Orientador: Gastão Wagner de Sousa Campos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T17:31:05Z (GMT). No. of bitstreams: 1 Nascimento_RobertaSoares_D.pdf: 1746323 bytes, checksum: c99f33ea2452bdbaaa3f70d60f291f19 (MD5) Previous issue date: 2010 / Resumo: A Hipertensão Arterial (HA) e o Acidente Vascular Cerebral (AVC) como analisadores da atenção básica no SUS em Campinas. No Brasil o AVC é uma das primeiras causas de morte e importante fonte de incapacidade permanente entre adultos. Utilizaremos este agravo como analisador da atenção básica e sua relação com o diagnóstico e tratamento da HA. Descrevemos o perfil das vítimas de AVC e seu atendimento hospitalar no período de abril de 2006 a março de 2007. Descrevemos a ocorrência do agravo como indicador indireto de acesso de pacientes crônicos ao SUS, uma vez que o principal precursor do AVC é a HA que é um problema com prioridade de abordagem na rede básica. Analisamos narrativas produzidas a partir de grupos focais entre usuários e trabalhadores das Unidades Básicas de Saúde (UBS) sobre a amplitude de sua intervenção clínica. Consultamos as fichas familiares dos referidos pacientes na UBS e entrevistamos gerentes locais sobre a organização dos serviços. Agrupamos 06 UBS em três diferentes graus de implantação dos arranjos organizacionais e diretrizes do projeto Paidéia de saúde da Família, como o vínculo e adscrição de clientela por equipe de referência, a institucionalização do trabalho em equipe, atividades assistenciais coletivas e estratégias de intervenção no território. Analisamos as UBS com SUS dependência alta mas ao mesmo tempo com um grau de organização e cobertura assistencial maior ou igual a 50% Observamos a organização do processo de trabalho, agendas individuais, grupos, outras ações de promoção em saúde e atendimento domiciliar / Abstract: Arterial Hypertension and Cerebrovascular Accident as analyzers of primary care in the health care system in Campinas. In Brazil, the stroke is one of the leading causes of death and a major source of permanent disability among adults. We will use this harm as the primary analyzer of the basic attention and its relationship with diagnosis and treatment of hypertension. We describe the victims' profile of stroke and their hospital care from April 2006 to March 2007. We describe the occurrence of the disease as an indirect indicator of chronic patients' access to SUS since the main precursor of stroke is hypertension, which is a problem with priority in the basic approach. We analyzed narratives produced from focus groups among users and employees of the Basic Health Units (UBS) on the extent of their clinical intervention; consulted the records of those patients' family in the UBS and interviewed local managers on the organization of services. 06 UBS were grouped into three different degrees of implementation of organizational arrangements - Paideia Health Family Project's guidelines - as the bond and assignment of customers for reference team, the institutionalization of work, the teamwork, the collective welfare activities and the strategies of intervention on territory. We analyzed UBS with similar characteristics and with high dependence for the population by the Unified Health System (SUS) but, at the same time, with a degree of organization installed and welfare coverage greater than or equal to 50%. We observed the organization of the work process, individual agendas, educational groups on health and other actions to promote health and home care / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

A violência sexual provoca sofrimento e produz consequências de ordem física e psicológica que se fazem escutar no espaço clínico. É preconizado pelo Ministério da Saúde que a assistência se faça por meio de abordagem interdisciplinar capacitada, porém, nota-se que existe uma carência na literatura a respeito de atendimentos psicológicos realizados e seus resultados, principalmente na abordagem psicanalítica. É dado clínico que a violência sexual se repete em muitos casos, que mulheres adultas que relatam ter vivido essa experiência na infância mantenham segredo, e que a manutenção desse segredo resulta em consequências, muitas vezes sobrecarregando os serviços públicos de saúde. Temos percebido que o segredo vem sendo justificado em função do vínculo afetivo existente entre agredido e agressor, entretanto a clínica nos mostra que apesar da presença dessas características, nem sempre esse silenciamento se dá em função disso e que frequentemente o segredo vem ocupar uma função de possível manutenção de uma posição subjetiva que talvez não possa ser revelada. Assim, essa justificativa engessada poderia impossibilitar que essas mulheres fossem tratadas. Acreditando na relevância da compreensão clínica da função do segredo no tratamento psíquico de cada mulher, tanto do ponto de vista conceitual quanto da manutenção de uma posição subjetiva, apresentamos uma investigação teórica a respeito da violência sexual e do conceito de segredo nas obras de Freud e de Lacan, bem como uma revisão da literatura científica especializada. Abordamos também conceitos psicanalíticos como silêncio, não-dito, complexo de édipo e constituição de sujeito, trauma, repetição e fantasia, para discutir questões relacionadas às articulações da violência sexual e o segredo com a psicanálise, enfatizando a escolha pelo segredo como algo que tem a função de resguardar a fantasia. Refletimos também a importância de serviços à violência sexual para o sistema de saúde brasileiro no que se refere a possível contribuição para a diminuição da sobrecarga nas instituições públicas, bem como caminhos para que psicólogos que trabalhem ou pretendam trabalhar em instituições de saúde e/ou consultórios particulares com pacientes que apresentam histórico de violência sexual, possam pensar em possibilidades de prevenção, direção de tratamento do sofrimento psíquico e interlocução com os demais saberes da área da saúde, corroborando para novos projetos de serviços interdisciplinares e novas pesquisas / The Sexual violence causes suffering and produces physical and psychological consequences that can be listened in the clinical space. The Brazilian health department recommends that social assistance should be provided by specialized interdisciplinary approach; however, there is a lack of literature about psychological services and results performed, especially in the psychoanalytic approach. The clinical observation testifies that sexual violence can be a repetition in many cases, that the adult women who have suffered abuse during their childhood keep the that as a secret, and that the maintenance of such secrecy results in consequences, that often overload the public health services. We realized along the studies that the secret has been justified by the emotional connection between the abused and the abuser, however the clinic experience shows us that despite the presence of these characteristics, this silencing is not always related to the emotional relationship described above but is often related to the possibility of maintaining a subjective position which may not be revealed. Therefore, this \"assumed\" reason could make it impossible for these women to be treated. Based on the belief that clinically the secrecy has its function on the way we can conduct the treatment of each women from the theoretical point of view as well as the maintenance of a subjective position we present a theoretical research about sexual violence and the concept of secrecy in the Freud and Lacan literature, as well as review of the specialized scientific researches. We analyzed psychoanalytic concepts such as silence, the unsaid, the Oedipus complex and the psychic constitution, trauma, repetition and fantasy. We discussed the issues related to the links of sexual violence and secrecy with the psychoanalysis, emphasizing the \"choice\" for the secrecy as something that has the function of protecting the fantasy. We also considered the importance of multidisciplinary services supporting treatments of sexual violence victims in the Brazilian health system in order to reduce the overload on public institutions, as well as, the possibility of finding ways for psychologists to work with patients who have sexual violence history. At last, we discussed the possibilities of prevention, the treatment of psychological suffering and the dialogue among the health fields such as medical and social services, corroborating for new projects of interdisciplinary services and new researches

