nÃo hà / A avaliaÃÃo da AtenÃÃo PrimÃria à SaÃde ganha destaque no Sistema Ãnico de SaÃde (SUS), mas enfrenta desafios teÃricos e operacionais decorrentes da complexidade de seus processos e de suas mÃltiplas causas conjunturais e histÃricas. Em Sobral, CearÃ, a construÃÃo do Sistema Municipal de SaÃde, enquanto um conjunto de serviÃos coordenados por gestÃo local, com Ãrea geogrÃfica definida e metas para melhoria da situaÃÃo de saÃde da populaÃÃo claramente estabelecidas, iniciou-se em 1997. Diante disso, nos reportamos ao modelo de atenÃÃo a saÃde vigente em Sobral, completou dez anos de implantaÃÃo, embasado nos pressupostos do Programa SaÃde da FamÃlia, e centrado nas aÃÃes de promoÃÃo da saÃde e prevenÃÃo das doenÃas, no sentido de avaliar como se encontra esse processo de mudanÃa ao longo desse perÃodo. Nos propomos, neste estudo a analisar o cenÃrio da AtenÃÃo PrimÃria à SaÃde à luz do pensamento sistÃmico. Para tanto, desenvolvemos um estudo avaliativo de abordagem qualitativa, a partir dos referenciais do Pensamento SistÃmico (PS). Os atores sociais da pesquisa foram os profissionais que atuam na EstratÃgia SaÃde da FamÃlia de trÃs Centros de SaÃde da FamÃlia de Sobral, CearÃ, os gerentes destes Centros de SaÃde e os usuÃrios do serviÃo de saÃde, que aceitaram participar da pesquisa a partir da utilizaÃÃo do Termo de Consentimento Livre e Esclarecido. As informaÃÃes foram coletadas durante o ano de 2006, a partir de formulÃrio, grupo focal e entrevista. Os dados foram analisados a partir da TÃcnica do Discurso do Sujeito Coletivo. Nos resultados, prevaleceram os fatores facilitadores da satisfaÃÃo dos serviÃos apresentados: acolhimento, sentimento de conforto, limpeza das UBS, satisfaÃÃo com o atendimento, a nÃo existÃncia de dÃvidas pÃs-consulta, confianÃa no trabalho da equipe, respeito demonstrado pela equipe; Sendo os restritivos: limitadas informaÃÃes sobre o funcionamento do serviÃo e pouca receptividade dos usuÃrios para participaÃÃo nas sessÃes educativas. O estudo demonstrou ainda que os profissionais da equipe de saÃde da famÃlia, tem uma forte relaÃÃo estabelecida com a comunidade do territÃrio de abrangÃncia da mesma e isso se apresenta como um determinante da qualidade da assistÃncia prestada, mostra tambÃm a importÃncia do agente comunitÃrio de saÃde como elo de ligaÃÃo entre profissionais e comunidade, a participaÃÃo da comunidade nas tomadas de decisÃo atravÃs do espaÃo da roda de co gestÃo de coletivos, percebemos ainda a dificuldade dos gerentes dos Centros de SaÃde da FamÃlia em assumir dois papÃis gerenciamento e cuidado das famÃlias, a dificuldade de acesso da populaÃÃo em relaÃÃo aos serviÃos mÃdicos. Por fim, o estudo demonstrou que os princÃpios da promoÃÃo da saÃde estÃo presentes em alguns aspectos, mas ainda precisam esforÃos de todas as esferas de governo para que as aÃÃes sejam fortalecidas atravÃs de polÃticas centradas na promoÃÃo da saÃde e prevenÃÃo de doenÃas, permitindo um melhor desempenho dos atores na ESF, inclusive de mais investimentos que priorizem o financiamento dos componentes que dÃo sustentabilidade as polÃticas na atenÃÃo primÃria. / The evaluation of Primary Health Care gains importance in the Unified Health System (UHS), yet it faces theoretical and operational challenges due to the complexity of its processes and its multiple conjunct and historical causes. In Sobral, CearÃ, the construction of the Municipal Health System, as a set of services coordinated by local management, with defined geographic area and goals to improve the populationâs health situation clearly established, began in 1997. Through this, we report on the current health care model in Sobral that has completed ten years of implantation, based on presuppositions from the Family Health Program and centered on health promotion actions and illness prevention, in the sense of evaluating how this process of change is faring throughout this process and socialize, after research, the main indicators of change, enabling the redirecting of actions proposed by the actors involved in the system from the perspective of health care professionals and users. Understanding the intrinsic relationship between the Health Care model developed in Sobral and the presuppositions of Health Promotion, we propose in this study to analyze the Primary Health Care scenario in the light of systemic thinking, taking the year 2006 as reference. For which, we developed an evaluative study