Ana Rita Barbieri

O contexto da formação dos agentes comunitários de saúde no Brasil

Este estudio tuvo como objetivo identificar y describir el proceso historico de la formacion profesional de los agentes comunitarios de salud, mediante el analisis de documentos relativos a la formacion tecnica en salud. Es una investigacion documental realizada en documentos normativos e instrumentales en los registros administrativos y de gestion del Departamento de Atencion Primaria, con investigacion bibliografica en las bases de datos Medline y LILACS, de publicaciones orientadas a la politica de formacion profesional, en el periodo de 1986 a 2006, y de lectura con analisis tematico. En respuesta a las demandas politicas y economicas, el agente comunitario de salud se convirtio en profesion en 2002. Sus funciones fueron ampliadas, motivo por el cual, en 2006 ya habia en Brasil mas de 200 mil profesionales trabajando segun el nuevo reglamento: la Ley 11.350, que revoco la ley anterior. El agente comunitario se convirtio en un elemento importante para la promocion de cambios en el modelo asistencial y el fortalecimiento de la atencion primaria en salud.The purpose of this study was to investigate and describe the historical development of the professional education of community health agents by analyzing documents related to technical education in the health area. Documental investigation of normative and instrumental documents within the managerial and administrative records of the Primary Care Department was carried out with a literature survey in the Medline and Lilacs databases of sources that guided educational policies between 1986 and 2006, as well as theme analysis reading. In response to political and economic demands, the profession of community health agent was established in 2002, with subsequent increases in attributions. In 2006, over 200 000 professionals were active in Brazil with their role regulated by Federal Law 11,350, which superseded previous legislation. In conclusion, community health agents have become an important element in promoting changes to the care model and strengthening primary care services. DESCRIPTORS: Professional education. Health professionals. Educational measurement. EL CONTEXTO DE LA FORMACION PROFESIONAL DE LOS AGENTES COMUNITARIOS DE SALUD EN BRASIL RESUMEN: Este estudio tuvo como objetivo identificar y describir el proceso historico de la formacion profesional de los agentes comunitarios de salud, mediante el analisis de documentos relativos a la formacion tecnica en salud. Es una investigacion documental realizada en documentos normativos e instrumentales en los registros administrativos y de gestion del Departamento de Atencion Primaria, con investigacion bibliografica en las bases de datos Medline y LILACS, de publicaciones orientadas a la politica de formacion profesional, en el periodo de 1986 a 2006, y de lectura con analisis tematico. En respuesta a las demandas politicas y economicas, el agente comunitario de salud se convirtio en profesion en 2002. Sus funciones fueron ampliadas, motivo por el cual, en 2006 ya habia en Brasil mas de 200 mil profesionales trabajando segun el nuevo reglamento: la Ley 11.350, que revoco la ley anterior. El agente comunitario se convirtio en un elemento importante para la promocion de cambios en el modelo asistencial y el fortalecimiento de la atencion primaria en salud. DESCRIPTORES: Educacion profesional. Profesional de salud. Evaluacion educacional.

Acolhimento na Atenção Primária à Saúde: revisão integrativa

ABSTRACT The present study aims to analyze the knowledge produced about the reception in the Primary Health Care, in the last eight years. It is about an integrative review, also related to the reception within the Family Health Strategy. It can be stated that the reception process is not yet fully systematized in the models of health care, and this may be a justification for the difficulties presented by both professionals and users. There are necessary studies with new approaches or strategies for the systematizing of the reception in units of Primary Health Care, and verify if these actually have an impact on the quality of services and in the users satisfaction. ERDS User embracement; Health care (Public Health); Primary Health Care; Family Health Strategy. SAUDE DEBATE | rio de Janeiro, v. 39, n. 105, p.514-524, aBr-JUn 2015 514 Acolhimento na Atencao Primaria Sade reisao interatia reception in primar Health Care: an integrative revie Larissa Rachel Palhares Coutinho 1 , Ana Rita Barbieri

A incorporação da avaliação da atenção básica no nível estadual do Sistema Único de Saúde através de processos participativos de ensino-aprendizagem-trabalho

