Development and Psychometric Validation of a Screening Questionnaire to Detect Excessive Menstrual Blood Loss That Interferes in Quality of Life: The SAMANTA Questionnaire.

Background: Heavy menstrual bleeding (HMB) affects up to 35% of women at some point in their lives, and has an important impact on their quality of life (QoL). Current techniques to assess and quantify menstrual blood loss are inconvenient and the correlation between actual and perceived blood loss is poor. This study aimed to develop and validate a screening questionnaire in Spanish to identify HMB in women of reproductive age. Methods: The study consisted of two phases: the conceptual development of a set of items to discriminate between women with and without HMB and the assessment of the sensitivity and specificity of these items. Correlation of the screening tool with women's perception of the intensity of bleeding and the interference in their daily life activities was also assessed. Results: An initial set of 46 items were identified, from which 21 items were selected following the cognitive interviews. For the psychometric validation phase, 389 patients were enrolled, of whom 364 were assessable: 211 cases with Pictorial Blood loss Assessment Chart-confirmed excessive menstrual loss (EML) and 153 controls. Six items met entry criteria in the model and together yielded a sensitivity of 86.7% and specificity of 89.5% to identify cases and controls. These items were weighted according to their contribution to the final model to yield a tool that can be scored from 0 to 10 being 3 the cutoff point to diagnose EML that interferes in QoL. Conclusions: The 6-item SAMANTA questionnaire represents a valid screening tool to easily identify women with EML that interfere with QoL.

Anticoncepción en mujeres nulíparas: necesidades no cubiertas y barreras a la anticoncepción intrauterina / Contraception in nulliparous women: uncovered needs and barriers for intrauterine contraception

El cada vez mayor retraso en la edad de la primera maternidad en nuestro país, que ya supera los 31 años, implica la existencia de un volumen importante de mujeres menores de 30 años, nulíparas, con necesidad de una anticoncepción efectiva. La elevada utilización de métodos anticonceptivos con alta dependencia activa de la usuaria, como el preservativo y la píldora, pone a estas mujeres en un alto riesgo de embarazo no deseado. Las cifras acerca de las interrupciones voluntarias del embarazo entre mujeres de esta edad lo confirman. Los anticonceptivos de larga duración reversibles (LARC por sus siglas en inglés: long-acting reversible contraception) -siendo los más populares el dispositivo intrauterino (DIU) de cobre (DIU-Cu) y el liberador de levonorgestrel (DIU-LNG)- tienen la ventaja de no depender de la participación activa de las usuarias, lo que les confiere una alta efectividad y tasas de continuidad superiores a las de otros métodos. Presentan pocas contraindicaciones y ofrecen una protección anticonceptiva efectiva durante el tiempo que la mujer desee. Sociedades médicas internacionales los recomiendan para todas las mujeres, incluidas las adolescentes, como estrategia para evitar embarazos no deseados. Sin embargo, su uso en nuestro país es muy limitado, se cree que debido a la falta de experiencia y a la existencia de creencias erróneas por parte del profesional sanitario. El escaso conocimiento que adolescentes y jóvenes tienen sobre los LARC afecta también a su actitud hacia los mismos. Se analizan en profundidad barreras como la dificultad de inserción (incluido el riesgo de perforación y el dolor provocado por ésta), el riesgo de expulsión, de enfermedad inflamatoria pélvica y de infertilidad subsecuente y se plantea el beneficio que un nuevo DIU-LNG, de menor tamaño y contenido hormonal, puede tener en estas mujeres (AU)

First child birth in contemporary women is becoming delayed, and it’s nowadays set on 31 years old within Spanish women. This fact indicates that a wide population of fertile nulliparous women under 30 years old is requiring for effective and safe contraception. The extensive use of contraceptive methods which require user’s active participation, such as oral contraceptive pills or condoms, exposes these women to high risk of unintended pregnancy. Unfortunately, termination of pregnancy data confirms that situation. Long-acting reversible contraceptive methods (LARC), with cooper intrauterine device (Cooper-IUD) and levonorgestrel intrauterine device (LNG-IUD) being the most popular, give the advantage of offering the user independence for compliance, and this confers them higher efficacy and continuation rates compared to other contraceptive methods. Moreover, few contraindications are described for intrauterine device use, and contraceptive protection is guaranteed for as long as women wish. Several international medical societies do recommend its use for all women, including adolescents, to prevent effectively unintended pregnancies. However, use of LARC methods in Spain is yet limited, probably because of lack of experience and misperceptions among healthcare providers. Adolescents and young women’s little knowledge about LARC also affects their attitude towards them. In this review we deeply analyse those barriers such as difficulty of insertion (including pain during insertion and risk of perforation), expulsion risk, and pelvic inflammatory disease and subsequent infertility. We propose the option of a new, smaller, low-dose LNG-IUD, which can offer numerous benefits for these women (AU)

