Made available in DSpace on 2014-12-17T14:46:54Z (GMT). No. of bitstreams: 1 MariaGPA_DISSERT.pdf: 2796113 bytes, checksum: d2967bb8bd56144b41ef8989cbf03470 (MD5) Previous issue date: 2011-05-30 / The Urinary Tract Infection (UTI) in pregnancy is important as a consequence of the high incidence during the gestation. It is the third most common clinical complication in pregnancy affecting 10-12% of women whether prevalence is increasing in the first trimester of pregnancy, it may also contribute to maternal and infant mortality. Due the relevance for the results of obstetric and neonatal complications from UTI, these complications must be prevented, because it can lead to health hazards to pregnant women and newborns, producing a direct effect on morbidity and perinatal mortality. On this basis, it was defined as objectives of this research the identification of the profile of nurses from the Family Health Strategy (FHS) in the East and West Health Districts from the city of Natal / RN before the women with UTI and to verify the nurse performance during prenatal consultations. This is an exploratory study with a quantitative approach using a sample of 40 nurses active workers during this survey, it was approved by the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte Protocol n0 232/10 P-CEP/UFRN and opinion n0 080/2011. The tool for data collection was a structured interview. The data collected were organized into an electronic database application Microsoft ? Excel 2007, exported and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0, and coded, tabulated and presented through tables and charts into their respective percentage distributions, using the descriptive and inferential statistical analysis, chi-square test and significance level of 5% (distribution in relative and absolute frequencies) in the independent variables. Therefore, it was observed from these results that the longer action of nurses in the FHS from the East and Weast health districts of the city of Natal/RN contributed to the development of a greater number of activities to control the incidence of UTI in women who are attended in the prenatal care service, proven by significance in statistics / A Infec??o do Trato Urin?rio (ITU) na gesta??o ? de import?ncia em fun??o da elevada incid?ncia nessa fase. ? a terceira intercorr?ncia cl?nica mais comum na gesta??o acometendo de 10 a 12% das gr?vidas sendo sua maior ocorr?ncia no primeiro trimestre, podendo contribuir tamb?m para a mortalidade materno-infantil. Devido ? relev?ncia para os resultados obst?tricos e neonatais das complica??es derivadas da ITU, as mesmas devem ser evitadas, visto causar preju?zos ? sa?de da gestante e do rec?m-nascido, produzindo efeito direto no ?ndice de morbidade e mortalidade perinatal. Com base nisso, definiu-se como objetivos deste trabalho, identificar o perfil dos enfermeiros na Estrat?gia Sa?de da Fam?lia (ESF) nos Distritos Sanit?rios Leste e Oeste no Munic?pio de Natal/RN frente ?s gestantes com ITU e verificar a conduta do enfermeiro frente a uma gestante com ITU durante as consultas no pr?natal. Trata-se de um estudo explorat?rio descritivo com abordagem quantitativa tendo-se uma amostra de 40 enfermeiros atuantes durante o per?odo da pesquisa, a qual teve parecer favor?vel do Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte com Protocolo de n0 232/10-P CEP/UFRN e Parecer de n0 080/2011. O instrumento de coleta de dados foi uma entrevista estruturada. Os dados coletados foram organizados em um banco de dados eletr?nico do aplicativo Microsoft? Excel 2007, exportados e analisados no programa Statistical Package for Social Sciences (SPSS) vers?o 17.0, sendo codificados, tabulados e apresentados em forma de tabela e quadro com suas respectivas distribui??es percentuais, empregando-se a an?lise estat?stica descritiva e inferencial, teste do Qui- Quadrado e n?vel de signific?ncia de 5% (distribui??o em frequ?ncias relativas e absolutas) nas vari?veis independentes. Portanto, observou-se com estes resultados que o maior tempo de atua??o dos enfermeiros na ESF dos Distritos Sanit?rios Leste e Oeste do Munic?pio de Natal/RN contribuiu para o desenvolvimento de um maior n?mero de condutas no controle da ITU em gestantes que frequentam um servi?o de pr?-natal, comprovado por meio de signific?ncia estat?stica

Made available in DSpace on 2014-12-17T14:46:56Z (GMT). No. of bitstreams: 1 FernandaMF_DISSERT.pdf: 2890013 bytes, checksum: fba9e29d40c009c20f9cc99c08beda68 (MD5) Previous issue date: 2012-03-30 / According to demographic estimates, by the year 2025 Brazil will be the sixth country in the world in number of elderly. For this reason, it is a purpose of public policies to help people to reach that age being healthier. The current health care model of health surveillance through the Family Health Strategy (EFS, in portuguese) is configured as a gateway into the care of the elderly in the Unified Health System (SUS, in portuguese). It is also an area of development of practices to promote health, prevention and control of chronic nondegenerative diseases. The aim of this study was to analyze the health care of the elderly provided by ESF professionals for the achievement of a full care. The study is descriptive case study with a quantitative approach, performed in the city of Santo Ant?nio/RN. The population included all health professionals, who are FHS members of the city that agreed to participate of the survey, a total of 80 professionals. Data were collected using a structured questionnaire, having mostly closed questions and divided into two parts: one containing sociodemographic information of health professionals and vocational training and the other, the activities carried on by the professionals in senior care, being analyzed from a database tabulated in a spreadsheet and discussed according to the descriptive statistics in tables, graphs and charts using frequencies, medians and values of central tendency. It was verified a predominance of professionals who finished highschool, mostly female, aged from 30 to 34 years old, with training completed in the last 10 years, without being graduated in the field of geriatrics or gerontology and mostly without training in gerontology. Family members and caregivers were the components of the social support network most identified by the professionals (66.3%).The elderly access to the Family Health Basic Unit was considered by83.8% of professionals as the most important factor that interferes in the activities of health care of the elderly. Considering the inclusion of the family in care: 98.8% of professionals consider the family as one of the goals of care, but 82.5% assist the family to know their role and participate in the care of the elderly, emphasizing that no professional makes use of tools for evaluating the functionality of the family. Regarding the actions taken to assist the elderly, 91.25% have home visits program to the elderly, 88.75% use the host program; 77.5% know the habits of life, cultural, ethical and religious values of the elderly, their families and their community ;51.25% complement the activities through intersectoral actions, 