Mirna Barros Teixeira

Avaliação das práticas de promoção da saúde: um olhar das equipes participantes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica

As praticas de Promocao da Saude das equipes de Atencao Basica no Brasil e macrorregioes foram analisadas a partir do PMAQ-AB (2012). Foram estudadas as frequencias de variaveis nos eixos: Reorientacao de Servicos; Acoes Comunitarias; Ambientes Saudaveis; Habilidades Pessoais (n=17.202 equipes). A abordagem territorial restringe-se aos aspectos geograficos; reconhece-se a vulnerabilidade de beneficiarios do Bolsa Familia; na escola ha predominio das acoes clinicas (saude bucal); educacao para sexualidade/reproducao; informacoes do ambiente foram restritas. Conclui-se que as praticas sao fragmentadas e focalizadas; urge integrar, equilibradamente, cuidado clinico, prevencao e promocao da saude.The Health Promotion practices of the basic attention teams in Brazil and macro-regions were analyzed from the PMAQ-AB (2012). The variable frequency axes were studied: Services Reorientation; Community Actions; Healthy Environments; Personal Skills (n = 17,202 teams). The territorial approach is restricted to geographic aspects; the vulnerability of the “Bolsa Familia Program” beneficiaries; there is a predominance of clinical actions at school (buccal health); sexuality/reproduction education; environmental information were restricted. It is concluded that the practices are still fragmented and focused; an even integration of clinical care, prevention and health promotion shall be urged.

Equipe “consultório na rua” de Manguinhos, rio de Janeiro, Brasil: práticas de cuidado e promoção da saúde em um território vulnerável

The structuring of care to the homeless people through Primary Health Care (PHC), standardized in 2012 is a challenge to the Brazilian Health System. This article discuss the practices of a Street Clinic (eCnaR) team for the homeless and alcohol, crack and other drugs users in order to provide comprehensive care implemented according to PHC and health promotion conceptions. A qualitative analysis of an eCnaR of the Municipality of Rio de Janeiro in the period 2011-2013 was performed, considering PHC essential atributes, with the following analytical categories: the territorial approach; open-door reception services; the complexity of care to vulnerable groups and the coordination of the health and intersectoral network. As theoretical framework, we systematized the concepts of care provided for in Brazilian policies/standards, considering health needs, as well as alcohol, crack and drug dependence in the homeless. As a PHC team for vulnerable populations and territories, the eCnaR was powerful in promoting access, building longitudinality, providing comprehensive care from the perspective of harm reduction and extended clinic. There are challenges to achieve effectiveness of care, such as the multi-professional education and composition; logistical and specialized support to address complex cases and also, the fragility of the network.

O apoio institucional como pilar na cogestão da atenção primária à saúde: a experiência do Programa TEIAS - Escola Manguinhos no Rio de Janeiro, Brasil

This article presents reflections regarding the concepts and praxis of a new feature for health care and management, namely institutional support. It is seen as a management tool for enhancing quality of care, which has the potential to reformulate the hierarchical and authoritarian practices of health coordination and planning. Institutional support is a trigger for change that can enhance the autonomy, accountability, collective practices and new relationships between managers, professionals and users of the health system. These assumptions are aligned with the concepts of comprehensive and participatory Primary Health Care (PHC), which lead us to the conclusion that matricial and institutional support are processes that generate new models of health care and management. To appreciate the modus operandi of this feature, the Teias Escola Manguinhos/ENSP/Fiocruz experience is presented as a case study, one of the main pillars of which is the adoption of institutional support as a strategy for joint accountability and participative management of PHC in a community in the city of Rio de Janeiro.

Tensões paradigmáticas nas políticas públicas sobre drogas: análise da legislação brasileira no período de 2000 a 2016

Brazilian public policy on drugs has been permeated by two diametrically opposing approaches: one focusing on prohibition and the other on non- prohibition. Similarly, there have been two opposing approaches to mental healthcare, one centered on hospitalization and the other psychosocial care and development. In the context of these different paradigms, this article presents an analysis of twenty-two documents sourced by the legislative rules over the last sixteen years. After the year 2000, a renewed focus by healthcare community on drugs was noticeable as was the immersion of a harm reducing approach. Following international trends, although there are still considerable divergencies between (a) psychosocial care and(b) residential care in the therapeutic communities there seems to be an alignment to anti- prohibition approaches.

