Navegando por Palavras-chave "Atenção Primária À Saúde"
Agora exibindo 1 - 20 de 24
Resultados por página
Opções de Ordenação
- ItemSomente MetadadadosAções para o controle do câncer de mama entre usuárias da atenção primária em dois municípios da Amazônia ocidental(Universidade Federal de São Paulo (UNIFESP), 2020-03-05) Silva, Maria Susana Barboza Da [UNIFESP]; Gabrielloni, Maria Cristina [UNIFESP]; Universidade Federal de São PauloObjective: Evaluate the implementation of actions for early detection of breast cancer in Primary Health Care (PHC) by users of Basic Health Units (UBS) in two municipalities of Western Amazon. Method: Cross-sectional study. The sample consisted of 736 women from 35 to 69 years old, eligible UBS users. The collection took place in Family Health Strategy UBS from September / 2017 to March 2018, using a structured questionnaire, based on national protocols and guidelines published until 2015 as references. Statistical analysis was performed using the R® Core Team (2018) software, applying Chi-square or Fisher Exact tests, with a significance level of 5%. Results: Among the 736 women, 82.3% lived in the urban area, 40.1% were married, 76.4% of mixed race / brown color, 48.2% were illiterate or had not completed elementary school and 63.9% were from the city. class of. The frequency of breast examination in women at high risk and standard risk was 39.7% and mammography 42%. The adequacy of clinical breast examination reached 21% of women at risk for breast cancer. Proper mammography was performed in 66.7% in high-risk women and 5.8% in standard-risk women. Most women were instructed to have mammography after 40 years, consequently, the prevalence of annual mammographic examination was higher in women from 40 to 49 years. There was greater adequacy in the clinical examination of breasts and mammography in women with standard risk for breast cancer in Cruzeiro do Sul than in Rodrigues Alves, but this is much lower than recommended. Conclusion: In the socio-demographic characterization of the age groups, it was found that low education and income are more frequent in women from 50 to 69 years old than in women from 35 to 39 years old and from 40 to 49 years old, making them more vulnerable. socially. The early detection actions implemented are in disagreement with national recommendations, which may pose a higher risk to women. Given this, it is necessary to create strategies to increase the adherence of health professionals to government proposals, as well as continuous evaluation of actions performed in PHC services.
- ItemSomente MetadadadosAções para o controle do câncer de mama na atenção primária à saúde na perspectiva das usuárias(Universidade Federal de São Paulo (UNIFESP), 2019-09-28) Goncalves, Valterli Conceicao Sanches [UNIFESP]; Gutierrez, Maria Gaby Rivero De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Cancer is considered an important public health problem, due to its epidemiological, social and economic relevance, in both developed and developing countries. For early detection of this condition, the Ministry of Health recommends diagnostic and screening actions, making clear the need for the tripod: population warned of signs and symptoms; health professionals trained to evaluate suspected cases and health systems, and services prepared to ensure timely diagnostic confirmation, with quality and guarantee of comprehensive care throughout the care line. It is relevant to know preventive practices related to early detection and diagnosis, since this information can support the planning of effective strategies in Primary Health Care. Objective: To evaluate the implementation of opportunistic screening actions for breast cancer control, proposed by the Ministry of Health, in Primary Health Care, through information from users. Method: Cross-sectional study conducted in 18 BHUs in the municipality of Diadema, with 675 users, aged 35-69 years, from November 2014 to March 2015. It is linked to the multicenter project entitled “Actions on Breast Cancer Control: identification of practices in Primary Care” developed by the Nursing Schools of the Federal University of São Paulo (Paulista School of Nursing / UNIFESP) and the University of São Paulo - Ribeirão Preto College of Nursing (EERP-USP), which purpose is to portray the implementation of the actions recommended by the Ministry of Health for the screening of breast cancer among users of Primary Health Care. Used a validated questionnaire which was applied after approval of the UNIFESP Research Ethics Committee. The project was approved under CAAE No. 20021714.5.0000.5505. The collected data were analyzed descriptively and analytically. Results: Of the users, 50.5% declared to be white; 44.3% married; 32.2% said they were illiterate or had completed Elementary School. 61.6% belonged to social class C and 62.1% do not perform any paid activity. Most (83.8%) used exclusively Unified Health Care System services and only 16.2% had health insurance, using it for consultations and exams. As for the risk for breast cancer, 4.7% reported having family risk factor for the neoplasm and 63.1% said the health professional asked about family risk for breast cancer; 37.5% of users at high risk for breast cancer reported having undergone breast clinical examination annually; 20.9% of users aged 50 to 69 years and at population risk performed mammography. Only 8.7% of users reported having attended an educational meeting on breast cancer. Regarding the adequacy of the parameters established by the Consensus for mammography and clinical breast examination, rates of 8.9%, 10.6% and 7.7% were found for age groups 35 to 39, 40 to 49 and 50. to 60 years, respectively. Conclusion: the opportunistic screening actions for breast cancer, carried out by Primary Health Care, need to be adjusted to comply with the guidelines proposed by the Ministry of Health in all age groups studied.