OBJETIVOS: desenvolver uma metodologia de intervencao e aplica-la as equipes das Secretarias Estaduais de Saude (SES) objetivando incorporar a pratica de monitoramento e avaliacao da atencao basica atraves de processo de capacitacao e realizacao de atividade real de planejamento e programacao em saude. METODOS: foi desenvolvido um processo de ensino-aprendizagem-trabalho que incorporou ao processo de capacitacao uma atividade de planejamento em saude. A qualidade dos dois processos e assegurada atraves do estabelecimento de principios e criterios para a organizacao da capacitacao, para a elaboracao da proposta metodologica de monitoramento e avaliacao e para a conducao didatico-pedagogica do curso. RESULTADOS: a metodologia foi aplicada nos Estados de Mato Grosso do Sul (MS), Tocantins (TO) e Amazonas (AM), respeitando as particularidades locais em termos de organizacao da SES e da qualificacao e capacidade dos tecnicos responsaveis pela atencao basica. Foram produzidas propostas metodologicas estruturalmente semelhantes, mas diferentes nas suas prioridades e propostas de desenvolvimento. Dois anos apos o termino da intervencao, efeitos desse trabalho ainda estao sendo identificados. CONCLUSOES: os resultados obtidos em MS, TO e AM revelam a capacidade que a abordagem baseada na triade ensino-aprendizagem-trabalho possui para a institucionalizacao de novas praticas de trabalho nos servicos de saude.

Scope and efficiency of the newborn screening program in identifying hemoglobin S

Background In 2001, the Brazilian Ministry of Health added hemoglobinopathies to the National Neonatal Screening Program to be implemented in three steps. In order to meet the proposed goals, it is crucial to establish periodic assessments of this program with the aim of monitoring its implementation. Objective To assess the scope and the efficiency of the stages of the National Newborn Screening Program in identifying hemoglobin S. Methods A cross-sectional study was developed with the results of the heel prick test using the high performance liquid chromatography method for babies born in Mato Grosso do Sul from 2006 to 2010. The following variables were investigated: year, number of live births, total screening, coverage ratio, prevalence, time between the child birth and the blood collection; age at diagnosis; age at the time of the first consultation; and time between the diagnosis and the first appointment. Results Over the five years of the study, the mean coverage rate was 91.77%. The prevalences of hemoglobin FAS and hemoglobin FS were 1.65% and 0.011%, respectively. Blood samples from 43.48% of children were collected from the second to the seventh day. The age at diagnosis was within the first 28 days in 87.80% of the screened children. The lowest mean indices for the first consultation and the time between the diagnosis and the first appointment (58.8 and 46.4 days, respectively) occurred in 2010. Conclusions The scope of the National Neonatal Screening Program for hemoglobinopathies is good, with a large number of individuals being tested. Efficiency is a suitable indicator to assess the program steps. Three points are recommended: the training of the individuals involved, studies to assess the assistance provided to the affected child, and genetic counseling to the mothers.

SITUAÇÃO DOS HOSPITAIS DE REFERÊNCIA PARA IMPLANTAÇÃO/FUNCIONAMENTO DO NÚCLEO DE SEGURANÇA DO PACIENTE

Este estudo objetivou conhecer a situacao dos hospitais de referencia quanto ao uso de normas e protocolos sobre seguranca do paciente diante da implantacao da respectiva politica nacional. Foi realizado um estudo descritivo de abordagem quantitativa nos seis hospitais de referencia de Mato Grosso do Sul em 2014, com o uso de um roteiro desenvolvido a partir do arcabouco normativo da Politica Nacional de Seguranca do Paciente, resolucoes da Vigilância Sanitaria e recomendacoes da Organizacao Mundial de Saude. Os achados evidenciam que mesmo com o Nucleo de Seguranca do Paciente implantado, protocolos como de profilaxia cirurgica, de checagem de verificacao de cirurgias, notificacoes de eventos adversos sao cumpridos. Ha falta de estrutura em algumas instituicoes hospitalares que prejudicam o pleno desenvolvimento de protocolos como falta de profissionais, de equipamentos e materiais. Os resultados apontam que a existencia de resolucoes e normas nao sao suficientes para garantir a seguranca do paciente.

