Avaliação da saúde bucal do idoso em uma instituição de apoio a idosos no Distrito Federal / Oral health evaluation of the elderly in a supporting institution to the elderly in the Distrito Federal

INTRODUÇÃO: A equipe odontológica deve estar inserida numa abordagem de saúde com caráter multi e interdisciplinar, atuando favoravelmente para o entendimento do idoso, suas especificidades, conhecendo o contexto biopsicossocial dessa clientela, a fim de que o plano de tratamento vise saúde do indivíduo na sua integralidade. OBJETIVO: O objetivo deste trabalho foi avaliar a saúde bucal de idosos frequentadores de uma instituição de apoio a idosos na Ceilândia - Distrito Federal. MATERIAIS E MÉTODOS: Estudo descritivo, transversal que avaliou a saúde bucal de 106 idosos, que frequentam a escola de avós da Ceilândia ­ Distrito Federal. Foram realizados exames bucais e aplicação de questionário. Aspectos bucais de relevância foram anotados nos formulários que nortearam o exame da cavidade bucal, assim como o preenchimento do questionário. RESULTADOS: As análises dos exames bucais demonstraram que as lesões bucais mais frequentes foram as de mucosa jugal, seguindo- -se das de gengiva/rebordo alveolar. As lesões brancas, fibroses e candidoses encontradas nas mucosas orais estavam relacionadas ao uso de próteses mal adaptadas, antigas e mal higienizadas. Enquanto que os hematomas por trauma na mucosa jugal e no fundo de saco de vestíbulo foram devido a próteses fraturadas e mal adaptadas. Observou-se uma grande quantidade de próteses removíveis, principalmente próteses totais. Suas necessidades também foram detectadas pela ausência total no arco, assim como pela estimativa de troca. Quanto ao nível de instrução de higiene oral, observou- -se que: 97,16% dos idosos examinados sabem higienizar os dentes/ próteses, 68,86% higienizam os dentes/próteses três vezes ou mais ao dia. E, 43,39% desses idosos disseram ter aprendido sobre higiene oral com a equipe de saúde bucal da escola de avós, mas apenas 35,84% desses idosos sabem fazer o autoexame da boca. CONCLUSÃO: O estudo confirmou a importância da saúde bucal dos idosos e das atividades preventivo-promocionais da equipe de profissionais da escola de avós ­ Ceilândia ­ Distrito Federal para o autocuidado desses idosos

INTRODUCTION: The dental team should be inserted in a health team with multi and interdisciplinary approach, acting positively to the understanding of the elderly, their specificities, knowing the biopsychosocial context of this clientele, so that the treatment plan aimed at health of the individual as a whole. OBJECTIVE: The objective of this study was to evaluate the oral health of elderly in an institution to support seniors in Ceilândia - Federal District. METHODS: A descriptive cross-sectional study that evaluated the oral health of 106 elderly who attend the school grandparents Ceilândia - Federal District. Oral examinations and a questionnaire were performed. Oral aspects of relevance were noted on the forms that guided the examination of the oral cavity, as well as the questionnaire. RESULTS: The analysis of oral examinations showed that the most frequent oral lesions were the buccal mucosa, followed by the gum / alveolar ridge. The white lesions, fibrosis and candidoses found in the oral mucosa were related to the use of ill-fitting, old and poorly cleaned dentures. While the trauma bruises on the oral mucosa and in the foyer of fornix were due to fractured and poorly fitting dentures. There was a lot of removable dentures, especially full dentures. Their needs were also detected by the total absence in the arc, as well as the estimated return. The level of oral hygiene instruction, it was observed that: 97.16% of elderly examined know sanitize teeth / dentures, 68.86% sanitize teeth / dentures three or more times a day. And 43.39% of seniors said they learned about oral hygiene to dental health team school grandparents, but only 35.84% of the elderly know how to do self-examination of the mouth. CONCLUSION: The study confirmed the importance of oral health of the elderly and preventive-promotional activities of the team of grandparents of school professionals - Ceilândia - Federal District for self-care of the elderly.

"Vamos conversar sobre seu filho?": relato de experiência de intervenção em grupo na comunidade / "Let's talk about your child?": experience report on group intervention in the community

Ações de prevenção e promoção à saúde são realizadas com o intuito de ampliar o acesso integral de moradores de uma comunidade através de sua participação em diferentes atividades. Esse relato de experiência tem como objetivo apresentar um trabalho de intervenção psicossocial em grupo de pais, em uma comunidade na Região Metropolitana de Porto Alegre. Foram realizados 17 encontros, entre julho e dezembro de 2013, conduzidos por acadêmicas de Psicologia e supervisionadas por professora psicóloga. Participaram dos grupos 118 pais e familiares, com idades a partir de 25 anos. A duração dos encontros foi, em média, de 90 minutos, com frequência quinzenal. Temas ligados às conflitivas do desenvolvimento infantil e da adolescência e os desafios da criação dos filhos foram discutidos. Os resultados foram analisados à luz da literatura, a partir das repercussões da intervenção para os pais e cuidadores. Destacou-se o benefício da troca de experiências e informações entre os participantes. O trabalho em grupo ofereceu orientações de forma preventiva quanto às questões ligadas aos conflitos familiares inerentes ao desenvolvimento dos filhos, com destaque para a promoção da saúde e da qualidade de vida dos participantes.(AU)