- ItemAcesso aberto (Open Access)O adoecer em usuários de insulina acompanhados no Programa de Automonitoramento Glicêmico: da prática assistencial à integralidade em saúde(Universidade Federal de São Paulo (UNIFESP), 2019-02-15) Dias, Ivan Wilson Hossni [UNIFESP]; Junqueira, Virginia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Diabetes Mellitus patients using insulin have singularities in the way they fall ill and in the recovery of functional normality in their daily lives. Investigating the work process of the professionals of the Glycemic Self-Monitoring Program, comparing the health needs of insulin users, can contribute to the improvement of care practices from the perspective of integrality. Objectives: subsidize healthcare practices within the scope of the Glycemic Self Monitoring Program of a Basic Health Unit based on the characterization of the health needs of individuals with DM in insulin use. Identify and characterize the health needs of individuals with DM who use insulin accompanied by the Glycemic Self Monitoring Program of a Basic Health Unit. Identify and characterize health practices within the scope of the Glycemic Self Monitoring Program in the perspective of integrality of care. Discuss with the professionals working in the GSMP the experience of the sickness of users with DM in use of insulin. Methods: qualitative design study. Two conversation wheels were carried out with insulin users followed up by the Family Health Strategy team and five semi-structured interviews with all health professionals working in the GSMP of a Basic Health Unit in the city of São Paulo. The recorded material was submitted to the technique of content analysis. Results: The process of sickness of insulin users is directly related to the obstacles that this practice imposes to social and productive normality. It is remarkable in the experience of getting sick the difficulties of reordering the vital functionality by the sick people, expressed by a behavioral tendency of resistance to the therapeutic proposals that affect the ways of life. The need for perception of the pharmacological effect on the lived body is revealed in the dimension of the insulin treatment, in the search for the recovery of the biological self, as well as the conflict subsequent to the need for insulin management inserted within a singular aesthetic of living. The group activities developed by the GSMP of the Basic Health Unit operate as a potential space for dialogical exchange between the community and health workers, an expectation that is incorporated into the distribution of inputs and management of clinical records. From the perspective of health professionals, the work process presents operational obstacles, related mainly to the divergence and articulation of information among health equipment workers. The difficulty in promoting the autonomy of the sick people has been associated with the symbolic fatalism resulting from the inability of the insulin users to reproduce technical-instrumental knowledge. Conclusion: The practice of care in the context of the Basic Health Unit finds difficulties in responding to the health needs of insulin users. The constitution of dialogical spaces with the community in the context of the GSMP and the incorporation of different knowledge in the day-to-day care showed to be relevant for the characterization of their lifestyles and thus can determine singular approaches in the planning of the care of the people in use of insulin.
- ItemAcesso aberto (Open Access)Análise do currículo de um curso de medicina em implantação no interior do estado de Minas Gerais(Universidade Federal de São Paulo (UNIFESP), 2021) Barreiro, Francisca Raimunda De Souza [UNIFESP]; Ferreira, Beatriz Jansen [UNIFESP]; Universidade Federal de São PauloThe research aimed to analyze the curriculum of a medical course in implementation in the state of Minas Gerais in the light of articles 3o, 5o, 26, 29 of the Diretrizes Curriculares nacionais (DCN), of 2014. To achieve the objective, we opted for a qualitative methodology, with a descriptive and exploratory case study. The research instruments were composed of a case study, semi-structured interview and focus group. Data analysis occurred through content analysis in the thematic modality. The context was within the scope of a medical course at a private university in the interior of the State of Minas Gerais created in 2018, with the admission of two classes of students, with 50 students per class (100 students). The study population was composed of the Coordinator of the medical course, ten professors, and fifteen students. The research evidenced the challenges and potentialities of the curriculum of this medical course compared to that proposed in the new DCN of 2014, and the initial trajectory of the training of the medical professional in the different and possible teaching-learning scenarios in the Sistema Único de Saúde (SUS) network. It was inferred that this medical course, in its initial trajectory, responded to the proposals of the DCN 2014, however, being clear the concern of the interviewees with the possibility of “change of focus” for a technical training from the contact with medical specialties in Secondary and Tertiary Care, being a possible influencer the presence of teachers who do not understand, or even do not value the work of Primary Care, and who were not trained in the proposal of the Expanded Clinic. It was inferred that, although the students understand the importance of critical, ethical, reflective training, and for this the need for disciplines that bring scientific, social and philosophical support for this formation, they still have an insecurity about the possibility of such disciplines occupying the "space" of disciplines with biologicist content, and this impairs the quality of medical training. Weaknesses are scored in the agreement of teaching-service integration. Despite the recognition of the importance of the perspective of interprofessional training, there is still a distance between interprofessionality andmultiprofessionality. The greatest challenge pointed out by all interviewees was the student-centered teaching proposal, with its autonomy in the construction of learning, facilitated by the teacher, and the development of the course based on a methodology with emphasis on constructivism (active teaching-learning methodology). However, students and teachers admit that the construction of autonomy in learning involves the use of active methodologies.
- ItemAcesso aberto (Open Access)O apoio institucional como ferramenta do trabalho médico em um território de saúde da zona leste do município de São Paulo: Avanços e desafios(Universidade Federal de São Paulo (UNIFESP), 2019-07-11) Toledo, Ana Clara Pedroso [UNIFESP]; Pezzato, Luciane Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Institutional support is a tool to support the health actions of the teams putting them in the spotlight of their reflections and the changes in their work processes. The present study aims to investigate the institutional support performed to Ermelino Matarazzo’ s physicians and contribute to the local care process and to explore the needs of institutional support performed to the local teams, from a medical perspective, through the self-application of research questionnaires with the use of Minayo’ s analysis . As a result, the need for local medical teams to strengthen support channels and technical assistance was evidenced, as well as the adjustment of administrative routines that fit their daily activities of the medical staff to the management contract in force in the municipality, transposing the recommended assistance quantitative, imposing quality concepts through reflection resulting from the Method Paideia.
