Racial disparities and maternal mortality in Brazil: findings from a national database.

OBJECTIVE: To assess maternal mortality (MM) in Brazilian Black, Pardo, and White women. METHODS: We evaluated the maternal mortality rate (MMR) using data from the Brazilian Ministry of Health public databases from 2017 to 2022. We compared MMR among Black, Pardo, and White women according to the region of the country, age, and cause. For statistical analysis, the Q2 test prevalence ratio (PR) and confidence interval (CI) were calculated. RESULTS: From 2017 to 2022, the general MMR was 68.0/100,000 live births (LB). The MMR was almost twice as high among Black women compared to White (125.81 vs 64.15, PR = 1.96, 95%CI:1.84-2.08) and Pardo women (125.8 vs 64.0, PR = 1.96, 95%CI: 1.85-2.09). MMR was higher among Black women in all geographical regions, and the Southeast region reached the highest difference among Black and White women (115.5 versus 60.8, PR = 2.48, 95%CI: 2.03-3.03). During the covid-19 pandemic, MMR increased in all groups of women (Black 144.1, Pardo 74.8 and White 80.5/100.000 LB), and the differences between Black and White (PR = 1.79, 95%CI: 1.64-1.95) and Black and Pardo (PR = 1.92, 95%CI: 1.77-2.09) remained. MMR was significantly higher among Black women than among White or Pardo women in all age ranges and for all causes. CONCLUSION: Black women presented higher MMR in all years, in all geographic regions, age groups, and causes. In Brazil, Black skin color is a key MM determinant. Reducing MM requires reducing racial disparities.

[Working Education Program in Health: transforming experience of nursing teaching and practice]. / Programa de Educação pelo Trabalho para Saúde: experiência de transformação do ensino e prática de enfermagem.

This is an experience report of tutors from nursing Working Education Program in Health ( PET- Saúde ) from the Federal University of Alagoas, from May 2009 to April 2010. The objective of the nursing PET-Saúde was to develop health education actions aimed at the needs of the communities attended by the Family Health Units in Maceio, Alagoas. We conducted a health planning guided by the problem-based methodology. The activities resulted in changes in student learning and in the practice of nurses PET-Saúde , indicating the importance of this program for teaching and practice of nursing.

Street Clinics and the Healthcare of Vulnerable Homeless Communities in Brazil: A Qualitative Study.

(1) Background: homeless people are characterized by serious social vulnerability and difficulty in accessing health services worldwide. In Brazil, this population is supported by the Street Clinic teams who are challenged to establish intersectoral networks to expand access and promote unique and humanized care from the perspective of harm reduction. The study aimed to analyze the practices of professionals working at the Street Clinic in a city in the interior of São Paulo, Brazil, to tackle the vulnerabilities of the homeless population and expand access to the health care network. (2) Methods: a qualitative study was conducted with a social approach in which we interviewed eight workers from the Street Clinic. Data were analyzed using the thematic content analysis tool. (3) Results: three nuclei of meaning were built: stigma and prejudice as the main barriers to accessing services, harm reduction as a humanized care practice and valuing autonomy, and Street Clinic as a gateway to the health system and main interlocutor with other services. (4) Conclusions: the articulation with network services is marked by contradictory relationships, of conflict and trust, signaling the need for greater investment in educational qualifications and working conditions for professionals at all levels of care to expand access to health care.

Gender debate as a challenge in nursing training.

OBJECTIVES: to understand the challenges of introducing gender debate in nursing training from undergraduate students' perspective. METHODS: a qualitative, exploratory-explanatory study. Data were collected through a semi-structured interview applied to 12 undergraduate nursing students at a public university in São Paulo. For data treatment and analysis, the Discourse of the Collective Subject was used in light of Boaventura de Sousa Santos' knowledge production paradigm theoretical framework. RESULTS: nursing education remains centered on the traditional scientific model, neglecting gender and strengthening stereotypes aimed at the feminization of the profession. FINAL CONSIDERATIONS: nursing training has a challenge of implementing actions that deepen the gender theme. Therefore, some strategies are suggested, such as improving professor training and appropriating emancipatory pedagogical practices; reviewing pedagogical political projects; curriculum theorization and restructuring; problematizing gender issues for nursing leadership.

Historical and social construction of the practices of auxiliary nurses and nurse technicians in Primary Care.

