Organização e dificuldades no rastreamento do câncer do colo do útero na perspectiva dos profissionais da Atenção Primária à Saúde / Organization and Difficulties in Cervical Cancer Screening from the perspective of Primary Health Care professionals

Este estudo visa compreender a organização e as dificuldades no rastreamento do câncer do colo do útero na perspectiva dos profissionais da Atenção Primária à Saúde do município do Rio de Janeiro. Trata-se de estudo descritivo-exploratório, com 34 entrevistas semiestruturadas, gravadas, transcritas e submetidas a análise temática. A amostra teve como critério de escolha a área programática que obteve a média de cobertura (30.38%) mais próxima da média do município (30.93%) no ano de 2015: 4 unidades com menos de 30% de cobertura, uma unidade com residência médica (36,64%) e a de maior cobertura da área (56,86%). Estudamos, ainda, a unidade de maior destaque (89.18%) do município. Constatou-se dificuldade na captação das mulheres e grande volume de pacientes por equipe impactando negativamente na cobertura. O alto absenteísmo das mulheres sugere problemas no vínculo ou questões culturais. Em relação ao registro, não existem problemas com a utilização do prontuário eletrônico, mas exames realizados fora das unidades não são contabilizados. Nas clínicas com maiores coberturas, houve mais empenho do gestor local no monitoramento deste indicador, gerando motivação e envolvimento dos profissionais em várias estratégias de captação, sugerindo que a questão gerencial é fundamental para melhor índice de cobertura.

This study aims to comprehend the organization and difficulties in screening uterine cancer were studied from the perspective of Primary Health Care professionals. This is a descriptive-exploratory study, with 34 semi-structured interviews, which were, recorded, transcribed verbatim and submitted to thematic analysis. The chosen samples were the ones with average coverage (30.38%) closer to the municipality average (30.93%) in the year 2015: 4 units with less than 30% coverage, one unit with medical residency (36.64%) and the unit with the greater area coverage (56.86%). We also studied the most prominent unit in the municipality (89.18%). It was detected both difficulty in attracting the women and large volumes of patients per team, negatively impacting coverage. High absenteeism among the women suggests bond or cultural issues. There are no issues with management of the electronic medical record, but tests performed outside the units are not accounted for. In the clinics with the highest coverages, there was greater effort by the local manager in monitoring this key performance indicator, generating greater motivation and involvement of professionals in various attraction strategies, suggesting that the management issue is key for the best coverage index.

Internato de Saúde Mental para alunos de Medicina: qual o melhor cenário de formação? / Internado de Salud Mental para alumnos de Medicina: ¿ cuál es el mejor escenario de formación? / Mental Health Internship for Medical students: which is the best training setting?

As Diretrizes Curriculares do curso de graduação em Medicina de 2014 incluem a Saúde Mental (SM) como uma das áreas obrigatórias do internato. O objetivo deste trabalho é apresentar o internato integrado de SM e de Medicina de Família e Comunidade (MFC) da Universidade Federal do Rio de Janeiro (UFRJ) e a fundamentação da escolha da Atenção Primária à Saúde (APS) como cenário de formação dos internos. Trata-se do relato da experiência do internato integrado de SM e MFC da UFRJ e da discussão de seus marcos teóricos. A alta prevalência de sofrimento psíquico e transtornos mentais na APS, o fato de ela ser a porta de entrada do Sistema Único de Saúde (SUS) e o fato de que a faculdade de Medicina deve formar médicos generalistas fazem deste cenário lócus privilegiado para o treinamento dos internos de Medicina em SM.(AU)

Las Directrices Curriculares del Curso de Graduación en Medicina de Curso de 2014 incluyen la salud mental (SM) como una de las áreas obligatorias del internado. El objetivo de este trabajo es presentar el internado integrado de SM y Medicina de Familia y Comunidad (MFC) de la UFRJ y la fundamentación de la Escuela de Atención Primaria de la Salud (APS) como escenario de formación de los internos. Se trata del relato del internado integrado de SM y MFC de la UFRJ y de la discusión de sus marcos teóricos. La alta prevalencia de sufrimiento psíquico y trastornos mentales en la APS, el hecho de que la APS es la puerta de entrada del sistema único de salud (SUS) y el hecho de que la facultad de medicina debe formar a médicos generalistas, hace que este escenario sea un locus privilegiado para el entrenamiento de los internos de medicina en salud mental.(AU)

The 2014 Curricular Guidelines of the medical undergraduate courses include Mental Health (MH) as one of the required areas of internship. The objective of this paper is to present the integrated internship for MH and Family and Community Medicine (FCM) of UFRJ, as well as the rationale for choosing Primary Health Care (PHC) as the setting for the internship training. It presents a report of the experience of the integrated internship for MH and FCM of UFRJ and the discussion of its theoretical frameworks. The high prevalence of psychological distress and mental disorders in PHC, the fact that PHC is the gateway to the unified national health system (SUS) and the fact that the medical school must train general practitioners, make PHC a privileged locus for the training of medical interns in mental health.(AU)

Physical disability and social participation in patients affected by leprosy after discontinuation of multidrug therapy.

OBJECTIVES: To describe the social participation frequency and the physical disability of patients who were discharged after the multidrug therapy (MDT/WHO) and factors associated with these variables. METHOD: A cross-sectional and analytical study, examining associations, which took place Nova Iguaçu/Brazil. A random sample of patients treated with multidrug therapy from 1997 to 2006 was selected. The rationale for sample size was determined by the estimated proportion of physical disability in the amount of 23%, with an acceptable sampling error rate of 5%; significance level was established as 5% among the 1080 patients finally a total sample of 225 patients. The evaluations were performed from January 2010 to December 2011 and Socio-demographic and clinical data were collected from the applications completed in the national notifiable diseases information system (SINAN). RESULTS: In the period of interest, 2179 cases were diagnosed with leprosy; 1080 met the criteria for inclusion. Of these, 225 were randomly selected patients who had mean age 56.12 (±17.34 years), 55.6% were women, 39.9% went to high school and 28.9% were Caucasians. A total of 55.3% (125) showed multibacillary form, with a predominant dimorphous leprosy in 40.4%. Physical disability was present in 60.9% and social restrictions in 24.9% of patients. The variable physical disability was associated with the therapeutic regimen multibacillary and social participation. CONCLUSION: We observed a high frequency of disability and social restriction after long period after the start of MDT/WHO suggesting the late diagnosis of leprosy or inadequate follow-up after discharge. This study highlights the importance of systematic monitoring of these patients with their own criteria which could be held at the Family Health Strategy.