Práticas educativas e integralidade na saúde da família: um estudo etnográfico

Primary Health Care, especially in the family health strategy, it is expected that the joint assistance and actions of health promotion. The Ministry of health (BRAZIL, 2007) defines health education as an eyeshadow strategy of prevention and health promotion, based on reflective practices, which allow the user to their condition of historical, social and political subject, under the vision of an expanded clinic on the part of health professionals. In this sense, there are guidelines for it professionals to develop educational activities and that they can interfere in the health/disease process of the population, with a view to the development of autonomy of the subject. This research had as objective to understand in the light of the integrality of the care, as is the production of health education practices, within the framework of the family health strategy from ethnographic study in a family health unit (USF). The location of the research was the unit of USF Felipe Camarão II in West Health District, in the city of Natal, RN, Brazil, selected from preliminary mapping of educational practices deployed in units of health of the family of this municipality, based on criteria such as time-to-deployment of USF and sustainability of existing actions. Immersion in the field consisted of participant observation with journaling, held during the period of August 2012 to January 2013, in which she accompanied team work processes in clinical-welfare actions on the USF, in households and in educational activities of group character. The results presented in ethnographic description were analyzed based on the axes proposed by Ayres (2009) for identification of integrality in health practices:the axis of the needs; the axis of the purposes; the joint axis; and the axis of the interactionsThe evidence described from observation point the presence of each axle up health education practices developed by the teams, even incipient form, namely: articulation and appreciation of knowledge and practices of popular culture with local initiatives (Pastoril do Peixe Boi Encantado, Auto de Natal e Grupo Terapia e Arte); Clinical integration with health promotion actions and coordination of multidisciplinary knowledge, with professional-user link (course for pregnant women). However, a few challenges were identified to be faced in order to move forward in these practices in integral care: the need to break with the fragmentation of actions; strengthening teamwork; need for greater sustainability policy of collective actions; intersectoral work aimed at a better role of the State in the face of the health-disease process, adding to the action of individuals.The analysis produced from observation of the processes experienced indicates the need for a better recognition of local managers that actions similar to those that occur in the USF Felipe Camarão II enable advances in completeness as allows inclusion of actors involved in the processes of health work, and stimulate participation and shared responsibility in the fight for health-disease situations

Integralidade do cuidado com o idoso na estrategia de saude da familia: visao da equipe

Tal estudo buscou compreender como vem sendo realizado o cuidado ao idoso em Unidade de Saúde da Família segundo a visão dos profissionais de saúde.MÉTODOS:Estudo qualitativo, com a análise fenomenológica social de Alfred Schutz.RESULTADOS:Foram entrevistados sete profissionais de nível superior por meio de questão norteadora. A análise possibilitou evidenciar: cuidados pautados em programas de saúde, com prejuízo da integralidade do cuidado e da clínica ampliada, e visão das necessidades e perspectivas do cuidado integral.CONCLUSÃO:O estudo revela a necessidade de avançarmos no cuidado ao idoso. Os profissionais reconhecem o envelhecimento da população e apontam a necessidade de capacitação para o cuidado. A educação dos trabalhadores se dá como ponto de partida para a mudança. Também é preciso que os gestores e o Estado organizem uma rede de cuidado que inclua a pessoa idosa, com ofertas de serviços de acordo com a demanda apresentada.

Educação em saúde para atenção à gestante: paralelo de experiências entre Brasil e Portugal

Care practices have raised some questions concerning the attention given to women, specifically when it comes to issues of extreme importance in Public Health's approach of pre-natal care. The present study intends to discuss the scope and challenges of the integral care in maternal health, taking into consideration the experiences of one of the authors in the health scenarios from both Brazil and Portugal. A comparative analysis was conducted on the format of the pre-natal classes offered to groups of pregnant women, a frequent practice of Primary Care in both countries. The method of participant observation of two groups of pregnant women, one in each country was used. The organization of each group is presented and evaluated regarding its methodological and practical settings. The analysis of the experiences indicates that both groups can be considered as informative or educative, since the chosen methodology and structure was formed by lectures with predefined themes; there was reduced reflection and empowerment possibilities, due to the fragmented presentation form, and this could also mean diminished reflection on the changes of the feminine role. It is thus concluded that the need for offering care for women in different periods of their lives should include a continuous fight for an amplified and integral approach, with emphasis in the care network and in health promotion.

