Anna Maria Chiesa

Geoprocessing and health promotion: social and environmental inequalities, Brazil

OBJECTIVE To characterize social inequalities that represent risk conditions for respiratory tract diseases in children and to describe geoprocessing techniques to identify homogeneous social groups and intervention actions for health promotion. METHODS The study area comprised the surroundings of a health school center in the city of S o Paulo. Based on 1991 census, housing data on 49 census units in the study area were statistically analyzed and it was obtained the mean of characteristic social and environment variables in these units. Together with local representatives, variables were selected that made up composite indicators related to social insertion and housing quality to allow identifying different conditions of potential exposure to respiratory tract diseases. Using geoprocessing techniques, four homogeneous groups were identified in terms of potential exposure to risk conditions for respiratory diseases. RESULTS It was obtained a spatial configuration of the groups reflecting different needs in the study area. The methodological instruments used revealed to be important for the development of local actions to be implemented in services that operate in specific geographical areas. CONCLUSIONS The study contributed to the identification of risk conditions in the health center area, making it possible the joint and inter-sector discussion of conditions related to respiratory tract diseases in children, aiming at promoting equity and improving child health.

O processo de comunicação na promoção do aleitamento materno

La lactancia materna es un comportamiento humano complejo que contribuye con la reduccion de la mortalidad y morbilidad infantil. Las investigaciones desarrolladas acerca de la experiencia vivida por las madres demuestran que amamantar, muchas veces, es una actividad dolorosa, sea psiquica o fisicamente. El personal de salud necesita estar capacitado para relacionarse con las madres y esto incluye tener habilidades de comunicacion. Las autoras presentan el proceso de comunicacion cuyo eje de abordaje este centrado en la persona. La utilizacion de esta comunicacion constituye un cuidado efectivo hacia la mujer.La lactancia materna es un comportamiento humano complejo que contribuye con la reduccion de la mortalidad y morbilidad infantil. Las investigaciones desarrolladas acerca de la experiencia vivida por las madres demuestran que amamantar, muchas veces, es una actividad dolorosa, sea psiquica o fisicamente. El personal de salud necesita estar capacitado para relacionarse con las madres y esto incluye tener habilidades de comunicacion. Las autoras presentan el proceso de comunicacion cuyo eje de abordaje este centrado en la persona. La utilizacion de esta comunicacion constituye un cuidado efectivo hacia la mujer.

Autonomia e necessidades de saúde na sistematização da assistência de Enfermagem no olhar da saúde coletiva

Given recent changes in the organization of the primary health care in Brazil, it is necessary to reflect on the contributions of nursing care. This article aims to review the concepts of autonomy and health needs and its applications in different proposals for the systematization of the nursing care. It is a literature review on systematization of the nursing assistance, autonomy and health needs in databases LILACS and BDENF. The most relevant results indicate that autonomy incorporates aspects professional and patients that are sustained by their respective categories. About needs we found that tracks biological needs and social needs, which intersect with the psychological to cover biopsychosocial needs. It was found that the application of the concepts was not present in classification systems of nursing. However, they were more related to International Classification of Nursing Practice (ICNP) and International Classification of Nursing Practice in Collective Heath (ICNPCH) projects.Given recent changes in the organization of the primary health care in Brazil, it is necessary to reflect on the contributions of nursing care. This article aims to review the concepts of autonomy and health needs and its applications in different proposals for the systematization of the nursing care. It is a literature review on systematization of the nursing assistance, autonomy and health needs in databases LILACS and BDENF. The most relevant results indicate that autonomy incorporates aspects professional and patients that are sustained by their respective categories. About needs we found that tracks biological needs and social needs, which intersect with the psychological to cover biopsychosocial needs. It was found that the application of the concepts was not present in classification systems of nursing. However, they were more related to International Classification of Nursing Practice (ICNP) and International Classification of Nursing Practice in Collective Heath (ICNPCH) projects.

Vulnerability of children in adverse situations to their development: proposed analytical matrix

This theoretical study presents a conceptual matrix built to analyze the vulnerability of children in adverse situations to their development. It proposes that the vulnerability of children is analyzed by means of the following dimensions: individual , which is related to ongoing nurturing relationships, physical protection and security; social , which concerns the social insertion of family and access to rights of social protection and promotion; and programmatic , which involves the political-programmatic scenario and the guidelines and political-programmatic implementation. The practical application of this matrix allows apprehending the health-disease process beyond the individual dimension, enabling the articulation of public policies and actions of professionals to achieve effectiveness in meeting the needs of children. The use of this conceptual matrix can provide to health teams a specific understanding of the adverse situations to child development as well as subsidizing intervention plans based on the analytical dimensions of vulnerability.

The potential of an instrument to identify social vulnerabilities and health needs: collective health knowledge and practices.