Empty follicle syndrome prevalence and management in oocyte donors.

STUDY QUESTION: Is the drug used for final oocyte maturation a factor in determining the prevalence of empty follicle syndrome (EFS)? SUMMARY ANSWER: The drug used for final oocyte maturation is not a factor in determining the prevalence of EFS among women unaffected by infertility. WHAT IS KNOWN ALREADY: Despite satisfactory follicular stimulation and adequate follicular development, cases of EFS, i.e. failure to recover any cumulus oocyte complex, have been reported both with hCG and GnRH agonist triggering. No standard management protocol has been proposed so far. STUDY DESIGN, SIZE, DURATION: Retrospective analysis of oocyte donation cycles performed between August 2006 and April 2013 in a large private fertility centre. PARTICIPANTS/MATERIALS, SETTING, METHODS: The analysis included 12 483 oocyte donation cycles of which 74 were EFS cycles. All cycles were triggered with either hCG or GnRH agonists. MAIN RESULTS AND THE ROLE OF CHANCE: There were no differences in the gonadotropic stimulation, pituitary suppression and triggering drug between cycles where oocytes were recovered successfully and EFS cycles. The total prevalence of EFS was 0.59%. Given the rarity of the syndrome, caution is advised when interpreting the analysis. LIMITATIONS, REASONS FOR CAUTION: The main limitation of this study is its retrospective nature. Although this is the largest analysis of EFS in donors reported so far, its statistical power is limited because the syndrome has a low incidence. In some cycles of EFS from 2006 to 2007 there is a lack of hormone data. WIDER IMPLICATIONS OF THE FINDINGS: Our findings may be generalized to oocyte donors and IVF patients younger than 35 years old, with cycles undergoing final maturation triggering with either hCG or GnRH agonists. The generalization cannot be extended to patients with an ovarian factor as the cause of their reproductive pathology. The theoretical aetiology of a temporary hypothalamic-pituitary hyposensitivity can explain the cycles where a rescue protocol with hCG has been successful. STUDY FUNDING/COMPETING INTERESTS: This work was supported in part by funding from Fundaciò EUGIN. The authors have no conflicts to declare. TRIAL REGISTRATION NUMBER: NA.

Estudio retrospectivo de la hemorragia uterina excesiva en la adolescencia / Retrospective study of heavy uterine bleeding in adolescence

Introducción. El objetivo principal es revisar la casuística de las adolescentes que consultaron por hemorragia uterina excesiva en la Unidad de Ginecología de la Adolescencia del Institut Universitari Dexeus de Barcelona, así como el tratamiento y la evolución de las mismas. Material y métodos. Estudio retrospectivo entre enero del 2005 y diciembre del 2009 en 178 adolescentes. Resultados. Los episodios de hemorragia uterina excesiva observados, clasificados según los niveles de la hemoglobina, fueron leves (53,4%), moderados (11,2%) y graves (2,2%). Se alcanzó una mejoría de la sintomatología en el 43% de las adolescentes que han recibido ferroterapia, un 48% con antiinflamatorios no esteroideos, un 55% con antifibrinolíticos, un 59% con gestágenos, un 54% con estroprogestágenos y un 56% con anticonceptivos hormonales combinados. Conclusión. La hemorragia uterina en exceso es una patología frecuente en la consulta de Ginecología de la Adolescencia. Su manejo y las medidas terapéuticas son de fácil aplicación(AU)

