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Orientador: Luiz Carlos de Oliveira Cecilio / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T00:32:05Z (GMT). No. of bitstreams: 1 Pereira_JoceleneBatista_D.pdf: 38372542 bytes, checksum: 4bb3070c799aff463c9e2d4d0f4156f2 (MD5) Previous issue date: 2006 / Resumo: O presente trabalho estudou a assistência aos portadores de hipertensão arterial, sob a ótica da integralidade do cuidado, na região de abrangência da Coordenação de Saúde de São Miguel Paulista, no município de São Paulo-SP. Foram realizadas entrevistas estruturadas com 804 usuários do serviço de urgência/emergência do Hospital Municipal Tide Setúbal, referência hospitalar da região, identificando potenciais hipertensos e investigando suas referências para a assistência, possíveis complicações, adesão ao tratamento e eventuais mudanças no estilo de vida em decorrência da doença. Os resultados mostraram prevalência de 18% de potenciais hipertensos no pronto-socorro, utilizando-se como critério de corte os valores de 140x90mmHg (associados ou isolados), segundo recomendações do protocolo da Sociedade Brasileira de Hipertensão Arterial, sendo que metade desconhecia sua condição de risco para hipertensão arterial.Também foram realizados grupos focais com médicos e gerentes das unidades de saúde da região, visando fazer uma caracterização da visão dos mesmos com relação à doença, ao comportamento dos pacientes e às dificuldades para se tratar a hipertensão arterial. Os pacientes que fizeram o diagnóstico na UBS/PSF mencionaram maior adesão aos medicamentos (80%) e menor proporção de internações (19,5%), quando comparados com aqueles que fizeram diagnóstico no pronto-socorro ou outro serviço Só houve associação estatística significante entre o local de diagnóstico UBS/PSF e hábitos que adotou após saber da HA, com os itens ir ao médico regularmente e fazer exames complementares de controle. Não se encontrou uma associação estatística significante entre local de diagnóstico e outros hábitos, como diminuição do sal, diminuição de gorduras, prática de exercícios físicos regulares, emagrecimento e controle do estresse Mas diminuir sal e gorduras na alimentação, emagrecer, ir ao médico regularmente e fazer exames complementares de controle da HA, apareceram como associadas estatisticamente a menores índices de internação No entanto, 10% dos hipertensos entrevistados durante a pesquisa declararam que não farão seguimento ambulatorial. Nos grupos focais, a necessidade de vínculo, escuta e equipe multidisciplinar é reconhecida pelos profissionais de saúde, mas prevalece uma marcada opinião de que os pacientes são "rebeldes", "resistentes" e não "obedecem" ao tratamento proposto, o que denota uma visão ainda muito normativa e autoritária dos profissionais em relação aos usuários que são acompanhados nos serviços de saúde, possivelmente dificultando o reconhecimento de suas necessidades singulares Os profissionais reconhecem a dificuldade de integração da equipe para o trabalho coletivo, mostrando contradição entre a prática efetiva cotidiana e o discurso idealizado da necessária integração e complementariedade do trabalho dos profissionais de saúde. O estudo permite afirmar que não há integralidade na atenção prestada aos hipertensos da região estudada, não havendo a configuração de uma rede articulada de serviços que assuma, efetivamente, a responsabilização e acompanhamento dos hipertensos / Abstract: This paper deals with the attendance to the hypertensive people, from the point of view of the care integrality, in the area of São Miguel Paulista Health Coordination, São Paulo city. State of São Paulo. Structured interviews were accomplished with 804 users of the urgency and emergency service of the Municipal Hospital Tide Setúbal, a reference hospital in the region, in order to identify potential hypertensive people and to investigate their references about the attendance, any possible disease complications, their adhesion to the treatment and occasional lifestyle changes resulted from the disease The results showed prevalence of 18% potential hypertensive people in the hospital emergency room - using the reference value of 140x90mmHg (associated or isolated), according to the protocol of the Brazilian Society of Arterial Hypertension recommendations - half of them ignoring their risk condition for the disease. The methodology also accomplished focal groups with doctors and managers of the health units in the area, focusing to characterize their vision about the disease, about the patients' behavior and about the difficulties of treating arterial hypertension The