Acolhimento na estratégia saúde da família: o que dizem os usuários?

The objective of the National Humanization Policy (NHP) is to humanize relations between professionals and users. It is guided by the proposal of expanded clinic and proposes the embracement as a strategy for its existence. The embracement requires qualified hearing, the provision of adequate technologies and the establishment of relations for better solving health problems of users. The objective of this study was to evaluate user satisfaction of the Family Health Strategy (FHS) regarding the embracement from the perspective of qualified hearing and improved relations in the city of Recife- PE. In this quantitative, qualitative, evaluative and cross-sectional study, 297 users of the services offered by the FHS were interviewed in six health districts of the city. For data collection, the Satisfaction Rating Scale of users with Mental Health Services - Satis-BR- abbreviated and adapted to the subject embracement was used. Quantitative data were analyzed by using the software Statistical Package for Social Science (SPSS) 17.0, calculating the absolute and relative frequencies. Qualitative data were analyzed by content analysis of Bardin with the elaboration of thematic categories. The results indicate that most users are satisfied with the embracement offered by the teams. About 66% reported being very or fairly heard by professionals; 80.2% reported to have obtained some or much help when searched for embracement; 64.6% indicated that the embracement is friendly or very friendly. Regarding ambience, 55.9% of users demonstrated indifference and dissatisfaction with comfort and appearance; regarding general facilities of the service, 69.4% reported as regular to awful. Three thematic categories were revealed by the speeches: satisfaction with embracement, dissatisfaction with the ambience, and suggestions for improvements in embracement and service. This study contributed to the understanding that both the hearing and relations are present in the embracement of the city and also to demonstrate that the ambience is a possible weakness in the opinion of the users.

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

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

Matriciamento em saúde mental: atuação de núcleos de apoio à saúde da família

In the context of break with psychiatric hospitals, the Brazilian Psychiatric Reform is a historical process of reformulation of knowledge and mental health practices. In this way, the Centers of Support for Family Health (NASF) have been acting in the supply of matrix support in mental health. So, the present research aims to analyze the actions which the NASF is taking for the matrix support in mental health in the city of Natal/RN. This is a kind of research descriptive, exploratory and qualitative. The data collection, was made by a direct observation of the professional pratices and semi-structured interviews with health professionals NASF's. The Data were analyzed according to thematic analysis technique, with the support of the content analysis method, which is a way to investigate clusters of meanings which make up the communication of the investigated object. Three analytical categories were organized by this method, whose titles were inspired in two theories in the health field called “Health to Paidéia” and “Expanded Clinic”. The name of the categories are: 1. “Mental illness in brackets: working dimensions of the Centers of Support for Family Health interfaces with the concrete subject”, which is about the work process of NASF; 2. “Freedom and engagement in the arrangement of matrix support in mental health”, which explore the matrix support limitations in mental health in Natal/RN from the professionals interviewed at the NASF’s; 3. “Between the desire and interest: influence of expert orientation in mental health in Psychosocial Care Network” (RAPS), which is related to matrix support in mental health, as an organizational arrangement responsible to ensure intersectoral and comprehensive care, strategies inside of context of the constitution of RAPS. We can extract and say that the actions of NASF teams in the brazilian city called Natal/RN, still not part of a structured link with health care networks, as happens with the absence of discussions and lack of professionals in the matrix support. In addition, there is a difficulty to do an specialized orientation in mental health because of the lack of human resources in this area and of the insufficient number of the replacement services for psychiatric hospital pratices, bringing up the discussion about the consolidation and expansion of RAPS in fact investigated.

Estimated Disability-adjusted Life Years Averted By Long-term Provision Of Long Acting Contraceptive Methods In A Brazilian Clinic.

