Custos e benefícios de um programa de exercício aeróbios na doença pulmonar obstrutica crônica: ensaio cliníco aleatório controlado

Pulmonary Rehabilitation, especially due to aerobic exercise, positive impact in reducing morbidity/mortality of patients with COPD, however the economic impact with costs of implementing simple programs of aerobic exercise are scarce. This is a blind randomized clinical trials, which aimed to evaluate the costs and benefits of a simple program of aerobic exercise in individuals with COPD, considering the financial costs of the Public Health System and its secondary endpoints. We evaluated lung function, the distance walked during six minutes of walking, the respiratory and peripheral muscle strength, quality of life related to health (QLRH), body composition and level of activity of daily living (ADL) before and after eight weeks of an aerobic exercise program consisting of educational guidance for both groups, control and intervention and supervised walks to the intervention group. The health costs generated in both groups were calculated following table Brazilian Public Health System. The sample consisted of forty patients, two being excluded in the initial phase of desaturation during the walk test six minutes. Were randomized into control and intervention group thirty-eight patients, three were excluded from the control group and one was excluded from the intervention group. At the end, thirty-four COPD comprised the sample, 16 in the control group and 18 in the intervention group (FEV1: 50.9 ± 14% pred and FEV1: 56 ± 0.5% pred, respectively). After for intervention, the intervention group showed improvement in meters walked, the sensation of dyspnea and fatigue at work, BODE index (p <0.01) in QLRH, ADL level (p <0.001) as well as increased strength lower limbs (p <0.05). The final cost of the program for the intervention group was R $ 148.75, including: assessments, hiking supervised by a physiotherapist and reassessments. No patient had exacerbation of IG, while 2 patients in the CG exacerbated, generating an average individual cost of R $ 689.15. The aerobic exercises in the form of walking showed significant clinical benefits and economic feasibility of its implementation, due to low cost and easy accessibility for patients, allowing them to add their daily practice of aerobic exercises

Financiamento e gasto público em saúde: o caso do Rio Grande do Norte

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Iniqüidade em saúde: uma extensão das desigualdades sociais no sistema público de saúde do Brasil (2003-2006)

This issue analises the unevenness in the brazilian system of public health care as an extension of socials inequities. It is a theoretical study based in a historical method, using empirical camp from academic, corporation and institution researchs, along the period 2002-2006. Equality and effectiveness in health systems are analitical basic cathegories grap in the root of the doctrine, principles and organization of the Unique Health System, in which sectorial actions are inserted. Discuss the estructural prodution and determined those inequalities through some social determiners of health system: income, land, food securitiy, nutritional situation, basic sanitation, epidemiological inequities and public management policy. Carry out a thematic review over health social production, it formlation and the goals of social policies, as well as the insertion of the equality principle in the assistance system, in the frame of the running public health regulations. It uses reflections that enlighted the correlation between the process of political-institutional actions and equity on health assistance. Analized the pertinency of sectorial reorganizational strategies on basic attendance, confronting the hipothesis that those strategies reinforce social inequities in health system, because it organize diferential assistance levels over not equal baselines. The results show up that social inequalities, even remaining, have had a small decrease; that the selectiviness of actual public policies and the duplication of the health system, increases the differences within and between the social classes and configures the assistance as inequal. The basic care system has great shortages that also appeares in middle and complex assistance levels. As conclusion, it remarks that the health assintance system, even with it integrality has limits; structural problems on material conditions of living and health system could not be reversed only with institutional legal arragements; by the contrary, in border conditions, these strategies produce policies that reinforce inequities, neglecting the equity principle of the system in which frame, they work. One patina of this tim

Dependência química em mulheres :um estudo sobre o consumo de medicamentos ansiolíticos no serviço público de saúde de Natal/RN

