Historicamente, o Sistema de Informações de Doenças de Notificação Compulsória tem sido o principal instrumento da Vigilância Epidemiológica. As doenças que vêm compondo este Sistema têm sido aquelas que podem colocar em risco a saúde das coletividades e, tradicionalmente, vem se restringindo às doenças transmissíveis, ainda que no Guia vigente estejam incorporados outros agravos e algumas doenças crônico-degenerativas, como câncer e diabetes. As subnotificações se constituem em uma das principais dificuldades para a Vigilância Epidemiológica, com causas variadas que apontam sobretudo para a forma de organização dos serviços de saúde. A discussão e implantação de novos modelos assistenciais podem contribuir para esta problemática, à medida que atenderem à proposta de transformação dos atuais sistemas de atenção a doenças, num sistema de vigilância da saúde, conseqüentemente de atenção a vida. A rede básica de saúde, como o local que se constitui na principal porta do sistema de saúde, onde se destaca de forma crescente, não só a prestação de assistência médica, mas sua organização em modalidade de pronto- atendimento, se constitui também no local de atendimento das doenças de notificação compulsória. Assim, para a realização deste estudo, elegemos o trabalho na Unidade Básica de Saúde, buscando analisar como se conforma a prática da Vigilância Epidemiológica na Unidade Básica de Saúde no contexto do SUS, segundo o entendimento dos trabalhadores do nível local. Foram escolhidas cinco Unidades Básicas de Saúde, segundo o critério de produção de atendimentos e foram utilizadas entrevistas semi-estruturadas para apreensão do objeto de estudo junto aos trabalhadores escolhidos por sorteio, sendo um médico, um enfermeiro, um trabalhador do nível médio e o gerente de cada local de estudo escolhido, totalizando 20 sujeitos. Não houve agrupamento por categoria profissional. Os resultados evidenciaram dois significados para a prática da vigilância epidemiológica: controlar e prevenir, das doenças e agravos infecciosos, e a compreensão como uma prática de assistir e vigiar, quando a identifica como uma prática necessária aos serviços de saúde, que possibilita um outro modo de agir em saúde, contribuindo para a integralidade da atenção preconizada pelo Sistema Único de Saúde (SUS) e implicando numa mudança na forma de organização da atenção à saúde. Apontamos para a implementação da descentralização das ações de vigilância epidemiológica para o nível local, como perspectiva desse novo modo de agir em saúde, pautado num permanente “vigiar”, para articular ações promocionais, preventivas e curativas, redefinindo o processo de trabalho em saúde. / Historically, the Information System of Compulsory Notification Diseases has been the main instrument of Epidemiological Surveillance. The diseases that are part of this system have been those that can cause risk to the collective health and, traditionally, are restricted to the transmissible diseases, even though that in the present Guide other circumstances and some chronic degenerative diseases such as cancer and diabetes are incorporated. The sub notifications are one of the main difficulties faced by Epidemiological Surveillance, with varied causes that especially indicate the organization of health services. The discussion and implementation of new care models can contribute to overcome this problem, while adopting the proposal of transforming the present health care system to a system of Health Surveillance, and consequently a system of life care. The Basic Health Network is the place that represents the main access to the health system and where is growing the emphasis not only on medical care but also on its organization as emergency care. Therefore, the Network is the place of care and compulsory notification of diseases as well. Thus, this study was developed in Basic Health Units. The purpose of this work is to analyze how the practice of Epidemiological Surveillance, in Basic Health Units, is performed according to the understanding of local workers. Five Basic Health Units were chosen in the Municipal Health System of the city of Ribeirão Preto, considering the criterion of care production. To achieve this goal, the author used semi-structured interviews conducted with the workers, such as a doctor, a nurse, a nursing assistant and a manager chosen at random in every place of the study, totalizing 20 subjects. They were not divided in professional categories. Results evidenced two meanings to the practice of Epidemiological Surveillance: to control and to prevent, when surveillance is understood as a restricted action to control infectious diseases; and the understanding of care and vigilance, when they are identified as necessary practices to health services, contributing to an integral care, as it is recommended by the Unified Health System in Brazil (SUS), implying a change in the organization of health care. The author recommended the decentralization of the epidemiological Surveillance actions in a local space, as a perspective for that new way of acting in health, guided by a permanent “vigilance” and the communication of promotion, prevention and curative actions, redefining the health work process.

Background: Attention and vigilance is highlighted as an adaptive function which facilitates a faster response to threat. It is also proposed as a maintenance factor in problems with anxiety, and more recently within physical health conditions. Researchers have hypothesised that due to the role of attention in anxiety, modifying this attention will result in a reduction of anxiety levels. In addition, research is now emerging in relation to the role of attention in paediatric health conditions. Due to the importance of early targeting in interventions for both anxiety and physical health conditions, further research is needed in this area. Aims: The research aims were twofold. The first aim was to review the literature and evidence related to the anxiolytic effect of Attention Bias Modification (ABM) in child and adolescent populations. The second aim was to investigate if children with asthma show an attentional bias to different threat related stimuli (asthma, anxiety or general negative emotion) and the relationship between this and other health related factors. Method: A systematic review of the current literature was carried out to address the first aim. This included 10 quantitative studies which all examined the effect of ABM on either child or adolescent anxiety levels. To address the second aim, 36 children aged nine to twelve participated in an empirical study. 18 of the participants had asthma, and 18 were asthma free and both groups were asked to complete a computer task designed to measure attentional bias to the different threat related stimuli. In addition, caregivers completed a questionnaire to measure their own anxiety levels, and the children with asthma completed measures focused on quality of life, coping strategies and inhaler use. Results: Research regarding the effectiveness of ABM for youth anxiety is in its early stages. However, preliminary conclusions can be drawn suggesting that it may be an effective intervention to reduce anxiety levels. Additional, rigorous research is required to standardise treatment protocols and answer further questions. Within the empirical study, repeated measures ANOVA revealed that children with asthma show an attentional bias to asthma cues whereas children without asthma do not. Furthermore, there was no selective attention to general negative words, suggesting that attentional bias was not due to general sensitivity to emotional stimuli. A Pearson’s correlation showed that vigilance to asthma cues was associated with parental anxiety. There was no attentional bias to anxiety symptom words and no significant correlations between bias scores and the measured health related factors. Conclusion: The results from the systematic review provide further evidence for the role of attention in paediatric anxiety problems. In addition, the outcome of the empirical study suggests an unconscious threat association in childhood asthma. Further research may yield a viable computerised treatment for paediatric anxiety. Regardless of this, it will be important to consider the role of attention in clinical practice, both in the treatment of anxiety and complex chronic health problems such as asthma.

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