Pedro Henrique Antunes da Costa

Participacao social e saude no Brasil: revisao sistematica sobre o tema

O processo de democratizacao brasileiro contribuiu para a emergencia de conselhos gestores e conferencias tematicas no contexto das politicas publicas de saude. O objetivo do presente artigo foi realizar uma revisao sistematica de literatura com o intuito de conhecer os fatores relacionados ao processo de institucionalizacao destas arenas democraticas. Foram pesquisadas as seguintes bases: Lilacs, Ibecs, Medline, Scielo, Paho, Psycinfo, Web of Science, Social Science e Ebsco. Para a composicao da amostra de 25 artigos foram associados os seguintes descritores: Social Control, Social Participation, Consumer Participation, Community Participation, Public Participation, Citizen Participation, Political Participation, Participative Management, Participative Democracy, Deliberative Democracy com Health Councils e Health Conferences. Os resultados encontrados sintetizam um conjunto de categorias que tem impactado os espacos publicos participativos: representatividade e capacitacao politica, relacoes entre os atores sociais, desenho institucional, cultura politica, discursos sobre saude/doenca e o debate em torno da democracia. Os achados contribuem para avancarmos na compreensao de tais instituicoes, favorecendo a construcao de alternativas comprometidas com o fortalecimento da democracia em nosso pais.

Desatando a trama das redes assistenciais sobre drogas: uma revisão narrativa da literatura

Acalorados debates sobre determinados modelos de tratamento para usuarios de drogas ocorrem no âmbito da academia, das politicas publicas, alem da midia. A rede assistencial sobre drogas e apresentada neste contexto como um importante mecanismo, mas sua construcao torna-se um desafio. Assim, realizou-se uma analise critica da literatura academica acerca das redes assistenciais sobre drogas, na forma de uma revisao narrativa, visando levantar seus desafios e possibilidades de consolidacao. Os resultados encontrados foram: a) uma escassez de estudos especificos sobre a rede assistencial sobre drogas; b) cobertura insuficiente e desintegrada frente a demanda de tratamento; c) necessidade de se repensar o papel dos Centros de Atencao Psicossocial para Alcool e outras Drogas, visando seu fortalecimento, expansao, melhoria estrutural e readequacao de praticas; d) ausencia de analises criticas sobre o processo de construcao dos modelos assistenciais sobre drogas nos servicos publicos; e, e) responsabilidade do Estado em fornecer melhores alternativas ao panorama encontrado, avancando no fortalecimento das acoes intersetoriais, articulacao do cuidado e no aprimoramento das condicoes de trabalho.Heated debates on given models of treatment for drug users have raged in the halls of academia, in public policies, not to mention in the media. The care network on drugs is presented in this context as an important mechanism for users, but its construction turns out to be a challenge. Therefore, a critical analysis and narrative review of the scientific literature on the care network on drugs was conducted, seeking to pinpoint the challenges and opportunities for its consolidation. The results found include: a) a lack of specific studies on the care network on drugs; b) insufficient and disjointed coverage regarding the demand for treatment; c) the need to rethink the role of the Psychosocial Care Centers for Alcohol and other Drugs, seeking to strengthen, expand, structurally improve and readjust their practices; d) lack of critical analysis about the construction process of care models on drugs in public services; and e) the States responsibility to provide better alternatives to the existing panorama revealed, making progress on strengthening intersectorial actions, structuring care and improving working conditions.

Metodologia de implementação de práticas preventivas ao uso de drogas na atenção primária latino-americana

OBJETIVO: Desenvolver uma metodologia para implementacao de praticas de prevencao ao uso de alcool e outras drogas no âmbito da atencao primaria a saude (APS) que contribua com o debate sobre acoes e politicas nos paises latino-americanos. METODOS: Trata-se de uma pesquisa-intervencao realizada em um municipio brasileiro de pequeno/medio porte. O processo foi avaliado atraves da observacao participante, visando adequacao as necessidades locais e ressaltando pontos de facilitacao e dificuldade na implantacao. RESULTADOS: Foi desenvolvido um modelo com seis etapas: contato inicial e planejamento, diagnostico e mapeamento, sensibilizacao, capacitacao, acompanhamento e devolutiva. Foram percebidos os seguintes pontos de dificuldade: insuficiencia de recursos (humanos, financeiros, infraestrutura), falta de integralidade e intersetorialidade da rede assistencial, falta de participacao dos medicos, formacao calcada no saber medico, participacao insuficiente da gestao de saude, falta de mobilizacao e participacao da sociedade civil, ausencia de momentos onde a populacao fosse convidada a participar do planejamento e execucao das politicas publicas. Pontos fortes foram: participacao dos agentes comunitarios e enfermeiros na aplicacao, organizacao e planejamento das praticas, alem da realizacao de praticas educacionais e preventivas nas escolas e comunidades pelas equipes de saude. Isso indica que e possivel implementar iniciativas de triagem, intervencao breve e encaminhamento para tratar (SBIRT) no contexto da APS latino-americana. CONCLUSOES: A metodologia desenvolvida neste estudo pode ser util para paises latino-americanos desde que sejam consideradas as necessidades locais. Entretanto, os resultados serao observados apenas a medio e longo prazo, sem mudancas instantâneas.

