Democratização da gestão pública: a municipalização da saúde nos municípios brasileiros de pequeno e médio porte

The present study analyses the relationship between Democracy and Local Government concerning Public Health Policy of small and medium Brazilian municipalities (with less than 50 thousand inhabitants). The management of the Department of Health in these municipalities was analysed to observe the democratization of public health through the main innovations on the way of management and on the health assistance. A comparison between the answers of the Health Department Managers of municipalities with less than 50 thousand inhabitants and the ones with more than 50 thousand inhabitants (collected in another research) was made as well as the elaboration of a factorial analysis model which verifies the relationship between Manage Profile, Innovating Management and Municipality Demographic Size. Innovating features are found in the small and medium municipalities although in a weaker degree than in the big ones. The relationship observed between the Demographic Extent and Innovating Management as well as the first and Manager Profile are not as strong as the Manager Profile and Innovating Management, concluding that the small dimension of a municipality is not an impediment to a more democratic health management.

Saber e poder: agentes comunitários de saúde aproximando saberes locais e políticas públicas

Incorporar os diversos saberes locais nas políticas públicas é uma forma não apenas de garantir sua apropriação pela sociedade, mas também de promover cidadania com base na garantia de eqüidade e da diferença. Este trabalho busca analisar como os Agentes Comunitários de Saúde do Programa Saúde da Família realizam uma ponte entre os saberes locais, dos espaços e cotidianos vividos, e as políticas públicas de saúde. O trabalho retoma, primeiramente, conceitos como nova cidadania, direito à eqüidade e à diferença, espaço, território e saberes locais. Em seguida são analisadas as experiências de Sobral-CE e Londrina-PR a partir do acompanhamento do trabalho de Agentes Comunitários de Saúde nestas localidades. O objetivo é traçar algumas conclusões sobre a importância de se envolver pessoas da comunidade para que as políticas públicas promovam cidadania, acesso a serviços, direito à igualdade e à diferença e garantam melhores resultados.

Trabalhadores de saúde mental : reforma psiquiátrica, saúde do trabalhador e modos de subjetivação nos serviços de saúde mental

A presente dissertação tem como principal objetivo analisar os efeitos da implantação da Reforma Psiquiátrica na saúde e nos processos de subjetivação dos trabalhadores de saúde mental. Valendo-se da genealogia, tal como entendida por Michel Foucault, o primeiro passo foi analisar as relações de forças que perpassam os acontecimentos históricos, determinando os diferentes regimes de verdade que sustentam as políticas públicas no Brasil, especialmente a saúde mental e a saúde do trabalhador. Identificamos, ainda, os cruzamentos e distanciamentos entre estes dois movimentos, a partir da análise dos relatórios das Conferências Nacionais de Saúde do Trabalhador e de Saúde Mental. Nosso segundo objetivo foi conhecer as políticas e ações de atenção à saúde do trabalhador de saúde mental, concluindo que as ações voltadas à atenção da saúde do servidor público não integram uma política pública, sendo que os enunciados da saúde do trabalhador têm uma frágil penetração em um campo ainda hegemônico da medicina do trabalho. O servidor público, como trabalhador, não tem merecido investimento, apenas controle, em consonância com um longo histórico de desvalorização do setor público Esta realidade reflete-se nos serviços de saúde mental, onde o acolhimento (ou não) das questões relacionadas à saúde no trabalho dependem, exclusivamente, do funcionamento e das diretrizes de cada serviço. Entre as questões apontadas pelos trabalhadores de serviços de saúde mental em relação às iniciativas de cuidado com o trabalhador, cumprem papel de destaque a equipe e a supervisão. Outro fator apontado pelos entrevistados como fonte de estresse em seu trabalho, foram as limitações não apenas dos serviços de saúde mental mas, sobretudo, de outros equipamentos e ações de suporte social. Mesmo com todas as exigências e limitações dos serviços sob a égide da Reforma Psiquiátrica, a possibilidade de “inventar” o próprio trabalho, contrapõe-se à falta de perspectivas característica do trabalho nos hospitais psiquiátricos. Por fim, buscamos estabelecer a relação entre a rede enunciativa presente nos textos de sustentação das políticas de Saúde Mental e de Saúde do Trabalhador, e como esta rede atravessa e constitui o sujeito trabalhador dos serviços de saúde mental (subjetivação Desenvolvemos a idéia de que o trabalhador de saúde mental, hoje, constrói-se em meio à disputa dos discursos que refletem o embate interno ao campo designado como Saúde Mental. É um espaço tenso por estar habitado por diferentes formações discursivas, desde a crença de que cuidar é uma forma de caridade (discurso religioso), passando pela afirmação de que é a ciência que pode falar do tratamento da loucura (discurso científico), até o entendimento de que não basta apenas conhecimento técnico-científico, mas também implicação política e afetiva com a construção de um outro modo de se relacionar com a loucura (Reforma Psiquiátrica). O trabalhador dos serviços de saúde mental constitui-se, ainda, na tensão entre o habitar um lugar rico para criação e invenção, e o confronto com a desvalorização de seu papel de servidor público, com a falta de investimentos e de ações intersetoriais, que impõem limites para a prática e sobrecarregam o trabalhador. É neste jogo que temos a subjetivação do trabalhador de saúde mental, considerando que é no confronto com o sofrimento - seja valendo-se dele para criar, seja lutando para não adoecer - que se dá o cotidiano do seu trabalho.