50%participate in groups of living with the elderly; 33.75% keeps track and maintain updated the health information of the elderly; 11.25% of the professionals perform the Single Therapy Planning (PTS, in portuguese) and few implement the actions to promote health according to PTS; there is a deficit in the number of professional categories in the identification and monitoring of the frail older people in their households. It is concluded that the health care of the elderly developed by ESF professionals differs among the professional categories. It was identified weaknesses in the promotion of an active and healthy aging and also in the establishment of an integrated and full care of the elderly. It is recommended the adoption of permanent educational activities by the City Management, initially for ESF professionals in the the perspective of the guidelines of the National Policy of Health Care for the Elderly and later to the other professionals that are part of the health care network of the elderly, at all levels of care in the city for the development of strategies and practices that promote the improvement of the quality of healthcare for the elderly, expecting concrete and effective results in terms of promoting health within Brazilian reality / Segundo estimativas demogr?ficas, at? o ano de 2025 o Brasil ser? o sexto pa?s do mundo em n?mero de idosos. Por essa raz?o, ? fun??o das pol?ticas p?blicas contribuir para que as pessoas alcancem idades avan?adas com melhor sa?de. O atual modelo assistencial de vigil?ncia ? sa?de atrav?s da Estrat?gia Sa?de da Fam?lia (ESF) configura-se como a porta de entrada no atendimento da pessoa idosa no Sistema ?nico de Sa?de (SUS), favorecendo pr?ticas de promo??o a sa?de, preven??o e controle das doen?as cr?nicas n?o degenerativas. Objetivou-se neste estudo analisar a aten??o ? sa?de da pessoa idosa prestada pelos profissionais da ESF com vista ao alcance de um atendimento integral. O estudo ? descritivo do tipo estudo de caso com abordagem quantitativa, realizado no munic?pio de Santo Ant?nio/RN. A popula??o incluiu todos os profissionais de sa?de integrantes da ESF do munic?pio que aceitaram participar da pesquisa, totalizando 80 profissionais. Os dados foram coletados atrav?s de um question?rio estruturado com quest?es fechadas em sua maioria, dividido em duas partes: uma contendo informa??es s?cio demogr?ficas dos profissionais de sa?de e de forma??o profissional e outra sobre a??es desenvolvidas pelos profissionais no atendimento ao idoso, sendo analisados a partir de um banco de dados tabulado na planilha excel e discutidos de acordo com a estat?stica descritiva em tabelas, gr?ficos e quadros atrav?s de frequ?ncias, mediana e valores de tend?ncia central. Obteve-se predom?nio de profissionais de n?vel m?dio, do sexo feminino, com idade entre 30 a 34 anos, com forma??o profissional conclu?da nos ?ltimos 10 anos, sem p?s- gradua??o na ?rea de geriatria ou gerontologia e maioria sem capacita??o em gerontologia. Os familiares e cuidadores foram os componentes da rede social de apoio mais identificados pelos profissionais (66,3%). O acesso da pessoa idosa ? Unidade B?sica de Sa?de da Fam?lia foi considerado por 83,8% dos profissionais como o fator que mais interfere nas a??es de sa?de junto ao idoso. Quanto a inser??o da fam?lia no cuidado: 98,8% dos profissionais consideram a fam?lia como um dos objetivos da assist?ncia, por?m 82,5% auxiliam a fam?lia a conhecer sua fun??o e participar do cuidado junto ao idoso, destacando-se que nenhum profissional faz uso de instrumentos de avalia??o da funcionalidade da fam?lia. Quanto ?s a??es realizadas junto ao idoso, 91,25% realizam visita domiciliar ao idoso; 88,75% realizam o acolhimento; 77,5% conhecem os h?bitos de vida, valores culturais, ?ticos e religiosos dos idosos, suas fam?lias e da comunidade; 51,25% complementam as a??es atrav?s da intersetorialidade; 50% participam de grupos de viv?ncia de idosos; 33,75% mantem a caderneta de sa?de da pessoa idosa atualizados; 11,25% dos profissionais realizam o Planejamento Terap?utico Singular (PTS) e poucos implementam as a??es de promo??o ? sa?de de acordo com o PTS; h? d?ficit em algumas categorias profissionais na identifica??o de idosos fr?geis e o acompanhamento dos mesmos em domic?lio. Conclui-se, que a aten??o ? sa?de da pessoa idosa desenvolvida pelos profissionais da ESF diverge entre as categorias profissionais. Verificou-se fragilidades quanto a promo??o do envelhecimento ativo e saud?vel e no estabelecimento de uma aten??o integral e integrada a pessoa idosa. Recomenda-se a ado??o de atividades de educa??o permanente por parte da Gest?o Municipal, a priori para os profissionais da ESF na perspectiva das diretrizes da Pol?tica Nacional de Aten??o ? Sa?de da Pessoa Idosa e posteriormente para os demais profissionais que integram a rede de aten??o a sa?de da pessoa idosa em todos os n?veis de aten??o no munic?pio para a elabora??o de estrat?gias e pr?ticas que promovam a melhoria da qualidade da aten??o ? sa?de da pessoa idosa, impactando resultados efetivos e concretos em termos de produ??o de sa?de na realidade brasileira

Made available in DSpace on 2014-12-17T14:47:03Z (GMT). No. of bitstreams: 1 AnaCCC_DISSERT.pdf: 1211717 bytes, checksum: b5ad649e07e3a5cf0a918bac46944489 (MD5) Previous issue date: 2013-12-12 / The present study aims to analyze the nurse s work process at Family Health Strategy, considering its basic elements and dynamic, and searching to identify aspects that may constitute strengths and weaknesses in its development. This is an analytical case study, with qualitative approach and theoretical-conceptual mark grounded in Dialectic Hermeneutics. Empirical research fields were the Family Health Units of Natal, RN, Brazil. The subjects are nurses working in this Strategy. Data collection was conducted through semi-structured individual interviews combined with field observation. The research was initiated after approval by the Ethics Committee of Universidade Federal do Rio Grande do Norte, according to the guidelines and rules for research involving humans (Resolution 466/12), ensuring proper ethical precepts. The project was approved by register number 398.929, CAAE 19588813.7.0000.5537. From the 9 interviewed nurses, 8 were female and 1 male, average age of 52 years, average graduation time of 27 years and average time they stayed at the same Family Health territory of 7 years. It was found that it is up to the professional nurse in the Family Health care the important role of taking care of human beings in their life, family and community contexts, producing conditions to meet their needs through therapeutic act in health, using for such purpose both materials and immaterial instruments. It was possible to relate aspects that characterize strengths and weaknesses in the work process of nurses in the ESF, according to the speech of the interviewed workers, including the meanings and contradictions. Among the potentialities observed, it was possible to highlight the wide role of the nurse at Family Health; the perception of nurses about teamwork; the relative autonomy of nurses; the commitment of professionals to