- ItemAcesso aberto (Open Access)Atenção básica e educação permanente na percepção dos coordenadores municipais de atenção basica de uma região de saúde no estado de São Paulo(Universidade Federal de São Paulo (UNIFESP), 2019-02-28) Carvalho, Rita De Cassia Silva [UNIFESP]; Nicolau, Stella Maris [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Primary Health Care and Continuous Education perceptions of the county coordinators of Primary Health Care from a countryside area of the state of São Paulo, Brazil. The city coordinators of primary health care have an important role in the management of the Brazilian Unified Health Care System, mainly in small counties where health care is composed of substantially by basic primary health care units. The knowledge of the county coordinators of primary health care about what is Primary Health Care and Continued Education in Health demonstrates relevant aspects addressing their practice in the health care system. The objective of this study is to understand the perceptions of primary health care managers from a health care place of the State of São Paulo concerning the Primary Health Care (PHC) and Continuous Education. This is a qualitative research approach with data collection using questionnaires, interviews and a focus group with the aim to describe in details the conceptions of these managers of some counties of a Regional Health Care System number 8 (around Sorocaba city). Thirteen municipal counties participated in this research, twelve were women, nurses, with a lack of training to work in the Unified Health Care System during the undergraduation. All participants were regular public employees. Those, only three had officially the coordinated position, six of them received additional gratuity income as a manager, all had less than five years of practice with management, and seven had no more than a year of management experience at the time of the data collection. Results showed a profile of coordinators with little experience, where most of all started to work as managers after the changing of the city councils in the year of 2017, which demonstrates the predominance the eligibility for this position more by a political-partisan than a technical and work career criteria. There was also identified a major reductionism and simplifying conception of PHC and Continuous Education among the coordinators, which indicates the need of investment in opportunities to debate and reflect under the pedagogical approach of the continuous education and its tools to empower these managers about the amplified conception of PHC and based on the integral health care. There was identified a value given by the participants in working groups of PHC as an important place of exchanges and training for this type of work.
- ItemSomente MetadadadosAvaliação da validade e reprodutibilidade das categorias diagnósticas da décima primeira edição da Classificação Internacional os transtornos mentais na Atenção Primária: CID-11 AP(Universidade Federal de São Paulo (UNIFESP), 2020-04-08) Jorquera, Carolina Andrea Ziebold [UNIFESP]; Mari, Jair De Jesus [UNIFESP]; Universidade Federal de São PauloIntroduction: The World Health Organization is preparing a primary care version of the eleventh revision of the International Classification of Diseases (ICD-11 PHC). To collaborate with the development of this classification, it was proposed to examine the validity and reliability of the ICD-11 PHC categories of anxious depression and bodily stress syndrome (BSS) to diagnose the most common mental health disorders presented in primary care. Methods: Were analyzed data collected through the ICD-11 PHC field trials in five countries (N= 2.279). General physicians, using screening questionnaires, referred patients they suspected to have depressive and/or anxiety or BSS symptoms to be interviewed by a research assistant using the Clinical Interview Schedule-Revised, a measure of disability (12-WHODAS 2.0) and two five-items depression and anxiety scales. Analysis of variance and x2 tests were used to evaluate the impact of the reduced anxiety duration criteria on disability and suicidality, respectively. Structural analysis was used to examine the construct validity and reliability of the scales containing the symptoms proposed for depression, anxiety and BSS in the ICD-11 PHC. Results: Under the ICD-11 PHC, AD was the most frequent and disabling diagnosis among participants (47.7%). One third of individuals diagnosed with AD had anxiety durations between 2 weeks and 3 months and presented as much disability and suicidal ideation as individuals with longer anxiety durations. Regarding the structural analysis, two bi-factor models fit the data well: (1) all symptoms loaded on a general factor, along with one of three specific depression, anxiety and somatic factors [x2 (627) = 741.016, p <0.0011, RMSEA = 0.015, CFI = 0.911, TLI = 0.900]; and (2) a general factor and two specific anxious depression and somatic factors [x2 (627) = 663.065, p = 0.1543, RMSEA = 0.008, CFI = 0.954, TLI = 0.948]. Conclusions: This study provided support for the validity and reliability of the newly category of AD and the reduced requirement for anxiety duration. The co-occurrence of depressive, anxiety and somatic symptoms in PHC it would be explained by a shared latent construct. To guarantee the validity and reliability of the BSS diagnosis, it is advisable to assess the presence of depressives and anxiety symptoms in patients suspected of BSS.
