This article addresses the possibilities and challenges in the performance of the community health worker (CHW) from the perspective of the National Policy of Popular Health Education. It is based on the analysis of findings from a research-intervention carried out at a Family Health Center in a small city in the southern region of Brazil. The data analyzed was produced in meetings with the research team, in activities with the CHWs (individual interviews and workshops), and in feedback sessions with the team regarding the intervention. Among the results, the intertwined role of the CHW within the team was emphasized. In situating themselves between technical and popular forms of knowledge, the work of the CHW potentializes the actions of the Popular Health Education program, as it points to the need for training, agreement of the developed practices, and professional valorization. From these findings we were able to approach and understand the results in terms of the National Policy of Popular Health Education. Based on the analyses, we recommend the establishment of practices associated with the broader concept of health sustained in holistic teamwork that valorizes the knowledge/action of CHW and of the community, inspired in the guiding principles of PNEP-SUS.

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O trabalho do agente comunitário de saúde na perspectiva da educação popular em saúde: possibilidades e desafios

Resumo O objetivo deste estudo consistiu em caracterizar o perfil e os aspectos relacionados a gestao do trabalho dos agentes comunitarios de saude na Regiao Nordeste do Brasil. Trata-se de um estudo transversal, que contemplou 535 agentes comunitarios distribuidos em 107 unidades basicas de saude da Regiao Nordeste do Brasil. Os dados foram extraidos de oito blocos de questoes referentes a Percepcao dos Agentes Comunitarios de Saude sobre aspectos: sociodemograficos, economico e politico; mecanismos de contratacao e remuneracao; valorizacao do trabalhador, condicoes de trabalho e processos de formacao dos agentes. Os resultados apontam que a proporcao de agentes comunitarios contratados pela administracao direta na Regiao Nordeste e predominante. A forma de insercao dos agentes comunitarios nos servicos de saude se deu por concurso seguido de selecao publica. A administracao direta e a principal forma de contratacao, no entanto, novas modalidades, como as fundacoes de direito publico e privado, organizacoes sociais e consorcios intermunicipais, constituem alternativas adotadas pelos gestores, produzindo um conjunto de fragilidades provocadas pela flexibilizacao das relacoes de trabalho.

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Trabalho em saúde: retrato dos Agentes Comunitários de Saúde da Região Nordeste do Brasil.

Objetivou-se compreender a satisfacao dos usuarios com acesso e acolhimento da Atencao Primaria a Saude (APS) a partir da demanda nao urgente do Pronto Atendimento (PA). Entrevistaram-se intencionalmente 28 usuarios nao urgentes dos PA dos cinco Distritos de Saude (DS) de Ribeirao Preto-SP que passaram em atendimento na APS ao menos uma vez nos seis meses que antecederam a coleta de dados para avaliar o atendimento. Analisaram-se as entrevistas semidirigidas pela tecnica de analise de conteudo. Identificou-se satisfacao com o atendimento recebido pelos profissionais de saude na APS e insatisfacao com a demora no agendamento de consultas e dificuldade de acolhimento por demanda espontânea. Nao foram observadas divergencias da satisfacao do usuario nos diferentes DS. Conclui-se que os obstaculos com o acesso aos servicos de APS constituem entrave para populacao obter atendimento, repercutindo na satisfacao e alta demanda pelo PA.

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A satisfação do usuário com a atenção primária à saúde: uma análise do acesso e acolhimento

