Basic Family Health Unit Research Articles

Percursos e obstáculos na Rede de Atenção à Saúde: trajetórias assistenciais de mulheres em região de saúde do Nordeste brasileiro

The article aims to assess organization and access to the Healthcare Network in a health region, from the perspective of female users. Healthcare trajectories were constructed for women with high-grade cervical squamous intraepithelial lesions, covered by different modalities of primary health care (PHC) in urban and rural areas, in municipalities in the interior, and in the capital city of the Northeast health region, Brazil. Women used PHC as their regular service for prevention and care, but reported barriers to access to medical appointments, especially in rural areas. Positive assessments were associated with positive reception by the health service and representation of the basic health unit or family health unit as the available locus for care. A perception of low case-resolution capacity in PHC was associated with delays in scheduling referrals, irregular/insufficient supply of medicines, and physician turnover. Women reported difficulty in access to specialized care, especially in municipalities in the interior, with the use of public and private services. All the users in the capital city of the health region underwent confirmatory diagnostic tests and surgeries in the Brazilian Unified National Health System (SUS). Support from family members, friends, and local politicians were part of the healthcare trajectories. Interprofessional communication was nearly non-existent and health professional-patient communication was precarious. The regionalized network appeared disconnected and with confusing flows in terms of guaranteeing timely access for users in municipalities in the interior and with additional difficulties for those in rural areas, even in the capital city, revealing incompleteness in regional arrangements and persistence of inter- and intra-municipal inequalities in access.

Access by lesbians, gays, bisexuals and transvestites/transsexuals to the Basic Family Health Units

Objective: to understand the access of lesbians, gays, bisexuals and transvestites/transsexuals to the Basic Family Health Units. Methods: qualitative research held with 54 patients. A semi-structured interview and the free association test were used. The data were processed by the software IRaMuTeQ® and submitted to the technique of Content Analysis in the thematic modality. Results: six categories emerged: Silencing regarding sexual orientation and gender identity – access is facilitated as they do not reveal themselves; Invisibility and indifference to legal political references - antagonism between the paradigm thought and executed; Homophobic manifestations and effects on access - restricted use of the service; Embarrassment and distancing - removal and search for private services; Des (humanized) and unethical practices - lack of awareness, secrecy; and Stigma and access - permanence of stigmata between Acquired Immunodeficiency Syndrome and homosexuality. Conclusion: the access to health services is limited with intolerance, constraints, exclusionary and aerial positions.

Prevalence of anemia and correlation between the concentration of hemoglobin and cognitive factors among the elderly

The scope of this study was to determine the prevalence of anemia and the correlation between the concentration of hemoglobin and cognitive factors in an elderly population group resident in Campina Grande, Paraiba, Brazil. It was a cross-sectional study with individuals aged 60 or older. Men with hemoglobin levels <13 g / dL and women with levels <12 g / dL were considered anemic. Sociodemographic, cognitive condition and nutritional status variables were analyzed. Statistical analysis was performed by means of simple and multiple linear regression. Among the 360 elderly patients evaluated (67.2% women), the prevalence of anemia was 12.5%. The average concentration of hemoglobin found was 13.5 g / dL and was correlated to sex variables (β = -0.44, 95% CI: -1.35, -0.85), age (β = -0.14 ; 95% CI: -0.03, -0.01), nutritional status (β = 0.16; 95% CI: 0.01, 0.06), memory impairment (β = 0.12; 95% CI: - 0.06, -0.01), and dementia (β = -0.13, 95% CI: -0.06, -0.01). Routine blood testing among the elderly makes it possible to detect and treat anemia at an early stage. Actions geared towards the elderly who show a cognitive decline should be developed in the Basic Family Health Units in order to improve the quality of life of this population.

