Gender and Violence in the Daily Routine of Community Health Workers in Fortaleza, Brazil.

Community Health Workers (CHWs) are the link between the Brazilian primary health care system and the community. Since CHWs live in the same neighborhoods they work, they are involved in what happens in the community, including observants and or potential targets of violence. However, it is not known if female and male CHWs perceive and suffer violence similarly. This study aimed to investigate the violence to which CHWs are exposed and if female CHWs experience and or perceive violence the same way as male CHWs. A structured questionnaire was used to collect information from CHWs. Two periods (2019 [n=1402] and 2021 [n=364]) were compared. The data show that more than 80% of CHWs were exposed to violence, either as victims or witnesses within the community they served. In general, while the occurrence of violence towards CHWs decreased, their perception of community violence increased. Over time, the perception of urban/community violence remained constant among male CHWs, but increased among female CHWs, as shown by the significant rise between 2019 and 2021 in the percentage of female CHWs reporting witnessing or hearing about manifestations of violence (e.g., physical aggression; assault; stabbing; lethal gunshot; non-lethal gunshot; and gang violence). Among male CHWs, perception only increased with regard to the item assault. Given the complexity of violence and its repercussions on the daily routines of CHWs, intersectoral and interdisciplinary partnerships between health workers and other stakeholders are needed to create strategies capable of dealing with expressions of violence in the territories served.

Therapeutic communication in the interaction between health workers and hypertensive patients in the family health strategy. / Comunicação terapêutica na interação profissional de saúde e hipertenso na estratégia saúde da família.

OBJECTIVE To analyze the therapeutic communication in the interaction between health professionals and hypertensive patients in the Family Health Strategy. METHODS Descriptive study with qualitative approach. The sample consisted of 14 hypertensive patients and two health professionals of the Family Health Strategy (ESF - "Estratégia Saúde Família") in a city of the state of Ceará, Brazil, in 2016. In the data collection, a checklist was used for non-participant systematic observation containing the strategies of therapeutic communication, namely: expression, clarity, validation, and a field diary, being these subjected to content analysis. RESULTS It was noted that ESF professionals do not adequately use therapeutic communication, indicating the need of investment in this device, which acts as a bridge for users, enhances care practices and opens paths that instrumentalize interpersonal relationships. CONCLUSIONS It was realized that health professionals are not fully exploring therapeutic communication strategies, therefore being necessary to develop skills to use these techniques correctly when caring for hypertensive patients.

Access to health care among female prisoners in a penitentiary in Ceará, Brazil. / Acesso e cuidado a saúde de mulheres privadas de liberdade na penitenciária cearense.

This study investigated access to health care among female prisoners in the state of Ceará, Brazil, and screened for common mental disorders. We conducted an analytical cross-sectional study in the only female prison in the state. Ninety detainees participated in the study. All participants were either pregnant or postpartum women or had one or more of the following health problems: hypertension, diabetes mellitus, tuberculosis, syphilis, hepatitis B, HIV/AIDS. The data were collected using a structured questionnaire. The findings reveal that access to health care was limited, violating the fundamental rights of the prisoners. Screening for diseases on admission to prison was limited, especially among non-pregnant women. Differences in health care were found between health conditions, with priority being given to pregnant and postpartum women. Most of the inmates (68.24%) were found to be at risk for common mental disorders (SRQ score > 7). A positive correlation was found between age and mental health problems (p = 0.0002). Despite legislation guaranteeing access to health care in prisons, the prison system is unprepared to meet the health needs of female prisoners with comorbidities and pregnant and puerperal women.

O estudo analisa o acesso ao cuidado em saúde de mulheres encarceradas no estado do Ceará, rastreando transtornos mentais comuns. Estudo analítico, transversal, de natureza quantitativa, desenvolvido na única penitenciária feminina do Ceará. Participaram 90 detentas, todas com alguma das seguintes questões de saúde: gestantes, puérperas, portadoras de hipertensão arterial sistêmica, diabetes mellitus, tuberculose, sífilis, hepatite B ou HIV/Aids. Os dados foram coletados por entrevista estruturada. Evidenciou-se acesso limitado à atenção à saúde das detentas, violando direitos básicos sob tutela do Estado. Foram constatadas limitações de exames de rastreamento de doenças nas presidiárias na ocasião de seu acesso ao cárcere, principalmente as que não se encontravam grávidas no momento do encarceramento. Houve diferenças entre as distintas condições de saúde analisadas, com prioridade da atenção às gestantes e puérperas. Entre as detentas, 68,24% apresentavam risco de transtornos mentais comuns (SRQ > 7). Houve correlação positiva entre idade e saúde mental (p = 0,0002). Embora exista legislação pertinente de garantia de acesso à saúde no cárcere, o sistema prisional está despreparado para atender às necessidades de portadoras de comorbidades, gestantes e puérperas.

Violence in the neighborhood and mental health of community health workers in a Brazilian metropolis.

Violence is a major social problem in Brazil, with severe repercussions on the health care sector. Primary health care professionals, especially community health workers (CHWs), are at high risk of violence at facilities and in the socially vulnerable area where they work. This study analyzed the relationships between adverse working conditions and dimensions of localized violence on the prevalence of common mental disorders (CMD) among CHWs in Fortaleza, a state capital in Northeastern Brazil. Information was collected with a self-report questionnaire containing items on sociodemographic data, work-related violence, psychoemotional signs and symptoms (Self-Reporting Questionnaire-20), mental health care, and absence from work due to general or mental health issues. Based on the responses of 1,437 CHWs, the prevalence of CMD (32.75%) was associated with perceived, witnessed, or suffered violence in the work area. In the hierarchical analysis, CMD were associated with age, sex, religious identity, years of experience as a CHW with the Family Health Strategy (FHS), work neighborhood, activities in the community, considering the lack of bonding with families as an obstacle, having suffered domestic violence, use of medication for emotional dysregulation, identifying the neighborhood as violent, considering violence a physical or mental health determinant, and identifying impunity as a cause of violence. Thus, the work and mental health of CHWs were significantly affected by violence dimensions. Our findings are relevant to the adoption of strategies to mitigate the effects of violence on the work and mental health of CHWs.

