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Os invisibilizados da cidade: o estigma da População em Situação de Rua no Rio de Janeiro
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Teixeira, Mirna Barros

; Belmonte, Pilar

; Engstrom, Elyne Montenegro

; Lacerda, Alda

Saúde em Debate

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dec 2019, Volume 43 N. spe7 Pages 92 - 101

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Evidencia-se, no Brasil e em outros países da América Latina, o aumento da população de rua, muitos dos quais são usuários de crack. Essa população sofre de estigmas vinculados a uma percepção de fragilidade do caráter, como vontade fraca para interromper o uso da droga e como pessoa perigosa na medida em que é temida pela sociedade, visto que é percebida como agressora. Isso traz consequências como o isolamento social, a perda da autoestima, dificuldade de acesso aos serviços de saúde que provocam o afastamento da busca de suporte social e de saúde por parte do usuário, agravando suas condições de vida. Como metodologia, foram realizadas 48 entrevistas com trabalhadores e usuários das equipes de Consultório na Rua nas quais foi possível reconhecer o estigma internalizado pelas pessoas que se reconhecem como portadoras das características negativas que lhes são imputadas, assim como percepção dos profissionais de saúde da estigmatização sofrida por essa população. O desvelamento dos estigmas e sua análise podem auxiliar na reorientação de um conjunto de práticas de cuidado que garantam direitos básicos de saúde, educação, moradia e trabalho constituintes da cidadania, de modo a fomentar processos de democratização e de inclusão social dessa população estigmatizada em situação de extrema vulnerabilidade.

ABSTRACT People living in the streets, many of whom are crack users, are on the rise in Brazil and other Latin American countries. Such a population suffers from stigmas linked to a perception of fragile character, such as weak willpower to stop drug use, and a dangerous individual feared by society because perceived as an aggressor. The consequences of those stigmas are social isolation, loss of self-esteem, difficulty in accessing health services, which make users withdraw from social and health support, deteriorating their living conditions. Forty-eight interviews were conducted with workers and users of the Street Clinic (Consultório na Rua), which revealed the stigma internalized by people recognized as carriers of the negative traits assigned to them, as well as health professionals’ perception of the stigma suffered by such population. The unveiling of stigmas and their analysis can reorient a set of care practices to ensure fundamental rights in health, education, housing, and work, which underpin citizenship, to promote the democratization and social inclusion process of the stigmatized people living in a situation of extreme vulnerability.

https://doi.org/10.1590/0103-11042019s707

A dimensão do cuidado pelas equipes de Consultório na Rua: desafios da clínica em defesa da vida
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Engstrom, Elyne Montenegro

; Lacerda, Alda

; Belmonte, Pilar

; Teixeira, Mirna Barros

Saúde em Debate

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dec 2019, Volume 43 N. spe7 Pages 50 - 61

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O estudo objetivou analisar a produção de cuidados primários à saúde à população em situação de rua, prestados por equipes de Consultório na Rua (eCR) no contexto de uma metrópole brasileira, identificando potencialidades e dificuldades. Estudo de caso, de abordagem qualitativa, considerando o universo das sete equipes no ano 2016/2017, com observação direta do trabalho e realização de entrevistas semiestruturadas com profissionais de várias categorias (n=34), com análise temática de conteúdo. Observou-se que as eCR atuavam com escopo ampliado e integral de ações, cuidados clínicos e intersetoriais, nos espaços das ruas e nos serviços, em trabalho de equipe integrado. Organizavam-se com flexibilidade, baixa exigência, busca ativa nos territórios, de forma itinerante, no tempo oportuno, imediato, construção de planos terapêuticos compartilhados, que promoviam autonomia, baseados na redução de danos. Dificuldades eram inerentes às vulnerabilidades e complexidades dos casos, à fragmentação da rede de atenção, à qualidade dos instrumentos para registro em saúde e à carência de recursos estruturais (transporte, insumos para ações de promoção da saúde). Concluiu-se que o cuidado se sustentava na dimensão ético-política, usuário-centrado, na solidariedade e na defesa da vida.