with qualitative approach, from the referential of Systemic Thinking (ST). The social actors in the survey were the professionals that perform in the Family Health Strategy in the three Health Centers in Sobral, CearÃ: Pedrinhas, Sumarà and Padre Palhano, the managers of these Health Centers and the health service users, who accepted to participate in the survey by means of a Term of Free and Informed Consent. The information was collected by means of a form, group focus and interview. For the data from interviews, managers and focus groups, we used the Collective Subject Speech technique. In the results, the facilitating factors for the satisfaction of presented services prevailed: reception, sense of comfort, at Basic Health Units, attendance satisfaction, and non-existence of post-consultation doubts, confidence in the work team, respect demonstrated by the team; With limitations being in smaller proportions and overcome by the relevance of facilitating factors, being presented by: limited information on the running of the service and little receptivity from users for participation in educative sessions. The study demonstrated that the professionals from the Family Health Team (FHT) had a strong relationship established with the community in the territory covered and this is presented as a determinant in the quality of assistance provided. Finally, we require articulation from all the governmental and non-governmental spheres to rethink, discuss and redirect strategies that permit better performance and running of (FHTs), including more investments that prioritize the financing of components that give sustainability to policies in primary care.

nÃo hà / A promoÃÃo da saÃde surge como importante modo de reestruturaÃÃo da rede de atenÃÃo à saÃde, inserindo num cuidar do processo saÃde-doenÃa, um olhar integral sobre o indivÃduo. A DeclaraÃÃo de Budapeste sobre PromoÃÃo da SaÃde em Hospitais traz as recomendaÃÃes para a implantaÃÃo dessa estratÃgia, utilizada desde a dÃcada de 90 na Europa. O estudo objetivou validar uma escala de avaliaÃÃo de promoÃÃo da saÃde no ambiente hospitalar, a partir da DeclaraÃÃo de Budapeste. Pesquisa metodolÃgica, de abordagem quantitativa, envolvendo 115 enfermeiros de dois hospitais de ensino do municÃpio de Fortaleza-CE, que prestam cuidados diretos ao usuÃrio. A escala foi construÃda, validada por juÃzes, testada em um grupo piloto literalmente, aplicada como questionÃrio no perÃodo de out/2010 a jan/2011. A confiabilidade da escala foi verificada por meio do teste IVC e as anÃlises de associaÃÃo foram feitas por meio dos testes Qui-Quadrado e razÃo de verossimilhanÃa. As mÃdias de dois grupos foram comparadas pelo teste t de Student; as mÃdias de trÃs ou mais grupos foram comparadas pelo teste F de Snedecor e, em sendo estatisticamente significante, as comparaÃÃes mÃltiplas foram realizadas pelo teste de Tukey, Kruskall-Wallis e Dwass-Stell-Chritchlow-Fligner. Antes dos testes estatÃsticos, foi verificada a normalidade das variÃveis, bem como a igualdade de variÃncias. Para todas as anÃlises consideraram-se como estatisticamente significante aquelas com p < 0,05. Os dados das perguntas abertas foram tratados atravÃs da anÃlise de conteÃdo de Bardin. Os resultados indicam que o conteÃdo das escalas foi considerado compreensivo segundo comità de juÃzes. O questionÃrio à viÃvel quanto a sua estrutura semÃntica (escore entre 100% e 80%); tem alta confiabilidade (IVC= 0,87) e significÃncia (p<0, 005) em todos os itens, e foi considerado pelos enfermeiros como de fÃcil compreensÃo. A anÃlise quanto atividade total demonstra que houve significÃncia positiva (95,6%), com mÃdia igual a 78,9  10, 2, ou seja, os enfermeiros desenvolvem aÃÃes na sua prÃtica hospitalar, que contemplam os princÃpios da promoÃÃo da saÃde; no domÃnio estrutura, houve boa significÃncia (80%). As concepÃÃes do enfermeiro sobre a promoÃÃo da saÃde na Ãrea hospitalar resultaram em duas categorias: ConcepÃÃo de promoÃÃo da saÃde com enfoque no cuidado da doenÃa (51,4%) e ConcepÃÃo ampliada de promoÃÃo da saÃde (41,8%). Concluiu-se, portanto, que se obteve um instrumento confiÃvel, vÃlido e capaz de avaliar as concepÃÃes e prÃticas de promoÃÃo da saÃde dos enfermeiros em ambiente hospitalar. Ressalte-se, ainda, que os enfermeiros desenvolvem aÃÃes, na sua prÃtica hospitalar, que contemplam os princÃpios da promoÃÃo da saÃde, apesar de muitas vezes nÃo reconhecerem essas aÃÃes como tal.