- ItemAcesso aberto (Open Access)Da aprendizagem fragmentada ao desafio de uma formação integral: narrativas da construção do saber(Universidade Federal de São Paulo (UNIFESP), 2019-07-02) Araujo, Joao Felix Leandro De Sousa [UNIFESP]; Kinker, Fernando Sfair [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)For years medical training has been carried out in a fragmented way, reducing the complexity of the individual to organs and systems, neglecting socio-cultural aspects, as well as the dynamics and the interaction of the individual in the family and community sphere. Recently, with the last change made in the National Curricular Guidelines of the Undergraduate Course in Medicine (NCG) in 2014, the proposal arises that medical education should have an expanded formative character, with a general, critical, reflexive and ethical formation in purpose to form an egress enabled for action at different levels of health care, able to handle various pathological conditions indistinctly, to perform the coordination of care and management of the clinic. The objective of this study is to analyze the perceptions, expectations and experiences of undergraduate students of the third year of medicine at the Centro Universitário São Camilo, in the context of a discipline with a comprehensive approach to care, trying to understand the phenomenon of knowledge formation, starting with it is a logic of teaching fragmented by focal specialties, until arriving at one whose focus on integral care is the counterpoint of the previous formation. This is a qualitative, descriptive study, guided by the documental analysis of field diaries produced by the students, the researcher's field diary, and discourse analysis in conversation wheels, aiming to discuss the ideas and experiences in the outpatient clinic visits, as well as their role in the student's formation as a future generalist. The conclusion that has been reached is that even many changes that the medical curriculum has undergone over the last decades, we still have a categorized, fragmented formation with few moments to reflect on the practice, even in a non-flexible Fordist model, where more emphasis is placed on the content to be taught than the subjects' autonomy. At the same time, it has advanced in many dimensions of teaching, having demonstrated the research experience that the dialogic and reflexive process of teaching can contribute much with a quality education and that values the ethical aspects of care.
- ItemAcesso aberto (Open Access)Dificuldades e desafios dos gestores em unidade de atenção básica no município de Santos(Universidade Federal de São Paulo (UNIFESP), 2020-12-09) Matos, Renato Aparecido Dutra [UNIFESP]; Queiróz, Maria de Fátima Ferreira [UNIFESP]; Universidade Federal de São PauloIn view of the conjuncture of political and economic crisis that has been affecting the country, Health Services in Primary Care are increasingly being discussed in terms of Health Management, quality of care provided, access and qualified listening , solving identified problems and resolving referrals. In this study, the qualitative approach was chosen through an individual structured interview with the Primary Health Care Unit Managers in the municipality of Santos. It aims to analyze the perception of Primary Health Care Unit Managers in the Municipality of Santos regarding the difficulties and challenges of being a Manager to ensure universal, comprehensive and equal access in the Unified Health System. The current service scenario in Primary Care, it has had repercussions on managers in the way teams are organized, service flows and access to users. The qualitative dimension of this study contributed to understand about the difficulties and challenges of the Manager in the Primary Care Unit in the Municipality of Santos, despite the limitations, the Managers are able to conduct necessary strategies for public, universal, integral and equitable health, which sometimes cannot perceived by the managers themselves as determinants of their actions.
- ItemSomente MetadadadosA Educação Permanente E As Ações Na Alteração Primária À Saúde(Universidade Federal de São Paulo (UNIFESP), 2017-08-29) Terrazas, Caroline [UNIFESP]; Pinto, Umberto De Andrade [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This research aims to analyze the processes of permanent education in health (PEH) offered to professionals that work in Primary Attention to Health (PAH) through the Family Health Strategy (FHS) of the city of São Paulo. This is a qualitative study in which 14 semi-structured interviews were carried out. Among the professionals interviewed, 13 are hired by 6 different Social Health Organizations (SHO) and, among these, 6 develop PEH actions and the other 7 are FHS workers who participated in some permanent education process and interview with a professional of the Municipal Health Secretary responsible for PEH in PAH. The interviews were handled by content analysis according to Bardin. The empirical data were interpreted by the intersection between education and health, with the respective theoretical references of Freire, Saviani, Paim, Ceccim, and by the manuals of the Ministry of Health and by the National Policy of Permanent Education in Health (NPPEH). From the analysis procedure, the following categories emerged: The PEH processes; the PEH at the FHS; Proposals and themes of PEH; Methodologies and didactics adopted at the PEH; Challenges and Reflections about the practice of PEH. The research showed that the PEH actions, carried out with the PAH workers acting at the FHS, are educational practices based on the concepts of Continuing Education and Education in Service. The methodologies adopted are the same of the initial education processes and, because of this, there is no employee participation. The proposals and themes are developed through programmed courses, previously, by the Municipal Planning of Permanent Education, which is done annually. The educational actions are made by professional categories, themes related to the relational knowledge of the practice are not addressed, there is established mismatch between the principles of the SUS with the contracts of management established by the partnership between OSS and SMS-SP. Therefore, PEH is a practice that is still far from the NPPEH proposal.
