Boletim do Instituto de Saúde - BIS

Professional Master's in Collective Health from the Institute of Health

Silvia Helena Bastos de Paula — 2023-12-30

The Professional Master's Degree (MP) is a postgraduate modality that stands out for its practical application. The MP should contribute to transforming work processes and generating scientific knowledge. It promotes integration between the educational institution and society, focusing on reality transformation. In the field of Collective Health, the MP should generate knowledge with applicable power to the Unified Health System (SUS). The purpose of the article is to present a characterization of the research conducted by students of the Professional Master's Program in Collective Health at the Institute of Health, within the São Paulo State Health Department, that completed the program from 2011 to 2018. This is a qualitative-quantitative research, based on the documentary analysis of 54 abstracts from the dissertations of the four cohorts. Thus, a framework was built using an Excel program with categories related to the production and design of these research projects and their potential for application. The results of 34 studies point to processes of changes and adjustments in policy implementation and practices, indicating the need to prepare the master's students for leading change processes within organizational environments and professional behaviors, with a view to the application of the results.

The health training that a state policy requires

Lilian Soares Vidal Terra — 2023-12-14

A state policy for the health sector in Brazil, as is intended to be built through the Unified Health System, requires a large investment
in the workforce, with training being one of its pillars. However, the teaching-learning processes for health workers have been
configured in static hierarchical and technocratic models, guided by positivist science, unable to respond to the challenges of the
system. Thus, this article proposes to criticize the hegemonic training and reflect on the formative and emancipatory potential of
learning through praxis, as intended by the Professional Master's programs in Health. To this end, it analyzes pedagogical processes
conducted through Balint-Paideia Groups, based on the constructivist pedagogy from Gramsci to Freire, which invest in the protagonism of workers in training, in addition to considering the subjective and power crossings present in all clinical, management and training meetings. It concludes that the Paideia training is a pedagogy of autonomy, dedicated to increasing the trainees' capacity for analysis and intervention and innovates by working with reference to the axes of knowledge, affection and power, enabling training aimed at the emancipation of workers and the strengthening of the Unified Health System.

Postural balance by the Mini-Balance Evaluation Systems Test (Mni-BESTest)

Aline Juliane Pereira da Silva — 2023-12-14

Introduction: Hansen´s disease is a chronic infectious and contagious illness that can cause decreased physical sensitivity and
motor changes. The Mini-BESTest is an instrument for the clinical assessment of body balance. Objective: We propose to evaluate
the performance of the Mini-BESTest regarding dynamic balance in people with Hansen´s disease in the following subsystems: anticipatory postural adjustment, reactive postural responses, sensory orientation and gait stability. Methods: The Simplified Neurological Assessment (SNA) was used to classify the presence or absence of disability, and the Mini-BESTest scores related to the
total points per subsystem was applied to 54 SUS (Brazilian Unified Health System) users. Results: By way of univariate analysis
it was found that older ages had lower scores. The multivariate analysis indicated that the SNA is important in explaining the scores
controlling for sex and age, where lower scores occur among people with disabilities in the four subsystems. Conclusions: The
Mini-BESTest indicates a decrease in the dynamic balance among people with Hansen´s disease, with physical disability, its use
can guide the clinical practice of the physiotherapist. otential applicability: The Mini-BESTest, a cheap method that is easy and
quick to apply, is capable of contributing to the improvement of care for Hansen’s disease.

Critical education in diabetes in Itanhaém city

Amanda Donnangelo Martins — 2023-12-14

Introduction: Type 2 diabetes mellitus (DM) affects hundreds of millions of people and represents a major challenge for health
systems. Differing from the main diabetes education guidelines, popular health education in the SUS adopts a critical pedagogical
approach. Materials and Methods: qualitative research of the research-action type based on Freire's model of Culture Circles in
a family health unit (USF) in the city of Itanhaém-SP. Results and Discussion: People with diabetes and health professionals discussed topics related to DM, focusing on healthy eating, public policies and social determinants of health. Conclusion: Critical
pedagogy resolved everyday situations and proved capable of progressing to complex political-structural issues that favor improvement and the confrontation of social inequalities.