This work was concerned to investigate the meaning attributed to anxiolytic drugs by women, in public health service. It proposes a joint analysis through a link between three dimensions: the woman, the drug, and public health service itself, in an hegemonic medical assistance model. It is observed that the relation between these elements has a great influence over the use and construction of a particular meaning, by the user. The medication is analysed as a consumption merchandise and as an health symbol. In this way, it reflects a biologized vision, which believes the drug as a solution for all health problems. It tries to analyse the generalized medical prescription for anxiolythics and it s consequences. It focalizes also the production and utilization of public health services by patients, mainly women. The question related to the use of anxiolytics and the meaning construted by women is analysed focusing the way that relations of masculine/feminine gender are organized in our society. At this point of view, it tries to understand the dimension that these questions have in subjectivity production, and how it acts in the health/disease process. Finally, this work tries to understand, in a broad sense, the use of anxiolytics looking at the problem not only as a biological question, but also as a cultural matter. The research was done over seventeen women, all of them anxiolytic users. It was used, as research instrument, semi-structured interview associated with methodological analysis of user s speeches

Frequencia de enteroparasitoses em usuários do servico público de saúde na mesorregião do oeste potiguar

Em um mundo de grande pobreza, as enteroparasitoses podem exercer um papel importante no que se refere às desigualdades sociais, pois estas mazelas se apresentam, em sua grande maioria, na população mais carente. Estas mesmas doenças causam inúmeros casos de faltas ao trabalho e a escola, gerando preocupação dos profissionais de saúde, já que estes parasitas podem agravar ou desencadear quadros de anemia e desnutrição. O trabalho procurou pesquisar a prevalência de enteroparasitas na Mesorregião do Oeste Potiguar, em uma população que utiliza o sistema público de saúde, buscando associar as variáveis, como: sexo, faixa etária, período sazonal, renda familiar e número de parasitas. Foi utilizada a técnica de Hofmann (sedimentação espontânea) e o material fecal foi analisado pelos funcionários do Laboratório Central de Mossoró e Pau dos Ferros. Foi realizado no período de 02 de março de 2010 a 28 de março de 2011 o exame coprológico em 16.246 pessoas no laboratório Central de Mossoró (Lacen) e Pau dos Ferros, RN. A análise dos exames mostrou que 69,23% dos infectados eram mulheres e 33,07% eram homens. A maior prevalência ocorreu com Endolimax nana (41,61%), seguido de Entamoeba coli (18,46%) e Giardia lamblia (18,59%) em 3.407 parasitas encontrados. Dentre os exames realizados, o Endolimax nana foi o mais prevalente entre os organismos encontrados. A diferença nos resultados entre mulheres e homens pode determinar um foco domiciliar, pelo descaso do poder público com as políticas de saneamento básico e falta de higiene da população, e pela atividade das mesmas com trabalhos domésticos

(In)visibilidade da violência doméstica no atendimento do Sistema Público de Saúde: nos bairros das Quintas e de Felipe Camarão

It analyses the approach given by health professionals (social workers, nurses and doctors) against woman violence at the Medical Unities of Felipe Camarão and Quintas of the City of Natal and searches to identify if the domestic violence is (in)visible at the Public Health Assistance System attendance. and It refers to the grandiosity of this violence and its consequences to the women health, recognizing it as a public health problem. To the comprehension of the relationship between violent acts against women and their health serious damages, exposes the battle history of the feminist movements and the brazilian women, demonstrating the visibility acquired by theses conquests of the questions related to the women and how the gender study becomes the central category to (re) think the social relations involving women and men, specially, the violent relationships between them. It analyses, mainly, those practiced by the husbands, partners, boyfriends or lovers. It refers, at the end, about the public politics of violence combat adopted at police stations at health centers, showing the difficulties to establish the legislation that exists to combat the violence suffered by the women that look for assistance at the health unities. It intends, with this way, to give more visibility to the domestic questions at the marital relations and ask attention from the public power and health professionals between them, the social worker to the (in) visibility of this problems at the attendances practiced

Os rumos do fundo público no capitalismo contemporâneo: uma análise sobre o financiamento da Política de saúde no estado do Rio Grande do Norte