ABSTRACT The study aimed to analyze the production of Primary Health Care to people living in the streets, provided by Street Office (eCR) teams in the context of a Brazilian metropolis, identifying potentialities and difficulties. This is a qualitative case study considering the universe of the seven teams in the 2016-2017 period, with direct observation of the work and conducting semi-structured interviews with professionals from various categories (n=34), with thematic content analysis. We observed that the eCR operated with an enlarged and comprehensive scope of actions, clinical and intersectoral care, in street spaces and services, through integrated teamwork. They were organized with flexibility, low demand, active search in the territories, in an itinerant way, timely, and immediately, with the construction of shared therapeutic plans, which promoted autonomy, based on harm reduction. Difficulties were inherent to the vulnerabilities and complexities of the cases, the fragmentation of the health care network, the quality of the instruments for health registration and the lack of structural resources (transportation and inputs for health promotion actions). We concluded that care was sustained in the ethical-political, user-centered dimension, in solidarity and in the defense of life.

https://doi.org/10.1590/0103-11042019s704

Os invisibilizados da cidade: o estigma da População em Situação de Rua no Rio de Janeiro
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Teixeira, Mirna Barros

; Belmonte, Pilar

; Engstrom, Elyne Montenegro

; Lacerda, Alda

Saúde em Debate

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2019, Volume 43 N. spe7 Pages 92 - 101

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/0103-11042019s707 2304 downloads

A dimensão do cuidado pelas equipes de Consultório na Rua: desafios da clínica em defesa da vida
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Engstrom, Elyne Montenegro

; Lacerda, Alda

; Belmonte, Pilar

; Teixeira, Mirna Barros

Saúde em Debate

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2019, Volume 43 N. spe7 Pages 50 - 61

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/0103-11042019s704 2153 downloads

O debate legislativo carioca sobre a “mudança da homossexualidade”: ciência, política e religião
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Venancio, Ana Teresa Acatauassú

; Belmonte, Pilar Rodriguez

Sexualidad, Salud y Sociedad (Rio de Janeiro)

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aug 2017, N. 26 Pages 103 - 125

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo O artigo analisa o debate na mídia impressa em torno do projeto de lei 717/03, apresentado na Assembleia Legislativa do Rio de Janeiro em agosto de 2003, que previa o uso de verbas públicas para a “mudança da homossexualidade”. Foram utilizadas como fontes de pesquisa notícias sobre este projeto publicadas em jornais e revistas de grande circulação estadual e nacional, considerando-se os autores, os atores sociais e as categorias citadas nos diferentes tipos de matéria, bem como os argumentos contrários e favoráveis à proposta legislativa. Verificamos assim o modo como argumentos relativos aos campos científico, religioso e político ressignificaram as relações entre natureza/cultura e normal/patológico, operando de modo especifico, e por vezes contraditório, com valores caros às sociedades modernas contemporâneas, como igualdade entre os homens e livre arbítrio individual.

Abstract The article analyzes the debate in printed media about the 717/03 law proposal which was presented at the Legislative Assembly of Rio de Janeiro in August 2003. This bill provided for the use of public funds for the “change of homosexuality.” News about this project published in newspapers and magazines of statewide and nationwide coverage were used in the research considering the authors, social actors and categories that appeared in the different types of material, as well as the opposing and favorable arguments about the Legislative proposal. We have thus verified how arguments related to the scientific, religious and political fields have reconfigured the relations between nature/culture and normal/pathological, operating in a specific and sometimes contradictory way, with dear values to contemporary modern societies, as equality among men and individual will.

Resumen El artículo analiza el debate en los medios impresos en torno al proyecto de ley 717/03, presentado en la Asamblea Legislativa de Río de Janeiro en agosto de 2003, que preveía el uso de fondos públicos para el “cambio de la homosexualidad”. Se utilizaron como fuentes de investigación noticias sobre este proyecto, publicadas en periódicos y revistas de gran circulación estatal y nacional, considerando los autores, los actores sociales y categorías citadas en los diferentes tipos de noticia, así como los argumentos contrarios y favorables sobre la propuesta legislativa. De esta forma verificamos el modo como argumentos relativos a los campos científico, religioso y político resignificaron las relaciones entre naturaleza / cultura y normal / patológico, operando de modo específico, y a veces contradictorio, con valores importantes a las sociedades modernas contemporáneas, como la igualdad entre los hombres y el libre albedrío.

https://doi.org/10.1590/1984-6487.sess.2017.26.06.a 1505 downloads

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study)
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Torres, Armando