Access in São Bernardo do Campo Primary Care

Bárbara Navajas de Sá Leite — 2023-12-14

The article addresses the theme Advanced Access (AA), implemented in 2019 in São Bernardo do Campo (SBC), and aims to analyze
the perception of teams regarding this device for organizing demand in Primary Care. Through the application of questionnaires, it
was possible to observe that all team members participated in the practice of AA. The main difficulties pointed out involved the high
turnover of professionals, lag in the HR staff and inadequate physical space. Faced with difficulties, the teams found, on their own
initiative, solutions aimed at improving the practice of AA and began to perceive it as an arrangement for strengthening bonds and
problem-solving ability in user care. Actions involving permanent education, appropriation of the practice by the team and use of
physical spaces outside the UBS enhanced the practice of this device. Given these results, the study concluded that the successful
implementation of the AA depends on the availability of managers to provide good working conditions, and the ability to incorporate some modifications that allow the device to be unique to the local reality. The stiffness in the organization of work tends to make AA's potential unfeasible.

Obesity care at the Centro de Referência do Idoso da Zona Norte

Carolina de Campos Horvat Borrego — 2023-12-14

Introduction: The increase in the elderly population is also accompanied by changes in dietary patterns and a reduction in physical
activities, leading to an increase in the prevalence of overweight and obesity in this population. Objective: to evaluate the effects of
an educational/therapeutic group with elderly people undergoing obesity treatment. Methodology: an evaluation of the effects of the educational/therapeutic group was carried out with elderly users of a reference center, by comparing the results before and after the group intervention. Anthropometric data, physical tests, scale of self-perception of performance in activities of daily living, and food consumption were analyzed. Results: we observed a reduction in anthropometric measurements, an improvement in self-rated health, a positive change in behaviors at mealtimes and in food consumption, an improvement in the physical test, in addition to an improvement in functional performance in activities of daily living. It was observed that people who consumed sweetened beverages after the intervention were significantly less likely to lose weight; that people aged 75 and over were less likely to improve physical performance. Conclusion: the positive results found after the interventions suggest that the multiprofessional intervention strategies based on nutritional education, the practice of regular physical exercises and also the stimulation of self-care in health in general had the expected success.

Longitudinality and tuberculosis control

Enver Lamarca Oliveira Santos — 2023-12-14

The current literature highlights global efforts to reduce the incidence rate and deaths related to tuberculosis. However, these
indicators are still high in Brazilian capitals, with emphasis on the homeless population. This article presents the results of
the dissertation of the Professional Master's Degree in Collective Health by “Instituto de Saúde de São Paulo” (the São Paulo Health
Institute), entitled "Longitudinality and tuberculosis control: interventions of Street Clinic teams (eCnaR) in the city of São
Paulo". It aimed to identify the Healthcare practices performed by four eCnaR. Two data collection tools were used, aimed at health
professionals and patients followed by the teams, correlating the attributes of longitudinality with the analysis of the content
obtained. The role of the Health Agents as powerful links in building the bond between patients and eCnaR was evidenced, as
well as the strategies used in negotiations and construction of agreements with patients. The importance of the interface with
professionals in the Centers of Welcoming for the homeless population, other eCnaR and other partner services for the completion
of tuberculosis treatment was also pointed out, effectively constituting the care network, given the itinerancy and difficulties
faced by the homeless population.

Knowledge and Use of the Food Guide in Promotion of Adequate and Healthy Food

Hariane Thaine Bueno Rodrigues — 2023-12-14

This study aimed to measure the knowledge and perception of self-efficacy and collective efficacy in applying the Food Guide
for the Brazilian Population in actions to promote adequate and healthy food (PAAS) among physicians and nurses of the Family
Health Strategy (ESF) teams from Santa Bárbara d'Oeste-SP. It is a descriptive cross-sectional study, and data collection used
two validated scales. GAB1 measured knowledge about the Food Guide, while GAB2 identified the perception of self-efficacy and
collective effectiveness in applying the Guide in PAAS actions. The professionals showed moderate mean values of knowledge
and self-efficacy in using the Food Guide. However, we observed gaps and insecurities regarding the content and uste of this material, with a limited perception of collective effectiveness. These results point to the need to provide training to FHS professionals, emphasizing the content and proper use of the Food Guide, aiming to strengthen the PAAS and improve the effectiveness of actions in Primary Health Care.