work; Humanization as a technology; the presence of other agents at work, such as directors and officers at the primary health units; the professional s experience time and contract type in the case studied. As weaknesses in the work process of nurses at Family Health Strategy, were highlighted the limited skills of the workforce; the difficulty in 10 identifying specific limits of the work of nurses in this scenario; the disturbances that occur in the process, the existing gaps in multiprofessional teams; Structural deficits of the units in the studied case, the low coverage of the Family Health in the county, and the political vulnerability of the work conditions. It is considered necessary to understand the dilemmas experienced in everyday life of nurses at Family Health Strategy as part of multiprofessional teams, facing actual achievement of changes in work processes necessary for the reorientation of health care in Brazil. In accordance, it is necessary to promote proper working conditions and welfare of labor agents which are protagonists the work at the United Health System / O presente estudo tem como objetivo analisar o processo de trabalho do enfermeiro na Estrat?gia Sa?de da Fam?lia (ESF), considerando seus elementos b?sicos e din?mica, e buscando identificar aspectos que possam configurar potencialidades e fragilidades no seu desenvolvimento. Trata-se de um estudo de caso anal?tico, com abordagem qualitativa e marco te?rico-metodol?gico na Hermen?utica Dial?tica. Foram campos emp?ricos da pesquisa as Unidades de Sa?de da Fam?lia do munic?pio de Natal, RN, Brasil. Os sujeitos do estudo s?o enfermeiros que atuam nessa Estrat?gia. A coleta de informa??es foi realizada atrav?s de entrevista individual semiestruturada aliada ? observa??o de campo. Foi iniciada ap?s aprova??o no Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte, conforme diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos (resolu??o 466/12), assegurando os devidos preceitos ?ticos. O projeto foi aprovado pelo parecer de n?mero 398.929, CAAE 19588813.7.0000.5537. Dos 9 enfermeiros entrevistados, s?o 8 do sexo feminino e 1 masculino, com m?dia de idade de 52 anos, m?dia de tempo de gradua??o de 27 anos e tempo m?dio de perman?ncia num mesmo territ?rio da ESF de 7 anos. Verificou-se que cabe ao profissional enfermeiro na Sa?de da Fam?lia o importante papel de cuidar do ser humano em seus contextos de vida, fam?lia e comunidade, produzindo condi??es ? satisfa??o de suas necessidades atrav?s do agir terap?utico em sa?de, utilizando para tanto instrumentos materiais e imateriais. Foi poss?vel relacionar aspectos que configuram potencialidades e fragilidades no processo de trabalho do enfermeiro na ESF, segundo o discurso dos trabalhadores entrevistados, incluindo-se os sentidos e contradi??es. Entre as potencialidades, foram destacadas o papel ampliado do enfermeiro na ESF; a percep??o do enfermeiro sobre o trabalho em equipe; a autonomia relativa do enfermeiro; o compromisso dos profissionais com o trabalho; a Humaniza??o como tecnologia; a presen?a de outros agentes no trabalho, como diretores e administradores nas Unidades B?sicas de Sa?de; o tempo de 8 experi?ncia e a forma de vincula??o dos profissionais no caso estudado; e a ades?o do munic?pio de Natal/RN a estrat?gias e programas federais no ?mbito da sa?de. Como fragilidades no processo de trabalho do enfermeiro na Sa?de da Fam?lia, foram apontadas a limitada qualifica??o da for?a de trabalho; a dif?cil delimita??o das especificidades do trabalho do enfermeiro nesse cen?rio; os transtornos que ocorrem no processo; as lacunas persistentes nas equipes multiprofissionais; os d?ficits estruturais das UBS no caso em estudo; a baixa cobertura da Estrat?gia no munic?pio; e a vulnerabilidade pol?tica das condi??es para a realiza??o do trabalho. Considera-se necess?rio compreender os dilemas vivenciados no cotidiano dos enfermeiros da Sa?de da Fam?lia, como parte de equipes multiprofissionais, tendo em vista a conquista real de mudan?as nos processos de trabalho, necess?rias ? reorienta??o do modelo de aten??o ? sa?de brasileiro. Em conson?ncia, ? preciso promover condi??es de trabalho adequadas e o bem estar dos agentes que protagonizam do trabalho no Sistema ?nico de Sa?de

Made available in DSpace on 2014-12-17T14:47:07Z (GMT). No. of bitstreams: 1 JussaraPN.pdf: 862677 bytes, checksum: 1ea45865c41e2e534902a9bd38c2853e (MD5) Previous issue date: 2006-12-04 / Descriptive research aimed at evaluating the assistance offered to patients with venous ulcers, on lower limbs, attended by the Family Health Program (FHP) team, from the municipality of Natal/RN. The target population was composed of 74 patients with venous ulcers (VU), attended by the FHP teams in the 31 FHUs. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (protocol n.55/05). The data collection was performed in patients homes and in the FHUs, through structured interviews and physical examinations of patients with VU and non-participant observation during the changing of wound dressings in these Units and in users homes. The data was organized into an Excel electronic table and transported into the SPSS 14.0 program, for descriptive analysis on 2x2 contingency tables and inferential (Qui-Square &#967;2, Spearman Correlation, Binomial Proportion Test and p-value <0.05). The prevalence of VU (0.36/1000) in the target population (over 20 years of age) was greater than in the population registered in FHP (0.25/1000). We detected a greater prevalence in the age area of over 60 years (2.22/1000), with 2.98/1000 for females and 1.3/1000 for males (p-value=0.008). The sociodemographical and health characteristics of patients with VU revealed predominance of females (74.5%), elders over 60 years of age (67.6%), with fundamental education (74.3%), family earnings of up to 2 minimum wages (68.9%), retired (90.5%), ortostatic position (23.0%), inadequate sleep (59,9%), presence of CVI (100.0%), hypertension (44.6%) and diabetes (25.7%). As for the time of existence of the VU, 64.9% had over 1 year, and 35.1% less than 1 year), with predominance of one wound (67.6%). The changing of wound dressings is performed mostly at home, in and inadequate way, especially with incorrect cleaning techniques, likewise incorrect use of products and substances, and reduced participation of the FHP team on the evaluation and application of the dressing and choosing of products and substances. The compressive therapy is not part of therapeutic conducts for treatment in the FHUs. As for the evaluation of assistance to patients with VU, 90.5% were inadequate and only 9.5% adequate. The main inadequacy factors were the absence of: diagnosis (47.3%), consultation with and angiologist (63.5%), compressive treatment (100.0%), adequate optical therapy (98.62%), adequate dressing kit (70.3%), training for the changing of dressings (67.6%), following by the FHP team (51.4%) and performed exams (55.4%). We ve concluded that patients with VU mostly present now socioeconomical level and associated chronic diseases. Considering that assistance offered by FHP is non-systematic, fragmented, with no diagnosis planning, continual