Prevention and health promotion interventions are carried out in order to extend the full access of residents of a community through their participation in different activities. This experience report aims to present a psychosocial intervention group of parents in a community of Porto Alegre Metropolitan Region. Seventeen meetings were performed between July and December 2013, conducted by Psychology students and supervised by a professor psychologist. The participants totalized 118 parents and family members, aged from 25 years on. The meetings lasts on average 90 minutes, with fortnightly basis. Topics related to conflicts on child and adolescent development and the challenges of parenting were discussed. The results were analyzed according to the literature, considering the impact of the intervention for parents and caregivers. The author's emphasized the benefit of the exchange of experiences and information among participants. Group work preventively offered guidance on issues related to family conflicts inherent to human development, emphasising health promotion and the life quality of the participants.(AU)

Precarização do trabalho e risco de acidentes na construção civil: um estudo com base na Análise Coletiva do Trabalho (ACT) / Work precariousness and risk of accidents in civil construction: a study based on the Collective Work Analysis

Este artigo descreve a atividade e a percepção dos trabalhadores da construção civil sobre os riscos e a carga de trabalho. O estudo, com base na Análise Coletiva de Trabalho (ACT), é parte de pesquisa em políticas públicas para aprimoramento do Sistema de Vigilância em Acidentes de Trabalho (SIVAT) de Piracicaba-SP. Priorizou-se a construção civil pela magnitude epidemiológica de ocorrência de acidentes de trabalho e a baixa eficácia das ações tradicionais de vigilância pelas características de informalidade, terceirização e rotatividade do setor. Os trabalhadores revelaram elevada percepção dos riscos de acidentes e que as medidas de segurança dificultam ou impedem a realização do trabalho. Os achados questionam a eficácia dos treinamentos para adesão às medidas de segurança e evidenciam a necessidade de uma pedagogia transformadora nas ações de promoção da saúde e prevenção dos acidentes de trabalho.

La innovación psicosocial: planificar su implementación y difusión para prevenir la delincuencia juvenil / The Psychosocial Innovation: Planification of Implementation and Dissemination to Prevent Juvenile Delinquency

La innovación en la prevención de la delincuencia juvenil orienta sus acciones hacia el mejoramiento de la calidad de los ambientes sociales. Eso significa que las personas que interactúan en la vida cotidiana con los niños y adolescentes en dificultad en sus medios naturales (familia, escuela, barrio) se transforman en los grupos objetivo para participar en programas preventivos. Este enfoque recibe un sólido fundamento científico, pero su aplicación concreta está a menudo limitada debido a problemas en la difusión de la innovación psicosocial. Podemos fácilmente imaginar los obstáculos que puede haber para establecer un sistema eficaz de comunicación entre los diferentes grupos involucrados (investigadores, tomadores de decisión, agentes de intervención y miembros de la comunidad). Es importante reflexionar sobre este problema ya que la dificultad de difundir las nuevas prácticas en terreno puede poner en riesgo los efectos benéficos esperados. El presente texto tiene por objetivo el proponer un marco integrador orientado a optimizar el paso entre los universos científico, político y práctico apoyándose en la teoría de la difusión de la innovación.

Evidence-based psychosocial treatments for the prevention of juvenile delinquency emphasize the importance of a high quality social environment. However the promotion of this approach in real life is somewhat hindered by diffusion-related problems associated with psychosocial innovation. Indeed, communication between researchers, policy makers, clinicians and members of the community is not an easy task. The communication gap between research and practice is an important issue because its failure could compromise the impact of the intervention on youths at risk of juvenile delinquency. The objective of this article is to put forth a conceptual framework based on theory of diffusion of innovation specifically geared towards optimizing the cohesion between the scientific, politic and practice worlds.

Factores asociados prospectivamente a sintomatología depresiva en adolescentes tempranos de sexo femenino / Factors Prospectively Associated with of Depressive Symptomatology in Early Female Adolescents

Este estudio analiza prospectivamente la relación entre soporte familiar, estilo inferencial depresogénico y rumiación negativa con sintomatología depresiva en adolescentes. Se focaliza en adolescentes de sexo femenino, donde la depresión es más prevalente. Participaron 142 estudiantes de primer año de secundaria, con un promedio de edad de 14.2 años. Las evaluaciones de seguimiento fueron a 6, 13 y 24 meses de la primera evaluación. Controlada la depresión inicial, se observó relación entre soporte familiar y estilo inferencial depresogénico con sintomatología depresiva. Los resultados respaldan las teorías cognitivas de la depresión e indican la importancia de considerar estos factores en los programas preventivos de depresión.