Mental health of community health workers in the COVID-19 context. / Saúde mental de agentes comunitários de saúde no contexto da COVID-19.

This study aimed to analyze the factors related to the mental health of Community Health Workers (ACS) in the COVID-19 context. A total of 1,935 ACS from four Northeastern capitals and four cities in the inland region of Ceará participated. The following data were collected: sociodemographic; professional; SRQ-20; WHOQOL-Bref, exposure to violence, General Self-Efficacy Scale (EAEG), Multidimensional Scale of Perceived Social Support (MSPSS), COVID-19-related information, and the coronavirus anxiety scale (EAC). Approximately 40.5% had SRQ > 7, signaling high levels of Common Mental Disorders (CMD)/mental health issues. We adopted the Multiple linear (backward) regression. We observed that the increased risk of CMD was influenced by exposure to violence, EAC, not knowing they had COVID-19, not knowing the variables that reduced the risk, the physical and psychological domains of the WHOQOL-Bref, not having increased working hours, and not having had COVID-19. The data reveal the multidimensional dynamics of mental health and help understand the relationship between community violence, COVID-19, quality of life, age, and ESF working time with the mental health of ACS.

O objetivo deste estudo foi analisar os fatores relacionados à saúde mental dos agentes comunitários de saúde (ACS) no contexto da COVID-19. Participaram 1.935 ACS de quatro capitais nordestinas e de quatro cidades do interior do Ceará. Foram coletados dados sociodemográficos e profissiográficos; SRQ-20; WHOQOL-Bref; exposição à violência; Escala de Autoeficácia Geral (EAEG); Escala Multidimensional de Suporte Social Percebido (MSPSS); informações relacionadas à COVID-19 e Escala de Ansiedade para Coronavírus (EAC). 40,5% exibiram SRQ > 7, sinalizando altos níveis de transtornos mentais comuns (TMC)/problemas de saúde mental. Utilizou-se a regressão linear múltiplas (backward). Observou-se que o aumento de risco de TCM foi influenciado pelos seguintes fatores: exposição à violência; EAC; não saber se teve COVID-19; desconhecer as variáveis que diminuíam o risco; os domínios físico e psicológico do WHOQOL-Bref; não ter aumento da jornada de trabalho; e não ter tido COVID-19. Os dados revelam a dinâmica multidimensional da saúde mental e ajudam a compreender a relação entre violência comunitária, COVID-19, qualidade de vida, idade e tempo de atuação na ESF com a saúde mental dos ACS.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil.

This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

[Violence and vulnerability of the Community Health Worker in the territory: implications for tackling COVID-19]. / Violência e vulnerabilidade no território do agente comunitário de saúde: implicações no enfrentamento da COVID-19.

The scope of the study was to investigate the relationship between COVID-19 and social vulnerability variables in Fortaleza, as well as to verify the influence of violence on the work of the Community Health Worker (ACS) and the implications for tackling COVID-19. Primary quantitative data (e.g., questionnaires with the ACS) and secondary data (e.g., HDI, homicide, illiteracy, Bolsa Família [PBF] coverage and Family Health Strategy [ESF] coverage) were used. There was a relationship between COVID-19 and indicators of social vulnerability, where cases had a negative relationship with HDI and illiteracy; and deaths had a positive relationship with the homicide rate and PBF coverage. Regions with high death rates due to COVID-19 and social vulnerability have greater FHS coverage and less home visits by the CHA. The latter's role in tackling COVID-19 is limited by the violence in the territory. The thorough performance of the ACS in confronting this pandemic is dependent on intersectoral policies. Thus, the creation of a policy to tackle COVID-19 with the participation of the ACS needs to consider intersectoral actions for curtailing and preventing violence in the territory, in addition to adequate training in the prevention and detection of COVID-19.

Objetivou-se averiguar a relação da COVID-19 com variáveis de vulnerabilidade social em Fortaleza e verificar a influência da violência no trabalho do ACS e suas implicações no enfrentamento da COVID-19. Dados quantitativos primários (e.g., questionários com ACS) e secundários (e.g., IDH, homicídio, analfabetismo, cobertura do Programa Bolsa Família [PBF] e da Estratégia Saúde da Família [ESF]) foram utilizados. Observou-se relação da COVID-19 com indicadores de vulnerabilidade social, onde os casos têm relação negativa com IDH e analfabetismo; e os óbitos relação positiva com taxa de homicídios e cobertura do PBF. Regiões com altas taxas de óbito por COVID-19 e vulnerabilidade social possuem maior cobertura da ESF e menor realização de visita domiciliar pelo ACS. A atuação deste, no enfrentamento da pandemia, é limitada pela violência do território. A plena atuação do ACS, no enfrentamento da COVID-19, é dependente de políticas intersetoriais. Assim, a construção de uma política de enfrentamento da COVID-19, com participação do ACS, precisa levar em consideração, além de seu adequado treinamento na prevenção e detecção de COVID-19, ações intersetoriais para o enfrentamento e prevenção da violência no território.