Living Style of Diabetic Patients Type 2

Introduction: Due to the aging process, there are disabling chronic diseases that have gained greater evidence in the public health scenario. Among them is diabetes mellitus (DM), which is one of the most common chronic diseases among the elderly. Life style is an important determinant of glycemic control in type 2 diabetic patients. Objectives: To describe the lifestyle of type 2 diabetic patients treated at the Family Health Basic Unit III, in the city of Santa Cecilia-PB. Methodology: Descriptive study, population composed of 55 diabetics, adults, type 2, data collected from a pre-structured interview. Results and Discussion: 56% female, 44% male, 29% have good eating habits, 8% practice regular physical exercises, 75% are overweight, 20% are medicated. The World Health Organization considers that the diet of the diabetic is one of the factors responsible for keeping the glycemic levels within desirable limits. The survey found that only 29% of those involved have a proper diet with a very low index. Many studies suggest that sedentarism favored by modern life is a risk factor as important as inadequate diet in the etiology of obesity and has a direct and positive relationship with the increased incidence of DM 2 in adults. The practice of physical exercise for people living with diabetes is very low. Only 8% reported regular exercise. Conclusion: It is important to emphasize that glycemic control depends, in addition to drug therapy, on changes in lifestyle. Since 90% of respondents said they had good adherence to drug treatment. It is necessary to implement strategies that seek to raise awareness about the importance of lifestyle change.

Profile of users followed in a basic family health unit hospitalized due to chronic non-communicable diseases

Profile of users followed in a basic family health unit hospitalized due to chronic non-communicable diseases

PERFIL DE SAÚDE DOS IDOSOS ATENDIDOS NAS UNIDADES BÁSICAS DE SAÚDE DA FAMÍLIA (UBSF) EM ITUIUTABA, MINAS GERAIS

Introduction: The aging process is characterized by biological changes that occur throughout life. These changes can cause diseases or organic dysfunctions, in which Chronic Non-communicable Diseases (DCNT) stand out. Objective: Considering the importance of DCNT, the study identified the socioeconomic and demographic profiles of the elderly assisted at Family Health Basic Units (UBSF) in the municipality of Ituiutaba/MG. Material and methods: A descriptive cross-sectional study was carried out on 149 elderly people assisted in 11 UBSF, who were interviewed through a semi-structured questionnaire. Results: Their mean age was 70 years old, most of them were of the female gender, literate and with up to four years of study. Approximately 90% of the elderly reported the use of allopathic drugs, 47% used herbal medicines and 19.5% used herbal medicines. Only 14.7% of the elderlies reported the concomitant use of these three treatment modalities. Most of the interviewees used 2 to 4 allopathic medications (51.7%). Regarding the self-reported diseases, the most prevalent diseases were those from the circulatory system (75.8%), especially hypertension (72.5%), as well as musculoskeletal system diseases (41.6%) and diabetes mellitus (39.9%). Conclusion: According to the data obtained, it was possible to perform a diagnosis of the elderly assisted at the UBSF of Ituiutaba/MG. These data are essential for the implementation of public, social and educational policies directed to this population, in order to meet the socio-economic and behavioral needs, aiming to promote a healthy and active aging.

&lt;b&gt;Nutritional status of children under five years living in area of social vulnerability of Campina Grande, Paraíba State

The nutritional status of children under five years living in an area of social vulnerability and its association with personal and socioeconomic characteristics are evaluated by a cross-sectional study conducted at the Basic Family Health Units (I and II) of the Mutirao district in Campina Grande PB Brazil. Current study included 76 families with under-five-year-old children and any former collector of recyclable materials from the Campina Grande landfill. The nutritional status of children was analyzed by weight / age (W/A), height / age (H/A) and weight / height (W/H) indexes to determine their anthropometric deviations and etiological analyses with children´s socioeconomic characteristics. Prevalence of 6.6% in weight deficit and 19.7% in height deficit were reported. Multivariate linear regression analysis revealed that W/A, H/A and W/H indexes were negatively influenced in cases of children born with low birth weight, in children who had diarrhea during the last 15 days prior to the interview and those who had protozoan parasites during the same period. Height and weight deficits were the most common nutritional disorders. Results emphasize the need to carry out periodic assessments of children´s nutritional status featuring health and socioeconomic characteristics of vulnerability.

