Gracyelle Alves Remigio Moreira

Autópsia psicológica e psicossocial sobre suicídio de idosos: abordagem metodológica

The article analyzes the quality and consistency of a semi-structured interview script, adapted for the study on suicide among elderly people, and presents the psychological and psychosocial autopsy method, which is the result of application of this instrument. The objective is to demonstrate how the in-depth interview and subsequent data organization and analyses were tested and improved by a network of researchers from eight regions in Brazil. Evaluation of the method was conducted before and after the application of the instruments to collect, systematize and analyze the data. This methodology was applied in 51 cases of elderly people who committed suicide in ten Brazilian municipalities. The study did more than just collect data with scientific rigor, since it also verified the consistency of the instrument used and the applicability of the method. The improved script and the instructions of how to apply and analyze it are thus presented here. The results reveal the rigor and credibility of this methodological approach tested and qualified by a multidisciplinary and inter-institutional procedure.O artigo analisa a qualidade e a consistencia de um roteiro de entrevista semiestruturada, adaptado para o estudo do suicidio de pessoas idosas e apresenta o metodo das autopsias psicossociais que resultou da aplicacao desse instrumento. O objetivo e demonstrar como o uso da entrevista em profundidade e sua forma de organizacao e analise de dados foram testados e aperfeicoados por uma rede de pesquisadores de varios centros de pesquisa do Brasil. O metodo envolveu a aplicacao do instrumento em que se socializou um manual de instrucoes sobre a coleta, sistematizacao e analise de dados. A metodologia foi aplicada no estudo de 51 casos de idosos que faleceram por suicidio em dez municipios brasileiros, e permitiu a verificacao da consistencia do instrumento usado e a aplicabilidade do seu metodo, durante o processo e ao final, por meio de uma avaliacao em rede. O roteiro aperfeicoado e as instrucoes para replica-lo e analisa-lo sao aqui apresentados. Os resultados apontam o rigor e a credibilidade dessa abordagem metodologica testada e qualificada de um modo interdisciplinar e interinstitucional.

Cuidado ao paciente com Doença Renal Crônica no nível primário: pensando a integralidade e o matriciamento

A Doenca Renal Cronica e um problema de saude publica crescente no mundo. A deteccao e o tratamento precoces reduziriam as altas taxas de morbimortalidade e os custos associados. Este trabalho buscou identificar o panorama do acesso ao cuidado a partir da conduta dos medicos da Atencao Primaria a Saude na linha de cuidado da doenca. Aplicaram-se questionarios para 62 medicos de familia dos Centros de Saude da Familia do municipio de Fortaleza. Os achados apontam que a Taxa de Filtracao Glomerular foi mensurada por apenas 8.1% dos medicos para pacientes diabeticos e 4.8% para pacientes hipertensos. Mais da metade dos medicos (51.2%) referenciariam o paciente apresentando reducao leve/moderada da Taxa de Filtracao Glomerular ao nivel secundario. Por outro lado, 25.8% dos medicos nao referenciariam o paciente com Doenca Renal Cronica avancada ao especialista. A lacuna entre esses dois niveis da atencao implica em barreira de acesso ao usuario, podendo comprometer avancos no plano da integralidade. A criacao de novos dispositivos no processo de trabalho torna-se urgente e o apoio matricial apresenta-se como proposta viavel para a articulacao das acoes entre os niveis da atencao no cuidado do portador da Doenca Renal Cronica ou seus fatores de risco.

Subnotificação de maus-tratos em crianças e adolescentes na Atenção Básica e análise de fatores associados

Estudo transversal que analisou os fatores associados a subnotificacao de maus-tratos em criancas e adolescentes. Participaram do estudo 1.055 profissionais que trabalhavam na Atencao Basica em 85 municipios cearenses. Os dados foram obtidos por meio de questionario e submetidos a analise bivariada e multivariada por regressao logistica. O modelo final mostrou que ter menos de cinco anos de trabalho, nao conhecer a ficha de notificacao, nao ter a ficha na unidade de saude, nao confiar nos orgaos de protecao, nao saber para onde encaminhar os casos e ter medo de envolvimento legal aumentou a chance dos profissionais nao notificarem situacoes de maus-tratos nesse grupo.