OBJECTIVES: to analyze the practices of nursing auxiliaries and technicians in the context of Primary Health Care in a city in the interior of the state of São Paulo. METHODS: transversal, quantitative study, realized with 104 nursing auxiliaries and 46 nursing technicians acting in the Primary Attention. The data, collected using structured questionnaires, are presented by descriptive statistics, and analyzed based on the essential elements of First Contact and Longitudinality. RESULTS: the professionals were, majority, women, married, with children, low political and collective participation. We identified thirteen activities related to the First Contact: and ten on Longitudinality. CONCLUSIONS: the insertion and capillarization of auxiliary and nursing technicians' practices show these professionals as the main ones responsible for the first contact in this context, highlighting their relevance in the longitudinality of care and the work composition of health teams, contributing to the consolidation of the Unified Health System (SUS).

Planning, construction and use of handmade simulators to enhance the teaching and learning in Obstetrics.

METHOD: to describe the development process and present the results of a pilot study on the use of low-cost handmade simulators for teaching and learning Obstetrics.presentation of 3 low-cost simulators designing, based on educational needs identified in real-world training contexts. The developing process is presented in detail and each simulator was tested and re-tested, being submitted to improvements until their final version. The simulators presented are: delivery simulator shorts, Neoprene uterus for postpartum hemorrhage management, and perineal repair simulator. A pilot study was carried out to evaluate the perception of apprentices through a structured questionnaire, using the Kirkpatrick evaluation model. Data were descriptively analyzed. RESULTS: the respondents (31 apprentices) positively evaluated the simulators, perceiving significant gains in theoretical knowledge, ability to solve clinical problems and decreased anxiety to deal with situations similar to those simulated. CONCLUSION: low-cost, handmade simulators are feasible and effective, resulting in positive learner evaluations. Their availability as open technology allows the dissemination of their use.

Nurses' work at Family Health Strategy: possibilities to operate health needs.

OBJECTIVES: to identify and analyze possibilities for recognizing health needs in the nurses' work at Family Health Strategy. METHODS: a qualitative study with interviews and observation of the nurses' work in the countryside of São Paulo. The empirical material was subjected to thematic content analysis and interpreted in the light of the health work process. RESULTS: two themes emerged: Possibilities utilized and Possibilities neglected to recognize health needs. Careful observation, welcoming, attention, listening, bonding and dialogue developed by nurses, in live work in action with users, touched on the possibilities, which, taken advantage of, were evidenced in care in spontaneous demand, scheduled consultation, examination gynecological and group activities. FINAL CONSIDERATIONS: nurses are able to recognize health needs, which can expand their clinical practice and interprofessionality in Family Health.

Racial disparities and maternal mortality in Brazil: findings from a national database

ABSTRACT OBJECTIVE To assess maternal mortality (MM) in Brazilian Black, Pardo, and White women. METHODS We evaluated the maternal mortality rate (MMR) using data from the Brazilian Ministry of Health public databases from 2017 to 2022. We compared MMR among Black, Pardo, and White women according to the region of the country, age, and cause. For statistical analysis, the Q2 test prevalence ratio (PR) and confidence interval (CI) were calculated. RESULTS From 2017 to 2022, the general MMR was 68.0/100,000 live births (LB). The MMR was almost twice as high among Black women compared to White (125.81 vs 64.15, PR = 1.96, 95%CI:1.84-2.08) and Pardo women (125.8 vs 64.0, PR = 1.96, 95%CI: 1.85-2.09). MMR was higher among Black women in all geographical regions, and the Southeast region reached the highest difference among Black and White women (115.5 versus 60.8, PR = 2.48, 95%CI: 2.03-3.03). During the covid-19 pandemic, MMR increased in all groups of women (Black 144.1, Pardo 74.8 and White 80.5/100.000 LB), and the differences between Black and White (PR = 1.79, 95%CI: 1.64-1.95) and Black and Pardo (PR = 1.92, 95%CI: 1.77-2.09) remained. MMR was significantly higher among Black women than among White or Pardo women in all age ranges and for all causes. CONCLUSION Black women presented higher MMR in all years, in all geographic regions, age groups, and causes. In Brazil, Black skin color is a key MM determinant. Reducing MM requires reducing racial disparities.

Prevalence of sexually transmitted infections and bacterial vaginosis among lesbian women: systematic review and recommendations to improve care.