nÃo hà / Os aspectos espaciais e epidemiolÃgicos envolvidos na deficiÃncia ainda nÃo foram abordados de modo expressivo nas pesquisas demogrÃficas e de saÃde no Brasil. Realizar estudos sobre a prevalÃncia das problemÃticas inerentes à real situaÃÃo dessas pessoas à imprescindÃvel por possibilitar conhecer seu perfil de saÃde e condiÃÃes de vida. Teve-se como objetivo geral analisar a distribuiÃÃo espacial das pessoas com deficiÃncia no municÃpio do Crato-CE e, especificamente, identificar as pessoas com pessoas com deficiÃncia, descrever o perfil epidemiolÃgico das pessoas com deficiÃncia e distribuir espacialmente essas pessoas para descriÃÃo dos eventos e localizaÃÃo de Ãreas de sobre-risco. Estudo do tipo transversal com abordagem quantitativa, elaborado de janeiro de 2010 a outubro de 2011. Na primeira fase promoveu-se capacitaÃÃo prÃvia dos ACS mediante aplicaÃÃo do plano de capacitaÃÃo para desenvolvimento de competÃncias relativas à assistÃncia à pessoa com deficiÃncia, passo metodolÃgico de suporte à coleta de dados. Neste momento utilizaram-se instrumentos para a avaliaÃÃo de competÃncias do ACS. Na segunda fase os ACS identificaram as pessoas com deficiÃncia visual, auditiva e fÃsica residentes em suas Ãreas de abrangÃncia utilizando ficha de cadastro. Na terceira fase os domicÃlios das pessoas com deficiÃncia foram georreferenciados. Na quarta os dados nÃo grÃficos foram submetidos à anÃlise estatÃstica atravÃs do programa SPSS versÃo 18. Foram realizados teste Qui-Quadrado e Qui-Quadrado para dados emparelhados nos dados relativos ao perfil do ACS e desenvolvimento de competÃncias. Descreveu-se o perfil das pessoas com deficiÃncia e calculou-se a razÃo de prevalÃncia das variÃveis socioeconÃmicas. Os dados grÃficos foram analisados mediante o software Arcgis versÃo 9.2., empregando-se estimador de intensidade de Kernel. Desse modo, buscou-se verificar a intensidade dos eventos nas Ãreas adstritas a fim de identificar Ãreas de sobre-risco. No decorrer da pesquisa considerou-se a ResoluÃÃo 196/96 inerente à pesquisa envolvendo seres humanos. Nos resultados identificou-se o perfil das PcD como homens em idade produtiva, que moram em zona rural, tÃm baixa instruÃÃo e renda familiar, procedentes do municÃpio de Crato. Na distribuiÃÃo espacial evidenciou-se maior prevalÃncia em zona rural, com maior nÃmero de residentes nos distritos de Dom Quintino, Bela Vista, Campo Alegre, Ponta da Serra e Ãreas urbanas de menor indicador socioeconÃmico. A cobertura dos serviÃos de saÃde à satisfatÃria em relaÃÃo à ESF, mas os serviÃos de reabilitaÃÃo, apoio diagnÃstico, marcaÃÃo de exames e consultas especializadas e os serviÃos ambulatoriais e hospitalares estÃo concentrados na zona urbana. Desse modo, como se supunha, as caracterÃsticas daqueles com deficiÃncia resultam em um perfil que dificulta o acesso e a acessibilidade aos serviÃos de saÃde de reabilitaÃÃo, especialidades mÃdicas e de Ãmbito hospitalar. Ademais, o perfil à sugestivo de pessoas com exacerbada dependÃncia dos serviÃos pÃblicos, portanto, à preciso se criar estratÃgias de mobilidade para promover o acesso aos serviÃos de saÃde. E, ainda: os ACS sÃo sensÃveis a este pleito, mas carecem de medidas adequadas para prover cuidados de promoÃÃo de saÃde na perspectiva do seu papel de mediador. / The spatial and epidemiological aspects involved in disability have not been meaningfully addressed yet in demographic and health research in Brazil. Research on the prevalence of the problems inherent in these peopleâs actual situation is fundamental because this permits knowledge on their health profile and living conditions. The general aim was to analyze the spatial distribution of disabled people in Crato-CE, while the specific aim was to identify disabled people, describe their epidemiological profile and the spatial distribution of these people to describe the events and location of excess risk areas. Cross-sectional study with a quantitative approach, elaborated between January 2010 and October 2011. In the first phase, Community Health Agents (CHA) received previous training through the application of the training plan for competency development in care delivery for disabled people, a methodological phase to support data collection. At that moment, instruments were used to assess the CHAsâ competences. In the second phase, the CHAs identified people with visual, hearing and