A POLÍTICA NACIONAL DE ATENÇÃO BÁSICA NO PIAUÍ: uma análise com foco na equidade

O estudo analisa a implementação da Política Nacional de Atenção Básica no Estado do Piauí com o objetivo de discutir a equidade do acesso à saúde no Piauí, nos anos de 2006 a 2011, a partir da alocação dos recursos federais em saúde e o acesso a ações de Atenção Básica, em especial as consultas médicas para a população geral, infantil e de gestantes. Utiliza estatística descritiva para analisar os indicadores municipais agregados em quintis de renda média domiciliar per capita municipal. Analisa a evolução das transferências federais do Bloco da Atenção Básica do Piauí e utiliza um modelo de regressão linear múltipla para estimar se parâmetros socioeconômicos orientaram a alocação dos recursos federais. Verifica melhoria dos indicadores de acesso avaliados, mas a principal mudança observada foi o aumento da disponibilidade de recursos federais para os municípios, especialmente no componente variável do financiamento da Atenção Básica. Não foi possível identificar associação entre as transferências de recursos federais da saúde e critérios de alocação equitativa, com base em indicadores socioeconômicos.Palavras-chave: Política de saúde, SUS, Atenção básica, Financiamento em saúde, Equidade.NATIONAL POLICY OF PRIMARY HEALTH CARE IN PIAUÍ: an analysis focused on equity Abstract: The implementation of the National Policy of Primary Care in Piauí State was analyzed with the objective to discuss equity to access health, in 2006 to 2011, taking the allocation of federal resources and access to Primary Health Care, especially medical appointments for the general population, children and pregnant women. Was used descriptive statistics to analyze municipal indicators aggregated into quintiles of household income. The study analyzed the evolution of federal transfers for the Primary Health Care in Piauí and used a linear regression model to estimate the effect of socioeconomic parameters on the allocation of federal resources. It has been found improving in the evaluated access indicators but the main change was the increased availability of federal resources for the municipalities, especially in the variable component financing of Primary Health Care. It was not possible to identify association between the federal transfers and the analyzed socioeconomic criteria for an equitable allocation based on the socioeconomic indicators. Key words: Health policy, SUS, Primary health care, Health financing, Equity

The Advance of Neoliberalism as an Obstacle for the Consolidation of the Protection of Children and Adolescents

This work aims to reflect on the relationship among "social issue", neoliberalism and the protection of children and adolescents. In order to do so, the paper proposes some reflections about the main conceptual aspects of the mentioned categories, as well as of the reform of the State and networks of protection; based on Netto (2001), Pastorini (2010), Telles (1996, 1999), Amaro (2014), among others. The construction of this text enabled the comprehension of the relation of the "social issue" with capitalism and the contradictions involved in this process, and how the advance of neoliberalism has been going backwards concerning social rights which directly affect the protection of children and adolescents, as well as the rights of the working class in general