; Torregrosa, Vicens

; Marcen, Roberto

; Campistol, Josep María

; Arias, Manuel

; Hernández, Domingo

; Fernández, Constantino

; Esforzado, Nuria

; Paschoalin, Raphael

; Pérez, Nuria

; García, Ana Isabel

; Amo, Montserrat del

; Pomés, Jaume

; González Rinne, Ana

; Marrero, Domingo

; Pérez, Estefanía

; Henríquez, Fernando

; Díaz, Juan Manuel

; Silva, Irene

; López, Verónica

; Perello, Manuel

; Ramos, David

; Beneyto, Isabel

; Cruzado, José María

; Martínez Castelao, Alberto

; Bravo, Juan

; Rodríguez, Minerva

; Díaz, Carmen

; Crespo, Josep

; Anaya, Fernando

; Rodríguez, María Luisa

; Cubero, Juan José

; Pascual, Pilar

; Romero, Rafael

; Andrés Belmonte, Amado

; Checa, María Dolores

; Jiménez, Carlos

; Escuin, Fernando

; Crespo, Marta

; Mir, Marisa

; Gómez, Gonzalo

; Bayes, Beatriz

; González, María José

; Gutiérrez, Alex

; Cuberes, Marta

; Rodríguez Benoit, Alberto

; García, Teresa

; Llamas, Francisco

; Ortega, Agustín

; Conde, José Luis

; Gómez Alamillo, Carlos

Nefrología (Madrid)

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jun 2016, Volume 36 N. 3 Pages 255 - 267

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Background and objectives: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. Method: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. Results: Vitamin D deficiency (25OHD3 < 15 ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p = 0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p = 0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100 pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. Conclusions: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.

resumen está disponible en el texto completo

https://doi.org/10.1016/j.nefro.2016.03.004 345 downloads

Chinchón declaration: decalogue on low- and no-calorie sweeteners (LNCS)
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Serra-Majem, Lluís

; Riobó Serván, Pilar

; Belmonte Cortés, Susana

; Anadón Navarro, Arturo

; Aranceta Bartrina, Javier

; Franco Vargas, Eladia

; García-Closas, Reina

; Gómez-Candela, Carmen

; Herrero Sancho, Elvira

; La Vecchia, Carlo

; López Díaz-Ufano, M.ª Luisa

; Varela-Moreiras, Gregorio

; Vázquez Castro, Jesús

; Ribas-Barba, Lourdes

; Alcaraz-Cebrián, Francisca

; García-Luna, Pedro Pablo

; González-Gomis, Mercedes

; González-Gross, Marcela

; Granado de la Orden, Susana

; López-Sobaler, Ana María

; Moreno Villares, José Manuel

; Ortega Anta, Rosa María

; Pérez-Rodrigo, Carmen

; Polanco Allué, Isabel

; Urrialde de Andrés, Rafael

Nutrición Hospitalaria

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apr 2014, Volume 29 N. 4 Pages 719 - 734

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Multidisciplinary experts in the areas of nutrition and health met in Chinchón, Madrid, on November 25-26, 2013 under the auspices of the Fundación para la Investigación Nutricional (Nutrition Research Foundation) and with the collaboration of the Madrid Regional Government´s Health Ministry, the International Sweeteners Association and the Carlos III Health Institute CIBER of Physiopathology of Obesity and Nutrition. They analyzed the current status of scientific knowledge on low- and no-calorie sweeteners (LNCS) and developed a consensus Decalogue on their use; this constitutes the Chinchón Declaration. Sweeteners, including sugar, represent a subject of undeniable interest and are currently a popular topic, although areas relating to their safety and benefits remain unknown to segments of academia and the general public. The nature of LNCS makes them vulnerable to biased and even contradictory information. They are food additives that are broadly used as sugar substitutes to sweeten foods, medicines and food supplements when non-nutritional or non-caloric alternatives are needed. The Chinchón Decalogue is the outcome of a meeting for reflection and consensus by a group of experts with backgrounds in different scientific disciplines (toxicology, clinical nutrition, community nutrition, physiology, food science, public health, pediatrics, endocrinology and nutrition, nursing, pharmaceutical care and food legislation). The Decalogue includes different aspects of LNCS related to regulation, use, benefits and safety. In general, benefits of LNCS have been traditionally neglected in comparison with the tendency for emphasising unexisting or unproven possible risks. The need to strengthen research on LNCS in Spain was emphasized, as well as the need to educate both professionals and the public.