What is the contribution of the provision, at no cost for users, of long acting reversible contraceptive methods (LARC; copper intrauterine device [IUD], the levonorgestrel-releasing intrauterine system [LNG-IUS], contraceptive implants and depot-medroxyprogesterone [DMPA] injection) towards the disability-adjusted life years (DALY) averted through a Brazilian university-based clinic established over 30 years ago. Over the last 10 years of evaluation, provision of LARC methods and DMPA by the clinic are estimated to have contributed to DALY averted by between 37 and 60 maternal deaths, 315-424 child mortalities, 634-853 combined maternal morbidity and mortality and child mortality, and 1056-1412 unsafe abortions averted. LARC methods are associated with a high contraceptive effectiveness when compared with contraceptive methods which need frequent attention; perhaps because LARC methods are independent of individual or couple compliance. However, in general previous studies have evaluated contraceptive methods during clinical studies over a short period of time, or not more than 10 years. Furthermore, information regarding the estimation of the DALY averted is scarce. We reviewed 50 004 medical charts from women who consulted for the first time looking for a contraceptive method over the period from 2 January 1980 through 31 December 2012. Women who consulted at the Department of Obstetrics and Gynaecology, University of Campinas, Brazil were new users and users switching contraceptive, including the copper IUD (n = 13 826), the LNG-IUS (n = 1525), implants (n = 277) and DMPA (n = 9387). Estimation of the DALY averted included maternal morbidity and mortality, child mortality and unsafe abortions averted. We obtained 29 416 contraceptive segments of use including 25 009 contraceptive segments of use from 20 821 new users or switchers to any LARC method or DMPA with at least 1 year of follow-up. The mean (± SD) age of the women at first consultation ranged from 25.3 ± 5.7 (range 12-47) years in the 1980s, to 31.9 ± 7.4 (range 16-50) years in 2010-2011. The most common contraceptive chosen at the first consultation was copper IUD (48.3, 74.5 and 64.7% in the 1980s, 1990s and 2000s, respectively). For an evaluation over 20 years, the cumulative pregnancy rates (SEM) were 0.4 (0.2), 2.8 (2.1), 4.0 (0.4) and 1.3 (0.4) for the LNG-IUS, the implants, copper IUD and DMPA, respectively and cumulative continuation rates (SEM) were 15.1 (3.7), 3.9 (1.4), 14.1 (0.6) and 7.3 (1.7) for the LNG-IUS, implants, copper IUD and DMPA, respectively (P < 0.001). Over the last 10 years of evaluation, the estimation of the contribution of the clinic through the provision of LARC methods and DMPA to DALY averted was 37-60 maternal deaths; between 315 and 424 child mortalities; combined maternal morbidity and mortality and child mortality of between 634 and 853, and 1056-1412 unsafe abortions averted. The main limitations are the number of women who never returned to the clinic (overall 14% among the four methods under evaluation); consequently the pregnancy rate could be different. Other limitations include the analysis of two kinds of copper IUD and two kinds of contraceptive implants as the same IUD or implant, and the low number of users of implants. In addition, the DALY calculation relies on a number of estimates, which may vary in different parts of the world. LARC methods and DMPA are highly effective and women who were well-counselled used these methods for a long time. The benefit of averting maternal morbidity and mortality, child mortality, and unsafe abortions is an example to health policy makers to implement more family planning programmes and to offer contraceptive methods, mainly LARC and DMPA, at no cost or at affordable cost for the underprivileged population. This study received partial financial support from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), grant # 2012/12810-4 and from the National Research Council (CNPq), grant #573747/2008-3. B.F.B., M.P.G., and V.M.C. were fellows from the scientific initiation programme from FAPESP. Since the year 2001, all the TCu380A IUD were donated by Injeflex, São Paulo, Brazil, and from the year 2006 all the LNG-IUS were donated by the International Contraceptive Access Foundation (ICA), Turku, Finland. Both donations are as unrestricted grants. The authors declare that there are no conflicts of interest associated with this study.

[between The Country And The Laboratory: The Dynamics Of The Production Of Knowledge At The Menopause Outpatients Clinic At Caism, Unicamp.]

This study investigates the practices involved in the production of knowledge about menopause at Caism, Unicamp, a reference center for public policies for women's health. Gynecological appointments and psychological support meetings were observed, and women and doctors were interviewed in order to identify what discourse circulates there and how different actors are brought in to ensure that the knowledge produced attains credibility and travels beyond the boundaries of the teaching hospital to become universal. The analysis is based on localized studies aligned with social studies of science and technology.

[between The Country And The Laboratory: The Dynamics Of The Production Of Knowledge At The Menopause Outpatients Clinic At Caism, Unicamp].

