Maria Rita Bertolozzi

Pode o conceito de vulnerabilidade apoiar a construção do conhecimento em Saúde Coletiva

The term vulnerability has been frequently used in scientific literature, especially after the 80s, in some epidemiologic studies, mainly focusing the risk perspective. The purpose of this article is to review the vulnerability concept through a systematic study of national and international circulation newspapers, to support knowledge and practices in the collective health care field. Furthermore, it indicates how this concept has been revisited in studies conducted in Brazil, mentioning issues which support the structural dimension of reality, linking them to the needs of a program for patients, health care users and their families. It is important to study the vulnerability concept due to the fact that an understanding of this concept will contribute to support the delivery of care, of collective health care including individual health care programs and health care policies.

The use of the "vulnerability" concept in the nursing area

2 Este artigo teve por objetivo realizar breve resgate do conceito de vulnerabilidade que vem sendo utilizado na area da saude e discutir sua utilizacao pela enfermagem. Os estudos, em meio a diversidade de enfoques e objetos, tem buscado superar o raciocinio classico de risco em epidemiologia, avancando para a discussao dos determinantes sociais na producao dos agravos.The objective of this article was to briefly retrieve the meaning of the vulnerability concept, which has been used in the healthcare area; also, to discuss how it has been used in the Nursing area. Amidst several different focuses and objects, studies have been attempting to overcome the classical reasoning of risk in epidemiology, advancing towards the discussion of the social determinants for the production of health problems.

Os conceitos de vulnerabilidade e adesão na Saúde Coletiva

Los conceptos de Vulnerabilidad y Adhesion han sido foco de debate en la Salud Colectiva. El desafio puesto por este campo, de propiciar tecnologias, dispositivos e instrumentos que apoyen la construccion de practicas calificadas, para atender a las necesidades de los grupos sociales, ha constituido el terreno donde se elabora el conocimiento, buscando la innovacion en el desarrollo de instrumentos que apoyen la captacion de la realidad, apoyen la lectura de las necesidades y en el desencadenamiento y sustentacion de proyectos de intervencion que produzcan el impacto deseado: atender los grupos sociales que mas carecen de apoyo para conquistar autonomia para vivir la vida con calidad y la consecucion del auto-cuidado, en el escenario de la equidad y de la justicia social. El articulo presenta aspectos de las categorias analiticas Adhesion y Vulnerabilidad, en cuanto a la proposicion de indicadores para su monitoreo, lo que puede contribuir para el desarrollo del concepto y para las practicas en el proceso de produccion a la salud.The Vulnerability and the Compliance are concepts that have being focus of debate in the Collective Health field. The challenge of the Collective Health is to promote tech- nologies, and tools to support qualified actions, and to answer to the social groups´ needs, looking for the innovation of the in- struments to apprehend the reality and to develop interventions that could produce impacts: attending these social groups who needs support to conquer autonomy in the self-care. This article presents aspects of the analytic categories Compliance and Vulnerability, proposing indicators for monitoring it, in order to contribute to the development of the concepts as to the health production process.

A utilização do conceito "vulnerabilidade" pela enfermagem

2 Este artigo teve por objetivo realizar breve resgate do conceito de vulnerabilidade que vem sendo utilizado na area da saude e discutir sua utilizacao pela enfermagem. Os estudos, em meio a diversidade de enfoques e objetos, tem buscado superar o raciocinio classico de risco em epidemiologia, avancando para a discussao dos determinantes sociais na producao dos agravos.The objective of this article was to briefly retrieve the meaning of the vulnerability concept, which has been used in the healthcare area; also, to discuss how it has been used in the Nursing area. Amidst several different focuses and objects, studies have been attempting to overcome the classical reasoning of risk in epidemiology, advancing towards the discussion of the social determinants for the production of health problems.

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.

Percepções sobre necessidades de saúde na Atenção Básica segundo usuários de um serviço de saúde

This qualitative, exploratory study was performed with the purpose of identifying the concept of health needs according to the perception of health service users located in the State of Sao Paulo. Fifteen interviews were performed using a semi-structured script, in January 2009. The exhaustive reading of the interviews allow for identifying the elements that comprise the categories, which had been previously defined according to the Taxonomy of Health Needs. It was observed that users view themselves as holders of needs: the social context may strongly affect their health, and therefore the users have the need for autonomy in making decisions. As for attachment, it is observed that it is closely related to the autonomy/self care needs, as, in a certain way, it is necessary to strengthen the trust relationship so that the potentials to face the health-disease process may also be strengthened. In conclusion, there is a need for instruments that help collective health professionals to identify the health need of users.

As políticas de saúde no Brasil: reconstrução histórica e perspectivas atuais

Authors presents an evolution of the public healths politics in Brasil through a critical review of the historical process. Besides this they call to the importance of this issue in the undergraduate curricular in nursing.Authors presents an evolution of the public healths politics in Brasil through a critical review of the historical process. Besides this they call to the importance of this issue in the undergraduate curricular in nursing.

