DGard Software Compliance Manager Descargar
Edelira Longinotti
This network relates the types of care and the management of this care in the health of farmers in general and in agricultural communities1. The vulnerability of riverside communities is due to their complexity in relations with the environment and natural phenomena, as well as other public health hazards, such as river floods and communicable diseases [2]. Intoxications, deaths and injuries are frequent in farmers who use pesticides, but the absence of systematization in the recording of these procedures hinders the accuracy of data on their prevalence [3].
The notification of pesticide poisoning is compulsory, and must be performed in the face of suspicion or confirmation of disease or injury, and can be made by physicians, other health professionals or responsible for health facilities, public or private, according to Ordinance GM/MS No. 204, of February 17, 2016 [4].
The health care of farmers in health services should consider the insertion of these in production processes, while recognizing work and modes of production, such as the use of pesticides in their crops, which define the health-disease-care process. Thus, it is necessary that the Family Health Teams (ESF) in the Basic Health Units (UBS) know the work or occupation of the user-worker and incorporate this knowledge to the actions of promotion, protection and surveillance, care and rehabilitation, in the care networks of the Unified Health System (SUS) [3].
Studies conducted in the state of Pernambuco [7] and Bahia [8] confirm that there is great exposure of rural workers to agricultural pesticides and highlight situations such as: ignorance of risk factors, non-use of Personal Protective Equipment (PPE), carcinogenic potential of the substances used, among others [9, 10].
The municipalities of Petrolina (PE) and Juazeiro (BA) have a very similar population of riverside farmers in the San Francisco river hydroterritory of 7,000 farmers. It is divided by communities that are assisted in health units, at the level of primary care and some points of supply at the level of secondary care (AS, e.g. Polyclinics) and CEREST. The people responsible for the care of the riverside farmer who uses pesticides are the Health Department (SSM), and the UBS under the management of the professional (coordinator of the UBS) selected by them [11, 12].
Even though two municipalities are so close and using the same pesticides, Juazeiro over the last few years has decreased the number of notifications for annual injuries when compared to the municipality of Petrolina [13]. Thus, how are the services being made in the health care networks of riverside farmers who use pesticides in the municipalities of Petrolina (PE) and Juazeiro (BA)?
If the impact on health by the use of pesticides is a problem not yet solved in Brazil [14], the health of communities that use pesticides is further neglected due to the lack of greater social compression of health damage and an insufficient care network. The objective of the research was to investigate health management practices, from the perspective of the expanded health care network (RAS), focusing on riverside farmers who use pesticides in the municipalities of Petrolina (PE) and Juazeiro (BA) in the Northeast of Brazil. The study aimed to explore these practices from the perspective of the healthcare network (RAS).
This study contributes to the progression of theoretical knowledge by visualizing the network of management and care, with the aim of developing an explanatory theoretical model based on empirical data and its limitations in the functioning of the integral service, for the planning of managers. New studies can mitigate health damage by the use of pesticides working in the field of human behavior in different spheres where the riverside farmer needs an adequate and fair social environment.
This is a cross-sectional study, with a qualitative, exploratory and descriptive approach to understand the actions and functioning of the health Care Management network of riverside farmers who use pesticides, in each of their service points. Having as methodological reference the Grounded Theory (CGT), opting for the use of the constructivist current of knowledge, proposed by Charmaz [15].
The participants included in the study consisted of: 26 (13 in each group) health professionals and managers, workers in the municipal and state RNS of Petrolina and Juazeiro in the various points of care located in PHC and outpatient secondary care in each municipality, as well as in the municipal and state health departments, with at least one year of care experience. The signing of the free and informed consent form of the research was also requested and the willingness to answer the questions of the interview. However, professionals and managers who were on vacation or on leave were excluded from the research during the period of data collection of the points of the network visited.
At the end of the interview, the relationship points that the networks of the municipalities had to support the riverside farmers inside and outside the SUS were asked. This provides the visualization of the network, in addition to the functions of each point of assistance, to draw a representative figure of this process, which in the literature was not found.
The explanations of the functioning of the management network and the care of farmers were related to the role of the other points of attention, as well as the understanding of managerial aspects, in addition to care in a care network [16].
The data were coded in categories that represented the parts of the process and subcategories that explained them [15]. Thus, this approach was carried out the study of the care management network of riverside farmers, little researched in the scientific literature (See Fig. 1).
In the initial codification the choice was the group of interviews in the municipality of Petrolina. The excerpts of the interviews were thoroughly analyzed, and initial codes resulted from them, which were reformulated until the last interviewee. The categories emerged from the product of the constant comparative method, establishing analytical distinctions and making comparisons at each level of functioning in care management. The CGT comprises some coding steps to achieve the theoretical model [15].
The second stage consisted of focused coding, in which the codes are more directed, selective and conceptual when compared to the initial coding. During the focused coding process, the subcategories emerged, from the aggregation of the initial codes, by the continuous process of comparison of the analyzed data [15].
The third stage performed in data analysis was theoretical coding, in which the categories and subcategories that emerge from the codes are formed and integrated in order to expose the phenomenon or the central category. The validation of the theoretical model was performed with the participants of the second sample group, in order to discuss its resonance, each level of functioning and the veracity of the knowledge of each group [15] in the management network and the care of the riverside farmer [17], due to the health risk that pesticides cause [5, 9].
The research followed the guidelines and regulatory norms of the research involving human beings that make up Resolution 466/12, first obtaining the approval of the municipal bodies for its realization, with subsequent submission and approval of the research project in the Ethics Committee on Research with Human Beings of the State University of Bahia (UNEB) - opinion number 5.181.184 of December 21, 2021.
In this sense, for the CM to be consolidated, it is necessary the knowledge on the part of the professional, about how the farmer uses the pesticide, since the period of graduation and during his performance in health, performing the care at his point of attention, as well as in the referral of this person to the other levels of the RNS, according to the demands presented. For the regulation to happen properly, the points of attention must have their well-defined roles in the care of the riverside farmer who uses pesticides, in order to carry out the actions that compete with him.
These actions do not overlap, they happen in an integrated and circular way, restarting with the emergence of new situations, causing the CM to emerge to the riverside farmer who uses pesticides from the perspective of networked care, as a process in constant construction, coordinated by PHC.
In this research, the participants reinforced that the dimensions presented for the construction of the CM are at the same level of importance, as well as interconnect and share responsibilities, creating horizontal relationships between them. It is noteworthy that the CM should provide the planned care, through the use of available resources as are the CHA, and listing objectives, goals and strategies, manifesting itself as a creative and motivational process, with the intention of maintaining and favoring care, ensuring its quality to users and their families.
There are no mechanisms within the networks, during the study period, for performing molecular examination of the type of pesticide, which farmers would need in case they did not know the substance that causes the disease. Likewise, there is no multiprofessional team that performs specific rehabilitation care to the riverside farmer who uses pesticides, and the reference for cases of difficult management in primary care is limited. The number of vacancies of specialists, as in the case of dermatoses, the lack of dermatologists via SUS, make the regulation of these cases even more difficult. The medical specialists included in the research reported in the interview that: they are reserved in decisions about giving a clinical diagnosis that place pesticides as causing problems in human health by the political force that the ruralist bench has in government.
According to what the interviewees reported, the CM network in the SUS has the following flow relationships: the UBS as the entrance ports of the network, being the most important to achieve complete monitoring; the UPA and hospitals in cases of urgency or emergency; and even the same CEREST when the farmer is not well informed.
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