physical impairments living in their coverage area through the registration forms. In the third phase, the disabled peopleâs homes were georeferenced. In the fourth phase, non-geographical data were submitted to statistical analysis in SPSS version 18. Chi-squared and chi-squared tests for paired data were applied to data on the CHAsâ profile and competency development. The profile of disabled people was described and the prevalence rates of socioeconomic variables were calculated. Graphical data were analyzed in Arcgis version 9.2., using Kernelâs intensity estimator. Thus, the goal was to verify the intensity of events in the areas concerned in order to identify excess risk areas. The research complied with Resolution 196/96, concerning research involving human beings. In the results, the disabled peopleâs profile was identified as men of productive age, living in rural areas, with low education and family income levels, coming from the city of Crato. In the spatial distribution, higher prevalence levels were evidenced in rural areas, with a larger number of residents in the Dom Quintino, Bela Vista, Campo Alegre, Ponta da Serra districts, as well as in urban areas with lower socioeconomic indicators. Health service coverage is satisfactory concerning the FHS, but rehabilitation, diagnostic support, test and specialized appointment scheduling and outpatient and hospital services are concentrated in the urban area. Thus, as supposed, the characteristics of the disabled people result in a profile that hampers the access to and accessibility of rehabilitation services, medical specialties and hospital services. Moreover, the profile suggests people with increased dependence on public services. Therefore, mobility strategies need to be created to enhance health service access. And, also: the CHAs are sensitive to this plea, but lack adequate measures to deliver health promotion care within the perspective of their mediating role.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Objetivou-se identificar os fatores de risco para diabetes mellitus tipo 2 em uma populaÃÃo de estudantes de graduaÃÃo de uma universidade pÃblica. Estudo transversal realizado de setembro a novembro de 2010 e de fevereiro a junho de 2011, envolvendo 702 universitÃrios da Universidade Federal do CearÃ. Aplicou-se um questionÃrio contendo dados sociodemogrÃficos e relacionado à prÃtica de atividade fÃsica. Mensurou-se o peso, a altura para o cÃlculo do IMC, a circunferÃncia abdominal e a pressÃo arterial. Colheu-se uma amostra sanguÃnea para exame de glicemia em jejum. ApÃs tripla digitaÃÃo, os dados foram armazenados em um banco de dados construÃdo no Excel e processados no programa estatÃstico Statistical Package for Science Social versÃo 18.0. Os resultados foram submetidos a tratamento estatÃstico e analisados com apoio na literatura especÃfica. AprÂÂÂÂÂovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ, o estudo recebeu o protocolo n 208/10. Dos 702 participantes, 62,7% eram do sexo feminino; a idade mÃdia foi de 21,5 anos, sendo 53,3% situados na faixa etÃria de 20 a 24 anos; 92% eram solteiros; 49,1% da raÃa parda; 69,1% eram novatos e estavam cursando os primeiros semestres da graduaÃÃo; a renda mensal mÃdia foi de 3.211,66 reais; 79% pertenciam Ãs classes B+C; 64,7% apenas estudavam e 70,4% moravam com os pais. No referente aos fatores de risco, 70,2% eram sedentÃrios, 26,2% estavam com excesso de peso, dos quais 21,2% com sobrepeso e 5% com obesidade; 5,4% apresentaram a medida da CA alterada; 7,4% tinham a pressÃo arterial elevada, sendo 4,4% classificados como limÃtrofe e 3% como hipertensÃo; 12,1% apresentaram o valor da glicemia venosa em jejum alterada. Ademais, em 55,3% dos indivÃduos observou-se pelo menos um fator de risco. Ao associar os fatores de risco com as Ãreas de conhecimento, apenas o excesso de peso, a circunferÃncia abdominal e a glicemia venosa em jejum mostraram diferenÃa estatisticamente significativa, sendo mais prevalentes nas Ãreas de ciÃncias, humanas e tecnologia, respectivamente. Diante do exposto evidencia-se a necessidade de motivaÃÃo à adoÃÃo de um estilo de vida saudÃvel por parte dos estudantes universitÃrios. Deve-se combater esses FR mediante a conscientizaÃÃo da populaÃÃo acerca do risco em desenvolver nÃo apenas o DM2, mas outras doenÃas crÃnicas nÃo transmissÃveis. Os resultados encontrados neste estudo