evaluation and evolution, we qualify the assistance as inadequate and with low level of solution, directly interfering on the maintenance of the VUs chronic state / Pesquisa descritiva que objetivou avaliar a assist?ncia prestada aos portadores de ?lceras venosas, em membros inferiores, atendidos pelas equipes do Programa Sa?de da Fam?lia (PSF), do munic?pio de Natal/RN. A popula??o alvo foi composta por 74 portadores de ?lceras venosas (UV), atendidos pelas equipes do PSF nas 31 USFs. O estudo obteve parecer favor?vel do Comit? de ?tica da Universidade Federal do Rio Grande do Norte (Protocolo n.55/05). A coleta de dados foi realizada domiciliarmente e nas USFs, por meio de entrevista estruturada e exame f?sico dos portadores de UV e observa??o n?o participante durante a troca de curativos nessas Unidades e domic?lios dos usu?rios. Os dados foram organizados em planilha eletr?nica Excel e transportados para o Programa SPSS 14,0, para an?lises descritiva em tabelas de conting?ncias 2x2 e inferencial (Qui-Quadrado -&#967;2, Correla??o de Spearmam, Teste de Propor??o Binomial e p-valor < 0,05). A preval?ncia de UV (0,36/1000) na popula??o alvo (a partir de 20 anos) foi maior que na popula??o cadastrada no PSF (0,25/1000). Detectamos uma preval?ncia maior na faixa et?ria a partir de 60 anos (2,22/1000), sendo 2,98/1000 no sexo feminino e 1,3/1000 no masculino (p-valor= 0,008). As caracter?sticas sociodemogr?ficas e de sa?de dos portadores de UV revelaram predomin?ncia do sexo feminino (74,5%), idosos a partir de 60 anos (67,6%), ensino fundamental (74,3%), renda familiar at? 2 SMs (68,9%), aposentados (90,5%), posi??o ortost?tica (23,0%), sono inadequado (59,5%), presen?a de IVC (100,0%), hipertens?o (44,6%) e diabetes (25,7%). Quanto ao tempo de exist?ncia da UV, 64,9% tinham mais de 1 ano, e 35,1% menos de 1 ano, com predomin?ncia de uma les?o (67,6%). A troca de curativos, em sua maioria, ? domiciliar, realizada de forma inadequada, destacando-se a t?cnica incorreta de limpeza, uso e associa??es tamb?m incorretas de produtos e subst?ncias, e pouca participa??o da equipe do PSF na avalia??o, realiza??o do curativo e escolhas de produtos e subst?ncias. A terapia compressiva n?o faz parte das condutas terap?uticas de tratamento de UV nas USFs. Quanto ? avalia??o da assist?ncia aos portadores de UV, 90,5% estavam inadequadas e apenas 9,5% adequadas. Os principais fatores de inadequa??o foram aus?ncia de: diagn?stico (47,3%), consulta com angiologista (63,5%), tratamento compressivo (100,0%), terapia t?pica adequada (98,62%), quite curativo adequado (70,3%), treinamento para troca de curativo (67,6%), acompanhamento pela equipe do PSF (51,4%) e exames realizados (55,4%). Conclu?mos que os portadores de UV, em sua maioria, apresentam baixo n?vel socioecon?mico e com doen?as cr?nicas associadas. Considerando que a assist?ncia prestada pelo PSF ? assistem?tica, fragmentada, sem diagn?stico, planejamento, avalia??o e evolu??o cont?nua, qualificamos a assist?ncia desenvolvida como inadequada e com pouco n?vel de resolutividade interferindo diretamente na manuten??o da cronicidade das UVs

Made available in DSpace on 2014-12-17T14:13:37Z (GMT). No. of bitstreams: 1 CarmenRSP_TESE.pdf: 2081735 bytes, checksum: fbb93d99085a18a01a87f966bcf12fa0 (MD5) Previous issue date: 2010-11-16 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This study examined in municipalities of Northeast of Brazil with more than one hundred thousand people who incorporation of Oral Health Teams (OHT) into the Family Health Strategy (FHE) the possible impact on oral health indicators. Sought to answer whether implementation OHT brought the best indicators of health problems and coverage, compared to areas without coverage by the FHE through a community trial in parallel, quasi-randomized. In each of the municipalities surveyed were 20 census tracts, 10 were located in areas covered by oral health teams in the ESF and 10 industries in areas not covered. The final sample consisted of 59.221 individuals. We compared oral health indicators related to health problems, access to services and coverage of oral health actions. The analysis strategy was based on the calculation of prevalence ratios and confidence intervals, adjusted for confounding factors through Poisson regression with robust variance. It also has measured the association between an indicator of social inequality for comparison between areas. The best results are associated with indicators of access and coverage of oral health actions at the expense of the indicators of health problems, suggesting a possible maintenance of a traditional model of practice yet. The results also suggest a possible effect of a specific policy in the area of primary care on inequality in access. From the discussions presented throughout this work, we can see that the impact analysis of public policy, obtained by comparing areas with and without the intervention, not only captures the effect on the target population, but other dimensions of organization service and therefore should be understood as one of the analytical possibilities related to the management / Este estudo verificou, nos munic?pios da regi?o Nordeste com mais de cem mil habitantes que incorporaram a equipe de Sa?de Bucal (SB) na Estrat?gia de Sa?de da Fam?lia (ESF), o poss?vel impacto sobre os indicadores de sa?de bucal. Procurou responder se a implanta??o da ESF com equipe de SB trouxe melhores indicadores de agravos e cobertura, comparativamente ?s ?reas sem cobertura da estrat?gia por meio de um ensaio comunit?rio em paralelo, quase-randomizado. Em cada um dos munic?pios foram pesquisados 20 setores censit?rios, sendo 10 inseridos em ?reas cobertas pelas equipes de sa?de bucal na ESF e 10 setores de ?reas n?o cobertas. A amostra final constou de 59.221 indiv?duos. Foram comparados indicadores de sa?de bucal relativos a agravos, acesso a servi?os e cobertura de a??es de sa?de bucal. A estrat?gia de an?lise baseou-se no c?lculo das raz?es de preval?ncia e respectivos intervalos de confian?a, ajustadas para os fatores de confundimento por interm?dio da regress?o de Poisson com vari?ncia robusta. Tamb?m foi realizada medida de associa??o entre um indicador de desigualdade social para compara??o entre as ?reas. Os melhores resultados est?o associados aos indicadores de acesso e cobertura de a??es de sa?de bucal em detrimento dos indicadores de agravos, sugerindo a prov?vel manuten??o de um modelo de pr?tica ainda tradicional. Os resultados tamb?m apontam para um poss?vel efeito de uma pol?tica p?blica espec?fica na ?rea de aten??o prim?ria sobre a desigualdade no acesso. A partir das discuss?es apresentadas ao longo deste trabalho, podemos perceber que a an?lise de impacto de uma pol?tica p?blica, obtida por meio da compara??o entre ?reas com e sem a interven??o, capta n?o s? o efeito sobre a popula??o alvo, mas outras dimens?es da organiza??o do servi?o e, portanto deve ser compreendida como uma das possibilidades anal?ticas ligadas ? gest?o