The production of care in psychosocial care services: home visits as an intervention technology to be used in the territory. / Produção do cuidado na atenção psicossocial: visita domiciliar como tecnologia de intervenção no território.

Home visits are a technology used in mental health services to address individuals with mental distress and their families. The intent is to analyze different types of knowledge and professional practices related to home visits, grounded on the analytical framework provided by the Psychiatric Reform's dimensions, namely: theoretical-conceptual, technical assistance, legal-political, and sociocultural. This case study with a qualitative approach was conducted in a Psychosocial Care Center (CAPS) located in Fortaleza, Ceará, Brazil. Observation and semi-structured interviews were held with workers and later analyzed from a critical hermeneutic perspective. The results show the territory covered by the service is acknowledged as a social space in which individuals are allowed to express their experience/suffering and a place where care is produced. Home visits require the reorganization of work processes and the development of deinstitutionalization strategies, which in turn promote the patients' autonomy and contractual power. There are, however, challenges to be overcome, such as insufficient human resources and a lack of material resources. Additionally, workers have to deal with urban violence and impediments to cultural change in the way society deals with mental illness. Home visits are essential within CAPS as a strategy to dismantle the traditional asylum apparatus.

A visita domiciliar na atenção à saúde mental constitui tecnologia de abordagem ao sujeito em sofrimento psíquico e à sua família. Pretende-se analisar os saberes e as práticas dos profissionais relacionadas à visita domiciliar, tomando como referencial analítico as dimensões da Reforma Psiquiátrica: teórico-conceitual, tecnoassistencial, jurídico-política e sociocultural. Trata-se de um estudo de caso com abordagem qualitativa, realizado num Centro de Atenção Psicossocial (CAPS) de Fortaleza, Ceará, Brasil. Realizaram-se entrevistas semiestruturadas com profissionais, além de observação livre, analisadas com base na hermenêutica crítica. Os resultados apontam o reconhecimento do território como espaço social da experiência-sofrimento e de produção do cuidado. A visita domiciliar induz a reorganização do processo de trabalho e o desenvolvimento de estratégias de desinstitucionalização, que potencializam a construção de autonomia e de poder contratual do usuário. Contudo, enfrenta desafios relacionados ao serviço, como equipe mínima e ausência de veículo. Além destes, o risco de violência no território e dificuldades no agir para a mudança cultural nos modos de lidar com a loucura. A visita domiciliar é imprescindível no CAPS, como estratégia de ruptura com o aparato manicomial.

The use of assistance flow by nurses to the patient with chest pain: facilities and difficulties.

OBJECTIVE: to analyze the facilities and difficulties in the use by nurses of the care flow for patients with chest pain. METHODS: descriptive analytical study, with a qualitative approach, conducted with 17 nurses from an emergency care unit in a municipality of the State of Ceara, in 2018. Data collected through documents and interviews, analyzed in a descriptive manner, in absolute and relative frequencies and through content analysis thematic. RESULTS: the use of assistance flow streamlines the process of transferring to referral units, reducing serious and lethal complications in the patient. It considers teamwork and communication as facilitating points in the care of patients with chest pain. The lack of permanent education, physical structure, equipment, transport delay and patient regulation as factors that hamper. FINAL CONSIDERATIONS: investments in physical structure and equipment, in the reorganization of the care network and in permanent education to enable benefits to the service of excellence in health care.

Social representations on diabetic foot: contributions to PHC in the Brazilian Northeast. / Representações sociais sobre pé diabético: contribuições para Atenção Primária à saúde no Nordeste brasileiro.

This study aimed to identify the structuring elements guiding the establishment of the social representations of diabetic foot among people with diabetes mellitus. This qualitative study is based on the Social Representations Theory and was conducted in a capital of the Brazilian Northeast. The free word association test and a roadmap were used to characterize the sociodemographic and clinical profile to collect data. The analysis was performed using openEVOC software. The constituent elements of the diabetic foot's social representation "cure" and "really bad", revealing that living with a diabetic foot is challenging, but there is hope for a cure, which is a driving force in the daily search for care. The "prevention" element emerged in the representational field, denoting a more critical view and a capacity to transform the identified core elements. We found that the representational structure is based on subjective, valuating, and attitudinal contents. This knowledge can contribute to the design of interventions in the provision of care and diabetic foot screening in PHC services.

A investigação tem por objetivo identificar os elementos estruturantes que orientam a formação das representações sociais do pé diabético entre pessoas com diabetes mellitus. Estudo qualitativo, fundamentado na Teoria das Representações Sociais, seguindo a vertente estrutural complementar, realizado em uma capital do Nordeste brasileiro, de fevereiro a maio de 2019, com a participação de 100 pessoas com pé diabético. Para a coleta dos dados, utilizou-se o teste de associação livre de palavras e o roteiro para caracterização do perfil sociodemográfico e clínico. A análise foi realizada por meio do software openEVOC. Os elementos constituintes da representação social do pé diabético referem-se às evocações são "cura" e "muito ruim", e revelam que viver com pé diabético é desafiador, mas que há uma esperança de cura que se constitui em mola propulsora na busca cotidiana do cuidado. O elemento prevenção apareceu no campo representacional, o que denota uma visão mais crítica, podendo transformar os elementos nucleares identificados. Constata-se que a estrutura representacional encontra-se ancorada em conteúdos subjetivos, valorativos e atitudinais. Conclui-se que este conhecimento pode contribuir com o desenho de intervenções que auxiliem nas práticas de cuidados e rastreamento do pé diabético nos serviços ofertados na Atenção Primária à Saúde.

