Alberto Durán González

Integralidade da saúde: norteando mudanças na graduação dos novos profissionais

The strong changes happened in the health sector with the creation of the Brazilian Unified Health System had forced a reflexion about the formation of the new health professionals. However, the substitution of the dominant health care system, centered in the illness, hospital and super specialized assistance, by attentions models that value the integrality, the humanized care and the healths promotion, was not yet conquered and depends, in great measured, on the formations profile and the practice of the health professionals. It is in the distance between the new professionals formation and the users necessities of the system that is the great obstacle of the relation of health services and health education. This essay tries to formulate an understanding about the necessity of a more integral formation for a more integral service. It aims to give subsidize to affirm that the integrality of the health actions must be preceded by the integrality of the thought and health education.

Relações entre concepções e práticas de educação em saúde na visão de uma equipe de saúde da família

Este estudo objetiva analisar as concepcoes de educacao em saude de profissionais da equipe de Saude da Familia e pensar criticamente sobre a relacao estabelecida entre as praticas de educacao em saude e os discursos desses trabalhadores. Trata-se de uma pesquisa qualitativa que adota a analise de discurso como referencial teorico e tecnicas de observacao e entrevistas para a producao dos dados. Os modelos curativos e de transmissao do conhecimento encontram-se fortemente arraigados na concepcao e nas praticas de educacao em saude, prevalecendo uma relacao vertical, impositiva, superior, na qual o profissional e o detentor do saber. Os trabalhadores sentem-se educadores, e observa-se uma postura que considera o processo de trabalho educativo voltado para o aprendizado mutuo e o respeito aos conhecimentos previos da populacao, porem essa percepcao encontra-se presente somente em seu discurso, necessitando ser incorporada a sua pratica para que haja a mudanca nos servicos de saude. Verificou-se a necessidade de maior valorizacao do papel do trabalhador como sujeito propulsor de mudancas na pratica educativa e no modelo de atencao em saude vigente, bem como a importância do reconhecimento do usuario como sujeito atuante na propria saude e com capacidade de intervencao na sua realidade.

Movimentos de mudança na formação em saúde: da medicina comunitária às diretrizes curriculares

Este ensaio busca refletir as diversas iniciativas pro-mudanca na formacao superior em saude implantadas no Brasil. Esta analise historica faz-se necessaria tendo em vista a importância da sistematizacao e difusao das experiencias anteriores para o auxilio na construcao das novas propostas pro-mudanca. Estamos hoje refletindo sobre processos ativos de ensino-aprendizagem por termos vivenciado propostas como a da Medicina Comunitaria, o Projeto de Integracao Docente Assistencial, o Programa UNI, o movimento da Rede UNIDA, a Lei de Diretrizes Curriculares, Educacao Permanente em Saude e o Curso de Ativadores. Avancamos a partir da construcao da tentativa anterior. Nao e necessaria a descoberta da roda a todo momento. Ela pode ser adaptada e voltar a girar. O olhar para as experiencias do passado e para as necessidades do presente ajuda na construcao do futuro almejado.

Prevalência de fatores de risco cardiovascular em pessoas com 40 anos ou mais de idade, em Cambé, Paraná (2011): estudo de base populacional

Objective: to estimate the prevalence of cardiovascular disease risk factors by sex and socioeconomic status. Methods: cross-sectional population-based representative sample of people aged 40 or older, living in Cambe-PR. Household interviews were conducted, collecting anthropometric measurements and laboratory tests in the first half of 2011. Prevalence, prevalence ratios (PR) and 95% confidence intervals (95% CI) were calculated. Results: 1,180 people were interviewed. Most prevalent risk factors were physical inactivity during leisure (71.4%), overweight/obesity (68.3%), hypertension (55.9%) and low consumption of fruit (54.3%) and vegetables (35.5%). Overweight/obesity prevalence was lower among men compared to women (PR 0.82, 95% CI 0.73-0.92). Physical inactivity during leisure, as well as low fruit and vegetable consumption were more prevalent among men and women of lower socioeconomic classes. Conclusion: high cardiovascular disease risk factor prevalence was found, especially among individuals from lower socioeconomic classes.