Made available in DSpace on 2014-12-17T14:13:53Z (GMT). No. of bitstreams: 1 NadjaSPDR_TESE.pdf: 886215 bytes, checksum: 920fddff7bf323b0b91d52f0af285470 (MD5) Previous issue date: 2013-10-18 / Objective: To evaluate the implementation of the Family Health Strategy (FHS) in Brazilian cities of the Northeast, expanding coverage, analyzing the progress, challenges and innovations. Methods: Multicentric Evaluation Research, Studies Baselines in urban centers, using as a case study method. Selected cases of Aracaju, being capital, advanced coverage with extended team, and Fortaleza, capital coverage incipient and minimal staff. In Fortaleza, purposive sample of 11 Units Primary (APS), 03 managers, 53 professionals and 109 users. In Aracaju, 09 units of APS, 02 managers, 36 professionals, and 90 users. Structured interviews for managers, and structured to professionals and users. Descriptive analysis focusing on the political and institutional dimensions, organization and comprehensive care. Results: There was consensus that the ESF is the preferred port users and acts as inducing changes in care. In the case of Fortaleza, the specificities were: care protocols and community activities aimed at chronic conditions (100%) , with greater participation of doctors and nurses (93%) ; conjunction with more complex services, but the teams reported difficulties with the examination center and experts, the long waits and poor access to local services were the main difficulties reported by users., As innovative practice, the therapeutic group of elderly caregivers mentioned by respondents; There was intersectoral initiatives and teams 87 % of users have participated in meetings about health problems. In the case of Aracaju, care protocols were directed to the lines of care and formulated locally, 85 % coverage of the population with FHS counterpart local financing; employees hired by public tender; 70 % of teams with expertise in public health center for continuing education acting; democratization in management; access technologies, welcoming and computerization in different integrated networks, and evaluation matrix. Conclusions: The ESF has promoted access to health care and inclusion of disadvantaged populations. Different perceptions and practices in the organization of care, with distinct trajectories of reorganization. In the case of Fortaleza, predominance of model programs valuing older, with evidence of advances in care practices and teamwork, but restricted to primary care practices and incipient in public policy perspective. In Aracaju, had network integration with technologies related to the family, in which the ESF is consolidated as public policy. It can be argued that the XII APS expanding coverage, exhibited efficacy, despite the challenges inherent to the different degrees of implementation / Objetivo: avaliar a implementa??o da Estrat?gia Sa?de da Fam?lia (ESF), em metr?poles brasileiras da Regi?o Nordeste, em expans?o de cobertura, analisando os avan?os, desafios e inova??es. M?todo: Pesquisa Avaliativa Multic?ntrica, Estudos Linhas de Base em centros urbanos, usando como m?todo o Estudo de Caso. Selecionados os casos de Aracaju, por ser capital, cobertura avan?ada com equipe ampliada, e, Fortaleza, capital, cobertura incipiente e com equipe m?nima. Em Fortaleza, amostra intencional de 11 Unidades de Aten??o Prim?ria (APS), 03 gestores, 53 profissionais e 109 usu?rios. Em Aracaju, 09 Unidades de APS, 02 gestores, 36 profissionais e 90 usu?rios. Entrevistas semiestruturadas para gestores, e estruturadas para profissionais e usu?rios. An?lise descritiva com enfoque nas dimens?es pol?tico-institucional, organiza??o da aten??o e cuidado integral. Resultados: Houve consenso de que a ESF ? a porta preferencial dos usu?rios e atua como indutora nas mudan?as do cuidado. No caso de Fortaleza, as especificidades foram: protocolos assistenciais e atividades comunit?rias voltadas ?s situa??es cr?nicas (100%), com maior participa??o de m?dicos e enfermeiros (93,3%); articula??o com servi?os de maior complexidade, por?m as equipes referiram dificuldades com a central de exames e especialistas; o longo tempo de espera e o dif?cil acesso aos locais do atendimento foram as principais dificuldades referidas pelos usu?rios; Como pr?tica inovadora, o grupo terap?utico de cuidadores de idosos foi referido pelos entrevistados; N?o havia iniciativas intersetoriais pelas equipes e 87% dos usu?rios n?o participaram de reuni?es sobre problemas de sa?de. No caso de Aracaju, havia protocolos assistenciais voltados ?s linhas de cuidado e formulados localmente; 85% de cobertura populacional da ESF com contrapartida de financiamento local; profissionais admitidos por concurso p?blico; 70% das equipes com especializa??o em sa?de p?blica; centro de educa??o permanente atuante; democratiza??o na gest?o; tecnologias de acesso, acolhimento e de informatiza??o em distintas redes integradas; e, avalia??o matricial. Conclus?es: A ESF promoveu acesso aos cuidados de sa?de e inclus?o de popula??es desfavorecidas. Diferentes percep??es e pr?ticas na organiza??o do cuidado, com trajet?rias distintas de reorganiza??o. No caso de Fortaleza, predom?nio do modelo de programas valorizando idosos, com evid?ncias de X avan?os nas pr?ticas de aten??o e no trabalho em equipe, por?m restritas ao primeiro n?vel de aten??o e com pr?ticas incipientes na perspectiva de pol?tica p?blica. Em Aracaju, havia integra??o em redes com tecnologias voltadas ? fam?lia, em que a ESF se consolida como pol?tica p?blica. Pode-se afirmar que, a APS em expans?o de cobertura, apresentou efic?cia, apesar dos desafios inerentes aos distintos graus de implementa??o

Made available in DSpace on 2014-12-17T14:20:13Z (GMT). No. of bitstreams: 1 RosanaLAV.pdf: 1507819 bytes, checksum: 15b7e1ba8865dba5987cca21057dd0af (MD5) Previous issue date: 2009-08-26 / This study approaches the topic of humanization in health that involves the set of policies implemented by the Ministry of Health in Brazil. Its aims are directed towards a reflection on the guiding theoretical and organizing axes of the National Humanization Policy (NHP) and their repercussions on municipal health policy of Natal, Brazil; an analysis of the results of the policy at the local level; knowledge of the views and experiences of the humanization agents in the daily work process and identification of the main challenges of the policy. The empirical field of investigation was the Family Health Strategy (FHS) of the city of Natal. The assumption of the study is that the FHS has produced local experiences with potentialities that must not be wasted, in which there are difficulties and discrepancies between the real and proposed model. The contradictions and challenges in the social and political context of Brazil in the early XXI century and their consequences in the field of health reflect anti-utilitarian aspects anchored strongly in the theoretical concepts of Boaventura de Sousa Santos about the sociology of privations and emergencies as well as of the work of translating. The predominantly qualitative approach collects some complementary quantitative data. The study procedures used were the following: bibliographic research; documental research; interviews; and direct observation. Interpretation of the information obtained was based on