CONHECIMENTO SOBRE CONTRACEPÇÃO E FATORES ASSOCIADOS AO PLANEJAMENTO DE GRAVIDEZ NA ADOLESCÊNCIA

Objetivo: avaliar o conhecimento de adolescentes sobre práticas contraceptivas e sua associação com gravidez não planejada. Método: estudo transversal, desenvolvido com 258 adolescentes gestantes na Estratégia Saúde da Família, de Teresina-PI. A coleta de dados foi realizada nos meses de janeiro a julho de 2015. A identificação de associações realizou-se por meio do teste qui-quadrado, e a significância estatística foi de p<0,05. A força de associações entre as variáveis foi medida pelos odds ratio e intervalos de confiança (IC=95%). Resultados: a pesquisa mostrou que o baixo conhecimento das práticas contraceptivas está associado ao planejamento de gravidez, aumentando em 4,5% as chances de uma gravidez não planejada. Conclusão: o conhecimento não é o único fator responsável, mas contribui significativamente para o desfecho da gravidez não planejada, considerando que o fato de a adolescente não saber utilizar a pílula do dia seguinte aumenta em 3,93 vezes a chance de ter uma gravidez não planejada.Objetivo: evaluar el conocimiento de adolescentes acerca de prácticas contraceptivas y su asociación con gravidez no planeada.Método: estudio transversal, desarrollado con 258 adolescentes gestantes en la Estrategia Salud de la Familia, de Teresina-PI. Se recogieronlos datos en los meses de enero a julio de 2015. La identificación de asociaciones se realizó por medio del test chi cuadrado, y la significanciaestadística fue de p<0,05. La fuerza de asociaciones entre las variables fue medida por los odds ratio e intervalos de confianza (IC=95%).Resultados: la investigación apuntó que el poco conocimiento de las prácticas contraceptivas está asociado al planeamiento del embarazo,aumentando en 4,5% las chances de una gravidez no planeada. Conclusión: el conocimiento no es el único factor responsable, perocontribuye de modo significativo para el desenlace de la gravidez no planeada, considerando que el hecho de que la adolescente no sabeutilizar la píldora del día siguiente aumenta en 3,93 veces la chance de tener un embarazo no planeado.Objective: to evaluate the knowledge of adolescents regarding contraceptive practices and their association with unplannedpregnancies. Method: a cross-sectional study, developed with 258 pregnant adolescents in the Family Health Strategy of Teresina-PI. Datacollection was performed from January to July 2015. The associations were identified using the chi-square test, with statistical significancebeing p<0.05. The strength of associations between the variables was measured through odds ratios and confidence intervals (CI=95%).Results: the study showed that low knowledge of contraceptive practices was associated with pregnancy planning, increasing the chancesof an unplanned pregnancy by 4.5%. Conclusion: knowledge is not the only factor responsible, however, it contributes significantly to theoutcome of unplanned pregnancy, considering that when the adolescent did not know how to use the morning-after pill, the chance of havingan unplanned pregnancy increased by 3.93 times

Training of nurses in primary health of women

Objectives: To evaluate the influence of the nursing education process in primary care related to women's health. In addition, to analyze nursing training in primary care for women's health and as a National Policy for Comprehensive Care of Women's Health. Method: An exploratory study with 30 nurses from the Family Health Strategy. Data were generated through interviews, processed and analyzed in Alceste 4.8 by Descending Hierarchical Classification. Results: The data were presented as dendrogram classes: training at the graduate level to work in the area of women's health; the work of nurses in primary care to women's health; the Program for Integral Attention to Women's Health in primary care and continuing education of nurses in primary health care of women. Conclusion: Permanent education of nurses is necessary for the promotion healthcare and public policy on care for women

MORTALIDAD PERINATAL: UN ANÁLISIS CON ENFOQUE EN LA EVITABITABILIDAD

The study analyses the evitability of perinatal deaths in Piripiri in the state of Piauí in 2008 and considers its importance in the composition of infant mortality. Data for determining the coefficients of infant mortality were taken from the Ministry of Health’s ‘System for Information on Mortality’ and ‘System for Information on Live Births’. Death certificates and the files on perinatal deaths were also analysed. Data was grouped according to Wigglesworth’s evitability classification system, whose parameters are time of death, birth weight and basic cause. It is concluded that, despite the low Infant Mortality coefficient observed, perinatal mortality still represents a challenge for efforts to reduce infant mortality in the county, considering that 61.9% of perinatal deaths analysed appeared to have been evitable. This should serve as a stimulus to improvement in prenatal care, obstetric management and neonatal care.O estudo analisa a evitabilidade dos óbitos perinatais de Piripiri, Estado do Piauí, ocorridos em 2008 e sua importância para a composição da mortalidade infantil. Foram utilizados dados do Sistema de Informação sobre Mortalidade e do Sistema de Informação de Nascidos Vivos do Ministério da Saúde para a determinação dos coeficientes de mortalidade infantil, e analisadas as Declarações de Óbito e as fichas de investigação dos óbitos perinatais. Procedeu-se à classificação segundo os critérios de evitabilidade de Wigglesworth que tem como parâmetros o momento do óbito, o peso ao nascer e a causa básica. Concluiu-se que, apesar do baixo Coeficiente de Mortalidade Infantil observado, a mortalidade perinatal ainda representa um desafio à redução da mortalidade infantil no município, verificando-se que 61,9% dos óbitos perinatais analisados apresentaram-se como evitáveis, suscitando a necessidade de ações de melhoria na atenção pré-natal, manejo obstétrico e atendimento ao neonato.El estudio analiza la evitabilidad de los óbitos perinatales de Piripiri, estado de Piauí, ocurridos en 2008 y su importancia para la composición de la mortalidade infantil. Fueron utilizados datos del Sistema de Información sobre Mortalidad y del Sistema de Información de Nacidos Vivos del Ministerio de la Salud para determinación de los coeficientes de mortalidad infantil, y analizadas las Declaraciones de Óbito y las fichas de investigación de los óbitos perinatales. Se procedió a la clasificación de acuerdo a los criterios de evitabilidad de Wigglesworth, lo cual tiene como parámetros el momento del óbito, el peso al nacer y la causa básica. Se concluyó que, a pesar del bajo Coeficiente de Mortalidad Infantil observado, la mortalidad perinatal todavía representa un desafío a la reducción de la mortalidad infantil en el municipio, observándose que 61,9% de los óbitos perinatales analizados se presentaron como evitables, suscitando la necesidad de acciones de mejoría en la atención prenatal, manejo obstétrico y atendimiento al neonato

