Cleide Lavieri Martins

Atenção básica de saúde e a assistência em Hanseníase em serviços de saúde de um município do Estado de São Paulo

UNLABELLED This descriptive study was carried out in a municipality of Sao Paulo State. The objective was to identify and to characterize the Leprosy Control Program in primary care in the city of research. METHODOLOGY the interviews were conducted with professionals responsable for care in Hansens Disease and with manager of public health policies. RESULTS the public health policies prioritize the development of primary care and emphasis on the public health. The control actions are held by trained and experient professionals. It emphasizes absence of active search for cases which undermines the real epidemiological situation, and the important health education to the reduction of stigma and bring the subject of adjustments necessary in new situation of life and overcome limitations.This descriptive study was carried out in a municipality of Sao Paulo State. The objective was to identify and to characterize the Leprosy Control Program in primary care in the city of research. Methodology: the interviews were conducted with professionals responsable for care in Hansens Disease and with manager of public health policies. Results: the public health policies prioritize the development of primary care and emphasis on the public health. The control actions are held by trained and experient professionals. It emphasizes absence of active search for cases which undermines the real epidemiological situation, and the important health education to the reduction of stigma and bring the subject of adjustments necessary in new situation of life and overcome limitations.

Hanseníase no Estado do Espírito Santo, Brasil: uma endemia em ascensão?

Descricao do comportamento e analise da tendencia da hanseniase entre pacientes residentes no Estado do Espirito Santo, Brasil, de 1980 a 2003. Utilizando modelos estatisticos para series temporais, identificou-se tendencia crescente para todo o periodo da taxa de deteccao global (p < 0,05) com aparente estabilizacao no final do periodo, verificamos tambem tendencia crescente para os periodos: (i) 1980-1987 nos grupos etarios de < 15 anos e 50 anos e mais e para formas paucibacilares; (ii) 1988-1995 para as faixas de 15-19 anos, 20-29 e 50 anos e mais e para formas multibacilares; (iii) 1996-2003 no grupo de 20-29 anos e formas paucibacilares. Os indicadores de avaliacao da endemia apontaram patamares estaveis do grau de incapacidade 2 (em media 6%); a proporcao de casos entre < 15 anos situou-se abaixo de 10% e a de abandono de tratamento em torno de 6%. A prevalencia apresentou forte declinio. A tendencia crescente pode ser explicada, em parte pela maior sensibilidade da vigilância, mas a elevada proporcao entre < 15 anos aponta a necessidade de estudos visando ao melhor conhecimento dos residuos de fontes de infeccao especialmente no domicilio.

Colaboração interprofissional na Estratégia Saúde da Família: implicações para a produção do cuidado e a gestão do trabalho

Interprofessional collaboration is seen as a resource for tackling model of care and workforce problems. The scope of this study was to understand the perception about the shared work and interprofessional collaboration of professionals who work in primary health care. A qualitative study was conducted in Sao Paulo city. In-depth interviews were performed with professionals from distinct categories who worked in the Family Health Strategy and Support Center for Family Health. The results highlighted the empirical ‘professional interaction’ and ‘production goals’ categories. The forms of interaction, the role of specialized matrix support and the perspective in which production goals are perceived by the professionals pointed to tensions between traditional professional logic and collaboration logic. It also revealed the tensions between a model based on specialized procedures and a more collaborative model centered on health needs of families and of the community. The sharing of responsibilities and practices, changes in the logic of patient referral to specialized services and inadequate organizational arrangements remain major challenges to the integration of interprofessional collaboration for the development of new care practices.