This study investigates the practices involved in the production of knowledge about menopause at Caism, Unicamp, a reference center for public policies for women's health. Gynecological appointments and psychological support meetings were observed, and women and doctors were interviewed in order to identify what discourse circulates there and how different actors are brought in to ensure that the knowledge produced attains credibility and travels beyond the boundaries of the teaching hospital to become universal. The analysis is based on localized studies aligned with social studies of science and technology.

Clinic and ambulatory blood pressure responses after resistance exercise

Queiroz, ACC, Gagliardi, JFL, Forjaz, CLM, and Rezk, CC. Clinic and ambulatory blood pressure responses after resistance exercise. J Strength Cond Res 23(2): 571-578, 2009-This study investigated clinic and ambulatory blood pressure (BP) responses after a single bout of low-intensity resistance exercise in normotensive subjects. Fifteen healthy subjects underwent 2 experimental sessions: control-40 minutes of seated rest, and exercise-6 resistance exercises, with 3 sets of as many repetitions as possible until moderate fatigue, with an intensity of 50% of 1-repetition maximum (1RM). Before and for 60 minutes after interventions, clinic BP was measured by auscultatory and oscillometric methods. Postintervention ambulatory BP levels were also measured for 24 hours. In comparison with preintervention values, clinic systolic BP, as measured by the auscultatory method, did not change in the control group, but it decreased after exercise (-3.7 +/- 1.6 mm Hg, p < 0.05). Diastolic and mean BP levels increased after intervention in the control group (+3.4 +/- 1.0 and +3.0 +/- 0.8 mm Hg, respectively, p, 0.05) and decreased in the exercise group (-3.6 +/- 1.7 and -3.4 +/- 1.4 mm Hg, respectively, p < 0.05). Systolic and mean oscillometric BP levels did not change after interventions either in the control or exercise sessions, whereas diastolic BP increased after intervention in the control group (+5.0 +/- 1.7 mm Hg, p < 0.05) but not change after exercise. Ambulatory BP behaviors after interventions were similar in the control and exercise sessions. Significant and positive correlations were observed between preexercise values and postexercise clinic and ambulatory BP decreases. In conclusion, in the whole sample, a single bout of low-intensity resistance exercise decreased postexercise BP under clinic, but not ambulatory, conditions. However, considering individual responses, postexercise clinic and ambulatory hypotensive effects were greater in subjects with higher preexercise BP levels.

Friere`s Dialogic Concept Enables Family Health Program Teams to Incorporate Health Promotion

Objective The study analyzes the possibility of incorporating health promotion measures into the work processes of Family Health Program teams at a primary health care clinic in Brazil. Design and Sample We used the participatory research concept developed in 1968 by Freire. The study sample comprised the end-users of the health care system, together with 3 multidisciplinary teams. A total of 77 health care users and 55 health professionals participated in the study. Measures Culture circles composed of health care professionals, and users from different areas investigated generative topics, encoded/decoded topics, and engaged in critical probing for clarification. Topics affecting quality of life and health were heuristically evaluated. Results Although most topics were related to changing the focus of health care facilities, some were related to subsidizing community-based interventions, improving environmental strategies, individual skills, and public policies. Incorporating the novel health promotion measures and creating an expanded full-treatment clinic are important steps toward that goal. Conclusions Topics that can stimulate dialogue among the members of the culture circles include creating an environment of closer cultural contact, with repercussions for work processes, family health models, and general health models, as well as the inclusion of social aspects in the decision-making processes related to health issues that affect the living conditions of the population.

X-ray diffraction characterisation of expanded austenite and ferrite in plasma nitrided stainless steels

The S phase, known as expanded austenite, is formed on the surfaces of austenitic stainless steels that are nitrided under low temperature plasma. A similar phase was observed for nitrided ferritic stainless steels and was designed as expanded ferrite or ferritic S phase. The authors treated samples of austenitic AISI 304L and AISI 316L and ferritic AISI 409 stainless steels by plasma nitriding at different temperatures and then studied the structural, morphological, chemical and corrosion characteristics of the modified layers by X-ray diffraction, scanning electron microscopy/energy dispersive spectroscopy and electrochemical tests. For both austenitic AISI 304L and AISI 316L stainless steels, the results showed that a hard S phase layer was formed on the surfaces, promoting an anodic polarisation curve displacement to higher current density values that depend on the plasma nitriding temperature. A layer having a high amount of nitrogen was formed on the ferritic AISI 409 stainless steel. X-ray diffraction measurements indicated high strain states for the modified layers formed on the three stainless steels, being more pronounced for the ferritic S phase.