Avaliação de serviços em saúde mental no Brasil: revisão sistemática da literatura

Assessment in the mental health area is a mechanism able to generate information that positively helps decision-making. Therefore, it is necessary to appropriate on the existing discussions, reasoning the challenges and possibilities linked to knowledge production within this scientific filed. A systematic review of publications about the Brazilian scientific production on mental health service assessment was performed, identifying and discussing methods, assessment perspectives and results. The search for articles was done in IBECS, Lilacs and Scielo databases, considering the publication of Federal Law 10.216. Thirty-five articles were selected based on the used terms and on the inclusion and exclusion criteria. Scientific production in this field is concentrated in the South and Southwest regions and holds different scopes and participants. Such wide range of possibilities is adopted as a way to help improving services and decision-making processes in mental health care. Advances in humanized, participative and community care are highlighted, but requiring more investments, professional qualification and organizational improvements. It is postulated greater integration among research, with evaluations going beyond structural aspects and the comparison with hospitalocentric models.Assessment in the mental health area is a mechanism able to generate information that positively helps decision-making. Therefore, it is necessary to appropriate on the existing discussions, reasoning the challenges and possibilities linked to knowledge production within this scientific filed. A systematic review of publications about the Brazilian scientific production on mental health service assessment was performed, identifying and discussing methods, assessment perspectives and results. The search for articles was done in IBECS, Lilacs and Scielo databases, considering the publication of Federal Law 10.216. Thirty-five articles were selected based on the used terms and on the inclusion and exclusion criteria. Scientific production in this field is concentrated in the South and Southwest regions and holds different scopes and participants. Such wide range of possibilities is adopted as a way to help improving services and decision-making processes in mental health care. Advances in humanized, participative and community care are highlighted, but requiring more investments, professional qualification and organizational improvements. It is postulated greater integration among research, with evaluations going beyond structural aspects and the comparison with hospitalocentric models.

Capacitação em álcool e outras drogas para profissionais da saúde e assistência social: relato de experiência

Como alternativa ao panorama deficitario de formacao profissional para atuacao na area do uso de alcool e outras drogas, e visando a incorporacao de mudancas praticas, sao criados os Centros Regionais de Referencia sobre Drogas (CRRs). Faz-se necessario compreender e refletir sobre o papel dos CRRs nos cenarios de formacao e atuacao sobre a tematica. A partir disso, o presente artigo pretende discutir aspectos sobre a capacitacao de profissionais do Sistema Unico de Saude e Assistencia Social, por meio do relato de experiencia de um CRR de Minas Gerais. A implantacao do presente CRR possibilitou a qualificacao de profissionais em direcao a abordagens integrais e reflexivas sobre a tematica. Contudo, sao necessarias reformulacoes sobre o seu modelo, com uma posicao mais bem definida e atuante dentro das politicas sobre drogas, garantindo continuidade nas acoes e auxiliando na reformulacao das praticas.

Sistema de referência e de contrarreferência na rede de atenção aos usuários de drogas: contribuições da análise de redes sociais

Abstract This paper analyzed the reference and counter-referral system of a care network for drug users, from Social Network Analysis (SNA). It is a cross-sectional survey conducted in the city of Juiz de Fora, Minas Gerais, with professionals from the drug users’ treatment services. Data was collected through a questionnaire that measured referral and counter-referral relations of drug users between network services. Data from SNA was analyzed using the Gephi software, extracting the following metrics: Degree Centrality and Intermediation Centrality. Results indicated a higher prevalence of referencing rather than counter-referral, with a centralization in specialized, medium and high complexity, and emergency services. It is expected to demonstrate the potential of SNA in the understanding of organizational networks and influence new research that aims to comprehend different care realities for drug users in national and international context. Keywords: social networking; health care (public health); delivery of health care; referral and consultation; substance-related disorders.