- ItemSomente MetadadadosEstágios curriculares de nutrição em saúde coletiva: trajetórias e percepções de supervisores docentes do município de São Paulo(Universidade Federal de São Paulo (UNIFESP), 2020-03-24) Freitas, Alexandra Correa De [UNIFESP]; Juzwiak, Claudia Ridel [UNIFESP]; Universidade Federal de São Paulo
- ItemAcesso aberto (Open Access)O farmacêutico em tempo integral e as práticas em saúde na estratégia de saúde em família(Universidade Federal de São Paulo (UNIFESP), 2021) Nascimento, Juçara Barga Do [UNIFESP]; Figueiredo, Lucia Da Rocha Uchoa [UNIFESP]; Universidade Federal de São PauloIntroduction: This research presents the activity of the pharmaceutical professional in the Brazilian Unique Health System (SUS) which, even inserted in this public policy, it has a timid performance in Primary Care. From the perspective of comprehensiveness, concern is expressed every day the guarantee of access to health, supported by the assertion that this guiding axis leads to health practices unimaginable until then. It is believed, therefore, that the Pharmacist supports this aspect, including the identification of this performance combined with interprofessional initiatives with the team of the Family Health Strategy. The study purpose is to evaluate the interprofessional collaboration of the health team of the Family Health Strategy (FHS), as well as the care exercises of the Pharmacist, when their full-time work activities are thus preserved. Method: exploratory-descriptive study with a qualitative approach, using the Interprofessional Team Collaboration Assessment Scale (AITCS II-BR), based on a cross-cultural translation by Bispo and Rossit (2019), which assesses the work of the health team for the Collaborative Interprofessional Practice. It consisted of applying this instrument containing 23 assertions, through the Likert Scale, divided into 3 dimensions: partnership, cooperation and coordination for Collaborative Practice. The attitudinal analysis used in the AITCS II-BR instrument was the mathematical treatment of means, whose assertions and dimensions were classified as "comfort zone" (3.68-5.0), "alert zone" (2.34-3, 67) and "danger zone" (1.0-2.33), categorizations that register in the comfort zone, a positive aspect of the research, in the alert zone, need for changes and in the danger zone, urgent intervention. The focus group was used only for the ESF Pharmacists and the treatment of group conversations was submitted to content analysis, determining lines that considered the contribution of the Pharmacist to the team and their interventions in the field of health care. Results: The research showed that the ESF team has collaborative engagement, the partnership and cooperation dimensions showed averages of 4.06 and 3.88 respectively, pointing these dimensions to the comfort zone, which demonstrates a positive aspect of teamwork in the development of interprofessionalism. The coordination dimension revealed a result in the alert zone, the average obtained was 3.36, whose result demonstrates the weakness of this dimension, indicating the need for the team to develop better for interprofessionalism. The focus group identified a good participation of the Pharmacist with the team, with statements that promote interprofessional actions and in line with the integrality axis of the SUS. Their full-time presence has contributed to the possibility of integrating themselves into the minimum team of the Family Health Strategy, thus breaking the silencing of health care, generated by the absence of this professional, this deficiency commonly observed when verifying the actions of the Pharmacist in Primary Health Care. Final considerations: The analysis of the AITCS II-BR showed that the professional inserted in the SUS policy has an interprofessional profile. It can be linked to the environment that develops the professional naturally for this aspect, because apparently they are initiatives linked to the intuitive and empirical field that lead them to such results. It is necessary to solidify this theme, from an intentional project for interprofessional education, identifying the weaknesses established by the usual uniprofessional training of health professionals. With the municipalization of all Primary Health Care, it will be possible to avoid the recurrent displacements of outsourced workers today, generating an improvement in the interprofessional articulation and professional training for the SUS. The creation of the Multiprofessional Residency can also contribute to the training process of these professionals. Continuing education is a fundamental resource for this achievement, capable of deepening and amplifying learning related to the Singular Therapeutic Project, shared leadership, improvement for an affectionate look at what the Extended Clinic establishes and many other concepts about interprofessionalism and health care. The view of most municipal managers on the involvement of the Pharmacist is still a challenge to be overcome, precisely because of their low participation in this type of service. Although SUS inducing policies increasingly place the need for this professional in technical-assistance activities, there are many planning, cultural, legal, organizational and human resources barriers that prevent the commitment of this social actor in the Health Strategy policy of the Family. Thus, every day in which he is inserted, the Pharmacist has demonstrated a better approach to the rational use of medicines, based on cooperation events.
- ItemAcesso aberto (Open Access)Formação em saúde para o trabalho em equipe: a educação interprofissional no âmbito do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde) e Programa de Educação pelo Trabalho para Saúde (PET-Saúde)(Universidade Federal de São Paulo (UNIFESP), 2019-05-23) Medeiros, Nara Maria Holanda de [UNIFESP]; Rossit, Rosana Aparecida Salvador [UNIFESP]; http://lattes.cnpq.br/3333865775403342; http://lattes.cnpq.br/7622095686832163; Universidade Federal de São Paulo (UNIFESP)Esta pesquisa trata-se de cinco pesquisas que constituem o Estudo de Caso Avaliativo, exploratório e descritivo com abordagem qualitativa e quantitativa, cujos os objetivos foram avaliar o Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde) e o Programa de Educação pelo Trabalho para Saúde (PET-Saúde) nas perspectivas da Educação Interprofissional (EIP), da Prática Colaborativa (PC) e do Trabalho em Equipe Interprofissional (TEI), nas dimensões, do ensino, aprendizagem e avaliação das Instituições de Ensino Superior (IES) de São Paulo; construir, validar e aplicar instrumentos de avaliação; avaliar concepções, propostas e métodos de ensino/aprendizagem/avaliação por meio de análise documental e avaliar a relação de ensino/aprendizagem/avaliação nos Programas a partir da concepção dos ex-discentes. Os meios de investigação foram realizados mediante a realização de cinco pesquisas, Construção e Validação da Matriz de Análise com Termos Rastreadores; Pesquisa Documental; Construção e Validação da Escala Atitudinal de Avaliação da Interprofissionalidade, na perspectiva da EIP, PC e do TEI; Avaliação da Concepção dos Ex-Discentes dos Programas, no tocante à relação de ensino/aprendizagem/avaliação e o Estudo de Caso Avaliativo, de avaliação dos Programas, considerando os resultados dos cinco estudos. A Matriz de Análise com Termos Rastreadores foi validada para aplicação e análise dos Projetos das IES e possibilita sua utilização para análise de outras propostas de Reorientação da Formação relacionadas com a EIP, PC e TEI, no âmbito da Formação e de outras