O tratamento diretamente supervisionado (DOTS) contribui para a adesão ao tratamento da tuberculose

This is a qualitative study performed in the theoretical framework of the Theory of Social Determination of the Health-Disease process and the concept of Compliance. The goal was to analyze meanings of DOTS in compliance with tuberculosis treatment, according to healthcare professionals of the Technical Healthcare Supervision of Butantã (SUVIS), a region of the São Paulo City Healthcare Secretariat, Brazil. The project was submitted to the Ethics Committee of the São Paulo Municipal Health Secretariat. All professionals (22 people) developing DOTS were interviewed, including service coordinators, healthcare professionals and the DOTS coordinator for the region. The statements were analyzed with an appropriate technique for discourse analysis. The results appoint that the strategy presents more potentialities than limits and is effective regarding compliance, since it allows the professionals to welcome and monitor the patients, considering their needs. The importance of increasing the understanding of compliance is also noted, so that it can go beyond the simple intake of medication, integrating the care for the sick person and his or her necessities by transcending those restricted to the biological dimension.This is a qualitative study performed in the theoretical framework of the Theory of Social Determination of the Health-Disease process and the concept of Compliance. The goal was to analyze meanings of DOTS in compliance with tuberculosis treatment, according to healthcare professionals of the Technical Healthcare Supervision of Butanta (SUVIS), a region of the Sao Paulo City Healthcare Secretariat, Brazil. The project was submitted to the Ethics Committee of the Sao Paulo Municipal Health Secretariat. All professionals (22 people) developing DOTS were interviewed, including service coordinators, healthcare professionals and the DOTS coordinator for the region. The statements were analyzed with an appropriate technique for discourse analysis. The results appoint that the strategy presents more potentialities than limits and is effective regarding compliance, since it allows the professionals to welcome and monitor the patients, considering their needs. The importance of increasing the understanding of compliance is also noted, so that it can go beyond the simple intake of medication, integrating the care for the sick person and his or her necessities by transcending those restricted to the biological dimension.This is a qualitative study performed in the theoretical framework of the Theory of Social Determination of the Health-Disease process and the concept of Compliance. The goal was to analyze meanings of DOTS in compliance with tuberculosis treatment, according to healthcare professionals of the Technical Healthcare Supervision of Butanta (SUVIS), a region of the Sao Paulo City Healthcare Secretariat, Brazil. The project was submitted to the Ethics Committee of the Sao Paulo Municipal Health Secretariat. All professionals (22 people) developing DOTS were interviewed, including service coordinators, healthcare professionals and the DOTS coordinator for the region. The statements were analyzed with an appropriate technique for discourse analysis. The results appoint that the strategy presents more potentialities than limits and is effective regarding compliance, since it allows the professionals to welcome and monitor the patients, considering their needs. The importance of increasing the understanding of compliance is also noted, so that it can go beyond the simple intake of medication, integrating the care for the sick person and his or her necessities by transcending those restricted to the biological dimension.

The vulnerability of nursing workers to tuberculosis in a teaching hospital

This study aimed to identify aspects that potentially increase the vulnerability of nursing workers to tuberculosis, through the verification of personal life, work and disease knowledge indexes. The sample is composed of 81 nursing workers involved with assistance in the night and day shifts at USP Teaching Hospital, who answered a questionnaire about life and work habits. The sample aggregated the indexes that increase vulnerability to tuberculosis: long professional experience in hospitals and work load longer than 12 hours. Data show that nursing auxiliaries and workers from the night shift in general have a higher number of vulnerability indexes.En este estudio se busco identificar aspectos que pueden potenciar la vulnerabilidad de los trabajadores de enfermeria frente a la tuberculosis, utilizando la verificacion de indicadores de vida personal, trabajo y los relacionados al conocimiento de la enfermedad. La muestra estuvo conformada por 81 trabajadores de enfermeria involucrados con la asistencia en los turnos diurno y nocturno del Hospital Universitario de la USP, los cuales respondieron a un cuestionario sobre los habitos de vida y de trabajo. A traves de la muestra fue posible mostrar indicadores sobre la vulnerabilidad a la tuberculosis: una larga experiencia profesional en hospital y jornada con mas de 12 horas diarias. Los datos mostraron que, auxiliares de enfermeria y trabajadores del turno nocturno presentan mayor numero de indicadores de vulnerabilidad. Gran parte de los trabajadores mostraron conocimiento equivocado sobre la enfermedad, a pesar de brindar atencion a pacientes con tuberculosis. Los resultados evidenciaron la necesidad de difundir el conocimiento apropiado sobre la tuberculosis, ya que estos trabajadores constituyen agentes para su control.

Revisão sistemática: noções gerais

Systematic review is a useful methodology in health, as it makes it possible to identify the best evidence and sumamrize them so as to found proposals for changes in the areas of prevention, diagnosis, treatment and rehabilitation. The purpose of this article is to provide support for planning systematic reviews by answering the following questions: What is evidence-based practice? What is systematic review? Should systematic reviews be anchored on qualitative or quantitative research? What are the pertinent information sources to identify the evidence? What is evidence? What are the procedures to validate a systematic review? How can the quality of evidence be evaluated? What methodology is used to summarize the evidence? How should a systematic review be planned?A revisao sistematica e uma metodologia util em saude, dado que possibilita identificar as melhores evidencias e sintetiza-las, para fundamentar propostas de mudancas nas areas de prevencao, diagnostico, tratamento e reabilitacao. Este artigo tem como objetivo oferecer subsidios para o planejamento da revisao sistematica respondendo as seguintes perguntas: O que e Pratica Baseada em Evidencias? O que e revisao sistematica? A revisao sistematica deve estar ancorada em pesquisas qualitativas ou quantitativas? Quais sao as fontes de informacao pertinentes para identificar as evidencias? O que e evidencia? Quais os procedimentos para validar a revisao sistematica? Como avaliar a qualidade das evidencias? Qual metodologia e empregada para a sintese das evidencias? Como planejar a revisao sistematica?