documental analysis and on the symbolic cartography of the social representations. Cartographic evidence suggests that practices still take place under dehumanizing conditions that compromise the quality of care given. However, there is a movement aimed at changing the work process that has been strengthening the link and widening the measures developed, incorporating new directions in diversity, integrality and solidarity. The map drawn shows a reality manifested by explicit intentions in a political agenda, by concrete solutions marked by an assortment of difficulties and expressed in the words of the agents and by latent clues identified in successful local experiences, posing many challenges for the consolidation of the proposed changes / Esta pesquisa aborda o tema da humaniza??o na sa?de que integra a agenda da pol?tica de sa?de no Brasil. O pressuposto ? que apesar do contexto social e pol?tico do Brasil neste principio do s?culo XXI e seus reflexos no campo da sa?de, com muitas contradi??es e desafios, o modelo de aten??o da Estrat?gia Sa?de da Fam?lia, mesmo com muitas dificuldades e discrep?ncias entre o real e o proposto, vem produzindo experi?ncias locais com potencialidades que n?o devem ser desperdi?adas. Recorre a marcos antiutilitaristas, ancorando-se mais fortemente nos aportes te?ricos de Boaventura de Sousa Santos, acerca da sociologia das aus?ncias e das emerg?ncias e do trabalho de tradu??o. Seus objetivos est?o direcionados para a reflex?o sobre os eixos te?ricos e organizativos norteadores da Pol?tica Nacional de Humaniza??o-PNH e seus ecos na pol?tica municipal de sa?de de Natal; para an?lise dos marcos da referida pol?tica no n?vel local; para o conhecimento das vis?es e viv?ncias dos agentes da humaniza??o no cotidiano do processo de trabalho e para os principais desafios da pol?tica. Teve como campo de investiga??o emp?rica a Estrat?gia Sa?de da Fam?lia do munic?pio de Natal-RN, utilizando uma abordagem predominantemente qualitativa, apesar de feitos alguns levantamentos quantitativos com um car?ter complementar. Para sua operacionaliza??o, utilizou procedimentos variados, como: a pesquisa bibliogr?fica; a pesquisa documental; e o trabalho de campo onde foram realizadas entrevistas e observa??o direta. A interpreta??o das informa??es obtidas foi fundamentada na an?lise documental e na cartografia simb?lica das representa??es sociais. As evid?ncias cartografadas apontaram que as pr?ticas ainda ocorrem em condi??es desumanizadoras comprometendo a qualidade da aten??o prestada, mas tamb?m a exist?ncia de um movimento de mudan?as no processo de trabalho, que vem fortalecendo o v?nculo e ampliando a??es desenvolvidas incorporando novos sentidos na perspectiva da diversidade, da integralidade e da solidariedade. O mapa delineado mostra uma realidade sinalizada por inten??es explicitadas em uma agenda pol?tica, por situa??es concretas marcadas por dificuldades de diversas naturezas observadas no trabalho desenvolvido e expressadas nas palavras dos agentes, e por pistas latentes identificadas em experi?ncias locais exitosas, que demandam ainda muitos desafios a serem enfrentados para consolida??o das mudan?as propostas

Made available in DSpace on 2014-12-17T14:20:21Z (GMT). No. of bitstreams: 1 SuzanaCAF_TESE.pdf: 4464002 bytes, checksum: ccbf9e6b9c67d3cd5262a8dc96f14579 (MD5) Previous issue date: 2010-11-29 / This qualitative research aimed to understand the educational activities carried out in Family Health Units, of the municipality of Mossor?-RN. It was used symbolic cartography to organize and present data from reality. It started on the approach of Health Education and knowledge transformation practice, aiming at the development of autonomy and responsibility of individuals and healthcare, publicized by the appreciation of the interpersonal relations area established in services, such as educational emancipator practices contexts. Individual and collective interviews were realized, conducted with health professionals and users of ESF, about themes, activities, membership, the difficulties, the potential and the design of health education that permeate everyday Family Health Strategy. From what was apprehended, thematic maps were done with the analysis of educational practices of professionals belonging to the Family&#8223;s Health. Links are built with the wires of conceptions of education reflected on themes and activities of family health teams. The storylines are rebinded by voices about the difficulties and the potential of educational processes for emancipator postures. For users, health education means proper care and information on disease prevention. Professionals understand that it is all information that is given to users, about health, social well-being, economic and general condition of human being as a way of preventing and treating disease. Mark printed on voices denote that activities and themes worked don&#8223;t motivate users enough for their participation, being that physicians and dentists also get excluded themselves from educational practices. Elderly groups are those who get most involved with the activities. The size of the contained area and its seclusion from community make harder the access of users, as well as diminishing the quality of educational actions and links users-professionals. Therefore, the searching for medicines, medical consultations and wish to be well served are trademarks of voices from the users that interconnect with enlightening information and guidelines offered by professionals to users. It brings out practices that need to incorporate the social, the subjective and act with practices of prevention and health promotion, on the basis of lifestyles. The dialogical model, which needs to be approached since planning phase of health education actions could arouse interest of involved groups; promoting a relationship of dialogue and listening; discussing the local reality; stimulating practical methodological dialetics; promoting processes of deconstruction of concepts, values and attitudes, as more necessary than construction, using multiple languages. The defended thesis denotes paths to other studies aimed at understanding a dialogical template committed to exchanges of knowledge, and discover strategies that encourage formation of critical consciousness and the discovery of how is the training of new generations of healthcare professionals to belong to the project of society, in its technical, scientific, pedagogical, ethical, political and humanistic dimensions / Esta pesquisa qualitativa buscou compreender as atividades educativas, realizadas em Unidades de Sa?de da Fam?lia, do Munic?pio de Mossor?