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UNIVERSIDADE FEDERAL DO CEARÁ FACULDADE DE MEDICINA DEPARTAMENTO DE SAÚDE COMUNITÁRIA MESTRADO EM SAÚDE PÚBLICA ANDRÉ LUÍS BEZERRA TAVARES DEMANDA E PERCEPÇÕES DO SOFRIMENTO PSÍQUICO ENTRE USUÁRIOS DA ESTRATÉGIA SAÚDE DA FAMÍLIA FORTALEZA 2012

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Dissertação de mestrado em saúde pública/ufc
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A ambiência constitui-se em uma importante ferramenta facilitadora do processo de trabalho das equipes de saúde da família, tanto no seu aspecto estrutural quanto nos relacionados às interações entre trabalhadores e usuários. O artigo tem como objetivo analisar os aspectos relacionados à ambiência na percepção dos profissionais da Estratégia de Saúde da Família. Trata-se de um estudo descritivo, exploratório com abordagem quantitativa, realizado nos municípios capixabas com população superior a 50 mil habitantes. Os resultados demonstraram que mais da metade dos profissionais consideraram que o espaço físico não permitia o atendimento de forma confortável. Observou-se divergência nas respostas em relação ao acesso à tecnologia para desenvolvimento das ações básicas entendidas equivocadamente somente como um produto ou equipamento — tecnologia dura, em detrimento das tecnologias leves. Foram apontadas limitações e dificuldades pelos trabalhadores em manter a privacidade dos usuários; informaram ainda ausência de manutenção satisfatória do espaço físico e apresentaram opiniões contraditórias em relação à construção das Unidades Básicas de Saúde. Conclui-se que os profissionais demonstraram olhares diferenciados sobre o seu local de trabalho e persistem limitações em relação à ambiência para a produção do trabalho em equipe na Estratégia de Saúde da Família. -----------------------------------------------------------------------------------------------Ambience is considered an important factor that affects the work process of family healthcare teams, their structural aspect, as well as the aspects related to the interaction among workers and clients. The article aims to analyze the aspects related to ambience in the perception of the professionals involved in the Family Healthcare Strategy. This descriptive exploratory study with a quantitative approach was performed in Espirito Santo’s state municipalities having a population of more than 50,000 inhabitants. The results showed that more than half of the professionals considered that the physical space did not allow for comfortable care of the client. A divergence was observed in the answers related to access to technology for the development of basic actions. Technology was misunderstood as being a product or piece of equipment only (hard technology), as opposed to soft technology, i.e., different types of knowledge. The workers pointed out the limitations and difficulties in maintaining the privacy of the clients. They also highlighted the absence of satisfactory maintenance of the physical space and presented contradictory opinions in relation to the facilities of the basic healthcare units. It was concluded that the professionals have different viewpoints regarding their place of work and that there are limitations in the ambience for the production of teamwork in the Family Healthcare Strategy.
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ABSTRAT: The development of projects of attention towards mental health inside the Program of Family Health (PFH) is presented based on a brief rescue of some aspects that compose the PFH, the Psychiatric Reform/Mental Health and the Unique Heath System. The insertion of attentive actions towards mental health in the PFH from the existence and the non-existence of one of the substitutives services of the mental health net around the cities, points out some articulation possibilities and an united development of how to do it. KEY-WORDS: Mental Health, Program of Family Health
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O presente trabalho é um texto didático introdutório ao conceito de autocontrole, numa perspectiva analítico-comportamental. Pretende-se neste trabalho fazer uma diferenciação entre o conceito usado no senso comum e aquele desenvolvido pela análise do comportamento, demonstrando que as explicações mentalistas usadas no cotidiano e na própria psicologia dificultam a investigação científica do comportamento de autocontrole. Também tem como objetivo discutir o uso desse conceito e suas possíveis implicações e aplicações por uma ciência do comportamento. Por fim, ressalta a importância de estudar o autocontrole, considerando-se que este pode ser de fundamental importância para a resolução de inúmeros problemas relativos ao futuro de nossa sociedade.