Orientador: Jamile Sanches Codogno / Resumo: A Síndrome Metabólica (SM) tem sido apontada como importante fator no aumento do risco de doenças cardiovasculares, problema de saúde pública mundial. A doença tem apresentado elevados custos com a utilização de serviços de saúde direcionados aos seus componentes. O estudo objetivou avaliar a presença de SM em adultos, atendidos pelo SUS, assim como a influência da prática de atividade física habitual (AFH) nos custos com serviços de saúde de pacientes com SM. O estudo é de característica transversal, a amostra foi selecionada por meio da sexta coleta de estudo de coorte, realizada na atenção primária de duas Unidade Básicas de Saúde (UBS) da cidade de Presidente Prudente. Participaram deste estudo aqueles que faziam parte da coorte e demonstraram interesse em participar e estiveram presentes em todas as avaliações anteriores. Era necessário ter idade igual ou acima de 50 anos e ter registro ativo na UBS. A SM foi verificada por meio das variáveis bioquímicas, glicose, lipoproteína de alta densidade (HDL) e triglicerídeos (TG) analisadas por meio de exames laboratoriais realizados por laboratórios credenciados. A pressão arterial sistólica e diastólica a circunferência de cintura fora, verificadas por avaliadores. O nível da atividade física habitual (AFH) foi avaliado por questionário e, através de registros em prontuários médicos, foram verificados os custos com serviços de saúde dos pacientes participantes da pesquisa. Esta dissertação foi estruturada em dois capítulos, di... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The study aimed to evaluate the presence of MS in adults, assisted by SUS, as well as the influence of the practice of habitual physical activity (AFH) in the costs of health services for patients with MS. The study is cross-sectional, the sample was selected through the sixth collection of a cohort study, carried out in the primary care of two Basic Health Units (UBS) in the city of Presidente Prudente. Participated in this study those who were part of the cohort who showed interest in participating and were present in all previous evaluations. It was necessary to be 50 years old or over and have active registration at UBS. MS was verified by means of the biochemical variables glucose, high-density lipoprotein (HDL) and triglycerides (TG) were analyzed through laboratory tests performed by accredited laboratories, the systolic and diastolic blood pressure and waist circumference was verified by evaluators. The level of habitual physical activity (AFH) was assessed using a questionnaire, and through medical records, the costs of health services of the patients participating in the research were verified. This dissertation was structured in two chapters, divided as follows: Chapter 1- introduction, objectives and general methodology of the dissertation; Chapter 2- article with the objective of evaluating the prevalence of MS in patients of the Unified Health System (SUS) in Presidente Prudente and analyzing the contribution of its components on the costs of health services in ... (Complete abstract click electronic access below) / Mestre

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The Department of Health estimates that 80 percent of South Africans consult traditional healers before consulting modern medicine. The aim of this study is to investigate the extent of the use of traditional medicine in local communities in the Limpopo Province, and add value to a draft policy that was introduced by the Minister of Health. (South Africa, Department of Health 2007a) Traditional healers are regarded as an important national health resource. They share the same cultural beliefs and values as their patients. They are respected in their communities. In South Africa, traditional healers have no formal recognition as health care professionals. Despite the advantages of modern medicine, there is a dramatic evolution in traditional medicine developing and developed countries. In recognition of the value that traditional medicine has added to people’s health needs, government organisations have realised the gap and needed to embark on public participation to bring to light the solution, by implementing a relevant policy (Matomela 2004). According to research done by Pefile (2005), positive outcomes that resulted from the use of traditional medicine include a more holistic treatment, a wider choice of health care that suits people’s needs, and scientific advancement, this paves a way forward for a policy to be put into place for the legal recognition of traditional medicine. New legislations have been brought about in regulating traditional medicine and practitioners. This paper provides a synopsis of government initiatives to close the gap and address the concerns of integrating traditional and modern medicine. The thesis addresses the challenges involved in incorporating the two disciplines for the best possible impact of local communities in accessing their rights as vested in the constitution. The study is a qualitative study where relevant practicing traditional healers, users, Western doctors, nurses, managers and government policy makers were interviewed regarding the draft policy on traditional medicine. This was to obtain information on the challenges, gaps and possible solutions regarding the integration of African traditional medicine into the health care system of Southern Africa. Findings show the following: a majority of traditional healers do not agree to scientific trialling and testing on the herbs that they prescribe, and Western doctors feel that traditional healers should only treat patients spiritually unless they have a scientifically tested scope and limitations on their field. The study also found that traditional healers want to be registered and integrated into the health care system, but do not agree to have regulated price fixing. Other conclusions included that the communities seek traditional help for cultural reasons and more benevolent purposes, but are changing their focus towards seeking medical help from clinics where it is provided for them. However, people within the communities are still confused whether to seek traditional or western medicine and therefore seek both. It was found that medications are not readily available in district clinics and hospital waiting times force