O vínculo na atenção à saúde: revisão sistematizada na literatura, Brasil (1998-2007)*Bond in health care: a systematic review of literature in Brazil (1998Brazil ( -2007 El vínculo en la atención a la salud: revisión sistematizada en la literatura, Brasil (1998Brasil ( -2007 ABSTRACT Objective:To review the Brazilian scientific literature on bond in health care. Methods: The review was limited to the period from 1998 to 2007. A literature search was conducted in the LILACS and SciELO databases using the following key words: primary health care, acceptance, tuberculosis (indexed), bond, adhesion, health, basic care, continuity, and abandon (not indexed). Initially 50 publications were selected and categorized. Results: The findings suggest a greater interest on the topic after 2004. There was a predominance of publications on primary health care in journals that value community health. Conclusions: Bond was found to be an important factor in primary health care and led to better understanding of the real problems of the population receiving care in those services. In addition, bond facilitated the interactions between clients and health care professionals. Key Words: Primary health care; Scientific and technical publications; Professional-patient relations. RESUMENEl objetivo del estudio fue levantar producciones científicas brasileñas que se relacionaban con la dimensión vínculo en la atención primaria a la salud. El estudio abarcó el período de 1998 a 2007, a partir de las bases de datos LILACS y SciELO por medio de las palabras clave: atención primaria a la salud, acogimiento, tuberculosis (indexados), vínculo, adhesión, salud, atención básica, longitudinal y abandono (no indexados). Fueron seleccionadas 50 producciones que posteriormente fueron categorizadas. Los hallazgos mostraron que hubo un interés mayor por la temática después del año de 2004, predominando publicaciones en periódicos que valorizan la salud colectiva y estudios que se sitúan en el nivel primario de atención. Se entiende que el vínculo es un factor importante para la atención a la salud y tiende a mejorar el conocimiento de los reales problemas de la población atendida por los servicios, además de facilitar la relación de los usuarios con los profesionales que los atienden. Palabras clave: Atención primaria a la salud; Publicaciones científicas y técnicas; Relaciones profesional-paciente.

Estudo epidemiológico descritivo que analisa a coordenação da assistência ao doente de Tuberculose em Serviços de Atenção Primária segundo 23 doentes, 16 profissionais e 17 gestores em Ribeirão Preto-SP, através de instrumento adaptado para avaliar a tuberculose. De acordo com os informantes, a coordenação da assistência ao doente em tratamento pela equipe do programa de controle da tuberculose foi considerada satisfatória. No entanto, quando há necessidade de encaminhar o doente a outros pontos de atenção, a coordenação da assistência apresenta pontos deficientes como descontinuidade do fluxo de comunicação e participação incipiente do doente no processo de atenção, havendo necessidade de aumentar a responsabilização pelo cuidado do doente e estimulá-lo como agente ativo do processo.

RESUMOEste é um estudo exploratório de natureza quantitativa e qualitativa, que avalia o desempenho dos serviços de saúde na execução do DOT no domicílio em um município de grande porte. Para a análise quantitativa foram construídos indicadores que avaliaram a otimização dos recursos materiais/ humanos e a efetivação da observação da ingestão da medicação. Identificou-se que o desempenho dos serviços é influenciado pela disponibilidade de recursos humanos/ materiais, organização interna dos serviços e ausência do doente no domicílio. Para a análise qualitativa, utilizou-se a técnica de análise de conteúdo, modalidade temática. A Debilidade de recursos materiais e humanos dos serviços de saúde e o Contexto só-cio-cultural e econômico do doente foram identificados como os principais fatores que influenciam no desempenho dos serviços de saúde. Considera-se necessário uma permanente qualificação gerencial, organizativa e técnico-assistencial dos profissionais no controle da TB. DESCRITORESTuberculose. Terapia diretamente observada. Serviços de assistência domiciliar. Avaliação de serviços de saúde. ABSTRACTExploratory study of qualitative and quantitative nature that evaluates the performance of the health services in providing DOT in households of a big city in Brazil. For the quantitative analysis, indexes were created to evaluate the optimization of material/human resources and the observation of the medicine ingestion. It was observed that performance of services is influenced by the availability of human/material resources, the internal organization of services and the absence of the ill person in the household. For the qualitative analysis it was used the content analysis, thematic modality. The main factors influencing the performance of the health service were found to be its insufficiency of material and human resources and the ill person's socialcultural and economic context. Concluding, it is necessary permanent managerial, organizational and techno-assistance qualification of the health professionals in the TB control. KEY WORDSTuberculosis. Directly observed therapy. Home care services. Health services evaluation. RESUMENEstudio exploratorio de tipo cuantitativo y cualitativo, que evalúa el desempeño de los servicios de salud al realizar el DOT en el domicilio en una ciudad grande. Para el análisis cuantitativo fueron construidos indicadores que evalúan la optimización de los recursos materiales/humanos y la observación de la ingestión de los medicamentos. Se identificó que el desempeño es influenciado por la disponibilidad de recursos humanos/materiales, organización interna de los servicios y la ausencia del enfermo en el domicilio. Para el análisis cualitativo, se utilizó la técnica de análisis de contenido por temática. La Debilidad en cuanto a recursos materiales y humanos en los servicios de salud y el Contexto sociocultural y económico del enfermo fueron identificados como principales factores que influyen en el desempeño de los servicios de salud. Es importante una permanente calificación gerenc...