contribuirÃo para a construÃÃo e implementaÃÃo da assistÃncia de enfermagem, por meio de estratÃgias de educaÃÃo em saÃde. / To objective was to identify risk factors for type 2 diabetes mellitus in a population of undergraduate studentes at a public university. Cross-sectional study conducted from September to November 2010 and February to june 2011, involving 702 college studentes of the Federal University of CearÃ. We applied a questionnaire containing demographic data and related to physical activity and weight were measured, the height to calculate BMI, waist circumference and weght were measured, the height to calculate BMI, waist circumference and blood pressure. We collected a sample for blood glucose test fasting. After triple typing, data were stored in a database built in excel and processed in the statistical package for social science version 18.0. The results were analyzed statistically and analyzed with support in the literature. Approved by the ethics committee in research of Federal University of Cearà received the study protocol no. 208/10. Of the 702 participants, 62.7% were female, the mean age was 21.5 years and 53.3% located in the age group 20-24 years, 92% were single, 49.1% mulatto, 69.1% were beginners and were attending the first semester of graduation, the average monthly income was3,211.66 reais, 79% belonged to classes B + C, 64.7% were in school and only 70.4% lived with parents. With regard to risk factors, 70.2% were sedentary, 26.2% were overweight, of which 21.2% were overweight and 5% were obese, 5,4% had a measure of the CA amended, 7.4% had high blood pressure, 4.4% classified as borderline and 3% as hypertension, 12.1% showed the value of fasting venous plasma glucose changes. Moreover, in 55.3% of individuals observed at least one risk factor. At the risk factors associated with the areas of knowledge, only the escess weight, waist circumference and fasting venous blood glucose showed a statistically significant difference, being more prevalente in the sciences, humanities and technology, respectively. Given the above highlights the need to be motivated to adopt a healthy lifestyle on the part of students. One must fight these FR by public awareness about the risk of developing type 2 diabetes not only, but other chronic diseases. The results of this study contribute to the construction and implementation of nursing care through health education strategies.

O estudo teve o objetivo de analisar a incorporação das ações de promoção da saúde no processo de trabalho das equipes de Saúde da Família, em uma Unidade Básica de Saúde. As ações referidas foram política pública saudável; criação de ambiente favorável; desenvolvimento de habilidades pessoais, reforço da ação comunitária e reorientação do sistema de saúde. Como fundamentação teórica buscou-se compreender a origem e as bases da nova promoção da saúde e sua aproximação com o pensamento e a obra de Paulo Freire. Como metodologia de trabalho, foi utilizado o itinerário de pesquisa do educador Paulo Freire (1968), que possui como pano de fundo uma proposta pedagógica libertadora e constitui uma referência internacional para abordagem de promoção à saúde. O trabalho de campo foi realizado através de Círculos de Cultura em diferentes eventos ocorridos com profissionais, usuários e lideranças comunitárias da unidade de estudo. Os dados empíricos foram coletados no período de abril a dezembro de 2005 e constou de 03 etapas: a entrada no campo com investigação dos temas geradores; codificação e descodificação dos temas; desvelamento crítico. Foram identificadas 29 temáticas significativas, agrupadas a seguir em 21 e priorizados em 09 temas mais relevantes: depressão na população; superpopulação na comunidade; necessidade de pronto atendimento 24 horas ou equipe de referência; resistência dos profissionais de saúde para trabalhar na lógica da Estratégia de Saúde da Família; dificuldade para atender e acolher as necessidades e os problemas da população; dificuldade para realizar acolhimento; necessidade de maior capacitação prática das equipes; resistência dos profissionais e população para o trabalho dos Agentes Comunitários de Saúde; falta de informação sobre o tema da promoção à saúde. Na fase do desvelamento crítico estes temas foram ainda priorizados pelos sujeitos como sendo 03 os mais significativos: superpopulação na comunidade; necessidade de pronto