people into seeking traditional help. Nurses, doctors and caregivers acknowledge that traditional healers are hampering the health care of patients by delaying hospital treatment of patients hence progressing illnesses. However, they also state that traditional healers help people spiritually and mentally. Therefore policy makers have found solutions to educate healers and create regulatory boards to limit and create a scope of practice for traditional healers. Recommendations and solutions for the relevant policy are as follows: It is recommended that traditional health practitioners should only be allowed to practice and train over the age of 21. They must be prohibited from certain procedures, for example: drawing blood, treating cancers, and treating AIDS/HIV. They should only be allowed to practice midwifery if they have had training. They should be prohibited from administering injections and supervised drugs, unless trained at a tertiary level traditional healers can be used as home caregivers, spiritual healers, and traditional advice counselling entities in the communities. Traditional healers must be prevented from referring to themselves as a ‘doctor’ or ‘professor’. This misleads people into believing that they are allopathic doctors. ‘Traditional health practitioners’ must realise that they are holistic healers, and must be addressed as such. A strong recommendation is to rename ‘traditional health practitioners’ as ‘spiritual practitioners’. With regards to regulations, it must be imperative that every practicing traditional health practitioner be registered annually with the relevant board. A good suggestion is for traditional health practitioners (THP) to attend formal training courses, under an experienced herbalist, and it should be documented on paper. A written record of the location of practice, and specialty must also be documented. There must be policies on health and safety, hygiene and sterility that need to be in place. It is suggested that training on patient confidentially must be taught and implemented. A code of conduct and a standard of professional ethics must also be implemented. Health and safety regulations pertaining to the profession and the citizens must be listed. Efforts towards dispelling myths and making people aware, thereby filtering out the positive side of the traditional medicine (e.g. medical benefits with some herbs), and rooting out the ‘quack’ practices (e.g. the use of amulets around a patient’s body to cure diseases) should be practiced. Pertaining to co-operative relationships between modern medical doctors and traditional practitioners, it is recommended that the use of exchange workshops between the two professionals needs to be developed. Also scientific information and technology must be available to traditional healers. A continued professional development (CPD) programme should be a mandatory requirement, as for all other health care professionals. It seems the development of traditional hospitals, in which a scope of practice is defined, can be used as a recovery ward and a spiritual guidance centre. The above recommendations will encourage a healthier, safer and transparent health care system in South Africa, where all disciplines of medicine co-exist in one National Health Care System. / AFRIKAANSE OPSOMMING: Nadat navorsing deur die Departement van Gesondheid gedoen is, is daar gevind dat 80 persent van Suid-Afrikaners tradisionele genesers besoek. Die doel van hierdie navorsing is om ondersoek te doen na die gebruik van tradisionele medisyne deur landelike gemeenskappe in die Limpopo Provinsie, en om ook ‘n bydrae te lewer tot die konsepbeleid wat deur die Minister van Gesondheid bekendgestel is (South Africa, Department of Health 2007a). Tradisionele genesers kan beskou word as ‘n belangrike hulpbron in die nasionale gesondheidsdiens. Hulle deel in kulturele gelowe en waardes van hulle pasiente en word ook gerespekteer in hulle gemeenskappe. Suid-Afrika egter, gee geen erkenning aan tradisionele genesers of die feit dat hulle in die gesondheidsdiens is nie. Ondanks die feit van moderne geneesmiddels, is daar ‘n dramatiese evolusie wat besig is om plaas te vind in die Westerse Wêreld. Die erkenning en waarde van tradisionele medisyne wat bydra tot mense se gesondheidkwaliteit, het daartoe gelei dat Staatsorganisasies begin insien het dat daar ‘n gaping is en dat publieke peilings gedoen word om ‘n oplossing te vind en ‘n beleidsdokument saam te stel wat tradisionele genesers insluit (Matomela 2004). Die ondersoek wat Pefile (2005) gedoen het, het positiewe resultate getoon by die gebruik van tradisionele medisyne wat ‘n holistiese behandeling in ‘n wyer verskeidendheid van medisyne insluit by gebruikers. Ook die wetenskaplike vooruitgang van tradisionele medisyne het daartoe bygedra dat ‘n beleidsdokument in plek gesit word vir die wettige erkenning daarvan. Nuwe wetgewing is in werking gestel om beheer uit te oefen oor tradisionele genesers en tradisionele medisyne. Hierdie dokument verskaf ‘n sinopsis van die Staat se inisiatiewe om die gaping tussen moderne medisyne en tradisionele medisyne aan te spreek en ook om landelike gemeenskappe toe te laat om hulle reg uit te oefen soos wat in die Grondwet vervat is. Die studie is kwalitatief waar relevante praktiserende tradisionele genesers, verbruikers, Westerse dokters, verpleegkundiges, bestuurders en staatsdiensbeleidvormers ondervra is oor ‘n konsep beleidsdokument oor tradisionele medisyne. Dit was gedoen om informasie rakende die uitdaging , gapings en 'n moontlike oplossing te vind vir die integrasie van Afrika se tradisionele medisyne in die gesondheidsorgsisteem van Suidelike Afrika. Belangrike bevindings sluit die volgende in: die meerdeerheid tradisionele genesers stem nie saam dat wetenskaplike toetse gedoen word op kruie wat hulle voorskryf nie; tradisionele genesers will geregisteer en geïntegreer word in die gesondheidsorgsisteem maar stem nie saam oor prysregulering en prysvasstelling nie; Westerse dokters is van mening dat tradisionele genesers net pasiënte geestelik moet kan behandel tensy hulle ‘n wetenskaplik getoetse doel en beperkings in hulle veld het; Westerse dokters glo dat tradisionele genesers dwarsboom die gesondheidsorgsisteem deurdat hulle behandeling vetraag; die gemeenskap soek tradisionele hulp op vir kulturele redes en ander welwillendheidsredes maar gaan soek mediese hulp by klinieke waar dit aan hulle verskaf word; mense van gemeenskappe is verward en raadpleeg beide tradisionele genesers en Westerse dokters vir hulp; sommige medisyne is nie altyd by klinieke beskikbaar nie en mense sien nie kans om in lang rye te wag by hospitale nie en dit noop dat hulle tradisionele medisyne gebruik; verpleegkundiges en gesondheidswerkers erken dat tradisionele genesers mense vertraag om gesondheidsorg en behandeling by hospitale te kry, maar verstaan ook dat tradisionele genesers aan mense geestelike hulp verleen; en besleidskrywers moet oplossings vind om tradisionele genesers op te voed en om komitees te stig wat tradisionele genesers se ruimte van praktisering in toom te hou. Die volgende word as voorstelle tot aanpassing van die genoemde beleidsdokument geïdentifiseer:- Tradisionele genesers mag alleenlik praktiseer en opleiding verskaf na die ouderdom van 21 jaar. Hulle moet verbied word om sekere prosedures, byvoorbeeld die trek van bloed; behandeling van HIV/VIGS; om voor te gee dat hulle mediese praktisyns