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To evaluate, from the patient's perspective, actions of orientation for the community and community participation carried out in tuberculosis control in health services in Ribeirão Preto -SP. This was an evaluative quantitative exploratory study which used part of the Primary Care Assessment Tool, adapted and validated for tuberculosis care, applied through interview, with 100 patients. Indicators of the instrument and analysis of variance were used. The realization of social partnerships for delivery of the sputum pot together with the community, the delivery of the sputum pot to the community by professionals, and the participation of the community to discuss the problem of tuberculosis were identified, 5%, 6% and 5%, respectively. The health services with fewer patients in treatment showed the best indicators. The actions of social partnerships, searching for respiratory symptomatics in the community and community participation in tuberculosis control are poorly incorporated by health services. Descriptors Control de la tuberculosis: percepción de los enfermos sobre orientación a la comunidad y participación comunitariaEl objetivo de este estudio fue evaluar, bajo la perspectiva de los enfermos, las acciones de orientación para la comunidad y la participación comunitaria, realizadas en el control de la tuberculosis en servicios de salud de Ribeirao Preto, Sao Paulo. Se trata de una investigación de evaluación cuantitativa exploratoria que utilizó parte del Primary Care Assessment Tool, adaptado y validado para la atención a la tuberculosis, aplicado por medio de entrevista a 100 enfermos. Fueron utilizados indicadores del instrumento y el análisis de la variancia. Fueron identificadas: la realización de alianzas sociales para obtener el pote para recolección de esputo junto a la comunidad (5%); la entrega del pote para recolección de esputo en la comunidad por los profesionales (6%); y, la participación de la comunidad en la discusión del problema de la tuberculosis (5%).Los servicios de salud con menor número de enfermos en tratamiento presentaron los mejores indicadores. Se concluye que las alianzas sociales, la búsqueda de sintomáticos respiratorios en la comunidad y, la participación de la comunidad en el control de la tuberculosis son poco incorporadas por los servicios de salud.

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OBJECTIVE: to propose a discussion about traces of the derivation of meanings, the subjects' discomfort and resistance when they are called upon to signify a questionnaire on the transfer of the Directly Observed Treatment of Tuberculosis policy, in order to reveal the limitations of closed questionnaires in the subject's interpretation process. METHOD: health professionals from a Primary Health Care Unit in Porto Alegre/RS were interviewed and some excerpts from the interviews were investigated in the light of French Discourse Analysis. RESULTS: resistance, discomfort, slips, silencing and the derivation of meanings were observed in the subjects' interpretation. CONCLUSION: the interpretation process has multiple meanings and varies from subject to subject. The questionnaire, as a prototype of the logically stabilized universe, fails when the purpose is to control the interpretation. Its isolated use in health research can entail inexactness or incompleteness of the collected data. Therefore, its use associated with qualitative research techniques is ideal.

This qualitative study was conducted using discourse analysis, the objective of which was analyzed the reports of different level managers regarding policy transfer of Directly Observed Treatment (DOT) in the control of tuberculosis. This analysis starts with the context of macro-political decisions in the micro-political context and the local setting was the city of Ribeirão Preto, SP, Brazil, considered a priority in the control of the disease. Four managers involved with the DOT policy at the state, regional, and city levels and another manager in the intermediate level between region and city were interviewed after signing consent forms. Data were collected from August to December 2013. The interviews were recorded, transcribed, respecting it in its entirety. The study's corpus was composed of excerpts, discursive formations and linguistics marks, which were selected from the participants' reports according to the guiding question. Analysis was based on the French theoretical-methodological framework of Discourse Analysis, which in turn is grounded on three theoretical aspects: the Historical Materialism, Linguistics and Psychoanalysis. An exhaustive horizontal analysis, or an analysis that encompasses the entire extent of the research's object, is not intended in this type of analysis because the topic is not exhausted and discourses are always instituted in relation to others. The objective is to be supported in vertical exhaustiveness to contemplate the objective of the study and the topic under study. Data were organized under policy transfer' and tuberculosis' thematic axis, which indicate different effects of meanings during DOT policy transfer, such as muting, blanking, polyphony, polysemy, and contradictions during this policy transfer process at the different levels of management, which gradually moved from an authoritative transfer to a voluntary transfer, from a higher political instance to a lower one. Nonetheless, this process was not completed in the city because the paradigm decentralizing TB actions from Primary Health Care (PHC) was not overcome.