The physiotherapy workforce in the Brazilian Unified Health Care System.

BACKGROUND: Maintaining sufficient health care workforce is a global priority to achieve universal health coverage. Therefore this study addresses the availability of physiotherapists in Brazil. OBJECTIVE: To describe secular trends of the physiotherapy workforce-to-population ratio in the Unified Health System, considering public and private sector and care level (primary, secondary, tertiary) in Brazil and its regions. METHOD: Descriptive exploratory quantitative study based on secondary sources. All data related to the distribution of physiotherapists between August 2007 and September 2016 regarding facilities types, location and public and private sectors was obtained from the Brazilian National Registry of Health Care Facilities. Data related to the population of Brazil was extracted from Brazilian Institute of Geography and Statistics. The physiotherapy workforce-to-population ratio was calculated by the number of physiotherapists per 1000 population (public and private sector and care level) by ANOVA test. The distribution trends are represented on maps. Annual growth rates were estimated with Prais-Winsten linear regression models, with a significance level of 0.05, autocorrelation was checked by the Durbin-Watson test. RESULTS: The physiotherapists ratio in Brazil was 0.22/1000 population in 2007 and 0.41 in 2016, showing growth of 86%, with an increasing trend of 0.5% on an annual average. The public sector had the biggest physiotherapy workforce in the country in 2007 and 2016. The primary health care had the smallest physiotherapy workforce-to-population ratio (2007: p > 0.001 and 2016: p = 0.003), even though it had the largest growth trend in annual average (0.9% p > 0.001), followed by public and private tertiary health care sectors (0.8% p > 0.001). The workforce in secondary health care was bigger in the private sector than in the public sector (0.6% p > 0.001 vs. 0.2% p = 0.004). Overall, all regions had greater growth of physiotherapy workforce-to-population ratio in public primary and tertiary health care sectors, and private secondary health care sector, mainly the Southeast, South and Central-West regions. CONCLUSION: Although the physiotherapy workforce in Brazil is relatively small, there was a trend towards growth with differences among care levels, and public and private sectors. The physiotherapy workforce-to-population ratio is bigger in the private secondary health care sector, followed by public tertiary, secondary and primary health care sectors. Sub-national regions show similar trends to the national estimates, with minor variations by region.

Sauté External Rotation in Beginner and Advanced Ballet Dancers Trained in Different Backgrounds The Turnout Paradigm.

This study compared lower limb external rotation kinematic patterns during sautés in first position in beginners and experienced ballet dancers with various training backgrounds. The ability to attain a perfect turnout is traditionally thought to be a fundamental aspect of classical ballet, and turnout is identified in the literature as one of the leading causes of dance-related injuries and technical limitations among dancers. Twenty-eight ballet dancers of different technical levels and methods (three groups) were assessed. Coefficients of variation (CV), range of motion (ROM), and mean external rotation angles of hip, knee, and ankle in first position sauté were calculated. Differences among groups were tested with ANOVAs (Tukey's post hoc; p < 0.05). The hip mean external rotation values found during the jump were different between both experienced groups from different training backgrounds (p = 0.02). The inexperienced group presented a significantly greater hip external rotation CV compared to the experienced groups (p ≤ 0.001). There were no differences between groups for values of external rotation at the knee and ankle. It is concluded that higher technical level dancers produce lower variability of hip external rotation while performing sauté in first position. Ballet training background also seems to influence the hip external rotation pattern. Moreover, the knee contributes decisively to turnout composition, not only the hip, as expected.

Danças Circulares enquanto cuidado à saúde: a perspectiva de usuários de uma unidade básica de saúde da região oeste de São Paulo / Circular dances as health care: the perspective of users of a basic health unit in the western region of São Paulo

