Ana Cecília de Sousa Bastos

Ambiente familiar e desenvolvimento cognitivo infantil: uma abordagem epidemiológica

OBJETIVO: Analisar a associacao entre a qualidade do estimulo domestico e o desempenho cognitivo infantil, identificando o impacto da escolaridade materna sobre a qualidade dessa estimulacao. METODOS: Estudo de corte transversal, com 350 criancas entre 17 e 42 meses, examinadas em 1999, em areas centrais e perifericas de Salvador, Estado da Bahia. Utilizou-se um questionario socioeconomico, o inventario Home Observation for Measurement of the Environment Scale (HOME) para mensurar a estimulacao no ambiente familiar, e a escala Bayley de desenvolvimento infantil. Foram realizadas analises univariadas e multiplas, por meio da regressao linear, considerando nivel de significância de 5%. RESULTADOS: Encontrou-se associacao positiva (beta=0,66) e estatisticamente significante entre a qualidade da estimulacao no ambiente domestico e o desempenho cognitivo infantil. Parte do efeito da estimulacao sobre a cognicao foi mediada pela condicao materna de trabalho e seu nivel de escolaridade. Verificou-se que as criancas ocupando as primeiras ordens de nascimento, convivendo com reduzido numero de menores de cinco anos, usufruem de melhor qualidade da estimulacao no ambiente domestico. Esse padrao de estimulacao se mantem entre criancas convivendo com seus pais, cujas maes possuem melhor escolaridade, trabalham fora e convivem com companheiros no ambiente familiar. CONCLUSOES: Confirma-se a importância da qualidade do estimulo domestico para o desenvolvimento cognitivo infantil, alem do relevante papel das condicoes materiais e dinâmica familiar. Os achados apontam a pertinencia de acoes de intervencao que favorecam a qualidade do ambiente e da relacao cuidador-crianca para o desenvolvimento cognitivo.

Estudo etnográfico da satisfação do usuário do Programa de Saúde da Família (PSF) na Bahia

O presente estudo consiste em uma avaliacao qualitativa de satisfacao de usuarios em areas cobertas pelo Programa de Saude da Familia/PSF, situadas em cinco municipios da Bahia. Foram consideradas nesta avaliacao as seguintes dimensoes: cognitiva, relacional, organizacional e profissional; vistas tambem sob o ponto de vista das equipes de saude da familia. Tendo em vista as criticas apontadas pela literatura quanto as limitacoes metodologicas em estudos que avaliam a satisfacao de usuarios, notadamente vieses ligados a desejabilidade social ou a reducao do processo subjetivo de avaliacao a respostas do tipo sim/nao em questionarios fechados, privilegiamos neste caso estrategias metodologicas de cunho etnografico. A partir da tecnica de grupos focais, os usuarios expressaram sua percepcao sobre o programa e os servicos oferecidos pelas equipes, ao tempo que revelavam suas necessidades e expectativas de satisfacao das mesmas.

O impacto sócio-cultural do Programa de Saúde da Família (PSF): uma proposta de avaliação

This paper develops a critical analysis of the implications of defining the family as an object of intervention in health, taking as reference case the Family Health Program and proposing an evaluation of its socio-cultural impact. As a strategic space for manifestation, confrontation, and therefore observation of the health-illness process, the family requires a multidisciplinary approach to its structure, dynamics, and behavior in the face of health-related problems, determinants, and actions. We present a proposal for assessment of the Family Health Program based on the premise that problems and practices in the health field are socio-culturally determined.

Determinants of cognitive function in childhood: A cohort study in a middle income context

BackgroundThere is evidence that poverty, health and nutrition affect childrens cognitive development. This study aimed to examine the relative contributions of both proximal and distal risk factors on child cognitive development, by breaking down the possible causal pathways through which poverty affects cognition.MethodsThis cohort study collected data on family socioeconomic status, household and neighbourhood environmental conditions, child health and nutritional status, psychosocial stimulation and nursery school attendance. The effect of these on Wechsler Pre-School and Primary Scale of Intelligence scores at five years of age was investigated using a multivariable hierarchical analysis, guided by the proposed conceptual framework.ResultsUnfavourable socioeconomic conditions, poorly educated mother, absent father, poor sanitary conditions at home and in the neighbourhood and low birth weight were negatively associated with cognitive performance at five years of age, while strong positive associations were found with high levels of domestic stimulation and nursery school attendance.ConclusionChildrens cognitive development in urban contexts in developing countries could be substantially increased by interventions promoting early psychosocial stimulation and preschool experience, together with efforts to prevent low birth weight and promote adequate nutritional status.