instâncias. Foi criado um novo percurso metodológico para Pesquisa Documental, uma adaptação do percurso metodológico de Bohomol (2013), apresentado como manual claro para realização de outras pesquisas desta natureza. A partir da Pesquisa Documental verificou-se que os cinco Projetos das IES apresentaram 1.572 núcleos de significados a partir de 122 Termos Rastreadores, evidenciando que todas as IES apresentaram arcabouço teórico/metodológico e mecanismos determinantes para compreensão e implementação da EIP, PC e do TEI. A Escala Atitudinal de Avaliação da Interprofissionalidade obteve ótima validação de conteúdo, com perda de quatro asserções num total de 30 (13,13%), enquanto a literatura considera aceitável perda de até 40% (até 12 asserções). A validação de confiabilidade foi de 0,96, denotando ótima consistência estatística ao instrumento aplicado. Essa Escala é pioneira no país, construída segundo evidências científicas do contexto das práticas nacionais de Atenção Primária à Saúde, nas perspectivas da EIP, PC e do TEI. A Pesquisa de Avaliação da Concepção Discente revelou que os Programas são terrenos férteis para o desenvolvimento de competências (colaborativas, complementares e comuns) para a EIP, as PC e o TEI através do reconhecimento das mesmas, dos princípios, conceitos, pressupostos e de ações conjuntas consistentes. A pesquisa Estudo de Caso Avaliativo evidenciou coerência entre as propostas do Ministério da Saúde e da Educação com as das IES e que impactaram positivamente no desenvolvimento das ações de saúde, conclusivo de que os Programas das cinco IES construíram suas identidades e implementaram as ações fundamentados na EIP, PC e no TEI, viabilizando reformas curriculares, fortalecendo a integração ensino-serviço; consolidando inovações dos métodos de ensino/aprendizagem/avaliação e agregando saberes e competências entre os profissionais e discentes.
- ItemAcesso aberto (Open Access)Grupo educativo junto a pessoas com diabetes: desafios para ampliar o autocuidado e a escuta da equipe da atenção básica(Universidade Federal de São Paulo (UNIFESP), 2019-07-17) Takayanagi, Irvin Jo [UNIFESP]; Spedo, Sandra Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Diabetes Mellitus is today a major challenge for health systems worldwide, because of its high prevalence and severity of complications, and health education has been recommended by several international and national organizations as a pillar for improving self-care of the person with diabetes. Based on the theoretical framework of health education, empowerment and educational group, an intervention study was developed to discuss and reflect on the repercussions of an educational group for the care of those with diabetes. Objective: to implement and analyze educational process with people with diabetes accompanied in a basic health unit. Study course: a qualitative intervention-study in which an educational group was designed and built with the participation of 11 people with diabetes, coordinated and facilitated by the researcher who played an active role as well, with the support of other professionals from Health Basic Unit. The educational group was developed in 12 meetings using planned dynamics and finalized with a discussion in the conversation wheel about the subjects raised by the participants. In this process, four analytical categories were identified: (a) the senses of eating in the lives of people with diabetes, in which it was possible to evaluate the intimate relationship between the act of eating and life; (b) the meaning of insulin for people with diabetes, in which we evaluate the different meanings of medication use, including those that transcend the patient's simple metabolic need; (c) the negative burden of diabetes and its repercussions on the ways of walking through life, in which we evaluate how the disease negatively impacts people's lives; (d) (un)knowledge about diabetes and the challenges to self-care, in which we evaluate how people incorporate and develop their own knowledge about the disease influencing their self-care; (e) repercussions of the group on the perceptions of people with diabetes, in which we assess the influences of the educational process on the lives of these people. Final considerations: the discussions and reflections in the conversation’s wheels of the educational group, allowed us to contribute to the resignification of the disease in the lives of people with diabetes. And the detailing of the potencies, difficulties and weaknesses of this type of intervention opens the way for other professionals to be influenced and to reflect on their current practices.
- ItemSomente MetadadadosImplantação de um programa de Residência Médica em Medicina de Família e Comunidade no Sistema Único de Saúde (SUS) de município de grande porte da região metropolitana de São Paulo(Universidade Federal de São Paulo (UNIFESP), 2019-07-26) Oliveira, Denize Ornelas Pereira Salvador de [UNIFESP]; Pinto, Nicanor Rodrigues da Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Faced with the challenge of expanding access to and improving Primary Health Care quality in Brazil, the development of medical specialists in Family and Community Medicine (MFC) stands out as a central issue. In Brazil, the Ministries of Health and Education have been promoting public policies to address this gap and some Brazilian municipalities have strategically taken over the responsibility to organize and offer of places of medical residency in MFC. This study aims to describe and analyze the experience of implantation of the Medical Residency Program in Family and Community Medicine (PRMMFC) linked to the municipal administration of the Unified Health System (SUS) in the municipality of São Bernardo do Campo (SBC), highlighting the strategies adopted to attract and retain medical residents between 2013 to 2017. For that matter a qualitative applied research in the form of a case study was carried out. Public documents from local SUS management were used as source of information and evidence, as well as semi-structured interviews that were perfomed with key informants, including municipal SUS managers, residents, preceptors and coordinator. The data analysis was performed using the technique of Content Analysis and the theoretical framework of the Policy Cycle Approach. It was observed that the process of implantation of the PRMMFC within the SUS of SBC adopted strategies to attract residents that considered the dynamics of the labor market and used local processes of structuring and qualification of SUS. Investment in the training of preceptors; support for the role of residents and preceptors in the work process; offer of practice scenarios in a diversified service network and the actors commitment with the construction of the local SUS were identified as strategic elements for attraction and retention of medical residents. The adoption of a supplemental amount to the regular medical residency wages, which was enacted through a municipal law, appears to have been a fundamental element to attract and retain medical residents. The role of the program coordination in the implementation of program was highlighted, which points to the need for national studies on the role of supervision /director. As limitations of the implantation of the PRMMFC were mentioned: the low adherence of preceptors of other levels of the health care network under municipal SUS administration, the internal disagreements among managers about the concept of health care network and the failure to monitor and assess pedagogical processes pela Comissão de Residência Médica.