Permanent nursing education in family health strategy

Objective: to analyze the permanent education process of Nurses in the Family Health Strategy and its relationship with the quality of the care provided. Method: This is a qualitative research, carried out with 26 Nurses of Primary Healthcare Units. The data were collected from April to June 2012, by means of semi-structured interview, processed in Alcest 4.8 and analyzed by descending hierarchical classification. Results: They were presented in four classes, namely: the availability of nurses for trainings; the permanent education policy; the quality of nursing work and vocational training through the introductory course and specialization. Conclusion: The permanent education process of nurses in the Family Health Strategy depends on the Permanent Education Policy adopted in the municipality, with the training of nurses. The permanent education is directly related to the quality of care

Difficulties faced by nurses on the applicability of phytotherapy in the basic attention: an integrative review

Objective: Analyzing the articles available in the literature about difficulties found by nurses on the applicability of phytotherapy in Basic Care. Method: The integrative review was the method adopted. To searching for studies, the following databases were selected: PubMed, LILACS and Portal Capes. There were included seven studies. Results: The articles indicated the absence of planning at the implementation of phytotherapy and other integrative practices and a part of management and of the proper health team as the main difficulties found. Conclusion: It needs for investments by the part of the managers on the introduction of implementation programs of those integrative therapies and complementary, beyond training and formation of human resources in the área

SENTIMENTOS VIVENCIADOS POR MULHERES DURANTE TRABALHO DE PARTO E PARTO

Este estudo teve por objeto as percepções e sentimentos das mulheres durante o trabalho de parto e parto. Objetivou conhecer as vivências das parturientes/puérperas e discutir seus sentimentos no processo parturitivo. Utilizou-se para produção dos dados roteiro de entrevista semi-estruturado e observação participante. Os sujeitos do estudo totalizaram dez mulheres internadas numa maternidade pública de Teresina (PI), procedentes da referida cidade. As categorias emergentes das depoentes foram: percepção, sentimentos e experiências/ expectativas vivenciadas. Expressaram medo, ansiedade, alegria, tristeza e outros sentimentos. Referiram-se à carência de atendimento humanizado. Para elas, a experiência do parto foi traumática. Mostraram-se receptivas às orientações nos quatro períodos clínicos do parto e apontaram indicativos para melhorar o serviço de enfermagem junto à parturiente. Constatou-se a importância da assistência humanizada para a redução dos sentimentos negativos da parturiente

Contraception in adolescence: knowledge, chosen methods and criteria adopted

Objective: Analyzing the scientific production in the ten-year period related to knowledge about contraception in adolescence. Method: To reach the proposed objective we opted for the choice of the integrative review (RI). The search for primary studies took place in September 2014 and included 13 articles. Results: Studies have shown that most teens are aware only of the condom and oral and injectable contraceptives, also showing strong relationship between low education and the young age, with no use of the methods. Conclusion: Young people begin their sexual activity increasingly early, which has provided a gradual increase access and to the knowledge about contraceptive use. But still, there are many uncertainties in relation to contraceptive methods, requiring investments in sexual education of adolescents