Sons, silenciamentos, poder e subjetivação no hospital : a musicoterapia na saúde do trabalhador

Este trabalho propõe e analisa a Musicoterapia como estratégia de produção de saúde do trabalhador, em pesquisa desenvolvida com técnicas de enfermagem de uma Unidade de Terapia Intensiva infantil de um hospital geral público de Porto Alegre. A atenção à saúde dos trabalhadores produz novas questões teórico-conceituais, práticas, éticas e políticas no campo da Musicoterapia, que estão ligadas ao território do trabalho e suas configurações contemporâneas, ao "ser" trabalhador e à saúde, e que têm implicações sobre a Musicoterapia e o musicoterapeuta na contemporaneidade. À luz das contribuições de Foucault, este trabalho centraliza-se na discussão do hospital como território de produção de subjetividades, a partir do desenvolvimento do conceito de ‘Panáudio’, mapeando e analisando efeitos deste dispositivo, que se efetivam pelos contextos sonoros. Aponta controles e resistências possíveis e propõe a produção de novas subjetividades pelo uso da música em Musicoterapia. Esta é uma pesquisa exploratória, baseada na pesquisa-intervenção e inspirada nos modos de ação da cartografia. Este trabalho é parte da construção de uma perspectiva de Musicoterapia Institucional.

Comparando a saúde no Brasil com os países da OCDE: explorando dados de saúde pública

A atenção à saúde da população no Brasil gera um grande volume de dados sobre os serviços de saúde prestados. O tratamento adequado destes dados com técnicas de acesso à grande massa de dados pode permitir a extração de informações importantes para um melhor conhecimento do setor saúde. Avaliar o desempenho dos sistemas de saúde através da utilização da massa de dados produzida tem sido uma tendência mundial, uma vez que vários países já mantêm programas de avaliação baseados em dados e indicadores. Neste contexto, A OCDE – Organização para Cooperação e Desenvolvimento Econômico, que é uma organização internacional que avalia as políticas econômicas de seus 34 países membros, possui uma publicação bienal, chamada Health at a Glance, que tem por objetivo fazer a comparação dos sistemas de saúde dos países membros da OCDE. Embora o Brasil não seja um membro, a OCDE procura incluí-lo no cálculo de alguns indicadores, quando os dados estão disponíveis, pois considera o Brasil como uma das maiores economias que não é um país membro. O presente estudo tem por objetivo propor e implementar, com base na metodologia da publicação Health at a Glance de 2015, o cálculo para o Brasil de 22 indicadores em saúde que compõem o domínio “utilização de serviços em saúde” da publicação da OCDE. Para isto foi feito um levantamento das principais bases de dados nacionais em saúde disponíveis que posteriormente foram capturadas, conforme necessidade, através de técnicas para acessar e tratar o grande volume de dados em saúde no Brasil. As bases de dados utilizadas são provenientes de três principais fontes remuneração: SUS, planos privados de saúde e outras fontes de remuneração como, por exemplo, planos públicos de saúde, DPVAT e particular. A realização deste trabalho permitiu verificar que os dados em saúde disponíveis publicamente no Brasil podem ser usados na avaliação do desempenho do sistema de saúde, e além de incluir o Brasil no benchmark internacional dos países da OCDE nestes 22 indicadores, promoveu a comparação destes indicadores entre o setor público de saúde do Brasil, o SUS, e o setor de planos privados de saúde, a chamada saúde suplementar. Além disso, também foi possível comparar os indicadores calculados para o SUS para cada UF, demonstrando assim as diferenças na prestação de serviços de saúde nos estados do Brasil para o setor público. A análise dos resultados demonstrou que, em geral, o Brasil comparado com os países da OCDE apresenta um desempenho abaixo da média dos demais países, o que indica necessidade de esforços para atingir um nível mais alto na prestação de serviços em saúde que estão no âmbito de avaliação dos indicadores calculados. Quando segmentado entre SUS e saúde suplementar, a análise dos resultados dos indicadores do Brasil aponta para uma aproximação do desempenho do setor de saúde suplementar em relação à média dos demais países da OCDE, e por outro lado um distanciamento do SUS em relação a esta média. Isto evidencia a diferença no nível de prestação de serviços dentro do Brasil entre o SUS e a saúde suplementar. Por fim, como proposta de melhoria na qualidade dos resultados obtidos neste estudo sugere-se o uso da base de dados do TISS/ANS para as informações provenientes do setor de saúde suplementar, uma vez que o TISS reflete toda a troca de informações entre os prestadores de serviços de saúde e as operadoras de planos privados de saúde para fins de pagamento dos serviços prestados.