Our aim was to systematically review data about the risk of sexually transmitted infections (STI) and bacterial vaginosis among lesbian women and to suggest strategies to improve prevention, diagnosis and treatment. A search strategy for lesbian, STI and bacterial vaginosis was applied to PubMed, LILACS and BDENF databases. Of 387 unique references retrieved, 22 fulfilled the inclusion criteria (cross-sectional studies reporting prevalence for 8 STIs/bacterial vaginosis and history of a STI). The most frequent infection reported was bacterial vaginosis, and none study reported data on hepatitis B. A wide range of prevalence was observed for most infections. In terms of risk factors, the number of sexual partners, the past or current smoking, a history of forced sex and sexual stigma seem to increase the risk of STI and bacterial vaginosis. The findings of this review are discussed considering guidelines directly addressing the LGBT community's health and relevant studies investigating both safe sexual practices and the intricate relationship between LGBT people and their care providers. A set of recommendations to improve preventive care for lesbian women is proposed. Affirming that little is known about the extent of STIs and bacterial vaginosis transmission in female-to-female sexual activities or about the risk factors for STI and bacterial vaginosis among lesbian women is reasonable. In fact, the overall quality of the studies was low or very low with significant uncertainty around their findings. However, we consider that the available knowledge indicates some paths to be followed by care providers and policy decision-makers to improve their actions towards better sexual health of lesbian women.

[Work process in Family Health Program: the potential of subjectivity of care for reconfiguration of the care model]. / Processo de trabalho na Estratégia de Saúde da Família: potencialidades da subjetividade do cuidado para reconfiguração do modelo de atenção.

This is a study with a qualitative approach that aims to analyze the subjective dimension of the Family Health teams' practices conducted in order to reconfigure the care model, using the work process in health as the fundamental analytical category from the Marxist standpoint. The data gathering tool used was the focus group, applied in 13 Family Health teams in Maceió, Alagoas. Thematic analysis combined with principles of hermeneutics and dialectics was used for treatment and interpretation of the data. The results indicate that the user´s needs identified by the teams are multiple and permeated by a lack of sympathetic care, and that the user repeatedly wishes to be "heard." The teams show that they are open to the use of soft technologies of compassionate care, although they do not legitimate them as instruments of their work. Clinical knowledge and techniques are prioritized in the work process, which limits the potential of its subjective dimension in order to (re)configure a care model which attends the user´s needs and is sustained by integrated care.

Estudo de abordagem qualitativa com objetivo de analisar a potencialidade da dimensão subjetiva das práticas de equipes de Saúde da Família para reconfiguração do modelo de atenção, utilizando como referencial teórico-metodológico o processo de trabalho em saúde na perspectiva marxista. Teve como instrumento de coleta de dados o grupo focal, realizado em 13 equipes de Saúde de Família de Maceió, Alagoas. A análise temática, combinada a princípios da hermenêutica e dialética, foi utilizada no tratamento e interpretação dos dados. Os resultados apontam que as necessidades de saúde identificadas pelas equipes são múltiplas e permeadas pela carência afetiva do usuário que busca recorrentemente ser "ouvido". As equipes mostram-se abertas para o território das tecnologias leves de acolhimento, embora não as legitimem como instrumentos do seu trabalho. Saberes e tecnologias da clínica médica continuam sendo privilegiados no processo de trabalho, limitando a potencialidade de sua dimensão subjetiva para (re)configuração de um modelo que atenda as necessidades de saúde e ampare-se na integralidade da atenção.

Challenges and potentialities of nursing work in street medical offices.

OBJECTIVE: to analyze elements of the nursing work process in the Street Medical Offices, highlighting the challenges and potentialities of care for homeless people. METHOD: this is an exploratory research of qualitative nature supported by the perspective of the health work process. The study was conducted through semi-structured interviews with nurses from the teams of the street medical offices at the city of Maceió and data were analyzed according to the content analysis technique, approaching issues related to the object, instruments and purposes of the nursing work process. RESULTS: the identified themes were: Need for health care in the context of social and health vulnerability; Strategic planning and teamwork as tools for organizing the work process; Purposes and products of work: guaranteeing the right to access and care. . Before a work object designed by serious health needs resulting from the social vulnerability of this population, nurses use different instruments in their work process: strategic planning, acting in multiprofessional team and valorization of the light technologies of reception and bonding. CONCLUSION: apart from the difficulties, the study presents a successful experience that explores the potentiality of sharing relationships of humanized care.