atendimento 24 horas e falta de informação sobre o tema da promoção da saúde. Considerou-se que dentre as temáticas investigadas estas foram as que mais interferiam nas condições de vida e saúde da Unidade e comunidade. Houve certa resistência em não discutir aqueles outros temas que diziam respeito diretamente ao modo de produzir a atenção em Saúde da Família como resistência dos profissionais em trabalhar na lógica da Estratégia de Saúde da Família. A interpretação dos dados revelou significados e compreensão atribuídos à importância de exercer um diálogo crítico entre os profissionais das equipes de Saúde da Família, usuários e lideranças comunitárias, e proporcionar ações focadas nos princípios e diretrizes da promoção da saúde e que possam intervir na melhoria da qualidade de vida e saúde dos cidadãos e comunidade. Apesar disso, percebe-se que ainda se mantém uma atenção de saúde de caráter curativo, individual e fragmentado e faz-se necessário estimular a participação do usuário, família e população, para que, em conjunto com os profissionais dos serviços de saúde, universidades, possam construir uma prática de saúde mais emancipatória, autônoma e dialógica sobre os determinantes do processo saúde e doença, e que interferem no seu adoecer e ser saudável. / This study had the goal of to analyze the incorporation of the actions of health promotion in the work process of the Health Family team in the Health Basic Unit. These actions were favorable public policy, creating supportive environments, strengthening community action, developing personal skills and reorientation health services. As theoretical ground, it tried to understand the origin and the bases of the health promotion that maintain the modern conception of health promotion and their approach with the Paulo Freire?s thought and work. As methodology of work, Paulo Freire?s (1968) research itinerary was used because which contains as backgrounds the liberating pedagogical proposal and constitutes an international reference to approach of health promotion. The fieldwork was developed through of culture circles in different events occurred with professionals, users and leaderships of the community of the study unit. The empirical data were collected from April to December of 2005 and had 03 stages: the entrance in the field with thematic investigation; codification and no codification of the theme and critical clarification. It was identified 29 significant thematic that were synthesized in 21 and prioritized in 09 the most important themes: population depression; super population in the community; necessity of 24-hour prompt attention or reference team; resistance of the health professionals to work according to the Health Family strategy; difficulty to attend the problem of the population and realize welcome; necessity of most practice capacity of the team; resistance of the Health Community Agent; lack of information about the health promotion thematic. On the stage of clarification, these themes were prioritized by the subjects as being 03 the most significant: super population in the community; necessity of 24-hour prompt attention and lack of information about the health promotion thematic. Among the investigated themes, these were the most which interfered in the conditions of life and health in the community and had resistance in don?t discuss that other 06 thematic that said respect the form of to produce the Health Family attention as resistance of the professional in to work in the health family strategy logic. The interpretation of the data revealed meanings and comprehension attributed to the importance of practice a critical dialogue among professionals of the Family Health team, users and community leaderships, as well as provide focused actions on the principles and directives of the health promotion and that can interfere in the improvement of the quality of life and health of the citizens and community. However, it was observed that it still maintains a health attention with curative, individual and fragmented character and it is necessary to stimulate the participation of the user, the family and population together with the professionals of the university and services in order to create a health practice more emancipated, autonomous and dialogical about the determiners of the health and illness process that interfere in the act of sicken and be healthy.