Saúde bucal no programa de saude da família: o caso do distrito sanitário norte em Natal - RN

The inclusion of the dentist in the Family Health Program (FHP) teams designates a reorganization of the mouth health care in your country and establishes a new scenario in Brazilian odontology, through of a new way to organize the basic health care, creating conditions to consolidate in mouth health practice actions, in the level of the basic attention, the validation of Unique Health System (UHS) constitutional principles. The purpose of this research is to verify if the actuation of mouth health teams (MHT) dentists, in Natal city north sanitary district, is tuned with FHP goals.The target research population was composed by all dentists working in Basic Health Units (BHU) of Natal north sanitary district. Fifth-eight questionnaires were applied and using open and closed questions we look for identify the functional characteristics of each BHU, the dentists professional attributions on each BHU, as well as the clinical procedures that they execute. This research also searched to identify the factors that facilitate and/or difficult the inclusion process and the dentists activities performance on these BHUs, as well as the necessary actions to north sanitary district MHTs to fulfill the objectives proposed by FHP. The results point that the inclusion of mouth health actions in north sanitary district FHPs brought the incorporation of new values to the used practices. Whoever, its necessary a more frequent evaluation of the carried actions, in a way they can be adapted to the real community necessities, and, is fundamental the data accompaniment, for that these serve of base for planning and redirecting activities, in a way that we do not have only a reproduction of traditional practices, fragmented and isolated, but a truly substitution of the traditional practices and a new way of promoting health

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

Saúde Mental e enfermagem: em busca da integralidade na ESF

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

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.

Análise de qualidade da atenção à criança na estratégia saúde da família: o óbito infantil evitável como referência

Alma-Ata declaration bring the Primary Attention to the Health (PAH) as first level of health attention for individuals, family and community, which considers infant group as priority. Several initiatives that gave bases to integral attention to the children health formalized in the principles of Unique Health System. Family Health Strategy (FHS) comes to strengthen this attention, instituting new ways of work organization and professional practices that gave impact in their quality indicators. One of them is children mortality, showing decline in their values. Though, studies indicates persistence of avoidable infant deaths. In Natal RN, this reality is also perceptible leading to inquietudes, mainly at the space of services production, it means, which motivated the accomplishment of the present study intending to analyse the way that the organizational and structural processes as long as the professional practices in FHS interfered in the quality of children s health attention who died by avoidable death in the year of 2007 in municipal district of Natal-RN. It treats, therefore, to an exploratory and descriptive survey of cases study type, thar had as primary sources the oficial documents of MH, the family prontuary, pregnant card, child card and testimony obt ined from instrument of research elaborated based in investigation form of infant death by MH, applied to 10 mothers of children who had avoidable death. In analysis it was appealed silmultaneous triangulation of methods and sources, allowing a bigger aproximation from obtained informations. To elucidate the cases, the aspects studied were analyzed to the light of explicative model of Social Determinants of Health. Among individual and family aspects were highlighted the related to age, schooling, family habits and customs and mother s economic condition, besides of pregnancy age, newborn weight and associated diseases, which don t differ from literature about the theme. Reffering to the factors organizational and structural processes and professionals practice, highlihgted, the treatment given by the professionals, the territorialization and adscription of areas, the difficulty of having access to the services or sleepers and the reference and counterreference. But also, the ausence or few greet, the lack of communication, few assiduity and ponctuality by professionals in service, among others. In a general way mothers considers the attendance received in the hospital good and very good , opnions that in the Basic Attention weren t so favorable, in spite of many of predictible actions in this level have been performed in the studied cases. It is observed, therefore, that the social determinants of health has a strong influence in ocurrence of infant deaths, what implicates in a large actuation by Infant Mortality Committee from municipal district. This way, it becomes fundamental the reflection and evaluation about the effectiveness and execution by the processes of vigilance to health in FHUs; the rethink about the social determinants of health in a wide and articulate way to the services quality, to permanent education, to management in service, to the given attention and to the way how it is installed the popular participation and social control. To the professionals it is presented the great challenge to review their daily practice, their values, behaviors and commitment, which ones must be guided by logical of sharing, work in team, humanescence and alterity, not only by the accomplishment of a professional duty

As ações de controle da tuberculose na atenção primária à saúde: a visão do doente

Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health.

