Pedro Fredemir Palha

A incorporação da busca ativa de sintomáticos respiratórios para o controle da tuberculose na prática do agente comunitário de saúde

Este estudo procurou analisar, sob a percepcao dos enfermeiros supervisores do Programa de Agentes Comunitarios de Saude (PACS), a incorporacao da busca ativa de sintomaticos respiratorios (SR) para o controle da tuberculose em um distrito de saude do municipio de Ribeirao Preto. A populacao estudada constituiu-se de oito enfermeiros/supervisores. Utilizou-se entrevista semi-estruturada como instrumento de coleta de dados. O tratamento dos dados fundamentou-se no metodo de analise de conteudo, elegendo-se duas Unidades Tematicas: 1) a insercao do PACS em Unidades de Saude e suas debilidades, e 2) a relacao entre o PACS e a Unidade de Saude nas acoes de controle da Tuberculose. As debilidades apontadas referem-se ao processo de conformacao e organizacao do PACS: ausencia de discussao sobre a insercao do agente na equipe de saude; ausencia de lideranca municipal do PACS; acumulo de funcoes do enfermeiro supervisor; capacitacao insuficiente dos agentes. Quanto a incorporacao das acoes de controle da tuberculose apontam que a descentralizacao poderia resultar em beneficios para o usuario. Entretanto, julga-se necessario repensar a forma de organizacao dos servicos de saude de modo que seja assumido um conjunto de acoes que avancem para uma nova logica de trabalho.

A atencao primaria a saude na coordenacao das redes de atencao: uma revisao integrativa

Health systems organized in health care networks and coordinated by Primary Health Care can contribute to an improvement in clinical quality with a positive impact on health outcomes and user satisfaction (by improving access and resolubility) and a reduction in the costs of local health systems. Thus, the scope of this paper is to analyze the scientific output about the evidence, potential, challenges and prospects of Primary Health Care in the coordination of Health Care Networks. To achieve this, the integrative review method was selected covering the period between 2000 and 2011. The databases selected were Medline (Medical Literature Analysis and Retrieval System online), Lilacs (Latin American Literature in Health Sciences) and SciELO (Scientific Electronic Library Online). Eighteen articles fulfilled the selection criteria. It was seen that the potential impacts of primary care services supersede the inherent weaknesses. However, the results revealed the need for research with a higher level of classification of the scientific evidence about the role of Primary Healh Care in the coordination of Health Care Networks.

Tratamento supervisionado no controle da tuberculose em uma unidade de saúde de Ribeirão Preto: a percepção do doente

The goal of this study was to analyze the perception of tuberculosis patients under direct observed treatment (DOT) in a District Health Unit in the City of Ribeirao Preto SP. A qualitative analysis was selected as the methodological approach. The study analized 6 tuberculosis patients participating in the Tuberculosis Control Program under the a regimen of supervised treatment. The patients’ medical records, the Epidemiological Form of Disease Notification and semi-structured interviews were used as instruments for data collection. The following were used as guiding questions: “the significance of tuberculosis” and “the supervised treatment in the patient’s life”. The Content Analysis technique Thematic Modality was used for data analysis. The main thematic unit “Supervised treatment in tuberculosis: the patient’s perception” was found from the following meaning units: the focus of ST as a therapeutic action (medication ingestion and the weaknesses and strengths of ST); and the Singularities of patients under supervised treatment (The perception of the disease, Living with the disease, The consequences of ST on the patient’s life). The following were perceived by patients as strengths in the disease and treatment process: the provision of free medication; the availability of other forms of incentive such funding basic alimentation and transportation vouchers; supervision through home visits. These factors were considered responsible for the link between health workers, the patients and their families. The perceived weaknesses of ST were perceived: the surveillance of medication ingestion and the dependence on the visiting hours for medication ingestion. The social actors involved in the treatment, such as the family and the health care team (in the visiting figure), were identified as factors responsible for adherence to the treatment.

A porta de entrada para o diagnóstico da tuberculose no sistema de saúde de Ribeirão Preto/SP

O primeiro contato do doente de tuberculose (TB) com o sistema de saude se da na porta de entrada, e e fundamental para o acesso ao diagnostico. Objetivou-se identificar e analisar a porta de entrada no sistema de saude de Ribeirao Preto para o diagnostico da TB. Baseou-se em um instrumento do Primary Care Assessment Tool, adaptado para a TB no Brasil. Realizou-se entrevista estruturada com 100 doentes de TB diagnosticados entre Junho de 2006 e Julho de 2007. Destes, 61% chegaram ao local de diagnostico por encaminhamento e apenas 29% se apresentaram espontaneamente; 66% procuraram por servicos de atencao primaria, 34% por servicos de nivel secundario e terciario. Ademais, 89% foram diagnosticados em servicos publicos e destes, 44% foram diagnosticados nos pronto-atendimentos. Alem disso, 88% foram diagnosticados fora de sua area de abrangencia. Apesar dos doentes terem procurado atendimento na atencao primaria e mais proximo de suas residencias, o diagnostico se deu na atencao secundaria e terciaria.

