Humanização dos serviços de saúde: avanços, paradoxos e desafios

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas, Programa de Pós-Graduação em Sociologia Política, Florianópolis, 2015.Este trabalho refere-se ao estudo dos avanços, paradoxos e desafios da Política Nacional de Humanização na atenção e gestão dos serviços de saúde encontrados nos discursos dos consultores dessa política e dos trabalhadores e gestores do SUS de Januária - MG. Através das entrevistas foi possível identificar: 1) a polissemia que o termo humanização assume nos territórios reforça uma concepção romântica e desloca a perspectiva apresentada pela Política Nacional de Humanização, sendo necessário, portanto, uma ressignificação do termo para que o movimento da humanização das práticas de atenção e gestão seja desviado de uma possível idealização do humano e passe a ser compreendido como um processo de caráter instituinte e que se constrói coletivamente através da inclusão dos diferentes sujeitos envolvidos na produção de saúde; 2) a lógica hegemônica de produção de saúde encontra-se alicerçada num modelo autoritário e não favorece a democratização institucional; 3) as instituições formadoras reiteram o modelo biomédico e exclui a produção de subjetividades do processo de produção de saúde; 4) os consultores percebem uma tensionalidade entre a lógica da PNH e o modo de fazer das outras políticas de saúde. Sobre este último item, percebemos que essa incongruência faz com que os gestores de saúde encontrem pouca ou nenhuma correspondência entre a PNH e as demais políticas do MS e, como consequência, a gestão tende a concentrar os seus esforços prioritariamente nos aspectos quantitativos da produção de saúde em detrimento da qualidade dos processos e da valorização do trabalho e do trabalhador. Concluímos com esse trabalho que embora a força instituinte da PNH seja uma ferramenta precípua para a defesa do SUS, ainda é necessária uma articulação mais fortalecida com as demais políticas públicas de saúde e um esforço multissetorial para fortalecer a humanização nos mais diversos e singulares territórios, fomentando nos gestores e trabalhadores do SUS um modo mais reflexivo e cogerido de executar as políticas de saúde.Abstract : This work refers to the study of the advances, paradoxes and challenges of the Humanization National Policy in care and management of health services found in the speeches of consultants from this policy, workers and managers from SUS at Januária - MG. Through this interview was possible to identify: 1) The polysemy from the term humanization assumed on the territory reinforces a romantic conception and deviates from the perspective presented by the Humanization National Policy, being necessary, then, to reframe the term so the care and management practices from the humanization movement is diverted from a possible idealization of human and starts to be comprehended as an establishing character process that is collectively build thorough the inclusion of different individuals involved in the health production; 2) The health production hegemonic logic lies in an authoritarian model and does not help institutional democratization; 3) The institutions formed reinforce the biomedical model and excludes the subjectivities production of the health production process; 4) The consultants notice a tension between the Humanization National Policy logic and the way to perform the other health policies. About the last item, we noticed that this inconsistency leave the health managers with little or none correspondence between Humanization National Policy and the other Ministry of Health policies and, as a consequence, the management tends to focus its efforts in quantitative aspects of health production impairing the process quality and the work and worker valuation. We conclude with this work, although the Humanization National Policy establishing force is the main tool for the SUS defense, that it is still needed some powerful articulation with other health public policies and a multisectoral effort to strengthen the humanization in unique and many other territories, promoting in SUS managers and workers a reflexive and co-managed way to perform health policies

Obesidade abdominal e fatores associados em comunidades quilombolas do Norte de Minas Gerais, 2019

Objective: to analyze the prevalence of abdominal obesity and associated factors in quilombola communities in Northern Minas Gerais, Brazil. Methods: cross-sectional study conducted in 2019 based on structured interviews and measurement of waist circumference; Poisson regression, separated by sex, was used to calculate prevalence ratios (PR) of abdominal obesity adjusted by independent variables and a 95% confidence interval (CI95%). Results: 56.6% (CI95% 50.9;62.0) had abdominal obesity. In the adjusted analysis, among men there was an association of the outcome with age ≥60 years (60-69 years: PR=2.52 – CI95% 1.33;4.75), non-smokers (PR=1.73 – CI95% 1.17;2.55), and hypertension (PR=1.42 – CI95% 1.11;1.80); in women, the outcome was associated with age ≥50 years (50-59 years: PR=1.25 – CI95% 1.01;1.54), ex-smokers (PR=1.26 – CI95% 1.00;1.58), consumption of chicken with skin (PR=1.09 – CI95% 1.00;1.19), and hypertension (PR=1.22 – CI95% 1.11;1.36). Conclusion: the prevalence of abdominal obesity was high among quilombolas, and it was higher in the elderly, hypertensive, smokers and ex-smokers.Objetivo: analisar a prevalência de obesidade abdominal e fatores associados em comunidades quilombolas do Norte de Minas Gerais, Brasil. Métodos: estudo transversal realizado em 2019, sobre entrevistas estruturadas e mensuração do perímetro da cintura; empregou-se regressão de Poisson, separada por sexo, para calcular razões de prevalências (RP) da obesidade abdominal ajustada pelas variáveis independentes e intervalo de confiança de 95% (IC95%). Resultados: 56,6% (IC95% 50,9;62,0) dos quilombolas observados apresentaram obesidade abdominal; na análise ajustada, entre homens, verificou-se associação do desfecho com idade de ≥60 anos (60-69 anos: RP=2,52 – IC95% 1,33;4,75), não ser tabagista (RP=1,73 – IC95% 1,17;2,55) e referir hipertensão arterial (RP=1,42 – IC95% 1,11;1,80), enquanto nas mulheres, associou-se com idade ≥50 anos (50-59 anos: RP=1,25 – IC95% 1,01;1,54), ex-tabagismo (RP=1,26 – IC95% 1,00;1,58), consumo de frango com pele (RP=1,09 – IC95% 1,00;1,19) e hipertensão (RP=1,22 – IC95% 1,11;1,36). Conclusão: encontrou-se prevalência de obesidade abdominal alta entre os quilombolas, maior nos idosos, hipertensos, fumantes e ex-fumantes