Uso de Audit and Feedback: lições de uma pesquisa de implementação / Uso de Audit and Feedback: lecciones de una investigación de implementación / Use of the Audit and Feedback: lessons from an implementation study

Resumo Objetivo Avaliar, a partir do discurso de profissionais da Atenção Básica, como o uso da estratégia Audit and Feedback contribuiu para geração de tensão por mudança na implementação de apoio matricial em um município paulista de médio porte. Métodos Estudo qualitativo, realizado por meio da análise da transcrição de Grupos de Apreciação Partilhada que empregaram a estratégia Audit and Feedback junto a cinco equipes de Atenção Básica em um município paulista de médio porte entre dezembro de 2019 e março de 2020. Para análise dos dados foi empregada análise de conteúdo que utilizou como categorias previamente definidas os desfechos de implementação: aceitabilidade, adequação e adoção, entendidos como principais desfechos relacionados à tensão por mudanças. Resultados As falas dos profissionais que participaram dos grupos em que foi empregada a estratégia Audit and Feedback permitiram identificar a geração de tensão por mudança produzida a partir dos dados que lhe foram apresentados. Indicativos de aceitabilidade, adequação e adoção em relação ao apoio matricial foram evidenciados, sugerindo assim a contribuição da estratégia empregada para o sucesso da implementação. Conclusão A estratégia Audit and Feedback se mostrou efetiva na geração de tensão por mudança, favorecendo assim o reconhecimento da necessidade da intervenção e consequentemente facilitando a sua implementação.

Resumen Objetivo Evaluar, a partir del discurso de profesionales de la Atención Básica, de qué forma el uso de la estrategia Audit and Feedback contribuyó para la generación de tensión por cambio en la implementación de apoyo matricial en un municipio del estado de São Paulo de tamaño mediano. Métodos Estudio cualitativo, realizado por medio del análisis de la transcripción de Grupos de Apreciación Compartida que utilizaron la estrategia Audit and Feedback con cinco equipos de Atención Básica en un municipio del estado de São Paulo de tamaño mediano entre diciembre de 2019 y marzo de 2020. Para el análisis de los datos se empleó el análisis de contenido que utilizó como categorías previamente definidas los desenlaces de implementación: aceptabilidad, adecuación y adopción, entendidos como principales desenlaces relacionados con la tensión por cambios. Resultados Los relatos de los profesionales que participaron de los grupos en los que se empleó la estrategia Audit and Feedback permitieron identificar la generación de tensión por cambio producida a partir de los datos que les presentaron. Se evidenciaron indicativos de aceptabilidad, adecuación y de adopción en relación con el apoyo matricial, lo que sugiere la contribución de la estrategia empleada para el éxito de la implementación. Conclusión La estrategia Audit and Feedback demostró ser efectiva en la generación de tensión por cambio, lo que favorece el reconocimiento de la necesidad de la intervención y, como consecuencia, facilita su implementación.

Abstract Objective Based on the discourse of Primary Care professionals, to assess how the use of the Audit and Feedback strategy contributed to the generate tension for change in the implementation of matrix support in a medium-sized city in São Paulo. Methods Qualitative study conducted by analyzing the transcript of Shared Appreciation Groups that used the Audit and Feedback strategy with five Primary Care teams in a medium-sized city in São Paulo between December 2019 and March 2020. Content analysis was used in data analysis. The implementation outcomes: acceptability, adequacy and adoption, understood as the main outcomes related to the tension for change, were previously defined as categories. Results The speeches of professionals who participated in the groups in which the Audit and Feedback strategy was used made it possible to identify the generation of tension for change produced from data presented to them. Indications of acceptability, adequacy and adoption in relation to the matrix support were evidenced, thereby suggesting the contribution of the strategy employed to the success of the implementation. Conclusion The Audit and Feedback strategy proved to be effective in generating tension for change, thereby favoring the recognition of the need for intervention and consequently facilitating its implementation.

Clínica de Enfermagem de Rua para o enfrentamento de vulnerabilidades / Street Clinic Nursing for coping with vulnerabilities

RESUMO Objetivo desvelar as percepções da enfermagem do Consultório na Rua voltadas para o enfrentamento das vulnerabilidades. Métodos estudo qualitativo, realizado por meio de observação participante das atividades da equipe, registro em diário de campo e entrevistas semiestruturadas com equipe de enfermagem, totalizando 17 participantes. Resultados revelaram-se situações vivenciadas pelas pessoas em situação de rua que aprofundam as iniquidades em saúde pela violação dos direitos. Dentre os instrumentos de trabalho da enfermagem, destacam-se a potencialidade das tecnologias de trabalho colaborativo, escuta e acolhimento como mediadoras de um cuidado mais humanizado. Carece-se de estratégias específicas norteadoras do cuidado de enfermagem na rua. Conclusão a enfermagem possui grande potencialidade de enfrentamento das vulnerabilidades da População em Situação de Rua por meio do uso das tecnologias leves e leves-duras.