Hemodialysis services: are public policies turned to guaranteeing the access?

The increasing incidence of chronic renal failure in Brazil and the consequential expansion of hemodialysis as a choice for treatment in final stage have to be taken into account to guarantee access to those in need. The ecological study conducted in Mato Grosso do Sul State, Brazil, in 2012, using data from the Brazilian Health Informatics Department (DATASUS) and from the analysis of medical records in 12 clinics, identified and mapped patients on hemodialysis, the distance they travelled and the estimated number of patients. The prevalence of hemodialysis patients in Mato Grosso do Sul State, about 55 per 100,000 inhabitants, is similar to the national average. The analyses indicated concentration of patients in counties with clinics and also geographical gaps that generate displacement of over 100km for more than 16% of patients. The results point to the necessity of strengthening public policies that consider, for decision-making, the decentralization of service, the expansion of home care and the follow-up education for professionals.

Screening for cervical cancer in imprisoned women in Brazil.

Context and objective Incarcerated women are more vulnerable to developing cervical cancer than women in general; therefore, screening and intervention programs must be included in their healthcare provision. We therefore aimed to investigate the state of cervical cancer screening for imprisoned women in Mato Grosso do Sul, and to analyze the interventions geared toward the control of cervical cancer. Materials and methods This was a cross-sectional study with analysis of primary and secondary data. Interviews were held with 510 women in seven prisons in the Brazilian state of Mato Grosso do Sul. The data for 352 medical records were analyzed statistically with the significance level set at 5%. Associations were assessed by the chi-squared test, adjusted by the Bonferroni correction. Results Most female prisoners had limited education, used tobacco, and had key risk factors for the development of cervical cancer. Half of the women interviewed (n = 255) stated that they had received a Papanicolaou (Pap) test in prison, but 134 (52.5%) of these did not know the result. Of those who had not received a Pap test, 149 (58.4%) stated that this was because of a lack of opportunity. There was no information regarding the provision of Pap tests or subsequent treatment in the medical records of 211 (59.9%) women. No protocols were in place for the provision of Pap tests in prison. There were statistical differences between prisons in terms of test frequency, the information provided to women, and how information was recorded in medical records. Conclusion The screening of cervical cancer in prisons is neither systematic nor regular, and the results are not communicated to women in a significant number of cases. It is necessary to organize health services within the prison environment, ensuring that tests are done and that there is investigation for human papillomavirus. This could increase the diagnosis of cervical cancer at less advanced stages of the disease.

Follow-up uterine cervical cancer: study of continue assistance to patient in a health region

Objetivo: Discutir o fluxo assistencial das mulheres com resultado do exame citopatologico alterado em uma rede de atencao a saude. Metodos: Estudo transversal em uma microrregiao composta por sete municipios em Mato Grosso do Sul, Brasil. Foram mapeados os pontos de atencao em todos os niveis de complexidade. Um formulario foi elaborado e cinquenta e dois profissionais foram entrevistados. Os dados foram analisados considerando a distribuicao de frequencias. Resultados: Ha inconformidade entre resultados de exames e intervencoes. Grande parte (78%) das lesoes nao neoplasicas de baixo grau e encaminhada e 21% das lesoes que deveriam ser encaminhadas sao tratadas no nivel primario. Ha falta de comunicacao entre os pontos de atencao e ausencia de protocolos de referencia e contra-referencia. Em 18 (54,5%) unidades de atencao basica, as mulheres buscam espontaneamente o servico de regulacao. Conclusao: Os servicos nao estao articulados, ha importantes falhas no seguimento.Objective: Discuss the context of assistance of women diagnosis with altered Pap Test in a health care unit. Methods: Cross-sectional study, held in a micro-region of Mato Grosso do Sul, Brazil. The points of attention were mapped in all levels of complexity. A form was prepared and fifty-two professionals were interviewed. Data were analyzed considering the distribution of frequencies. Results: There is incongruity between test results and interventions. Most (78%) of non-neoplastic lesions of low grade is forwarded and 21% of the lesions that should be addressed are treated at primary level. There is a lack of communication between the points of attention and lack of reference and counter-reference protocols. In 18 (54.5%) Primary Care Units, women spontaneously seek regulatory service. Conclusion: The services are not articulated, there are major errors in the follow-up.