Developing a method of implementation of screening, brief intervention, and referral to treatment in primary health care settings of Brazil and Latin America

Screening, brief intervention, and referral to treatment (SBIRT) appears to be an important tool in Brazil and Latin America to address the use/abuse of alcohol and other drugs and to help implement and organize preventive activities, particularly in the services of primary health care (PHC). Nevertheless, there are few studies evaluating the implementation of SBIRT in PHC of Latin American countries, identifying elements that promote positive results in the prevention and/or reduction of consumption according to each situation. Therefore, this study presents a method for implementing SBIRT developed in the PHC of a small/medium Brazilian city, highlighting challenges and possibilities for its dissemination in other cities and countries in Latin America. This is a research intervention, with data collection and evaluation through participant observation. The entire process was evaluated to the suitability to local needs, determining factors that could facilitate or impede its implementation. The method developed consisted of six stages: initial contact and planning, diagnosis and mapping, raising awareness, training and monitoring. In the process of implementation the hindering points detected were: insufficient resources (human, financial, infrastructure), shortage of integration and intersectional health care settings, lack of participation by physicians, focus in dependence, scarcity of participation of civil society and absence of spaces where this population could participate. However, the participation of community health workers and nurses in the implementation and organization of SBIRT, the actions implemented by health teams, such as educational and preventive practices in schools and discussion groups with communities, are positive prospects for the implementation of SBIRT in the Latin American PHC context. Finally, the method presented is considered a useful model to other Latin American cities and countries, with necessary adaptations. Despite the advances, progress is needed in preventing alcohol and other drug abuse in Latin America, with long-term measures.

Drugs and Poverty: Interfaces of Oppression in the Capitalist World

The topic of drugs and poverty is part of a discussion that is the reality of Brazil and other countries. These two issues have together had an impact on processes of oppression in people’s lives. This chapter aims to discuss the impact and functions of drug use among populations living in poverty. We discuss some misconceptions that occur when linking the structural responsibilities of the capitalist system only to people who experience the naturalization of poverty, blame for their situation, and criminalization of the use of drugs. Discrimination practices develop as a result of stigmatization of social classes and drug use issues, creating humiliation, feelings of shame, and fatalistic behavior. Actions of denaturalization and decriminalization are presented, using a contextualized view of social problems. An analysis of the implications of such practices in the lives of people who go through contexts of poverty and drug use is also presented.

Percepções e Práticas dos Profissionais da Atenção Primária à Saúde na Abordagem sobre Drogas

Este estudo teve como objetivo analisar as percepcoes dos profissionais da Atencao Primaria a Saude (APS) em relacao as praticas de prevencao e a abordagem ao usuario de alcool e outras drogas, levantando desafios e possibilidades da APS. Atraves de grupos focais, participaram 18 profissionais da APS de um municipio de pequeno/medio porte do estado de Minas Gerais, Brasil. Os resultados sugerem que ha um discurso a favor das praticas preventivas, mas enfoque no curativismo; limitada participacao dos usuarios nas atividades preventivas; dificuldade na abordagem aos usuarios de drogas; sobrecarga de trabalho; ausencia de engajamento dos medicos; cobertura assistencial insuficiente; falta de suporte da gestao, entre outros fatores que obstaculizam o desenvolvimento das acoes preventivas e interferem na abordagem aos usuarios de drogas.

Capacitación sobre alcohol y otras drogas para profesionales de la salud y asistencia social: relato de experiencia

Como alternativa ao panorama deficitario de formacao profissional para atuacao na area do uso de alcool e outras drogas, e visando a incorporacao de mudancas praticas, sao criados os Centros Regionais de Referencia sobre Drogas (CRRs). Faz-se necessario compreender e refletir sobre o papel dos CRRs nos cenarios de formacao e atuacao sobre a tematica. A partir disso, o presente artigo pretende discutir aspectos sobre a capacitacao de profissionais do Sistema Unico de Saude e Assistencia Social, por meio do relato de experiencia de um CRR de Minas Gerais. A implantacao do presente CRR possibilitou a qualificacao de profissionais em direcao a abordagens integrais e reflexivas sobre a tematica. Contudo, sao necessarias reformulacoes sobre o seu modelo, com uma posicao mais bem definida e atuante dentro das politicas sobre drogas, garantindo continuidade nas acoes e auxiliando na reformulacao das praticas.