Abstract

ObjectiveTo evaluate the implementation of a programme to provide primary care physicians for remote and deprived populations in Brazil.MethodsThe Mais Médicos (More Doctors) programme was launched in July 2013 with public calls to recruit physicians for priority areas. Other strategies were to increase primary care infrastructure investments and to provide more places at medical schools. We conducted a quasi-experimental, before-and-after evaluation of the implementation of the programme in 1708 municipalities with populations living in extreme poverty and in remote border areas. We compared physician density, primary care coverage and avoidable hospitalizations in municipalities enrolled (n = 1450) and not enrolled (n = 258) in the programme. Data extracted from health information systems and Ministry of Health publications were analysed.FindingsBy September 2015, 4917 physicians had been added to the 16 524 physicians already in place in municipalities with remote and deprived populations. The number of municipalities with ≥ 1.0 physician per 1000 inhabitants doubled from 163 in 2013 to 348 in 2015. Primary care coverage in enrolled municipalities (based on 3000 inhabitants per primary care team) increased from 77.9% in 2012 to 86.3% in 2015. Avoidable hospitalizations in enrolled municipalities decreased from 44.9% in 2012 to 41.2% in 2015, but remained unchanged in control municipalities. We also documented higher infrastructure investments in enrolled municipalities and an increase in the number of medical school places over the study period.ConclusionOther countries having shortages of physicians could benefit from the lessons of Brazil’s programme towards achieving universal right to health.

OBJECTIVE: To estimate the incidence of congenital syphilis and identify its relationship with Family Health Strategy coverage. METHODS:An observational ecological study was carried out with both descriptive and analytical components, by two different approaches: one that explores a temporal series (2003 to 2008) RESULTS:Increasingly trends of congenital syphilis notifi cation in Brazil refl ect social inequalities in the distribution of cases. The incidence of congenital syphilis was lower in the municipalities with high Family Health Strategy coverage; however, after controlling for the co-variables, such an effect might be attributed to the coverage of prenatal care and the demographic characteristics of the municipalities where the implementation of the Strategy was a priority. CONCLUSIONS:Despite the increase in prenatal care coverage, the actions implemented still exhibit low effectiveness in the prevention of congenital syphilis. Prenatal care performed by Family Health Strategy teams did not control syphilis better than the prenatal care performed within the context of other models of assistance.

The objective of this study was to identify and analyze work accidents as well the activities in which the nursing workers are exposed to. This is a study case, descriptive and exploratory, developed in a University Hospital in the Brazilian Federal District. It was done a survey on work accidents registered in SESMT and CCIH, from January 1998 to December 2002 and is was also identified work activities related to these accidents. We could noticed that the workers suffered 76 accidents. From those accidents 83.95% happened due to sharpened materials; 8.64% due to falls; 6.17% due to exposition to biological fluids and 1.24% due to injuries. The diversity and simultaneity of the work activities contribute to the occurrence of the work accidents.

O estudo teve como objetivo identificar e analisar as principais modificações que ocorrem no modo de vida do portador de estomia intestinal definitiva e as principais estratégias desenvolvidas para enfrentar a situação de ser estomizado. O método utilizado foi a história oral de vida tópica. As histórias foram obtidas de dez entrevistas semi-estruturadas com portadores de estomia intestinal definitiva. Utilizou-se a técnica de análise de conteúdo, especificamente, a temática. Da análise, emergiram cinco temas: a experiência de deparar-se com os sinais e sintomas da doença e necessidade de realização da estomia; o aprendizado de conviver com a estomia, o equipamento coletor e a busca de alternativas para suprir o uso do equipamento coletor; o enfrentamento das mudanças no modo de alimentar-se, vestir-se e vivenciar a sexualidade; a busca da reinserção social, o desafio de enfrentar a morte e a procura de perspectivas futuras; a busca da rede de apoio: crenças religiosas e espirituais, família e associação dos estomizados.

The purpose of this qualitative study, based on the Theory of Social Representations, was to identify and analyze what kind of representations and feelings are experienced and what kind of defense mechanisms are developed by nursing workers who deal with patients'dying process. The data were collected starting from semi-structured interviews held with four technicians and twelve nursing auxiliaries who work in Intensive Care Units, and were analyzed by the contents analysis technique, more precisely, the thematic analysis. Results showed that nursing workers suffer terribly when they take care of patients who are about to die. To deal with daily suffering, they use either individual or collective strategies and defense mechanisms, such as denial, new routines, isolation.

O estudo teve como objetivos analisar as representações sociais das gestantes acerca da gestação e a atenção recebida na consulta de enfermagem do pré-natal. Foram realizadas entrevistas semi-estruturadas com quinze gestantes, que foram analisados com o auxílio do software ALCEST. Identificaram-se três eixos temáticos: a vivência da gravidez, constituída pelas classes: o impacto e as mudanças provocadas pela gravidez, as orientações recebidas sobre a gravidez com as classes percepção da consulta de enfermagem e do planejamento familiar e os cuidados com o bebê com as classes como cuidar do recém nascido e como garantir uma boa amamentação. A consulta de enfermagem abarca as dimensões psicossociais dos cuidados com a gestante e com recém-nascido.

O presente estudo teve por objetivo explicitar e compreender as Representações Sociais das enfermeiras acerca do trabalho em Unidade de Terapia Intensiva (UTI) e os modos de expressão do sofrimento e do prazer ligados a esse trabalho. Foram realizadas entrevistas com seis enfermeiras das UTIs de Clínicas Médica, Cirúrgica e Pediátrica de uma instituição de ensino. A análise dessas representações possibili tou a apreensão da dimensão simbólica do trabalho, nos âmbitos: psicossocial (individual), sociodinâmico (grupo) e institucional (instituição).Constatamos também que o trabalho na UTI proporciona prazer às enfermeiras, apesar do desgaste emocional ser intenso. Este estudo permitiu ampla reflexão sobre a problemática e evidenciou a necessidade de aprofundar o estudo na dimensão subjetiva e simbólica que este trabalho compreende, como um ponto importante na administração de recursos humanos em enfermagem.