Made available in DSpace on 2014-12-17T15:38:49Z (GMT). No. of bitstreams: 1 MelinaSSR_DISSERT.pdf: 766520 bytes, checksum: 94ba69fb0fb57c7457d4913d723795f2 (MD5) Previous issue date: 2010-08-20 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Abortion is a very controversial and stigmatized subject, target of many criticism and discussions, mainly regarding to the legal, bioethical and religious aspects involved. In Brazil, abortion is considered a serious public health problem, being the major cause of maternal death due to its criminalization. The woman who causes an abortion is not up looked by society, since motherhood, culturally and historically, was imposed as a destination. Our main goal is to understand, from the existential-phenomenological perspective, the unique experience of the woman who induced the abortion This study is an offshoot of a larger study from USP in partnership with UFRN. Our participants were women who checked in on a maternity hospital in Natal with a miscarriage diagnosis and, among them, those who reported having induced abortion. Altogether, five women were interviewed. The used method was a phenomenological hermeneutics. The research revealed that the experience of abortion is a possibility that permeates women s life, being understood as a choice. This choice pervaded by much suffering, once it goes against everything that women are culturally taught and meant to be. The feeling more surfacing in this experiment, confirming the literature review, was blame. Abortion was also shown as an experience of helplessness and loneliness, due to lack of support from family and the partner. It was also revealed that abortion was made, mainly, by the desire of going along with future projects, including the prosecute of motherhood in the therms of what they consider ideal to a son s arrival, meaning, a family formation grounded on a stable relationship. Regarding the care provided by health professionals to these women, there is the need of restructuring the operating logic of SUS, so that women have the right to health in a integrate manner. This experience also made women reconsider the meanings they had towards abortion, and their life projects / O aborto provocado ? um tema bastante pol?mico e estigmatizado, sendo alvo de muitas cr?ticas e discuss?es, principalmente no que se refere aos aspectos legais, bio?ticos e religiosos envolvidos. No Brasil, o aborto ? considerado um grave problema de sa?de p?blica, sendo um dos maiores causadores de morte materna devido ? sua criminaliza??o. A mulher que provoca um aborto n?o ? bem vista pela sociedade, uma vez que a maternidade, cultural e historicamente, lhe foi imposta como destino. O nosso principal objetivo ? compreender, a partir da perspectiva fenomenol?gico-existencial, a experi?ncia singular dessa mulher que provocou o aborto. O presente estudo ? um desdobramento de uma pesquisa mais ampla da USP em parceria com a UFRN. As nossas participantes foram mulheres que deram entrada em uma maternidade da cidade de Natal com diagn?stico de abortamento e, dentre estas, as que relataram ter provocado o aborto. Ao todo, cinco mulheres foram entrevistadas. O m?todo utilizado foi a hermen?utica fenomenol?gica. A pesquisa revelou que a experi?ncia do aborto ? uma possibilidade que permeia a exist?ncia da mulher, sendo compreendido como uma escolha. Escolha essa perpassada por muito sofrimento, na medida em que a mulher se posiciona contra tudo o que lhe foi ensinado e destinado culturalmente. O sentimento que mais vem ? tona nessa experi?ncia, confirmando a revis?o de literatura, ? a culpa. O aborto tamb?m se mostrou como uma experi?ncia de desamparo e solid?o, devido ? falta de apoio da fam?lia e do parceiro. Tamb?m foi revelado que o aborto se deu, em grande parte, pelo desejo de dar continuidade aos projetos futuros, inclusive o exerc?cio da maternidade dentro do que consideram ideal para a chegada de um filho, isto ?, a constitui??o de uma fam?lia alicer?ada num relacionamento est?vel. No que refere ao atendimento prestado pelos profissionais de sa?de a essas mulheres, revela-se a necessidade de uma reestrutura??o da l?gica de funcionamento do SUS para que estas tenham direito a sa?de de forma integral. Essa experi?ncia tamb?m fez as mulheres reverem os significados que tinham em rela??o ao aborto, bem como os seus projetos de vida

Made available in DSpace on 2014-12-17T15:39:06Z (GMT). No. of bitstreams: 1 MarianaC_DISSERT.pdf: 567306 bytes, checksum: 98e0c97a228543f71cd01d3b7c71e3cb (MD5) Previous issue date: 2014-01-27 / Universidade Federal do Rio Grande do Norte / The Brazilian Ministry of Health regulated in 2008 the Family Health Support Nucleus (FHSN) as a device for support and complementarity to the Family Health Strategy. The FHSN, through the matrix support, potentiates the Family Health teams on dealing with a great variety of demands and activities that are under their responsibilities. It is structured in teams of professionals from various health specialties, among which is the mental health. In preliminary studies we noticed that the psychologists have been the main representatives of mental health professionals at the FHSN from Rio Grande do Norte (RN-Brazil). On this scenario, this study intends to problematize the professional practice of the psychologists who work at the FHSN teams in RN, regarding how their work is done, discussing it under the perspective of collective health and the directions for the basic health care on Brazilian s health system. Still as a goal, in more specific ways: identify the forms of professional insertion of the psychologists in this field; characterize the work done by the psychologist at the FHSN (developed activities); and produce an analysis of the characteristics and limits of those actions, from theoretical and methodological references based on Marxian ontology. Were performed semistructured interviews with psychologists working in the oldest FHSN teams form RN. We conducted the analysis of the material following the blocks of information: determinants of the psychologist entry at the services, training for current practice; operation of FHSN; activities performed by FHSN team and the psychologist; joint actions; and limits of psychology practice in the FHSN. An important result, we observed the little articulation of practicing between the psychology and other professionals and teams, further indicating the prevalence of the traditional medical model (individual and outpatient) as guidance of their performance instead of the matrix logic that is the foundation of the proposed action for the FHSN. We also emphasize the potential of psychologists actions at the FHSN on contributing to the achievement of comprehensive care / O Minist?rio da Sa?de regulamentou em 2008 o N?cleo de