O Papel Transformador do Estudante de Medicina no Cenário da Endemia de Hanseníase no Brasil: Relato de Experiência

RESUMO Durante o Internato em Saúde da Comunidade, os acadêmicos de Medicina vivenciaram uma experiência em que foi possível desenvolver habilidades e atitudes na resolução de um caso de diagnóstico tardio de hanseníase. Trata-se de um estudo descritivo de abordagem qualitativa, envolvendo uma Unidade Básica de Saúde da Família em Campo Grande (MS) e a Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul. O acompanhamento desta paciente permitiu reflexões e aprendizado quanto à necessidade de realizar exame físico e, com base em protocolos para diagnóstico e tratamento da hanseníase, assegurar o acompanhamento e seguimento de um caso que permaneceu por mais de dois anos sem tratamento apesar dos evidentes sinais clínicos da doença. Por outro lado, o analfabetismo, a ocupação e o espaço geográfico da paciente contribuíram para o agravamento do quadro. Este estudo de caso favoreceu uma visão ampliada da formação de profissionais, que praticaram a integração dos diferentes campos de conhecimento para garantir a assistência integral à paciente.

Sociodemographic Characteristics Related to Resistance to Breast Cancer Screening

Objective: To describe the sociodemographic characteristics of women related to resistance to breast cancer. Methods: Cross-sectional study, with a quantitative approach, whose research took place in the Basic Family Health Units of the municipality of Mossoró. The study included 362 women aged between 40 and 69 years. One used a validated questionnaire with questions divided into five blocks. The data were entered in a spreadsheet, transferred to the SPSS software, and subsequently coded to perform the analysis. The Research Ethics Committee of the State University of Rio Grande do Norte, in Opinion No. 356958, approved the project. Results: Black women were two times more likely to be resistant when compared to white women (OR = 2.01, 95% CI = 1.12 - 3.69; p = 0.018). Women who have studied up to primary school 122 (58.1%) were two times more likely to be resistant when compared to those 14 (6.7%) who studied up to higher education (OR = 2.69; 95% CI = 1.31 - 5.48; p = 0.012). Women who had first-degree relatives with breast cancer 153 (72.9%) were three times more likely to be resistant. Conclusions: The findings show the need for investments in educational practices with a view to public awareness and professionals’ training to disseminate information regarding tests used in practice directed to women’s health.

Assistência pré-natal: ações essenciais desenvolvidas pelos enfermeiros

Objetivo: Investigar el perfil, el conocimiento y la práctica de las enfermeras que trabajan la atención prenatal de bajo riesgo.&lt;br /&gt;Métodos: Estudio cuantitativo, descriptivo, transversal realizado en las Unidades Básicas de Salud Familiar Campina Grande / Paraíba, Brasil. Se incluyeron quince UBSF’s del distrito sanitario I de Campina Grande, totalizando 15 enfermeros que respondieron a un cuestionario. La colecta de datos se llevó a cabo entre marzo y junio de 2013. El análisis de datos se realizó de forma manual, en mapa resumen, según la población estudiada y posteriormente se analizaron mediante estadística descriptiva y organizados en gráficosy tablas de frecuencias absoluta y relativa.&lt;br /&gt;Resultados: Se puede considerar satisfactoria la atención prenatal realizada por los enfermeros, ya que además de los procedimientos y las pruebas de rutina, se observó que también llevan a cabo los procedimientos y pruebas consideradas como complementaria, de acuerdo con el Ministerio de Salud&lt;br /&gt;Conclusión: Es necesario proporcionar un mayor número de orientación con respecto al uso de métodos anticonceptivos tras el periodo gestacional. Se revela también la necesidad de estudios de evaluación de la calidad y el impacto de la atención prenatal realizados por enfermeros especializados en la reducción de la morbilidad y mortalidad materna y neonatal en el municipio, este enfoque sería de gran importancia para la consolidación de una práctica exitosa en Campina Grande.&lt;br /&gt;&lt;br /&gt;

Assistência pré-natal e peso ao nascer: uma análise no contexto de unidades básicas de saúde da família