Instrumentação e conhecimento dos profissionais da equipe saúde da família sobre a notificação de maus-tratos em crianças e adolescentes

OBJECTIVE To analyze training and knowledge of professionals in the Family Health Team on reporting the mistreatment of children and adolescents. METHODS Cross-sectional study carried out in three municipalities of Ceará State, Northeast Brazil, from January to April 2012. The research included 51 professionals: physicians (9), nurses (26), and dentists (16) who worked in the Family Health Strategy. A questionnaire was used for data collection, which received descriptive statistical analysis with the Pearsons chi-square test, being significant p≤0.05. RESULTS There was a predominance of professionals who had not participated in violence against children and adolescents training (86.3%); who knew the Child and Adolescent Statute (90.2%), and how to notify mistreatment (62.7%). Most interviewees said that the health unit had the form (70.5%), and they knew where to refer victims to (82.3%). Most professionals did not have any contact with mistreatment situations (62.8%). Only 37.2% had already identified some case and, among them, 60.0% reported the occurrences. There was a significant association (p=0.035) between the act of notifying and the participation in a training on the subject. CONCLUSIONS This study showed that the participants have difficulties in the reporting mistreatment of children and adolescents, and there are gaps in knowledge and weaknesses in training in this area.Objective: To analyze training and knowledge of professionals in the Family Health Team on reporting the mistreatment of children and adolescents. Methods: Cross-sectional study carried out in three municipalities of Ceara State, Northeast Brazil, from January to April 2012. The research included 51 professionals: physicians (9), nurses (26), and dentists (16) who worked in the Family Health Strategy. A questionnaire was used for data collection, which received descriptive statistical analysis with the Pearson’s chi-square test, being significant p≤0.05. Results: There was a predominance of professionals who had not participated in violence against children and adolescents training (86.3%); who knew the Child and Adolescent Statute (90.2%), and how to notify mistreatment (62.7%). Most interviewees said that the health unit had the form (70.5%), and they knew where to refer victims to

Factors associated to the imposition of types of violence against women informed in sentry services

OBJECTIVE to identify the prevalence and the factors associated to the imposition of the different types of violence against women informed in sentry services. METHOD transversal study accomplished through 939 notification forms of cases of violence against women, referring to the three years from 2006 to 2008 in Fortaleza, Ceará. Univariate and multiple analyses by logistic regression were realized. RESULT the results showed a positive association between the imposition of types of violence against women with a schooling varying from illiterate to basic education and the aggression which had occurred other times. CONCLUSION this knowledge contributes to the delineation of specific actions that aim at facing this problem, as well as generates subsidies for adequate attendance proposals and guidance for the victims who call on health services.OBJETIVO: identificar a prevalencia e os fatores associados a sobreposicao dos diferentes tipos de violencia contra a mulher, notificada em servicos sentinela. METODO: estudo transversal, realizado com 939 fichas de notificacao de casos de violencia contra a mulher, referentes ao trienio de 2006 a 2008, em Fortaleza, Ceara. Analises univariada e multipla por regressao logistica foram realizadas. RESULTADO: os resultados mostraram associacao positiva entre a sobreposicao de tipos de violencia contra a mulher com a escolaridade variando de analfabeta a ensino fundamental e a agressao ter ocorrido outras vezes. CONCLUSAO: esse conhecimento contribui para o delineamento de acoes especificas que visam o enfrentamento dessa problematica, assim como gera subsidios para proposta adequada de atendimento e encaminhamento das vitimas que buscam os servicos de saude.

Fatores associados à notificação de maus-tratos em crianças e adolescentes na atenção básica

This study aimed to analyze factors associated with the reporting of child and adolescent abuse in primary healthcare. It is a cross-sectional study conducted with 381 professionals (physicians, nurses and dental surgeons) from three healthcare regions of the state of Ceara, Brazil. It used a self-administered questionnaire asking for socio-demographic data, vocational education and training, instrumentation and knowledge on the issue, identification and reporting of abuse cases. Bivariate and multivariate analyses using logistic regression were performed. There was a frequency of 17% of abuse reporting by basic healthcare professionals. The multivariate analysis showed that participating in the training on the issue (OR = 2.18; CI95% = 1.05-4.53), being familiar with the reporting form (OR = 3.03; CI95% = 1.47-6.24) and knowing how to refer the case properly (OR = 2.55; CI95% = 1.01-6.43) increased the chance of professionals reporting child and adolescent abuse. The variables identified in the final model showed a direct association between the act of reporting and matters related to knowledge and training on the issue. Investments in the training of healthcare professionals are required in order to favor the qualification of the practice for this public health problem.

Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents

OBJECTIVE To analyze training and knowledge of professionals in the Family Health Team on reporting the mistreatment of children and adolescents. METHODS Cross-sectional study carried out in three municipalities of Ceará State, Northeast Brazil, from January to April 2012. The research included 51 professionals: physicians (9), nurses (26), and dentists (16) who worked in the Family Health Strategy. A questionnaire was used for data collection, which received descriptive statistical analysis with the Pearsons chi-square test, being significant p≤0.05. RESULTS There was a predominance of professionals who had not participated in violence against children and adolescents training (86.3%); who knew the Child and Adolescent Statute (90.2%), and how to notify mistreatment (62.7%). Most interviewees said that the health unit had the form (70.5%), and they knew where to refer victims to (82.3%). Most professionals did not have any contact with mistreatment situations (62.8%). Only 37.2% had already identified some case and, among them, 60.0% reported the occurrences. There was a significant association (p=0.035) between the act of notifying and the participation in a training on the subject. CONCLUSIONS This study showed that the participants have difficulties in the reporting mistreatment of children and adolescents, and there are gaps in knowledge and weaknesses in training in this area.Objective: To analyze training and knowledge of professionals in the Family Health Team on reporting the mistreatment of children and adolescents. Methods: Cross-sectional study carried out in three municipalities of Ceara State, Northeast Brazil, from January to April 2012. The research included 51 professionals: physicians (9), nurses (26), and dentists (16) who worked in the Family Health Strategy. A questionnaire was used for data collection, which received descriptive statistical analysis with the Pearson’s chi-square test, being significant p≤0.05. Results: There was a predominance of professionals who had not participated in violence against children and adolescents training (86.3%); who knew the Child and Adolescent Statute (90.2%), and how to notify mistreatment (62.7%). Most interviewees said that the health unit had the form (70.5%), and they knew where to refer victims to

Protocolos na atenção à saúde de mulheres em situação de violência sexual sob a ótica de profissionais de saúde

The use of protocols in health care for women suffering from sexual violence was analyzed from the standpoint of health professionals. It involved a qualitative study conducted in 18 institutions with 140 professionals interviewed in Fortaleza and Rio de Janeiro. After organization of the data, the clusters of meaning pointed to the potential benefits of the use of protocols; limits to be faced in the adoption of protocols; and the need for protocol development and professional training. The results revealed points of convergence and divergence between the two municipalities regarding the use of protocols in health care for women suffering from sexual violence. In Rio de Janeiro, the adoption of protocols in the services by the majority of interviewees and the existence of an established reporting system are acknowledged and involve the work of professionals from different areas. In Fortaleza, the participants of only one institution mentioned the use of protocols and an internal reporting system. In both capitals, professional qualifications to work with women suffering from sexual violence is inadequate due to the limited coverage of the issue during the undergraduate years of the healthcare professions and the lack of training in the health services.

Factors associated with reporting of abuse against children and adolescents by nurses within Primary Health Care

OBJECTIVE: to analyze the factors associated with the underreporting on the part of nurses within Primary Health Care of abuse against children and adolescents. METHOD: cross-sectional study with 616 nurses. A questionnaire addressed socio-demographic data, profession, instrumentation and knowledge on the topic, identification and reporting of abuse cases. Bivariate and multivariate logistic regression was used. RESULTS: female nurses, aged between 21 and 32 years old, not married, with five or more years since graduation, with graduate studies, and working for five or more years in PHC predominated. The final regression model showed that factors such as working for five or more years, having a reporting form within the PHC unit, and believing that reporting within Primary Health Care is an advantage, facilitate reporting. CONCLUSION: the studys results may, in addition to sensitizing nurses, support management professionals in establishing strategies intended to produce compliance with reporting as a legal device that ensures the rights of children and adolescents.OBJECTIVE: to analyze the factors associated with the underreporting on the part of nurses within Primary Health Care of abuse against children and adolescents. METHOD: cross-sectional study with 616 nurses. A questionnaire addressed socio-demographic data, profession, instrumentation and knowledge on the topic, identification and reporting of abuse cases. Bivariate and multivariate logistic regression was used. RESULTS: female nurses, aged between 21 and 32 years old, not married, with five or more years since graduation, with graduate studies, and working for five or more years in PHC predominated. The final regression model showed that factors such as working for five or more years, having a reporting form within the PHC unit, and believing that reporting within Primary Health Care is an advantage, facilitate reporting. CONCLUSION: the studys results may, in addition to sensitizing nurses, support management professionals in establishing strategies intended to produce compliance with reporting as a legal device that ensures the rights of children and adolescents.

Implementação da atenção em saúde às violências sexuais contra as mulheres em duas capitais brasileiras

Este artigo analisa a implementacao da atencao em saude as mulheres em situacao de violencia sexual em duas capitais brasileiras (Rio de Janeiro/Fortaleza). O estudo qualitativo analisou documentos sobre o tema e entrevistas semiestruturadas com 37 gestores dos sistemas de saude municipais. A questao vem sendo abordada de forma diferenciada pelos municipios, o que decorre das distintas trajetorias de consolidacao dos servicos, das aproximacoes com o movimento feminista e dos contextos culturais especificos. Notou-se que a implementacao das acoes nesse âmbito ainda apresenta fragilidades, exigindo esforcos de articulacao politica e tecnica para a estruturacao e a manutencao dos servicos.