Apoio ? Sa?de da Fam?lia (NASF) como um dispositivo de suporte e complementaridade da Estrat?gia Sa?de da Fam?lia. O NASF, por meio do apoio matricial, potencializa as equipes Sa?de da Fam?lia frente ? grande variedade de demandas e atividades que se encontram sob seu encargo. Estruturam-se em equipes com profissionais de diversas especialidades da sa?de, dentre as quais se encontra a sa?de mental. Em estudos preliminares, observou-se que os psic?logos t?m sido os principais representantes da sa?de mental nos NASF instalados no Rio Grande do Norte. Diante deste quadro, este estudo se prop?e a problematizar a pr?tica profissional dos psic?logos que atuam em equipes NASF no RN, no que se refere aos modelos de atua??o empregados, discutindo-as sob a ?tica proposta pela sa?de coletiva e pelos direcionamentos do SUS para a aten??o b?sica. Objetiva-se ainda, de maneira mais espec?fica: identificar as formas de inser??o profissional do psic?logo neste campo; caracterizar o trabalho exercido pelo psic?logo no NASF (atividades desenvolvidas); e produzir uma an?lise das caracter?sticas e limites dessa a??o, a partir das refer?ncias te?rico-metodol?gicas fundadas na ontologia marxiana. Foram realizadas entrevistas semiestruturadas com psic?logos que atuam nas equipes NASF mais antigas do RN. Realizou-se a an?lise do material seguindo os blocos de informa??o: determinantes da entrada no psic?logo nos servi?os; forma??o para a pr?tica atual; funcionamento do NASF; atividades realizadas pela equipe NASF e pelo psic?logo; articula??o de a??es; e limites da atua??o do psic?logo no NASF. Destaca-se nos resultados obtidos a pouca articula??o do trabalho do psic?logo com outros profissionais e equipes, indicando ainda a preval?ncia do modelo cl?nico tradicional (individual e ambulatorial) como orienta??o da sua atua??o em detrimento da l?gica matricial que ? fundamento da proposta de a??o do NASF. Ressalta-se ainda o potencial da a??o dos psic?logos no NASF, em contribuir para a realiza??o do cuidado integral

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-03-17T19:22:31Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ariane_goncalves_oliveira.pdf: 1863224 bytes, checksum: 4295821735b48afb31676da9dd939d09 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-04-20T14:51:34Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ariane_goncalves_oliveira.pdf: 1863224 bytes, checksum: 4295821735b48afb31676da9dd939d09 (MD5) / Made available in DSpace on 2017-04-20T14:51:34Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) ariane_goncalves_oliveira.pdf: 1863224 bytes, checksum: 4295821735b48afb31676da9dd939d09 (MD5) Previous issue date: 2016 / Instituto Federal do Norte de Minas Gerais (IFNMG) / A forma??o profissional na ?rea da sa?de apresenta como um dos desafios atuais a necessidade de integra??o entre ensino, servi?o e comunidade. Alguns estudos e experi?ncias profissionais no munic?pio de Janu?ria mostram que os cursos e os servi?os de sa?de nem sempre trabalham de forma integrada. Levantou-se ent?o o problema: Como acontece a integra??o ensino-servi?o entre o Curso T?cnico em Enfermagem do Instituto Federal do Norte de Minas Gerais e os servi?os de sa?de do munic?pio de Janu?ria-MG? Quais os desafios e as facilidades? O objetivo geral do estudo foi conhecer o processo de integra??o ensino-servi?o entre o curso referido e os servi?os de sa?de de Janu?ria-MG. Definiu-se abordagem qualitativa para o estudo, cujo cen?rio foi o munic?pio de Janu?ria, seus servi?os de sa?de e o Curso T?cnico em Enfermagem do Instituto Federal do Norte de Minas Gerais. Os sujeitos foram enfermeiros dos servi?os de sa?de que s?o cen?rios de pr?tica do curso t?cnico em estudo, docentes e discentes do curso. Para coleta de dados, foram realizados grupos focais, dois com discentes, um com os docentes e um com enfermeiros assistenciais. Os dados foram analisados de acordo com a an?lise de conte?do de Bardin. A partir da an?lise foram definidas unidades tem?ticas que constitu?ram tr?s artigos. O primeiro artigo trata sobre a caracteriza??o da integra??o ensino-servi?o no munic?pio de Janu?ria. Observou-se que a integra??o ensino-servi?o em Janu?ria ? incipiente, e destaca-se na fala dos discentes um conceito de integra??o reduzido ? aplica??o da teoria na pr?tica nos campos de est?gio. O segundo artigo abordou a tem?tica das facilidades e desafios para integrar trabalho e a forma??o em sa?de. Como potencialidades foram apontados o reconhecimento dos servi?os de sa?de como espa?o de aprendizagem e o relacionamento interpessoal entre os atores da integra??o ensino-servi?o. Al?m da atua??o humanizada junto ao usu?rio, a boa intera??o e comunica??o entre estagi?rios, docentes e equipe de sa?de pode interferir tanto no aprendizado como na articula??o das tarefas nas unidades de sa?de. Quanto aos desafios, evidenciou-se a dist?ncia entre a teoria e a realidade nos cen?rios de pr?tica, e a escassez de recursos. Outras quest?es apontadas: matriz curricular n?o contextualizada aos servi?os, equipes com profissionais resistentes ao estagi?rio e a mudan?as de rotina, n?o envolvimento dos gestores no processo, e dist?ncia entre enfermeiros docentes e assistenciais. No terceiro artigo foram apresentadas propostas para efetivar a integra??o como estrat?gia de reorienta??o na forma??o em sa?de. Considera-se necess?ria a formaliza??o da parceria entre servi?o e escola, com a participa??o dos gestores nesse v?nculo, e sugere-se a constitui??o de uma comiss?o no munic?pio para discuss?o da tem?tica integra??o ensino-servi?o. Sugere-se tamb?m a realiza??o de mais estudos sobre a forma??o do profissional de sa?de de n?vel t?cnico ? luz das pol?ticas de integra??o ensino-servi?o. Por fim, espera-se a partir deste estudo, elaborar a??es e documentos que favore?am melhorias nos servi?os de sa?de prestados ? comunidade atrav?s da Integra??o Ensino-Servi?o, al?m de novas reflex?es sobre o Projeto Pol?tico Pedag?gico do Curso T?cnico em Enfermagem. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / Professional training in the health area presents as one of the current challenges the need for integration between teaching, service and community. Some studies and professional experiences in the municipality of Janu?ria show that courses and health services do not always work in an integrated way. The problem then arose: How is the teaching-service integration between the Nursing technical course of the Federal Institute of North Minas Gerais and the health services of the municipality of Janu?ria-MG? What are the challenges and the facilities? The general objective of the study was to know the process of teaching-service integration between the referred course and the health services of Janu?ria-MG. A qualitative approach was defined for the study, whose setting was the municipality of Janu?ria, its health services and the nursing course of the Federal Institute of the North of Minas Gerais. The subjects were nurses of the health services that are scenarios of practice of the technical course under study, teachers and students of the course. For data collection, focus groups were held, two with students, one with teachers and one with nurse assistants. The data were analyzed according to the Bardin content analysis. From the analysis, thematic units were defined that constituted three articles. The first article deals with the characterization of teaching and service integration in the municipality of Janu?ria. It was observed that the integration of service teaching in Janu?ria is incipient, and it emphasizes in the students' speech a concept of integration reduced to the application of theory in practice in the fields of internship. The second article addressed the theme of facilities and challenges to integrate work and health training. As potentialities were pointed out the recognition of health services as a space for learning and the interpersonal relationship between the actors of teaching and service integration. In addition to the humanized interaction with the user, good interaction and communication between trainees, teachers and health staff can interfere both in learning and in the articulation of tasks in health units. As for the challenges, the distance between theory and reality in the practice scenarios, and the scarcity of resources, was evidenced. Other issues pointed out: curricular matrix not contextualized to services, teams with professionals resistant to the trainee and routine changes, non-involvement of managers in the process, and distance between teaching and healthcare nurses. In the third article, proposals were presented to effect integration as a reorientation strategy in health education. It is considered necessary the formalization of the partnership between service and school, with the participation of the managers in this link, and it is suggested the constitution of a commission in the city to discuss the thematic integration education and service. It is also suggested that further studies be carried out on the training of health professionals at a technical level in the light of integration policies for teaching and service. Finally, it is expected from this study, to elaborate actions and documents that favor improvements in the health services provided to the community through the Teaching-Service Integration, as well as new reflections on the Pedagogical Political Project of the Nursing Technical Course.

Made available in DSpace on 2014-12-17T14:13:27Z (GMT). No. of bitstreams: 1 LucianaCBO_texto_completo.pdf: 9696567 bytes, checksum: d49f53dc6179e052feaec6aa13aac92a (MD5) Previous issue date: 2008-12-18 / It is noticeable that pressure, tension and overwork are frequent in health professionals routine. The work related to the ward area demands deep attention and surveillance. Because of that, it is essential to have a specific look at the humanization directed at health professionals, considering that taking care of other human beings is the essence of their job. This study has analyzed the psychic health levels, as well as the stress health professionals are submitted to, providing a debate about the humanization in 06 public hospitals (03 of them awarded by actions of humanization, and 03 not awarded) in Rio Grande do Norte state, Brazil. A study with 126 active health professionals (doctors, nurses, psychologists, nutritionists and social workers) in ward areas in their respective institutions was carried out. The thesis presented, with multi-disciplinary characteristic, counted on the support of statisticians (to calculate samples and data analysis), psychologists, social workers and administrators (linked to the human resources sector in each hospital). A cross-sectional study was performed, taking into consideration both quantitative and qualitative factors. The tools used for that were a semistructured questionnaire with socio-demographic characteristics, work and humanization; Lipp's Stress Symptoms Inventory for Adults (ISSL), and the Goldberg s General Health Questionnaire (QSG). The workers are predominantly women (84,9%), married (54,8%), between 46 and 55 years old (40,5%), working in the same institution for more than 20 years (22,2%), and between 16 and 20 years (20,6%), respectively. They work 40 hours a week (71,4%) and have multiple jobs (61,9%). Although most of these individuals global psychic health is in a good level, there are a significant number of people that is gradually getting worse concerning psychic stress (F1) showed by QSG (54,7%), and stress showed by ISSL(42,1%). Observing the categories, nurses (41,5%). Nutritionists (20,8%), doctors and social workers (18,9%), were among the most affected. About general health (F6), 63% of the awarded hospitals and 70% of the not awarded ones, presented good health levels (ranging from 5 to 50%). It was also noticed that, in the groups mentioned above, 25 and 20% respectively, were inserted in scores between 55 to 90%, what means that they are in worsening phase. The fact that the hospital is awarded or well recognized doesn t interfere in health professionals stress level and in their psychic health. Through what was heard from these individuals, it was possible to verify that they know little about humanization, once few of them identify or know that the service they offer is in an adoption process by Ministerial Policies. It was also detected the necessity of developing actions aimed at worker s health. Such results showed the importance of have more investments in programs that are directed to workers well-being, because they deal with other people s health and it is known that it is difficult for them to offer high-quality assistance if there are not suitable physical, psychological and material conditions to help them develop their jobs. As a warning, it is fair to say that investments in actions that provide humanized care to health professionals, mainly concerning preventive care for their health and life quality in their work / Observa-se que press?o, tens?o e sobrecarga de trabalho s?o uma constante na rotina dos profissionais de sa?de. O trabalho vinculado ao setor de enfermaria exige aten??o e vigil?ncia. Neste sentido, torna-se pertinente um olhar espec?fico ? humaniza??o direcionada ao profissional de sa?de, j? que este tem em seu of?cio o cuidar do outro. Este estudo analisou os n?veis de sa?de ps?quica e stress dos profissionais de sa?de abrindo um debate sobre a humaniza??o em 06 hospitais p?blicos (03 premidos pelas a??es de Humaniza??o e 03 n?o premiados) no Estado do Rio Grande do Norte, Brasil. Foi realizado um estudo com 126 profissionais