Organização de serviços de saúde na eliminação da Hanseníase em municípios do Estado de São Paulo

Este trabalho tem como objetivo analisar as acoes de controle da hanseniase desenvolvidas em nove municipios do Estado de Sao Paulo e uma coordenadoria de saude da Capital, selecionados a partir de sua populacao, localizacao geografica e coeficientes de prevalencia. Foi aprovado pelo Comite de Etica no 514/05 e foram aplicados instrumentos por meio de entrevistas em 59 profissionais e 17 interlocutores. Os dados foram analisados utilizando o programa SPSS (Statistical Package for Social Scientists). Verificou-se que a prevalencia apresenta declinio e a deteccao permanece estavel. As acoes de prevencao de incapacidade fisica, educacao em saude e a busca ativa sao pouco desenvolvidas. Os profissionais mais capacitados encontram-se nas unidades de referencia, ha fragilidade quanto ao trabalho em equipe.The present study aims to analyze actions to control Hansens disease developed in nine municipalities of the State of São Paulo and one of the health authorities of the city of São Paulo, selected based on their population, geographic location and prevalence coefficients. The study was approved by the Ethics Committee n masculine 514/05 and instruments were administered by means of interviews to 59 professionals, 17 interlocutors and 9 managers. Data were analyzed using the program SPSS (Statistical Package for Social Scientists). It was verified that prevalence is on the decline and detection remains stable. The physical incapacity prevention actions, health education and active search have not been satisfactorily developed. The most qualified professionals are in the reference units and teamwork is fragile.

Conhecendo egressos do curso técnico de Enfermagem do PROFAE

El PROFAE (Proyecto de Profesionalizacion de Trabajadores del Area de Enfermeria) fue una iniciativa importante en la educacion profesional. Se objetivo describir el perfil de egresados del curso de tecnico en enfermeria de centros de formacion de la Secretaria de Estado de Salud de San Pablo y conocer los resultados para desempeno profesional y movimiento del mercado laboral. La recoleccion de datos se realizo mediante cuestionario respondido por 216 egresados y cuatro grupos focales de egresados-enfermeros supervisores. Quienes respondieron fueron mayoritariamente mujeres con media etaria 42,2 anos. El curso fue bien evaluado, destacandose el apoyo institucional y las resoluciones del Consejo Regional de Enfermeria (COREN) como impulsores de su promocion. Los egresados perciben tener mayor iniciativa y preparacion teorica luego del curso. En el area, la funcion mas ejercida es la de auxiliar de enfermeria. Esto genera insatisfaccion, pues principalmente en servicios publicos, no existen cargos de tecnico.The PROFAE (Professionalization Project in Nursing) was a relevant initiative for professional education. The objectives were to describe the profile of the former students of the technical nursing course of the São Paulo Health Department training centers so as to evaluate the effects of the course for the mobility and professional performance in the working market. Data collection was performed using a questionnaire answered by 216 former students and four focal groups with former students and nurse supervisors. Most respondents were women, with an average age of 42.2. The course received a positive evaluation, and two aspects were pointed out as motivating for searching for it: institutional support and CORENs resolutions. The former students perceive they had more initiative and theoretical preparation after the course. Nursing aide remains as the most common position in the area, thus causing dissatisfaction, because, especially in public services, technician positions are not available.

A construção do cuidado: o atendimento às situações de violência doméstica por equipes de Saúde da Família

Abstract As violence has proved to be an important public health issue, it has stimulated scientific production and the development of public policies. The objective of the present article is to understand the care stra -tegies developed by Family Health Program Teams in Diadema to handle domestic violence situations. A qualitative analysis approach of selected cases identified by the teams as “difficult”, “typical” and “successful” was adopted. Two Family Health Pro-gram teams and different professionals from the intersectoral network were interviewed. Organizing services according to the Family Health Strategy guidelines has shown to be a facilitating factor to develop care strategies to handle domestic violence. Professionals identified different kinds of violence in the assisted families, but the actions of the teams focused mainly on the child abuse related situations. Violence against women in general was not taken into account by the teams, which shows different degrees of “visibility” among the various types of violence. Strategies included actions to promote deeper bonds with the family, cases monitoring and biomedical aspects evaluation, as well as more acu -te actions such as mandatory hospitalization. The strategies developed alternate from a prescriptive perspectivel to one more centered in the concept of Care, during the interaction with the families and regarding their needs. The community health agents and NASF professionals were the main protagonists in these cases, articulating practical and technical knowledge. Keywords: Domestic Violence; Child Abuse; Violence against Women; Primary Health Care.