Contributions of a deliberative dialogue in evaluating the implementation of an Integrative and Complementary Health Practices program

Josiane Aparecida Melo Faria — 2023-12-14

In 2006, Complementary Terapies (PICS) became part of the list of activities in the Brazilian health system services. During the
Covid-19 pandemic, they were also implemented at UBS Jardim Miriam II for the health workers’ care. Considering the benefits
observed during this period, an implementation research was carried out, with the aim of understanding the process and
identifying possibilities for maintaining PICS activities for health workers. To better assess the program's implementation, a Deliberative Dialogue (DD) was held, it is a powerful tool to obtain contributions from the many interested in the studied problem.
The speeches of the DD participants were submitted to a content analysis and indicate that the acceptability of the program
was good, considering the gains in quality of life and improvement of care processes. Furthermore, the maintenance cost of
the actions is low since the materials have an affordable price. It was also found that it is possible to arrange schedules to ensure
workers' participation in individual activities. On the other hand, it was said that there is a lack of training opportunities so
that other types of PICS can be offered. The implemented program proved to be viable and could be part of a regular schedule
for Primary Care workers.

Challenges and strategies for implementing pro-breastfeeding actions in Primary Care, under the perception of nurses

Keite Helen dos Santos — 2023-12-14

Breastfeeding can be understood as a natural process, if we think that all women can produce milk and exclusively offer this
complete food to their children for at least six months, with the recommendation of offering breast milk until they are two years
old or older. However, there are some obstacles for breastfeeding rates to become desirable, and it is necessary to invest in new
strategies that make breastfeeding viable. The purpose of the study was to analyze the perception of nurses in Jaguariúna regarding
the factors that influence the implementation of pro-breastfeeding actions. This is a qualitative research, anchored in the
theoretical framework of Foucault. Data collection was carried out through interviews with twelve nurses from the basic network
who work in the care of the mother-baby binomial. By identifying the professionals' perception of breastfeeding implementation
strategies, it was possible to understand the configuration of power relations and the biopolitics of breastfeeding, it is possible
to intervene in the organization of the work process of health services, strengthening teamwork, respect for autonomy of individuals
and accountability of all professionals for the success of pro-breastfeeding actions.

Attention to the Mental Health Crisis

Marinês Santos de Oliveira — 2023-12-14

Introduction: In the Psychosocial C are Network, i t i s recommended, instead of asylum institutions, specific services and care actions to support individuals in crisis, despite the legal guarantee of psychiatric hospitalization. Methods: qualitative approach, in
which we use narrative as a research strategy, based on professional experiences in Mental Health Crisis Care. Results and Discussion: We verified the need for intense investment in the teams, for the involvement of the home as a locus of care and as a support for strengthening family relationships and social networks and the effectiveness of mental health care in AB. Conclusion: The itineraries reveal that the psychosocial clinic has sophisticated care technologies, aligned with the proposal of the psychosocial
model and potent in crisis care.

Feeding practices of children under 12 months

Natália da Costa Selinger — 2023-12-14

Objectives: To characterize the feeding practices of children aged between 0 and 12 months and the profile of the UBS regarding the
promotion of breastfeeding (BF) and complementary feeding (CF) in the municipality of Jacareí. Methodology: Population-based descriptive cross-sectional study. A household survey was carried out with caregivers of infants younger than 12 months and interviews with supervisors from all UBS in the municipality. Results: 253 infants younger than six months and 287 between six and twelve months participated in the study. The prevalence of exclusive breastfeeding (EBF) was 34.3%, and continued breastfeeding was 55.1%. Significant associations were identified between maternal schooling and maternal work outside the home and offering healthy and unhealthy foods to children aged between six and twelve months. As for the work profile of the UBS, the promotion of adequate BF and AC in childcare actions was lower than in prenatal care groups. The prevalence of postpartum home visits within seven days was 27.8%. Conclusion: Identifying dietary p rofiles and the work p rocess of health teams support the planning of public policies, especially for the promotion of EBF, adequate food introduction, training of professionals, and implementation of postpartum and childcare protocols.

Evaluation of the implementation process of a telepharmacy service

Priscilla Alves Rocha — 2023-12-14

Viral hepatitis are a serious public health problem and the need for long-term medication imposes challenges for adherence to
treatment. The care of a pharmacist, in face-to-face or remote consultations, can be decisive in achieving good results for the
users’ health. The implementation of a program for patients with chronic hepatitis B was conducted in a teaching hospital. A
Deliberative Dialogue (DD), a tool for stakeholders’ participation on a priority problem, was held, and its results were used to assess
the implementation process. Participants in the DD were health professionals, including pharmacists and physicians (both
from care services and management), telehealth service manager and a researcher. Contributions were analyzed according to
the thematic content analysis and categorized between barriers, facilitators and improvement proposals for full implementation of
the service.