Expertos de carácter multidisciplinar de las áreas de conocimiento de la nutrición y la salud reunidos en Chinchón, Madrid, los días 25 y 26 de noviembre de 2013 , bajo los auspicios de la Fundación para la Investigación Nutricional y con la colaboración de la Consejería de Sanidad del Gobierno de la Comunidad de Madrid, la International Sweeteners Association y el CIBER de Fisiopatología de la Obesidad y la Nutrición del Instituto de Salud Carlos III, analizaron el estado actual del conocimiento científico en torno a los Edulcorantes sin y bajos en calorías (ESBC) y desarrollaron un Decálogo sobre su uso que constituye la Declaración de Chinchón. Los edulcorantes, incluido el azúcar, constituyen un elemento de indudable interés y actualidad, aunque no exento de desconocimiento por algunos sectores tanto académicos como de la población en general. La propia naturaleza de los ESBC los hace susceptibles de informaciones tergiversadas e incluso contradictorias. Son aditivos alimentarios ampliamente utilizados como sustitutivos del azúcar para endulzar alimentos, medicamentos y complementos alimenticios cuando se persiguen fines no nutritivos. El Decálogo de Chinchón es fruto de una reunión de reflexión y consenso por parte de un grupo de expertos procedentes de distintas disciplinas científicas (toxicología, nutrición clínica, nutrición comunitaria, fisiología, bromatología, salud pública, atención primaria, pediatría, endocrinología y nutrición, enfermería, atención farmacéutica y legislación alimentaria). El decálogo incluye diferentes aspectos de los EBSC relacionados con la legislación, uso, beneficios y seguridad. En general, los beneficios de los EBSC han sido tradicionalmente desatendidos en comparación con la tendencia de destacar posibles riesgos inexistentes o que no han sido probados. Hace especial hincapié en la necesidad de fortalecer la investigación de los EBSC en España, así como la necesidad de formar en este ámbito a los profesionales y a los consumidores en general.

https://doi.org/10.3305/nh.2014.29.4.7393 941 downloads

Obesity and sedentarism in the 21st century: what can be done and what must be done?
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Varela-Moreiras, Gregorio

; Alguacil Merino, Luis Fernando

; Alonso Aperte, Elena

; Aranceta Bartrina, Javier

; Ávila Torres, José Manuel

; Aznar Laín, Susana

; Belmonte Cortés, Susana

; Cabrerizo García, Lucio

; Dal Re Saavedra, María Ángeles

; Delgado Rubio, Alfonso

; Garaulet Aza, Marta

; García Luna, Pedro Pablo

; Gil Hernández, Ángel

; González-Gross, Marcela

; López Díaz-Ufano, María Luisa

; Marcos Sánchez, Ascensión

; Martínez De Victoria Muñoz, Emilio

; Martínez Vizcaíno, Vicente

; Moreno Aznar, Luis

; Murillo Ramos, Juan José

; Ordovás Muñoz, José María

; Ortega Anta, Mª Rosa

; Palacios Gil-Antuñano, Nieves

; Palou Oliver, Andreu

; Pérez Rodrigo, Carmen

; Riobó Serván, Pilar

; Serra Majem, Lluis

; Tur Mari, Josep

; Urrialde De Andrés, Rafael

; Varela Moreiras, Gregorio

; Zamora Navarro, Salvador

Nutrición Hospitalaria

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sep 2013, Volume 28 Suppl. 5 Pages 1 - 12

Abstract: En | Text: En | PDF: En

13496 downloads

Evaluación clínica abierta multicéntrica no aleatorizada y prospectiva de la efectividad de una emulsión a base de ácidos grasos hiperoxigenados, Aloe barbadensis y Mimosa tenuiflora (Mepentol® Leche) en diferentes tipos de pacientes con riesgo de ulceración
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Puentes Sánchez, José

; Pardo González, Cármen M.ª

; Pardo González, M.ª Belén

; Navarro Casado, Félix J.

; Puentes Sánchez, Román

; Méndez González, Juan Miguel

; González Rojo, Josefa

; Juárez Morales, Antonia

; López Fernández, Isabel M.ª

; Rodríguez Gómez, Inmaculada

; Capel López, M.ª Dolores

; Capel López, Joaquina

; Puentes Carmena, José Luis

; Méndez Sánchez, María

; Miguel González, Marta de

; Santana Palma, José Luis

; Belmonte Milán, Pedro

; Sánchez Moreno, Encarnación

; Rodríguez Fernández, M.ª D.

; Bacas Pérez, Miguel

; Lao Moya, Francisco Javier

; García Navarro, Soledad

; Manzano Martín, Alicia

; Llorente Ruiz, Gema

; Segura Herrada, Fermín

; Mercado Polo, Pilar

; García Rodríguez, Dolores

; Martín Fernández, Gador

; Sánchez Lara, M.ª Isabel

Gerokomos

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sep 2012, Volume 23 N. 3 Pages 123 - 127

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

The lower extremity wounds are a serious health problem that affects a large number of patients, thereby assuming a great challenge to work for health professionals. Hyperoxygenated fatty acids (AGHO), have demonstrated efficacy in the prevention of this type of ulcers. Thanks to the good results obtained in a previous study, we plan to continue evaluating the effectiveness of Mepentol® Leche, an emulsion-based hyper-oxygenated fatty acids, Aloe barbadensis and Mimosa tenuiflora in skin care and relief of symptoms, in patients with this problem, but expanding the sample size and focusing on diabetic patients with concomitant diseases. Also in this study have been involving nurses in six provinces: Almería, Alicante, Granada, Seville, Malaga and Ceuta. Again with this study, a total of 2,145 patients, we demonstrated that no patient has ulcerated during the follow-up and treatment with Mepentol® Leche and its systematic application significantly improves the symptoms before the onset of ulcers, preventing dryness skin, reducing itching, burning, pain and eczema, and returning the skin of these patients to their normal color.