ABSTRACT Objective to unveil the perceptions of the Street Clinic nursing staff about coping with vulnerabilities. Methods qualitative study, carried out by means of participant observation of the team's activities, recording in a field diary and semi-structured interviews with the nursing team, totaling 17 participants. Results situations experienced by people living on the streets that deepen health inequities by violating rights were revealed. Among the nursing work tools, the potential of collaborative work, listening, and welcoming technologies stand out as mediators of a more humanized care. There is a need for specific strategies to guide nursing care on the streets. Conclusion nursing has great potential for addressing the vulnerabilities of the homeless population using soft and soft-hard technologies.

Historical and social construction of the practices of auxiliary nurses and nurse technicians in Primary Care / Construcción histórica y social de las prácticas auxiliares y técnicas de enfermería en Atención Primaria / Construção histórica e social das práticas de auxiliares e técnicas de enfermagem na Atenção Primária

ABSTRACT Objectives: to analyze the practices of nursing auxiliaries and technicians in the context of Primary Health Care in a city in the interior of the state of São Paulo. Methods: transversal, quantitative study, realized with 104 nursing auxiliaries and 46 nursing technicians acting in the Primary Attention. The data, collected using structured questionnaires, are presented by descriptive statistics, and analyzed based on the essential elements of First Contact and Longitudinality. Results: the professionals were, majority, women, married, with children, low political and collective participation. We identified thirteen activities related to the First Contact: and ten on Longitudinality. Conclusions: the insertion and capillarization of auxiliary and nursing technicians' practices show these professionals as the main ones responsible for the first contact in this context, highlighting their relevance in the longitudinality of care and the work composition of health teams, contributing to the consolidation of the Unified Health System (SUS).

RESUMEN Objetivos: analizar las prácticas de las auxiliares y técnicas de enfermería en el contexto de Atención Primaria de Salud en un municipio de São Paulo. Métodos: estudio transversal, cuantitativo, realizado con 104 auxiliares de enfermería y 46 técnicas de enfermería actuantes en Atención Primaria. Los datos, recogidos por medio de encuestas estructuradas, presentados por estadística descriptiva y analizados basado en elementos esenciales de Primer contacto y Longitudinalidad. Resultados: las profesionales eran, mayoritariamente, mujeres, casadas, con hijos, baja participación política y colectiva. Identificadas 13 actividades relacionadas al Primer contacto; y 10, sobre la Longitudinalidad. Conclusiones: la inserción y la capilarización de las prácticas de las auxiliares y técnicas de enfermería evidencian esas profesionales como principales responsables por el primer contacto en ese contexto, destacando su relevancia en la longitudinalidad del cuidado y en la composición del trabajo de los equipos de salud, contribuyendo para la consolidación del Sistema Único de Salud.

RESUMO Objetivos: analisar as práticas das auxiliares e técnicas de enfermagem no contexto da Atenção Primária em Saúde em município do interior do estado de São Paulo. Métodos: estudo transversal, quantitativo, realizado com 104 auxiliares de enfermagem e 46 técnicas de enfermagem atuantes na Atenção Primária. Os dados, coletados por meio de questionários estruturados, são apresentados por estatística descritiva e analisados com base nos elementos essenciais de Primeiro contato e Longitudinalidade. Resultados: as profissionais eram, majoritariamente, mulheres, casadas, com filhos, baixa participação política e coletiva. Foram identificadas 13 atividades relacionadas ao Primeiro contato; e 10, sobre a Longitudinalidade. Conclusões: a inserção e a capilarização das práticas das auxiliares e técnicas de enfermagem evidenciam essas profissionais como principais responsáveis pelo primeiro contato nesse contexto, destacando sua relevância na longitudinalidade do cuidado e na composição do trabalho das equipes de saúde, contribuindo para a consolidação do Sistema Único de Saúde.