To characterize prenatal care and to evaluate the association of its adequacy with maternal, socioeconomic and environmental sanitation characteristics, as well as the influence of these factors on the birth weight of the children. The eligible population for the study consisted of all women who had children during 2009 and lived in the city of Queimadas at the time of data collection. Information was collected with a questionnaire applied to the mothers in Family Health Basic Units or in their residence. The prenatal care adequacy index (outcome variable) was defined as adequate when the mother attended six or more prenatal visits and began monitoring during the first trimester of pregnancy (<20 weeks). Hierarchical logistic regression was performed to estimate the odds ratios for inadequate prenatal care and a multiple linear regression model was used to estimate the effect of adequacy of prenatal care and maternal, socioeconomic and environmental sanitation variables on birth weight. The statistical program used was Rv2.10.0, with the level of significance set at p <5%. Of a total of 199 women studied, 78.4% were classified as having received adequate prenatal care. After adjustment for other predictors, maternal age of 19 years or less remained as an explanatory variable of inadequate prenatal care (OR 4.27, 95%CI 1.10 - 15.89). Even after controlling for variables, child's birth weight was negatively associated with water supply from a well/spring and burnt/buried garbage, accounting for weight reductions of the order of 563.8, 262.0 and 951.9 g, respectively. Adequate prenatal care can alleviate the influence of socioeconomic disparities related to health care. Even in this situation, teenage mothers are more likely to receive inadequate prenatal care and low birth weight is favored by improper sanitation conditions (such as water supply and garbage disposal).

Accessibility of hypertensive users to health units and treatment adherence

We aimed to analyze the accessibility of hypertensive users to the health system with focus on treatment adherence. A cross-sectional study with quantitative approach was conducted in four Family Health Basic Units of Fortaleza-CE, Brazil. The sample consisted of 400 users. Data collection happened through a form applied from May to August 2011. About 97.5% of users were older than 40 years, and 67.2% were female. The accessibility to the referral service occurred in 47.2% of users to secondary care, of which 101 (25.2%) were referred to Emergency Units, and 88 (22.0%) were admitted to Inpatient Units. Most hypertensive patients adhered to healthy habits, except the use of dietetic sweeteners (36.0%) and physical exercise (35.0%). The hypertensive patients had good treatment adherence and difficulty in accessibility regarding counter-referral services to secondary and tertiary care services.

Educação em saúde com adolescentes: compartilhando vivências e reflexões

This is a report of an educational experience with adolescents, resultant from the partnership between School and Family Health Basic Unit that develops Health and Prevention Projects in Schools as a field of action and research of the Educational Program for Health Work in Maracanau-CE, Brazil. The purpose was to describe experiences of health education in two meetings, with 16 school adolescents from 13 to 19 years of age, with the problem axis pregnancy and contraceptive methods. The meetings were guided by the theoretical framework of culture circle proposed by Paulo Freire. Ludic and constructive tools, facilitating the reflection and construction of knowledge among professionals and students were used. The adolescents denied the possibility of pregnancy as real and relevant in life, and demonstrated knowledge on contraceptive methods. There is an urgent need to strengthen preventive actions regarding information on sex and reproduction among adolescents, as well as encourage the autonomy of these individuals in the social family context. The educational proposal in a problematical perspective was configured as a key strategy to involve adolescents in the theme discussion and knowledge appropriation.

Hipertensão comunicada e hipertensão compreendida: saberes e práticas de enfermagem em um Programa de Saúde da Família de Fortaleza, Ceará

The scope of the study was to examine the communication practices of nurses in consultation of arterial hypertension in the Family Health Program in Fortaleza, Ceará, revealing the elements that cause asymmetry of power between nurses and the hypertensive individuals verbal expression. The theoretical references are Critical Discourse Analysis and Pragmatics. This is an exploratory descriptive and qualitative study, in which participant observation was conducted in a Basic Family Health Unit. The following discourses arose: the nurse as conductor of the interaction with verbal and nonverbal discursive commands; the hypertensive subject as subjugated by the nurse; the nurse as an articulated instrument that communicates a body of social practice; the body of the hypertensive person as a tool that supports an imaginary power load; the interaction between nurse and the hypertensive person in a one-sided situation, obliging the hypertensive individual to obey orders. The relationship between the nurse and the hypertensive person develops asymmetrically, built on symbolic materials of social practices under the legitimacy of the paradigm of current Nursing Consultation in our society.