This work analizes the financing of Health Policies on the state of Rio Grande Do Norte, starting at the presumption that SUS is “Bombarded” by fiscal ajustments, as a neoliberal strategy to face capital crises.The trafectory of the financing of SUS demands the comprehension of two principles which are, in essence, contradictory: the “principle of universatility”, which is caracterized by the uncompromising defence of the fundaments of the Sanitary Reform, and the “principle of containment of social costs”, articulating the macroeconomic policy that has being developed in Brazil since the 1990s and which substantiantes itself on the 2000s.This last defends the reduction of the social costs, the maintanance of primary surplus and the privatization of public social services. Considering these determinations, the objective of this research constitues in bringing a critical reflection sorrounding the financing of the Health Policies on the state of Rio Grande do Norte, on the period from 2004 to 2012.Starting from a bibliografic and documentary research, it sought out to analyze the budget planning forseen on the Budget Guideline Law (LDO) and on the Multiannual Plans (PPA), investigating the reports of the Court of Auditors of the State of RN and gathering information about expenses with health, available on the System of Information About Public Budgeting in Health (SIOPS).The Analises of the data obtained, in light of the theoretic referece chosen, reveals trends in the public budget setting for health on the State of Rio Grande do Norte, which are: a tiny share of investment expenditure on health, when compared to other expenses, the amount used in daily fees and advertising; the high expense in personnel expenses, especially for hiring medical cooperatives;the strong dependence of the state on revenue transferences from the Union; the aplication of resources in actions of other nature considered as health, in exemple of the expenditures undertaken by the budgeting unit Supplying Center S/A (CEASA) on the function of health and subfunction of prophylactic and therapeutic and on the Popular Pharmacy program. Since 2006, expenses refering to Regime Security Servers (RPPA) on the area of health also have being considered as public actions and services in health for constitutional limit ends, beyond the inconsistencies on the PPAs with the actions performed efectively.

Conselho Municipal de Saúde de Pedras de Fogo - PB: um estudo sobre participação

The present study aims to understand the process of Participation of the Health Council- CMS in the formularization, implementation and control of the Municipal health plan of Pedras de Fogo, through four criteria of quality of participation considered by Demo (1993): representation, legitimacy, base participation, and self-responsibility. The criteria of representation is related to the quality of politics of the representative over the representings. Legitimacy is related to the politics` quality of the process of participation based on norms and rules that stipulate the participation, the base participation is a necessary political support so that the power authorization directed to the representings can be effective and the self-responsibility refers to the capacity of being responsible when it concerns to the public service or property. Through the descriptive and exploratory study a qualitative method was adopted to consider the conditions of the participation of the twelve council members of the City council of Health of Pedras de Fogo, through a formulated Instrument based on the criteria of DEMO (1993). It was concluded that the quality of the participation of the council members of the CMS of Pedras de Fogo understands essential aspects of the criteria of quality considered by Demo (1993) but it shows fragilities as unfamiliarity with the norms that legitimize the performance of the council; unfamiliarity of its condition of being an agent and the importance of the participation of the base for the reinforcement of its participation, as well as inertia related to the check and rendering of accounts on its performance. This way it makes sense that the participation of the council in the four criteria of quality of politics considered in this paper needs to improve

A ouvidoria pública como instrumento de controle das ações da Secretaria de Saúde do Pará

The State and Public Administration have gone through several reforms in search of a quick operation and the provision of services with quality. With the democratization of the country and the issue of the Constitution in 1988, further reform of the State and Public Administration, joined the government agenda in 1995 and included among its objectives, the principles of participation and social control. In view of this, it raises the Public Ombudsman in order to be a channel for the participation of users in the management of public affairs, social control, transparency of administrative actions, improving the quality of service and meeting the needs of the community. The aim of this study is to assess whether the Ombudsman of the State Department of Public Health to contribute to the period 2006-2008, for the improvement of specialized consulting services. The research is characterized as descriptive, qualitative approach. The collection technique used was the interview, conducted with 37 service users and two servants of the Ombudsman. The analysis was developed based on the perception of users and servers in the opinion of the Ombudsman. The most relevant results of the research showed that 41% of users search the Ombudsman because they believed that solve the problem presented. However, even with this level of public acceptance, the Ombudsman reached average index of resolvability of 53% in the period. In his role has not developed mechanisms for quality control of services, which is mentioned by 67% of users. It turned out the same fact in relation to popular participation, which is confirmed by 84% of users. For 24% of users, the problems raised were resolved, and of these, 56% believe that the Ombudsman has contributed to the positive outcome. As a result of the search results, it appears that the Ombudsman's SESPA / PA, is not fulfilling its role to ensuring the democratization of articipation in management, social control and has limited contribution to solving the problems of users and to improve the quality of services

