Effective doctor-patient communication is critical to improving health outcomes. Good communication improves emotional health, symptom resolution, functional and physiologic status, and pain control. Conversely, ineffective communication leads to misdiagnosis, inappropriate treatment poor adherence, misuse of health services, and high patient stress. In the U.S., Hispanics are the fastest growing minority. Despite the high burden of illness among this population, Hispanics are less likely than other minorities to regularly see a health professional. This is explained in part because Hispanics navigate a health system designed for the majority, experience a mismatch between cultural values and health beliefs, and have limited English proficiency. These communication challenges contribute to health disparities among the Hispanic population living in the U.S. Despite the importance of doctor-patient communication, few communication interventions that focus on improving patient skills have been tested in this population. Therefore, the purpose of this study was to evaluate whether a patient communication intervention tailored for female Hispanic patients could be practically implemented in a practice setting. The first aim focused on adapting existing communication skills training tools for a Hispanic population. The second aim assessed the feasibility of implementing the training tool in a federally qualified health center in a US-Mexico border community. The third aim explored the extent to which trained patients were able to integrate the information provided. Results indicate that it is feasible to implement communication training when delivered by clinical staff. Patient follow-up revealed that patients valued training on how to communicate with their doctor the most. Moreover, it is feasible to sustain the intervention when it is aligned with the priorities of the clinical site. Patient communication training in medically underserved rural areas could improve barriers to improved health outcomes in communities with a high prevalence of Hispanic patients. Future funding is needed to further test, dissemination of communication training programs.

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Programa de Apoio aos Planos de Reestruturação e Expansão das Universidades Federais / The rouse of the mental health workers launches the Brazilian Psychiatric Reform, aiming to overcome the model of health care centered in the hospital, leading the suffering subject to a more humanitarian form of treatment. Thus, the Psychosocial Health Centers enter into force to restore the bonds among the user, his/her familiy and society, broadening the possibilities of user embracement and care. The psychologist, together with other professionals, is inserted in such new model. This study aimed to know the interventions practiced by psychology, from the perspective of the multiprofessional team of two Psychosocial Health Centers of a medium-sized city in the interior of Rio Grande do Sul. A qualitative study was carried out, using semi-directed interviews, together with systematic observations in the two Psychosocial Health Centers. Content analysis, more specifically thematic content analysis was used to analyze data. Results are presented in two articles. The first one is entitled Resignifying Psychological Practice: the perspective of the multiprofessional team of Psychosocial Health Centers and approaches themes regarding the psychological practice in the perspective of professionals who took part in the study. Psychological practice was highlighted as relevant to assistance, being constituted of actions that include, besides the individual assistance activities, group, collective and interdisciplinary activities. The psychologist was identified as an integrating and participatory professional in the service, and pointed out as the professional who mediates the link among health professionals team-family-society. Psychological understanding was mentioned as differentiated from the other modalities of understanding, being the main tool used by the psychologist in such professional context. The second article, entitled The Multiprofessional Team and the interdisciplinary practice: challenges of the new health care model in Mental Health portrays themes concerning the multiprofessional work in an interdisciplinary and transdisciplinary perspective. Initially, the professionals pointed out the unpreparedness and the difficulties lived when the professionals began their activities in a PHC. Regarding such aspect, they refer the clinical and institutional supervision as one of the devices that helps overcoming the fragilities faced daily. The professionals emphasized