de sa?de (m?dicos, enfermeiros, psic?logos, nutricionistas e assistente sociais), atuantes no setor de enfermaria nas respectivas institui??es. A Tese apresentada de car?ter multidisciplinar contou com o apoio de estat?sticos (para o c?lculo amostral e an?lise dos dados), psic?logos, assistente social e administradores (vinculados ao setor de pessoal de cada hospital). Foi efetivado um estudo de delineamento transversal, de natureza quantitativa e qualitativa. Como instrumentos, foram utilizados: um question?rio semi-aberto constando caracter?sticas s?cio-demogr?ficas, de trabalho e humaniza??o; o Invent?rio de Sintomas de Stress para Adultos de LIPP (ISSL), e; o Question?rio de Sa?de Geral de Goldberg (QSG). Os trabalhadores s?o predominantemente mulheres (84,9%), casados (54,8%), apresentando idades de 46 a 55 anos (40,5%), cujo tempo de servi?o na institui??o permeia entre acima de 20 anos (22,2%) e 16 a 20 anos (20,6%) respectivamente. Contam com uma carga hor?ria de trabalho de 40 horas semanais (71,4%), al?m de apresentar m?ltiplos v?nculos de trabalho (61,9%). A sa?de ps?quica global dos sujeitos encontra-se em um n?vel bom, no entanto, tamb?m h? indiv?duos em n?mero significativo de processo de agravamento tanto no stress ps?quico (F1) apresentado pelo QSG (54,7%) quanto pelo stress demonstrado pelo ISSL (42,1%). Ao observar as categorias, os enfermeiros (41,5%), nutricionistas (20,8%), m?dicos e assistentes sociais (18,9%) estiveram entre os mais atingidos. Analisando os grupos de hospitais que apresentaram uma boa sa?de geral - F6, (com escores entre 5 a 50%) estavam 63% do grupo de hospitais premiados e 70% do grupo de hospitais n?o premiados. Percebe-se que o fato do hospital ser premiado, ou reconhecido n?o interfere no n?vel de stress e na sa?de ps?quica do profissional de sa?de. Quanto aos discursos dos sujeitos foi poss?vel constatar um baixo conhecimento sobre o tema da humaniza??o, de modo que poucos identificam ou sabem que o servi?o ao qual assiste est? em processo de ado??o a uma Pol?tica Ministerial. Detectou-se tamb?m a necessidade de a??es voltadas a sa?de do trabalhador. Tais resultados apontaram para a necessidade de se investir mais em programas direcionados ao bem-estar dos profissionais que lidam diretamente com a sa?de das outras pessoas, visto que se torna muito dif?cil a estes sujeitos oferecer um atendimento de qualidade quando n?o se disp?e de condi??es f?sicas, psicol?gicas e materiais para o desempenho de suas fun??es. Cabe o alerta para investimentos em a??es que busquem um cuidado humanizado ao profissional de sa?de principalmente quanto ao enfoque preventivo para sua sa?de e qualidades de vida no trabalho

Made available in DSpace on 2014-12-17T15:30:50Z (GMT). No. of bitstreams: 1 LuanaCA.pdf: 403938 bytes, checksum: f5f0a31844ee99a3cfe60b1ea4adf78f (MD5) Previous issue date: 2006-05-19 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This study tried to know the social representation of dentists surgeons about the Family Health Program (FHP). Where used as methodological instruments a semi-structured interview and direct observation of work process in tive towns that are part of the metropolis region ofNatal city. During the interview some aspects where broached, such as the reasons of dentists surgeons join the FHP, what are the implications ofthe introduction of this program in the everyday practice, what kind of activities are they practicing and what are those professional missing the most in the FHP. In the direct observation where take in account some aspects related to the physic structure of health units, its service organization and demand, relationship amongst dentist and other member of the team, and about patient receptiveness, when they arrives at health unit. This study also identifY the researches subject showing their age, sex, for how they are graduates, what are them specialty and for how long they work for the FHP. The data had been analyzed through the analysis of content of Bardin5. The dentists depict the FHP for the change in assistance model through the preventive proposal of social work that makes possible to work with an ample concept of health. However what makes the FHP more attractive to dentists is the salary questiono The creation of bonds whit the community and the work whit groups and in team had been the main occurred changes in the daily one of the pratices ones of these professionals. The principal activities executed for these professionals inside of the new strategy of assistance in oral health are the carried trough preventive activities achieved in health units and social area. To them, the absence of institutional support and the employment of only one dentist for each team it is one the main point of strangling. There is no doubt that FHP is new strategy and that it is need a better integration amongst the professional, the institution / Este estudo se prop?s a conhecer as representa??es sociais dos cirurgi?es dentistas sobre o Programa Sa?de da Fam?lia. Utilizou-se como instrumentos metodol?gicos a entrevista semi-estruturada e a observa??o direta do processo de trabalho, nas unidades de sa?de de cinco munic?pios que comp?em a regi?o metropolitana do munic?pio de Natal. Durante a entrevista foram abordados aspectos como os motivos que levaram o cirurgi?o-dentista a se inserir no PSF, quais as implica??es da implanta??o deste programa no cotidiano de suas pr?ticas, que tipos de atividades eles est?o realizando e por fim, de qu? estes profissionais est?o sentindo falta no PSF. Na observa??o direta foram levados em conta alguns aspectos relacionados ? estrutura fisica das unidades de sa?de, organiza??o no atendimento e sua demanda, aspectos de relacionamento entre o dentista e demais membros da equipe e sobre o acolhimento do paciente, quando da sua chegada ? unidade de sa?de. Procurou-se tamb?m fazer uma caracteriza??o dos sujeitos pesquisados quanto ? idade, sexo, tempo de formado, tipo de especialidade e tempo de inser??o no PSF. Os dados foram analisados atrav?s da an?lise de conte?do de Bardin5. Os dentistas representam o PSF pela mudan?a no modelo de assist?ncia atrav?s de sua proposta preventiva, que possibilita trabalhar com o conceito ampliado de sa?de. Por?m, apontam como principal motivo para sua inser??o neste programa a quest?o salarial. A cria??o de v?nculos com a comunidade e o trabalho com grupos e em equipe foram as principais mudan?as ocorridas no cotidiano das pr?ticas destes profissionais. As principais atividades executadas por estes profissionais dentro da nova estrat?gia de assist?ncia em sa?de bucal s?o as atividades preventivas realizadas na unidade de sa?de e em espa?os sociais. Para eles, a falta de apoio institucional e a equipara??o de uma dentista para cada equipe aparecem como principais pontos de estrangulamento. N?o resta d?vida que o PSF ? uma estrat?gia nova e que necessita de uma maior integra??o entre o profissional, a institui??o e a comunidade, para que se tenha uma maior resolutividade nas a??es realizadas