Family support, depressogenic inferential style and rumination were longitudinally analysed in a sample of female adolescents wherein depression is more prevalent compared to adolescente male population. The sample comprised a group of 142 first grade secondary school students, with an average age of 14.2 years. The assessment was undertaken 6, 13 and 24 months after the first evaluation. Controled the initial depression, results indicated a relationship between depressive symptomatology with family support and depressogenic inferential style. These results support the cognitive theories of depression and indicate the importance of considering these factors in depression preventive programs.

Prevalencia de los factores de riesgo perinatales en los Trastornos Generalizados del Desarrollo / Prevalence of Perinatal Risk Factors in the Pervasive Developmental Disorders

Los Trastornos Generalizados del Desarrollo (TGD) son perturbaciones graves y generalizadas que afectan áreas centrales del desarrollo (DSM-IV-TR). Se propone que el período perigestacional aglutina una serie de factores de riesgo que influyen y condicionan el desarrollo normal del feto. El objetivo de este artículo fue estudiar la presencia de riesgos durante el desarrollo perinatal, considerando las respuestas de 93 madres con hijos que presentan un Trastorno Generalizado del Desarrollo a un autoinforme estructurado, tal como es el caso del trastorno autista, trastorno de Asperger y TGD-no especificado. Del análisis de las respuestas al autoinforme se han encontrado diferencias significativas entre los grupos de TGD en la dimensión pregestacional -malnutrición/anorexia e hipertensión-, en la perigestacional -malnutrición/anorexia y problemas con el líquido amniótico- y en la psicosocial -género no deseado del bebé-.

Pervasive Developmental Disorders (PDDs) are severe and pervasive disturbances affecting central areas of development (DSM-IV-TR). It is proponed that the perigestational period encompasses a number of risk factors that influence and affect normal fetal development. The aim of this paper was to study the presence of risks during the perinatal development, considering the responses of 93 mothers of children with a pervasive developmental disorder -autistic disorder, Asperger disorder and PDD-NOS- to a structured self-report. We found significant differences among the PDD groups in the pregestational -malnutrition/anorexia and hypertension- , in the perigestational - malnutrition/anorexia and problems with the amniotic fluid-, and in the psychosocial -unwanted gender baby- dimensions from the analysis of the responses.

Riesgo Familiar Total y Grado de Salud Familiar en Familias con Preescolares Enfermos Pereira, Risaralda / Total Family Risk and Degree of Family Health in Families with Sick Preschoolers Pereira, Risaralda

Objetivo: Caracterizar el Riesgo Familiar Total (RFT) y el grado de Salud Familiar General (GEN) en familias con preescolares enfermos en un Centro de salud de Pereira, Risaralda, entre abril y mayo de 2011. Materiales y métodos: Estudio descriptivo transversal. Muestra aleatoria simple de tamaño 44 correspondiente a un error máximo admisible de 1,5 y una confianza de 95, ajustada a 50. Previo consentimiento informado se aplicó encuesta a un miembro de la familia adulto. Cada familia se valoró con los dos instrumentos Riesgo Familiar Total RFT 5-33 y Salud Familiar General ISF: GEN 21 (Amaya 2004). Resultados: las 50 familias están conformadas por 204 personas. El 40 por ciento de estas familias se encuentran en situación de desplazamiento. Cerca de la mitad de la población son niñas, niños y adolescentes (43%), predominan las familias tipo I nucleares (64%), con un promedio de 3,8 personas por familia. El 46 por ciento de familias se encuentran amenazadas, especialmente por condiciones psicoafectivas (88%), se perciben poco organizadas (74%) y satisfechas (98%). Discusión y Conclusiones: Todas las familias con preescolares están expuestas a riesgos biológico demográficos (por su composición, trayectoria de morbi-mortalidad), socioeconómicos, psicoafectivas, por el estilo de vida, prácticas habituales de salud y servicios sociales y de salud. Hay complejidad en la interacción de los riesgos y sus efectos, que ameritan el estudio permanente, conceptual y metodológico. La salud familiar es un proceso cambiante, dependiente de las influencias internas y externas a la familia que modifican la percepción individual de los riesgos y de las dimensiones de salud.