the importance of the integration of professionals that are part of the multiprofessional teams, of the health care team meetings, and, at the same time, they mentioned the importance of the specificity of each professional nucleus, as regards the construction of a wider perspective in relation to the phenomena. Final considerations emphasize a significant movement of the psychological practice, evidenced by the overcoming of the basic individual model, that has marked the path of the professional practice. The resignification of the psychologist s practice in the daily work of institutions was identified, redefining his/her place within the mental health teams. In conclusion, the results convey that the psychology professional was not the only one who needed to resignify his/her practice. The other members of the multiprofessional team also needed to reorganize their functions regarding such new modality of mental health care that emerges from the emergence of PHC. Therefore, a movement in the direction of a more integrated practice, including interdisciplinary actions and supported by an interdisciplinary perspective, is evidenced. / Com o despertar dos trabalhadores em saúde mental surge a Reforma Psiquiátrica Brasileira na perspectiva de superar o modelo hospitalocêntrico, levando ao sujeito que sofre uma forma mais humanitária de tratamento. Assim, os Centros de Atenção Psicossocial entram em vigor com a finalidade de restabelecer os laços entre o usuário, a família e a sociedade, ampliando as possibilidades de acolhimento e atendimento. O psicólogo, ao lado de outros profissionais, passa a se inserir nesse novo modelo. O presente estudo teve como objetivo conhecer o fazer da prática psicológica a partir do olhar da equipe multiprofissional de dois Centros de Atenção Psicossocial de uma cidade de porte médio do interior do Rio Grande do Sul. Com esse intuito, foi realizado um estudo de caráter qualitativo com a utilização da técnica de entrevista semidirigida, juntamente com observações sistemáticas ocorridas nos dois Centros de Atenção Psicossocial. A análise dos dados foi feita através da análise de conteúdo, mais especificamente a Analise de Conteúdo Temática. Os resultados são apresentados através de dois artigos. O primeiro intitulado Ressignificando a prática psicológica: o olhar da equipe multiprofissional dos Centros de Atenção Psicossocial aborda questões sobre a pratica psicológica na visão dos profissionais que compuseram o estudo. Destaca-se que a prática psicológica foi apontada como relevante para o serviço, constituindo-se em ações que incluem para além das atividades de atendimento individual, a realização de grupos, atividades coletivas e interdisciplinares. O psicólogo foi identificado como um profissional integrado e participativo no serviço, alem de ser o profissional que faz o link entre equipe-família-sociedade. A escuta psicológica foi destacada como sendo diferenciada das demais modalidades de escuta, constituindo-se por sua especificidade na principal ferramenta utilizada pelo psicólogo dentro desse contexto de atuação. O segundo artigo intitulado A Equipe Multiprofissional e a prática interdisciplinar: desafios do novo modelo de atenção em Saúde Mental retrata as questões referentes ao trabalho multiprofissional dentro de uma perspectiva inter e transdisciplinar. Inicialmente os profissionais apontaram o despreparo e as dificuldades vivenciadas quando da inserção num CAPS. Em relação a este aspecto, referem a supervisão clínico-institucional como um dos dispositivos que auxilia na superação das fragilidades encontradas no cotidiano. Os profissionais destacaram a importância da integração dos profissionais que compõem as equipes multiprofissionais, da realização das reuniões de equipe, ao mesmo tempo em que lembraram a importância da especificidade de cada núcleo profissional com vistas à construção de um olhar ampliado em relação ao fenômeno. As considerações finais apontam um movimento significativo da pratica psicológica, o qual pode ser evidenciado pela superação do modelo prioritariamente individual que marcou a trajetória da prática profissional. Identificou-se um ressignificar da atuação do psicólogo no cotidiano das instituições, redefinindo o seu lugar dentro das equipes de saúde mental. Conclui-se ainda que, não foi só o profissional da psicologia que precisou ressignificar sua pratica, os integrantes da equipe multiprofissional também necessitaram reorganizar suas funções perante a essa nova modalidade de atenção em saúde mental, que emerge com a criação dos CAPS. Assim, vê-se um movimento na direção de uma prática mais integrada, com ações interdisciplinares e sustentada por uma perspectiva transdisciplinar.