Infrastructure and work process in primary health care: PMAQ in Ceará.

OBJECTIVE To analyze the quality of the infrastructure and work process of the Family Health Strategy in the municipalities of Ceará between 2012 and 2014. METHODS Cross-sectional study, using secondary data from the external evaluation of the 1st (2012) and 2nd (2014) cycle of the National Program for Improvement of Access and Quality of Primary Care in Ceará. A total of 20 composite indicators were used to verify the quality of infrastructure and work process. RESULTS Data from 183 (99.4%) of the 184 municipalities of Ceará were collected in both cycles. A total of 1,441 teams were evaluated for the infrastructure and 800 for the work process. Among the 20 composite indicators evaluated, 18 presented an improvement, but in a non-homogeneous way, ranging between 0.0 and 413.5%. We observed that the lower the initial value of the indicator, the greater the variation in quality between 2012 and 2014. The indicators of infrastructure and work process were influenced by the regional health system and population size of the municipality, being more evident the influence on the variables of the work process. CONCLUSIONS We identified that quality improvements related to infrastructure and work process occurred in the period of implementation of the program in the state of Ceará in an equitable manner, being influenced by population size and regional health system, showing the influence of the context in the implementation of public policies of this nature.

Ensino remoto de educação em saúde na pós-graduação em saúde coletiva: possibilidades no contexto da pandemia de covid-19 / Remote teaching of health education in the postgraduate program in collective health: possibilities in the context of the covid-19 pandemic / Enseñanza a distância de educación para la salud en el posgrado en salud colectiva: posibilidades en el contexto de la pandemia del covid-19

O ensino remoto emergencial ocasionou mudanças no processo de ensino-aprendizagem, requisitando criatividade e incorporação de novas estratégias pedagógicas. Aqui, o objetivo é descrever a experiência de ensino-aprendizagem na disciplina educação em saúde, no contexto da pandemia de covid-19. Trata-se de um relato de experiência sobre o ensino remoto de educação em saúde no Programa de Pós-Graduação em Saúde Coletiva da Universidade Estadual do Ceará, no período letivo 2021.1. A disciplina foi ministrada por meio da plataforma Google Meet®, adotando-se estratégias ativas de ensino-aprendizagem. Os conteúdos mostraram--se relevantes. Ademais, a experiência promoveu a articulação teórico-prática, valorizou os saberes prévios dos pós-graduandos e estimulou a interatividade. Buscou-se superar o modelo tradicional de ensino, com vistas a propiciar autonomia e uma aprendizagem significativa. Os desafios encontrados e as possibilidades identificadas permitem a reflexão sobre a práxis docente, no que tange ao estímulo à participação e ao engajamento discente em ambiente virtual, além da incorporação de estratégias ativas de ensino, sobretudo no ensino remoto.

Emergency remote teaching caused changes in the teaching-learning process, requiring creativity and the incorporation of new pedagogical strategies. Here, the objective is to describe the teaching-learning experience in the health education discipline, in the context of the covid-19 pandemic. This is an experience report on remote teaching of health education in the postgraduate program in public health, at the Ceará State University, Brazil, in the 2021.1 academic period. The classes were given using the Google Meet® platform, adopting active teaching-learning strategies. The contents proved to be relevant. Moreover, the experience promoted theoretical-practical articulation, valued the prior knowledge of the postgraduate students and encouraged interactivity. We sought to overcome the traditional teaching model, in order to provide autonomy and a meaningful learning. The challenges experienced and the possibilities identified allow reflection on teaching practice in terms of encouraging student participation and engagement in a virtual environment, in addition to the incorporation of active teaching strategies in especially remote teaching.

La educación remota de emergencia provocó cambios en el proceso de enseñanza-aprendizaje, requiriendo creatividad y la incorporación de nuevas estrategias pedagógicas. El objetivo aquí es describir la experiencia de enseñanza-aprendizaje en la disciplina educación para la salud, en el contexto de la pandemia covid-19. Se trata de un relato de experiencia sobre la enseñanza remota de educación para la salud en el programa de posgrado en Salud Pública, de la Universidad Estadual de Ceará, en el período académico 2021.1. El curso se impartió utilizando la plataforma Google Meet®, adoptando estrategias activas de enseñanza-aprendi-zaje. Los contenidos han demonstrado ser relevantes. Además, la experiencia fomentó la articulación teó-rico-práctica, valoró los conocimientos previos de los estudiantes de posgrado y impulsó la interactividad. Buscamos superar el modelo de enseñanza tradicional, con el propósito de proporcionar autonomía y un aprendizaje significativo. Los desafíos enfrentados y las posibilidades identificadas permiten reflexionar sobre la práctica docente, en relación a incentivar la participación y el compromiso de los estudiantes en un ambiente virtual, además de la incorporación de estrategias activas en la enseñanza remota.

Acesso e cuidado a saúde de mulheres privadas de liberdade na penitenciária cearense / Access to health care among female prisoners in a penitentiary in Ceará, Brazil

Resumo O estudo analisa o acesso ao cuidado em saúde de mulheres encarceradas no estado do Ceará, rastreando transtornos mentais comuns. Estudo analítico, transversal, de natureza quantitativa, desenvolvido na única penitenciária feminina do Ceará. Participaram 90 detentas, todas com alguma das seguintes questões de saúde: gestantes, puérperas, portadoras de hipertensão arterial sistêmica, diabetes mellitus, tuberculose, sífilis, hepatite B ou HIV/Aids. Os dados foram coletados por entrevista estruturada. Evidenciou-se acesso limitado à atenção à saúde das detentas, violando direitos básicos sob tutela do Estado. Foram constatadas limitações de exames de rastreamento de doenças nas presidiárias na ocasião de seu acesso ao cárcere, principalmente as que não se encontravam grávidas no momento do encarceramento. Houve diferenças entre as distintas condições de saúde analisadas, com prioridade da atenção às gestantes e puérperas. Entre as detentas, 68,24% apresentavam risco de transtornos mentais comuns (SRQ > 7). Houve correlação positiva entre idade e saúde mental (p = 0,0002). Embora exista legislação pertinente de garantia de acesso à saúde no cárcere, o sistema prisional está despreparado para atender às necessidades de portadoras de comorbidades, gestantes e puérperas.