Objective: To characterize the Family Risk Total (FRT) and the degree Family Health General (FHG) in families with preschool patients in a health center Pereira, Risaralda, between April and May 2011. Methods: Cross sectional study. Simple random sample of size 44 corresponding to a maximum permissible error of 1.5 and a confidence of 95, set to 50. Informed consent was surveyed to adult family member. Each family was assessed with the two instruments RFT 5-33 Total Family Risk and Family Health General ISF: GEN 21 (Amaya 2004). Results: 50 families are made up of 204 people. 40 percent of these families are in situations of displacement. About half of the population are children and adolescents (43%), predominantly type I nuclear families (64%), with an average of 3.8 persons per family. 46 percent of families are threatened, especially psycho conditions (88%), perceived poorly organized (74%) and satisfied (98%). Discussion and Conclusions: All families with preschoolers exposed to biological risk population (for its composition, history of morbidity and mortality), socioeconomic, psycho, the lifestyle practices of health and social services and health. There is complexity in the interplay of risks and their effects, which deserve continuing study, conceptual and methodological. Family health is a changing process, dependent on internal and external influences that modify the family's perception of risk and health dimensions.

El papel del perfeccionismo en la insatisfacción corporal, la influencia sociocultural del modelo de delgadez y los síntomas de trastorno del comportamiento alimentario / Perfectionism in body dissatisfaction, sociocultural influence of the thinness model and symptoms of eating disorders

El propósito de este estudio fue analizar si los componentes de la conducta perfeccionista explican la insatisfacción corporal (IC), la influencia socio-cultural del modelo de delgadez (ISMD) y los síntomas de Trastorno del Comportamiento Alimentario (TCA). Participaron 30 mujeres con Bulimia Nerviosa (BN), 35 con Trastorno Alimentario no Especificado (TANE) y 63 sin TCA. El análisis de regresión mostró que la Preocupación por los Errores (PE) y la Indecisión de Acción explicaron la IC y la ISMD en BN; mientras que PE solo explicó la ISMD en TANE. Se concluye que solo dos componentes del perfeccionismo explican significativamente la interiorización del ideal de delgadez y la IC, las cuales son consideradas factores de riesgo importantes para los TCA.

The purpose of this study was to assess if perfectionism components explained body dissatisfaction (BD), sociocultural influences of aesthetic model (SIAM) and symptoms of eating disorders (ED). The sample comprised 30 women with Bulimia Nervosa (BN), 35 women with Eating Disorder not Otherwise Specified (EDNOS) and 63 women without ED. A regression analysis showed that concern over mistakes (CM) and doubt about actions explained BD and SIAM in the BN sample; while concern over mistakes only explained SIAM in the EDNOS sample. These findings evidence that two perfectionism components contribute to vulnerability of thinness ideal and BD among women, which constitute two important risk factors for ED.

Impacto de la osteoporosis en el desarrollo social / Impact of osteoporosis in the social development

INTRODUCCION: la osteoporosis constituye un problema social, económico y de salud pública con características de epidemia en los países desarrollados, que nos obliga a preparar y difundir programas de promoción de salud y prevención de enfermedades, porque se conocen los factores de riesgo y se dispone de métodos diagnósticos para cuantificar la masa ósea y su pérdida. El estudio de los factores que influyen en la salud es un aspecto importante dentro de un planteamiento sociopolítico que aspire al logro de la estabilidad de las sociedades. OBJETIVOS: analizar la incidencia de los aspectos socioeconómicos en el desarrollo de la osteoporosis, así como valorar la responsabilidad social de la comunidad científica en el planteamiento de posibles soluciones. DESARROLLO: los costos del tratamiento de la osteoporosis son cuantiosos y la tendencia es que se incrementen aún más, no obstante, a pesar de que Cuba atraviesa serias dificultades en el orden económico ocasionadas, sobre todo, por el bloqueo económico impuesto por el gobierno de EE. UU., el estado cubano ha mantenido una atención priorizada al sector salud, que incluye el desarrollo de un sistema de atención que cubre a toda la población y que ha hecho posible alcanzar y sostener importantes logros en esta esfera. CONCLUSIONES: las restricciones impuestas a la adquisición de suministros y tecnologías médicas de procedencia norteamericana para su empleo en Cuba, han causado considerables perjuicios a los servicios de la salud pública. La osteoporosis requiere de acciones con otras entidades fuera del sistema de salud para prevenirla, y de una acción directa sobre los factores de riesgo que la provocan. Los profesionales de la atención primaria se enfrentan a problemas éticos y legales por la alta demanda de los servicios de salud y sociales de estos pacientes

INTRODUCTION: the osteoporosis is a social, economic and of public health problem characterized by epidemics in developed countries compelling us to prepare and to diffuse programs or health promotion and diseases prevention due to the know risk factors and the availability of diagnostic methods to quantify the bone mass and its loss. The study of the factor influencing in health is an important feature in the sociopolitical planning to achieve the stability of societies. OBJECTIVES: to analyze the incidence of socioeconomic features in the development of osteoporosis, as well as to assess the social responsibility of scientific community in approach of the potential solutions. DEVELOPMENT: the costs of the osteoporosis's treatment are substantial trending to increase even more, however, despite the serious Cuban difficulties in the economic order mainly because of the economic blockade imposed by the United States government , the Cuban state has maintained a prioritized care to health field including the development of a care system covering all the population and that make possible to obtain and maintain significant achievements in this sphere. CONCLUSIONS: the restrictions imposed for purchase of supplies and medical technologies of American origin to use in Cuba, have caused significant damages in the public health services. The osteoporosis requires of actions with other entities out of the health system for its prevention and of a direct action on the risk factors provoking it. The primary care professionals face ethics and legal problems due to the high demand of health and social services for these patients