Introduction. The main objective of this study was to review the casuistics of adolescent women who consulted the Unidad de Ginecología de la Adolescencia del Institut Universitari Dexeus in Barcelona, Spain, for heavy uterine bleeding, as well as their treatments and outcomes. Material and methods. We performed a retrospective study of 178 adolescents treated between January 2005 and December 2009. Results. The severity of uterine bleeding was classified according to hemoglobin levels as mild (53.4%), moderate (11.2%) and severe (2.2%). Symptoms improved in 43% of the patients treated with iron therapy, 48% of those treated with non-steroidal anti-inflammatory drugs, 55% of patients who received antifibrinolytic agents, 59% of those treated with progestogens, 54% of patients who received estro-progestogens and 56% of those who received combined hormonal contraceptives. Conclusion. Heavy uterine bleeding is a common gynecological condition in adolescence, whose management and therapeutic measures are easy to apply(AU)

Percepções de gestantes e puérperas acerca da sala de espera em uma unidade básica de saúde integrada à estratégia saúde da familia / Percepciones de mujeres embarazadas y puérperas acerca de la sala de espera en una Unidad Básica de Salud Integrada em la Estrategia Salud para la Familia / Pregnant and postpartum women perceptions about waitingroom in a Primary Health Care Unit included in the Family Health Strategy

Objetivo: Analisar a percepção de gestantes e puérperas acerca de suas experiências vivenciadas em sala de espera. Métodos: Estudo descritivo, analítico, de abordagem qualitativa, realizado em uma Unidade Básica de Saúde integrada à Estratégia Saúde daFamília (ESF), em um município do interior do estado do Rio Grande do Sul, Brasil. Os dados foram coletados no mês de dezembro de 2011, mediante entrevistas com questõesabertas e fechadas analisadas pela técnica de análise de conteúdo. Os sujeitos compreenderam 10 mulheres, sendo sete gestantes e três puérperas, que realizaram pré-natal e participaram das atividades em sala de espera no período de setembro a dezembro de 2011. Resultados: Segundo a percepção das participantes, a sala de espera é um espaço atencioso, promotor de tranquilidade, conhecimento e esclarecimento de dúvidas relacionadas ao processo gravídico puerperal. Conclusões: A formação de grupos de educação em saúde intermediados pelo diálogo problematizador, visando promover a reciprocidade do aprender e ensinar, tendo como foco a concepção ampliada de saúde, é um ponto relevante no espaço sala de espera. Ainda é importante destacar a necessidade de que sejam efetivadas ações de educação permanente junto aos profissionais de saúde, tendo como eixo a problematização da realidade social e dos serviços, bem como a integração de aspectos gerenciais, pedagógicos e políticos. Isso pode contribuir para a verdadeira construção do conhecimento politizado em saúde,como anunciam os documentos oficiais da esfera da saúde e da educação.

Objective: To analyze the perception of pregnant and postpartum women about their experiences in the waiting room. Methods: A descriptive analytic study, of qualitative approach, conducted in a Primary Health Care Unit integrated into the Family Health Strategy (Estratégia Saúde da Família-PSF) in a municipality of the state of Rio Grande do Sul, Brazil. The data was collected in December 2011, through interviews with open and closed questions, and was analyzed using content analysis technique. The sample consisted of 10 women, seven of them being pregnant and three in postpartum period; all having received prenatal care and taken part in waiting room activities from September to December 2011. Results: According to the participants? perception, the waiting room is a space of attentiveness, promoter of tranquility, understanding and clarification of questions related to pregnancy and childbirth process. Conclusions: The formation of health education groups intermediated by problem-based dialogue, aiming to promote reciprocal learning and teaching, with focus on the extensive concept of health, is a relevant issue in the waiting room. It is also important to highlight the need to accomplish continuing education initiatives involving healthcare professionals, centered on a questioning approach of social reality and services, along with the integration of managerial, educational and political aspects. This shall contribute to the real construction of politicized knowledge in health, as report the official documents of health and education sphere.