Made available in DSpace on 2014-12-17T15:30:55Z (GMT). No. of bitstreams: 1 TatianaMSS.pdf: 644050 bytes, checksum: 04ba840cc19aa0c3d292c0d2a4e7bec0 (MD5) Previous issue date: 2005-02-09 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The Health Family Program (HFP) was founded in the 1990s with the objective of changing the health care model through a restructuring of primary care. Oral health was officially incorporated into HFP mainly through the efforts of dental professionals, and was seen as a way to break from oral health care models based on curative, technical biological and inequity methods. Despite the fast expansion of HFP oral health teams, it is essential to ask if changes are really occurring in the oral health model of municipalities. Therefore, the purpose of this study is to evaluate the incorporation of oral health teams into the Health Family Program by analyzing the factors that may interfere positively or negatively in the implementation of this strategy and consequently in the process of changing oral health care models in the National Health System in the state of Rio Grande do Norte, Brazil. This evaluation involves three dimensions: access, work organization and strategies of planning. For this purpose,19 municipalities, geographically distributed according to Regional Public Health Units (RPHU), were randomly selected. The data collection instruments used were: structured interview of supervisors and dentists, structured observation, documental research and data from national health data banks. It was possible to identify critical points that may be impeding the implementation of oral health into HFP, such as, low incomes, no legal employment contract, difficulty in referring patients for high-complexity procedures, in developing intersectoral actions and program strategies such as epidemiologic diagnosis and evaluation of the new actions. The majority of municipalities showed little or no improvement in oral health care after incorporating the new model into HFP. All of them had failures in most of the aspects mentioned above. Furthermore, these municipalities are similar in other areas, such as low educational levels in children from 7 to 14 years of age, high child mortality rates and wide social inequalities. On the other hand, the five municipalities that had improved oral health, according to the categories analyzed, offered better living conditions to the population, with higher life expectancy, low infant mortality rates, per capita income among the highest in the state as well as high Human Development Index (HDI) means. Therefore, it is possible to conclude that public policies that include aspects beyond the health sector are decisive for a real change in health care models / O Programa Sa?de da Fam?lia (PSF) surgiu na d?cada de 1990, como uma proposta de mudan?a do modelo assistencial a partir de uma reorganiza??o da Aten??o B?sica, atrav?s da vigil?ncia ? sa?de. Entendendo a sa?de bucal como integrante desse processo, a sua incorpora??o oficial no PSF, fruto principalmente de uma luta corporativa, tem sido vista como possibilidade de romper com os modelos assistenciais em sa?de bucal baseados no curativismo, tecnicismo, biologicismo e excludentes. Apesar da r?pida expans?o das Equipes de sa?de bucal no PSF, ? preciso questionar se realmente est? ocorrendo mudan?as no modelo assistencial em sa?de bucal dos munic?pios. Portanto, este trabalho tem como objetivo avaliar a incorpora??o da Sa?de Bucal no Programa Sa?de da Fam?lia a partir da an?lise de fatores que possam interferir positiva ou negativamente, na implementa??o dessa estrat?gia e, conseq?entemente no processo de mudan?a nos modelos assistenciais de sa?de bucal no Sistema ?nico de Sa?de no estado do Rio Grande do Norte. Esta avalia??o tomou como refer?ncia tr?s dimens?es as quais foram, o acesso, a organiza??o do trabalho e as estrat?gias de programa??o. Para isto, foram sorteados 19 munic?pios no estado, distribu?dos geograficamente pelas Unidades Regionais de Sa?de P?blica (URSAPs). Os instrumentos de coleta foram a entrevista estruturada aplicada a gestores e dentistas; a observa??o estruturada; a pesquisa documental e os dados do Sistema de Informa??o em Sa?de dos munic?pios. Foi poss?vel identificar pontos cr?ticos, que podem estar dificultando a implementa??o da sa?de bucal no PSF, os quais foram as prec?rias rela??es de trabalho, as dificuldades no referenciamento dos pacientes para a??es de m?dia e alta complexidade, no desenvolvimento de a??es intersetoriais e nas estrat?gias de programa??o como diagn?stico epidemiol?gico e avalia??o das a??es. A maioria dos munic?pios apresentou pouco ou nenhum avan?o no modelo assistencial em sa?de bucal, ap?s a incorpora??o da mesma no PSF, demonstrando falhas na maior parte dos aspectos relacionados acima. Al?m disso, s?o munic?pios, que apresentam caracter?sticas semelhantes em outros aspectos, como altas taxas de analfabetismo em crian?as de 7 a 14 anos, altas taxas de mortalidade infantil e grandes desigualdades sociais. Por outro lado, os cinco munic?pios que demontraram avan?os na sa?de bucal, de acordo com as categorias analisadas, apresentaram caracter?sticas de melhores condi??es de vida da popula??o, como alta expectativa de vida ao nascer, baixas taxas de mortalidade infantil, valores per capita entre os mais altos do estado, bem como, altos valores de IDH-M. Portanto, ? poss?vel concluir que as pol?ticas p?blicas mais amplas, que contemplem aspectos situados al?m do setor sa?de, s?o decisivas para uma real mudan?a nos modelos assistenciais em sa?de