La dispensarización del riesgo laboral desde la perspectiva de residentes venezolanos de Medicina General Integral / Medical assessment of working risk from the perspective of the Venezuelan residents of Integral General Medicine

Objetivo: caracterizar aspectos del nivel de preparación, conocimiento actual y tratamiento de los factores de riesgo laboral en el proceso de dispensarización que realizan los residentes venezolanos de Medicina General Integral del Estado de Barinas. Métodos: se utilizaron métodos teóricos, empíricos y procedimientos estadísticos. Se aplicó una encuesta al universo de residentes de Medicina General Integral (65 médicos) para determinar el nivel de preparación previa y conocimientos sobre riesgo laboral y su aplicación en el proceso de dispensarización de su comunidad. Se revisaron los informes de Diagnóstico y Análisis de la Situación de Salud a partir de una guía diseñada al efecto, para evaluar el tratamiento del riesgo laboral en la determinante de salud medio ambiente. Además, se entrevistó, de forma individual, a 5 médicos venezolanos considerados como expertos. Resultados: el 73,9 % de los residentes no trataron los factores de riesgo laboral en el Diagnóstico y Análisis de la Situación de Salud, lo que demuestra una marcada insuficiencia en los conocimientos adquiridos en los estudios de pregrado. Se clasifica de manera correcta a la población trabajadora según grupo dispensarial, sin embargo, el 83,1 % de los médicos no realizan de forma adecuada la evaluación de la dispensarización, y resultan escasas las acciones de promoción de salud y prevención de enfermedades. Conclusiones: el tratamiento de los factores de riesgo laboral en el proceso de dispensarización es insuficiente, condicionado por el escaso nivel de preparación y conocimiento que tienen los residentes, aspectos que pueden ser superados a partir del desarrollo del programa de especialización en Medicina General Integral.

Objective: To characterize the features of training level, current knowledge and treatment of working risk factors in the medical assessment made by Venezuelan residents of Integral General Medicine un Barinas State. Methods: Theoretical, empirical and statistic procedures were used. A survey was applied among the residents of integral general medicine (65 physicians) to determine the previous training level and the knowledges on the working risk and its application in medical assessment in their community. Reports of Diagnosis and Analysis of Health Situation were reviewed from the designed guide to assess the working risk treatment in the determinant health-environment. Also, five experienced Venezuelan physicians were polled. Results: The working risk factors were not approached in the Diagnosis and Analysis of Health Situation by the 73,9% of residents, demonstrating a marked lack of the knowledges acquired during pregraduate studies. Working population was classified in a appropriate way according the medical assessment, however, the 83,1% of physicians don't do properly this assessment and there is a lack of health promotion and diseases prevention actions. Conclusions: Treatment of working risk factors in the medical assessment process is insufficient due to the scarce training level and knowledge of residents, features that may be overcome from the development of the specialization program in integral general medicine.

El futuro de la salud pública en el contexto político-social actual / The future of the public health in the political and social setting

Organizaciones mundiales de la salud han planteado, desde hace más de 30 años, la necesidad de trabajar para lograr un alto nivel de salud para todos los ciudadanos del planeta. Para alcanzar la meta propuesta de "Salud para todos en el año 2000", se necesita realizar acciones políticas y sociales estrechamente vinculadas, entre ellas pueden citarse: a) el desarrollo social y económico que les permita a los pueblos el derecho al desarrollo sostenible, b) la voluntad política de los gobiernos de priorizar la educación y la salud como uno de los derechos humanos más noble y, c) la transformación revolucionaria de los sistemas de salud, con la intención explícita de colocar a la atención primaria, con los conceptos de promoción y prevención de salud, en la estrategia principal para lograr mejorar los sistemas sanitarios de los pueblos. Sin embargo, a pesar de que el futuro de la salud es una preocupación de prestadores y usuarios de sus servicios, políticos, científicos e intelectuales; puede decirse que en la actualidad tal futuro es incierto, amenazado por las tendencias neoliberales, pero con una realidad alentadora en los países que hoy están optando por el cambio y que se integran al proyecto ALBA. La meta "Salud para todos en el año 2000", está distante aún, todo dependerá de la medida en que el mundo comprenda que la paz, la solidaridad, el respeto a los derechos humanos y la integración de los pueblos, son el único camino para acercarse a esos sueños.

