ABSTRACT
A saúde mental brasileira é marcada por saberes e práticas baseados em aspectos estigmatizantes sobre o usuário de drogas. Mudanças foram possibilitadas a partir da reforma psiquiátrica. Contudo, o que vigorou durante anos deixou resquícios na rede de atenção ao usuário de álcool e outras drogas como nas políticas públicas. Os profissionais que lidam com esse tema almejam por formação. Para tanto, foram criadas estratégias de formação permanente, como os Centros Regionais de Referência em Políticas Públicas sobre Drogas (CRRs). O CRR da Universidade Federal de São João del-Rei é foco desse trabalho, bem como a metodologia de formação ativa. Esta nos possibilitou contemplar o tema das drogas a partir de uma proposta crítico-reflexiva que leve em consideração a experiência dos profissionais, sendo possível pensar em novas formas de ser e estar como profissionais e sujeitos ativos.
The Brazilian mental health is marked by knowledges and practices based on stigmatizing aspects of the drug user. The psychiatric reform has allowed some changes. However, those primary knowledges left traces in public policy and in the care network for alcohol and other drugs users. Professionals who deal with this issue are eager to receive training. Therefore, strategies of continuing education were created, such as the Regional Reference Centers for Public Policy on Drugs (CRRs). The CRR from Federal University of Sao Joao del-Rei is the focus of this work, as well the as active training methodology. This methodology enabled us to contemplate the issue of drugs from a critical-reflexive proposal that takes into account the experience of professionals, allowing new ways of thinking and being as professionals and active subjects.
La salud mental brasileira es marcada por saberes y prácticas basados en aspectos estigmatizantes sobre el usuario de drogas. La reforma psiquiátrica posibilitó algunos cambios. No obstante, ese conocimiento primario dejó huellas en las políticas públicas y en la red de atención a los usuarios de alcohol y otras drogas. Los profesionales que lidian con ese tema necesitan formación. Para ello, fueron creadas estrategias de formación permanente, como los Centros Regionales de Referencia en Políticas Públicas sobre Drogas (CRRs). El CRR de la Universidad Federal de São João del-Rei es foco de ese trabajo, además de la metodología de formación activa. Esta metodología nos posibilitó abordar el tema de las drogas a partir de una propuesta critico-reflexiva que lleva en consideración la experiencia de los profesionales, permitiendo nuevas formas de pensar y ser en cuanto profesionales y sujetos activos
Subject(s)
Public Policy , Health Care Facilities, Manpower, and Services , Psychology, Social , Social Support , Illicit Drugs , Substance-Related Disorders , Methodology as a SubjectABSTRACT
Este artigo discute a emergência dos Centros de Referência da Assistência Social (CRAS) destacando as artes de governar que engendram sua criação. Indica que o CRAS, equipamento estratégico da Política Nacional de Assistência Social (PNAS), é efeito do entrecruzamento de práticas sociais diversas, condensando em sua emergência o modo biopolítico de gestão das populações, o modo neoliberal como arte de governar, a Assistência Social como campo de saber e de práticas sociais e as práticas psi. Apontamos que o CRAS pode funcionar como dispositivo de controle e também espaço de produção de desvios no campo das políticas de assistência social.
This article discusses the emergence of Social Assistance Reference Centers (CRAS) highlighting the arts of governing that engender its creation. Also indicates that the CRAS, a strategic equipment of the National Social Assistance Policy (PNAS), is effect of crossing of diverse social practices, condensing into its emergency a biopolitical mode of management of populations, the neoliberal statecraft as art of government, the social assistance as field of knowledge and social practices and psychological practices. We point out that the CRAS can function as a control device and also as a field of production of deviations in social policies.