Introdução. O trabalho em equipe interdisciplinar é considerado um importante pressuposto para reorganização do processo de trabalho nas práticas de promoção da saúde e prevenção de doenças, visando a uma abordagem mais integral e resolutiva. Objetivo. Discutir aspectos das relações disciplinares entre profissionais de saúde, incluindo barreiras e facilitadores à prática da interdisciplinaridade, tomando como referência o caso de um centro universitário voltado ao ensino e pesquisa em promoção da saúde e prevenção de doenças na prática clínica. Método. Pesquisa qualitativa, realizada no Centro de Promoção da Saúde do Serviço de Clínica Geral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (CPS-HCFMUSP), com emprego de observação participante e entrevistas semiestruturadas com profissionais de saúde, iniciada após prévia aprovação do Comitê de Ética em Pesquisa e consentimento esclarecido dos entrevistados. Os dados foram submetidos à análise qualitativa, através da análise de conteúdo, modalidade temática. Resultados. Encontram-se práticas realizadas por profissionais com mesmos objetivos, porém com pequena interação entre si, sem método e linguagem comuns, trabalhando sem integração, mas com conhecimento unificado e com diferentes níveis de hierarquia horizontal. No conjunto, esta situação pode representar um momento de transição da pluridisciplinaridade para a interdisciplinaridade. Conclusão. A interdisciplinaridade no caso avaliado não é uma realidade posta, mas um processo ainda em evolução. Fatores sócio-culturais, institucionais e subjetivos podem agir tanto como facilitadores quanto como obstáculos à interdisciplinaridade. / Introduction. Interdisciplinary teams are considered an important premise for the rearrangement of the work process in practices of health promotion and disease prevention, aiming at an integral and resolutive approach. Objective. Discuss the disciplinary relationships among health professionals, including barriers and facilitators to the practice of interdisciplinarity, in the context of a university center for education and research in health promotion and disease prevention in clinical practice. Method. Qualitative research, conducted at the Centro de Promoção da Saúde do Serviço de Clínica Geral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo -CPS-HCFMUSP, using participant observation and semi-structured interviews with health professionals, started up after approval by the HCFMUSP - Research Ethics Committee and the informed consent of interviewees. The data was subjected to qualitative content analysis, on the basis of thematic modality. Results. It was observed practices performed by professionals with little interaction, no common language and method and lack of integration, but with similar goals, unified knowledge and different levels of horizontal hierarchy. Overall, this may represent a moment of transition from multidisciplinary to interdisciplinary work. Conclusion. Interdisciplinarity is not a fact, but a process still in evolution. Socio-cultural, institutional and individual factors can act both as facilitators or as barriers to its implementation.

Disorders of lifestyle are increasing globally; countries in transition are suffering the double burden of both contagious and chronic disorders. The utilization of health education to address these issues has had variable results, but the most successful have incorporated human contact. The aim of this study was to measure the quantitative and qualitative impact of a wellness promotion programme on university students. The objective was to provide a structured facilitated holistic wellness education programme to a sample of socioeconomically disadvantaged students in Higher Education in the Eastern Cape Province, South Africa. Using a pragmatic mixed methodological approach to this critical evaluation, the impact on both wellness and academic progress was measured. Initial demographic data was gathered via a biographical questionnaire, pre- and post-intervention measurement of wellness, using the Wellness Questionnaire for Higher Education, as well as a semi-structured qualitative questionnaire and transcripts of academic results. Quantitative data was analysed using SPSS analysis software and qualitative data using the NVivo analysis package. The findings were that all students improved throughout the year in their overall wellness scores, in particular in areas such as avoiding excessive sun exposure and increasing the amount of physical exercise. This corresponded with an increase in the value that the participants attached to information on these aspects of wellness, which was attributed to the programme. Results revealed that there was a weak correlation between student wellness measured at the year-end and academic success overall, but a strong correlation between student wellness and academic success for the students that gained the highest marks. Analysis of the dimensions of wellness that correlated best with student success revealed that there was a particularly strong correlation between year-end career wellness and year-end academic success. In conclusion it was found that a positive and holistic salutogenic wellness education programme increased levels of student wellness overall, which translated into student academic success. The link between wellness and success was particularly strong in students that gained higher marks. Recommendations include that first-year higher education students receive a positive wellness education programme built into the curriculum of their first year of study and that the overall impact be monitored across a broader spectrum of students over the duration of their diploma or degree programme.