Health organizations worldwide have stated for more than 30 years the need of working hard to attain high health levels for all the citizens in this planet. To fulfill the goal " Health for all in the year 2000", closely linked political and social actions are required, among them the following a) the social and economic development that gives the peoples the right to sustainable development; b) the political willingness of governments to give priority to education and healthcare as two of the noblest human rights and c) the revolutionary transformation of healthcare systems, with the explicit aim of placing the primary healthcare in the forefront of the main strategy for improving the healthcare systems of the countries under the concepts of health promotion and prevention. However, in spite of the fact that the future of healthcare is a permanent concern for health service providers and users, politicians, scientists and intellectuals, it may be said that at present this future is uncertain and threatened by neoliberal tendencies, except for the encouraging realities in those countries opting for change and participating in the ALBA program (Bolivarian Alternative for the Americas). The goal "Health for all in the year 2000" is still far from being accomplished; all this will depend on to what extent the world is able to understand that peace, solidarity, respect to human rights and integration of peoples are the only way to make these dreams come true.

Factores relacionados con la consulta tardía a dermatología por cáncer de piel: prueba piloto: Departamento de Caldas / Fatores relacionados com a consulta tardia a dermatologia por câncer de pele: demostração piloto: Departamento de Caldas / Factors related to late dermatological consultation for skin cancer: test pilot: Department of Caldas

Introducción: investigaciones realizadas por la Universidad de Caldas, ponen de manifiesto la tendencia a consultar tardíamente por cáncer de piel al especialista. Objetivo: identificar en el departamento de Caldas los factores por los cuales los pacientes con cáncer de piel consultan de manera tardía a dermatología. Materiales y métodos: estudio descriptivo retrospectivo en 62 pacientes con cáncer de piel, atendidos en la Universidad de Caldas desde enero de 2005 hasta junio de 2007. Se estudiaron las características demográficas, socioeconómicas y actitudinales de los pacientes, los factores asociados con el sistema de salud y con la lesión cutánea. Los resultados se describieron utilizando promedio, desviación estándar, valores mínimo y máximo, percentiles y frecuencias relativas. Se buscó diferencia entre los retrasos según las características de los pacientes con la prueba chi2. Se aceptó como significativa un p<0,05. El análisis estadístico se realizó con el software SPSS 15.0. Resultados: se identificó al paciente como el principal factor de retraso para consultar. Sobresalieron en ellos: sexo femenino, edad superior a 60 años, baja escolaridad y régimen subsidiado. La mayor parte de ellos refirió no haber recibido información previa sobre el tema. Conclusión: si bien hay aspectos por mejorar en los distintos niveles de atención en salud, el factor preponderante que podría explicar la consulta tardía por cáncer de piel a dermatología se relacionó con las características y actitudes de los pacientes.

Researches conducted by the Universidad de Caldas reveal a tendency in late consultations to specialists regarding skin cancer. The purpose of this study is to identify the factors by which patients with skin cancer consult dermatologists so late, for the specific case of the department of Caldas. This was a retrospective descriptive study on 62 patients with skin cancer, treated at the Universidad de Caldas from January 2005 up to June 2007. The demographic, socioeconomic and behavioral characteristics of patients were studied, as well as the factors associated with the health system and the skin lesion. The results were described using average, standard deviation, minimum and maximum values, percentiles and relative frequencies. Differences between the delays were determined according to the characteristics of patients with the chi2 test, taking p<0.05 as a significant mark. The statistical analysis was performed with SPSS 15.0 software. The patient was identified as the main factor for delay in the consultation, highlighting factors such as: female gender, over 60 years of age, little schooling and welfare system. Most of them said they had not received prior information on the subject. While there is room for improvement in the various levels of health care, the predominant factor that could explain the late consultation of skin cancer is related to the patients’ characteristics and attitudes.

Introdução: pesquisas realizadas pela Universidade de Caldas põem de manifesto a tendência a consultar tardiamente por o câncer de pele ao especialista. Objetivo: Identificar no Estado de Caldas os fatores por os quais os pacientes com câncer de pele consultam de maneira tardia a dermatologia. Materiais e métodos: a pesquisa retrospectiva em 62 pacientes com câncer de pele, atendidos na Universidade de Caldas desde janeiro de 2005 ate junho de 2007. Estudaram se as características demográficas, socioeconômicas e atitudinais dos pacientes, os fatores associados com o sistema de saúde e com a lesão cutânea. Os resultados descreveram se utilizando a média, desviarão standard, valores mínimo e maximo, percentiis e freqüências relativas. Pesquisou-se diferencia entre os retraços conforme as características dos pacientes com a amostra chi2. Aceitou-se como significativa um p<0,05. A análise estadística se realizou com o software SPSS 15.0. Resultados: se identificou ao paciente como o principal fator de retraso para consultar. Destaca-se em eles: sexo feminino, idade superior a 60 anos, baixa escolaridade e regime subsidiado. A maior parte de eles referiu Não haver recebido informação previa sobre o tema. Conclusão: Si bem há aspetos por melhorar nos distintos neveis de atenção em saúde, o fator preponderante que poderia explicar a consulta tardia por câncer de pele a dermatologia se relacionou com as características e atitudes dos pacientes.

