Ana Lúcia Andrade da Silva

Estudo sobre a violência doméstica contra a criança em unidades básicas de saúde do município de São Paulo - Brasil

OBJETIVO: Saber como profissionais da Estrategia Saude da Familia atuam ao se deparar com situacoes de violencia domestica contra a crianca. Metodo: Trata-se de estudo qualitativo de investigacao, realizado por meio de entrevista do tipo semidirigido. A pesquisa desenvolveu-se na cidade de Sao Paulo, em cinco Unidades Basicas de Saude (UBS) de cinco regioes. Foram entrevistados 21 profissionais e utilizou-se a analise de conteudo tematica. RESULTADOS: A analise tematica apontou quatro categorias: identificacao da violencia domestica; tipos de violencia domestica; dificuldades no atendimento em situacoes de violencia domestica e acoes profissionais diante da violencia domestica. A identificacao da violencia aconteceu em visitas que os profissionais realizaram na comunidade, em especial, os Agentes Comunitarios de Saude (ACS), sendo corroborada em consulta clinica, mediante observacao e exame fisico da crianca. Uma das acoes mais presentes no discurso dos profissionais e a de encaminhamento da crianca vitimizada ao Conselho Tutelar. CONCLUSOES: Os resultados refletem uma realidade da Atencao Basica em Saude que gera angustia nos profissionais, que se sentem despreparados e desprotegidos para atender e resolver demandas de criancas vitimas por violencia domestica. Constatou-se que o Sistema Unico de Saude/Estrategia Saude da Familia (SUS/ESF) tem de avancar no atendimento dessas situacoes. A intersetorialidade, a integralidade e a resolutividade foram mencionadas pelos entrevistados, evidenciando lacunas geradoras de sofrimento, que precisam ser reencaminhadas aos orgaos competentes.

Population aging in Brazil: current and future social challenges and consequences

Objective: To analyze the current and future challenges related to the planning of public policies and population aging. Method: A case study was conducted using quantitative and qualitative data from secondary data information systems and interviews with actors of social policy and the countrys health. Results: In 2010, there were 39 elderly persons for every 100 young people, while in 2040 there will be an estimated 153 elderly persons for every 100 young people. For those interviewed, Brazil is not prepared for the needs generated by such population aging, due to challenges such as the adequacy of the social security and health system. The growing number of elderly persons and increasing morbidity and mortality profiles worsen the heterogeneous epidemiological situation with disease, disability and sequelae that require the health system to be a continuous and multidisciplinary organization. The present study identified a reduction of beds and hospitalizations, which may reflect the improvement of primary care and quality of life, with a complexification of hospitalizations. Conclusion: With population aging and a lack of necessary support, society must be aware of the price that it must pay and the state must be prepared to provide specific policies to ensure comprehensive care, recognizing the characteristics of aging and preserving quality of life.

Condições e motivações para o trabalho de enfermeiros e médicos em serviços de emergência de alta complexidade

This study aimed to evaluate the motivations and conditions offered to the work of nurses and doctors in three high complexity emergency services of the city of Recife, Pernambuco. It is a descriptive transversal type study. It was interviewed 42 nurses and 84 doctors, of a total population of 97 nurses and 469 doctors. It was used a questionnaire prepared for this survey and the Scale of Values Related to Work. On the motivation assessment it was found that Professional Realization was the major motivational factor, and Prestige the less important factor.This study aimed to evaluate the motivations and conditions offered to the work of nurses and doctors in three high complexity emergency services of the city of Recife, Pernambuco. It is a descriptive transversal type study. It was interviewed 42 nurses and 84 doctors, of a total population of 97 nurses and 469 doctors. It was used a questionnaire prepared for this survey and the Scale of Values Related to Work. On the motivation assessment it was found that Professional Realization was the major motivational factor, and Prestige the less important factor.

Desafios das políticas públicas no cenário de transição demográfica e mudanças sociais no Brasil

Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.

Evaluation of maternal and neonatal hospital care: quality index of completeness

OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System. METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country. RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country. CONCLUSIONS The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations.