Made available in DSpace on 2014-12-17T15:31:01Z (GMT). No. of bitstreams: 1 SamaraCMS.pdf: 573528 bytes, checksum: 311fd624f3dee6677140c8c52aaee17b (MD5) Previous issue date: 2007-04-30 / Nowadays, the basic attention in health works according to the Health Family Program (HFP), which is responsible for the organization of the health services with view to provide an appropriate attendance to the needs of the population. Its expansion is expressive in whole country and, the oral health, included in this process, has been seen as a possibility of change the health practices centered in the disease. In face of this perspective, the proposal of study is to discover possible changes in the health care model of oral health in a district, made possible through the perception, evaluation and degree of satisfaction of the user s health service. To reach such objectives, the district of Maca?ba in the State of Rio Grande do Norte, was chosen for operational subjects, such as time of implantation of HFP and great covering of this program. The current research used interviews structured with objectives and subjectives questions and questionnaires of socioeconomic characterization addressed to two hundred and seventy (270) individuals (ninety users of an Urban PSF, ninety of a Rural PSF and ninety of an unit non PSF). The analysis of the data was accomplished through the software SPSS/99, that made possible a statistical and analytic appreciation. The HFP units and non HFP units has shown to sort the common odontology problems of the community, and this didn't establish a direct relationship with the general satisfaction. On the other hands, the programmed consultation is related with lager satisfaction of the users. The access form to the odontology treatment of the Units, the satisfaction with the attendance rendered by the dentist and the equip, enough dentists for the community and the social class of the user were decisive for the general satisfaction with the service of oral health. On the other hand, variables as age and education, resolution of the problem and physical conditions of the unit didn't influence the general satisfaction. In spite of the progresses in the implantation of the oral health in ESF, preventive activities, visits at home, access and social participation still reproduce the traditional model of attendance, showing a primary change process / A aten??o b?sica em sa?de ? atualmente operacionalizada atrav?s da Estrat?gia de Sa?de da Fam?lia (ESF). Esta ? respons?vel pela reorganiza??o e ordenamento dos servi?os de sa?de com vista a proporcionar um atendimento apropriado ?s necessidades da popula??o. Sua expans?o ? expressiva em todo pa?s e, a sa?de bucal ao incorporar-se neste processo tem sido vista como uma possibilidade de mudan?a das pr?ticas de sa?de centrada na doen?a. Diante desta perspectiva, este trabalho tem por objetivo caracterizar o modelo assistencial de sa?de bucal em n?vel local ou municipal, viabilizada atrav?s da percep??o, avalia??o e do grau de satisfa??o do principal interessado com o servi?o prestado pelo setor p?blico de sa?de: o usu?rio. Para atingir tais objetivos escolheu-se, intencionalmente, o Munic?pio de Maca?ba no Estado do Rio Grande do Norte, por quest?es operacionais, pelo tempo de implanta??o do ESF e sua alta cobertura. Para isto, utilizaram-se como instrumentos de coleta de informa??es, entrevistas estruturadas com quest?es fechadas e abertas e question?rios de caracteriza??o s?cio-econ?mica direcionados a duzentos e setenta (270) indiv?duos, sendo, esses, usu?rios do servi?o de sa?de bucal de Unidades B?sicas de Sa?de do Munic?pio (noventa usu?rios de um PSF Urbano, noventa de um PSF Rural e noventa de uma unidade n?o PSF). A an?lise dos dados foi realizada atrav?s do software SPSS/99, que possibilitou uma aprecia??o estat?stica e anal?tica. As unidades mostraram-se resolutivas n?o apresentando diferen?a estatisticamente significativa entre unidade n?o PSF e unidades PSF, e n?o estabeleceu uma rela??o direta com a satisfa??o geral. O sistema de refer?ncia e contra-refer?ncia n?o se encontra totalmente organizado e a forma de acesso na ESF n?o se apresenta definida, ocorrendo concomit?ncia entre livre demanda e agendamento, estando esta ?ltima relacionada com maior satisfa??o. A forma de acesso ao tratamento odontol?gico das Unidades, a satisfa??o com o atendimento prestado pelo dentista e sua equipe, o n?mero de dentistas suficientes para a comunidade e a classe social do usu?rio foi determinante para a satisfa??o geral destes com o servi?o de sa?de bucal. Por outro lado, vari?veis como idade e escolaridade, resolu??o do problema e condi??es f?sicas da unidade n?o influenciaram a satisfa??o geral. Apesar dos avan?os na implanta??o da sa?de bucal na ESF pode-se verificar que, em certos pontos, atividades preventivas, visitas domiciliares, acesso e participa??o social reproduzem, ainda, o tradicional modelo de assist?ncia, sinalizando um incipiente processo de mudan?a

Made available in DSpace on 2014-12-17T15:31:02Z (GMT). No. of bitstreams: 1 AlbertoARP.pdf: 2471246 bytes, checksum: fdc4a1ff3894363e270681912a069512 (MD5) Previous issue date: 2007-07-14 / The aim of this study was to assess the impact of the Family Health Program (FHP) on a number of oral health indicators in the population of Natal, Brazil. The study is characterized as a quasi-random community intervention trial. The intervention is represented by the implementation of an Oral Health Team (OHT) in the FHP prior to the study. A total of 15 sectors covered by the FHP with OHT were randomly drawn and paired with another 15 sectors, based on socioeconomic criteria, not covered by the teams. A few sectors were lost over the course of the study, resulting in a final number of 22 sectors, 11 covered and 11 not covered. We divided the non-covered areas into two conditions, one in which we considered areas that had some type of assistance program such as the Community Agents Program (CAP), FHP without OHT, BHU (Basic Health Unit) or no assistance, and the other, in which we considered areas that had only BHU or no assistance. Community Health Agents (CHAs) and Dental Office Assistants (DOAs) applied a questionnaire-interview to the most qualified individual of the household and the data obtained per household were transformed into the individual data of 7186 persons. The results show no statistical difference between the oral health outcomes analyzed in the areas covered by OHT in the FHP and in non-covered areas that have some type of assistance program, with a number of indicators showing better conditions in the non-covered areas. When we considered the association between covered and non-covered areas under the second condition, we found a statistical difference in the coverage indicators. Better conditions were found in covered areas for indicators such as I have not been to the dentist in the last year with p < 0.001 and OR of 1.64 and I had no access to dental care with p < 0.001 and OR of 2.22. However, the results show no impact of FHP with OHT on preventive action indicators under both non-covered conditions. This can be clearly seen when we analyze the toothache variable, which showed no significant difference between covered and non-covered areas. This variable is one of the most sensitive when assessing oral health programs, with p of 0.430 under condition 1 and p of 0.038 under condition 2, with CI = 0.70-0.90. In the analysis of health indicators in children where the proportion of deaths in children under age 1, the rate of hospitalization for ARI (Acute Respiratory Infections) in those under age 5 and the proportion of individuals born underweight were considered, a better condition was found in all the outcomes for areas with FHP. Therefore, we can conclude that