Objetivos: Analizar las percepciones de las mujeres embarazadas y puérperas acerca de sus experiencias en la sala de espera. Métodos: Estudio descriptivo, analítico, de abordaje cualitativo realizado en una Unidad Básica de Salud integrada en La Estrategia Salud para la Familia (ESF) en un municipio del interior del estado de Rio Grande do Sul, Brasil. Los datos fueron recopilados en diciembre de 2011 a través de entrevistas com preguntas abiertas y cerradas analizadas mediante el análisis de contenido. La muestra estuvo formada por 10 mujeres, siendo siete embarazadas y tres puérperas que tuvieron atención prenatal y participaron en las actividades de la sala de espera durante El período de septiembre a diciembre de 2011. Resultados: Según las percepciones de las participantes, la sala de espera es um espacio atento y promotor de la tranquilidad, del conocimiento y esclarecimiento de las dudas relacionadas con el embarazo y el proceso del parto y posparto. Conclusiones: La formación de grupos de educación en salud intermediados por el dialogo problematizado, promoviendo la reciprocidad del aprendizaje y la enseñanza centrándose en el concepto ampliado de salud, ES un aspecto relevante en el espacio de la sala de espera. También es importante destacar la necesidad de que las acciones de educación permanente sean realizadas junto con los profesionales sanitarios teniendo como eje la problemática de la realidad social y de los servicios, así como la integración de los aspectos administrativos, pedagógicos y políticos. Esto puede contribuir a la verdadera construcción del conocimiento politizado en salud, como anuncian los documentos oficiales de la esfera de la salud y la educación.

A articulação intrasetorial na promoção da saúde dos trabalhadores / The intersectoral links in the promotion of workers’ health

Objetivos: relatar as vivências desenvolvidas por meio da articulação Intrasetorial na Promoção da Saúde dos Trabalhadores de reflorestamento no município de Unistalda, Rio Grande do Sul. Método: a metodologia contemplou encenações teatrais, atividades lúdicas, dinâmicas de grupo, gincana educativa, conversas individuais e palestras. O fechamento do processo utilizou abordagem multiprofissional de temas acerca dos problemas de saúde frequentes no grupo. Resultados: a atuação ocorreu por meio de ações assistenciais/educativas acerca da interação saúde-trabalho-doença a partir do perfil dos trabalhadores. As ações problematizaram fatores determinantes do processo saúde-trabalho-doença e comportamentos favoráveis a um estilo de vida saudável. Conclusões: a integração entre Unidade de Saúde da Família, a Empresa de Reflorestamento e o curso de Graduação em Enfermagem da Universidade Regional Integrada do Alto Uruguai e das Missões Campus Santiago, possibilitou a promoção de ações assistenciais/educativas voltadas a integralidade do cuidado à saúde do trabalhador.

Objectives: to report experiences developed through intersectoral coordination for Promotion of Health of reforestation workers in the town of Unistalda, Rio Grande do Sul. Method: the methodology included theatrical, recreational activities, group dynamics, educational contest, individual conversations and lectures. The closing of the process used multidisciplinary approach to issues concerning the health problems most frequently raised among the group. Results: the action occurred trough the health care/educative actions about the interaction between health-work-disease from the profile of workers. The actions problematized determinants of the process health-job-seeking and behaviors favorable to a healthy lifestyle. Conclusions: the integration between the Family Health Unit, the Company of Reforestation and graduate course in Nursing of the Regional Integrated High Uruguay and Missions Campus Santiago, allowed the promotion of activities about health care and educational interventions directed to the integrality of health care to workers' health.

Objetivos: reportar las experiencias desarrolladas mediante los vínculos intersectoriales en la Promoción de la Salud de los Trabajadores de reforestación en Unistalda, Río Grande do Sul.Metodología: la metodología incluye actividades teatrales, recreativas, dinámicas grupales, concursos educativos, conversaciones individuales y conferencias. El cierre de los procedimientos utilizó el enfoque multiprofesional en problemas de salud frecuentes en el grupo. Resultados:la acción se produjo mediante acciones asistenciales/educativas acerca de la interacción entre salud-trabajo-enfermedad del perfil de los trabajadores. Las acciones fueron problematizadas con determinantes del proceso salud-trabajo-enfermedad y comportamientos favorables a un estilo de vida saludable. Conclusiones: la integración entre la Unidad de Salud de la Familia, el Compañía de Reforestación y el Curso de Graduación en Enfermería de la Regional Integrado Alto Uruguay y las Misiones Campus Santiago, permitió la promoción de actividades asistenciales/educativas para el cuidado integral de la salud de los trabajadores.