patients diagnosed by UBS/PSF mentioned larger adhesion to the medicines (80%) and smaller proportion of hospitalization (19,5%), when compared with those that were diagnosed in the emergency room or other services. There only was significant statistical association between the diagnosis place (UBS/PSF) and the habits adopted after knowing that they have HA, such as going regularly to the physician office and doing complementary control exams. There was no significant statistical association between the diagnosis place and other habits, such as salt and fat decreasing, regular exercising, loss of weigh and stress control. But, decreasing salt and fat, losing weight, attending regularly the physician and doing complementary control exams are events statistically associated to smaller hospitalization indexes. However, 10% of the hypertensive people interviewed during the research declared that they won't submit themselves to ambulatory follow up. The members of the focal groups recognized the necessity of the linkage between patients and physicians, the importance of hearing them and the existence of a multidisciplinary equip, but it prevailed the opinion that the patients are "rebellious", "resistant" and do not "obey" the proposed treatment, what denotes a still very normative and authoritarian vision of the professionals towards the patients attended by the health services, what may difficult the recognition of their singular needs. The professionals recognized the difficulty to integrate the team for collective tasks, showing contradiction between the daily effective practice and the idealized speech about the work integration. The results of this paper allows to affirm that there is no integrality in the attention offered to the hypertensive people of the studied area, and also that there is no articulate net of services that effectively should assume the responsibility on and the accompaniment of the hypertensive people / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

Under-utilisation of mental health services is widespread globally and within Australia, especially among culturally and linguistically diverse (CALD) communities. Improving service access is a priority, as is the need to deliver culturally competent services to the CALD communities. Having migrated to Australia in waves for approximately 150 years from China and South East Asia for various social, political and economic reasons, the Chinese population in Sydney is now the fastest growing non-English speaking ethnic group. There is a need to better understand the impact of culture on the emotional experiences of these Chinese in Australia. How do Chinese make sense of their depressive episodes? To address this question, this study explored the ways participants reach out for medical and/or non-medical help. Lay concepts of illness underpin these decisions and were thus unveiled. Mixed-method research design provided the opportunity to bring together multiple vantage points of investigation: population mental health, transcultural psychiatry and medical anthropology. A study combining quantitative survey and qualitative focus groups was undertaken in metropolitan Sydney. Narratives on symptoms, explanatory models and help-seeking strategies were articulated by focus group informants. Surveys covered demographics, symptom-recognition, previous depressive experiences and professional help sought. Depression measurement tools were cross-culturally validated. Self-ratings of ethnic identities and the Suinn-Lew Self-Identity Acculturation Scale were used to quantify Chinese participants' acculturation level. This allowed comparisons between 'low-acculturated' Chinese', highly-acculturated' Chinese and Australians. Survey results showed comparable levels of symptom-recognition in all subgroups. Focus group discussions provided rich data on informants' help-seeking strategies. Highly acculturated Chinese closely resembled the Australians in many study variables, yet qualitative data suggested cultural gaps beyond language barriers in influencing service use. Participants believed that trustful relationships could work as the bridge to link services with those in need. The implications for Australia's mental health policy include recognising the importance of rapport-building and the existence of cultural gaps. The study indicated professionals can benefit from acquiring information about the mental health beliefs both of individual clients and the wider ethnic communities in which they belong, and respecting the cultural differences between helper and helped as the first step towards cultural competency.