Hospital humano: etnografia da humanização hospitalar na perspectiva de usuários

This ethnographic work studies the experiences of patients admitted in public (PUH) and private (PRH) hospitals in the Brazilian northeastern region. 28 adult patients of different clinics participated in the study. Data were analyzed by the patient path method, consisting in a combination of complemented and articulated techniques free observation, participating observation, ethnographic interview and patient testimonials collected prospectively during the patients admissions, from their arrival and until their discharge. The analysis was carried out according to the Thematic Categories Analysis Technique and the data were interpreted pursuant to medical anthropology, healthcare humanization and healthcare promotion theoretical references. The ethical principles of Resolution 196/96 were followed. The human hospital, as revealed by the patient, highlights the significance of subjectivity. 225 (54.7%) out of 411 mentioned concepts were collected in a public hospital (PUH) and 186 (45.3%) in a private institution (PRH). The results show that the patient at the PUH and PRH ethnoevaluates different aspects of the healthcare professionals´ human and technical competence, the hospital´s functioning structure, the access to and the ethics in the financial management, and develops overcoming strategies for his stay at the hospital. This ethnoevaluation is mediated by different factors, namely: social and economic status, personality, religiosity, ironic speech, somber diagnosis and satisfied needs, prior hospital experiences and the conditions under which the interview was carried out. A pedagogic proposal for the hospital humanization must include structural, managerial and organizational changes of the offered services and use active methodologies aimed to the political resolution of problematic situations at work and the inclusion of affective and subjective factors, and become as well a tool for the collective learning. This study shows the importance for the user´s ethnoevaluation to be incorporated into the hospital management and care as a guideline in the decision making and clinical action, thus promoting practices that shall lead to a decent and humanized care. The multidisciplinary nature of this study allowed a wide understanding of the user´s perspective as a socially critical ethnoevaluator

Avaliação do cuidado na estratégia saúde da família em metrópoles do nordeste brasileiro

Objective: To evaluate the implementation of the Family Health Strategy (FHS) in Brazilian cities of the Northeast, expanding coverage, analyzing the progress, challenges and innovations. Methods: Multicentric Evaluation Research, Studies Baselines in urban centers, using as a case study method. Selected cases of Aracaju, being capital, advanced coverage with extended team, and Fortaleza, capital coverage incipient and minimal staff. In Fortaleza, purposive sample of 11 Units Primary (APS), 03 managers, 53 professionals and 109 users. In Aracaju, 09 units of APS, 02 managers, 36 professionals, and 90 users. Structured interviews for managers, and structured to professionals and users. Descriptive analysis focusing on the political and institutional dimensions, organization and comprehensive care. Results: There was consensus that the ESF is the preferred port users and acts as inducing changes in care. In the case of Fortaleza, the specificities were: care protocols and community activities aimed at chronic conditions (100%) , with greater participation of doctors and nurses (93%) ; conjunction with more complex services, but the teams reported difficulties with the examination center and experts, the long waits and poor access to local services were the main difficulties reported by users., As innovative practice, the therapeutic group of elderly caregivers mentioned by respondents; There was intersectoral initiatives and teams 87 % of users have participated in meetings about health problems. In the case of Aracaju, care protocols were directed to the lines of care and formulated locally, 85 % coverage of the population with FHS counterpart local financing; employees hired by public tender; 70 % of teams with expertise in public health center for continuing education acting; democratization in management; access technologies, welcoming and computerization in different integrated networks, and evaluation matrix. Conclusions: The ESF has promoted access to health care and inclusion of disadvantaged populations. Different perceptions and practices in the organization of care, with distinct trajectories of reorganization. In the case of Fortaleza, predominance of model programs valuing older, with evidence of advances in care practices and teamwork, but restricted to primary care practices and incipient in public policy perspective. In Aracaju, had network integration with technologies related to the family, in which the ESF is consolidated as public policy. It can be argued that the XII APS expanding coverage, exhibited efficacy, despite the challenges inherent to the different degrees of implementation