oral health in the FHP has little effect on oral health indicators, even though the strategy improves the general health conditions of the population, as, for example child health / O objetivo deste estudo foi avaliar o impacto do Programa de Sa?de da Fam?lia (PSF) sobre alguns indicadores de sa?de bucal na popula??o de Natal-RN, caracterizado como um estudo do tipo ensaio de interven??o comunit?ria em paralelo quase-randomizado. Interven??o representada pela implanta??o da Equipe de Sa?de Bucal (ESB) no PSF ocorrida em um tempo anterior ? realiza??o desse estudo. Foram sorteados 15 setores censit?rios em ?reas cobertas pelo PSF com ESB e emparelhados a outros 15 setores em ?reas n?o cobertas pelas equipes, a partir de crit?rios socioecon?micos. Durante a realiza??o do estudo alguns setores foram perdidos restando ao final 22 setores, sendo 11 cobertos e 11 n?o cobertos. As ?reas n?o cobertas foram divididas em duas condi??es, uma em que foram consideradas ?reas que apresentavam algum tipo de programa assistencial como Programa de Agentes Comunit?rios (PACS), PSF sem ESB, UBS (Unidade B?sica de Sa?de) ou sem assist?ncia, e uma outra em que foram consideradas ?reas que apresentavam apenas UBS ou aus?ncia de assist?ncia. Agentes Comunit?rios de Sa?de (ACSs) e Auxiliares de Consult?rio Dent?rio (ACDs) aplicaram um question?rio-entrevista junto ao informante mais qualificado do domic?lio e os dados obtidos por domic?lio foram transformados em dados por indiv?duos, totalizando 7.186 pessoas. Os resultados apontam para aus?ncia de diferen?a estat?stica entre os desfechos de sa?de bucal analisados na associa??o entre ?reas cobertas por ESB no PSF e ?reas n?o cobertas que apresentam algum tipo de programa assistencial, com alguns indicadores demonstrando melhores condi??es nas ?reas n?o cobertas. Quando se considera na an?lise a associa??o entre ?reas cobertas e ?reas n?o cobertas na segunda condi??o, percebe-se diferen?a estat?stica em indicadores de cobertura, com melhores condi??es para ?reas cobertas, como, por exemplo, nos indicadores N?o foi ao dentista no ?ltimo ano com p (<0,001) e OR de 1,64 e N?o teve acesso ? assist?ncia odontol?gica p (<0,001) e OR de 2,22. Por?m, os resultados demonstram aus?ncia de impacto do PSF com ESB sobre os indicadores de a??es preventivas, nas duas condi??es de n?o coberto. Isso ? percebido muito claramente quando analisamos a vari?vel dor de dente que n?o apresenta diferen?a significativa entre ?reas cobertas e n?o cobertas, vari?vel essa que ? uma das mais sens?veis na avalia??o de programas assistenciais de sa?de bucal, com p (0,430) na condi??o 1 e p (0,038) na condi??o 2, por?m, com IC (0,70-0,99). Na an?lise de indicadores de sa?de da crian?a em que ? considerada a propor??o de ?bitos em crian?as menores de um ano, a taxa de interna??o por IRA (Infec??es Respirat?rias Agudas) em menores de cinco anos e a propor??o de indiv?duos nascidos com baixo peso, verifica-se uma melhor condi??o em todos os desfechos para ?reas com PSF. Portanto, ? poss?vel concluir que a Sa?de Bucal no PSF est? exercendo pouco efeito sobre os indicadores de sa?de bucal, ainda que a estrat?gia melhore as condi??es de sa?de geral da popula??o, como, por exemplo, a sa?de da crian?a

Made available in DSpace on 2016-04-04T18:21:37Z (GMT). No. of bitstreams: 1 Karina Jorge.pdf: 3084239 bytes, checksum: 3de3e9558aa23fb366967551b5a3e910 (MD5) Previous issue date: 2006-12-13 / The intention of this research was to investigate as in the city of S?o Paulo, in elapsing of century XIX, the co-participation of knowing doctors to them, of engineering, of the architecture and the performance of the administrators they had implied in the modification in the urban configuration of the city and had defined a new structure in organization and functioning. It investigates, over all, the debate and practical the relative ones to the implantation of the hospitals, isolation hospitals, cemeteries and saint marries of mercy through the urban historical study of the S?o Paulo city. It tried to perceive how the urban practice implemented by the administrators through the doctors and engineers were based on the miasma theory. These buildings, according to related theory, would contain organic substance that when decomposing, exhaled miasmas, and therefore, they would have to be situated outside of the urban defined borders at that time. The studies had been made under the point of view of the public health, investigating the origin and formation of the buildings relating them, and the relation of these buildings with the urban way. It is also distinguished in this research, how the prescriptions in the medicine and architecture treaties about the salubrious of the cities, had been transferred to the legislation, through the Municipal Laws. By means of the law off August 30th of 1828, that it extinguished the positions of Physicist and Surgeon, the City councils had started to be responsible for public health and, through the Imperial Decree of October 1st of 1828, established it form of the elections of the members of the City councils and included the first Code of Positions in the organic law of the respective Chambers. / O prop?sito dessa pesquisa foi o de investigar como na cidade de S?o Paulo, no decorrer do s?culo XIX, a co-participa??o dos saberes m?dicos, da engenharia, da arquitetura e a atua??o dos administradores implicaram na modifica??o no tecido urbano da cidade e definiram uma nova estrutura de organiza??o e funcionamento. Investiga, sobretudo, o debate e as pr?ticas relativas ? implanta??o dos hospitais, lazaretos, cemit?rios e casas de miseric?rdia atrav?s do estudo hist?rico urban?stico da cidade de S?o Paulo. Procurou-se perceber como as pr?ticas urbanas implementadas pelos administradores atrav?s dos m?dicos e engenheiros aos seus servi?os estavam fundamentadas na teoria miasm?tica. Estes edif?cios, segundo a referida teoria, conteriam mat?ria org?nica que ao se decompor exalavam miasmas e, portanto, deveriam se localizar fora do meio urbano definido na ?poca. Os estudos foram feitos sob o ponto de vista da sa?de p?blica, investigando a origem e forma??o dos edif?cios relacionados ? mesma e a rela??o desses edif?cios com o meio urbano. Destaca-se nessa pesquisa tamb?m, como as prescri??es presentes nos tratados de medicina e arquitetura sobre a salubridade das cidades foram transferidas para a legisla??o, atrav?s das Posturas Municipais. Mediante a lei de 30 de agosto de 1828, que extinguiu os cargos de F?sico-mor e Cirurgi?o-mor, as C?maras Municipais passaram a ser respons?veis pela sa?de p?blica e, atrav?s do Decreto Imperial de 1? de outubro de 1828, estabeleceu-se a forma das elei??es dos membros das C?maras Municipais e incluiu-se o primeiro C?digo de Posturas na lei org?nica das respectivas C?maras.