Under-utilisation of mental health services is widespread globally and within Australia, especially among culturally and linguistically diverse (CALD) communities. Improving service access is a priority, as is the need to deliver culturally competent services to the CALD communities. Having migrated to Australia in waves for approximately 150 years from China and South East Asia for various social, political and economic reasons, the Chinese population in Sydney is now the fastest growing non-English speaking ethnic group. There is a need to better understand the impact of culture on the emotional experiences of these Chinese in Australia. How do Chinese make sense of their depressive episodes? To address this question, this study explored the ways participants reach out for medical and/or non-medical help. Lay concepts of illness underpin these decisions and were thus unveiled. Mixed-method research design provided the opportunity to bring together multiple vantage points of investigation: population mental health, transcultural psychiatry and medical anthropology. A study combining quantitative survey and qualitative focus groups was undertaken in metropolitan Sydney. Narratives on symptoms, explanatory models and help-seeking strategies were articulated by focus group informants. Surveys covered demographics, symptom-recognition, previous depressive experiences and professional help sought. Depression measurement tools were cross-culturally validated. Self-ratings of ethnic identities and the Suinn-Lew Self-Identity Acculturation Scale were used to quantify Chinese participants' acculturation level. This allowed comparisons between 'low-acculturated' Chinese', highly-acculturated' Chinese and Australians. Survey results showed comparable levels of symptom-recognition in all subgroups. Focus group discussions provided rich data on informants' help-seeking strategies. Highly acculturated Chinese closely resembled the Australians in many study variables, yet qualitative data suggested cultural gaps beyond language barriers in influencing service use. Participants believed that trustful relationships could work as the bridge to link services with those in need. The implications for Australia's mental health policy include recognising the importance of rapport-building and the existence of cultural gaps. The study indicated professionals can benefit from acquiring information about the mental health beliefs both of individual clients and the wider ethnic communities in which they belong, and respecting the cultural differences between helper and helped as the first step towards cultural competency.

Este estudo aborda o planeamento dedicado a diminuir os índices de mortalidade materna em cardiopatia e gravidez, a partir da metodologia apresentada pelo serviço do Instituto Dante Pazzanese de Cardiologia, verificando a utilização de equipamentos para o melhor diagnóstico, e do fluxo de atendimento na região do serviço do Sistema Único de Saúde. Foram analisados cinco serviços de atendimento às gestantes portadoras de cardiopatia dentro do Sistema Único de Saúde no Estado de São Paulo. Foram estudados os prontuários de 133 mulheres portadoras de cardiopatia no período gestacional. As cardiopatias encontradas foram classificadas em quatro categorias, as de origem reumática, as de origem genética, as miocardiopatias e no termo \"outras cardiopatias\". As regiões geográficas no Estado de São Paulo integrantes do nosso estudo, foram classificadas em suas políticas quanto a serem favoráveis ou não ao Sistema Único de Saúde, verificando os fatores que impedem o desenvolvimento das ações do Sistema Único de Saúde. Verificamos no prontuário das gestantes o município de procedência, a idade, o número de gestações, a paridade, o número de abortos, o peso e altura, a doença base e as doenças intercorrentes, se foi realizada cirurgia cardíaca, a utilização de equipamentos para diagnósticos, a semana da primeira consulta e a semana do parto, se o local do parto era referência do Sistema Único de Saúde. Para o recém-nascido foi verificado o peso, o comprimento, o sexo e a contagem de Apgar no primeiro e quinto minuto. Os resultados obtidos foram sempre que possivel colocados em tabelas. Foi verificado a necessidade do aconselhamento do planeamento familiar nos serviços visitados. Foi sugerido o número de médicos para atendimento ambulatorial e o número de leitos para o serviço de referência da região, de acordo com o número esperado de gestantes portadoras de cardiopatia. / This study intends to planify the way of diminish the maternal mortality scores in heart disease and pregnancy, using as model the methods in the Instituto Dante Pazzanese de Cardiologia verifying the use of equipments for diagnosis, and the attending flow in the region in the services from the Sistema Único de Saúde (SUS). (Unique health system) Five services for care of cardiac pregnant women of the SUS in the state of São Paulo were analysed. The heart disease diagnosis in these patients were classified in four groups: Rheumatic origen, genetic origen, miocadiopathy and the other heart disease. The regions of our study were classified in favourable or not favourable to the politics of the Sistema Único de Saúde, verifying the factors that block the development of the actions of the SUS. Several informations were obtained from the patients\' file: the district of procedure; the age; the number of gestations; the parity; the number of miscarriages; height and weight; the basic diseases and the intercorrent diseases; the kind of cardiac surgery, if it occurred; the use of diagnostic equipment; the week of gestation in the first appointment; the week of gestation when the delivery occurred; if the place where the delivery occurred was used as reference in the SUS. About the newborn it was observed: the sex; the weight; the height; the Apgar score. The results obtained were distributed in tables, everytime it was possible. It was observed the need of planning parenthood counselling in the visited services. Through the analyses of these informations it was suggested the number of doctors to the ambulatorial care and the number of beds to the reference service in the region according to the expectative of pregnant cardiac women.