-RN. Utilizou-se da cartografia simb?lica para organizar e apresentar os dados da realidade. Partiu da abordagem da Educa??o em Sa?de como pr?tica de transforma??o de saberes, visando o desenvolvimento da autonomia e da responsabilidade dos indiv?duos no cuidado ? sa?de, mediatizada pela valoriza??o do espa?o das rela??es interpessoais estabelecidas nos servi?os, como contextos de pr?ticas educativas emancipat?rias. Realizou entrevistas individual e coletiva, com profissionais de sa?de e usu?rios da ESF, sobre os temas, as atividades, a participa??o, as dificuldades, as potencialidades e a concep??o da educa??o em Sa?de que permeiam o cotidiano da Estrat?gia Sa?de da Fam?lia. Do apreendido fez mapas tem?ticos com a an?lise das pr?ticas educativas dos profissionais que integram a Sa?de da Fam?lia. Constr?i la?os com os fios das concep??es de educa??o refletidas nos temas e nas atividades das equipes de Sa?de da Fam?lia. Religa os enredos das vozes sobre as dificuldades e as potencialidades dos processos educativos em prol de posturas emancipat?rias. Para os usu?rios a Educa??o em Sa?de significa bom atendimento e a veicula??o de informa??es sobre a preven??o das doen?as. Os profissionais entendem que ? toda informa??o que se d? aos usu?rios, sobre a sa?de, o bem estar social, econ?mico e o estado geral do ser humano, como forma do mesmo se prevenir e tratar a doen?a. As marcas impressas nas vozes denotam que as atividades e os temas trabalhados pouco motivam os usu?rios ? participa??o, sendo que os m?dicos e dentistas tamb?m se excluem das pr?ticas educativas. Os grupos de idosos s?o os que mais se envolvem com as atividades. O tamanho da ?rea adstrita e seu distanciamento da comunidade dificultam o acesso dos usu?rios, bem como, diminuem a qualidade das a??es educativas e os v?nculos usu?rios-profissionais. Por conseguinte, a busca de medicamentos, a necessidade de consultas m?dicas e a vontade de serem bem atendidos s?o marcas das vozes dos usu?rios que se interligam com as informa??es esclarecedoras e orientadoras oferecidas pelos profissionais aos usu?rios. Disto decorre que as pr?ticas necessitam incorporar o social, o subjetivo e atuar com pr?ticas de preven??o e promo??o a sa?de, com base nos estilos de vida. O modelo dial?gico a ser adotado desde a fase do planejamento das a??es de educa??o em sa?de poderia despertar o interesse dos grupos envolvidos; promover uma rela??o de di?logo e de escuta; problematizar a realidade local; estimular a pr?tica metodol?gica dial?tica; promover processos de desconstru??o de conceitos, valores e posturas, como mais necess?rios que o de constru??o, usando m?ltiplas linguagens. A tese defendida denota caminhos para outros estudos voltados para a compreens?o de um modelo dial?gico compromissado com as trocas de saberes e a descoberta de estrat?gias que favore?am a forma??o da consci?ncia cr?tica e a descoberta de como est? a forma??o das novas gera??es profissionais da sa?de, de modo a pertencer ao projeto de sociedade, nas suas dimens?es t?cnica, cient?fica, pedag?gica, ?tica, human?stica e pol?tica

Made available in DSpace on 2014-12-17T14:20:30Z (GMT). No. of bitstreams: 1 PaulaFBBS_TESE.pdf: 1803693 bytes, checksum: d7c469a20b418a1c78b17be23cd82991 (MD5) Previous issue date: 2013-03-27 / The Family Health Program implemented in Brazilian municipalities from 1994 represents today the most promising proposal to promote important changes in municipality`s health systems, to allow universal access to health care, comprehensiveness, equity and to promote social control, achievements provided by the health reform process and incorporated to the Unified Health System principles. However, many are the challenges imposed to the Family Health Program so that it can cause these advances. In this study, we aimed to answer the following research question: what are the results of the Family Health Program in relation to beneficiaries at small, medium and large municipalities? The hypothesis that guided this work was that the variation in levels of achievement/results (strict, impacts and effects) of the Family Health Program is related to the size of the municipalities. Therefore, our general aim was to evaluate the results of the Family Health Program in municipalities at Rio Grande do Norte, Brazil. And as specific objectives, to measure strict results, effects and impacts of the Program, from the criteria of efficiency and effectiveness on the beneficiated population, and to measure the Program`s impact on the organization of municipality`s health system. This is an impact assessment research, developed from multiple case studies with quanti-qualitative approach. The study included small municipalities (Acari and Taipu), midsize (Canguaretama and Santa Cruz) and large (Natal and Mossor?). The individuals chosen to the research were users/beneficiaries of the Program and health professionals. Data analysis was performed using descriptive statistics and content analysis compared from the Program`s logical /theoretical model. The results obtained in relation to the principles evaluated (universality, comprehensiveness and community participation) presented that municipalities show different results, although not directly related to the size, but related with characteristics of the Program`s implementation form in each municipality and the arrangements made for its operationalization. The positive effect that generated significant change in people`s lives has been linked to the increase of access and to the decrease of geographic barriers. However, to the municipal health system, regarding the changes desired by the Program, it was not observed a positive impact, but a negative impact related to the increase of barriers for the user to access other levels of the health system / O Programa Sa?de da Fam?lia implantado nos munic?pios brasileiros a partir de 1994 representa hoje a proposta mais promissora para se promover mudan?as importantes nos sistemas municipais de sa?de, de forma a permitir o acesso universal ? assist?ncia ? sa?de, a integralidade, a equidade e promover o controle social, conquistas previstas pelo processo de reforma sanit?ria e incorporadas aos princ?pios do SUS. No entanto, muitos s?o os desafios impostos para que o PSF possa provocar estes avan?os. Neste estudo procuramos responder ao seguinte problema de pesquisa: quais s?o os resultados do Programa Sa?de da Fam?lia em rela??o aos benefici?rios em munic?pios de pequeno, m?dio e grande porte? A hip?tese que orientou a realiza??o do trabalho foi que a varia??o nos n?veis de realiza??o/resultados (estritos, impactos e efeitos) do Programa Sa?de da Fam?lia est? relacionada ao porte dos munic?pios. Para tanto, tivemos como objetivo geral avaliar os resultados do Programa Sa?de da Fam?lia nos munic?pios do Rio Grande do Norte. E como objetivos espec?ficos aferir os resultados estritos, os efeitos e impactos do programa, a partir dos crit?rios de efic?cia e efetividade sobre a popula??o benefici?ria; e aferir o impacto do programa sobre a organiza??o do sistema municipal de sa?de. Trata-se de uma pesquisa de avalia??o de impacto, desenvolvida a partir do estudo de casos m?ltiplos com abordagem quanti-qualitativa. Participaram do estudo os munic?pios de pequeno porte (Acari e Taipu), de m?dio porte (Canguaretama e Santa Cruz) e de grande porte (Natal e Mossor?). Os sujeitos da pesquisa foram os usu?rios/benefici?rios do programa e os profissionais de sa?de. A an?lise dos dados foi realizada atrav?s da estat?stica descritiva e da an?lise do conte?do comparada a partir do modelo l?gico/te?rico do programa. Os resultados obtidos no que se referem aos princ?pios avaliados (universaliza??o, integralidade e participa??o comunit?ria) nos mostram que os munic?pios apresentaram resultados distintos, por?m sem rela??o direta com o porte, mas com caracter?sticas da forma de implementa??o do programa em cada munic?pio e com os arranjos realizados para sua operacionaliza??o. O efeito positivo que gerou mudan?a significativa na vida das pessoas esteve vinculado ao aumento do acesso e diminui??o das barreiras geogr?ficas. No entanto, para o sistema municipal de sa?de, no que tange ?s mudan?as pretendidas pelo programa n?o observamos impacto positivo, mas sim, impacto negativo relativo a um aumento das barreiras para o usu?rio ter acesso aos demais n?veis do sistema de sa?de