Anaerobic fluidized bed reactor with expanded clay as support for hydrogen production through dark fermentation of glucose

This study evaluated hydrogen production in an anaerobic fluidized bed reactor (AFBR) fed with glucose-based synthetic wastewater. Particles of expanded clay (2.8-3.35 mm) were used as a support material for biomass immobilization. The reactor was operated with hydraulic retention times (HRT) ranging from 8 to 1 h. The hydrogen yield production increased from 1.41 to 2.49 mol H(2) Mol(-1) glucose as HRT decreased from 8 to 2 h. However, when HRT was 1 h, there was a slight decrease to 2.41 mol H(2) Mol(-1) glucose. The biogas produced was composed of H(2) and CO(2), and the H(2) content increased from 8% to 35% as HRT decreased. The major soluble metabolites during H(2) fermentation were acetic acid (HAc) and butyric acid (HBu), accounting for 36.1-53.3% and 37.7-44.9% of total soluble metabolites, respectively. Overall, the results demonstrate the potential of using expanded clay as support material for hydrogen production in AFBRs. (c) 2008 International Association for Hydrogen Energy. Published by Elsevier Ltd. All rights reserved.

Impact on perinatal mortality of missed opportunities to treat maternal syphilis in rural South Africa: baseline results from a clinic randomized controlled trial

OBJECTIVE To demonstrate the impact on perinatal mortality of inadequate treatment for maternal syphilis despite adequate screening. METHOD In 12 clinics providing antenatal care in Hlabisa, South Africa 1783 pregnant women were screened for syphilis at their first antenatal visit between June and October 1998. Pregnancy outcome was determined among those with syphilis. RESULTS A total of 158 women were diagnosed with syphilis: prevalence 9% (95% CI 8-10%). Mean gestation at first antenatal visit was 24 weeks. Thirty women (19%) received no treatment and 96 (61%) received all three recommended doses of penicillin. Among those receiving at least one dose, mean delay to the first dose was 20 days. Among those fully treated mean delay to treatment completion was 34 days. Pregnancy outcome was known for 142 women (90%) and there were 17 perinatal deaths among 15 women (11%). Eleven of 43 women (26%) who received one or fewer doses of penicillin experienced ii perinatal death whilst only four of 99 women (4%) who received two or more doses of penicillin did so (P = 0.0001). Protection from perinatal death increased with the number of doses of penicillin: linear modelling suggests that one dose reduced the risk by 41%, two doses by 65% and three doses by 79%, compared with no doses. A dose-specific, categorical model confirmed reduction in risk by 79% for all three doses. CONCLUSION Despite effective screening, many pregnant women with syphilis remain inadequately treated, resulting in avoidable perinatal mortality. Delays in starting and finishing treatment, as well as incomplete treatment occur. Near-patient syphilis testing in the antenatal clinic with early treatment could improve treatment of syphilis and reduce perinatal mortality, and a randomized trial to test this is underway.

Cytokine expanded myeloid precursors function as regulatory antigen presenting cells and induce tolerance through IL-10 producing regulatory T cells

The initiation of graft vs. host disease (GVHD) after stem cell transplantation is dependent on direct antigen presentation by host antigen presenting cells (APC) while the effect of indirect antigen presentation by donor APC is unknown. We have studied the role of indirect antigen presentation in allogenic responses by adding populations of cytokine-expanded donor APC to haematopoietic grafts that would otherwise induce lethal GVHD. Progenipoietin-1 (a synthetic G-CSF/Flt-3 L molecule) and G-CSF expanded myeloid DC, plasmacytoid DC and a novel granulocyte-monocyte precursor population (GM) that differentiate into class IIpos, CD80/CD86pos, CD40neg APC during GVHD. Whereas addition of plasmacytoid and myeloid donor DC augmented GVHD, GM cells induced transplant tolerance via MHC class II restricted generation of IL-10-secreting regulatory T cells. Thus a population of cytokine expanded granulocyte-monocyte precursors function as regulatory antigen presenting cells, suggesting that G-CSF derivatives may have application in disorders characterised by a loss of self-tolerance.