Abstract This study investigated access to health care among female prisoners in the state of Ceará, Brazil, and screened for common mental disorders. We conducted an analytical cross-sectional study in the only female prison in the state. Ninety detainees participated in the study. All participants were either pregnant or postpartum women or had one or more of the following health problems: hypertension, diabetes mellitus, tuberculosis, syphilis, hepatitis B, HIV/AIDS. The data were collected using a structured questionnaire. The findings reveal that access to health care was limited, violating the fundamental rights of the prisoners. Screening for diseases on admission to prison was limited, especially among non-pregnant women. Differences in health care were found between health conditions, with priority being given to pregnant and postpartum women. Most of the inmates (68.24%) were found to be at risk for common mental disorders (SRQ score > 7). A positive correlation was found between age and mental health problems (p = 0.0002). Despite legislation guaranteeing access to health care in prisons, the prison system is unprepared to meet the health needs of female prisoners with comorbidities and pregnant and puerperal women.

Intergeracionalidade e promoção da saúde: reflexões e desafios na atenção à pessoa idosa / Intergenerationality and Health Promotion: Reflections and Challenges in the Care of Older Adults

Resumo Objetivo Discutir sobre a promoção da saúde da pessoa idosa por meio da intergeracionalidade, com ênfase na educação intergeracional nos Programas Intergeracionais, como uma proposta de educação para o protagonismo da pessoa idosa e o envelhecimento bem-sucedido. Método Ensaio teórico, de cunho reflexivo com abordagem qualitativa. Embasando-se na leitura de documentos que reforçam o aumento da longevidade e a preocupação com a promoção da saúde para a pessoa idosa no Brasil, a fim de refletir sobre a intergeracionalidade na promoção da saúde e a utilização da educação intergeracional para promover o envelhecimento bem-sucedido, por meio dos Programas Intergeracionais. Resultados Organizaram-se em três tópicos: Promoção da saúde da pessoa idosa: desafios para o seu protagonismo; Compreensão sobre envelhecimento para a aprendizagem intergeracional; Programa intergeracional: protagonismo para a promoção da saúde da pessoa idosa. Conclusão Experiências exitosas na saúde, especificamente nos espaços ocupados pela Atenção Primária à Saúde ainda se mostram restritas ou pouco visualizadas para a construção de uma educação transformadora para a promoção da saúde da pessoa idosa. O desafio é fomentar pesquisas científicas, para que os profissionais, a partir da educação permanente, possam potencializar os momentos de educação em saúde a partir da educação intergeracional, sendo assim, a construção e implementação de Programas Intergeracionais podem representar essa possibilidade.

Abstract Objective To discuss the promotion of health for older adults through intergenerationality, with an emphasis on intergenerational education within Intergenerational Programs, as a proposal for education fostering the protagonism of older adults and successful aging. Method Theoretical essay, reflective in nature with a qualitative approach. Grounded in the examination of documents emphasizing the increase in longevity and the concern for health promotion among older adults in Brazil, the aim is to contemplate intergenerationality in health promotion and the utilization of intergenerational education to foster successful aging through Intergenerational Programs. Results Organized into three topics: Health promotion for older adults: challenges for their protagonism; Understanding aging for intergenerational learning; Intergenerational program: protagonism for the health promotion of older adults. Conclusion Successful experiences in health, specifically within the realms of Primary Health Care, still appear to be limited or insufficiently recognized for the development of transformative education in health promotion for older adults. The challenge lies in fostering scientific research so that professionals, through continuous education, can enhance health education moments through intergenerational education. Thus, the establishment and implementation of Intergenerational Programs may represent this promising possibility.

[Mental health and its dimensions: review of journal articles between 2000 and 2005]. / Saúde mental e suas dimensões: análise documental das publicações de periódicos de 2000 a 2005.

Considering the current changes in social conditions brought about by the psychiatry reform, effects of these transformations are also expected on the scientific producion in this field. The article aimed at analyzing studies published in journals between 2000 and 2005 discussing mental health and its dimensions. Nursing and Collective Health national and international journals, classified in Brazil as B or C, were reviewed. In the documental analysis of the material the following categories emerged: organizations and management of services, training of mental health professionals, psychosocial rehabilitation strategies and results, care of people with psychiatric suffering, and perceptions on mental illness. It noticed that the knowledge production in mental health is strongly influenced by practice.