O objetivo deste trabalho foi analisar a demanda das queixas músculo-esqueléticas, neurológicas e respiratórias em adultos no setor de recepção espontânea e pronto atendimento do serviço de saúde do adulto de em uma Unidade Básica de Saúde. O delineamento foi do tipo transversal e a população base constituída pelos usuários matriculados do Centro de Saúde Escola Butantã (CSEB) atendidos na recepção espontânea da unidade no período de março de 2010 a maio de 2011. A população efetivamente estudada foi composta por 1023 indivíduos. Os dados foram coletados de usuários que buscaram o serviço em quatro períodos da semana, 2 matutinos e 2 vespertinos. A caracterização das queixas foi realizada através de um questionário com dados demográficos e motivo da procura por atendimento. Os dados deste estudo mostraram que a maioria dos usuários que frequentam apresentam as seguintes características: pertencem ao sexo feminino (71,2%), estão na faixa etária de 31 a 60 anos (50%), são solteiros (31,6%), são aposentados (14,2%), residem no jardim São Remo (32,7%), apresentam queixas em vários sistemas (77,1%). Nas áreas mais diretamente relacionadas à fisioterapia, o sistema musculoesquelético é o mais acometido (14,4%) e dentro deste as dores na coluna são as mais prevalentes (31%). Avaliando as razões de chance de ocorrência de queixas músculo-esqueléticas com relação ás variáveis sócio demográficas, encontrou-se que a idade foi independentemente associada esta queixa. Pessoas com idade entre de 40 a 59 anos tem maior associação com essas dores músculo-esqueléticas do que as mais velhas e mais novas / The aim of this study was to analyze the demand of musculoskeletal, neurological and respiratory complaints, in adults in the sector of spontaneous reception and responsiveness of the health service of a Basic Health Unit The design was a crosssectional and population-based made by registered users of the Center for Health Butantã (CSEB) attended in the reception spontaneous unit from March 2010 to May 2011. The population studied consisted of 1023 individuals. Data were collected from users seeking service in periods of four weeks, two morning and two afternoons. The characterization of the complaints was conducted through a questionnaire with demographic data and reasons for the demand for care. Data from this study showed that most users who attend have the following characteristics: are women (71.2%) are aged 31 to 60 years (50%) are single (31.6%) are retired (14.2%) reside in the garden San Remo (32.7%), complain in several systems (77.1%). In the areas most directly related to physical therapy, the musculoskeletal system is the most affected (14.4%) and the backache are the most prevalent complaint (31%). Assessing the odds ratios of occurrence of musculoskeletal complaints in regard to the sociodemographic variables, it was found that age was independently associated with this complaint. People aged 40 to 59 years have the greatest association with musculoskeletal pains than the older and newer

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This work aims to inform about nursing care practices in a Family Health Center and its contribution to the reflection on academic nursing education. The method of this research was done through a qualitative case study approach. Part of the information was collected from a database from February to July 2012. The research was conducted at a Family Health Center in the City of Santa Maria/RS with two multidisciplinary teams and a dental health team. The data collected was composed of semi-structured interviews with nurses, participant observation with diary records of the care practices performed and documenting researches such as minutes from team meetings and records from information storage system. The analysis and interpretation of data were guided by the Operational Proposal with two operational moments, exploratory and interpretative. In relation to the second moment, three steps were performed: the Data Organization, all the material was organized in a specific order and performed according to database construction; the Data Classification, from dense and exhaustive readings and using the attributes of Primary Care as background, it was possible to construct the analytical categories; and the Final Analysis, considering a dialectical movement between the empirical and theoretical material, or vice versa. This study was approved by the Ethics Committee, Protocol 1939/11, in which the principal researcher consented to the use of data by signing the Authorization Term for Database Using. The results were presented in two articles. First, the analysis of care practices regarding the first contact attribute. It helped to alert to the academic education the necessity of interaction between nurses and other professionals, favoring an academic student to acquire more skills for the interdisciplinary team work. In addition, it stimulates on a student an opening for new sensibilities with a view on the development of abilities that can be translated in comprehension attitudes of others and investigate the pro-active behavior in a way that the student assumes their authentic participation in the act of meeting and reflecting about what is being naturalized, building their formative way. Second, the focus was on the longitudinality attribute. Guided to the care practices for specific situations of certain users at different times of data collection. In this sense, the academic education should provide a variety