Atenção primária à saúde e coordenação do cuidado nas regiões de saúde: perspectiva de gestores e usuários

This paper aims to analyze the healthcare coordination by Primary Health Care (PHC), with the backdrop of building a Health Care Network (RAS) in a region in the state of São Paulo, Brazil. We conducted a case study with qualitative and quantitative approaches, proceeding to the triangulation of data between the perception of managers and experience of users. We drew analysis realms and variables from the three pillars of healthcare coordination - informational, clinical and administrative/organizational. Stroke was the tracer event chosen and therapeutic itineraries were conducted with users and questionnaires applied to the managers. The central feature of the construction of the Health Care Network in the studied area is the prominence of a philanthropic organization. The results suggest fragility of PHC in healthcare coordination in all analyzed realms. Furthermore, we identified a public-private mix, in addition to services contracted from the Unified Health System (SUS), with out-of-pocket payments for specialist consultation, tests and rehabilitation. Much in the same way that there is no RAS without a robust PHC capable of coordinating care, PHC is unable to play its role without a solid regional arrangement and a virtuous articulation between the three federative levels.Resumo O objetivo deste artigo e analisar a coordenacao do cuidado pela Atencao Primaria a Saude (APS), tendo como pano de fundo o processo de construcao da Rede de Atencao a Saude (RAS) em regiao do estado de Sao Paulo. Foi realizado estudo de caso com abordagens quantitativa e qualitativa, procedendo-se a triangulacao dos dados, entre a percepcao dos gestores e as experiencias dos usuarios. As dimensoes e as variaveis de analise partiram dos tres pilares da coordenacao do cuidado – informacional, clinico, administrativo/organizacional. Tendo como evento tracador o Acidente Vascular Encefalico, itinerarios terapeuticos foram conduzidos com usuarios e questionarios aplicados a gestores. A construcao da Rede de Atencao a Saude na regiao estudada tem como traco central o protagonismo de entidade filantropica. Os resultados sugerem fragilidades da APS em assumir papel de coordenacao do cuidado em todas as dimensoes analisadas. Ademais, foi identificado mix publico-privado para alem dos servicos contratados pelo SUS, com desembolso direto para consultas especializadas, exames e reabilitacao. Da mesma forma que nao existe RAS sem APS robusta capaz de coordenar o cuidado, a APS nao consegue exercer seu papel sem um solido arranjo regional e uma articulacao virtuosa entre os tres entes federados.

A experiência da pessoa estomizada com câncer: uma análise segundo o Modelo de Trajetória da Doença Crônica proposto por Morse e Johnson

El estudio tuvo como objetivo, comprender el significado de la experiencia de la enfermedad, en un paciente con cancer al cual le fue realizada una ostomia permanente y las transformaciones en su identidad. De abordaje cualitativo guiado por el referencial metodologico de la historia oral de vida, acompanando a los deponentes durante un ano, contado este a partir de su internacion en hospital. Durante dicho periodo, se realizo una serie de 5 (cinco) entrevistas con cada uno de los participantes. La descripcion y analisis de la trayectoria recorrida fueron fundamentadas en el Modelo de Constelacion de la Enfermedad propuesto por Morse y Johnson. La discusion mostro que, despues de un profundo impacto ocasionado por la enfermedad y el estoma permanente, los pacientes inician un proceso de otorgar una nueva significacion a sus identidades, que incluye un proceso de reposicion de cada uno de ellos frente a la vida.The study aimed at understanding the meaning of the disease experience for the ostomized people with cancer and the changes on their identity. With a qualitative approach based on the methodological referential of the oral history of life, we have accompanied the subjects during one year, from the moment of hospitalization. During that period, a series of five interviews were performed with each subject. The description and analysis of the evolution were based on the Model of Constellation of the Disease proposed by Morse and Johnson. The analysis showed that, after the deep impact caused by the disease and the permanent ostomy, the subjects begin a new process of realizing their identities, which includes a rediscovery of their place in life.O estudo objetivou compreender o significado da experiencia de doenca para a pessoa estomizada com câncer e as transformacoes sobre sua identidade. De abordagem qualitativa guiado pelo referencial metodologico da historia oral de vida, acompanhou os depoentes durante um ano, a contar do momento da internacao hospitalar. Durante esse periodo, realizou-se uma serie de cinco entrevistas com cada um dos participantes. A descricao e analise da trajetoria percorrida foram embasadas no Modelo de Constelacao da Doenca proposto por Morse e Johnson. A discussao mostrou que, apos o profundo impacto ocasionado pela doenca e o estoma permanente, as pessoas iniciam um processo de ressignificacao de suas identidades, que inclui um reposicionamento de cada uma delas perante a vida.