Childbirth care in Brazil: a critical situation has not yet been overcome. 1999-2013

Objectives: to analyze the evolution of childbirth care in Brazil, between 1999-2013. Methods: a time-series ecological study, using data from Ministry of Health, Brazilian Institute of Geography and Statistics, and Interagency Network of Information for Health. 18 indicators were analyzed related to childbirth and mortality. Results: there was a reduction in rates of fertility, natality and the total number of births, with increased cesarean surgeries. Growth of prenatal consultation, intensive care beds and reduction of beds in obstetrics sector. The significant growth of caesarean deliveries, prenatal consultation coverage and concentration of births in hospitals occurred simultaneously with the growth: of preventable child deaths by adequate attention, management causes and appropriate delivery, prematurity; low weight; Downs syndrome; and the persistence of maternal deaths due to direct obstetric causes. Conclusions: persists hegemonic technocratic model of childbirth care without considering the observed changes in the profile of mothers and births, with slow reduction of perinatal and neonatal deaths and maintenance of high maternal mortality demonstrating that the critical situation of delivery care model in Brazil has not, yet, been overcome.

Public policies challenges on the background of demographic transition and social changes in Brazil

Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.

Desafíos de las políticas públicas en el escenario de transición demográfica y cambios sociales en Brasil

Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.Este trabalho teve como objetivo analisar as mudancas ocorridas nas caracteristicas demograficas e sociais do pais e discutir o desafio do desenvolvimento de politicas publicas, utilizando dados dos sistemas de informacoes e entrevistas com atores das politicas social e de saude do pais. Percebeu-se a reducao da fecundidade, da natalidade e da mortalidade com aumento da esperanca de vida ao nascer, caracterizando a terceira fase da transicao demografica. O investimento na saude e na educacao foi considerado essencial para que o pais possa aproveitar esse momento. Houve significativa reducao da pobreza, mas, em 2012, ainda representava 15,9% da populacao, o que exige manutencao, expansao e qualificacao dos programas de transferencia de renda. A transicao demografica proporciona oportunidades para o desenvolvimento de politicas que permitam o acesso universal a educacao, a saude e ao emprego e que superem os desafios do pais.

Conditions and motivations for the work of nurses and physicians in high complexity emergency services

This study aimed to evaluate the motivations and conditions offered to the work of nurses and doctors in three high complexity emergency services of the city of Recife, Pernambuco. It is a descriptive transversal type study. It was interviewed 42 nurses and 84 doctors, of a total population of 97 nurses and 469 doctors. It was used a questionnaire prepared for this survey and the Scale of Values Related to Work. On the motivation assessment it was found that Professional Realization was the major motivational factor, and Prestige the less important factor.This study aimed to evaluate the motivations and conditions offered to the work of nurses and doctors in three high complexity emergency services of the city of Recife, Pernambuco. It is a descriptive transversal type study. It was interviewed 42 nurses and 84 doctors, of a total population of 97 nurses and 469 doctors. It was used a questionnaire prepared for this survey and the Scale of Values Related to Work. On the motivation assessment it was found that Professional Realization was the major motivational factor, and Prestige the less important factor.

Condiciones y motivaciones para el trabajo de enfermeras y médicos en servicios de emergencia de alta complejidad

This study aimed to evaluate the motivations and conditions offered to the work of nurses and doctors in three high complexity emergency services of the city of Recife, Pernambuco. It is a descriptive transversal type study. It was interviewed 42 nurses and 84 doctors, of a total population of 97 nurses and 469 doctors. It was used a questionnaire prepared for this survey and the Scale of Values Related to Work. On the motivation assessment it was found that Professional Realization was the major motivational factor, and Prestige the less important factor.This study aimed to evaluate the motivations and conditions offered to the work of nurses and doctors in three high complexity emergency services of the city of Recife, Pernambuco. It is a descriptive transversal type study. It was interviewed 42 nurses and 84 doctors, of a total population of 97 nurses and 469 doctors. It was used a questionnaire prepared for this survey and the Scale of Values Related to Work. On the motivation assessment it was found that Professional Realization was the major motivational factor, and Prestige the less important factor.