Este estudo aborda o planeamento dedicado a diminuir os índices de mortalidade materna em cardiopatia e gravidez, a partir da metodologia apresentada pelo serviço do Instituto Dante Pazzanese de Cardiologia, verificando a utilização de equipamentos para o melhor diagnóstico, e do fluxo de atendimento na região do serviço do Sistema Único de Saúde. Foram analisados cinco serviços de atendimento às gestantes portadoras de cardiopatia dentro do Sistema Único de Saúde no Estado de São Paulo. Foram estudados os prontuários de 133 mulheres portadoras de cardiopatia no período gestacional. As cardiopatias encontradas foram classificadas em quatro categorias, as de origem reumática, as de origem genética, as miocardiopatias e no termo \"outras cardiopatias\". As regiões geográficas no Estado de São Paulo integrantes do nosso estudo, foram classificadas em suas políticas quanto a serem favoráveis ou não ao Sistema Único de Saúde, verificando os fatores que impedem o desenvolvimento das ações do Sistema Único de Saúde. Verificamos no prontuário das gestantes o município de procedência, a idade, o número de gestações, a paridade, o número de abortos, o peso e altura, a doença base e as doenças intercorrentes, se foi realizada cirurgia cardíaca, a utilização de equipamentos para diagnósticos, a semana da primeira consulta e a semana do parto, se o local do parto era referência do Sistema Único de Saúde. Para o recém-nascido foi verificado o peso, o comprimento, o sexo e a contagem de Apgar no primeiro e quinto minuto. Os resultados obtidos foram sempre que possivel colocados em tabelas. Foi verificado a necessidade do aconselhamento do planeamento familiar nos serviços visitados. Foi sugerido o número de médicos para atendimento ambulatorial e o número de leitos para o serviço de referência da região, de acordo com o número esperado de gestantes portadoras de cardiopatia. / This study intends to planify the way of diminish the maternal mortality scores in heart disease and pregnancy, using as model the methods in the Instituto Dante Pazzanese de Cardiologia verifying the use of equipments for diagnosis, and the attending flow in the region in the services from the Sistema Único de Saúde (SUS). (Unique health system) Five services for care of cardiac pregnant women of the SUS in the state of São Paulo were analysed. The heart disease diagnosis in these patients were classified in four groups: Rheumatic origen, genetic origen, miocadiopathy and the other heart disease. The regions of our study were classified in favourable or not favourable to the politics of the Sistema Único de Saúde, verifying the factors that block the development of the actions of the SUS. Several informations were obtained from the patients\' file: the district of procedure; the age; the number of gestations; the parity; the number of miscarriages; height and weight; the basic diseases and the intercorrent diseases; the kind of cardiac surgery, if it occurred; the use of diagnostic equipment; the week of gestation in the first appointment; the week of gestation when the delivery occurred; if the place where the delivery occurred was used as reference in the SUS. About the newborn it was observed: the sex; the weight; the height; the Apgar score. The results obtained were distributed in tables, everytime it was possible. It was observed the need of planning parenthood counselling in the visited services. Through the analyses of these informations it was suggested the number of doctors to the ambulatorial care and the number of beds to the reference service in the region according to the expectative of pregnant cardiac women.