Profissionalização de atendentes de enfermagem no Estado de São Paulo: um estudo sobre a oferta e demanda de formação

Este estudo exploratorio objetivou contextualizar a problematica de profissionalizacao dos atendentes de enfermagem e analisar a oferta de cursos e a demanda de formacao de nivel tecnico de enfermagem em Sao Paulo. As informacoes foram obtidas a partir de levantamento documental sobre qualificacao profissional na area, nos anos 90. Identificou-se um cenario de mudancas conceituais e politicas de profissionalizacao e a existencia de grande contingente de atendentes a serem profissionalizados. Verificou-se uma tendencia de aumento na oferta de cursos e na demanda para a formacao e as especializacoes de nivel tecnico.The purpose of this exploratory study was to verify the problem of nursing aides professionalization and to analyze the offer of courses and demand regarding technical level capacitation at the state of Sao Paulo, Brazil. Data were obtained through the analysis of documents on professional capacitation in the area in the 1990s. Authors identified a scenario of conceptual and political changes regarding the professionalization and the existence of a great number of aides being professionalized. They also verified a tendency to increase the offer of courses and the demand regarding the capacitation and specialization at the technical level.

The work of speech therapists under Support Centers for Family Health (NASF) - specificities of primary care

OBJETIVO:compreender o trabalho do fonoaudiologo no Nucleo de Apoio a Saude da Familia, identificando tecnologias incorporadas ao processo de trabalho tradicional desse profissional.METODOS:os sujeitos sao fonoaudiologos das equipes de Sao Paulo/SP do Nucleo de Apoio a Saude da Familia. Por meio de questionario on-line, foram levantadas informacoes acerca da formacao e dos processos de trabalho do fonoaudiologo como apoiador nessas equipes. Os dados quantitativos foram analisados por meio da Estatistica Descritiva e os qualitativos de acordo com os preceitos da Analise Categorial Tematica, sob o referencial teorico do Trabalho em Saude.RESULTADOS:o processo de trabalho foi caracterizado a partir dos elementos que o compoem, sendo que o objeto do trabalho consiste nas equipes de Saude da Familia e na populacao adscrita, o meio e o Apoio e os instrumentos consistem nas ferramentas tecnologicas preconizadas pelo Ministerio da Saude. A conformacao das equipes e variada e a organizacao do trabalho parte das reunioes de matriciamento. Suas praticas envolvem acoes de apoio a assistencia, acoes de apoio tecnico-pedagogico, acoes de articulacao de Rede e acoes de gestao do trabalho e os fonoaudiologos se apropriam de novos conhecimentos e estrategias por meio do trabalho compartilhado.CONCLUSAO:na Atencao Basica, as possibilidades de atuacao podem ser especificas ou compartilhadas, do nucleo de conhecimento ou de âmbito geral, e o enfoque dependera das caracteristicas do territorio e da disponibilidade dos profissionais. A formacao nao garante as competencias necessarias, havendo a incorporacao de novas praticas a partir das vivencias experimentadas em servico.