A violência sexual contra crianças e adolescentes: atuação do enfermeiro em sua prática profissional.

The sexual barbarity faced in childhood is identified as an obstacle in public health and a factor that causes numerous complications in the personal, family and social life of the victim; covering psychological, legal, social aspects causing traumas for the entire experience. Nursing is of utmost importance in preventive and educational actions, as well as in the suspicion of what has happened. Therefore, the article aims to identify sexual violence against children and adolescents, recognizing the role of nurses in their professional practice. This is an integrative bibliographic analysis with a qualitative approach, through bibliographic searches in the bases of BVS-BIREME, LILACS, SciELO and BDENF, and analysis of studies published in full, from 2017 to 2022, free in Portuguese, English and Spanish, which have in their title the health descriptors related to the theme. The research used for the preparation of this article demonstrate the assistance and care of nurses aimed at victims, describing their attributions and interventions in professional practice as well as possible complications and related diagnoses. It is concluded that nursing has an incisive role in the detection of such occurrences. However, to implement an effective performance and offer an adequate and efficient service, nurses must be trained for this purpose.A barbaridade sexual enfrentada na infância é identificada como um obstáculo na saúde pública e um fator que ocasiona inúmeras complicações na vida pessoal, familiar e social da vítima; abrangendo aspectos psicológicos legais, sociais ocasionando traumas para toda vivência. A enfermagem é de suma importância nas ações preventivas, educativas e da suspeita do ocorrido. Portanto, o artigo objetiva identificar a violência sexual contra crianças e adolescentes, reconhecendo a atuação do enfermeiro na sua prática profissional. Discorre de uma análise bibliográfica integrativa com abordagem qualitativa, por intermédio de buscas bibliográficas referentes nas bases da BVS-BIREME, LILACS, SciELO e BDENF, e análise dos estudos publicados na íntegra, de 2017 a 2022, gratuitos na língua portuguesa, inglesa e espanhola, que tem em seu título os descritores em saúde relacionados à temática. As pesquisas utilizadas para a elaboração deste artigo demonstram a assistência e os cuidados do enfermeiro voltado às vítimas, descrevendo as suas atribuições e intervenções no exercício profissional bem como possíveis complicações e diagnósticos relacionados. Conclui-se que a enfermagem tem um papel incisivo na detecção de tais ocorrências. Contudo, para implementação de uma atuação eficaz e ofertar um serviço adequado e eficiente, o enfermeiro deve capacitar-se para essa finalidade

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Humanização dos serviços de saúde