is; om vroedvroue te wees slegs indien gekwalifiseer daartoe; om inspuitings toe te dien en medisyne uit te reik slegs indien hulle tersiëre opleiding gehad het. Tradisionele genesers se dienste kan gebruik word as gemeenskapsgesondheid hulpwerkers, geestelike genesers, en kan tradisionele advies en begeleiding aan die gemeenskap lewer. Tradisionele genesers moet belet word om die titels “Dokter” en “Professor" te gebruik. Tradisionele genesers moet daarop let dat hulle holistiese genesers is en moet daarvolgens aangespreek word. Hulle moenie pasiënte mislei deur voor te gee dat hulle allopatiese geneeshere is nie. “Tradisionele genesers” moet hernoem word na “geestelike genesers”. Tradisionele genesers moet by ‘n erkende organisasie geregistreer word en moet so-ook jaarliks registrasie hernu. Formele onderrig wat deur ‘n ervare kruiegeneser aangebeid word moet bygewoon en gedokumenteer word. ‘n Geskrewe rekord van die ligging van die praktyk en betrokke spesialisering moet bygehou word. Beleidsvoorskrifte wat verband hou met gesondheid en veiligheid, hygiene en sterilisasie moet in die tradisionele gesondheidgeneserspraktyk geïmplementeer word. Opleiding in pasiëntkonfidensialiteit moet aangeleer en toegepas word. Samewerking en werkswinkels tussen moderne mediese dokters en tradisionele gesondheidgenesers moet geïmplementeer en ontwikkel word. Mediese wetenskapsinligting en tegnologie moet aan tradisionele genesers bekendgemaak word. Voorts moet ‘n voortgesette professionele ontwikkelingsprogram (POP) aan alle gesondheidswerkers voorgeskryf word. Dit blyk wenslik te wees om tradisionele hospitale tot stand te bring waar die bestek van praktyk gedefinieer word. Sulke hospitale kan dien as plekke waar pasiënte aansterk en geestelike onderskraging geniet. ‘n Etiese kode en standaard vir professionele etiek moet geskep word vir tradisionele genesers. Gesondheids- en sekureitsregulasies moet van toepassing wees en geïmplementeer word. Pasiënte moet ingelig word oor die wegdoen van mites en fabels. Daardeur kan die positiewe sy van tradisionele medisyne (byvoorbeeld mediese voordele van kruie), en uitroei van “kwakke” (byvoorbeeld dra van gelukbringers om die lywe), verdryf word. Dit sal die aanmoediging van ‘n gesonder, sekuriteitbewuste en deursigtige gesondheidsorg sisteem bewerkstellig in Suid-Afrika waar alle dissiplines van medisyne saam bestaan in die Nasionale Gesondheidsorgsisteem.

Thesis (MPhil)--Stellenbosch University, 2010. / ENGLISH ABSTRACT: The purpose of this study was to identify possible viable future healthcare models for South Africa, using the techniques and methodologies advocated in the field of future studies by futurists and erudite academics such as Ackoff, Drucker, De Jouvenel, Slaughter, Dostal and Roux. This topic necessitated a problem-orientated approach to future studies based on the complexities inherent thereto. A great deal of emphasis was therefore placed on the tools of rational analysis, which are supported by unregarded worldview assumptions about the ability of humans to regulate and control the world and therefore the framing of new laws, rules and regulations. The forward view was generated by using the appropriate methodologies such as environmental scanning and the analysis of trends and outcomes. Enrichment to the foresight work, beyond the respective models, was furthermore achieved by acknowledging the cultural and social-political arena wherein the current healthcare models in South Africa operate. The focused scan of salient and credible material and publications was extended to include research into healthcare outcomes achieved in countries with comparable economic and demographic profiles to South Africa. Supplementary research was also conducted into comprehensive aspects such as ethics and health economics in conjunction with recognised international healthcare models. The drivers of quality healthcare at primary and secondary healthcare levels and therefore also representing the constraining factors in the South African milieu being available healthcare practitioners, training, physical infrastructure, technology, access to facilities and the affordability of healthcare were explored to ensure the viability of the futures healthcare models contemplated. The identification of probable futures was accomplished by means of scenario development which focussed on the critical uncertainties of healthcare funding models and nationalisation as opposed to free market models competing for available resources in a semi-regulated environment. Thereafter Delphi techniques were used to acquire consensus from specialists currently working in the field of public and private healthcare along with stakeholders such as leaders of enterprise, healthcare funders and regulators as regards the identification of preferred future healthcare models that will meet, in a sustainable manner, the constitutional right to basic healthcare and enhance the quality of life and life expectancy of all South Africans. The relevance and credibility of the consensus opinions of the selected experts who participated in the research was again tested against the futures discourse publicised in the press to ensure that personal, cultural and organisational factors were not disregarded in the process. The study concluded on the fact that additional research and debate are required to ensure that the societal, organisational and individual aspects of the system wherein healthcare operates are comprehensively addressed by all relevant stakeholders in a manner that void of the neuroses caused by anxiety when thinking of the future. / AFRIKAANSE OPSOMMING: Die doel van die studie was om moontlike volhoubare toekomstige gesondheidsorgmodelle vir Suid-Afrika te identifiseer deur gebruik te maak van tegnieke en metodologieë soos voorgehou deur deskundiges en hoogs belese akademici in die veld van toekomstudies, soos Ackoff, Drucker, De Jouvenel, Dostal en Roux. Die studie het, as gevolg van die kompleksiteit daarvan, ´n probleem-gerigte benadering tot toekomstudies verlang. Gevolglik is baie klem geplaas op rasionele analise-tegnieke, wat ondersteun word deur wêreldsiening-aannames aangaande die mens se vermoeë om die wêreld te reguleer en te beheer deur middel van nuwe wetgewing, reëls en regulasies. Die toekomsgerigte siening is gegenereer deur die gebruik van toepaslike metodologieë, soos byvoorbeeld omgewingskandering en die analise van tendense en uitkomste. Die toekomsgerigte werk is aangevul deur erkenning te gee aan die kulturele en sosio-politiese milieu waarbinne die huidige gesondheidsorgmodelle in Suid Afrika funksioneer. Die gefokusde skandering van kredietwaardige bronne en publikasies is uitgebrei ten einde navorsing oor gesondheidsorguitkomste, soos behaal in lande met vergelykbare ekonomiese en demografiese profiele, soos Suid Afrika, in te sluit. Aanvullende navorsing is verder onderneem en was gerig op omvattende aspekte soos etiek en gesondheidsekonomie, tesame met erkende internasionale gesordheidsorgmodelle. Die kernbepalers van kwaliteit-gesondheidsorg op primêre en sekondêre gesondheidsorgvlak, wat dus ook die beperkende faktore in die Suid-Afrikaanse milieu verteenwoordig, naamlik beskikbaarheid van mediese praktisyns, opleiding, fisiese infrastruktuur, tegnologie, toegang tot fasiliteite en die bekostigbaarheid van gesondheidsorg, is ondersoek ten einde die volhoubaarheid van die toekomsgesondheidsmodelle te verseker. Die