A GERÊNCIA DAS AÇÕES DE CONTROLE DA TUBERCULOSE EM MUNICÍPIOS PRIORITÁRIOS DO INTERIOR PAULISTA

The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care.The aim of this study was to analyze tuberculosis control action management in counties in the interior of the Brazilian state of Sao Paulo. Data was collected in June of 2005 through semi-structured interviews with coordinators of Tuberculosis Control Program of seven priority municipalities, and subjected to thematic content analysis. The statements taken pointed out criticisms regarding raising and maintaining financial incentives to support human resources and means of transportation; inadequate and unprepared human resources; unfamiliarity concerning the destination of budget appropriations for Tuberculosis Control and a lack of autonomy in managing such resources; communication and interaction difficulties involving the project managers; a lack of policies prioritizing the disease in the political agenda; prioritization of appeals with political repercussions; and the need for partnerships. We conclude that the Project Coordinators work under pressure, occupying a double transmission position both on a hierarchical level and in environmental relationships, not always disposing of adequate and sufficient resources. DESCRIPTORS: Tuberculosis. Health Services Administration. Primary health care. GESTION DE PROGRAMAS DE CONTROL DE LA TUBERCULOSIS EN MUNICIPIOS DEL INTERIOR DEL ESTADO DE SAO PAULO RESUMEN: La investigacion tuvo como objetivo analizar la gestion de programas de control de la tuberculosis en municipios del interior del Estado de Sao Paulo. La recoleccion de datos se realizo en junio de 2005, a traves de entrevistas semiestructuradas con los coordinadores del Programa de Control de la Tuberculosis de los siete municipios prioritarios. Para el analisis de los datos se empleo el Analisis de Contenido Tematico. Las encuestas senalaron nudos criticos en la captacion y manutencion de presupuestos para recursos humanos y vehiculos; recursos humanos insuficientes y sin preparo; desconocimiento del destino de los presupuestos asignados al combate a la tuberculosis y falta de autonomia en la gestion de dichos recursos; dificultades de comunicacion e integracion con gestores; falta de priorizacion de la enfermedad en la agenda politica; priorizacion de otras enfermedades con repercusion politica mas visible y necesidad de coparticipacion. Se concluye que los coordinadores trabajan bajo presion; ocupan doble posicion de transmision, tanto en el plan jerarquico como en las relaciones con el ambiente y ni siempre disponen de recursos adecuados y suficientes. DESCRIPTORES: Tuberculosis. Gestion de servicios de sanidad. Atencion primaria de salud.

Abandono do tratamento de tuberculose e relações de vínculo com a equipe de saúde da família

A pesquisa objetivou analisar a relacao entre as singularidades do doente com historia de abandono do tratamento de tuberculose e a atencao dispensada pela equipe de saude da familia a luz do conceito de vinculo. A construcao do material empirico deu-se por meio de entrevistas gravadas, no periodo de julho a setembro de 2008, utilizando-se a Historia Oral Tematica. Foram entrevistados nove usuarios que tiveram o abandono como criterio de encerramento para o tratamento da tuberculose em dois municipios da regiao metropolitana de Joao Pessoa, Paraiba, Brasil. O estudo foi realizado conforme a tecnica da analise do discurso. Identificou-se que uma relacao terapeutica, com partilha de compromissos e valorizacao do usuario, fortalece o vinculo e produz a democratizacao da gestao do cuidado. Por outro lado, uma relacao vertical, com vinculo fragilizado, opoe-se ao proposito de uma pratica inter-subjetiva na perspectiva da co-gestao do cuidado.

Controle da tuberculose: descentralização, planejamento local e especificidades gerenciais

Buscou-se analisar, segundo a percepcao dos gestores de saude, as praticas que norteiam as acoes de controle da tuberculose, em municipios da regiao metropolitana de Joao Pessoa, PB. Trata-se de estudo qualitativo que envolveu oito profissionais que exerciam cargos de gestao. Os depoimentos foram coletados por meio de entrevista semiestruturada, entre maio e julho de 2009, e organizados mediante analise de conteudo. Embora se reconheca os beneficios da descentralizacao das acoes de controle da tuberculose, o planejamento local sinaliza a predominância de modelo burocratico restrito a negociacao e provisao de insumos. A programacao local centra-se na figura do coordenador, retratando uma linha de comando e gestao vertical que induzem a fragmentacao do processo de trabalho. A tarefa de gerenciar deve trilhar caminho inovador e transformador que ultrapasse as barreiras burocraticas e alcance o maior desafio que lhe e imposto: equilibrar as inter-relacoes profissionais no intuito de aperfeicoar o desempenho do trabalho em saude.The goal was to analyze, according to the perception of health managers, the practices that guide tuberculosis control actions in cities in the metropolitan region of João Pessoa - PB, Brazil. This qualitative study involved eight professionals in management functions. Testimonies were collected through semi-structured interviews between May and June 2009 and organized through content analysis. Despite the acknowledged benefits of tuberculosis control action decentralization, local planning indicates the predominance of a bureaucratic model that is restricted to negotiation and supplies. Local programming is centered on the coordinator, which shows a command line and vertical management that lead to the fragmentation of the work process. Management action should follow an innovative and transformative route that surpasses bureaucratic barriers and faces the biggest challenge it is proposed: to balance professional interrelations with a view to improving health work performance.