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Why are some people more vulnerable to common mental disorders than others?
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Traditionally, research concerned with the relationship between paid employment and women's experience of ill-health has focused on one or other of two competing explanatory models: the role enhancement model which postulates a positive health effect of paid employment and the role overload model which postulates a negative effect. Though a synthesis of these two models is becoming apparent in the literature (Arber 1990, 1991) a number of important issues remain neglected. This paper focuses on three of these neglected issues: the extent to which the relationship between employment and health is mediated by the nature and/or extent of the workload associated with both formal and domestic work; whether the relationship differs for different types of ill-health; and the role of health related selection into different social roles. Using data from the Health and Lifestyles survey, an innovative approach is taken to the measurement of domestic conditions, and separate measures of long-term health status, and of short-term physical and psychological health state are used. Proportional odds models are used to assess the relationship between employment status, domestic conditions and type of employment (measured in terms of the socio-economic group of a woman's own occupation) independent of underlying long-term health status. Our findings suggest that the presence of long-term illness is the single most powerful influence on present health state, but that this does not explain away the positive relationship between employment and women's health. They also suggest that this relationship is different for different types of ill health and is not the same for women in different types of occupation. In particular, our findings suggest that the association between paid work and better health is rather less apparent for physical than psychological health, and in women working full time in professional or managerial occupations. Domestic conditions appear to have an effect on women's health equal to or greater than employment status, depending on the health measure used. However, there was no evidence of an interaction between employment status and domestic conditions. We conclude with a discussion of the ways in which our findings fit in with those of previous research. We argue in particular for more attention to be given to the nature of both the dependent ('health') and explanatory ('work') variables used in research on the relationship between employment and women's health.
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Objective —To assess the clinical significance of mental stress—induced myocardial ischemia in patients with coronary artery disease (CAD). Design and Setting —Cohort study in outpatients in a tertiary care teaching hospital assessed at baseline and followed up for up to 5 years. Subjects —A total of 126 volunteer patients (112 men, 14 women; mean age, 59 years) with documented CAD and exercise-induced myocardial ischemia. Outcome Measures —Patients underwent baseline mental stress and exercise testing using radionuclide ventriculography and 48-hour Holter monitoring. Patients were subsequently contacted by mailed questionnaires or telephone to document cardiac events, including death, nonfatal myocardial infarction, and cardiac revascularization procedures. Logistic regression and Cox proportional hazards models were used to examine the prognostic value of the ischemic measures after adjusting for such potential confounding factors as age, baseline left ventricular ejection fraction (LVEF), and history of myocardial infarction. Results —Twenty-eight patients (22%) experienced at least 1 cardiac event. Baseline mental stress—induced ischemia was associated with significantly higher rates of subsequent cardiac events (odds ratio, 2.8; 95% confidence interval [CI], 1.0-7.7; P<.05). The LVEF change during mental stress was significantly related to event-free survival (risk ratio [RR], 2.4; 95% CI, 1. 12-5. 14; P=.02), controlling for age, history of prior myocardial infarction, and baseline LVEF. This relationship remained significant after controlling for electrocardiogram (ECG)—defined ischemia during exercise (RR, 2.2; 95% CI, 1.01-4.81; P<.05). The RR for ECG-defined ischemia during exercise testing was 1.9 (95% CI, 0.95-3.96; P=.07) and the RR for ambulatory ECG ischemia was 0.75 (95% CI, 0.35-1.64; P=.47). Conclusions —The presence of mental stress—induced ischemia is associated with significantly higher rates of subsequent fatal and nonfatal cardiac events, independent of age, baseline LVEF, and previous myocardial infarction, and predicted events over and above exercise-induced ischemia. These data suggest that the relationship between psychological stress and adverse cardiac events may be mediated by the occurrence of myocardial ischemia.(JAMA. 1996;275:1651-1656)