saúde da família e o Centro de Atenção Psicossocial: análise de experiência em município do Nordeste brasileiro

The antimanicomial psychiatric reform is a process that seeks to deconstruct the exclusionary logic caused by hospitalizations, providing strategies for social reintegration of individuals. In this sense, the primary care through the Family Health Strategy - FHS comes progressively becoming strategic space in mental health interventions, configured as a field of practice and production of new modes of care. In this perspective, there has been a process of implementing this proposal in the Areia Branca City/RN, through the articulation of Psychosocial Care Network and the Family Health Strategy / ESF. However, this process has not been able to bring changes in practices. From the view that the relationship between mental health and primary care is a challenge currently being faced, that improving the care provided and the expansion of the access to services with guaranteed continuity of care depend on the effectiveness of this joint, established themselves as research objective: To investigate how is the relationship between the FHS team and CAPS team in care mental health in the town of Areia Branca - RN from the speeches of professionals. And if you had specific purposes: 1) Know the demand in existing mental health in the town of White Sand - RN served by FHS; 2) Identify limits and difficulties in the relationship between the ESF teams and CAPS; 3) Identify potential for linkages between ESF teams and CAPS for the establishment of local RAPS. This was a descriptive, exploratory study with a qualitative methodological design, whose subjects were professionals from the Family Health Strategy, professionals Psychosocial Care Center and responsible for the conduct / management of mental health in the municipality. The research tools used informal observations, semistructured interviews and focus groups were used. The data obtained were analyzed for the content analysis of Bardin, allowing discuss the relevance of the theoretical framework with data obtained through observation and interpretation of the relationship between the Family Health Strategy and the network of Psychosocial Care in Areia Branca-RN. On the one hand, there was strong demand for mental health arising from users and their families and / or caregivers. On the other, it was verified that although there is some progress with regard to perceptions of mental health, there are still practical, historical and contextually rooted, which act as barriers to effective response to this demand in view of deinstitutionalization. In this sense, it is considered important to emphasize that the teams of the Family Health Strategy should be trained to ensure the health practice with integrity and incorporating the mental health network in the municipality. This training must occur through continuing health education.

Avaliação do acesso aos serviços de reabilitação física para vítimas de acidentes de trânsito: caminhos para melhoria da qualidade do sistema de saúde

The Physical Rehabilitation services (PR) are of fundamental importance in combating the global epidemic of Traffic Accidents (TA). Considering the numerous physical and social consequences of the survivors, quality problems in access to PR are a hazard to recovery of victims. It is necessary to improve the management of quality of services, assessing priority dimensions and intervening in their causes, to ensure rehabilitation available in time and suitable conditions. This study aimed to identify barriers to access to rehabilitation considering the perception of TA victims and professionals. The aim is also to estimate the access to rehabilitation and their associated factors. This is a qualitative and quantitative study of exploratory nature developed in Natal / RN with semi-structured interviews with 19 health professionals and telephone survey to 155 victims of traffic accidents. To explore barriers to access the speeches were transcribed and analyzed using the Alceste software (version 4.9). During the interviews used the following guiding question: “What barriers hinder or prevent access to physical rehabilitation for victims of traffic accidents?”. The names of classes and axes resulting from Alceste was performed by ad hoc query to three external researchers with subsequent consensus of the most representative name of analysis. We conducted multivariate analysis of the influence of the variables of the accident, sociodemographic, clinical and assistance on access to rehabilitation. Associations with p <0.20 in the bivariate analysis were submitted to logistic regression, step by step, with p <0.05 and confidence interval (CI) of 95%. The main barriers identified were: “Bureaucratic regulation”, “Long time to start rehabilitation”, “No post-surgery referral” and “inefficiency of public services”. These barriers were divided into a theoretical model built from the cause-effect diagram, in which we observed that insufficient access to rehabilitation is the product of causes related to organizational structure, work processes, professional and patients. Was constructed two logistic regression models: “General access to rehabilitation” and “Access to rehabilitation to public service”. 51.6% of patients had access to rehabilitation, and 32.9% in public and 17.9% in the private sector. The regression model “General access to rehabilitation” included the variables Income (OR:3.7), Informal Employment (OR:0.11), Unemployment (OR:0.15), Perceived Need for PR (OR:10) and Referral (OR: 27.5). The model “Access to rehabilitation in the public service” was represented by the “Referral to Public Service” (OR: 23.0) and “Private Health Plan” (OR: 0.07). Despite the known influence of social determinants on access to health services, a situation difficult to control by the public administration, this study found that the organizational and bureaucratic procedures established in health care greatly determine access to rehabilitation. Access difficulties show the seriousness of the problem and the factors suggest the need for improvements in comprehensive care for TA survivors and avoid unnecessary prolongation of the suffering of the victims of this epidemic.

A produção do cuidado no período gravídico-puerperal: experiência de mulheres usuárias de serviços públicos de saúde

Despite numerous government projects aimed at reorganizing and qualifying obstetric and neonatal care in Brazil, it remains problematic, with repercussions for maternal and newborn mortality and humanized care of both the mother and child. The objective of this study was to analyze the care provided to women during the pregnancy-puerperium cycle, based on reports of public health service users regarding their pregnancy and delivery experiences, using comprehensiveness and humanization as reference. The study applied a qualitative approach and the methodological strategy consisted of listening to the women, in order to identify, based on the meanings of their discourse concerning their experiences with health services, continuities and discontinuities of care during the pregnancy-puerperium cycle. Study participants were women who gave birth at a municipal public maternity, residents of Natal, Brazil, who at the time of the interviews, were between 10 and 42 days postpartum. Seven women reported their pregnancy and delivery experiences at public services. As interviews and observation took place, the material produced was also analyzed, in order to achieve simultaneous production and data analysis. Using systematization, a dialogue was established between the women’s discourses and production in the field of Collective Health, with respect to concepts and discussion about obstetric and neonatal care as well as the Comprehensiveness and Humanization of such care. Participant discourses underscored aspects related to prenatal care starting at pregnancy and its repercussions as well as prenatal monitoring by health services; aspects associated with care during labor and delivery, as well as those involved in postpartum in the maternity, both with respect to newborn and maternal careç and lastly, puerperium care after discharge from the maternity. Analysis of results sought to identify lines of continuity and discontinuity in the comprehensiveness and humanization of care. Based on these lines and as final contributions of the study, the following paths were proposed to achieve comprehensive and humanized production of health care for women during the pregnancy-puerperium cycle: Path 1- Reassess care in the maternal and newborn health network, aimed at comprehensiveness in terms of guaranteeing access to the various services and technological resources available to enhance health and life. Path 2- Reorganize work processes in order to attain comprehensive and humanized care for women in the pregnancy-puerperium cycle. Path 3 – Qualify the professional-user relationship in care management during the pregnancy-puerperium cycle. Path 4 – Invest in the qualification of communication processes in the different dimensions of care during the pregnancy-puerperium cycle.