Consulta de riesgo oncológico. Selección de grupos de riesgo y resultados / Oncologic risk counselling unit. Selection of risk groups and results

Fundamento y objetivo: valorar la selección de pacientes realizada y los resultados en cuanto a detección de mutaciones y seguimiento de las familias en una consulta de riesgo oncológico. Pacientes y método: se ha visitado a 153 pacientes correspondientes a 137 familias. De éstas, 77 se clasificaron como de alto riesgo, 35 de riesgo moderado y 25 de riesgo bajo. La clasificación de las pacientes en grupos de riesgo alto, moderado y bajo se realizó según las recomendaciones de las guías publicadas y la oncoguía de cáncer familiar del Departament de Salut de la Generalitat de Catalunya. Resultados: entre los antecedentes familiares se observó que las pacientes del grupo de riesgo alto presentaban una media (desviación estándar) de 2,80 (1,5) casos de cáncer de mama/ovario; las del grupo de riesgo moderado, 1,82 (0,75), y las del grupo de riesgo bajo, 1,05 (0,80). De las familias de riesgo alto, se estudió a 37 (51,9%) para la detección de mutaciones nocivas en los genes BRCA1 y BRCA2. De los 37 estudios completos, 5 resultaron positivos (uno para BRCA1 y uno para BRCA2), hubo 3 variantes de significado desconocido en BRCA2 y 25 (83,4%) no presentaron mutación nociva en BRCA1/2. Conclusiones: los resultados obtenidos, con un 16,6% de positividad en los estudios de BRCA realizados, indican que se está realizando una correcta selección de pacientes. Asimismo este hecho nos permite adecuar la planificación de cribado de forma correcta (AU)

Background and objective: We evaluated the patients’ selection and the results of the detection of mutations as well as the follow-up of families at a genetic counselling unit. Patients and method: One hundred and fifty three patients were visited corresponding to 137 families: 77 of them were classified as high-risk group, 35 as moderate-risk and 25 as low-risk. The classification of patients in each group was made according to the recommendations of the guidelines and the «Oncoguia de càncer familiar» of the Departament de Salut de la Generalitat de Catalunya. Results: With regard to familiar antecedents, patients of the high-risk group had an average (standard deviation) of 2.80 (1.5) cases of breast and/or ovarian cancer, while it was 1.82 (0.75) in the moderate-risk group, and 1.05 (0.80) in the low-risk group. Thirty seven families of high-risk (51.9%) were studied for the detection of deleterious mutations in BRCA1/2. Of 37 completed studies, 5 were positive (one BRCA1 and one BRCA2), 3 had variants of unknown significance in BRCA2 and 25 (83.4%) had no deleterious mutation in BRCA1/2. Conclusions: A correct selection of patients was performed, because 16.6% of BRCA's studies was positive. This fact allows us to adapt a planning of screening (AU)

[Oncologic risk counselling unit. Selection of risk groups and results]. / Consulta de riesgo oncológico. Selección de grupos de riesgo y resultados.

BACKGROUND AND OBJECTIVE: We evaluated the patients' selection and the results of the detection of mutations as well as the follow-up of families at a genetic counselling unit. PATIENTS AND METHOD: One hundred and fifty three patients were visited corresponding to 137 families: 77 of them were classified as high-risk group, 35 as moderate-risk and 25 as low-risk. The classification of patients in each group was made according to the recommendations of the guidelines and the "Oncoguia de càncer familiar" of the Departament de Salut de la Generalitat de Catalunya. RESULTS: With regard to familiar antecedents, patients of the high-risk group had an average (standard deviation) of 2.80 (1.5) cases of breast and/or ovarian cancer, while it was 1.82 (0.75) in the moderate-risk group, and 1.05 (0.80) in the low-risk group. Thirty seven families of high-risk (51.9%) were studied for the detection of deleterious mutations in BRCA1/2. Of 37 completed studies, 5 were positive (one BRCA1 and one BRCA2), 3 had variants of unknown significance in BRCA2 and 25 (83.4%) had no deleterious mutation in BRCA1/2. CONCLUSIONS: A correct selection of patients was performed, because 16.6% of BRCA's studies was positive. This fact allows us to adapt a planning of screening.