Lipodystrophy syndrome associated with antiretroviral therapy in HIV patients: considerations for psychosocial aspects

Several side effects have been strongly associated with antiretroviral therapy in HIV patients. Among them, the lipodystrophy syndrome which presents alterations in body shape with central adipose hypertrophy and peripheral lipoatrophy, reported by patients as a visible marker identifying them as HIV patients. This manuscript presents an analysis of current literature regarding the psychosocial aspects of HIV patients with lipodystrophy associated with antiretroviral therapy. The results show that the alterations in body shape can be disturbing in terms of psychosocial well being, affecting quality of life and increasing the stigma associated with the disease, with consequent disturbances in social relations. This analysis provides a preliminary review of the psychosocial aspects of lipodystrophy and further studies are needed for a better understanding of this complex syndrome, which could provide new information to be used in nursing care for HIV patients affected by this problem.Varios efectos secundarios han sido fuertemente asociados con la terapia antiretroviral en pacientes con HIV. Entre ellos, el sindrome de la lipodistrofia se presenta con alteraciones en la forma del cuerpo con hipertrofia adiposa central y lipoatrofia periferica, las cuales son reportadas por pacientes como marcas visibles que los identifica como pacientes con VIH. En este manuscrito, presentamos un analisis de literatura actual con respecto a los aspectos psicosociales de pacientes con VIH presentandose con lipodistrofia asociado con la terapia antiretroviral. Los resultados demuestran que las alteraciones de la forma del cuerpo pueden ser inquietantes en lo que se refiere al bienestar psicosocial, afectando la calidad de vida y aumentando el estigma asociado con la enfermedad, con las consiguientes dificultades en las relaciones sociales. Este analisis provee un repaso preliminar de los aspectos psicosociales de la lipodistrofia; sin embargo, otros estudios son necesarios para entender mejor este complejo sindrome, proveyendo nueva informacion para ser utilizada en el cuidado de enfermeria para pacientes con VIH que estan afectados por este problema.

Aposentados com diabetes tipo 2 na Saúde da Família em Ribeirão Preto, São Paulo - Brasil

The objective of the present study was to characterize aged pensioners with type 2 diabetes, users of a primary health care service. Participants were 43 individuals selected according to the inclusion criteria. Data was obtained from primary and secondary sources, and analyzed using the SPSS (Statistical Package for the Social Sciences) software. The average age was 75.3 years. There was little participation in community groups and in physical activities. Seventeen aged individuals used the primary healthcare service. Twelve men were retired and twelve women received pension. The average arterial blood pressure was 130 x 80 mmHg and the average glucose level was 141 mg/dl. Diet orientations were given mostly by physicians. Further studies are necessary to analyze the cause of the little adherence to the groups and to physical activity. Health teams should have an effective participation in diabetes control and should encourage the family to participate in the care process, as this diseases requires long-term management.O estudo objetivou caracterizar idosos aposentados com Diabetes tipo 2, usuarios de um servico de atencao primaria, e contou com 43 sujeitos que atenderam a criterios de inclusao. Os dados foram obtidos em fontes primarias e secundarias, e analisados no programa SPSS 15.0. A media de idade foi 75,3 anos. Houve pouca participacao em grupos comunitarios e na pratica de atividade fisica. Dezessete idosos utilizam a atencao primaria. Doze homens aposentaram-se por tempo de servico, e 12 mulheres recebem pensao. Niveis pressoricos apresentaram media de 130x80 mmHg e a Glicemia, media de 141 mg/dl. Orientacoes sobre dieta foram realizadas na sua maioria pelos medicos. Sao necessarios novos estudos para avaliar os motivos que levam a baixa adesao a grupos e pratica de atividade fisica. Sugere-se participacao efetiva da equipe no controle do Diabetes e no incentivo a participacao da familia nos cuidados, visto que essa doenca demanda gerenciamento de longo prazo.

ABANDONO DO TRATAMENTO DA TUBERCULOSE E INTEGRALIDADE DA ATENÇÃO NA ESTRATÉGIA SAÚDE DA FAMÍLIA

Qualitative study that aimed to analyze the reasons why the tuberculosis patients abandon treatment in the metropolitan region of Joao Pessoa-PB. Was used as a theoretical to comprehensive care. Data were collected from October to November 2008, by means of semi-structured interview. Participated nine users who abandoned the treatment of tuberculosis. In the identification of the units of meaning, the technique of analyzis of content was used. The results show inconsistencies related to the holistic care of the sick, when it comes to doctrinal guidelines of the Unified Health, the consideration of socio-cultural context of the user with tuberculosis and the weaknesses in continuity of care, and the inadequate monitoring by the network of health care. These aspects, complicate the construction of a network of care and support for tuberculosis patients and their families, contributing to the abandonment of tuberculosis treatment. DESCRIPTORS: Tuberculosis. Primary attention to health. Refusal of the patient to the treatment.