The Association of Chronic Neck Pain, Low Back Pain, and Migraine With Absenteeism Due to Health Problems in Spanish Workers

Study Design. Cross-sectional. Objective. To examine whether 3 types of chronic pain are associated with absenteeism and with the number of days absent from work in the general population of Spain. Summary of Background Data. Chronic pain has been associated with absenteeism, but most of the evidence is based on unadjusted analyses and on specific professional categories. Methods. A cross-sectional analysis was performed on the basis of data of 8283 Spanish workers. Chronic pain was ascertained from self-reported information on frequent symptoms of pain in the low back and neck and/or migraine in the last 12 months. Absenteeism was defined as missing at least 1 day from work because of health problems. Multivariate regression models were adjusted for the main confounders. Results. Health-related absenteeism was reported by 27.8% of subjects. The prevalence of chronic pain was reported to be 12.3% in the neck, 14.1% in the low back, and 10.3% migraine. In adjusted analyses, absenteeism was associated with chronic neck pain (odds ratio: 1.20; 95% confidence interval [CI], 1.02–1.40), low back pain (odds ratio: 1.22; 95% CI, 1.06–1.42), and migraine (odds ratio: 1.22; 95% CI, 1.04–1.44). These associations were strongest in younger (18–34 yr) rather than in older workers. Furthermore, those who reported frequent pain in the neck and low back were 44% more likely to be absent for more than 30 days in the past year than those who did not report these symptoms. Conclusion. Spanish workers with chronic pain were more likely to be absent from work and to stay absent from work for longer. These associations are independent of sociodemographic characteristics, occupation, lifestyle, health status, and analgesics use. Level of Evidence: N/A

Risk factors for foot ulcers—A cross sectional survey from a primary care setting in Brazil

AIMS To identify the prevalence of higher risk of foot ulceration and associated factors among patients with diabetes mellitus (DM) at primary health care services. METHODS Individuals with DM, registered at primary health care services in a municipality in southern Brazil, were interviewed and underwent foot examinations. Their risk of ulceration was classified in accordance with the recommendations of the International Working Group on the Diabetic Foot. Poisson bivariate and multivariate analyses were performed and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. RESULTS The prevalence of higher risk of foot ulceration among the 337 interviewees was 27.9% (95% CI 23.1-32.9). The following factors were associated with this risk: having been diagnosed with DM for more than 10 years (Adjusted-PR 1.669; 95% CI 1.175-2.373; p=0.004); having had previous diagnoses of acute myocardial infarction (Adjusted-PR 1.873; 95% CI 1.330-2.638; p<0.001) and stroke (Adjusted-PR 1.684; 95% CI 1.089-2.604; p=0.019); presenting interdigital mycosis (Adjusted-PR 1.539; 95% CI 1.030-2.300; p=0.035) and calluses (Adjusted-PR 1.654; 95% CI 1.117-2.451; p=0.012). CONCLUSIONS The prevalence of higher risk of ulceration was high, which reinforces the importance of continued education for health care professionals in order to prevent complications in the feet of these patients.

Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies

Burnout is a syndrome that results from chronic stress at work, with several consequences to workers’ well-being and health. This systematic review aimed to summarize the evidence of the physical, psychological and occupational consequences of job burnout in prospective studies. The PubMed, Science Direct, PsycInfo, SciELO, LILACS and Web of Science databases were searched without language or date restrictions. The Transparent Reporting of Systematic Reviews and Meta-Analyses guidelines were followed. Prospective studies that analyzed burnout as the exposure condition were included. Among the 993 articles initially identified, 61 fulfilled the inclusion criteria, and 36 were analyzed because they met three criteria that must be followed in prospective studies. Burnout was a significant predictor of the following physical consequences: hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries and mortality below the age of 45 years. The psychological effects were insomnia, depressive symptoms, use of psychotropic and antidepressant medications, hospitalization for mental disorders and psychological ill-health symptoms. Job dissatisfaction, absenteeism, new disability pension, job demands, job resources and presenteeism were identified as professional outcomes. Conflicting findings were observed. In conclusion, several prospective and high-quality studies showed physical, psychological and occupational consequences of job burnout. The individual and social impacts of burnout highlight the need for preventive interventions and early identification of this health condition in the work environment.

Tendência da epidemia de casos de aids no Sul do Brasil no período de 1986 a 2008