Gender debate as a challenge in nursing training / El debate de género como reto en la formación en enfermería / O debate de gênero como desafio na formação de enfermeiras e enfermeiros

ABSTRACT Objectives: to understand the challenges of introducing gender debate in nursing training from undergraduate students' perspective. Methods: a qualitative, exploratory-explanatory study. Data were collected through a semi-structured interview applied to 12 undergraduate nursing students at a public university in São Paulo. For data treatment and analysis, the Discourse of the Collective Subject was used in light of Boaventura de Sousa Santos' knowledge production paradigm theoretical framework. Results: nursing education remains centered on the traditional scientific model, neglecting gender and strengthening stereotypes aimed at the feminization of the profession. Final Considerations: nursing training has a challenge of implementing actions that deepen the gender theme. Therefore, some strategies are suggested, such as improving professor training and appropriating emancipatory pedagogical practices; reviewing pedagogical political projects; curriculum theorization and restructuring; problematizing gender issues for nursing leadership.

RESUMEN Objetivos: comprender los desafíos de insertar el debate de género en el proceso de formación de enfermeras desde la perspectiva de los estudiantes de pregrado. Métodos: estudio cualitativo, exploratorio-explicativo. Los datos fueron recolectados mediante entrevistas semiestructuradas aplicadas a 12 estudiantes de enfermería de una universidad pública de São Paulo. Para el tratamiento y análisis de los datos se utilizó el método del Discurso Colectivo del Sujeto a la luz del marco teórico del paradigma de producción de conocimiento de Boaventura de Sousa Santos. Resultados: la formación en enfermería sigue centrada en el modelo científico tradicional, descuidando el género y fortaleciendo los estereotipos orientados a la feminización de la profesión. Consideraciones Finales: la formación de enfermeras tiene el desafío de implementar acciones que profundicen el tema de género. Para ello, se sugieren algunas estrategias, como mejorar la formación del profesorado y apropiarse de prácticas pedagógicas emancipadoras; la revisión de proyectos políticos pedagógicos; teorización y reestructuración curricular; la problematización de las cuestiones de género para el liderazgo de enfermería.

RESUMO Objetivos: compreender os desafios da inserção do debate de gênero no processo formativo de enfermeiras(os) na perspectiva de estudantes de graduação. Métodos: estudo qualitativo, exploratório-explicativo. Os dados foram coletados por entrevista semiestruturada aplicada a 12 graduandas(os) de enfermagem de universidade pública paulista. Para tratamento e análise dos dados, utilizou-se o método do Discurso do Sujeito Coletivo à luz do referencial teórico do paradigma de produção de conhecimento de Boaventura de Sousa Santos. Resultados: a formação em enfermagem continua centrada no modelo científico tradicional, negligenciando o gênero e fortalecendo estereótipos voltados à feminilização da profissão. Considerações Finais: a formação das(os) enfermeiras(os) tem o desafio de implementar ações que aprofundem o tema gênero. Para tanto, sugerem-se algumas estratégias, como o aperfeiçoamento da formação docente e apropriação de práticas pedagógicas emancipatórias; a revisão dos projetos políticos pedagógicos; a teorização e reestruturação curricular; a problematização das questões de gênero para liderança de enfermagem.

Planning, construction and use of handmade simulators to enhance the teaching and learning in Obstetrics* / Planejamento, construção e utilização de simuladores artesanais para aprimoramento do ensino e aprendizagem de Obstetrícia) / Planificación, construcción y uso de simuladores artesanales para mejorar la enseñanza y el aprendizaje de la obstetricia)

Objective: to describe the development process and present the results of a pilot study on the use of low-cost handmade simulators for teaching and learning Obstetrics. Method: presentation of 3 low-cost simulators designing, based on educational needs identified in real-world training contexts. The developing process is presented in detail and each simulator was tested and re-tested, being submitted to improvements until their final version. The simulators presented are: delivery simulator shorts, Neoprene uterus for postpartum hemorrhage management, and perineal repair simulator. A pilot study was carried out to evaluate the perception of apprentices through a structured questionnaire, using the Kirkpatrick evaluation model. Data were descriptively analyzed. Results: the respondents (31 apprentices) positively evaluated the simulators, perceiving significant gains in theoretical knowledge, ability to solve clinical problems and decreased anxiety to deal with situations similar to those simulated. Conclusion: low-cost, handmade simulators are feasible and effective, resulting in positive learner evaluations. Their availability as open technology allows the dissemination of their use.