Diagnóstico prenatal en el segundo trimestre de displasia torácica asfixiante / Prenatal diagnosis in the second trimester of asphyxiating thoracic dysplasia

Describimos un caso de diagnóstico prenatal de síndrome de Jeune. Debido a su baja incidencia, es excepcional realizar el diagnóstico de este síndrome a las 21 semanas de gestación en una paciente de riesgo bajo. La displasia torácica asfixiante o síndrome de Jeune es una displasia esquelética hereditaria de carácter autonómico recesivo. El diagnóstico prenatal se puede realizar por ecografía; este síndrome se caracteriza por tórax pequeño, costillas cortas, anormalidades pélvicas, braquimelia rizomélica, y anomalías renales y hepáticas, entre otras. En nuestro caso, el diagnóstico prenatal fue confirmado con la necropsia

A case of prenatal diagnosis of Jeune’s syndrome is described. Because the incidence of this syndrome is low, diagnosis in the 21st week of pregnancy is exceptional. Jeune’s syndrome, or asphyxiating thoracic dysplasia, is a skeletal dysplasia with autosomal recessive inheritance. Prenatal diagnosis can be established by ultrasonographic findings of a small thorax, short ribs, pelvic abnormalities, rhizomelic brachymelia, and renal and liver anomalies, among others. In the present case, the prenatal diagnosis was confirmed at necropsy (AU)

[Education, care and management technologies: a reflection based on nursing teachers' conception]. / Tecnologias educacionais, assistenciais e gerenciais: uma reflexão a partir da concepção dos docentes de enfermagem.

This study involved the teachers of sixteen Nursing Courses at Higher Education Institutions in the State of Rio Grande do Sul and aimed to identify the care, education and management technologies that are used and/or produced in their professional praxis in professionalizing subjects. This text presents a research extract and focuses on the conceptions about the different types of technologies the teachers approached. Data were collected through a questionnaire with closed and open questions and later analyzed according to the methodological framework of content analysis. The study revealed that most teachers presented a restricted concept of the theme, manifesting difficulties for technology use and production and suggesting ways of support to overcome these difficulties, with a view to improving professional praxis.

Tecnologias educacionais, assistenciais e gerenciais: uma reflexão a partir da concepção dos docentes de enfermagem / Education, care and management technologies: a reflection based on nursing teachers' conception

Estudo realizado com os docentes de dezesseis Cursos de Enfermagem das Instituições de Ensino Superior do Estado do Rio Grande do Sul, com objetivo de identificar as tecnologias assistenciais, educacionais e gerenciais que vêm sendo utilizadas e/ou produzidas em sua práxis profissional nas disciplinas profissionalizantes. Este texto apresenta um recorte da investigação realizada e centra-se nas concepções das diferentes tipologias de tecnologias abordadas pelos docentes. Os dados foram coletados através de questionário com perguntas fechadas e abertas e, após, foram categorizados e analisados, apoiados nos referenciais metodológicos de análise de conteúdo. Ficou evidenciado que a maioria dos docentes apresentou concepção conceitual restrita a respeito da temática, manifestando dificuldades para produção e utilização de tecnologias e sugerindo formas de assessoramento para suprir as dificuldades na perspectiva de melhoria da práxis profissional.

[Nursing and planning in health: management report as an instrument of health planning]. / Enfermagem e planejamento em saúde: relatório de gestão como instrumento.

The involvement of the future nurse in the construction of the Management Report of the Actions of Health of a city in the interior of Rio Grande do Sul was the main objective of this study. The methodological strategy consisted of meetings with coordinators and technicians responsible for the sanitary units, the General Director Group and planning team of the health of the city, participation in the collection of data and elaboration of the related report. The literature revision contemplated: politics of health, a management report as an instrument of health planning, continued education and the role of the nurse on SUS improvement. This work contributed to the improvement of the report of health management, with sights to the planning and implementation of resolute and effective actions.