Subject(s)
Humans , Public Policy/history , Social WorkABSTRACT
Pavia, IRCCS Foundation, San Matteo Polyclinic Pavia, a reference laboratory for diagnosis of toxoplasmosis, in the investigation of women with suspected acute toxoplasmosis. Methods: All sera were tested with LIAISON® Toxo IgM and IgG II, Toxo IgG Avidity II kits (DiaSorin, Saluggia, Italy), VIDAS Toxo IgG II and Toxo IgG Avidity (bioMérieux, Marcy l?Etoile, France), IgM ISAGA (bioMérieux, Marcy l?Etoile, France) and ETI-TOXOK-A reverse PLUS (DiaSorin, Saluggia, Italy). When required (IgG negative/IgM positive women), IgG/IgM Western Blot II (LDBio, Lyon, France) was also performed. Prenatal diagnosis on amniotic fluid was done by nested PCR. All newborns were followed up to one year of age in order to exclude or confirm the diagnosis of congenital toxoplasmosis. All pregnant women with acute or undetermined stages of infection were treated. Results: In the course of 2007, 236 women with suspected acute (IgM-positive) Toxoplasma infection were followed up. In the reference laboratory, 91 women had test results indicating acute toxoplasmosis, and 10 had undetermined status of infection. These 101 patients represented 42.8% of the 236 women referred. Acute toxoplasmosis could be excluded in the remaining 135 patients, of whom 53 were non-immune. Three infected newborns were observed, all from mothers tested for the first time during the third trimester of pregnancy. Conclusions: The role of a reference laboratory in suspected toxoplasmosis acquired during pregnancy is crucial to date the infection and discriminate between seroconversion and false positive anti-Toxoplasma IgM antibodies. This avoids unnecessary anxiety in immune women, provides correct counseling about primary prevention and periodic testing for seronegative ones, and allows early treatment and follow-up of pregnant women with acute infection and their newborns.
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications , Prenatal Diagnosis , Infections , Toxoplasmosis/diagnosisABSTRACT
Aims: To evaluate the difficulties met in the care of pregnant women with toxoplasmosis diagnosis in antenatal care services. Methods: Longitudinal prospective study with 262 pregnant women referred to the Toxoplasmosis Clinic at Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, between January 2005 and July 2009. Results: Most women (91.2%) were in the second and third trimesters of pregnancy, and 81.3% were referred by public health services. The average delay was 113.4 days in the collection of the first sample for serological tests in antenatal care, 52.1 days for referral and 160.6 days in starting treatment. Younger women (P=0.03) and those from the public health system were referred later (P<0.05). Treatment was initiated at the origin for only 16% of the pregnant women, and 5% of these did not receive the recommended dose of spiramycin. At the Reference Center there was a low rate of confirmation of the serological tests performed in the health services of origin. It was found that 12.6% of pregnant women with an initial diagnosis of acute toxoplasmosis were susceptible to infection by Toxoplasma gondii. These tests were considered false positives. Conclusions: This study highlights the difficulties met in the management of pregnant women with toxoplasmosis in the antenatal care, including the quality of diagnostic tests and the need for greater emphasis on continuing education of health professionals.
Objetivos: avaliar as dificuldades encontradas no atendimento de gestantes com diagnóstico de toxoplasmose por parte de serviços de atendimento pré-natal. Métodos: estudo longitudinal, prospectivo, com 262 gestantes encaminhadas ao Ambulatório de Toxoplasmose do Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, entre janeiro de 2005 e julho de 2009. Resultados: a maioria das gestantes foram encaminhadas no segundo ou terceiro trimestre de gestação (91,2%) e por serviços públicos de saúde (81,3%). O tempo médio de demora na coleta de sangue para os testes sorológicos no pré-natal foi de 113,4 dias. Houve demora média de 52,1 dias para o encaminhamento e 160,6 dias para o início do tratamento. Mulheres mais jovens (P=0,03) e aquelas provenientes do sistema público de saúde (P<0,000) foram encaminhadas mais tardiamente. O tratamento foi iniciado na origem em apenas 16% das gestantes, e 5% destas não receberam a dose preconizada de espiramicina. No Centro de Referência houve baixa confirmação dos testes sorológicos realizados nos serviços de saúde de origem. Constatou-se que 12,6% das gestantes com diagnóstico inicial de toxoplasmose aguda eram suscetíveis à infecção por Toxoplasma gondii, sendo os testes considerados falso-positivos. Conclusões: este estudo destaca dificuldades observadas no manejo de gestantes com toxoplasmose por parte do atendimento pré-natal da rede básica de saúde, incluindo a atenção quanto à qualidade dos testes diagnósticos e a necessidade de maior ênfase na educação continuada dos profissionais de saúde.