<p>Community participation has been identified as a key facilitator of community health among marginalized populations in international health statements. However, knowledge gaps in the community participation literature regarding marginalized populations has been attributed to the lack of consistent definitions of community participation, ambiguity about the features of community participation initiatives (e.g., methods and strategies) that are appropriate for marginalized populations, and limitations of existing community participation frameworks in specifying the ways and means in which different marginalized populations might effectively participate, as well as in recognizing that community participation is highly contextual and situational. All of these factors have made it difficult to draw broader conclusions about the impact of participation methods and strategies for marginalized populations from evaluations of participation initiatives.</p> <p>The overall purpose of this thesis is to better understand how to involve marginalized populations in the planning and decision-making for local health services. First, a critical interpretive synthesis (CIS) was conducted to better understand the role of community development principles used in community participation initiatives with marginalized populations and the factors contributing to the influence of the principles in enabling the participation of these populations. Second, an in-depth comparative case study of four community participation initiatives in Ontario Community Health Centres (CHCs)—which are primary health care organizations serving 74 high-risk communities throughout the Province of Ontario—was conducted to identify the core features of participation initiatives with marginalized populations, and reflect on the particular challenges of engaging marginalized populations. Third, four focus groups were held at four Ontario CHCs to examine the role of frameworks as mechanisms for translating knowledge about community participation practice with marginalized populations. Overall, this thesis broadens our understanding of community participation with marginalized populations in the context of local health services planning and decision making. Specifically, this thesis contributes a theoretical basis for future research and provides practical knowledge for planning and evaluating community participation initiatives with marginalized populations.</p> / Doctor of Philosophy (PhD)

The system of care for persons suffering from schizophrenia is in a state of upheaval and the community in general is visibly frightened of an illness it knows little about except for the information acquired often from media reporting. Considering persons suffering from schizophrenia as holistic beings, this study explored and assessed the needs of these persons residing in the Mogoto Village, Zebediela District in the Northern Province. The primary purpose of the study was to explore and describe the holistic needs of persons suffering from schizophrenia thus facilitating the planning of care and care facilities for these individuals to enable them to function optimally in the community. To accomplish this purpose, specific objectives were formulated. A quantitative, exploratory and descriptive study based on the Nursing Theory for the Whole Person was carried out. Through purposive sampling 60 respondents were selected. A questionnaire was administered to the respondents. Data from questionnaires revealed that despite the diagnosis of schizophrenia, the respondents were still regarded as valuable members of the community by those who cared for them. There was also an indication that the needs of persons suffering from schizophrenia in the Mogoto Village did not differ from the needs of other persons in the rest of the world. Like any unique person they have specific needs. There was also an indication that mental illness is still rated low in the prioritisation of health problems, hence the lack of resources and support needed for the rehabilitation of persons suffering from schizophrenia, especially in the rural areas. / Advanced Nursing Sciences / M.A.(Nursing Science)

The system of care for persons suffering from schizophrenia is in a state of upheaval and the community in general is visibly frightened of an illness it knows little about except for the information acquired often from media reporting. Considering persons suffering from schizophrenia as holistic beings, this study explored and assessed the needs of these persons residing in the Mogoto Village, Zebediela District in the Northern Province. The primary purpose of the study was to explore and describe the holistic needs of persons suffering from schizophrenia thus facilitating the planning of care and care facilities for these individuals to enable them to function optimally in the community. To accomplish this purpose, specific objectives were formulated. A quantitative, exploratory and descriptive study based on the Nursing Theory for the Whole Person was carried out. Through purposive sampling 60 respondents were selected. A questionnaire was administered to the respondents. Data from questionnaires revealed that despite the diagnosis of schizophrenia, the respondents were still regarded as valuable members of the community by those who cared for them. There was also an indication that the needs of persons suffering from schizophrenia in the Mogoto Village did not differ from the needs of other persons in the rest of the world. Like any unique person they have specific needs. There was also an indication that mental illness is still rated low in the prioritisation of health problems, hence the lack of resources and support needed for the rehabilitation of persons suffering from schizophrenia, especially in the rural areas. / Advanced Nursing Sciences / M.A.(Nursing Science)