Omeprazole

Renata Rodriguez Imparato — 2023-12-14

Objective: Research developed to identify indications for omeprazole and strategies to promote its rational use in Primary Care in
a region of the city of São Paulo. Method: T his i s a c ross-sectional study through a survey conducted with physicians and pharmacists. Results: The 157 participating physicians reported prescribing omeprazole for gastroesophageal reflux disease (73.3%),
gastric ulcer due to Helicobacter pylori infection (65.1%), dyspeptic syndrome (62.3%), erosive esophagitis (46.6%), gastric and duodenal ulcer (43. 2%), gastric ulcer secondary to non-steroidal anti-inflammatory drugs (20.5%), specific conditions (16.4%) and other indications (15.8%). The 45 participating pharmacists reported pharmaceutical orientation (100%), pharmaceutical consultation (97.8%), team meeting (73.3%), educational groups (68.9%), home care (66.7%), permanent education (53.3%) and approach focused on omeprazole (48.9%). Conclusion: Most doctors reported prescribing omeprazole for indications supported by scientific evidence. Most pharmacists mentioned developing clinical services for the rational use of medicines and, some of them, also for actions aimed at omeprazole. A low percentage of pharmacists reported carrying out educational activities.

Appointment Scheduling in Primary Care

Sanni Silvino Parente — 2023-12-14

Introduction: Primary care access is related to the quality of care provided and must meet demands. There are three proposed models to organize scheduling that are described (traditional, carve-out and advanced access). This study aims to present effective
strategies for scheduling appointments in primary care with positive access outcomes. Methodology: A Synthesis of Evidence for
Policies was developed, followed by a Deliberative Dialogue, to discuss aspects related to the implementation of the strategies.
Results: Several effective strategies were identified, grouped by similarity of themes into six options: 1) Expansion of appointments
offer in the same day; 2) Multidisciplinary teams monitoring patients; 3) Capacity increase; 4) Patient Care Bundles; 5) Interventions
prior to scheduling the appointments; 6) Regulation between service levels. Discussion: These options can be implemented partially
or completely, associated between each other or not. It is necessary to observe barriers and facilitators for the implementation
of each of them in relation to four levels: service users, professionals, organization of services and health systems. Conclusion: The
synthesis offers the theoretical basis for improving scheduling in primary health care, but it has limitations and the results must be
interpreted with caution for the Brazilian reality.

Strategies to strengthen workers' health:

Carla Andrea Trapé — 2023-12-14

The workers' health is determined by the organization of the work process within the context of the capitalist mode of production, a
process that generates successive worker's wear out, including in the health field. We aim to present the process of c oping proposals development to address the Primary Health Care workers’ wear out through implementation research and participatory research, with a view to transform work processes. Seven emancipatory workshops were conducted to instrumentalize the workers
to implement health-strengthening strategies for workers. These strategies were validated through deliberative dialogue with a family health unit workers. The educational process was analyzed and it captured the workers’ wear out and its causes from their' perspective. These causes became increasingly complex throughout the process leading to a better understanding of the roots of the wear and tear. A guiding document was developed to support the workshops and prepare the workers for the implementation processes. This document constituted the product presented to the professional Master's Program to which the research is affiliated. The workshops proved to be a powerful instrument for transforming the understanding of worker health and the ways to face with the wear out that they experienced.

Influenza burden of disease in Brazil 2010 to 2016

Francisco José de Paula Júnior — 2023-12-14

Objective: To estimate the incidence of influenza-associated hospitalizations and deaths in Brazil from 2010 to 2016. Method: Records of hospital discharges and deaths (mortality system) were used by ICD codes J09-J18, data from laboratory influenza surveillance, and census population projections adjusted by the percentage of those using public health services. Meta-analysis was performed to determine the incidences of hospitalizations and deaths by age group in the five geographic regions of Brazil. Results: The estimates were 645,661 hospitalizations and 160,089 deaths from influenza from 2010 to 2016. The highest incidences of hospitalization occurred in older adults with ≥65 years (258.6/100.000) and children <5 years old (180.1/100,000), while deaths stood
out among individuals aged ≥65 (142.9/100,000) and aged 50 to 64 years (22.1/100,000). Regional differences were found, with
higher incidences predominantly in the Midwest, Southeast, and South regions. Conclusion: The burden of influenza in Brazil is of
concern, with a high number of hospitalizations and deaths from the disease. Regional and age group differences provide evidence
to support vaccination policy and the improvement of the influenza surveillance system.