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications, Infectious , Prenatal Care , Prenatal Diagnosis , Longitudinal Studies , Prospective Studies , Toxoplasmosis , Toxoplasmosis, Congenital/diagnosisABSTRACT
Aims: To review the significance of toxoplasmosis as a public health issue in Serbia, and analyze the current strategies to alleviate the burden of the disease. Source of data: Relevant clinical and epidemiological reports from Serbia published since 1975. Summary of findings: Despite 50 years of continuous work on Toxoplasma gondii and toxoplasmosis in Serbia, exact data on the frequency of acute clinical disease, acute infections in pregnancy and congenital infection in the offspring are still lacking, due to the vague legal provision that toxoplasmosis is subject to reporting ?in case of epidemiological indications?. What, however, is clear is that the major Toxoplasma-induced public health issue in Serbia, like elsewhere in Europe, is congenital toxoplasmosis. Continuous monitoring of particular patient groups showed a dramatic decrease in the prevalence of infection over the past two decades, and a consequently increased proportion of women susceptible to infection in pregnancy, suggesting a potential increase in the incidence of congenital toxoplasmosis. Studies of risk factors for infection transmission have provided data to guide national health education campaigns. Conclusions: It is expected that the recent appointment of the National Reference Laboratory for Toxoplasmosis as the focal point for the collection of data from the primary level, will provide the means for accurate assessment of the measure of the problem, which is a prerequisite of an evidence-based nation-wide prevention program. In the mean time, health education of all pregnant women, focused at risk factors of major local significance, is advocated as a sound and financially sustainable option to reduce congenital toxoplasmosis.
Subject(s)
Humans , Female , Pregnancy , HIV , Risk Factors , Opportunistic Infections , Public Health , Toxoplasma , Toxoplasmosis, Cerebral , Toxoplasmosis/epidemiology , Toxoplasmosis/prevention & controlABSTRACT
Fórmulas nutricionais especiais apresentam um alto custo que as tornam inacessíveis à maioria da população, cabendo aos estados da Federação seu fornecimento, conforme demandado pelos usuários do Sistema Único de Saúde. Este estudo teve como objetivo descrever a criação e implantação de um Centro de Referência para Assessoria em Fórmulas Nutricionais Especiais, no Estado do Rio Grande do Sul. O Centro de Referência foi criado por uma parceria entre a Secretaria Estadual de Saúde do Rio Grande do Sul e o Hospital de Clínicas de Porto Alegre, com a finalidade de analisar, periodicamente, a adequação dos processos de solicitação de fórmulas nutricionais especiais. Desde sua criação, o Centro de Referência padronizou fórmulas consideradas essenciais e desenvolveu rotinas de avaliação, atuando em conjunto com funcionários envolvidos no fluxo de atendimento aos processos de solicitação e compra de fórmulas de alto custo, com o objetivo de padronizar condutas e otimizar a utilização dos recursos financeiros destinados a esta área. Estudos futuros são necessários para avaliação dos desfechos gerados após a implantação do Centro de Referência no atendimento às solicitações de fórmulas nutricionais especiais e averiguação dos custos associados.
Special nutritional formulas have high costs, which make them inaccessible to most of the population, and, as a consequence, in Brazil, each state is responsible for providing them on demand to the users of the Unified Health System. The objective of this study was to describe the creation and implantation of a Reference Center for Assistance in Special Nutritional Formulas in the state of Rio Grande do Sul, Brazil. The Reference Center was created by means of a partnership between the Health Department of the State of Rio Grande do Sul and the Hospital de Clínicas de Porto Alegre, with the aim of analyzing on a regular basis the adequacy of the procedures requesting special nutritional formulas. Since its creation, the Reference Center standardized formulas considered essential and developed evaluation routines, working together with the staff involved in the process of requesting and buying high-cost formulas, with the aim of standardizing conducts and optimizing the use of financial resources provided to this area. Further studies are necessary to evaluate the outcomes generated after the implantation of the Reference Center to meet the demands for special nutritional formulas and investigate associated costs.