Made available in DSpace on 2014-12-17T15:30:58Z (GMT). No. of bitstreams: 1 LidianyVL_DISSERT.pdf: 1294064 bytes, checksum: a82c4b5ecb809f1a845083c8b4a7ce40 (MD5) Previous issue date: 2012-05-16 / As a result of the financial incentive provided by the GM / MS 1.444, since 2000, Brazil has experienced a substantial increase in the number of oral health services at the Family Health Strategy. There is, however, evidence that these teams have produced qualitatively different experiences which do not translate necessarily into improved quality of life and health. Thus, evaluative research of great importance. This study aims to assess the impact of the Family Health Strategy in oral health in a longitudinal perspective natalense the years 2006 and 2009. This is an intervention study whose design is a community trial in parallel, nearly randomized. The sample consisted of census tracts covered by oral health teams in the Family Health and the Traditional Model (Basic Health Units and non-FHS Program of Community Health Agents and areas not covered.) The sample was determined by drawing ten census tracts to form the experimental group and ten other sectors for the control group by pairing intentional based on socio-economic and geographic. To check the net effect of the intervention was performed multivariate analysis by Poisson regression. As a result of cross-sectional analysis of year 2009, it was found that the effects of the ESF in Natal were satisfactory only for the variables of injuries and for other purposes without and with negative impact on stock coverage reclaimers. However, the longitudinal analysis revealed that the ESB / ESF improved their performance in dealing with grievances, access and coverage of the type of actions and this fact is independent of age, sex and social and economic conditions. In other employees' words are related to the presence of the Family Health Strategy in the region. However it does not say that both models under study (the Family Health Strategy Model and Traditional) are different in terms of performance and it is pertinent to reflect on the need for further development of evaluation studies that use other approaches able to clarify the dynamics of the process whose results can come to the knowledge of the actors responsible for leading the ESF and encourage them to incorporate the assessment in their routine / Como resultado do incentivo financeiro estabelecido pela Portaria GM/MS n? 1.444, desde 2000, o Brasil tem apresentado um aumento substancial do n?mero de equipes de sa?de bucal na Estrat?gia Sa?de da Fam?lia. H?, no entanto, evid?ncias de que essas equipes v?m produzindo experi?ncias qualitativamente diferentes que n?o se traduzem, necessariamente, em melhorias na qualidade de vida e sa?de da popula??o. Desse modo, pesquisas avaliativas assumem grande relev?ncia. Este estudo se prop?e a avaliar o impacto da Estrat?gia Sa?de da Fam?lia na sa?de bucal da popula??o natalense numa perspectiva longitudinal dos anos 2006 e 2009. Trata-se de um estudo de interven??o cujo desenho ? um ensaio comunit?rio em paralelo, quase randomizado. A amostra constou de setores censit?rios cobertos pelas Equipes de Sa?de Bucal na Estrat?gia Sa?de da Fam?lia e pelo Modelo Tradicional (Unidades B?sicas de Sa?de com e sem ESF, com Programa de Agentes Comunit?rios de Sa?de e ?reas n?o cobertas). A amostra foi definida por sorteio de dez setores censit?rios para compor o grupo experimental e outros dez setores para o grupo controle atrav?s de emparelhamento intencional baseando-se no perfil s?cio-econ?mico e geogr?fico. Para verificar o efeito l?quido da interven??o foi realizada an?lise multivariada atrav?s da Regress?o de Poisson. Como resultado da an?lise transversal do ano 2009, verificou-se que os efeitos da ESF em Natal foram satisfat?rios apenas para as vari?veis de agravos sendo sem efeitos para as demais e com impacto negativo na cobertura de a??es recuperadoras. Contudo a an?lise longitudinal revelou que as ESB/ESF melhoraram seu desempenho nas quest?es relativas aos agravos, acesso e tipo de cobertura das a??es e este fato independe da idade, sexo e condi??es sociais e econ?micas. Em ouras palavras, est?o relacionadas com a presen?a da Estrat?gia Sa?de da Fam?lia na regi?o. Todavia ainda n?o cabe afirmar que ambos os modelos em estudo (Estrat?gia de Sa?de da Fam?lia e Modelo Tradicional) s?o diferentes do ponto de vista da atua??o. Desse modo, ? pertinente a reflex?o sobre a necessidade de elabora??o de mais estudos avaliativos que utilizem outras abordagens capazes de esclarecer as din?micas do processo cujos resultados possam chegar ao conhecimento dos atores respons?veis pela condu??o da ESF e motiv?-los a incorporar a avalia??o no seu cotidiano