Nivel de conocimientos y actuación de residentes venezolanos de Medicina General Integral acerca del proceso de la dispensarización de los factores de riesgo laboral / Level of knowledge and performance of the Venezuelan residents of General Comprehensive Medicine as regards the categorization process of occupational risk factors

Caracterizar aspectos del nivel de preparación, conocimiento actual y abordaje que realizan los residentes venezolanos de Medicina General Integral del Estado de Barinas, acerca de los factores de riesgo laboral en el proceso de dispensarización. El sistema de métodos utilizados fueron teóricos, empíricos y procedimientos estadísticos. Se confeccionó un instrumento de evaluación para la revisión de los informes de análisis de la situación de salud en la determinante medio ambiente. El universo estuvo constituido por los 65 residentes que cursaban primero y segundo año de la especialidad, a los que se les aplicó una encuesta que permitió determinar el nivel de conocimientos sobre factores de riesgo laboral y su aplicación en el proceso de dispensarización de la población económicamente activa de su comunidad. Además, se entrevistó de forma individual a 5 médicos venezolanos con experiencia profesional, considerados como expertos. Demuestran una marcada insuficiencia en los conocimientos adquiridos en los estudios de pregrado, muy variable entre las diferentes universidades, así como una pobre aplicación de los mismos en la dispensarización de la población laboral. Se fundamenta y plantea la conveniencia de realizar un rediseño del módulo correspondiente al Programa de Especialización de Medicina General Integral, con el propósito de mejorar el desempeño de los médicos en la dispensarización de riesgos laborales.

To characterize the aspects of the training level, current knowledge, and actions performed by the venezuelan residents of General Comprehensive Medicine in Barinas State as regards the occupational risk factors in the categorization process. The methods used were theoretical, empirical, and statistical procedures. An assessment tool was created to review the reports of analysis on health situation in the environmental determinant. The universe included 65 first and second year residents of the specialty that were surveyed to determine the knowledge level on occupational risk factors, and its application in the categorization process of the economically active population. 5 venezuelan physicians with professional experience, considered as experts, were also interviewed. They showed a marked insufficiency in the knowledge acquired in pregrade studies, which varies a lot among the different universities, as well as a poor application of their knowledge in the categorization process of the working population. The convenience of redesigning the module corresponding to the Program of Specialization of General Comprehensive Medicine is founded aimed at improving the performance of physicians in the categorization process of occupational risks.

Gestores Comunitarios de Salud: una experiencia pedagógica piloto en la Universidad del Rosario / Community Health Managers: A Pilot Pedagogic Experience in the University of Rosario

El Grupo de Estudios en Sistemas Tradicionales de Salud de la Facultad de Medicina de la Universidad del Rosario, en convenio con el Instituto de Etnobiología, ha diseñado un curso de capacitación de un nuevo agente de salud, el gestor comunitario de salud, que tenga en cuenta en su currículo las dificultades, las carencias y los aciertos del programa de Atención Primaria de Salud. En particular, se ha querido atender a las recomendaciones de la OMS en el sentido de facilitar, mediante el entrenamiento adecuado de personal local, la autorresponsabilidad y la autodeterminación en la prestación de los servicios de salud. Con esta propuesta de formación se busca tener en cuenta las distintas culturas y tradiciones, para ofrecer modelos de atención y promoción de salud que consideren las particularidades culturales, los perfiles epidemiológicos y las posibilidades contextuales, con una mirada intercultural. De ahí que el curso de capacitación tiene como objetivos, entre otros: formar un líder comunitario y ofrecerle herramientas de trabajo que buscan revalorar y promover conocimientos y prácticas tradicionales de salud; propender por la seguridad alimentaria, mediante la recuperación de sistemas productivos o la apropiación de tecnologías agroecológicas, y promover la conservación del medio ambiente. La evaluación preliminar sugiere que este nuevo agente de salud se perfila como un verdadero puente para el encuentro entre las comunidades y las ofertas médicas disponibles en favor de la preservación de formas saludables de vida cultural y ambientalmente sensibles.

The “Grupo de Estudios en Sistemas Tradicionales de Salud” from the School of Medicine of Universidad del Rosario, in agreement with the “Instituto de Etnobiología”, has designed a training course for a new health agent (the community health manager) meant to consider in its curriculum the difficulties, deficiencies and successes of the Primary Health Care Program. In particular, we have attended OMS suggestions in terms of adequate training of local leaders who should look for self-responsibility and selfdetermination in health care coverage. This training proposal is meant to take into account diverse cultures and traditions in order to offer health care models able to consider cultural particularities, epidemiological profiles, and contextual possibilities, with an intercultural point of view. Hence, the training course's objective is to offer working tools so that community leaders be able to value and promote traditional health knowledge and practices; seek for food security by means of recovery of traditional productive systems or adaptation of appropriate technologies; environment conservation; use of medicinal plants especially in self-care, and stimulation of community and institutional health promotion activities. Preliminary evaluation suggests that this new health agent will be able to set bridges between communities and health care offers available, always looking for healthy ways of life, culturally and environmentally friendly.