Sob o referencial da história das idéias, este estudo revisa o pensamento sanitarista brasileiro, norteado pela figura do Centro de Saúde. A reforma do Serviço Sanitário paulista de 1925 e a instituição das Unidades de Saúde da Família em 1994 definem os limites gerais da revisão. Considera-se a possibilidade de que o discurso sobre o Centro de Saúde inaugurou uma nova era epistemológica na saúde pública, definida pela dimensão individual da educação sanitária, em detrimento da medicina das cidades ou era bacteriana. As novas concepções surgiram, sustentaram e foram sustentadas pelo deslocamento da influência política e intelectual francesa para os Estados Unidos, materializada nas ações da Fundação Rockefeller, tendo por base a Universidade Johns Hopkins. São Paulo foi uma das cidades escolhidas para investimento maciço, como efeito demonstração do novo ideário. Embora a atuação institucional da Fundação tenha tido escala planetária, a apropriação discursiva e adaptação local se mostrou mais precoce e coesa na América Latina, dando ensejo a criação e fortalecimento de um verdadeiro pan-americanismo na saúde pública, com a participação do Brasil. No país, o discurso da era sanitária e seus corolários medicina preventiva, medicina integral, medicina comunitária e atenção básica/primária, foi clivado por três grandes matrizes políticas, que se sucederam e predominaram em momentos distintos: pensamento clássico, de matriz liberal e que dá significação cultural local às idéias que prevalecem no debate internacional a partir dos anos 1920; o pensamento radical, de matriz marxista, que aflora na segunda metade dos anos 1970, principalmente no seio da intelectualidade acadêmica; e o pensamento comunitário em saúde pública, de raízes no pensamento político da assistência social, estimulado pela estratégia da Saúde da Família nos anos 1990. O pensamento radical em saúde pública nasce sob incisiva oposição ao regime militar e ao pensamento clássico. Em sua matriz discursiva a saúde coletiva substitui as expressões anteriores e se concentra no determinantes sociais da saúde, relegando o debate setorial ao segundo plano. Embora sem a devida clareza, o pensamento comunitário recupera e busca atualizar muitas das concepções clássicas, sem fugir da composição com o discurso radical. Alguns conceitos originalmente ligados ao ideário dos Centros de Saúde se destacam ao longo do período analisado: integração (integralidade); descentralização (desconcentração); e socialização (universalidade). Num plano histórico mais abrangente, reconhece-se atualmente que a saúde pública brasileira esteve na essência de um projeto de construção nacional iniciado na Primeira República, mas efetivamente posto em ação na era Vargas. Os Centros de Saúde, hoje representados no ideário da Atenção Básica, não só participaram desta história, como, na realidade, lhe foram em grande parte seus protagonistas / This study reviews the history of ideas in the public health of Brazil. The reform of the Health Service of Sao Paulo in 1925 and the establishment of the Family Health Program in 1994 set the general limits of the review. It considers the possibility that the discourse on the Health Centre inaugurated a new epistemological era in public health, defined by the individual dimension of \"health education\", to the detriment of the \"medicine of the cities\" or \"bacterial era\". New concepts emerged, sustained and were sustained by the displacement of French intellectual and political influence for the United States, embodied in the actions of the Rockefeller Foundation, based on the Johns Hopkins University. São Paulo was one of the cities chosen for massive investment, as \"demonstration effect\" of those new ideas. Although the institutional performance of the Foundation has had a planetary scale, the discursive appropriation and local adaptation was earlier and more cohesive in Latin America, giving rise to creation and strengthening of a true Pan-Americanism in public health, with the participation of Brazil. Nationwide, the \"health education\" ideas and its corollaries \"preventive medicine\", \"comprehensive medicine\", \"community medicine and primary care, was cleaved by three major political perspectives that ensued and prevailed at different times. The \"classical thought\", in a liberal perspective, gave local significance to the ideas present in the international debate since the 1920s. The \"radical thought\", under a Marxist matrix, arouse in the second half of the 1970s, especially within academic intellectuals, and \"community thought\" in public health, stimulated by the Family Health Program in the 1990s. The radical thought in public health movement was strengthened in opposition to the military regime and the classical thought. \"Collective health\" replaced the previous expressions and focuses on social determinants of health, relegating the services organization in the background. Although lacking the necessary clarity, community thought recovers and seeks to update many of the classical concepts, in composition with the radical discourse. Some concepts originally linked to the ideals of the Health Centers are highlighted throughout the studied period: integration (comprehensiveness), decentralization and socialization (universality). In a broader historical view, it is current recognized the role of the Brazilian public health in the national identity construction started in the First Republic, but actually put into action in the Vargas era. Health Centres, today represented in the ideas of primary care, not only participated in this history, as indeed they were largely its protagonists