identifiserings van waarskynlike toekomste is bereik deur scenario-ontwikkeling wat gefokus het op die kritiese onsekerhede van gesondheidsorgbefondsing en nationalisering, teenoor ´n vryemarkstelsel wat meeding om beskikbare hulpbronne in ´n deels-gereguleerde omgewing. Daarna is Delphi-metodieke gebruik om konsensus te verkry onder kenners wat tans in die veld van openbare en privaat gesondheidsorg werksaam is, asook belanghebbendes soos leiers in besighede, gesondheidsorgbefondsers en reguleerders, ten opsigte van voorkeur-toekomsgesondheidsorgmodelle wat op ´n volhoubare wyse die grondwetlike regte tot basiese gesondheidsorg en die verbetering van die kwaliteit van lewe en lewensverwagting van alle Suid-Afrikaners sal bevorder. Die toepaslikheid en geloofwaardigheid van die konsensusmenings van die gekose kenners wat deelgeneem het aan die navorsing is weer getoets teen toekomsgesprekke soos gepubliseer in die media ten einde te verseker dat persoonlike, kulturele en organisatoriese faktore nie in die proses misken is nie. Die studie het tot die slotsom gekom dat verdere navorsing en debat nodig is ten einde te verseker dat die sosiale, organisatoriese en individuele aspekte van die stelsel waarbinne gesondheidsorg funksioneer omvattend aangespreek word deur alle belanghebbendes, en op ´n wyse wat enige neurose wat tot angstigheid oor toekomsdenke kan lei, die hok slaan.

A atividade turística em determinadas regiões brasileiras intensifica fluxos populacionais sazonais e gera impactos socioambientais, dentre eles agravos em saúde sexual e reprodutiva dos moradores das comunidades anfitriãs, o que exige respostas programáticas dos sistemas locais de saúde. Uma das estratégias de prevenção e promoção da saúde sexual que tem sido valorizada no debate sobre o tema constitui na maior incorporação de ações de prevenção ao Programa Saúde da Família (PSF), de acordo com suas diretrizes que prevêem a integração entre ações de prevenção, tratamento e reabilitação, de acordo com a realidade epidemiológica e sociocultural. Os objetivos do estudo foram: (1) descrever a vulnerabilidade social e programática às DST/HIV, gravidez não planejada e ao mercado sexual, entre jovens residentes em comunidades anfitriãs de turismo do litoral sul fluminense; (2) compreender de que modo os profissionais da rede básica/Programa Saúde da Família, da mesma localidade, reconhecem os impactos do contexto do turismo sobre a saúde do segmento jovem caiçara e quais as ações de prevenção que desenvolvem. O estudo de desenho qualitativo utilizou a observação etnográfica e entrevistas semi-estruturadas em profundidade realizadas com dois grupos de informantes: 12 jovens e 11 profissionais de saúde (dez da rede básica/PSF e um gestor da Coordenação Estadual de DST/Aids-RJ). RESULTADOS: O gênero, a cor/etnia, a geração, a nacionalidade e o status social mostraram-se fundamentais para a compreensão do cenário sexual e sociocultural, bem como das interações afetivo-sexuais entre jovens moradores locais e turistas. O cenário sexual amplia a vulnerabilidade dos (as) jovens às DST/HIV, à gravidez não-planejada e ao mercado sexual. A disponibilidade para as interações afetivo-sexuais entre jovens das comunidades e visitantes é marcada pelos estereótipos como turista, gringo (a), caiçara e nativo (a) e pelo intercâmbio de bens materiais e simbólicos que distinguem pessoas de fora e pessoas daqui. Os profissionais do PSF, por sua vez, reconhecem a vulnerabilidade específica da juventude; atribuem-na à pobreza, à escolaridade, à vida familiar, à promiscuidade e às características tradicionalmente atribuídas à fase da adolescência. A gravidez na adolescência e a multiplicidade de parceiros, significadas como promiscuidade são as problemáticas mais reconhecidas. Valorizam a prevenção e realizam ações educativas de base comunitária. Como obstáculos à qualidade da prevenção entre os jovens, o estudo identificou: 1) a compreensão pouco aprofundada do cenário sexual, das relações de gênero e das diferenças de status social enquanto aspectos relevantes ao planejamento das ações de promoção da saúde sexual e reprodutiva entre jovens caiçaras; 2) as abordagens utilizam prioritariamente o recurso das palestras que enfatizam aspectos biomédicos e a orientação como base em valores pessoais; 3) há dificuldades operacionais para disponibilizar insumos e planejar ações de prevenção no âmbito da rede básica/PSF; 4) a interlocução é incipiente entre Atenção Básica/PSF (municipal) e Programa Estadual de DST/Aids-RJ. CONCLUSÃO: A intensificação da economia associada ao turismo nas comunidades anfitriãs amplia a vulnerabilidade social ao sexo desprotegido e ao mercado sexual, atribuindo um caráter singular à desigualdade de gênero, cor/etnia e status social. Essas dimensões, invisíveis aos olhos dos profissionais do PSF, juntamente com o modelo de prevenção tradicional (palestras e orientações) ampliam a vulnerabilidade programática dos jovens às DST/Aids, gravidez não planejada e mercado sexual. Haja vista o repertório de atitudes e práticas dos profissionais ter se mostrado insuficiente para o manejo das tecnologias psicossociais que integram a dimensão sociocultural da sexualidade, recomenda-se fortemente o investimento na formação adequada dos profissionais do PSF para sofisticar suas ações de prevenção. / The touristic activity in certain Brazilian regions intensifies seasonal population flows and it generates socioenvironmental impacts, among which problems to the sexual and reproductive health of the host communities inhabitants. This demands scheduled responses by the local health systems. One of the strategies of prevention and promotion of sexual health is the accretion of more prevention actions into the Programa Saúde da Família PSF [Family Health Program]. This strategy has grown in the discussions on this theme. According to its guidelines, which foresee the integration between prevention actions, treatment and rehabilitation, and also according to the epidemiologic and sociocultural reality. The objectives of the study were: (1) describe the social and programmatic vulnerability to the STDs and AIDS, unplanned pregnancies and to the sexual market, among young residents of the host communities for tourism on the southern coast of the Rio de Janeiro state in Brazil; (2) understand how the professionals of the primary health care/PSF of those same places, recognize the impacts of the tourism context on the health of the Caiçara youth segment and what are the prevention actions that they develop. The qualitative design study used the ethnographic observation and semi structured in-depth interviews applied to two groups of informants: 12 of the youth of the host community and 11 health professionals ten from the primary health care/PSF and one member of the State Coordination of STDs and AIDS of the State of Rio de Janeiro. RESULTS: Gender, ethnic, the generation, the nationality and the social states were proven to be fundamental to understand the sexual and sociocultural scenery, as well as the sexual-affective interactions among tourists and young local residents. These social markers enhance the vulnerability of the youth to STDs and AIDS, unplanned pregnancies and to the sexual market. The availability to the sexualaffective interactions among youth of the host communities and the tourists is marked by the stereotypes like tourist, gringo(a) [commonly used slang in Brazil for foreigners], caiçara and