Conhecimento sobre desenvolvimento infantil em mães primíparas de diferentes centros urbanos do Brasil

Cognicoes parentais constituem importante componente do contexto sociocultural em que se da o desenvolvimento infantil, e a literatura brasileira sobre o tema e ainda escassa. O objetivo deste estudo e analisar a relacao entre conhecimento sobre desenvolvimento infantil e variaveis da mae e do bebe. Foi estudada uma amostra de 405 maes primiparas, com filhos menores de um ano, distribuida por seis cidades em diferentes regioes do Brasil. Utilizou-se o Inventario do Conhecimento do Desenvolvimento Infantil (KIDI). Foram encontrados efeitos significativos de escolaridade materna e centro urbano. O efeito significativo de escolaridade materna foi verificado em todas as cidades, menos em Porto Alegre, possivelmente pelas politicas de atencao materno-infantil ai implementadas. Estes resultados contribuem para o conhecimento de aspectos do contexto de desenvolvimento de criancas brasileiras, e tem implicacoes para o planejamento de programas de intervencao que visem a promocao de saude.

Práticas de atenção à saúde no contexto familiar: um estudo comparativo de casos

This paper examined everyday health care practices focusing on families with different structures and socioeconomic status, following an ethnographical study with ten low-income families and six middle-income families. Four families (single-mother versus new marital arrangement) were selected to the present analysis. The comparative analysis described the resources and strategies utilized and the social network available for each pair of families. The results suggested that, in all families, the mother is the most important caretaker when it comes to health problems. The expression institutionalized helplessness was employed to describe the insufficient resources available to poor families. The middle-income families showed consistently more preventive behaviors. The overworked single-mothers were characterized at the same time as caretakers and providers. This characteristic is presented as a risk to the family. The results were helped the understanding of mechanisms of risk-protection to health and to health promotion in family context.

Determinants of early cognitive development: hierarchical analysis of a longitudinal study

The study describes the relationship between anthropometric status, socioeconomic conditions, and quality of home environment and child cognitive development in 320 children from 20 to 42 months of age, randomly selected from 20,000 households that represent the range of socioeconomic and environmental conditions in Salvador, Bahia, Northeast Brazil. The inclusion criterion was to be less than 42 months of age between January and July 1999. Child cognitive development was assessed using the Bayley Scales for Infant Development, and the Home Observation for Measurement of the Environment Inventory (HOME) was applied to assess quality of home environment. Anthropometric status was measured using the indicators weight/age and height/age ratios (z-scores), and socioeconomic data were collected through a standard questionnaire. Statistical analysis was conducted through univariate and hierarchical linear regression. Socioeconomic factors were found to have an indirect impact on early cognitive development mediated by the childs proximal environment factors, such as appropriate play materials and games available and school attendance. No independent association was seen between nutritional status and early cognitive development.

Violência urbana: uma análise dos conceitos de professores do ensino fundamental

O objetivo principal foi descrever e contextualizar o conceito de violencia de professoras do ensino fundamental. Pretendeu-se, tambem, comparar os resultados obtidos com professoras de escolas publicas com os de escolas particulares. Os dados foram obtidos atraves de entrevista semi-estruturada, com 47 professoras de quatro escolas, duas publicas e duas particulares. Um Sistema de Categorias, extraido dos dados, permitiu descrever e contextualizar o conceito de violencia que, de acordo com os resultados, se caracteriza, preponderantemente, pelas classes violencia de delinquencia e estrutural; pelas modalidades violencia de marginais, escolar e familiar; pelas formas agressao fisica, assalto e agressao verbal. As diferencas entre professoras de escolas publicas e particulares foram relacionadas a caracteristicas de seus ambientes de trabalho.

A relação médico-paciente no Programa Saúde da Família: um estudo em três municípios do Estado da Bahia, Brasil

This study discusses the physician-patient relationship under the Family Health Program (FHP) in Bahia State, Brazil. Assuming that the physician-patient relationship is influenced by macro and micro-contextual factors, we linked health surveillance and the ecological model of human development, both influenced by contextualism. The methodological strategies included: a census of FHP physicians in Bahia and direct observation of consultations by 20 physicians in three municipalities (counties). There were significant differences in the implementation of the FHP in the three municipalities, with an impact on the physician-patient relationship. As for orientation of clinical practice, health surveillance has not been incorporated by the physicians observed in this study. According to the micro-contextual analysis, health problems were frequently not treated in a contextualized way. FHP guidelines, when incorporated by the municipalities, produce differences in care as observed in the physician-patient relationship. The health surveillance approach, reported as a tool for collective work, proves efficient for describing, evaluating, and improving the FHP, and this study concludes that it is a powerful conceptual tool for dealing with the physician-patient relationship.

UM OLHAR SOBRE O PROGRAMA DE SAÚDE DA FAMÍLIA: A PERSPECTIVA ECOLÓGICA NA PSICOLOGIA DO DESENVOLVIMENTO SEGUNDO BRONFENBRENNER E O MODELO DA VIGILÂNCIA DA SAÚDE

The activities of the Family Health Program have posed many challenges. One of these challenges is exemplified in a need for developing theoretical propositions that guide the praxis of family health and foster analysis of its practices. The Bronfenbrenner ecological approach of human development and the health care model are presented as viable theoretical tools for the Family Health Program. Examples extracted from reports of users and professionals of health services are used to illustrate relevant constructs. Different levels of ecological comprehension can be identified in these examples in which the family occupies a fundamental role on the three approaches and complemented it as informant, object of care and of self-care.