South Africa is one of the countries in the world with the highest number of people living with HIV/AIDS. Workplace HIV/AIDS programmes have been singled out by the Government as one of the measures to fight against the spread of the disease. However, it is quite concerning that managers in most organisations are very reluctant to actively participate in the programmes. One of such organisations is the Chris Hani District Municipality. Reluctance by managers to participate in these programmes has given rise to effects such as lower level employees also not willing to participate in the programmes; thereby undermining efforts by the municipality and the National Government as a whole to fight against the spread of the disease in South Africa. This study has developed a framework that may enable municipal managers to participate in HIV/AIDS programmes in the municipality. In addition the study has also explored factors that discourage managers from participating in HIV/AIDS programmes. The study took place in the Chris Hani municipality. The sample population was municipal managers from the different directorates. The methodological approach was quantitative. Data was collected with use of a questionnaire. The questionnaire was distributed physically and electronically by the researcher. The findings of the study show that in order for managers to actively participate in the programmes of HIV/AIDS, measures should be put place to enhance the following: self-awareness, positive attitude, effective communication, management involvement, management support, and relationship building. The researcher hopes that the study will not only enhance management participation in the Chris Hani municipality, but also other municipalities and organisations in South Africa interested in the fight against the spread of the HIV/AIDS disease.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: Several chronic health conditions that previously manifested in adulthood are now increasingly being identified in young people. Various health risk behaviours established during youth results in chronic diseases of lifestyle as well as behaviours leading to injury, trauma and substance abuse. Current evidence proposes that a school health programme could become one of the most efficient means available to improve the health promotion and education of people as it reaches large numbers of young people in a replicable and sustainable way. Aim: The purpose of the study was to determine health risk behaviours and investigate the understanding and perception of health promotion among adolescent learners attending secondary schools in the Theewaterskloof region. Objectives: 1) To determine the health risk behaviours that secondary school learners in the Theewaterskloof region engage in; 2) to explore and describe the understanding and perceptions of health promotion among secondary school learners in the Theewaterskloof region and 3) To explore and describe the understanding and perceptions of health promotion among life orientation educators in the Theewaterskloof region Methodology: The study used a sequential explanatory mixed methods approach. Quantitative data was collected by means of the Youth Risk Behaviour Surveillance Survey and qualitative data through focus group discussions. Ethics was obtained from the Research Ethics Committee of the University of the Western Cape (13/2/3) and permission was obtained from the Western Cape Education Department, school governing bodies, learners, parents and guardians of identified schools regarding the research. Results: Data from 276 participants in Grades 8-11 from secondary schools in a rural district within the Western Cape, South Africa was analysed. The most significant health risk behaviours engaged in by the participants was substance abuse, sexual activity and physical inactivity. In focus group discussions held with both the learners and educators, the most prevalent health risk behaviours were; substance use and sexual activity. Although the health risk behaviours were such a pertinent issue for both the learners and educators, current health promotion strategies were inadequate. In terms of health promotion strategies the learners highlighted the need for adequate support and guidance from both their parents and educators. They also made reference to themselves, their parents and educators playing a role in the improvement of their health status. The educators felt that parents needed to play their role in health promotion by disciplining their children and by being better role models. They were also of the opinion that the current socio-economic climate of the Theewaterskloof region predisposes learners to specific health risk behaviours. According to them, an effective health promotion strategy would include parents, educators and learners working together to promote better health behaviours. Conclusion: Health risk behaviours are rife in rural communities. Even though the adolescents feel that the management of the trajectory of their health is their responsibility, they see a need for collaboration between educators, parents and themselves in developing health promotion. / National Research Foundation (NRF)

M.Phil. (Biokinetics) / Although coronary artery bypass graft (CABG) is well-established worldwide as a safe, effective operation for the treatment of coronary artery disease (CAD), it is an invasive procedure that often leaves patients feeling very anxious about the recovery process. The post-surgery phase should not only entail exercise intervention, but should also be paralleled with education and counselling to encourage patients to become responsible for the management of their own health and to achieve good functional capacity and quality of life (QoL). This prospective longitudinal study was aimed at achieving return to health and wellness in a group of CABG patients (n=18) with a mean age of 65 years. Four questionnaires were administered at the pre- and post-test, including Stone’s Heart Disease Risk Factor Questionnaire (1984), Paffenbarger Physical Activity Questionnaire (1978), Hawkes and Nowak Nutrition Knowledge Questionnaire (1998) and the Quality of Life Questionnaire. Morphological variables, biological and physiological fitness parameters, and health-related fitness were also assessed at the pre- and post-test. Prescribed exercise and lifestyle modifications were employed over twelve weeks, with emphasis on healthier nutrition and improved mental health. The level of significance was set at 5% (p ≤ 0.05) and 1% (p ≤ 0.0167). The findings in this study reflected significant improvements in heart disease risk, kilocalorie expenditure, nutrition knowledge, physical and mental QoL, waist circumference, body fat percentage, resting and recovery systolic blood pressure, aerobic endurance, flexibility, agility and dynamic balance, and lower-body strength. However, no significant changes were found in distance walked per day, body weight, body mass index, resting heart rate, resting diastolic blood pressure, blood cholesterol, maximum heart rate, maximum systolic and diastolic blood pressure, rating of perceived exertion, recovery heart rate, and recovery diastolic blood pressure. In addition, a deleterious change was found in blood glucose. Significant improvements were noted in the QoL and nutrition knowledge of this group of participants. The role limitations due to physical health reflected the most prominent improvement, indicating that the intervention positively influenced overall health, wellness, and activities of daily living. This study concluded that cardiac rehabilitation encompassing exercise intervention, nutrition guidelines, and psychosocial advice has been successful in improving the QoL of patients who have undergone CABG surgery.