Introdução: As Danças Circulares têm se inserido nos serviços da Atenção Básica devido à demanda por cuidados que abordem a complexidade das necessidades de saúde. A prática traz como essência um processo de autopercepção e pertencimento. Alguns serviços de saúde têm utilizado as Danças Circulares como recurso terapêutico na perspectiva da integralidade do cuidado, pois explora aspectos físicos, mentais e emocionais. Para subsidiar gestores e profissionais quanto ao pleno aproveitamento do potencial da prática, faz-se necessário compreender a perspectiva e experiência dos usuários ao vivenciá-las. A presença das Danças Circulares em serviços vivenciados pelos residentes no programa de Residência Multiprofissional em Práticas Integrativas e Complementares possibilita investigá-las dessa perspectiva. Objetivos: Compreender de que forma as Danças Circulares são percebidas como cuidado à saúde na perspectiva dos usuários. Metodologia: Foi realizada pesquisa participante com integrantes do grupo de Danças Circulares de uma Unidade Básica de Saúde na Região Oeste de São Paulo. Os métodos empregados foram: observação participante; atuação na condução de sessões; e realização de uma sessão de grupo focal com usuários do grupo. Os registros foram realizados em cadernos de campo e digitalizados; o grupo focal foi realizado mediante roteiro, gravado e integralmente transcrito. Resultados: Observou-se 7 sessões do grupo na UBS e 3 de Supervisão. O grupo apresentou uma característica flexível de participação, com 12 a 20 participantes, todas mulheres, em sua maioria idosas. As usuárias levantaram percepções de bem-estar, melhoras na condição de saúde, autoestima, alegria, auto expressão, ampliação da desenvoltura no movimento e na comunicação, aprofundamento das relações, expansão das redes de convivência, com relações importantes com autocuidado e hábitos de saúde. Associaram ainda as profissionais do grupo como referência de cuidado. Emergiu ainda uma categoria relativa à perspectiva dessas profissionais, abordando o acolhimento das necessidades de saúde, relações vinculares, articulação da rede, o papel da Supervisão e contribuições da formação técnica das profissionais. Conclusão: Os aspectos trazidos pelas usuárias se apresentaram implicados com o exercício da autonomia no autocuidado. Os achados reiteram a pertinência da incorporação das Danças Circulares como recurso válido, com contribuições originais à produção de um cuidado integral na Atenção Primária.

Introduction: Circular Dances have been included in Primary Care services due to the demand for care that addresses the complexity of health. The practice brings as its essence a process of self-perception and belonging. Some health services have used Circular Dances as a therapeutic resource from the perspective of comprehensive care, as it explores physical, mental and emotional. To support managers and professionals regarding the full use the potential of the practice, it is necessary to understand the perspective and experience of users when experiencing them. The presence of Circular Dances in services experienced by residents in the Multiprofessional Residency in Practices program Integrative and Complementary makes it possible to investigate them from this perspective. Objectives: Understand how Circular Dances are perceived ashealth care from the users' perspective. Methodology: Participant research was carried out with members of the Dance group Circulars from a Basic Health Unit in the West Region of São Paulo. You methods used were: participant observation; performance in conducting sessions; and holding a focus group session with group users. You records were made in field notebooks and digitized; the focus group was carried out using a script, recorded and fully transcribed. Results: There were 7 group sessions at the UBS and 3 Supervision sessions. The group presented a flexible participation characteristic, with 12 to 20 participants, all women, mostly elderly. Users raised perceptions of well-being, improvements in health conditions, self-esteem, joy, self-expression, expansion of ease in movement and communication, deepening of relationships, expansion of social networks, with important relationships with self-care and health habits. They also associated the group's professionals as a reference for Careful. A category also emerged relating to the perspective of these professionals, addressing the acceptance of health needs, bonding relationships, articulation of the network, the role of Supervision and contributions from the technical training of professionals. Conclusion: The aspects brought up by users were implicated in the exercise of autonomy in self-care. The findings reiterate the relevance of incorporation of Circular Dances as a valid resource, with original contributions to the production of comprehensive care in Primary Care.

O acesso e o fazer da reabilitação na Atenção Primária à Saúde / El acceso y la práctica a la rehabilitación en la Atención Primaria de Salud / The access and rehabilitation working process in Primary Health Care

RESUMO Para a adequada oferta de serviços de reabilitação no Brasil é preciso conhecer a disponibilidade de acesso existente na Rede Assistencial de Saúde (RAS) e desenvolver práticas que atendam às necessidades de saúde. Buscou-se estimar a tendência da distribuição de recursos humanos de reabilitação na RAS 2007-2015, especificamente na Atenção Primária à Saúde (APS) e conhecer a prática de Clínica Ampliada (CA), Projeto Terapêutico Singular (PTS) e Apoio Matricial (AM) para fonoaudiólogos, fisioterapeutas e terapeutas ocupacionais. Buscou-se profissionais na Rede Assistencial pelo Cadastro Nacional de Estabelecimentos de Saúde (CNES). A tendência mensal foi construída por modelos de regressão linear Prais-Winsten. Para conhecer as práticas de CA, PTS e AM, construiu-se discursos do sujeito coletivo a partir de entrevistas de 12 profissionais. Média complexidade teve a maior concentração de profissionais, exceto em hospitais na cidade de São Paulo. A APS, por sua vez, teve a menor possibilidade de acesso. Mesmo tímido, houve crescimento dos três profissionais na assistência, com ênfase para os fisioterapeutas em hospital de São Paulo, em relação ao estado (0,73%) e cidade (0,95%). Na APS, o crescimento maior foi do terapeuta ocupacional em São Paulo-cidade e do fisioterapeuta no Brasil. Para AM, CA e PTS, além da dificuldade do fazer, destacaram-se, respectivamente, ideias de "pluralidade de concepções", "visão biopsicossocial" e "possibilidade de adaptação" do cuidado. Embora crescente, a disponibilidade de profissionais é baixa e desigual, concentrada na especialidade e enfatizando ampliação de fisioterapeutas no hospital e terapeutas ocupacionais na APS.