Las úlceras de la extremidad inferior suponen un grave problema sanitario que afecta a un gran número de pacientes, constituyendo por ello un gran reto de trabajo para los profesionales de la salud. Los ácidos grasos hiperoxigenados (AGHO) han demostrado tener eficacia en la prevención de este tipo de úlceras. Gracias a los buenos resultados obtenidos en un estudio previo, nos planteamos seguir evaluando la efectividad del producto Mepentol® Leche, una emulsión a base de ácidos grasos hiperoxigenados, Aloe barbadensis y Mimosa tenuiflora, en el cuidado de la piel y alivio de los síntomas en pacientes con este problema, pero ampliando el tamaño de la muestra y centrándonos en pacientes diabéticos junto con otras enfermedades concomitantes. Además, en este estudio se ha implicado a profesionales de enfermería de seis provincias: Almería, Alicante, Granada, Sevilla, Málaga y Ceuta. De nuevo con este estudio, realizado en un total de 2.145 pacientes, hemos demostrado que ningún paciente ha ulcerado durante el tiempo de seguimiento y tratamiento con Mepentol® Leche y que su aplicación sistemática mejora claramente los síntomas previos a la aparición de úlceras, evitando la sequedad cutánea, reduciendo el prurito, escozor, dolor y eccema, y devolviendo la piel de estos pacientes a su coloración normal.

1316 downloads

10.

Absceso de Psoas
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Lucas Pérez-Romero, Javier

; Salazar García, Pilar

; Lucas Pérez-Romero, Marta

; Belmonte, María Ángeles

Revista Clínica de Medicina de Familia

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feb 2011, Volume 4 N. 1 Pages 76 - 78

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Psoas abscess is a rare clinical entity often associated with gastrointestinal disease. Clinical manifestations are usually non-specific and therefore diagnosis is delayed leading to poor prognosis. It is important to emphasis that when a patient presents with an abscess or cutaneous emphysema in the muscle the possibility of abdominal origin should always be considered, because immediate, aggressive surgical drainage is the only effective treatment.

El absceso de psoas es una entidad infrecuente y suele estar relacionada con patología gastrointestinal. Las manifestaciones clínicas suelen ser inespecíficas por lo que el diagnóstico suele ser tardío y como consecuencia de ello el pronóstico malo. Es importante destacar que ante la presencia de un absceso o enfisema en el muslo se debe tener siempre en cuenta la posibilidad de un origen abdominal, ya que el drenaje quirúrgico urgente y agresivo es el único tratamiento eficaz en estas situaciones.

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11.

O campo da atenção psicossocial: formar e cuidar no Curso de Qualificação na Atenção Diária em Saúde Mental (CBAD)
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Belmonte, Pilar

Trabalho, Educação e Saúde

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mar 2006, Volume 4 N. 1 Pages 187 - 198

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Este texto se propõe a contribuir para a discussão acerca da formação de profissionais de saúde segundo os objetivos da Reforma Psiquiátrica. Para tanto, apresenta o caminho percorrido no Brasil desde o surgimento dos primeiros movimentos da Reforma no País, a construção do novo modelo assistencial vigente, alternativo ao modelo hospitalocêntrico, assim como a experiência do Curso de Qualificação na Atenção Diária em Saúde Mental (CBAD), que objetiva a formação de cuidadores em saúde mental. Discute também possíveis estratégias e propostas que garantam uma formação articulada com a prática, refletindo-se no cuidado multidisciplinar diferenciado e no alcance da maior autonomia possível da clientela atendida.

This article furthers the discussion on the training of health professionals according to the guidelines of the Psychiatric Reform by reviewing the steps taken by the country from the appearance of the first reform movements until the development of the current care model, an alternative to hospital-centered models. The article also presents the experience acquired in the Training Course on Day-Care in Mental Health, whose objective is to train health care professionals in mental health. Moreover, it also discusses possible strategies and proposals for assuring that the received training also involves practice, which would be reflected in differentiated multidisciplinary care and in a possibly larger autonomy of clients.

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