Saúde socioambiental na atenção básica: conhecimento, formação e prática
Data
2022-11-09
Autores
Castelo Branco, Jeffer [UNIFESP]
Orientadores
Batista, Nildo Alves [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A revolução industrial trouxe consigo, a partir do século XVIII, uma diversidade de novas substâncias e formulações químicas que encontrou, a partir do século XX, um ambiente favorável para sua produção em alta escala. Essa produção de controle tardio, e que ainda é inadequado, fez com que a exposição humana a agentes nocivos se tornasse e permanecesse uma realidade global, cuja manutenção requer cada vez mais ações de promoção da saúde às pessoas e comunidades expostas em seus territórios. Considerando que a Saúde Socioambiental (SSA) observa o movimento dos agentes nocivos na interface ambiente-saúde-sociedade, presentes como poluentes ou contaminantes no ar, no solo, na água, nos bens, produtos, serviços, bebidas e alimentos, como atingem a saúde e os meios e a atenção disponíveis, buscou-se analisar o conhecimento, a formação e a prática das equipes da atenção básica com relação à SSA, com foco na redução do adoecimento decorrente de exposição e intoxicação por esses agentes. A pesquisa foi conduzida em duas fases: na primeira, utilizou-se a escala do tipo Likert disponibilizada a todos os profissionais da Atenção Básica (AB) nos municípios de Santos, São Vicente e Cubatão, no estado de São Paulo, Brasil. A escala sem ponto central foi validada por um grupo de 11 especialistas e 3 profissionais da atenção básica. Garantiu-se a existência de mínima dispersão com a administração do estudo e o cálculo do coeficiente de correção linear de Pearson; e boa confiabilidade por meio do teste de coeficiente de confiabilidade de Spearman-Brown, em que foi usado o split-half method. Na segunda fase, visando a aprofundar os resultados, utilizou-se a entrevista semiestruturada aplicada junto aos chefes de Unidades Básicas de Saúde (UBS), elaborada com base nos resultados da primeira fase. Seus resultados foram analisados por meio da análise de conteúdo e correlacionados com os resultados da escala. Inicialmente, a pesquisa revelou haver situação de conforto na dimensão conhecimento, perigo na dimensão formação, e atenção na dimensão prática. Com base nos resultados, a formação é a única dimensão que demanda mudanças imediatas. Ainda que as dimensões conhecimento e prática profissional se apresentem, respectivamente, em situação de manutenção e aprimoramento, essas não se originam de instituições formais de ensino. Depreende-se desses resultados a necessidade de análise mais criteriosa quando se trata de dimensões complexas que vão se tecendo na linha do tempo, que há necessidade de capacitação dos profissionais na área da SSA tanto na formação inicial como na continuada, esperando-se com isso aportar conhecimentos necessários para a formulação de políticas que resultem em estratégicas gerenciais com reflexos concretos na prática da atenção integral. Para tanto, requer mudanças nos currículos formativos da área da saúde que possibilitem uma formação profissional de visão mais ampliada para lidar com a urgência química na contemporaneidade.
From the eighteenth century the industrial revolution brought a diversity of new chemical substances and formulations that found, from the twentieth century, a favorable environment for its production on a high scale. This late and still inadequate control production made human exposure to harmful agents become and remain a global reality, whose maintenance increasingly requires health promotion actions to people and communities exposed in their territories. Considering that Socio-Environmental Health (SEH) observes the movement of harmful agents in the environment-health-society interface, present as pollutants or contaminants in the air, soil, water, goods, products, services, beverages and food, that affect health, and the means and care available, it is sought to analyse the knowledge, training and practice of primary care teams regarding SEH, with a focus on reducing illness resulting from exposure and intoxication by these agents. The research was conducted in two phases: in the first phase, we used a Likert-type scale made available to all Primary Care (PC) professionals in the municipalities of Santos, São Vicente and Cubatão, in the state of São Paulo, Brazil. The scale without central point was validated by a group of 11 specialists and 3 primary care professionals. It was ensured the existence of minimal dispersion with the administration of the study and the calculation of Pearson's linear correction coefficient; and good reliability through the Spearman-Brown reliability coefficient test, in which the split-half method was used. In the second phase, aiming at deepening the results, it was used the semi-structured interview applied to the heads of the Basic Health Units (BHU), prepared based on the results of the first phase. Its results were analysed by means of content analysis and correlated with the results of the scale. Initially, the research revealed a situation of comfort in the knowledge dimension, danger in the training dimension, and attention in the practical dimension. Based on the results, training is the only dimension that demands immediate changes. Although the knowledge and professional practice dimensions are, respectively, in a situation of maintenance and improvement, they do not originate from formal educational institutions. It is clear from these results the need for more careful analysis when it comes to complex dimensions that will be woven into the timeline, and for training of professionals in HSE both in initial and continuing training, hopefully contributing with the necessary knowledge for the formulation of policies that result in management strategies with concrete reflections in the practice of comprehensive care. To this end, it requires changes in the curricula of health training that enable a broader professional training to deal with the chemical emergency in contemporary times.
From the eighteenth century the industrial revolution brought a diversity of new chemical substances and formulations that found, from the twentieth century, a favorable environment for its production on a high scale. This late and still inadequate control production made human exposure to harmful agents become and remain a global reality, whose maintenance increasingly requires health promotion actions to people and communities exposed in their territories. Considering that Socio-Environmental Health (SEH) observes the movement of harmful agents in the environment-health-society interface, present as pollutants or contaminants in the air, soil, water, goods, products, services, beverages and food, that affect health, and the means and care available, it is sought to analyse the knowledge, training and practice of primary care teams regarding SEH, with a focus on reducing illness resulting from exposure and intoxication by these agents. The research was conducted in two phases: in the first phase, we used a Likert-type scale made available to all Primary Care (PC) professionals in the municipalities of Santos, São Vicente and Cubatão, in the state of São Paulo, Brazil. The scale without central point was validated by a group of 11 specialists and 3 primary care professionals. It was ensured the existence of minimal dispersion with the administration of the study and the calculation of Pearson's linear correction coefficient; and good reliability through the Spearman-Brown reliability coefficient test, in which the split-half method was used. In the second phase, aiming at deepening the results, it was used the semi-structured interview applied to the heads of the Basic Health Units (BHU), prepared based on the results of the first phase. Its results were analysed by means of content analysis and correlated with the results of the scale. Initially, the research revealed a situation of comfort in the knowledge dimension, danger in the training dimension, and attention in the practical dimension. Based on the results, training is the only dimension that demands immediate changes. Although the knowledge and professional practice dimensions are, respectively, in a situation of maintenance and improvement, they do not originate from formal educational institutions. It is clear from these results the need for more careful analysis when it comes to complex dimensions that will be woven into the timeline, and for training of professionals in HSE both in initial and continuing training, hopefully contributing with the necessary knowledge for the formulation of policies that result in management strategies with concrete reflections in the practice of comprehensive care. To this end, it requires changes in the curricula of health training that enable a broader professional training to deal with the chemical emergency in contemporary times.
Descrição
Citação
CASTELO BRANCO, Jeffer. Saúde socioambiental na atenção básica: conhecimento formação e prática. 2022. 225 f. Tese (Doutorado Interdisciplinar em Ciências da Saúde) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2022.