of scenarios for a student to meet other contexts and the relationships between people and their surroundings; It should also encourage the development of information skills in values such as solidarity, accountability and inter-subjective understanding of people in which care is addressed; and, finally, encourage a student to understand the dialectical relationship between "managing" and "care" and the straight relation with the quality of care. As effects of this new bias in education, we have the transformation of care practices and also the formation of new professionals with collective consciousness, able to face the complexity, daring to invent new practices and ethical-political-sensitive whose health care model to achieve is care. It indicates that by knowing the practice of nurses, it was possible to think some ways whose academic education does not lose focus on the centrality of the student in order to make them protagonist and challenge them to be proactive in building the professional and be hence the construction of an identity with "being a nurse", emphasizing that more studies with this subject should be performed. / Objetivou-se conhecer as práticas de cuidado de enfermeiros em uma Unidade de Saúde da Família e sua contribuição para a reflexão da formação acadêmica do enfermeiro. A pesquisa delineou-se como estudo de caso de abordagem qualitativa. Utilizou-se um recorte de banco de dados coletado de fevereiro a julho de 2012. O cenário consistiu em uma Unidade de Saúde da Família do Município de Santa Maria/RS, com duas equipes básicas e uma equipe de saúde bucal. O recorte foi composto por entrevistas semiestruturadas com as enfermeiras, a observação participante com registros em diário de campo das práticas de cuidado e de buscas em documentos como atas de reuniões de equipe e relatórios de sistemas de informações. A análise e interpretação dos dados foram guiadas pela Proposta Operativa com dois momentos operacionais, exploratório e interpretativo. Em relação ao segundo momento, três etapas foram realizadas: a Ordenação dos Dados, com a organização do material em determinada ordem e realizada consoante à construção do banco de dados; a Classificação dos Dados, frente a leituras mais densas e exaustivas e utilizando como pano de fundo os atributos da Atenção Básica foi possível a construção de categorias analíticas; e a Análise Final, considerado um movimento dialético entre o material empírico ao teórico e vice-versa. A pesquisa foi aprovada pelo Comitê de Ética, Protocolo no 1939/11, no qual a pesquisadora principal consentiu a utilização do banco de dados mediante assinatura do Termo de Autorização para Utilização do Banco de Dados. Os resultados foram apresentados em dois artigos. No primeiro, as práticas de cuidado analisadas em face do atributo de primeiro contato. A análise das práticas de cuidado possibilitou acenar à formação acadêmica a necessidade da interação da enfermagem com outras profissões, favorecendo que o graduando adquira habilidades para a atuação interdisciplinar e de trabalho em equipe. Além de estimular no graduando a abertura para novas sensibilidades com vista ao desenvolvimento de habilidades que se traduzam em atitudes de compreensão do outro e instigar a postura pró-ativa de modo que o graduando assuma sua participação autêntica no ato de conhecer e refletir sobre o que está naturalizado, construindo seu próprio caminho formativo. No segundo artigo, o enfoque foi ao atributo da longitudinalidade. Pautou-se às práticas de cuidado destinadas a situações específicas de determinados usuários em diferentes momentos da coleta de dados. Neste sentido, a formação deve oportunizar uma diversidade de cenários para que o graduando conheça outros contextos e as relações existentes entre as pessoas e seu entorno; Deve, também, incitar o desenvolvimento de habilidades embasadas em valores como a solidariedade, a responsabilização e a compreensão intersubjetiva das pessoas no qual o cuidado está endereçado; e, por fim, incentivar no graduando a compreensão da relação dialética entre os termos gerenciar e cuidar , e a relação direta deste com a qualidade do cuidado. Como efeitos desse novo viés formativo, tem-se a transformação das práticas de cuidado e, também, a formação de novos profissionais com consciência de coletividade, aptos a enfrentar a complexidade, ousados para inventar novas práticas e ético-sensíveis-políticos cujo modelo de atenção à saúde a ser alcançado seja o cuidado. Sinaliza-se que, ao se conhecer as práticas de enfermeiros, foi possível pensar caminhos cuja formação não perca de foco a centralidade no graduando, de modo a torná-lo protagonista e desafiá-lo a ser pró-ativo na construção do ser profissional e, consequentemente, na construção de uma identidade com o ser enfermeiro , destacando-se que novas pesquisas com este objeto devem ser realizadas.

The initial development of a social services program in a college health setting is presented, with discussion regarding causes, methods, and outcomes. Both empirical and anecdotal data which were influential in the initial formation of the program are reviewed, in the context of an examination of the research literature relating to this area. The actual development and implementation of the program is followed through its first year of existence. Outcomes are presented in the form of qualitative data analysis and case studies. Discussion of the results and recommendations for both future research and improvements to the program are presented.