Incidentes críticos na convivência familiar e social de idosos com hiv/aids / Critical incidents in family and social life of elderly people with hiv/aids / Incidentes críticos en la interacción familiar y social de personas mayores con vih/sida

O aumento das Infecções Sexualmente Transmissíveis e dos casos de contágio pelo HIV/AIDS na população idosa reflete aspectos da prática sexual e vulnerabilidades que podem estar sendo enfrentadas por essas pessoas em seu convívio social e familiar. Objetivo: descrever, por meio de incidentes críticos, as situações, comportamentos e consequências relacionadas à descoberta do HIV/AIDS por pessoas idosas soropositivas. Método: estudo descritivo, com abordagem qualitativa, realizado no Centro de Infectologia de um município da região sul do estado do Ceará, utilizando a Técnica de Incidente Crítico (TIC), nos meses de fevereiro a setembro de 2020. Participaram 25 idosos cadastrados no serviço, com idades entre 55 e 77 anos. Os dados foram coletados por meio de entrevista semiestruturada e o conteúdo analisado com auxílio do software IRaMuTeQ por meio de categorias temáticas. Resultados: os dados empíricos contendo as situações, comportamentos e consequências (incidentes críticos) elucidaram quatro categorias empíricas: descoberta do diagnóstico de HIV/AIDS; sentimentos, estigmas e preconceitos vivenciados; soropositividade e reflexos no convívio familiar e social; e mudanças no comportamento sexual após diagnóstico de HIV/AIDS. Conclusão: as relações familiares e sociais vivenciadas e os desafios enfrentados pelas pessoas idosas com HIV/AIDS constituíram incidentes críticos complexos, afetando-as desde o momento do diagnóstico, com impactos negativos sobre seus modos de vida familiar e social, que dificultam a convivência inclusiva e não estigmatizante dentro e fora de casa.

The increase of Sexually Transmitted Infections and cases of HIV/AIDS in the elderly population reflects aspects of sexual practice and vulnerabilities that may be faced by these people in their social and family life. Objective: to describe, through critical incidents, the situations, behaviors and consequences related to the discovery of HIV/AIDS by seropositive elderly people. Method: a descriptive study with a qualitative approach, conducted at the Infectious Diseases Center of a city in the southern region of the state of Ceará, using the Critical Incident Technique (CIT), from February to September 2020. Twenty-five elderly people enrolled in the service, aged 55 to 77 years, participated. The data were collected through semi-structured interviews and the content analyzed with the help of IRaMuTeQ software through thematic categories. Results: The empirical data containing situations, behaviors and consequences (critical incidents) elucidated four empirical categories: discovery of the HIV/AIDS diagnosis; feelings, stigmas and prejudices experienced; seropositivity and reflections on family and social life; and changes in sexual behavior after the diagnosis of HIV/AIDS. Conclusion: the family and social relationships experienced and the challenges faced by elderly people with HIV/AIDS constituted complex critical incidents, affecting them from the moment of diagnosis, with negative impacts on their family and social lifestyles, which hinder inclusive and non-stigmatizing coexistence inside and outside the home.

El aumento de las Infecciones de Transmisión Sexual y de los casos de VIH/Sida en la población anciana refleja aspectos de la práctica sexual y vulnerabilidades que pueden enfrentar estas personas en su vida social y familiar. Objetivo: describir, a través de incidentes críticos, las situaciones, comportamientos y consecuencias relacionadas con el descubrimiento del VIH/SIDA por personas mayores seropositivas. Método: estudo descritivo, com abordagem qualitativa, realizado no Centro de Infectologia de um município da região sul do estado do Ceará, utilizando a Técnica de Incidente Crítico (TIC), nos meses de fevereiro a setembro de 2020. Participaron 25 ancianos registrados en el servicio, con edades comprendidas entre 55 y 77 años. Os dados foram recolhidos através de entrevistas semiestructuradas e o conteúdo foi analisado com a ajuda do software IRaMuTeQ através de categorias temáticas. Resultados: los datos empíricos que contienen las situaciones, comportamientos y consecuencias (incidentes críticos) elucidaron cuatro categorías empíricas: descripción del diagnóstico de VIH/SIDA; sentimientos, estigmas y preconceptos vividos; seropositividad y reflejos en la convivencia familiar y social; y cambios en el comportamiento sexual tras el diagnóstico de VIH/SIDA. Conclusão: as relações familiares e sociais vividas e os desafios enfrentados pelos idosos com HIV/AIDS constituem incidentes críticos complexos, afetando-as desde o momento do diagnóstico, com impactos negativos sobre seus modos de vida familiar e social, que dificultam a convivência inclusiva e não estigmatizante dentro e fora de casa.

Casos, óbitos e letalidade por COVID-19: análise de dados sociais e assistenciais do Nordeste brasileiro / Cases, deaths and lethality due to COVID-19: analysis of social and assistance data from the Brazilian Northeast

Objetivo: Analisar o impacto da cobertura da Atenção Primária à Saúde, Índice de Desenvolvimento Humano e Bolsa Família na ocorrência de casos, óbitos e letalidade por COVID-19 no Nordeste brasileiro. Método: Estudo descritivo, de caráter transversal, com dados extraídos das plataformas estaduais da COVID-19, Sistema de Informação em Saúde para Atenção Básica e Instituto de Pesquisa Econômica Aplicada. Foram utilizados testes de correlação de Spearman e Kruskal-Wallis. Resultados:Verificou-se que foram notificados 483.793 casos confirmados de COVID-19 e 19.307 óbitos por esse agravo no Nordeste brasileiro. Com relação à ocorrência da COVID-19, o Estado do Ceará apresentou maior taxa de casos (1200,83/100.000 habitantes). Observou-se que quanto maior cobertura da ESF maior identificação da ocorrência de casos confirmados (r=0,855 e p-valor=0,002) e óbitos (r=0,818 e p-valor=0,004) por COVID-19. Conclusão: A Estratégia Saúde da Família é um modelo organizativo da Atenção Primária à Saúde potente para enfrentamento da pandemia, a partir da prevenção, rastreamento entre grupos mais vulneráveis, identificação e notificação dos casos e óbitos por COVID-19. Descritores: Atenção Primária à Saúde; Cobertura de Serviços de Saúde; Indicadores de Desenvolvimento; Infecções por Coronavírus; Programas Sociais.