- ItemSomente MetadadadosA Implantação Do Currículo Baseado Em Competências Para Medicina De Família E Comunidade: Diagnóstico De Pré-Requisitos, Comissão Curricular E Portfolio De Aquisição De Competências.(Universidade Federal de São Paulo (UNIFESP), 2018-12-27) Hidalgo, Gabriela Alves De Oliveira [UNIFESP]; Goncalves, Daniel Almeida [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: Implementation Of The Competency-Based Curriculum For Family Practice (Cbc-Mfc) In The Medical Residency Of The Federal University Of São Paulo Using Three Steps: Diagnosis Of Prerequisites In Beginner Residents; Complementation Of The Contents Of Cbc-Mfc Through A Curriculum Committee Employing Consensus Methodology; Theoretical Mapping Of The Portfolio Of Competency Acquisition For Family And Community Medicine (Paco-Mfc). Method: Quantitative Analysis Of Cbc-Mfc Prerequisites In Beginner Residents; Delphi Method As Instrument To Complement The Cbc-Mfc Essential Competencies With Clinical Themes Through A Curriculum Committee; Description Of Paco-Mfc With The Number Of Modules, Grouping Of Competency Areas And Study Topics (Essential Competences Added To The Themes Included By The Curriculum Committee) And Structural Steps That Comprise Each Module. Results: The Prerequisites Diagnosis Show Us That The Group "Theoretical Foundations" Of The Cbc-Mfc Was The Most Fragile, Which Is Composed By The C
- ItemSomente MetadadadosA influência da privação de sono paradoxal na fisiologia do tecido adiposo branco, marrom e fígado de ratos(Universidade Federal de São Paulo (UNIFESP), 2017-02-13) Santos, Marcus Vinicius Lucio dos [UNIFESP]; Antunes, Hanna Karen Moreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: Verify the influence of sleep deprivation on the white, brown adipose tissue and liver physiology of rats. Methods: Thirty male wistar rats with 03-month-old were used. The animals were allocated into three groups: ten animals in the control group, ten animals in the paradoxical sleep deprivation group and ten animals in the sleep rebound group. The animals in the sleep deprivation and rebound group were subjected to the modified multiple platform method for 96 consecutive hours, then the animals in the rebound group returned to the housing to be submitted to the sleep rebound protocol for the same period. To understand the proposed objectives, the rats total mass was verified throughout the protocol. After euthanasia, animal interest tissues and blood were collected to analyze the following parameters: corticosterone, glucose, lactate, insulin, irisin, lipid profile and free fatty acids by the liquid chromatography method, enzyme immunoassay or colorimetric analysis according to the recommendation of the kit used for each parameter analyzed. Moreover, we analyzed the expression of the total and phosphorylated kinase B proteins, LC3A and PGC1-α, using western blotting method, and the COX-2, TNF-α and 8OHdG biomarkers were verified by the immunohistochemical method. Finally, rats body and tissue mass were verified, being: skeletal muscle, white adipose tissue, brown adipose tissue and liver. From these tissues, white, brown adipose tissue and liver area, diameter and nucleus density were verified by the histomorphometric method. Results: The total body mass (p≤0.01), skeletal muscle (p = 0.03), retroperitoneal adipose tissue (p = 0.01), epididymal adipose tissue (p = 0.01), liver (P≤0.01), glycaemia (p≤0.01), triacylglycerol / VLDL (p≤0.01), PGC1-α (p = 0.03), area and perimeter of white (p≤0.01) and brown adipose tissue (p≤0.01) of sleep deprivation group reduced when compared to the control group. In addition, we verify the increased in concentrations of corticosterone (p≤0.01), irisine (p≤0.01), free fatty acids (p≤0.01), LDL (p≤0.01) and LDL / HDL ratio (p = 0.02) in the same comparison. Finally, we observed an increase of aspartate aminotransferase (p = 0.01), COX-2 (p≤0.01) and 80HdG (p≤0.01) in the rebound sleep group compared to the control group. Conclusion: Sleep deprivation modifies the integrity and functionality of white, brown adipose tissue and liver, moreover, modulates lipid and glucose metabolism, as well as promotes oxidative stress and inflammation increase.