Vulnerabilidade à tuberculose em alunos moradores do conjunto Residencial de São Paulo (CRUSP) / Vulnerability to tuberculosis in students living in the Residential complex of São Paulo (CRUSP)

A permanência da tuberculose está intimamente associada às questões sociais. Assim, sendo a tuberculose questão prioritária do campo da Saúde Coletiva, faz-se imperativo analisá-la com óticas distintas das tradicionais. Nessa perspectiva, o presente estudo teve como objetivo identificar aspectos que caracterizam a vulnerabilidade individual e programática à tuberculose, em moradores de um conjunto residencial de uma Universidade, para disponibilizar informações que orientem os serviços de saúde na prestação da assistência. A população do estudo foi conformada por uma amostra estatisticamente significativa representada por 106 alunos, sendo 69,8% de graduação e 30,2% de pós-graduação. A investigação foi conduzida sob o referencial teórico e o marco de interpretação de vulnerabilidade. Os dados foram coletados através de questionário, após consentimento esclarecido dos participantes. No que diz respeito à Vulnerabilidade Individual dos estudantes, os aspectos mais relevantes dizem respeito às condições financeiras e de inserção no trabalho dos pais, a aglomeração nos apartamentos, o uso de drogas, a situação de imigrantes, dentre outros. Apontam-se ainda as dificuldades para acessar o serviço de saúde, como porta de entrada para a identificação oportuna de enfermidades em geral e, particularmente a tuberculose. Além disso, os conhecimentos acerca da tuberculose parecem ser insuficientes, identificando-se, também, concepções e atitudes preconceituosas em relação à doença. Em relação à Vulnerabilidade Programática, verificou-se distanciamento entre as atividades definidas pelo Ministério da Saúde e a operacionalização do Programa de Controle no nível local, reveladas através da taxa limitada de cura e de adesão ao tratamento. Os resultados apontam a necessidade de disponibilizar esforços no que se refere ao grau e à qualidade da informação sobre promoção e prevenção da saúde. É necessário disponibilizar recursos ) cognitivos e materiais, incentivando-se a participação dos alunos nas decisões que dizem respeito ao seu cotidiano junto à Universidade, assim como nas instituições de saúde a que encontram-se adscritos. No que diz respeito à Vulnerabilidade Programática, é necessário a revisão crítica da formulação e execução do Programa de Controle da Tuberculose na busca da detecção precoce e contenção da doença, trabalhando com equipes interdisciplinares e junto aos diversos setores da sociedade, comprometidos no monitoramento do Programa nos diferentes níveis de atenção

The permanence of the tuberculosis is intimately associated to the social subjects. Like this, being the tuberculosis priority subject of the field of the Collective Health, it is made imperative to analyze it with different optics from the traditional ones. In that perspective, the present study had as objective to identify aspects that characterize the individual vulnerability and programmatic to the tuberculosis, in residents of a residential group of an University, to make available information that guide the services of health in the installment of the attendance. The population of the study was conformed by a significant sample statistically acted by 106 students, being 69,8% of graduation and 30,2% of masters' degree. The investigation was driven under the theoretical referential and the mark of vulnerability interpretation. The data were collected through questionnaire, after the participants' illustrious consent. In what concerns the students' Individual Vulnerability, the most relevant aspects concern the financial conditions and of insert in the parents' work, the gathering in the apartments, the use of drugs, the immigrants' situation, among others. It is still pointed the difficulties to access the service of health, as entrance door for the opportune identification of illnesses in general and, particularly the tuberculosis. Besides, the knowledge concerning the tuberculosis seems to be insufficient, identifying, also, conceptions and prejudice attitudes in relation to the disease. In relation to the Vulnerability Programmatic, estrangement was verified among the defined activities by The Ministry of Health and the operation of the Program of Control in the local level, revealed through the limited tax of cure and of adhesion to the treatment. The results point the need to make available efforts in what refers to the degree and the quality of the information about promotion and prevention of the It is necessary to make available cognitive and material resources, motivating the students' participation in the decisions that concerns closely to their daily lives on the University, as well as in the institutions of health that are enrolled. In what they are concerned the Vulnerability Programmatic, is necessary the critical revision of the formulation and execution of the Program of Control of the Tuberculosis in the search of the precocious detection and contention of the disease, working with interdisciplinary teams and close to the several sections of the society, committed in the monitorizing of the Program in the different levels of attention.