Objective:To analyze the impact of the coverage of Primary Health Care, Human Development Index and Bolsa Família on the occurrence of cases, deaths and lethality due to COVID-19 in the Brazilian Northeast. Method:Descriptive, cross-sectional study, with data extracted from the state platforms for COVID-19, the Health Information System for Primary Care and the Institute for Applied Economic Research. Spearman and Kruskal-Wallis correlation tests were used. Results:It was found that 483,793 confirmed cases of COVID-19 and 19,307 deaths from this condition were reported in the Brazilian Northeast. Regarding the occurrence of COVID-19, the State of Ceará had the highest rate of cases (1200.83/100,000 inhabitants). It was observed that the greater the coverage of FHS, the greater the number of confirmed cases (r=0.855 and p-value=0.002) and deaths (r=0.818 and p-value=0.004) due to COVID-19. Conclusion:The Family Health Strategy is an organizational model of Primary Health Care powerful to cope with the pandemic, based on prevention, tracking among the most vulnerable groups, identification and notification of cases and deaths due to COVID-19.Descriptors:Primary Health Care; Health Services Coverage; Development Indicators; Coronavirus Infections; Social Programs.

Casos, óbitos e letalidade por COVID-19: análise de dados sociais e assistenciais do Nordeste brasileiro / Cases, deaths and lethality due to COVID-19: analysis of social and assistance data from the Brazilian Northeast

Objetivo: Analisar o impacto da cobertura da Atenção Primária à Saúde, Índice de Desenvolvimento Humano e Bolsa Família na ocorrência de casos, óbitos e letalidade por COVID-19 no Nordeste brasileiro. Método: Estudo descritivo, de caráter transversal, com dados extraídos das plataformas estaduais da COVID-19, Sistema de Informação em Saúde para Atenção Básica e Instituto de Pesquisa Econômica Aplicada. Foram utilizados testes de correlação de Spearman e Kruskal-Wallis. Resultados: Verificou-se que foram notificados 483.793 casos confirmados de COVID-19 e 19.307 óbitos por esse agravo no Nordeste brasileiro. Com relação à ocorrência da COVID-19, o Estado do Ceará apresentou maior taxa de casos (1200,83/100.000 habitantes). Observou-se que quanto maior cobertura da ESF maior identificação da ocorrência de casos confirmados (r=0,855 e p-valor=0,002) e óbitos (r=0,818 e p-valor=0,004) por COVID-19. Conclusão: A Estratégia Saúde da Família é um modelo organizativo da Atenção Primária à Saúde potente para enfrentamento da pandemia, a partir da prevenção, rastreamento entre grupos mais vulneráveis, identificação e notificação dos casos e óbitos por COVID-19. Descritores: Atenção Primária à Saúde; Cobertura de Serviços de Saúde; Indicadores de Desenvolvimento; Infecções por Coronavírus; Programas Sociais.

Objective:To analyze the impact of the coverage of Primary Health Care, Human Development Index and Bolsa Família on the occurrence of cases, deaths and lethality due to COVID-19 in the Brazilian Northeast. Method:Descriptive, cross-sectional study, with data extracted from the state platforms for COVID-19, the Health Information System for Primary Care and the Institute for Applied Economic Research. Spearman and Kruskal-Wallis correlation tests were used. Results:It was found that 483,793 confirmed cases of COVID-19 and 19,307 deaths from this condition were reported in the Brazilian Northeast. Regarding the occurrence of COVID-19, the State of Ceará had the highest rate of cases (1200.83/100,000 inhabitants). It was observed that the greater the coverage of FHS, the greater the number of confirmed cases (r=0.855 and p-value=0.002) and deaths (r=0.818 and p-value=0.004) due to COVID-19. Conclusion:The Family Health Strategy is an organizational model of Primary Health Care powerful to cope with the pandemic, based on prevention, tracking among the most vulnerable groups, identification and notification of cases and deaths due to COVID-19. Descriptors: Primary Health Care; Health Services Coverage; Development Indicators; Coronavirus Infections; Social Programs

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil / Perspectiva dos agentes comunitários de saúde sobre o impacto da COVID-19 na atenção primária à saúde no Nordeste do Brasil / Perspectiva de los agentes comunitarios de la salud sobre el impacto de pandemia de COVID-19 en la atención primaria a la salud en el Nordeste de Brasil