native and by the interchange of material and symbolic goods which separate people from abroad and people from here. On the other hand, the PSF professionals recognize the specific vulnerability of youth and link it to poverty, to schooling, to the family life, to promiscuity and to the characteristics usually linked to the adolescent phase. Adolescent pregnancy and the presence of multiple sexual partners, known as promiscuity are the better known problems. They value prevention and promote educational actions for the community. This study has identified some obstacles to the quality of the prevention among the youth of the host community as follows: (1) the little comprehension of the sexual scenery and of the gender and social class relations as relevant aspects to the planning of the sexual and 11 reproductive health promotion actions among the Caiçara youth; (2) the approaches use mainly the resource of lectures which emphasize biomedical aspects and orientation as a base for personal values; (3) there are operational difficulties to supply medicine needs and to plan prevention actions on the scope of the primary health care/PSF; treatment and rehabilitation actions are preferred; (4) the communication between the primary health care/PSF (municipal administration) and the State Program for STDs and AIDS of the State of Rio de Janeiro. CONCLUSION: The enhancement of the economy associated with the tourism on the host communities expands the social vulnerability to unprotected sex and to the sexual market, giving an unique character to the gender, ethnicity and social class differences. These dimensions, invisible to the eyes of the PSF professionals, along with the traditional prevention model of lectures and orientation, enlarge the programmatic vulnerability of the youth to the STDs and AIDS, to unplanned pregnancies and to the sexual market. Even though the assortment of attitudes and actions of the professionals has proven to be insufficient to manage psychosocial technologies which are part of the sociocultural dimension of sexuality, it is strongly recommended to invest on the proper education of the PSF professionals to expand their prevention actions.

Os serviços de saúde devem ser proporei~ nados de forma continua, em lugares acessiveis e de maneira aceitável pela população. O presente trabalho procurou tr! zer uma contribuição para o estudo da área de influência de oito postos municipais de saúde da região de Santo Amaro no Municlpio de são Paulo. Foram utilizados instrumentos da área de Geografia, que se mostraram eficientes, no sent! do de possibilitar uma visualização da distribuição geográfica do local de residência dos usuários que passaram por consulta médica de pediatria, no decurso de um ano, naque - les postos. O processo manual de localização dos endereços, que foi por nós empregado, apresenta boas condições de apl! cação, para populações de pequena ou média proporções. Para populações de dimensões maiores seria preferlvel a utilização da mesma metodologia, agora através de codificação e processamento, por computador. Assinalamos, ainda, que o trabalho apresentado pode ser identificado como parte in tegrante de um ramo da Geografia Humana, sugerindo-se ain da, para esse setor a denominação de \"Geografia em Saúde Pública\" / Health services should be offered in a continuous manner , in accessible places and in such a way that they be acceptable by the population. This paper is intended to bring forth a contribution towards the study of the area of influence of eight out-patient municipal health service units in the region of Santo Amaro, county of são Paulo Brazil. Instruments belonging to the field of Geography were employed and proved to be efficient as they allowed I a perfect insight regarding home addresses of the users of those units who had gone through paediatric consultations throughout a whole year. The manual procedure for placing such addresses developed by us was very useful as far as populations of minor or medium dimensions were concerned For larger populations it would be better to use the same methodology through coding and computer processing. We would also like to point ou that the present work could be identified as a branch of Human Geography and even suggest it be called \"Public Health Geography \"

Made available in DSpace on 2016-08-10T10:53:40Z (GMT). No. of bitstreams: 1 BERNARDETE GATTO.pdf: 1728558 bytes, checksum: 4a1558a8858f275753f9ef9626a7c582 (MD5) Previous issue date: 2012-03-13 / The health services solid waste (RSSS) have high levels of contamination, not only harmful to human health, but harmful to the environment. For the reduction of problems caused by these kinds of wastes it s important to have an administration and implementation of programs for the management of the health services solid waste (PGRSSS). This program must be implemented and monitored in the institutions that produce solid wastes, with the committed participation of all employees, rescuing ethical values and environmental responsibility. The main purpose of this study was to identify public policy of the management to the treatment of the health services solid waste and the actions to put in practice in the city of Rondonópolis, MT. To reach the purpose, it was developed an exploratory descriptive study, with secondary and primary data. It was found that the healthcare professionals of the city of Rondonopolis, MT does not have access to the PGRSSS printed and neither the knowledge about the actions to be performed in order to make the management of the public policies effective. It was also found that the healthcare professionals are not trained to work properly to have health, safety and environmental protection. During this study was noted that among the steps of PGRSSS, the temporary storage is one of the most precarious problems and has no proper place for storage. Besides that, the collection is been made in a way that does not comply with the relevant legislation, a fact that also occurs in the transport, in which the box trucks, although they are licensed, the RSSS are incorrectly accommodated, violating the rules that require sealed containers. It was concluded that there are absence of implementation of public policy for the management of the RSSS directed to the final disposal of this solid wastes, as well, the control from the public agencies with respect to all the stage of the PGRSSS. These measures would require from the government to perform and execute with more responsibility actions to the protection of the public health and the environment. / Os resíduos sólidos dos serviços de saúde (RSSS) são de alto teor de contaminação, nocivos não apenas a saúde dos seres humanos, mas agressivos ao meio ambiente. A redução dos problemas causados por estes resíduos fecunda-se na gestão e implantação de programas de gerenciamento dos resíduos sólidos dos serviços de saúde (PGRSSS). Este programa deve ser implantado e fiscalizado nas instituições geradoras de RSSS, com a participação comprometida de todos os trabalhadores, resgatando valores éticos e de responsabilidade ambiental. O objetivo geral deste estudo foi identificar as políticas públicas de gestão para o tratamento dos resíduos sólidos de saúde e as ações para sua implementação no Município de Rondonópolis-MT. Para o alcance do objetivo foi desenvolvido um estudo exploratório-descritivo, com dados secundários e primários. Constatou-se que os profissionais