Este estudio tuvo como objetivos analizar un instrumento de lectura del proceso salud enfermedad y evaluarsu potencial para el reconocimiento de vulnerabilidades sociales y necesidades de salud, posibilitandointervenciones mas adecuadas en un dado territorio. Los procedimientos usados se constituyeron de analisisdel instrumento de recoleccion de datos – compuesto por preguntas cerradas y abiertas para el reconocimientode los diferentes perfiles de reproduccion social (formas de trabajar y de vivir) – utilizado en el Proyecto deDesarrollo Pedagogico y de informes de las actividades desarrolladas por alumnos del Departamento deEnfermeria en Salud Colectiva de la Escuela de Enfermeria de la Universidad de San Pablo(USP). Se concluyeque el instrumento analizado posibilita a los profesionales de la salud, particularmente de Enfermeria en SaludColectiva, reconocer vulnerabilidades sociales y necesidades de salud, orientando sus intervenciones en diferentescontextos, segun la perspectiva de la promocion de la salud. Revela, asi, un potencial transformador de laspracticas de salud vigentes, caracter dinamico y de renovacion constante de esas practicas en diferentescontextos, segun la “radicalidad” propia de la Salud Colectiva.DESCRIPTORES: evaluacion de necesidades; vulnerabilidad social; enfermeria; salud publica; prestacion deatencion de salud; educacion

A construção de tecnologias de atenção em saúde com base na promoção da saúde

The article describes a reflection about the implication of the theoretical and methodological bases of Health Promotion to the development of empowerment technologies. It also discusses the complexity of caring out researches to evaluate the actions in this field. We initiated with a description of a protocol on child development focused on the critical bias of Health Promotion principles. The protocol was implemented by family health teams in critical regions of Sao Paulo city. The researches linked to the protocol evaluated used technologies and the strategies for its implementation. The results pointed that frameworks of Health Promotion contributes to the comprehensive care and strengthening of children and families health. Researches for evaluating the actions in Health Promotion require a variety of approaches, to cover the complexity of the processes and outcomes.The article describes a reflection about the implication of the theoretical and methodological bases of Health Promotion to the development of empowerment technologies. It also discusses the complexity of caring out researches to evaluate the actions in this field. We initiated with a description of a protocol on child development focused on the critical bias of Health Promotion principles. The protocol was implemented by family health teams in critical regions of Sao Paulo city. The researches linked to the protocol evaluated used technologies and the strategies for its implementation. The results pointed that frameworks of Health Promotion contributes to the comprehensive care and strengthening of children and families health. Researches for evaluating the actions in Health Promotion require a variety of approaches, to cover the complexity of the processes and outcomes.The article describes a reflection about the implication of the theoretical and methodological bases of Health Promotion to the development of empowerment technologies. It also discusses the complexity of caring out researches to evaluate the actions in this field. We initiated with a description of a protocol on child development focused on the critical bias of Health Promotion principles. The protocol was implemented by family health teams in critical regions of São Paulo city. The researches linked to the protocol evaluated used technologies and the strategies for its implementation. The results pointed that frameworks of Health Promotion contributes to the comprehensive care and strengthening of children and families health. Researches for evaluating the actions in Health Promotion require a variety of approaches, to cover the complexity of the processes and outcomes.

O potencial de um instrumento para o reconhecimento de vulnerabilidades sociais e necessidades de saúde: saberes e práticas em saúde coletiva

Este estudio tuvo como objetivos analizar un instrumento de lectura del proceso salud enfermedad y evaluarsu potencial para el reconocimiento de vulnerabilidades sociales y necesidades de salud, posibilitandointervenciones mas adecuadas en un dado territorio. Los procedimientos usados se constituyeron de analisisdel instrumento de recoleccion de datos – compuesto por preguntas cerradas y abiertas para el reconocimientode los diferentes perfiles de reproduccion social (formas de trabajar y de vivir) – utilizado en el Proyecto deDesarrollo Pedagogico y de informes de las actividades desarrolladas por alumnos del Departamento deEnfermeria en Salud Colectiva de la Escuela de Enfermeria de la Universidad de San Pablo(USP). Se concluyeque el instrumento analizado posibilita a los profesionales de la salud, particularmente de Enfermeria en SaludColectiva, reconocer vulnerabilidades sociales y necesidades de salud, orientando sus intervenciones en diferentescontextos, segun la perspectiva de la promocion de la salud. Revela, asi, un potencial transformador de laspracticas de salud vigentes, caracter dinamico y de renovacion constante de esas practicas en diferentescontextos, segun la “radicalidad” propia de la Salud Colectiva.DESCRIPTORES: evaluacion de necesidades; vulnerabilidad social; enfermeria; salud publica; prestacion deatencion de salud; educacion

Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) na prática de enfermeiros egressos da USP