RESUMEN Para que se tenga una adecuada oferta de servicios de rehabilitación en Brasil es necesario conocer el acceso disponible en la Red Asistencial de Salud (RAS) y desarrollar prácticas que abarcan las necesidades de la atención de salud. Se intentó estimar la distribución de los recursos humanos de rehabilitación en la RAS 2007-2015, en especial en la Atención Primaria de Salud (APS) y conocer la práctica de la Clínica Ampliada (CA), del Proyecto Terapéutico Singular (PTS) y de la Ayuda Matricial (AM) de fonoaudiólogos, fisioterapeutas y terapeutas ocupacionales. La búsqueda por estos profesionales de la Red Asistencial se dio a través del Registro Nacional de Establecimientos de Salud (RNES). Se estableció la tendencia mensual mediante modelos de regresión lineal Prais-Winsten. A fin de conocer las prácticas de los CA, PTS y AM se constituyeron discursos de sujeto colectivo desde entrevistas con 12 profesionales. La media complejidad concentró la mayoría de los profesionales, excepto en los hospitales de la ciudad de São Paulo. Pero la accesibilidad a la APS fue menor. Aunque no fue muy alta, se observó evolución de estos tres profesionales en la atención sanitaria, con énfasis en los fisioterapeutas del hospital de São Paulo, referente al estado (0,73%) y ciudad (0,95%). En la APS, el mayor incremento fue del terapeuta ocupacional en la ciudad de São Paulo y del fisioterapeuta por todo el país. En la AM, CA y PTS, además de la dificultad en la práctica, se encontraron respectivamente ideas de "pluralidad de conceptos", "perspectiva biopsicosocial" y "posibilidad de adaptarse" al cuidado. Aunque esté aumentando, la disponibilidad de estos profesionales todavía es pequeña y desigual, concentrada en la especialidad, lo que señala la necesidad de ampliar el número de fisioterapeutas en hospitales y de terapeutas ocupacionales en la APS.

ABSTRACT For adequate rehabilitation service offer in Brazil, it is necessary to understand the availability of access to Rede Assistencial de Saúde (RAS) [Brazilian Health Care Network (HCN)] and develop practices to meet health needs. The objective was to estimate the distribution trend of rehabilitation human resources in HCN between 2007 and 2015, especially in Primary Health Care (PHC) and get to know the practice of Clínica Ampliada (CA) [Extended Clinical Care (ECC)], Projeto Terapêutico Singular (PTS) [Singular Therapeutic Project (STP)], and Apoio Matricial (AM) [Matrix Support (MS)] of speech therapists, physical therapist, and occupational therapists. We searched for professionals from the Health Care Network using Cadastro Nacional de Estabelecimentos de Saúde (CNES) [Brazilian National Register of Health Establishments (NRHE)], and the monthly trend was elaborated through Prais-Winsten linear regression models. Aiming at knowing the practices of ECC, STP, and MS, "Discourses of the Collective Subject" were made from interviews held with 12 professionals. Medium complexity services had higher concentration of professionals, except for the hospitals in São Paulo city, and PHC had the lower possibility of access. Though shy, healthcare increased for all three professionals, with emphasis on physical therapists in hospitals in São Paulo city, in a comparison between the state (0.73%) and city (0.95%). In PHC, the highest raises were for occupational therapists of São Paulo city and physical therapists in Brazil. For MS, ECC and STP, besides the difficulty of the working process itself, ideas such as "plurality of concepts," "biopsychosocial perspective," and "possibility of adaptation" of care were predominant. Despite the growing numbers, the availability of professionals is still low and uneven, concentrated in specialty, and emphasising the expansion of physical therapy in hospitals and occupational therapy in PHC.