- ItemSomente MetadadadosLiderança do enfermeiro na atenção primária à saúde e sua relação com o ambiente da prática profissional em enfermagem(Universidade Federal de São Paulo (UNIFESP), 2020-09-24) Mattos, Julio Cesar De Oliveira [UNIFESP]; Balsanelli, Alexandre Pazetto [UNIFESP]; Universidade Federal de São PauloObjectives: 1-) To assess nurse‘s self-perception in coaching leadership in Primary Health Care; 2-) Verify how nursing assistants assess nurse‘s leadership; 3-) To Classify professional nursing practice environment; 4-) To correlate the perception about nursing leadership with professional nursing practice environment. Methods: this correlational, cross-sectional, descriptive and quantitative study was conducted at 13 health centers in the south of São Paulo, SP, Brazil, in which 150 nursing professionals, 75 nurses and 75 nursing assistants working at these units, participated. Two leadership coaching questionnaires were applied: Questionário de Autopercepção do Enfermeiro no Exercício da Liderança (QUAPEEL) and Questionário de Percepção do Técnico e Auxiliar de Enfermagem no Exercício da Liderança (QUEPTAEEL), Then, the Practice Environment Scale, Brazilian version (PES) was applied. For data analysis, we applied Multivariate Analysis of Variance (MANOVA) with the use of Pillai‘s Multivariate Screening Test, Univariate Analysis of Variance (ANOVA), Pearson’s Correlation Test and Effect Size by the Rosenthal “r” coefficient: small (between 0.100 and 0.299), medium (between 0.300 and 0.500) and large (above 0.500), with a significance level of 5% (p <0.05). Results: through the questionnaires’ measures and total scores and subscales, there was a statistically significant difference between the groups in relation to the measures of QUEPTAEEL/QUAPEEL. Professional nursing practice environment was favorable for both nurses and nursing assistants. Concerning variable “leadership”, the group of nurses had an average scoreclose to findings in the group of nursing assistants. When the self-perception of coaching leadership and the professional nursing practice environment domains were correlated among nurses, two positive linear correlations were noticed: communication and nursing fundamentals focused on quality of care and communication with collegial relations between nurses and physicians. In other words, the greater the communication between leader and team member, the greater the relationship with physician and quality of care. Nursing assistants, when assessing nurses’ coaching leadership and professional practice environment in nursing, significant correlations were obtained between many domains of the two scales. Conclusion: the skills of coaching leadership were perceived in both groups, being better assessed by nurses. The environment of professional nursing practice was assessed as favorable by both nurses and nursing assistants and was related to coaching leadership. Favorable environments associated with leadership contribute to better results and best practices in the organization.
- ItemAcesso aberto (Open Access)Percepções sobre dor crônica e o cuidado à saúde na atenção básica(Universidade Federal de São Paulo (UNIFESP), 2019-12-02) Tanaka, Roberta Aoqui [UNIFESP]; Poletto, Patricia Rios [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)In daily work in primary health care, the high demand of patients with complaints of chronic pain has provided questions on the resolution of care actions performed in primary health care. Thus, it is necessary to improve attention to the patient with chronic pain, seeking to ensure a more resolute and integral care in health education practices. This study aims to understand the perception of chronic pain, the self-care strategies of patients participating in a chronic pain group in a health service of São Bernardo do Campo/SP, and the understanding of the team responsible for the group about the health education process in this group. A cartography of an experience was performed in a group of chronic pain, in a health service, from the knowledge of the trajectories of the patients who participate in it, the look of the health professionals who perform it, and this researcher. Most patients have reported that the start of pain they feel is related to work. Pain is present in life, causing limitations in daily activities and work, dependence and support of family members. For some patients the pain is accepted as part of life and the suffering is evident. Patients reported benefits and improvement in pain after group activities, the benefits reflect in decreased medication use, and the importance of the interaction between them in the activities. The health professionals who care in the group describe it as a multidisciplinary teamwork, in which each one have a function in the activity. They promote in health education actions a change to a "healthier" lifestyle and there is a stimulus to self-care, with an opening to listen to the topics of interest to patients to then elaborate the activity that will be performed, considered as a space that reinforces the exchange of experiences. Patients report an improvement with group participation that is related to decreased pain, medication use, emotional well being, socialization and quality of life. The various contexts and life trajectories allowed to expose the experience of illness, making it possible to understand pain, its limiting aspects and strategies to care of pain, being a possibility of promoting care and an educational process with autonomy. Dialogic practices can represent advances for the clinic in primary health care, more comprehensive actions and more effective care.
- ItemSomente MetadadadosUma Pesquisa Avaliativa Sobre Os Núcleos De Apoio À Saúde Da Família(Universidade Federal de São Paulo (UNIFESP), 2017-08-18) Correia, Patricia Caroline Iacabo [UNIFESP]; Furtado, Juarez Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Endowed with a new working process model, the matrix support, the Family Health Support Centers (Nasf) were formulated with the objective of increasing the resolution of Primary Health Care in Brazil. However, concomitantly with the numerical expansion of these centers, there are questions about what and how to develop their attributions. An evaluability assessment on Nasf was carried out based on a systematic literature review and the official speech expressed in documents of the Ministry of Health. The findings proved that the initiative is evaluable and that the strategic and logical analyzes are pertinent for the current stage in which the centers are found, as the main questions about them are in their own tecno-assistential model. Through a case study, the analysis of the theoretical conceptions and hypotheses that support this initiative was carried out. Nasf still faces challenges to consolidate matrix support, as there is tension between general and specific performance, obstacles to professional collaboration and difficulties at centers’ coordination. However, there was an increase in the scope of actions offered in Primary Health Care and the incorporation of new knowledge by the teams.