Objetivo: descrever o processo de desenvolvimento e apresentar os resultados de um estudo piloto sobre o uso de simuladores artesanais de baixo custo para ensino e aprendizagem de obstetrícia. Método: apresentação do processo de desenvolvimento de três simuladores de baixo custo, a partir de necessidades educacionais identificadas em contextos reais de formação. O processo de elaboração é apresentado em detalhes e cada simulador foi testado e re-testado, sendo submetido a processos de melhorias até sua versão final. Os simuladores apresentados são: bermuda simuladora de parto, útero de Neoprene para tratamento de hemorragias e simulador de sutura de lacerações perineais. Foi realizado estudo piloto de avaliação da percepção dos aprendizes, através de questionário estruturado, empregando o modelo de avaliação de Kirkpatrik. Os dados foram analisados de forma descritiva. Resultados: os respondentes (31 aprendizes) avaliaram positivamente os simuladores, tendo percebido ganhos significativos em conhecimento teórico, habilidade para resolver problemas clínicos e diminuição da ansiedade para lidar com situações semelhantes às simuladas. Conclusão: simuladores artesanais e de baixo custo são factíveis e efetivos, resultando em avaliações positivas dos aprendizes. A disponibilidade dos mesmos como tecnologia aberta permite a disseminação de seu uso.

Objetivo: describir el proceso de desarrollo y presentar los resultados de un estudio piloto sobre el uso de simuladores artesanales de bajo costo para la enseñanza y el aprendizaje de la obstetricia. Método: presentación del proceso de desarrollo de tres simuladores de bajo costo, basado en necesidades educativas identificadas en contextos de capacitación reales. El proceso de elaboración se presenta en detalle. Cada simulador fue testeado una y otra vez y se sometió a procesos de mejora hasta su versión final. Los simuladores presentados son: pantalones cortos simuladores de parto, útero de neoprene para tratamiento de sangrado y simulador de sutura de laceraciones perineales. Se realizó un estudio piloto para evaluar la percepción de los alumnos, utilizando un cuestionario estructurado y se siguió el modelo de evaluación Kirkpatrik. Se practicó el análisis descriptivo de datos. Resultados: los encuestados (31 aprendices) evaluaron positivamente los simuladores, habiendo notado ganancias significativas en el conocimiento teórico, capacidad para resolver problemas clínicos y disminución de la ansiedad para lidiar con situaciones similares a las simuladas. Conclusión: los simuladores artesanales de bajo costo son factibles y efectivos, lo que resulta en evaluaciones positivas de los aprendices. Su disponibilidad como tecnología abierta permite la difusión de su uso.

Nurses' work at Family Health Strategy: possibilities to operate health needs / El trabajo de las enfermeras en la Estrategia de Salud Familiar: posibilidades de operar las necesidades de salud / O trabalho dos enfermeiros na Estratégia Saúde da Família: possibilidades para operar necessidades de saúde

ABSTRACT Objectives: to identify and analyze possibilities for recognizing health needs in the nurses' work at Family Health Strategy. Methods: a qualitative study with interviews and observation of the nurses' work in the countryside of São Paulo. The empirical material was subjected to thematic content analysis and interpreted in the light of the health work process. Results: two themes emerged: Possibilities utilized and Possibilities neglected to recognize health needs. Careful observation, welcoming, attention, listening, bonding and dialogue developed by nurses, in live work in action with users, touched on the possibilities, which, taken advantage of, were evidenced in care in spontaneous demand, scheduled consultation, examination gynecological and group activities. Final Considerations: nurses are able to recognize health needs, which can expand their clinical practice and interprofessionality in Family Health.

RESUMEN Objetivos: identificar y analizar, en el trabajo de las enfermeras en la Estrategia de Salud Familiar, las posibilidades para el reconocimiento de las necesidades de salud. Métodos: estudio cualitativo, con entrevistas y observación del trabajo de enfermeras en el interior de São Paulo. El material empírico fue sometido a análisis de contenido temático e interpretado a la luz del proceso de trabajo de salud. Resultados: surgieron dos temas: Posibilidades utilizadas y Posibilidades desatendidas para reconocer las necesidades de salud. La observación cuidadosa, la recepción, la atención, la escucha, el vínculo y el diálogo desarrollados por las enfermeras, en el trabajo en vivo en acción con los usuarios, tocaron las posibilidades que, aprovechadas, se evidenciaron en la atención en la demanda espontánea, consulta programada, examen actividades ginecológicas y grupales. Consideraciones finales: las enfermeras pueden reconocer las necesidades de salud, lo que puede ampliar su práctica clínica e interprofesionalidad en salud familiar.