da saúde de Rondonópolis-MT não possuem acesso ao PGRSSS impresso e nem conhecimento sobre as ações a serem realizadas de forma a tornar as políticas públicas de gestão eficazes. Foi observado ainda que os trabalhadores da saúde não são treinados para trabalhar de forma a ter saúde e segurança e proteção ambiental. Durante este estudo se observou que dentre as etapas do PGRSSS o armazenamento temporário é o mais precário e não possui local apropriado para acondicionamento, bem como a coleta é feita de forma a não cumprir com as legislações pertinentes, fator este que ocorre também no transporte, em que os caminhões do tipo baú, embora sejam licenciados, os RSSS são acomodados de forma incorreta, não obedecendo às normas que exigem bombonas ou conteiners lacrados. Concluiu-se que a falta da aplicação da política pública de gestão dos RSSS voltada para o descarte final destes resíduos, bem como, a fiscalização dos órgãos públicos com relação a todas as fases do PGRSSS. Essas medidas exigiriam do poder público executar com maior responsabilidade as ações voltadas para a proteção da saúde da população e do meio ambiente.

Introdução: Este estudo teve como referência os princípios do Sistema Único de Saúde (SUS) e da inclusão dos serviços substitutivos e comunitários, conquistados com a Reforma Psiquiátrica Brasileira, além da Política Nacional de Avaliação e o conceito de redes de atenção. Os cuidados primários em saúde são a base para um cuidado de alta qualidade em saúde mental. A integração dos serviços de saúde mental aos cuidados primários incluem a identificação e tratamento dos transtornos mentais, encaminhamento para outros níveis, quando necessário, atenção as necessidades de saúde mental e a promoção e prevenção da saúde mental. Objetivo: Descrever as ações de saúde mental realizadas nos Centros de Atenção Psicossocial (CAPS) e em alguns serviços da rede de Atenção Primária em Saúde (APS) do Sistema Único de Saúde (SUS), do município de Ribeirão Preto, segundo a opinião dos profissionais de saúde destes serviços. Material e Métodos: Trata-se de um estudo descritivo, tipo inquérito e levantamento. Amostra não probabilística intencional dos serviços especializados em saúde mental e dos serviços de atenção primária à saúde da rede pública, da cidade de Ribeirão Preto e, composta por profissionais de nível superior de 4 serviços de saúde mental e 6 serviços da atenção primária. Foi escolhido Ribeirão Preto por conveniência, onde o número de atendimentos fosse representativo para o tema da pesquisa. Foram utilizados dois questionários de pesquisa baseados no Primary Care Assessment Tool (PCAT), reformulados para que fosse possível verificar os aspectos referentes ao perfil sócio-demográfico dos profissionais e suas práticas, segundo os conceitos de acessibilidade, longitudinalidade, integração de cuidados, sistema de informações, integralidade, orientação familiar e orientação comunitária, nos diferentes serviços. A análise foi feita com técnicas de análise descritivas, Teste Exato de Fischer, para cada um dos atributos da Atenção Primária e da Saúde Mental utilizando, ainda, o software SAS/STATA® (SAS Institute Inc., 2003). Resultados e Discussão: Com os profissionais de nível superior foram realizadas 63 entrevistas. A análise dos dados mostrou que a integração entre os serviços da rede primária e especializada é incipiente e falta coordenação dos cuidados em relação aos pacientes nos dois tipos de serviços. Entre as potencialidades dos serviços especializados, foram percebidas nas entrevistas que os profissionais referiam cumprir os atributos de longitudinalidade (vínculo) e integralidade dos cuidados de saúde mental. Em relação aos atributos orientação familiar e comunitária os resultados mostraram uma situação interessante e até contraditória: 89,2% e 70,3% dos profissionais de saúde mental referiram fazer visitas domiciliares e que conheciam os problemas de saúde mental da comunidade e ouviam a comunidade em opiniões de melhorias dos serviços. Na Atenção Primária, 80,8% e 57,7% faziam visitas e conheciam os problemas de saúde mental, mas apenas 46,5% ouviam as opiniões da comunidade sobre a melhoria dos serviços. Conclusões: Este estudo possibilitou caracterizar a assistência em saúde mental realizada pelos profissionais dos serviços especializados (CAPS) e de atenção primária em Ribeirão Preto. A integração entre os serviços deixa a desejar. / Introduction: This study referenced the principles of the Unified Health System (SUS) and the inclusion of substitutive and community services, conquered with the Brazilian Psychiatric Reform, besides the National Evaluation Policy and the concept of care networks. The primary health care are the basis for a high-quality mental health care. The integration of mental health services to primary care include the identification and treatment of mental disorders, referral to other levels, as appropriate, attention to mental health needs and the promotion and prevention of mental health. Objective: To describe the mental health activities conducted in Psychosocial Care Centers (CAPS) and some services of Primary Care Network Health Care (PHC) of the Unified Health System (SUS) of Ribeirão Preto, in the opinion of health professionals of these services. Material and Methods: This is a descriptive study, type survey and survey. Sample unintentional probability of specialized services in mental health and primary care services to the health of the public, the city of Ribeirão Preto, and composed of top-level professionals from 4 mental health services and primary care services 6. It was chosen for convenience Ribeirão Preto, where the number of calls were representative for the research theme. two research questionnaires based on the Primary Care Assessment Tool was used (PCAT), reworded to make it possible to verify the aspects related to the socio-demographic profile of the professionals and their practices, according to the accessibility concepts, longitudinality, integration of care, system information, completeness, family counseling and community orientation in the different services. The analysis was done with descriptive analysis techniques, Fischer\'s exact test for each of the attributes of primary care and mental health using also the SAS / STATA software (SAS Institute Inc., 2003). Results and Discussion: With the top-level professionals were conducted 63 interviews. Data analysis showed that the integration between primary and specialized network services are weak and lack coordination of care compared to patients on both types of services. Among the potential of specialized services, they were noted in interviews that professionals referred fulfill the attributes of longitudinality (link) and completeness of mental health care. Regarding the attributes family and community orientation results showed an interesting and even contradictory situation: 89.2% and 70.3% of mental health professionals reported making home visits and who knew the mental health problems of the community and listened to the community in reviews of service improvements. In primary care, 80.8% and 57.7% were visits and knew the mental health problems, but only 46.5% listened to community views on the improvement of services. Conclusions: This study enabled us to characterize the mental health care held by professionals of specialized services (CAPS) and primary care in Ribeirão Preto. Integration between services is weak.

