The corporal practices and the \"amplified clinic\": physical education in primary health care

Nos últimos anos tem sido possível observar o aumento das experiências relacionadas à implementação de práticas corporais/atividade física no âmbito dos serviços de saúde, como uma estratégia voltada à ampliação dos níveis de saúde da população, especialmente em função de três iniciativas do Ministério da Saúde: a Política Nacional de Promoção da Saúde (PNPS), a criação do Núcleo de Apoio à Saúde da Família (NASF) e o Programa Academia da Saúde. No entanto, ainda que possam ser identificados avanços no desenvolvimento destas experiências, torna-se evidente o desafio apresentado aos profissionais da Educação Física no tocante à produção de ações condizentes com as necessidades de saúde dos sujeitos no âmbito da na atenção básica, sobretudo considerando o distanciamento entre formação e intervenção e também o modo de intervir tradicional/reduzido sobre o processo saúde-doença-intervenção nesta área específica. Sob esta perspectiva impõe-se a pertinência de uma reorientação teórico-metodológica que contribua para potencializar o trabalho com as práticas corporais, visando à saúde da população em perspectiva ampliada. É neste contexto que se insere o presente estudo, que teve como objetivo implementar um projeto de intervenção de práticas corporais para usuários do Centro de Saúde Escola (CSE) Geraldo Horácio de Paula Souza, da Faculdade de Saúde Pública da USP, para a experimentação da teoria da Clínica Ampliada, a fim de contribuir com o debate sobre a qualificação das ações dos profissionais de Educação Física no serviço público de saúde. A abordagem era de natureza qualitativa, fundamentada no Método da Roda, metodologia voltada à reformulação teórico-conceitual e organizacional do trabalho em saúde, utilizando como instrumentos a observação participante e as narrativas. A intervenção, aberta a diferentes faixas etárias, gêneros e estados clínicos, ocorreu por meio de encontros semanais realizados no período de um ano e contou com 51 sujeitos. Os encontros privilegiaram a oferta de atividades em sintonia com as necessidades, desejos e interesses que emergiam do contato com o grupo, utilizando como recursos de intervenção as práticas corporais e as rodas de conversa entre os participantes do grupo e os profissionais do CSE. A experiência no CSE Paula Souza mostrou que a teoria da Clínica Ampliada permite a produção de práticas de saúde para além da perspectiva hegemônica da Educação Física, mas também que é premente continuar avançando na formação dos profissionais da área, considerando o desafio de propor ações que dialoguem com as necessidades de saúde das pessoas e que sejam coerentes com os princípios do SUSIn recent years it has been possible to observe an increase in the number of experiences related to the introduction of corporal practices/physical activity in the context of health services, as a strategy aimed towards the improvement of the populations health, notably as a consequence of three initiatives of the Brazilian Ministry of Health: the National Policy for Health Promotion (PNPS), the establishment of the Support Centers for Family Healthcare (NASF) and the Academy of Health Program. However some progress may be perceived in the development of these experiments, it is evident the challenge presented to Physical Education professionals regarding the production of interventions consistent with the health needs of individuals in the context of primary health care, especially considering the gap between the professional education and the intervention, but also the traditional/reduced modes of intervention on the health-disease-intervention process in this particular field. From this perspective a theoretical-methodological shift imposes its pertinence, one that contributes to potentiate the work with corporal practices, aiming the populations health in an amplified perspective. It is in this context that the present study was conducted with the purpose of implementing an intervention project of corporal practices for the users of the Health School Center (CSE) Geraldo Horácio de Paula Souza, of the Faculty of Public Health of the University of São Paulo, to experience the Amplified Clinic\" theory in order to contribute to the debate on the qualification of the contribution of physical education professionals in the public health service. The approach was qualitative in nature, based on Method of the Wheel, a methodology focused on theoretical, conceptual and organizational reformulation of healthcare work, using tools such as participant observation and narratives. The intervention, open to people of different ages, genders and clinical states, occurred through weekly meetings held throughout one year and included 51 subjects. The meetings concentrated on the provision of activities in line with the needs, desires and interests that emerged from contact with the group, using as intervention tools the corporal practices and the \"wheels of discussion\" among group members and professionals of the CSE. The experience in the CSE showed that the theory of Amplified Clinic allows the production of health practices beyond the hegemonic perspective of physical education, but it showed also that it is urgent to continue advancing in the professional training in this field, considering the challenge of proposing actions that communicate with the health needs of the people while being consistent with the principles of the Brazilian Unified Health System (SUS

