Navegando por Palavras-chave "Assistência Integral À Saúde."

Agora exibindo 1 - 2 de 2
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Atenção às mulheres no período do climatério: a construção de diálogos com profissionais de saúde no município de Santos, São Paulo
    (Universidade Federal de São Paulo (UNIFESP), 2019-09-23) Luz, Milene Mori Ferreira [UNIFESP]; Frutuoso, Maria Fernanda Petroli [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Women's health has historically been one of the priority focuses of the health sector, especially with regard to actions in the reproductive period, with little emphasis on the climacteric, the transformation period, from the reproductive to the non-reproductive phase, which may cause various symptoms affecting women’s every day. With population aging and increased life expectancy, new approaches to care, disease prevention and climacteric women’s health promotion are needed. This study aimed to know the professionals’ practices and discuss the assistance provided to women in climacteric period in health primary care in Santos. This is an intervention research with teams of the Family Health Strategy (FHS) and the Extended Family Health Center (NASF), with nine professional categories. The data were produced from workshops encouraging the active participation of the subjects. They were recorded, transcribed and analyzed by content analysis. Professionals point out there are no actions focused on this population and that the complaints of women who are in the climacteric period are not perceived or are minimized by the lack of knowledge and reflection on the issue by the team. The FHS actions are still directed to the priority groups (hypertensive and diabetic patients, pregnant women) and some women's complaints are understood as a problem related to mental health (depression) giving invisibility to climacteric women. The workers recognize the difficulty for women to experience the climacteric syndrome with the actions offered by the services, which are not prepared for the approach in the climacteric period and the conditions of vulnerability of women in the studied region. The NASF team can contribute to multidisciplinary actions, which qualify care for women throughout the life cycle. The actions of permanent education in health, in the daily work of the FHS and NASF teams can extend the professionals' understanding of the women care, as well as rethink professional practices in the unique contexts of the territories. The data production from this research may support the construction of public policies in the area of Women's Health in the city of Santos aiming at comprehensive health care and humanized assistance to women in the climacteric period.
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Não adesão ao tratamento no transplante de fígado
    (Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Oliveira, Priscilla Caroliny De [UNIFESP]; Roza, Bartira De Aguiar [UNIFESP]; Schirmer, Janine [UNIFESP]; http://lattes.cnpq.br/3721636964139813; http://lattes.cnpq.br/9255434835123749; http://lattes.cnpq.br/3558901850783019; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To evaluate the interventions of the multiprofessional team that provide improved adherence to treatment after liver transplantation; to assess levels of non-adherence to immunosuppressive therapy in a sample of liver transplant recipients using the Basel Assessment of Adherence with immunosuppressive medication Scalee to correlate sociodemographic characteristics and clinical factors to non-adherence to medication; to develop a model of evaluation of nonadherence to the treatment in the context of liver transplantation capable of covering several dimensions of the phenomenon, correlating the levels of non adherence to the different methods of measurement applied in liver transplant patients; to reflect on the theoretical and practical aspects related to non-adherence to treatment in the context of liver transplantation and to correlate with the concepts of normality established by Michael Foucault and The Power as Knowing Participation in Change Theory. Methods: This study adopted a mixed method design, in which elements of qualitative and quantitative research were combined. The work was divided into four subprojects: 1- adherence to treatment in liver transplantation: an integrative review; 2- evaluation of adherence to treatment in patients submitted to liver transplantation; 3 - New perspectives of analysis in nonadherence research in liver transplantation by means of data association: pilot study. 4 - subjectivity, adherence in transplantation and biopolitics - possible reflections of power as normative practice in health. The study was and approved by the Ethics and Research Committee under the opinion 623.082 and Certificate of Presentation for Ethical Appreciation nº1643201470005505. Results: The integrative review, which aimed to evaluate the interventions of the multiprofessional team that provides the improvement of adherence to treatment after liver transplantation, initially selected 84 publications. After applying the exclusion criteria, 10 studies were selected. Four significant categories were found: educational interventions; adoption of an individual therapeutic plan; change in immunosuppressive regimen; emotional support, psychological support and strengthening of the support network. The level of nonadherence in liver transplantation was 49% and was directly related to the use of mycophenolic acid (p = 0.007) and administration of multiple doses of immunosuppressants daily (p = 0.004). No statistically significant correlations were found between non-adherence to immunosuppressive therapy and sociodemographic characteristics and other clinical variables analyzed. It was proposed a data triangulation model that evaluated the non adherence to liver transplantation under different aspects: a) direct evaluation of non adherence - through the application of a self-report instrument, associated to the perspective of the patient himself and the specialist responsible for follow-up; b) clinical evaluation, considering the serum immunosuppressive level in use, alterations of the aminotransferases, histological analysis of the graft and previous treatment for rejection; c) behavioral evaluation, which analyzed the existence of reports of therapeutic failure and absences on outpatient return. These indicators were analyzed individually and together. The theoretical essay aimed to develop a systematic reflection on adherence to treatment in the context of transplantation, based on the historicity of its concept of adherence through the construction of parallels between the concepts of adherence and health. The problem of non-adherence questions the team about its role, which requires listening to the demands that come in to everyday praxis. In this perspective, the theory of power as knowledge and participation for change of Elizabeth Barrett is emphasized, for emphasizing the subjective aspect present in health care, emphasizing the role of a dialogue and supported action in the establishment of solidarity and socio- and fostering the social role of users of transplantation actions and services. Conclusion: In view of the gaps highlighted and the results pointed out through the integrative review, it is understood that it is necessary to intensify efforts for the development of research with designs that produce strong evidences regarding the interventions adopted by the multiprofessional team capable of improving the adherence. This study showed that nearly half of the patients stopped adhering to immunosuppressive therapy after liver transplantation. Since unfavorable outcomes in transplantation are closely related to adherence failures, it is important that nurses assess this behavior during outpatient follow-up of liver transplant recipients. The application of triangulation methods to qualitatively assess noncompliance in an adult liver transplant program included 10 indicators in the analysis and identified a non-adherence level of 14.3%. At the end of the reflective study, it was possible to conclude that the phenomenon of adherence is more complex than we have traditionally described, because it depends on the subjective process that involves many questions that are not yet addressed by nurses in general. The threshold between adhesion and nonadherence is unique, even if it is influenced by plans that transcend the strictly individual, such as social, economic, political, historical and cultural.