Receptiveness to the teenager in nursing consultation - a qualitative study

Aim: To understand the relationship of nurses with the teenage mother in childcare consultation under the approach of the receptiveness. Method: A qualitative study was conducted from February to May 2011 in a Family Health Basic Unit of Fortaleza-CE, using systematic observation and semi-structured interview. Attended by five nurses and three teenage mothers who accompanied their children on this service. The information gathered from the interviews was subjected to content analysis from Bardin, from which emerged the categories: Receptiveness and listening; Reception ambience. Results: The receptiveness for the subject brings the significance of listening, responsiveness and includes forms of service organization engaging nurses. Discussion: The receptiveness, listening and reception ambience are important aspects of attention. Conclusion: Listening is a tool that nurses use to realize the receptiveness to the teenage mother to da �; dЂ�q�.

Cobertura do citopatológico do colo uterino em Unidades Básicas de Saúde da Família

To evaluate the coverage of Pap smear cytology at Basic Family Health Units (BFHU) and to describe the characteristics of non-performance of this test in the last three years. A cross-sectional study was conducted in Rio Grande (RS), Brazil, in areas covered by the Family Health Teams Family (FHT). The interviews were conducted by students participating in the Health-PET, at women's home. Crude analysis was performed using SPSS software to calculate prevalence ratio, 95% confidence intervals and p value. Multivariate analysis was performed by Poisson regression using Stata 9.0 software, which were included the variables with p value of up to 0.20 in the crude analysis. At the first level, the variables were age, having a partner, and literacy. At the second level, the variables were number of visits and offer of a Pap smear. The prevalence of Pap cytology performed 36 months ago or less was 66.3%. In adjusted analysis, women aged 19 years or less (p<0.001), without a partner (p<0.001), illiterate (p= 0.01), who had never consulted at the basic unit (p=0.02) and who had not been offered the examination during the visit (p=0.006), were more likely not to have had a cytopathology exam in the last 36 months. The local health proved to be ineffective and inequitable. Ineffective because it covers fewer women than indicated by the World Health Organization and uneven because access to this test varied according to some characteristics of the users.

Planejamento familiar: significado para mulheres em idade reprodutiva

The study sought to comprehend the significance of family planning from the standpoint of women of reproductive age and identify their perceptions about the care received and the partner's participation in the decisions about the use of contraceptive methods. It is a descriptive study using a qualitative approach, conducted with 24 women who participated in the Family Planning program in a Basic Family Health Unit in Fortaleza, State of Ceará, Brazil, between August and October 2007. The information gleaned from interviews was recorded, organized into themes and analyzed on the basis of the concept of significance of symbolic interactionism. The results revealed three significant themes: the significance of family planning from the viewpoint of women of fertile age; interactions of women of fertile age in a family planning service; and male participation in family planning in terms of female significance. It was revealed that the significance of family planning for these women is related to avoiding pregnancy and according to values pertaining to their cultural, economic and social reality. The care is received in an isolated manner, without prioritizing women's needs and without input of an educational or empowerment stamp.

Prevalência de transtornos mentais não-psicóticos e fatores associados em pessoas com hipertensão arterial sistêmica e/ou diabetes mellitus em Unidades de Saúde da Família em Blumenau, Santa Catarina

Objective: Evaluate the prevalence of non-psychotic mental disorders (NPMD) and associated factors in people with hypertension and/or diabetes from family health units in Blumenau, Santa Catarina, Brazil. Methods: Cross-sectional study, conducted in Blumenau, with 710 selected users, after probability sampling, and stratified by conglomerates, from family health basic units. Those selected were submitted to a questionnaire at home by trained interviewers and answered questions about socioeconomic, personal characteristics and medicines. The instrument used to screen NPMD was the Self-Report Questionnaire-20 (SRQ-20). The variables were submitted to univariate and multivariate analysis and other statistical tests appropriate to each variable studied. Results: The prevalence of NPMD was 39.44%. Factors associated with NPMD after multivariate analysis were: female (RP=1.50, 1.12-2.01CI 95%, p&lt;0.01), use of psychotropic drugs (RP=1.74, 1.34-2.26 CI 95%, p &lt;0.00 ), hospitalization and/or show the emergency medical services in the last year (RP=1.30, 1.02-1.66CI 95%, p&lt;0.03) and E class of consumption in the Associação Brasileira de Empresas de Pesquisa (ABEP, in English Brazilian Association of Market Research Companies) classification (RP=2.62, 1.09-6.27CI 95%; p&lt;0.03). Conclusions: The high incidence of NPMD, mostly related to women and to people with lower socioeconomic conditions, raises an organized and effective intervention, while the appropriate treatment of base disease and early detection of NPMD mean better use of public health resources.