Introdução: Este estudo teve como referência os princípios do Sistema Único de Saúde (SUS) e da inclusão dos serviços substitutivos e comunitários, conquistados com a Reforma Psiquiátrica Brasileira, além da Política Nacional de Avaliação e o conceito de redes de atenção. Os cuidados primários em saúde são a base para um cuidado de alta qualidade em saúde mental. A integração dos serviços de saúde mental aos cuidados primários incluem a identificação e tratamento dos transtornos mentais, encaminhamento para outros níveis, quando necessário, atenção as necessidades de saúde mental e a promoção e prevenção da saúde mental. Objetivo: Descrever as ações de saúde mental realizadas nos Centros de Atenção Psicossocial (CAPS) e em alguns serviços da rede de Atenção Primária em Saúde (APS) do Sistema Único de Saúde (SUS), do município de Ribeirão Preto, segundo a opinião dos profissionais de saúde destes serviços. Material e Métodos: Trata-se de um estudo descritivo, tipo inquérito e levantamento. Amostra não probabilística intencional dos serviços especializados em saúde mental e dos serviços de atenção primária à saúde da rede pública, da cidade de Ribeirão Preto e, composta por profissionais de nível superior de 4 serviços de saúde mental e 6 serviços da atenção primária. Foi escolhido Ribeirão Preto por conveniência, onde o número de atendimentos fosse representativo para o tema da pesquisa. Foram utilizados dois questionários de pesquisa baseados no Primary Care Assessment Tool (PCAT), reformulados para que fosse possível verificar os aspectos referentes ao perfil sócio-demográfico dos profissionais e suas práticas, segundo os conceitos de acessibilidade, longitudinalidade, integração de cuidados, sistema de informações, integralidade, orientação familiar e orientação comunitária, nos diferentes serviços. A análise foi feita com técnicas de análise descritivas, Teste Exato de Fischer, para cada um dos atributos da Atenção Primária e da Saúde Mental utilizando, ainda, o software SAS/STATA® (SAS Institute Inc., 2003). Resultados e Discussão: Com os profissionais de nível superior foram realizadas 63 entrevistas. A análise dos dados mostrou que a integração entre os serviços da rede primária e especializada é incipiente e falta coordenação dos cuidados em relação aos pacientes nos dois tipos de serviços. Entre as potencialidades dos serviços especializados, foram percebidas nas entrevistas que os profissionais referiam cumprir os atributos de longitudinalidade (vínculo) e integralidade dos cuidados de saúde mental. Em relação aos atributos orientação familiar e comunitária os resultados mostraram uma situação interessante e até contraditória: 89,2% e 70,3% dos profissionais de saúde mental referiram fazer visitas domiciliares e que conheciam os problemas de saúde mental da comunidade e ouviam a comunidade em opiniões de melhorias dos serviços. Na Atenção Primária, 80,8% e 57,7% faziam visitas e conheciam os problemas de saúde mental, mas apenas 46,5% ouviam as opiniões da comunidade sobre a melhoria dos serviços. Conclusões: Este estudo possibilitou caracterizar a assistência em saúde mental realizada pelos profissionais dos serviços especializados (CAPS) e de atenção primária em Ribeirão Preto. A integração entre os serviços deixa a desejar. / Introduction: This study referenced the principles of the Unified Health System (SUS) and the inclusion of substitutive and community services, conquered with the Brazilian Psychiatric Reform, besides the National Evaluation Policy and the concept of care networks. The primary health care are the basis for a high-quality mental health care. The integration of mental health services to primary care include the identification and treatment of mental disorders, referral to other levels, as appropriate, attention to mental health needs and the promotion and prevention of mental health. Objective: To describe the mental health activities conducted in Psychosocial Care Centers (CAPS) and some services of Primary Care Network Health Care (PHC) of the Unified Health System (SUS) of Ribeirão Preto, in the opinion of health professionals of these services. Material and Methods: This is a descriptive study, type survey and survey. Sample unintentional probability of specialized services in mental health and primary care services to the health of the public, the city of Ribeirão Preto, and composed of top-level professionals from 4 mental health services and primary care services 6. It was chosen for convenience Ribeirão Preto, where the number of calls were representative for the research theme. two research questionnaires based on the Primary Care Assessment Tool was used (PCAT), reworded to make it possible to verify the aspects related to the socio-demographic profile of the professionals and their practices, according to the accessibility concepts, longitudinality, integration of care, system information, completeness, family counseling and community orientation in the different services. The analysis was done with descriptive analysis techniques, Fischer\'s exact test for each of the attributes of primary care and mental health using also the SAS / STATA software (SAS Institute Inc., 2003). Results and Discussion: With the top-level professionals were conducted 63 interviews. Data analysis showed that the integration between primary and specialized network services are weak and lack coordination of care compared to patients on both types of services. Among the potential of specialized services, they were noted in interviews that professionals referred fulfill the attributes of longitudinality (link) and completeness of mental health care. Regarding the attributes family and community orientation results showed an interesting and even contradictory situation: 89.2% and 70.3% of mental health professionals reported making home visits and who knew the mental health problems of the community and listened to the community in reviews of service improvements. In primary care, 80.8% and 57.7% were visits and knew the mental health problems, but only 46.5% listened to community views on the improvement of services. Conclusions: This study enabled us to characterize the mental health care held by professionals of specialized services (CAPS) and primary care in Ribeirão Preto. Integration between services is weak.