RESUMO: Objetivo: Analisar os fatores associados ao acesso precario aos servicos de saude pela populacao brasileira de 19 anos ou mais. Metodos: Trata-se de estudo transversal, com base nos dados da Pesquisa Nacional de Saude, 2013, obtidos de uma amostragem complexa. O desfecho acesso precario foi definido como nao ter conseguido atendimento na ultima vez que procurou e nao ter tentado novo atendimento por falta de acessibilidade. Foi analisada a prevalencia do acesso precario e sua associacao com fatores socioeconomicos e de saude, por meio do calculo da razao de prevalencias (RP) com intervalos de confianca de 95%. Aplicou-se, ainda, o modelo multivariado pela regressao de Poisson, com teste de Wald para estimacao robusta. Resultados: Das 60.202 respostas validas, 12.435 individuos enquadraram-se nos criterios do acesso precario. A prevalencia do acesso precario foi de 18,1% (IC95% 16,8 - 19,4) e associou-se com os seguintes fatores: ter cor da pele preta/parda (RP = 1,2; IC95% 1,0 - 1,4); residir na regiao Norte (RP = 1,5; 1,3 - 1,9) e Nordeste (RP = 1,4; 1,2 - 1,6) em relacao a regiao Sudeste; viver na zona rural (RP = 1,2; 1,1 - 1,4); ser fumante (RP = 1,2; 1,0 - 1,4); ter autoavaliacao de saude ruim/muito ruim (RP = 1,3; 1,1 - 1,6); nao ter plano de saude privado (RP = 2,3; 1,7 - 2,9). Conclusao: O acesso aos servicos de saude ainda e precario para uma parcela consideravel da populacao brasileira, com destaque para a populacao mais vulneravel.

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Factors associated with poor access to health services in Brazil.

Resumo O estudo teve como objetivo avaliar, mediante revisao integrativa, o conhecimento produzido na literatura acerca das atividades desempenhadas pelos agentes comunitarios de saude no Brasil e em outros paises A busca de dados, realizada no periodo de 2010 a 2014, abrangeu: Portal de Periodicos da Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior; biblioteca eletronica Scientific Electronic Library Online; Literatura Latino-Americana e do Caribe em Ciencias da Saude; Medical Literature Analysis and Retrieval System On-line e US National Library of Medicine National Institutes of Health Dos 240 estudos identificados, 27 foram incluidos nesta revisao A literatura evidencia as funcoes que os agentes comunitarios de saude exercem, em variedade de acoes em diversos contextos geograficos e culturais O agente tem diferentes insercoes no mercado de trabalho e vivencia fragilidades, oriundas de contextos socioculturais da comunidade, da necessidade de maior reconhecimento do sistema de saude e da equipe Sua posicao entre a comunidade e a equipe de saude e estrategica, contribuindo para a saude da comunidade Deve-se proporcionar formacao propicia a sua atuacao e possibilitar o acesso a educacao permanente, alem de se promoverem recursos para maior valorizacao da equipe de saude em sua relacao com a sociedade

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Agentes comunitários de saúde na atenção primária no brasil: multiplicidade de atividades e fragilização da formação

This research sought to identify the actions developed by the Community Health Worker (CHW) in the context of family health in Montes Claros, State of Minas Gerais, Brazil. The research was conducted under the Program of Education through Work for Health-PET-SAUDE, and is a quantitative study and census together with 241 CHWs. Most of them make family registrations and home visits, identify families with health risks and inform the health team. They also instruct families about available health services, arrange referrals and schedule consultations/exams, perform health education and teamwork reflections. Some also assist in the clinical environment. The majority who provide health education and those who are responsible for the referrals feel that they are professionally qualified for such tasks. CHWs are a core element of health actions, but the scope of performance requires investment in professional training to maintain the quality of the work executed by them in surveillance activities and teamwork reflection. In this way, the CHW can be jointly responsible for primary care and integrate the system of health care administration.