Enfermagem e planejamento em saúde: relatório de gestão como instrumento / Nursing and planning in health: management report as an instrument of health planning / Enfermería y planificación en salud: informe de gestión como instrumento

Este estudo teve como principal objetivo o envolvimento do futuro enfermeiro na construção do Relatório de Gestão das Ações de Saúde de um município no interior do Rio Grande do Sul. A estratégia metodológica constou de reuniões envolvendo coordenadores e responsáveis técnicos das unidades sanitárias, a Diretora Geral e equipe de planejamento de saúde do município, participação na coleta de dados e elaboração do referido relatório. A revisão de literatura contemplou: políticas de saúde, relatório de gestão como instrumento de planejamento em saúde, educação continuada e o papel do enfermeiro no fortalecimento do SUS. O trabalho realizado contribuiu para o aprimoramento do relatório de gestão municipal da saúde, com vistas ao planejamento e implementação de ações efetivas e resolutivas.

The involvement of the future nurse in the construction of the Management Report of the Actions of Health of a city in the interior of Rio Grande do Sul was the main objective of this study. The methodological strategy consisted of meetings with coordinators and technicians responsible for the sanitary units, the General Director Group and planning team of the health of the city, participation in the collection of data and elaboration of the related report. The literature revision contemplated: politics of health, a management report as an instrument of health planning, continued education and the role of the nurse on SUS improvement. This work contributed to the improvement of the report of health management, with sights to the planning and implementation of resolute and effective actions.

Este estudio tuvo como principal objetivo el envolvimiento del futuro enfermero en la construcción del Informe de Gestión de las Acciones de Salud de un municipio en el interior de Rio Grande do Sul. La estrategia metodológica constó de reuniones envolviendo coordinadores y responsables técnicos de las unidades sanitarias, la Directora General y equipo de planificación de salud del municipio, participación en la recolección de datos y en la elaboración del referido informe. La revisión de literatura contempló: políticas de salud, informes de gestión como instrumento de planificación en salud, educación continuada y el papel del enfermero en el fortalecimiento del SUS. El trabajo realizado contribuyó para el perfeccionamiento del informe de gestión municipal de la salud, con vistas a la planificación e implementación de las acciones efectivas y resolutivas.

Diretrizes pedagógicas na formação em saúde: buscando uma relação educador/educando de cunho transformador / Pedagogical direction for health formation: aiming at a transforming teacher/student relationship

As autoras fazem uma reflexão a respeito da diretriz pedagógica convencional que vem orientando a formação em saúde e por conseguinte, reiterando uma relação educador/educando impregnada de dominação/subordinação. Apresentam algumas características de uma proposta educativa de cunho transformador, bem como sugerem alguns critérios possibilitadores de uma nova relação educador/educando, entendida como instrumento de mudança social com ressonância no ensino e na assistência de enfermagem...

The authors reflect on the conventional pedagogicaldirection that is guiding the health professionals aducation thus reinforcing a teacher-student relationship which is filled withsubordination/domination. They present some characteristics of an educative proposal of a transformer character, as well as suggest some criteria which make possible to establish a new educator-learner relationship. Such relationship is understood as an instrument of social change which affects teaching and nursing care...

Las autoras hacen una reflexión sobre la directriz pedagógica convencional que vie orientando la formación en salud y por consiguiente, veiterando una relación educador/educando impregnada de clominación y subordinación. Presentan algunas características de una propuesta educativa transformadora, como lo surgieren algunos criterios que posibilitan un cambio social con eco en la enseñanza y en la asistencia de la enfermería.

Construindo possibilidades para redefinir a prática de enfermagem em saúde pública: uma história a ser contada / Building possibilities to redefine nursing practice in public health: a story to be told

O texto tem a pretensäo de contar a trajetória de um grupo de professoras do Curso de Enfermagem da Universidade Federal de Santa Maria (RS), na busca por um modelo de ensino/assistência que possibilite redefinir os rumos da formaçäo profissional, ainda alicerçada nos pressupostos do modelo biomédico e numa base educativa convencional. Apesar das dificuldades encontradas ao longo do caminho, o trabalho tem avançado, evidenciando que é possível se construir uma maneira de trabalhar saúde de forma abrangente, no qual exista a indissociabilidade entre promoçäo, proteçäo e recuperaçäo da saúde, bem como entre as esferas individual/coletivo.