Uma avaliação do serviço de atenção domiciliar/programa melhor em casa: o caso do hospital Monsenhor Walfredo Gurgel

This dissertation try to understand how management actions implemented by Monsenhor Walfredo Gurgel Hospital in the city of Natal promote effectively the benefits of Home Care Services / Programa Melhor em Casa . The research is exploratory and descriptive, qualitative approach. Data were collected through document analysis and the interviews with the managers of the Program in Health Department and Hospital beyond the questionnaires with the home care teams and technical management unit of Hospital Jobs. The information were treatment trough categories that analyzed to implemented actions and program objectives. The results show that: the practices carried out by the host teams produce the humanization of care by seeking to ensure access to health services and solving human form; networks of health care are not yet finalized hindering the referral of patients to other units, the networks allow support from other institutions to minimize the problems encountered, the management unit vacancies allows the reduction of costs, mainly by regulating beds and record of health initiatives in home care assists in the monitoring and evaluation process of the Services Home Care / Programa Melhor em Casa primarily the epidemiological profile and patients individual treatment plan. Concludes that most of the actions implemented by the Hospital contribute to the effectiveness of the goals of Programa Melhor em Casa

A educação permanente em saúde na ótica dos cirurgiões dentistas

This study aimed to examine the perception of dentist-surgeon about the Permanent Education in Health (PEH). It is characterized as a qualitative research with focus in the field of public health policies. It refers specifically to the development of Permanent Education policy in Health in the state of Rio Grande do Norte. They were participants of this research 42 dentist surgeons and 83.3% females and 16.7% males, participants in Specialization courses approved and agreed by the Permanent Education Center in Health (PEC-RN) in the period 2005 to 2007. These professionals are part of the Family Health Strategy (FHS), and 11.9% work in management at the central level and 88.1% are directly related to oral health care in the Basic Health Units of the Family, 30 cities in the state. Data collection was through a questionnaire, with questions that guided the research development and achieve the objectives proposed. The socio-demographic data were analyzed using the descriptive statistics and subjective content was subjected to content analysis by Bardin. The emerging categories from the textual material generated by respondents were: program content, methodological approach and concepts of Permanent Education in Health. The subjects surveyed reported that the program content is more comprehensive and directs to the reflection of everyday practices, with regard to the methodological approach, concern that occurs through discussion and reflection with dynamic, participative, varied and constructive activities, questioning and putting as the main focus. As for understanding of the concepts of the PEH, there was a consensus that define as education stable strategies which contributing to transform and improve the health workers to have the upgrade, improvement of practices, being based on everyday experience and taking into account the accumulation and renewal of these experiences. Therefore, results presented showed that there is a clear understanding of the subjects on the proposals and guidelines of the PEH. It was concluded that lack continuous access to the policies proposed by Ministry of Health involving health workers, managers, communities, through social control and the teaching-service integration and that they are worked within the health system and can classify all these segments of society favor the existence of a more participatory, effective, fair and better quality health service

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

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

Avaliação da atenção ao recém-nascido de risco, na perspectiva de uma política pública de saúde

Objetivou-se avaliar a atenção à saúde de recém-nascidos de risco, acompanhados no primeiro ano de vida pelo Programa Crescer Feliz, desenvolvido em município do interior paulista. Trata-se de estudo epidemiológico populacional, do tipo avaliação de programa de saúde, que se baseou, para análise dos dados, nas diretrizes nacionais da Agenda de Compromissos da Criança. Os resultados evidenciaram a vulnerabilidade institucional do programa, decorrente de problemas relacionados à estrutura e processo, com implicações nos resultados. Considerando a adequação dos critérios adotados pelo programa, para definição dos recém-nascidos de risco e das intervenções e estratégias propostas, que se mostram em consonância com a Agenda de Compromissos, aponta-se a necessidade dos gestores priorizá-lo, inserindo-o, efetivamente, na política pública de saúde a ser desenvolvida no âmbito do município, para reversão da vulnerabilidade institucional identificada.