This is a description of the Integrated Management of Childhood Illness (IMCI) strategy in the professional practice of nurses graduated from the School of Nursing of University of São Paulo (EE-USP). This is a case study of qualitative approach. The data were collected through focus groups and analyzed using thematic content analysis. IMCI strategy was considered an important tool in child health care, but only the assessment module was apart of professional practice. Difficulties in the use of the IMCI were: the strategy was not implanted at health services, it was unknown by co-workers and institutional obstacles. In spite of the limited and non-systematic use of IMCI, it has allowed nurses to provide integrated and comprehensive attention to the child, which justifies its teaching on undergraduate courses. Maintenance of the educational video, expansion of the practice, integration of courses and optimization of content and workload were suggested for improving the teaching of IMCI at the undergraduate level.Descreveu-se a incorporacao da estrategia Atencao Integrada as Doencas Prevalentes na Infância (AIDPI) na pratica de enfermeiros egressos da Escola de Enfermagem da Universidade de Sao Paulo (EE-USP). Desenvolveuse estudo de caso de abordagem qualitativa, com coleta de dados em grupo focal e analise de conteudo do tipo tematica. A estrategia AIDPI foi considerada ferramenta importante na atencao a saude infantil, porem apenas o modulo de avaliacao fazia parte da pratica profissional. Destacam-se como dificuldades para sua utilizacao: nao implantacao nos servicos, desconhecimento por parte de colegas e barreiras institucionais. Ainda que com uso restrito e nao sistematizado, a AIDPI possibilita ao enfermeiro prestar atencao integrada e integral a crianca o que justifica sua abordagem na graduacao. Manutencao do video didatico, ampliacao da pratica, integracao das disciplinas e otimizacao dos conteudos e da carga horaria foram apontadas como relevantes para o aperfeicoamento do ensino da AIDPI na graduacao.

Innovación en el proceso de aprendizaje de enfermería en salud colectiva

Las autoras enfatizan el aprendizaje de los alumnos en el enfrentamiento con la realidad orientado por la investigacion pedagogica. Se busco sistematizar las facilidades y las dificultades observadas por los familiares en la atencion a la salud y analizar sus implicaciones pedagogicas en el proceso de aprendizaje de los alumnos en la asignatura Fundamentos y Practicas de Enfermeria en Salud Colectiva. El estudio fue retrospectivo, basado en datos de la encuesta domiciliaria producidos en la investigacion pedagogica, involucrando a estudiantes de graduacion en el 2006. Se adopto el metodo de Analisis de los Contenidos de los datos asociados a la vision de estructura y procesos de servicios. Las principales facilidades y dificultades observadas y consideradas como aspectos fundamentales fueron respectivamente la calidad de la relacion usuario-profesionales y la demora en la atencion a causa del exceso de demanda. Esas tematicas constituyeron momentos de movilizacion de la capacidad cognitiva de los estudiantes, pues permitieron observar las necesidades de los usuarios y fortificar la practica pedagogica en el proceso de formacion.

Building health care technologies based on health promotion

The article describes a reflection about the implication of the theoretical and methodological bases of Health Promotion to the development of empowerment technologies. It also discusses the complexity of caring out researches to evaluate the actions in this field. We initiated with a description of a protocol on child development focused on the critical bias of Health Promotion principles. The protocol was implemented by family health teams in critical regions of Sao Paulo city. The researches linked to the protocol evaluated used technologies and the strategies for its implementation. The results pointed that frameworks of Health Promotion contributes to the comprehensive care and strengthening of children and families health. Researches for evaluating the actions in Health Promotion require a variety of approaches, to cover the complexity of the processes and outcomes.The article describes a reflection about the implication of the theoretical and methodological bases of Health Promotion to the development of empowerment technologies. It also discusses the complexity of caring out researches to evaluate the actions in this field. We initiated with a description of a protocol on child development focused on the critical bias of Health Promotion principles. The protocol was implemented by family health teams in critical regions of Sao Paulo city. The researches linked to the protocol evaluated used technologies and the strategies for its implementation. The results pointed that frameworks of Health Promotion contributes to the comprehensive care and strengthening of children and families health. Researches for evaluating the actions in Health Promotion require a variety of approaches, to cover the complexity of the processes and outcomes.The article describes a reflection about the implication of the theoretical and methodological bases of Health Promotion to the development of empowerment technologies. It also discusses the complexity of caring out researches to evaluate the actions in this field. We initiated with a description of a protocol on child development focused on the critical bias of Health Promotion principles. The protocol was implemented by family health teams in critical regions of São Paulo city. The researches linked to the protocol evaluated used technologies and the strategies for its implementation. The results pointed that frameworks of Health Promotion contributes to the comprehensive care and strengthening of children and families health. Researches for evaluating the actions in Health Promotion require a variety of approaches, to cover the complexity of the processes and outcomes.