Abstract: This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

Resumo: Este artigo avalia as repercussões da pandemia da COVID-19 no cotidiano de trabalho da equipe da Estratégia Saúde da Família (ESF) em diversos municípios do Nordeste brasileiro, na perspectiva dos agentes comunitários de saúde (ACS). Um questionário estruturado foi utilizado para coletar informações sobre a COVID-19, atividades dos ACS e equipes da ESF em 2021. Participaram 1.935 ACS de quatro capitais (Fortaleza - Ceará, João Pessoa - Paraíba, Recife - Pernambuco e Teresina - Piauí) e quatro cidades do interior (Crato, Juazeiro do Norte, Barbalha e Sobral, Ceará). A idade média dos ACS era de 46,25±8,54 anos, sendo a maioria mulheres (82,42%). Muitos (39,92%) estavam infectados com COVID-19, dos quais 70,78% acreditavam ter sido infectados no ambiente de trabalho. Ao todo, 77,82% definiam seu papel como linha de frente no combate à COVID-19, 16,07% relataram receber treinamento para a COVID-19 e 13,74% tinham acesso a equipamentos de proteção suficientes contra a COVID-19. A maioria (90,27%) acredita que suas rotinas de trabalho foram modificadas pela pandemia, fortalecendo o espírito de equipe (41,46%) ou enfraquecendo-o (44,41%). Houve uma redução na promoção da saúde nas escolas (75,66%) e na frequência de visitas domiciliares (60,55%), de grupos específicos na comunidade (93,96%) e outros serviços comunitários locais (66,01%). Nos municípios avaliados, observou-se uma heterogeneidade significativa em relação à resposta à pandemia de COVID-19, possivelmente associada à falta de coordenação do Governo Federal. A pandemia levou a uma reconfiguração dos sistemas locais de saúde, fluxos de trabalho e protocolos de atenção primária para as equipes da ESF. A importância do Sistema Único de Saúde (SUS) e seu potencial de reorganização durante as crises devem ser reconhecidos, preservando-se os avanços alcançados até o momento.

Resumen: Este artículo evalúa las repercusiones de la pandemia de COVID-19 en el trabajo cotidiano del equipo de la Estrategia Salud de la Familia (ESF) en diversos municipios del Nordeste brasileño, desde la perspectiva de los agentes comunitarios de salud (ACS). Se utilizó un cuestionario estructurado para recopilar información sobre COVID-19, actividades de los ACS y equipos de la ESF en el 2021. Participaron 1.935 ACS de cuatro capitales (Fortaleza - Ceará, João Pessoa - Paraíba, Recife - Pernambuco y Teresina - Piauí) y cuatro ciudades del interior (Crato, Juazeiro do Norte, Barbalha y Sobral - Ceará). La edad media de los ACS era de 46,25±8,54 años, y la mayoría eran mujeres (82,42%). Muchos (39,92%) estaban infectados con COVID-19, de los cuales el 70,78% creía haberse contagiado en el entorno laboral. En total, el 77,82% definió su papel como línea de frente en el combate a la COVID-19, el 16,07% informó haber recibido capacitación para la COVID-19 y el 13,74% tuvo acceso a equipos de protección suficiente contra la COVID-19. La mayoría (90,27%) cree que sus rutinas de trabajo se vieron modificadas por la pandemia, fortaleciendo el espíritu de equipo (41,46%) o debilitándolo (44,41%). Hubo una reducción en la promoción de la salud en las escuelas (75,66%) y en la frecuencia de las visitas domiciliarias (60,55%), de grupos específicos en la comunidad (93,96%) y otros servicios comunitarios locales (66,01%). En los municipios analizados, se observó una heterogeneidad significativa con relación a la respuesta a la pandemia de COVID-19, posiblemente asociada a la falta de coordinación del Gobierno Federal. La pandemia condujo a una reconfiguración de los sistemas locales de salud, los flujos de trabajo y los protocolos de atención primaria para los equipos de la ESF. Se debe reconocer la importancia del Sistema Único de Salud y (SUS) su capacidad de reorganización durante las crisis, preservando los avances logrados hasta el momento.

Saúde mental de agentes comunitários de saúde no contexto da COVID-19 / Mental health of community health workers in the COVID-19 context

Resumo O objetivo deste estudo foi analisar os fatores relacionados à saúde mental dos agentes comunitários de saúde (ACS) no contexto da COVID-19. Participaram 1.935 ACS de quatro capitais nordestinas e de quatro cidades do interior do Ceará. Foram coletados dados sociodemográficos e profissiográficos; SRQ-20; WHOQOL-Bref; exposição à violência; Escala de Autoeficácia Geral (EAEG); Escala Multidimensional de Suporte Social Percebido (MSPSS); informações relacionadas à COVID-19 e Escala de Ansiedade para Coronavírus (EAC). 40,5% exibiram SRQ > 7, sinalizando altos níveis de transtornos mentais comuns (TMC)/problemas de saúde mental. Utilizou-se a regressão linear múltiplas (backward). Observou-se que o aumento de risco de TCM foi influenciado pelos seguintes fatores: exposição à violência; EAC; não saber se teve COVID-19; desconhecer as variáveis que diminuíam o risco; os domínios físico e psicológico do WHOQOL-Bref; não ter aumento da jornada de trabalho; e não ter tido COVID-19. Os dados revelam a dinâmica multidimensional da saúde mental e ajudam a compreender a relação entre violência comunitária, COVID-19, qualidade de vida, idade e tempo de atuação na ESF com a saúde mental dos ACS.

Abstract This study aimed to analyze the factors related to the mental health of Community Health Workers (ACS) in the COVID-19 context. A total of 1,935 ACS from four Northeastern capitals and four cities in the inland region of Ceará participated. The following data were collected: sociodemographic; professional; SRQ-20; WHOQOL-Bref, exposure to violence, General Self-Efficacy Scale (EAEG), Multidimensional Scale of Perceived Social Support (MSPSS), COVID-19-related information, and the coronavirus anxiety scale (EAC). Approximately 40.5% had SRQ > 7, signaling high levels of Common Mental Disorders (CMD)/mental health issues. We adopted the Multiple linear (backward) regression. We observed that the increased risk of CMD was influenced by exposure to violence, EAC, not knowing they had COVID-19, not knowing the variables that reduced the risk, the physical and psychological domains of the WHOQOL-Bref, not having increased working hours, and not having had COVID-19. The data reveal the multidimensional dynamics of mental health and help understand the relationship between community violence, COVID-19, quality of life, age, and ESF working time with the mental health of ACS.