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Agente Comunitário de Saúde: elemento nuclear das ações em saúde

Objective: To assess the accessibility to medical appointments in public health services. Methods: Transversal, analytic, population-based research in a medium-sized city in the state of Minas Gerais, Brazil. The data were collected from a semi structured questionnaire presented to a representative sample of the city, of 2150 people. The statistic treatment considered p<0.05 as the level of significance. Results: 19.4% of the interviewees reported having sought a public health professional/service up to 15 days prior to the interview. Among these cases, 75.6% occurred in the Primary Health Care (PHC). The majority of these seekers were females (p<0.001) and people with no private health insurance (p<0.001). The majority (77.2%) was seen in the first time they sought the public health service. A bigger prevalence of no access could be highlighted when the patient sought the PHC and for treatment/rehabilitation (p<0.05). The use of medical service in that year was reported to be 54.4%, with a higher average for women, adults and people with no private health insurance (p<0.05). Conclusion: It is necessary to think over the public health management and professional conduct to make medical appointments effective. Therefore, adopting welcoming and permanent teaching measures among family health professionals is advised.

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Acesso às consultas médicas nos serviços públicos de saúde

INTRODUCTION: The dental auxiliaries and the community health workers (CHWs) are practitioners that represent an important part in the Family Health Policy in Brazil and have several tasks. OBJECTIVE: To analyze the attributes of the dental auxiliaries and of the CHWs, regarding the application of their services and their education/training, to identify the similarities and contrasts between these health care practitioners. METHODOLOGY: Quantitative and census method data collection performed on the context of the Education Program for Health Workers - PET‑Saude, 2010‑2012. The data collection method was a semi-structured questionnaire. The analysis has a level of significance of p 0.05). CONCLUSION: Similarities and contrasts were identified between these health care workers. The dental auxiliaries, despite being mostly issued to specific assignments on a clinical environment, are able to shift their praxis by taking actions on a family and community context once integrated to a family health team.

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Dental auxiliaries versus community health workers: similarities and contrasts

Introduction: The dental auxiliaries and the community health workers (CHWs) are practitioners that represent an important part in the Family Health Policy in Brazil and have several tasks. Objective: To analyze the attributes of the dental auxiliaries and of the CHWs, regarding the application of their services and their education/training, to identify the similarities and contrasts between these health care practitioners. Methodology: Quantitative and census method data collection performed on the context of the Education Program for Health Workers - PET-Saude, 2010-2012. The data collection method was a semi-structured questionnaire. The analysis has a level of significance of p 0.05). Conclusion: Similarities and contrasts were identified between these health care workers. The dental auxiliaries, despite being mostly issued to specific assignments on a clinical environment, are able to shift their praxis by taking actions on a family and community context once integrated to a family health team.

Dental auxiliaries versus community health workers: similarities and contrasts Profissionais auxiliares da odontologia versus agente comunitário de saúde: similaridades e contrastes

Meniscal root tears represent radial tears or avulsions of the meniscal cartilage at the tibial attachment site that profoundly affect meniscal biomechanics and kinematics. Meniscal root tears have the functional effect of a total meniscectomy and can lead to rapid degenerative change with development of early knee osteoarthritis (OA). A growing range of arthroscopic surgical techniques have been developed to repair meniscal root tears with the aim of restoring joint kinematics and contact pressures and delaying the development of OA. Following increased understanding of the anatomy and biomechanics of the meniscal root, meniscal root injury repair has become the treatment of choice in knees with nonadvanced OA. This article reviews the anatomy and biomechanics of the meniscal roots, clinical and imaging diagnostic criteria of meniscal root tears, correlation between arthroscopy and MRI in the diagnosis and classification of meniscal root tears, and expected and abnormal MRI findings after meniscal root repair. Familiarity with MRI signs and classifications of meniscal root tears, as well as with root repair surgical techniques, can aid radiologists in correctly reporting preoperative and postoperative MRI findings.

Flávia Ferreira Araújo

Papers

Agente Comunitário de Saúde: elemento nuclear das ações em saúde

Acesso às consultas médicas nos serviços públicos de saúde

Dental auxiliaries versus community health workers: similarities and contrasts

Dental auxiliaries versus community health workers: similarities and contrasts Profissionais auxiliares da odontologia versus agente comunitário de saúde: similaridades e contrastes

Meniscal Root Tears: An Update Focused on Preoperative and Postoperative MRI Findings.