Perceived skills in conducting conversation circles for health promotion

Inara Pereira da Cunha — 2023-12-14

The study discusses the competencies involved in conducting the technique of conversation circles. It is an analytical and reflective account developed based on the experiences of students in the Health Promotion discipline of a Professional Master's program in Family Health in Mato Grosso do Sul, Brazil. The experiences were recorded in the form of experience reports and emphasized the use of conversation circles in Family Health Units. From the documentary corpus, the target audience, themes/ objectives, and four competencies applied for the development of conversation circles were identified: learning to know, learning to do, learning to live together, and learning to be. It was observed that the target audience and the themes developed in the conversation circles were related to the epidemiological situation of the territory. Furthermore, it was identified that the technique is often based on the theoretical framework of Paulo Freire, with systematic stages. The competencies of knowing and doing were challenging. The competencies of living together and being stood out positively in the described experiences. Finally, the experiences revealed that there are competencies that need to be improved for the facilitation of conversation circles to achieve their transformative potential.

Analysis of supply deadlines for drugs incorporated in the Specialized Component of Pharmaceutical Assistance between 2012 and 2016

Luciana Costa Xavier — 2023-12-14

Introduction: Access to medicines in the Unified Health System (SUS) is recommended by policies for pharmaceutical care and
the incorporation of technologies. Since 2011, with implementation of the National Commission for the Incorporation of Technologies in the SUS (Conitec), deadline to effective offering of the technologies incorporated is 180 days, counted from the date
of publication of the incorporation ordinance. Objective: Analyze the effective offer of medicines incorporated and allocated in the
Specialized Component of Pharmaceutical Assistance between 2012 and 2016, covering five years from the beginning of the
incorporation rule. Method: retrospective analytical study was developed, using databases from APAC/SIA-SUS related to drug dispensing that occurred between 2012 e 2017. The offer deadline was defined as the date of the first dispensing. Results: 1,198
records of the first dispensing were computed between 2012 e 2017, with only 12% (n = 144/1,198) achieved the deadline and
the average delay of those who did not meet the deadline was 14 months. Conclusion: The deadline was outside the established
limit, evidencing the need to improve the processes related to the supply of incorporated medicines, as well as reevaluate the
established rule in view of the profile presented and necessary procedures related to the acquisition and dispensing processes.

O residente multiprofissional e sua atuação segundo equipes da Atenção Primária à Saúde do Município de Campinas - SP

Samira Pereira Magalotti — 2023-12-14

O estudo objetivou descrever e analisar a percepção dos trabalhadores de quatro unidades de saúde da Atenção Primária à Saúde (APS) do município de Campinas sobre o papel dos residentes e suas possibilidades de atuação, com base no referencial do Apoio Paideia. As unidades selecionadas foram as pioneiras na participação do Programa de Residência Multiprofissional da Secretaria Municipal de Saúde. Trata-se de estudo qualitativo, com entrevista de sete profissionais dos centros de saúde selecionados. Os resultados indicam que os profissionais valorizam as contribuições dos residentes, mas foram encontradas lacunas na construção de competências de cuidado e gestão compartilhada, fragilidade na pactuação das atividades, desconhecimento das formas de avaliação dos residentes e enfraquecimento dos projetos terapêuticos compartilhados. Além disso, o trabalho na lógica do Apoio Matricial enfrenta resistência por parte das equipes. Destacou-se a necessidade de ampliar o debate sobre o Apoio Matricial e as potencialidades dos residentes multiprofissionais, alinhando suas atuações com as recomendações deste referencial.

Editorial

Mariana Tarricone Garcia — 2023-12-14

We are pleased to present this number of the BIS dedicated to the productions of the Master's Public Health Professional
at the Health Institute which, in an interinstitutional movement, also brought contributions from authors from other professional postgraduate programs. Our program was designed with the aim of train professionals with a critical
view of policies public health services and for transformative professional practice, through the production and 
application of knowledge scientific, aiming to solve problems or proposing innovations for the qualification of healthcare system care and management processes. Starting from the analysis of the production of the four classes
graduating from our program, carried out by Paula, Costa and Toma, the commitment to learning through praxis,
which is highlighted in the article authored by Terra, and which can be taken as the guiding axis of the Professional
Master’s proposal.