Objetivo: Determinar la relación entre las manifestaciones orales auto reportadas y el estrés laboral en personas que asisten a un centro de salud universitario de Lima. Materiales y métodos: Se evaluaron 194 trabajadores. El estrés laboral se evaluó con el cuestionario de estrés laboral OMS / OIT. Asimismo, para evaluar la estomatitis aftosa recurrente, frecuente dolor dental, manifestaciones gingivales, mal aliento, desgaste dental, diente con movilidad, alteraciones de la saliva y alteraciones temporomandibulares, se utilizó un cuestionario de manifestaciones orales. Además, se evaluaron las variables de ingresos personales mensuales, fumador actual, diabetes e hipertensión. Se realizó la prueba estadística de chi cuadrado para determinar la asociación entre las principales variables; y para el cálculo de las razones de prevalencia cruda y ajustada se utilizó la regresión de Poisson con un estimador de varianza robusto (p <0.05). Resultados: La mayor prevalencia encontrada fue “manifestaciones gingivales” (92.27%) observándose una asociación significativa con el estrés laboral (p=0.001). Además, la prevalencia de la manifestación “frecuente dolor dental” fue mayor en la población masculina (86.36%) encontrándose una relación significativa (p=0.027). Asimismo, se observó que para las manifestaciones gingivales y mal aliento la razón de prevalencia aumenta cuando el estrés laboral es mayor. Conclusiones: Se encontró que, las manifestaciones orales “Estomatitis aftosa recurrente”, “Frecuente dolor dental”, “Manifestaciones gingivales”, “Mal aliento” y “Desgaste dental” tienen una relación significativa con el nivel de estrés laboral cuando está ajustado a diversas co variables. Además, el riesgo de presentar manifestaciones aumenta cuando el nivel de estrés es mayor. / Objective: To determine the relationship between self-reported oral manifestations and work stress in people who attend a university health center in Lima. Materials and methods: 194 working people were evaluated. Work stress was assessed with the WHO / ILO work stress questionnaire. Likewise, to evaluate recurrent aphthous stomatitis, frequent dental pain, gingival manifestations, bad breath, dental wear, tooth with mobility, saliva alterations and temporomandibular alterations, a self-reported oral manifestations questionnaire was used. In addition, the variables of monthly personal income, current smoker, diabetes and hypertension were evaluated. The chi square statistical test was performed to determine the association between the main variables; and for the calculation of the crude and adjusted prevalence ratios, the Poisson regression was used with a robust variance estimator (p <0.05). Results: The highest prevalence found was "gingival manifestations" (92.27%), observing a significant association with work stress (p = 0.001). In addition, the prevalence of the "frequent dental pain" manifestation was higher in the male population (86.36%), finding a significant relationship (p = 0.027). Likewise, it was observed that for gingival manifestations and bad breath the prevalence ratio increases when work stress is greater. Conclusions: It was found that the oral manifestations "Recurrent aphthous stomatitis", "Frequent dental pain", "Gingival manifestations", "Bad breath" and "Dental wear" have a significant relationship with the level of work stress when adjusted to various co variables. In addition, the risk of presenting manifestations increases when the stress level is higher. / Tesis

These thesis deal with assessment influence thermal insulation of the health care in Jablunkov on outlay connected with operation. The first part is dedicated to demands of energy buildings in general, legislation and basic requirements on evaluation of energy performance of buildings. Afterwards there are described individual species of thermal insulation materials including different ways of thermal insulation of constructions. Then there are described methods of budgeting and economic evaluation of investment. The second part of these thesis deal with design of several variants of thermal insulation of the health care. On the basis of proposals of thermal insulation are then stated variations in expense for management of the health care without thermal insulation of perimeter structure and on the other side with the thermal insulation variants. At the end of thesis there are evaluated all proposed variants of thermal insulation in terms of economic returns if own financial resources and credit are used.

The Diploma Thesis deals with project documentation of a newly built health centre with regard to the requirements of thermal technology, fire safety and acoustics. It is a brick, detached, flat roof and three storey building. The construction is built on the foundation stripes. A seminar work is a part of the thesis. It includes all requirements that have to be complied during designing the health center. Next parts of the project focus on different specialisations processed at Institute of Concrete and Masonry Structures and at Institute of Building Services.

Diploma thesis solves the new building in Nitra. The building is located on Kmeťová street. The building has four floors above ground and one underground and the Garage. 1st floor is clinic. Other floors are for apartments .. The structural system is a monolithic reinforced concrete and brick. The building is covered with a flat roof. Foundation structure consists of reinforced concrete block.