Barriers to access and organization of primary health care services for rural riverside populations in the Amazon.

BACKGROUND: The ways of life in the Amazon are diverse and not widely known. In addition, social inequities, large geographic distances and inadequate health care network noticeably limit access to health services in rural areas. Over the last decades, Brazilian health authorities have implemented fluvial mobile units (FMU) as an alternative to increase access and healthcare coverage. The aim of the study was to identify the strategies of access and utilization of primary health care (PHC) services by assessing the strengths and limitations of the healthcare model offered by the FMU to reduce barriers to services and ensure the right to healthcare. METHODS: Qualitative and ethnographic research involving participant observation and semi-structured interviews. Data collection consisted of interviews with users and health professionals and the observation of service organization and healthcare delivered by the FMU, in addition to the therapeutic itineraries that determine demand, access and interaction of users with healthcare services. RESULTS: Primary care is offered by the monthly locomotion of the FMU that serves approximately 20 rural riverside communities. The effectiveness of the actions of the FMU proved to be adequate for conditions such as antenatal care for low-risk pregnancy, which require periodic consultations. However, conditions that require continued attention are not adequately met through the organization of care established in the FMU. The underutilization of the workforce of community health workers and disarrangement between their tasks and those of the rest of the multi-professional team are some of the reasons pointed out, making the healthcare continuity unfeasible within the intervals between the trips of the FMU. From the users' perspective, although the presence of the FMU provides healthcare coverage, the financial burden generated by the pursuit for services persists, since the dispersed housing pattern requires the locomotion of users to reach the mobile unit services as well as for specialized care in the urban centers. CONCLUSIONS: The implementation of the FMU represents an advance in terms of accessibility to PHC. However, the organization of their activity uncritically replicates the routines adopted in the daily routine of health services located in urban spaces, proving to be inadequate for providing healthcare strategies capable of mitigating social and health inequalities faced by the users.

Produção de conhecimento e formação em psicologia do esporte no Amazonas / Knowledge production and professional qualification in sport psychology in the Amazonas / Producción de conocimiento y formación em psicologia del deporte en el Amazonas

O presente estudo insere-se no âmbito da psicologia do esporte, especialidade e campo de atuação da psicologia. Considerando a interface entre as demais ciências do esporte, especialmente a educação física, buscou-se compreender a formação e a produção cientifica em psicologia do esporte no Amazonas. Mapeou-se possíveis produções, além de cursos credenciados de psicologia e educação física, suas respectivas estruturas curriculares visando identificar a inserção dessa área como disciplina, além de grupos e linhas de pesquisa. De modo geral os resultados apontam um contexto científico não consolidado com oferta de disciplinas de psicologia do esporte no bacharelado das formações em psicologia e educação física. Destaca-se o recente crescimento das monografias abordando a temática e a não divulgação dos resultados das pesquisas como uma problemática a ser enfrentada. Sugere-se a criação de alternativas no contexto acadêmico visando fomentar a divulgação das produções, assim como a relevante discussão sobre o campo da psicologia do esporte na formação acadêmica.

This study is within the scope of sport psychology, specialty and professional field of psychology. Considering the interface between the other sports sciences, especially physical education, we sought to understand the qualification and scientific production in sport psychology in Amazonas. Possible productions were mapped and accredited courses in psychology and physical education, their respective curricular structures in order to identify the insertion of this area as a discipline, in addition to groups and lines of research. Generally, the results point to an unconsolidated scientific context with the offer of sports psychology courses in the Bachelor of Psychology and Physical Education courses. We highlight the recent growth of monographs addressing the theme and the non-disclosure of research results as a problem to be faced. It is suggested to create alternatives inserted in the academic context in order to promote the dissemination of productions, as well as the relevant discussion on the field of sport psychology in qualification

Este estudio es parte del campo de la psicología del deporte, especialidad y campo de acción de la psicología. Considerando la interfaz entre las otras ciencias del deporte, especialmente la educación física, buscamos entender la formación y la producción científica en psicología del deporte en Amazonas. Fue mapeado las posibles producciones, los cursos autorizados de psicología y educación física, sus respectivas estructuras curriculares para identificar la inserción del campo como asignatura universitaria, además de grupos y líneas de investigación. En general, los resultados apuntan a un contexto científico no consolidado con la oferta de asignatura de psicología deportiva en los cursos de bachillerato en Psicología y Educación Física. Destacamos el reciente crecimiento de las monografías que abordan el tema y la falta de divulgación de los resultados de las investigaciones como un problema a enfrentar. Proponemos la creación de alternativas en el contexto académico para promover la difusión de producciones, así como la relevante discusión sobre el campo de la psicología del deporte en la formación académica