Strategic Analysis of Health Care Practices for the Homeless in Rio de Janeiro, Brazil

This chapter systematizes and analyzes a model for working with primary healthcare (PHC) teams specifically for homeless people in the municipality of Rio de Janeiro, a major metropolis in southeast Brazil. The chapter is organized as follows. The introduction reflects on the main theoretical references that underpin the workings of such teams, in Brazilian law called Consultorio na Rua (CnaR) (literally “street clinic teams” or “homeless care teams,” although most of the care is provided at PHC facilities) and, in this chapter, the intervention under study. The specific context where these teams work in the municipal region is then outlined so as to frame the problem that justifies such an intervention as well as its expected outcomes. Next, the section “The case of the CnaR Teams in Rio de Janeiro” presents unpublished primary data from an evaluation study by health personnel with the Rio CnaR teams in 2016. This mode of service forms a strategy directed at the homeless population based on the principle of guaranteeing access to basic services, especially health services, and promoting comprehensive care. The importance of this study is indicated by how recently these teams have been introduced in Brazil and in Rio de Janeiro (about 5 years ago), the complexity and relevance of their work, directed as it is at such vulnerable groups, and the lack of evaluation studies of how the CnaR teams work in practice. The methodology used, strategic analysis, is directed at mapping problems, modeling interventions, and identifying key outcomes and the partnerships established.

Revisão sistemática da literatura sobre crack: análise do seu uso prejudicial nas dimensões individual e contextual

RESUMO Este artigo visa investigar como se conformam, no Brasil e internacionalmente, as abordagens ao uso prejudicial do crack e outras drogas. Foi realizada uma revisao critica da literatura acerca do padrao de consumo do crack e os fatores a ele relacionados com busca sistematica em bases eletronicas no periodo de 2010 a 2016. Foram analisados 37 artigos por autor, ano, pais do estudo, metodologia; padrao de consumo de crack e fatores individuais e contextuais relativos a esse uso. Conclui-se que a abordagem ao uso de drogas deve estar focada na perspectiva da reducao de danos, na promocao da autonomia e dos direitos humanos, e nao na utopia de eliminacao do consumo e da producao de drogas.

Avaliação das práticas de promoção da saúde: um olhar das equipes participantes do Programa de Melhoria do Acesso e Qualidade da Atenção Básica – PMAQ-AB

As praticas de Promocao da Saude das equipes de Atencao Basica no Brasil e macrorregioes foram analisadas a partir do PMAQ-AB (2012). Foram estudadas as frequencias de variaveis nos eixos: Reorientacao de Servicos; Acoes Comunitarias; Ambientes Saudaveis; Habilidades Pessoais (n=17.202 equipes). A abordagem territorial restringe-se aos aspectos geograficos; reconhece-se a vulnerabilidade de beneficiarios do Bolsa Familia; na escola ha predominio das acoes clinicas (saude bucal); educacao para sexualidade/reproducao; informacoes do ambiente foram restritas. Conclui-se que as praticas sao fragmentadas e focalizadas; urge integrar, equilibradamente, cuidado clinico, prevencao e promocao da saude.The Health Promotion practices of the basic attention teams in Brazil and macro-regions were analyzed from the PMAQ-AB (2012). The variable frequency axes were studied: Services Reorientation; Community Actions; Healthy Environments; Personal Skills (n = 17,202 teams). The territorial approach is restricted to geographic aspects; the vulnerability of the “Bolsa Familia Program” beneficiaries; there is a predominance of clinical actions at school (buccal health); sexuality/reproduction education; environmental information were restricted. It is concluded that the practices are still fragmented and focused; an even integration of clinical care, prevention and health promotion shall be urged.

Evaluation of health promotion practices: a look from the participating teams of the National Program for Access and Quality Improvement in Primary Care

As praticas de Promocao da Saude das equipes de Atencao Basica no Brasil e macrorregioes foram analisadas a partir do PMAQ-AB (2012). Foram estudadas as frequencias de variaveis nos eixos: Reorientacao de Servicos; Acoes Comunitarias; Ambientes Saudaveis; Habilidades Pessoais (n=17.202 equipes). A abordagem territorial restringe-se aos aspectos geograficos; reconhece-se a vulnerabilidade de beneficiarios do Bolsa Familia; na escola ha predominio das acoes clinicas (saude bucal); educacao para sexualidade/reproducao; informacoes do ambiente foram restritas. Conclui-se que as praticas sao fragmentadas e focalizadas; urge integrar, equilibradamente, cuidado clinico, prevencao e promocao da saude.The Health Promotion practices of the basic attention teams in Brazil and macro-regions were analyzed from the PMAQ-AB (2012). The variable frequency axes were studied: Services Reorientation; Community Actions; Healthy Environments; Personal Skills (n = 17,202 teams). The territorial approach is restricted to geographic aspects; the vulnerability of the “Bolsa Familia Program” beneficiaries; there is a predominance of clinical actions at school (buccal health); sexuality/reproduction education; environmental information were restricted. It is concluded that the practices are still fragmented and focused; an even integration of clinical care, prevention and health promotion shall be urged.