Caminos de la integralidad: adolescentes y jóvenes en la Atención Primaria de Salud

Adolescentes e jovens constituem importante desafio para a construção da integralidade na Atenção Primária à Saúde (APS). Isso se deve à complexa apreensão e resposta ao conjunto de suas necessidades de saúde, decorrentes do processo de crescimento e desenvolvimento, próprio da fase, mas, sobretudo, dos aspectos socioculturais relacionados. O presente estudo buscou reconhecer alcances e limites em como o princípio da integralidade vem sendo operado em uma Unidade Básica de Saúde. Embora tenha sido possível identificar uma efetiva percepção da especificidade necessária à atenção à saúde desse grupo, também se verificaram importantes limitações relacionadas à construção de projetos de cuidado capazes de integrar as diversas finalidades do trabalho no cotidiano da Unidade, com destaque para a insuficiência de interações profissionais e setoriais, e fragilidades na comunicação de profissionais entre si e de profissionais e usuários

Profile of Brazilian smokers in the National Program for Tobacco Control

Objective:The treatment of tobacco addiction in Brazil has expanded in recent years; however, we must increase knowledge about the characteristics of individuals who adhere to cessation programs in order to adjust treatments to specific characteristics of the target population that favor success. The aim of this study was to describe the characteristics of smokers who present to Brazilian public health units seeking help to quit smoking based on the experience of a primary health care unit that covers a poor community in the city of Rio de Janeiro.Methods:Data were collected at a Teaching Health Center from January 03 2012 to January 03 2014.Results:Mean patient age was 49.32±11.82 years, and 71% were women. About half of the participants successfully quit smoking (n=125, 51%). Higher levels of nicotine dependence were associated with lower levels of smoking cessation. There was a notable decrease in the probability of remaining smoking throughout the first month of treatment. After 3 weeks of treatment, only 19% had not quit smoking. The probability of quitting smoking decreases by 2% for every additional year of age.Conclusion:There is a need to revise and expand current strategies to make them more effective in preventing smoking since childhood

Transcatheter Aortic Valve Replacement: The Experience of One Brazilian Health Care Center

Abstract Objective: Transcatheter aortic valve replacement has been an alternative to invasive treatment for symptomatic severe aortic stenosis in high risk patients. The primary endpoint was 30-day and 1-year mortality from any cause. Secondary endpoints were to compare the clinical and echocardiographic variation pre-and post- transcatheter aortic valve replacement, and the occurrence of complications throughout a 4-year follow-up period. Methods: This prospective cohort, nestled to a multicenter study (Registro Brasileiro de Implante de Bioprótese por Cateter), describes the experience of a public tertiary center in transcatheter aortic valve replacement. All patients who underwent this procedure between October 2011 and February 2016 were included. Results: Fifty-eight patients underwent transcatheter aortic valve replacement. The 30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10). A significant improvement in New York Heart Association functional classification was observed when comparing pre-and post- transcatheter aortic valve replacement (III or IV 84.4% versus 5.8%; P<0.001). A decline in peak was observed (P<0.001) and mean (P<0.001) systolic transaortic gradient. The results of peak and mean post-implant transaortic gradient were sustained after one year (P=0.29 and P=0.36, respectively). Left ventricular ejection fraction did not change significantly during follow-up (P=0.41). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (27.6%) and acute renal injury (20.6%). Conclusion: Mortality and complications in this study were consistent with worldwide experience. Transcatheter aortic valve replacement had positive clinical and hemodynamic results, when comparing pre-and post-procedure, and the hemodynamic profile of the prosthesis was sustained throughout follow-up