Made available in DSpace on 2014-12-17T14:46:32Z (GMT). No. of bitstreams: 1 SusannePCS.pdf: 615368 bytes, checksum: a47e9ae80c4e8f6719db3177a486b8db (MD5) Previous issue date: 2007-11-01 / The present study had the objective to identify to the Social Representations of the professionals of medicine and nursing superior level of the Program Health of the Family concerning the assistance for the gestation. The research was qualitative under the optics of the Theory of the Social Representations of Serge Moscovici, of the Central Nucleus of Jean-Claude Abric and of the Analysis of Content of Laurence Bardin. We worked with the following instruments for the collection of data: Questionnaires, with social-demographic data; Free association of Words, with the inductive terms Pregnancy, Assistance for Gestation and Care; Production of mental image and half-structuralized Interview, with the following question: What does the assistance for the gestation represent for you? . We interviewed all the professionals of nursing and medicine of the Program Health of the Family in the city of Santa Cruz /RN (ten for each profession) in the period of February and March of 2007. From the analysis of the social-demographics data, we respectively identified the following percentages for nursing and medicine: the feminine sex for nursing predominated (90%); the age between 24 and 33 (70 and 60%); the religion catholic (80 and 50%) and 50% of the two groups has up to two years of formation and work in the score of the research. The analysis of the others instruments resulted in two categories: Institutionalized vision and Vision of the Common-sense. In the free association of words, the category institutionalized vision is configured as Central Nucleus and of the common sense one as nucleus Peripheral, demonstrating that the Social Representations of the assistance for the gestation attendance are in the universes consensual. In the mental images, we identified to this same construction. In the content of the interviews, the institutionalized vision is permeated by the responsibility of making and the availability of having - assistance for the gestation is recommended by the Health department and necessary genders - while the vision of the common-sense can be represented by the category sort, whose role of professionals of the assistance for the gestation is to strengthen the responsibility for the woman of a maternity socially constructed. In short, the analyzed speeches reflect that, to the knowledge acquired in the academy, are incorporated in the knowledge of the daily professional, and conducted by popular myths. Medicine and nursing recognize the importance of the attendance in such a way for the chance to educate the women for the maternity as for the possibility to prevent complications, but in its speeches they had excluded from this process the masculine figure. We conclude that the meaning of the inductive term take care, part of the common-sense and is incorporated the institutionalized speech to humanize the assistance. However, the pregnancy ceases from being seen in its natural biological direction and starts to be analyzed as a moment of fragility and predisposition the illnesses. Finally, the social nursing and the central nucleus representations for the assistance in gestation for medicine is anchored in the speeches institutionalized and of the common-sense, reflecting the concern in establishing a humanized assistance with quality / O presente estudo teve por objetivo identificar as representa??es sociais dos profissionais de Medicina e Enfermagem de n?vel superior do Programa Sa?de da Fam?lia acerca do Pr?-Natal. A pesquisa foi qualitativa sob a ?tica da Teoria das Representa??es Sociais de Serge Moscovici, do N?cleo Central de Jean-Claude Abric e da An?lise de Conte?do de Laurence Bardin. Trabalhamos com os seguintes instrumentos para coleta de dados: question?rio, com dados sociodemogr?ficos; associa??o livre de palavras, com os termos indutores Gesta??o, Cuidado e Pr?-natal; produ??o de imagem mental e entrevista semi-estruturada, com a seguinte quest?o norteadora: O que representa o pr?-natal para voc?? . Entrevistamos todos os profissionais de Enfermagem e Medicina do Programa Sa?de da Fam?lia do munic?pio de Santa Cruz/RN (dez para cada profiss?o) no per?odo de fevereiro e mar?o de 2007. Da an?lise dos dados sociodemogr?ficos, identificamos os seguintes percentuais para Enfermagem e Medicina respectivamente: predominou o sexo feminino para Enfermagem (90%); a idade entre 24 e 33 anos (70 e 60%); a religi?o cat?lica (80 e 50%) e 50% dos dois grupos t?m at? dois anos de forma??o e de trabalho no cen?rio da pesquisa. A an?lise dos demais instrumentos resultou em duas categorias: Vis?o Institucionalizada e Vis?o do Senso comum. Na associa??o livre de palavras, a categoria vis?o institucionalizada configura-se como N?cleo Central e a do senso comum como N?cleo Perif?rico, demonstrando que as representa??es sociais do atendimento pr?-natal s?o pautadas nos universos consensual e reificado. Nas imagens mentais, identificamos essa mesma constru??o. No conte?do das entrevistas, a vis?o institucionalizada ? permeada pela responsabilidade do fazer e a disponibilidade do ter assist?ncia pr?-natal recomendada pelo Minist?rio da Sa?de e recursos necess?rios enquanto a vis?o do senso comum pode ser representada pela categoria g?nero, cujo papel de profissionais do pr?-natal ? refor?ar a responsabilidade da mulher diante de uma maternidade socialmente constru?da. Em suma, os discursos analisados refletem que ao conhecimento adquirido na academia, s?o incorporados saberes do cotidiano profissional, regido por mitos populares. Medicina e Enfermagem reconhecem a import?ncia do atendimento tanto pela oportunidade de educar as mulheres para a maternidade quanto pela possibilidade de prevenir complica??es, mas em seus discursos exclu?ram desse processo a figura masculina. Conclu?mos que o significado do termo indutor cuidado parte do senso comum e ? incorporado ao discurso institucionalizado para humanizar a assist?ncia. Entretanto, a gesta??o deixa de ser vista no seu sentido biol?gico natural e passa a ser analisada como um momento de fragilidade e predisposi??o ?s doen?as. Por fim, o N?cleo Central das representa??es sociais do pr?-natal para os(as) pesquisado(as) ? ancorado nos discursos institucionalizado e do senso comum, refletindo a preocupa??o em estabelecer uma assist?ncia humanizada e de qualidade