Prevalência de transtornos mentais não-psicóticos e fatores associados em pessoas com hipertensão arterial sistêmica e/ou diabetes mellitus em Unidades de Saúde da Família em Blumenau, Santa Catarina

Objective: Evaluate the prevalence of non-psychotic mental disorders (NPMD) and associated factors in people with hypertension and/or diabetes from family health units in Blumenau, Santa Catarina, Brazil. Methods: Cross-sectional study, conducted in Blumenau, with 710 selected users, after probability sampling, and stratified by conglomerates, from family health basic units. Those selected were submitted to a questionnaire at home by trained interviewers and answered questions about socioeconomic, personal characteristics and medicines. The instrument used to screen NPMD was the Self-Report Questionnaire-20 (SRQ-20). The variables were submitted to univariate and multivariate analysis and other statistical tests appropriate to each variable studied. Results: The prevalence of NPMD was 39.44%. Factors associated with NPMD after multivariate analysis were: female (RP=1.50, 1.12-2.01CI 95%, p&lt;0.01), use of psychotropic drugs (RP=1.74, 1.34-2.26 CI 95%, p &lt;0.00 ), hospitalization and/or show the emergency medical services in the last year (RP=1.30, 1.02-1.66CI 95%, p&lt;0.03) and E class of consumption in the Associação Brasileira de Empresas de Pesquisa (ABEP, in English Brazilian Association of Market Research Companies) classification (RP=2.62, 1.09-6.27CI 95%; p&lt;0.03). Conclusions: The high incidence of NPMD, mostly related to women and to people with lower socioeconomic conditions, raises an organized and effective intervention, while the appropriate treatment of base disease and early detection of NPMD mean better use of public health resources.

Prevalência de transtornos mentais não-psicóticos e fatores associados em pessoas com hipertensão arterial sistêmica e/ou diabetes mellitus em Unidades de Saúde da Família em Blumenau, Santa Catarina

Objetivo: Avaliar a prevalência de transtornos mentais não psicóticos (TMNP) e fatores associados em pessoas hipertensas e/ou diabéticas oriundas de Unidades de Saúde da Família de Blumenau, Santa Catarina. Métodos: Trata-se de um estudo transversal com 710 usuários de Unidades da Saúde da Família de Blumenau selecionados após amostragem probabilística, estratificada e por conglomerados. Os selecionados foram submetidos a um questionário domiciliar por entrevistadores treinados e responderam questões pertinentes a características socioeconômicas, pessoais e de medicamentos. O instrumento utilizado para o rastreamento de TMNP foi o Self-Report Questionnaire-20 (SRQ-20). As variáveis estudadas foram submetidas à análise uni e multivariada além de outros testes estatísticos adequados a cada uma delas. Resultados: A prevalência de TMNP encontrada foi de 39,44%. Fatores associados com TMNP, após analise multivariada, foram: sexo feminino (RP= 1,50; 1,12-2,01 IC95%; p&lt;0,01), uso de psicotrópicos (RP=1,74; 1,34-2,26 IC95%; p&lt;0,00), hospitalização e/ou comparecimento ao pronto-socorro no último ano (RP=1,30; 1,02-1,66 IC95%; p&lt;0,03) e classe de consumo E da classificação da Associação Brasileira de Empresas de Pesquisa (ABEP) (RP=2,62; 1,09-6,27IC95%; p&lt;0,03). Conclusões: A grande prevalência de TMNP, relacionados principalmente às mulheres e às pessoas em condições sociais desfavoráveis, suscita uma intervenção organizada e efetiva, enquanto o tratamento adequado da doença de base e a detecção precoce dos TMNP implicariam melhor uso dos recursos de saúde pública.