Seguimento do câncer de colo de útero: Estudo da continuidade da assistência à paciente em uma região de saúde

Objetivo: Discutir o fluxo assistencial das mulheres com resultado do exame citopatologico alterado em uma rede de atencao a saude. Metodos: Estudo transversal em uma microrregiao composta por sete municipios em Mato Grosso do Sul, Brasil. Foram mapeados os pontos de atencao em todos os niveis de complexidade. Um formulario foi elaborado e cinquenta e dois profissionais foram entrevistados. Os dados foram analisados considerando a distribuicao de frequencias. Resultados: Ha inconformidade entre resultados de exames e intervencoes. Grande parte (78%) das lesoes nao neoplasicas de baixo grau e encaminhada e 21% das lesoes que deveriam ser encaminhadas sao tratadas no nivel primario. Ha falta de comunicacao entre os pontos de atencao e ausencia de protocolos de referencia e contra-referencia. Em 18 (54,5%) unidades de atencao basica, as mulheres buscam espontaneamente o servico de regulacao. Conclusao: Os servicos nao estao articulados, ha importantes falhas no seguimento.Objective: Discuss the context of assistance of women diagnosis with altered Pap Test in a health care unit. Methods: Cross-sectional study, held in a micro-region of Mato Grosso do Sul, Brazil. The points of attention were mapped in all levels of complexity. A form was prepared and fifty-two professionals were interviewed. Data were analyzed considering the distribution of frequencies. Results: There is incongruity between test results and interventions. Most (78%) of non-neoplastic lesions of low grade is forwarded and 21% of the lesions that should be addressed are treated at primary level. There is a lack of communication between the points of attention and lack of reference and counter-reference protocols. In 18 (54.5%) Primary Care Units, women spontaneously seek regulatory service. Conclusion: The services are not articulated, there are major errors in the follow-up.

Acompañamiento del cáncer de cuello de útero: Estudio sobre la continuidad de la atención a la paciente en una región de salud

Objetivo: Discutir o fluxo assistencial das mulheres com resultado do exame citopatologico alterado em uma rede de atencao a saude. Metodos: Estudo transversal em uma microrregiao composta por sete municipios em Mato Grosso do Sul, Brasil. Foram mapeados os pontos de atencao em todos os niveis de complexidade. Um formulario foi elaborado e cinquenta e dois profissionais foram entrevistados. Os dados foram analisados considerando a distribuicao de frequencias. Resultados: Ha inconformidade entre resultados de exames e intervencoes. Grande parte (78%) das lesoes nao neoplasicas de baixo grau e encaminhada e 21% das lesoes que deveriam ser encaminhadas sao tratadas no nivel primario. Ha falta de comunicacao entre os pontos de atencao e ausencia de protocolos de referencia e contra-referencia. Em 18 (54,5%) unidades de atencao basica, as mulheres buscam espontaneamente o servico de regulacao. Conclusao: Os servicos nao estao articulados, ha importantes falhas no seguimento.Objective: Discuss the context of assistance of women diagnosis with altered Pap Test in a health care unit. Methods: Cross-sectional study, held in a micro-region of Mato Grosso do Sul, Brazil. The points of attention were mapped in all levels of complexity. A form was prepared and fifty-two professionals were interviewed. Data were analyzed considering the distribution of frequencies. Results: There is incongruity between test results and interventions. Most (78%) of non-neoplastic lesions of low grade is forwarded and 21% of the lesions that should be addressed are treated at primary level. There is a lack of communication between the points of attention and lack of reference and counter-reference protocols. In 18 (54.5%) Primary Care Units, women spontaneously seek regulatory service. Conclusion: The services are not articulated, there are major errors in the follow-up.