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas, Programa de Pós-Graduação em Sociologia Política, Florianópolis, 2015.Este trabalho refere-se ao estudo dos avanços, paradoxos e desafios da Política Nacional de Humanização na atenção e gestão dos serviços de saúde encontrados nos discursos dos consultores dessa política e dos trabalhadores e gestores do SUS de Januária - MG. Através das entrevistas foi possível identificar: 1) a polissemia que o termo humanização assume nos territórios reforça uma concepção romântica e desloca a perspectiva apresentada pela Política Nacional de Humanização, sendo necessário, portanto, uma ressignificação do termo para que o movimento da humanização das práticas de atenção e gestão seja desviado de uma possível idealização do humano e passe a ser compreendido como um processo de caráter instituinte e que se constrói coletivamente através da inclusão dos diferentes sujeitos envolvidos na produção de saúde; 2) a lógica hegemônica de produção de saúde encontra-se alicerçada num modelo autoritário e não favorece a democratização institucional; 3) as instituições formadoras reiteram o modelo biomédico e exclui a produção de subjetividades do processo de produção de saúde; 4) os consultores percebem uma tensionalidade entre a lógica da PNH e o modo de fazer das outras políticas de saúde. Sobre este último item, percebemos que essa incongruência faz com que os gestores de saúde encontrem pouca ou nenhuma correspondência entre a PNH e as demais políticas do MS e, como consequência, a gestão tende a concentrar os seus esforços prioritariamente nos aspectos quantitativos da produção de saúde em detrimento da qualidade dos processos e da valorização do trabalho e do trabalhador. Concluímos com esse trabalho que embora a força instituinte da PNH seja uma ferramenta precípua para a defesa do SUS, ainda é necessária uma articulação mais fortalecida com as demais políticas públicas de saúde e um esforço multissetorial para fortalecer a humanização nos mais diversos e singulares territórios, fomentando nos gestores e trabalhadores do SUS um modo mais reflexivo e cogerido de executar as políticas de saúde.<br>Abstract : This work refers to the study of the advances, paradoxes and challenges of the Humanization National Policy in care and management of health services found in the speeches of consultants from this policy, workers and managers from SUS at Januária - MG. Through this interview was possible to identify: 1) The polysemy from the term humanization assumed on the territory reinforces a romantic conception and deviates from the perspective presented by the Humanization National Policy, being necessary, then, to reframe the term so the care and management practices from the humanization movement is diverted from a possible idealization of human and starts to be comprehended as an establishing character process that is collectively build thorough the inclusion of different individuals involved in the health production; 2) The health production hegemonic logic lies in an authoritarian model and does not help institutional democratization; 3) The institutions formed reinforce the biomedical model and excludes the subjectivities production of the health production process; 4) The consultants notice a tension between the Humanization National Policy logic and the way to perform the other health policies. About the last item, we noticed that this inconsistency leave the health managers with little or none correspondence between Humanization National Policy and the other Ministry of Health policies and, as a consequence, the management tends to focus its efforts in quantitative aspects of health production impairing the process quality and the work and worker valuation. We conclude with this work, although the Humanization National Policy establishing force is the main tool for the SUS defense, that it is still needed some powerful articulation with other health public policies and a multisectoral effort to strengthen the humanization in unique and many other territories, promoting in SUS managers and workers a reflexive and co-managed way to perform health policies

Scaling up of Eco-Bio-Social Strategy to Control Aedes aegypti in Highly Vulnerable Areas in Fortaleza, Brazil: A Cluster, Non-Randomized Controlled Trial Protocol

Aedes aegypti is a cosmopolitan vector for arboviruses dengue, Zika and chikungunya, disseminated in all Brazilian states. The Eco-Bio-Social (EBS) strategy is vital in Aedes aegypti control as it mobilizes stakeholders (government, professionals, society, and academics) to promote healthy environments. This paper describes the rationale and methods of expanding the EBS strategy for Aedes aegypti control in Fortaleza, Northeast Brazil. A cluster, non-randomized controlled clinical trial was developed to analyze the strategy&rsquo;s effectiveness in vulnerable territories (high incidence of dengue and violent deaths; low HDI; substandard urban infrastructure, high population density, and water scarcity). We selected two intervention and two control groups, resulting in a sample of approximately 16,000 properties. The intervention consisted of environmental management by sealing large elevated water tanks, introduction of beta fish in waterholes, elimination of potential breeding sites, and mobilization and training of schoolchildren, endemic disease workers, health workers, social mobilizers, and community leaders; community surveillance of arboviruses; construction and validation of a booklet for the prevention of arboviruses in pregnant women. We analyzed the costs of arboviruses to government and households, the intervention cost-effectiveness, chikungunya&rsquo;s chronicity, and acceptance, sustainability, and governance of vector control actions. The primary outcome (infestation) was analyzed using the house, container, and Breteau indices. We hope that this study will help us understand how to scale up strategies to fight Aedes aegypti in vulnerable areas

Efficacy and safety of HD-tDCS and respiratory rehabilitation for critically ill patients with COVID-19 The HD-RECOVERY randomized clinical trial.

Acute Respiratory Distress Syndrome (ADRS) due to coronavirus disease 2019 (COVID-19) has been associated with muscle fatigue, corticospinal pathways dysfunction, and mortality. High-Definition transcranial Direct Current Stimulation (HD-tDCS) may be used to attenuate clinical impairment in these patients. The HD-RECOVERY randomized clinical trial was conducted to evaluate the efficacy and safety of HD-tDCS with respiratory rehabilitation in patients with moderate to severe ARDS due to COVID-19. Fifty-six critically ill patients were randomized 1:1 to active (n = 28) or sham (n = 28) HD-tDCS (twice a day, 30-min, 3-mA) plus respiratory rehabilitation for up to 10 days or until intensive care unit discharge. The primary outcome was ventilator-free days during the first 28 days, defined as the number of days free from mechanical ventilation. Furthermore, secondary outcomes such as delirium, organ failure, hospital length of stay and adverse effects were investigated. Active HD-tDCS induced more ventilator-free days compared to sham HD-tDCS. Patients in the active group vs in the sham group experienced lower organ dysfunction, delirium, and length of stay rates over time. In addition, positive clinical response was higher in the active vs sham group. There was no significant difference in the prespecified secondary outcomes at 5 days. Adverse events were similar between groups. Among patients with COVID-19 and moderate to severe ARDS, use of active HD-tDCS compared with sham HD-tDCS plus respiratory rehabilitation resulted in a statistically significant increase in the number of ventilator-free days over 28 days. HD-tDCS combined with concurrent rehabilitation therapy is a safe, feasible, potentially add-on intervention, and further trials should examine HD-tDCS efficacy in a larger sample of patients with COVID-19 and severe hypoxemia