RESUMO Objetivos: identificar e analisar, no trabalho do enfermeiro na Estratégia Saúde da Família, possibilidades para o reconhecimento de necessidades de saúde. Métodos: estudo qualitativo, com entrevistas e observação do trabalho de enfermeiros no interior paulista. O material empírico foi submetido à análise de conteúdo temática e interpretado à luz do processo de trabalho em saúde. Resultados: emergiram dois temas: Possibilidades aproveitadas e Possibilidades negligenciadas para reconhecer necessidades de saúde. A observação cuidadosa, o acolhimento, a atenção, a escuta, o vínculo e o diálogo desenvolvidos pelos enfermeiros, no trabalho vivo em ato com os usuários, afloraram as possibilidades, que aproveitadas, foram evidenciadas em atendimento na demanda espontânea, consulta agendada, exame ginecológico e atividades grupais. Considerações Finais: os enfermeiros são capazes de reconhecer necessidades de saúde, o que pode ampliar sua prática clínica e a interprofissionalidade na Saúde da Família.

The health-disease process and the family health strategy: the user's perspective.

OBJECTIVE: to analyze the meanings Primary Health Care users attribute to their health-disease process and the services used. METHODS: this qualitative research uses the focus group technique to interview two groups of users the service monitors. The first is a group of elderly people and the second of pregnant women. To analyze the meanings, the discourse analysis technique and the reference framework of health promotion are used. RESULTS: the group of elderly, being mostly female arterial hypertension and diabetes mellitus patients, visualizes the health-disease process as the evolution of human existence controlled by divine power, signifying the health service as a blessing in the control of the disease. The Group of young pregnant women signified health as the ability for self-care and disease as the disability for that purposes, considering the Primary Health Care service as responsible for the recovery of individual and family health. FINAL CONSIDERATIONS: the users demonstrated dissatisfaction with bureaucratic and vertical relations present at the health services. In each group, it was observed that the meanings for health and disease and meanings of the health service the users elaborated can be related.

Na ausência de endereço, onde mora a saúde? Determinantes sociais e populações de ocupações / In the absence of an address, where does health live? Social determinants and occupation populations

RESUMO Pesquisa qualitativa cujo objetivo foi analisar a influência dos Determinantes Sociais da Saúde no processo saúde-doença de população residente em área de ocupação de Campinas, com enfoque no acesso aos serviços de saúde, habitação (condições de moradia, água e esgoto) e trabalho (emprego e renda). Utilizaram-se entrevistas semiestruturadas com moradores e dados secundários oriundos de censo comunitário elaborado por lideranças locais para traçar o perfil sociodemográfico da população em estudo. Os resultados encontrados indicam desigualdades regionais reveladas nessa ocupação, onde a condição de pobreza, a miséria, a violência, o desemprego e a falta de acesso a direitos básicos de cidadania determinam a piora das condições de saúde de seus moradores. Conhecer e compreender como Determinantes Sociais da Saúde atuam no processo saúde-doença da população pode contribuir para que governos, profissionais de saúde e outros atores sociais, incluindo universidades públicas, intervenham, principalmente, com políticas públicas que busquem reduzir o impacto desses fatores e promover a melhoria das condições de vida e saúde dessas populações, vivendo na invisibilidade social, sujeitas a preconceitos e discriminação de diversas naturezas por parte da sociedade.

ABSTRACT Qualitative research in which the objective was to analyze the influence of the Social Determinants of Health on the health-disease process of the population living in the urban slum/occupation area of Campinas, focusing on access to health services, housing (housing, water, and sewage conditions) and work (employment and income). Semi-structured interviews with residents and secondary data from a community census prepared by local leaders were used to trace the sociodemographic profile of the population under study. The results found indicate regional inequalities revealed in the occupation, where the condition of poverty, misery, violence, unemployment, and lack of access to basic citizenship rights determine the worsening of the health conditions of its residents. Knowing and understanding how Social Determinants of Health work in the health-disease process of the population can contribute so that governments, health professionals, and other social actors, including public universities, can intervene, mainly with public policies that seek to reduce the impact of these factors and promote the improvement of living conditions and health of these populations, living in social invisibility, subject to prejudice and discrimination of various kinds by society in general.