OBJECTIVE To describe trends in the incidence of Aids cases according to age and gender from 1986 to 2008. METHODS Analyses of Aids trends according to age group and to gender was carried out Londrina, Southern Brazil. The timeframe was divided into two periods (1986-1995 and 1996-2008). Of the polynomial models, it was the first-degree polynomial model which best explained the Aids epidemic within the two periods. The incidence rate of Aids among men who have sex with other men (MSM), injecting drug users (IDU), heterosexual men and women was calculated. RESULTS During the first period, from 1986 to 1995, there was an increase in the incidence of Aids in almost all age groups and the epidemic spread across both sexes (p < 0.001), although this was more marked in men aged 14-39. The second period (1996-2008) did not show a positive or negative statistical increase, indicating that the epidemic had stabilized. A significant fall in the rate for the male 14 to 29 age group was found, with increases of 0.88 and 0.87 for the first and second period respectively. Cases in women aged 50 and over showed a marked increase (p = 0.019). The IDU and MSM groups predominated as the categories with the most exposure, with MSM taking over from IDU in the last three years of the study. From 2000 onwards, incidences in females aged 15 to 49 overtook that of heterosexual men. CONCLUSIONS The study showed a decrease in incidence in the younger age groups and stabilization in the other age groups. There is a need for different approaches in order to reach groups with several characteristics due to the increase in the proportion of women and MSM within the exposure categories.OBJETIVO: Descrever a tendencia dos casos de aids por sexo e faixa etaria de 1986 a 2008. METODOS: Foi analisada a tendencia da aids por faixa etaria e por sexo, em Londrina, PR, em dois periodos: 1986-1995 e 1996-2008. Dentre os modelos polinomiais, o de primeiro grau explicou melhor a tendencia da epidemia da aids nos dois periodos. Foram calculadas as taxas de incidencia para homens que fazem sexo com homens (HSH), usuarios de drogas injetaveis (UDI), homens heterossexuais e mulheres. RESULTADOS: No primeiro periodo, de 1986 a 1995, houve incremento das taxas de incidencia em quase todas as faixas etarias e crescimento da epidemia em ambos os sexos (p < 0,001), mais acentuado em homens de 14 a 39 anos. O segundo periodo (1996-2008) nao apresentou incremento estatistico positivo ou negativo, indicando estabilizacao da epidemia. Verificou-se que ocorreu queda significativa na faixa de 14 a 29 anos no sexo masculino, com incremento de 0,88 no primeiro periodo e 0,87 no segundo. Mulheres de 50 anos e mais apresentaram aumento significativo (p = 0,019). Os grupos UDI e HSH predominaram como categorias de exposicao e HSH ultrapassou UDI no ultimo trienio do estudo. A partir de 2000, a taxa de incidencia entre mulheres de 15 a 49 anos superou a de homens heterossexuais. CONCLUSOES: Houve queda nas taxas de incidencia nas faixas etarias mais jovens e estabilizacao nas demais idades. O aumento da proporcao de mulheres e do predominio de HSH entre as categorias de exposicao aponta para necessidade de estrategias diferenciadas para atingir grupos com caracteristicas diversas.

A educação em saúde na relação usuário-trabalhador no cotidiano de equipes de saúde da família

The scope of this research was to analyze how the practice of health education occurs in the informal user-worker relationship, and the strategies used for its implementation in routine primary care. It is a qualitative study conducted with two Family Health teams and the data was collected through observation and semi-structured interviews and assessed using discourse analysis. Health education in the informality of professional-user relations occurs in everyday conversations and guidance, and permeates the various issues involving the needs of users. Workers present educational strategies that occur in a non-structured manner, some of which portray a differentiated way of implementing educational practice, though most of these are restricted to the transfer of information, in which employees seek to transfer/inform reinforcing their attitude of imposition and control of know-how they consider to be right. It is necessary to rethink and enhance health education as labor technology, which reveals different processes for action in health, reorienting the practice into meaningful learning, which promotes change among users, workers, and in the current healthcare model.

Cross-cultural adaptation and validation of the Newest Vital Sign (NVS) health literacy instrument in general population and highly educated samples of Brazilian adults

OBJECTIVE The present work aimed at cross-cultural adaptation and validation of the health literacy assessment tool Newest Vital Sign (NVS) in general population (GP) and highly educated (HE) samples of Brazilian adults. DESIGN An expert committee reviewed the translation and back-translation processes and the cultural adaptation. The construct validity was analysed with confirmatory factor analysis and via associations with features of the study population. SETTING The final validation test was performed in two different populations from Londrina, a large town in southern Brazil. SUBJECTS Brazilian adults: GP (adult clients of community pharmacies; n 189) and HE (public school teachers; n 301). RESULTS The tool under validation showed good cross-cultural adaptation and internal consistency, with Cronbachs α of 0·75 for GP and 0·74 for HE. Confirmatory factor analysis showed acceptable models and identified two independent factors according to the relationship between components and numeracy for both GP and HE data. According to the Brazilian Portuguese version of the NVS instrument (NVS-BR), 48·7 % of GP and 33·5 % of HE presented adequate health literacy; this condition was inversely associated with age for both populations and directly correlated with educational level for GP. CONCLUSIONS The NVS-BR showed good validity in two different populations of Brazilian adults and can be considered an alternative in screening for inadequate health literacy.