Política de atenção à saúde do idoso em Mossoró/RN: potencialidades e possibilidades para promoção do envelhecimento saudável no estado do Rio Grande do Norte

It discusses the Health Care of the Elderly in the town of Mossoró, traversing the paths that discussed the history of health care, which has been altered by the new (con) formation and required adjustments of society which led the development and implementation of the National Health Care for the Elderly with the backdrop of the guiding principles of the Health System - SUS. The goals outlined were: To map the implementation of the policy of health care for the elderly in Mossoró considering whether this is based on the principles and guidelines of the NHS and National Health Policy of the Elderly; Check if health promotion is seen as a strategy that favors the elderly mossoroenses the possibility of healthy aging; identify the discourse of the elderly about the aging process and the strategies you use to take care of your needs. Applies as a methodological strategy BOAS, complemented by interviews with twenty (20) elderly residents of Mossoró with a view to understand the objective elements, and the political and subjective traits that express a regularity which marks the area of health care mossoroense elderly. The data were tabulated and the BOAS divided into nine sections for analysis. The speeches were transcribed seized and subjected to a thorough reading that allowed the visualization of issues that have been examined with theoretical and methodological support to the model proposed by Boaventura de Souza Santos (2006) designated this cosmopolitan reason being supported by three meta-sociological procedures, namely, the sociology of absences, the sociology of translation work and emergencies. It appears as a result the exclusion and discrimination of the elderly in different social settings, a condition that prevents them from being aware of their importance as citizens deserving of decent treatment and respect for the family, society and the government, when addressing health the elderly said the need to propose alternative models of care that has the paradigm of health promotion. We conclude that in these areas, meetings are held, to draw lines that were heterogeneous because they were built by the dissimilarities that engender incessantly and show that although we have advanced regarding the attention of the elderly in Mossoró there is still a long way to go in order to meet the needs revealed by the elderly. It is suggested that the practice of trial-creation-differentiation, while highlighting the historical and procedural dimension, deconstructions and negotiations with collective effects. A democratic paradigm and analytical creeps: the constitution are moments of Health Care for the Elderly shaping a new landscape in the town of Mossoró.

O direito à saúde: a medida do dever do estado de fornecer Medicamentos de dispensação excepcional à sociedade sob a ótica do desenvolvimento

It is a fact that the fundamental rights of citizens are being recognized and guaranteed by the state over time, regardless of the belief that if these rights has always been part of the heritage of subjective individuals, or whether they will be aggregated during the course of human history. In that, emerged the rights of freedom of men and, subsequently, the rights to create a situation of equality between the humans, the so-called social rights. In turn, as these rights known as social, to be implemented, need a positive action by the state, more precisely by the state power whose function is to manage public money and create policies for implementation of fundamental rights. Given this, pay attention to the right to health, was created the Programa de Medicamentos de Dispensação Excepcional, which aims to provide high-cost medicines to citizens Brazilian carriers of serious diseases, such as Alzheimer's and Mal Hepatitis C. Also on the program, it provides a way which will be mandatory that the drugs will be offered in such situations, and does not include a means of updating the list predicted able to monitor the progress of medicine that have been in the interest of the program. Given that, at present it is necessary to mention the recognition of another fundamental right: the right to development, which is the right of access to positive actions being implemented by the State, which are nothing more than public policy, gender which the Programa de Medicamentos de Dispensação Excepcional is kind. Thus, through the search in legislation and doctrine in relation to the theme, this work has the aim to examine the extent of the state to provide exceptional dispensing of medicines. Specifically, if the State in attention to the right to development and the implementation of the right to health, can really list exhaustively the drugs to be provided by the State, and what are the elements guiding this choice and how to control the same

Tributação, finanças públicas e política fiscal: uma análise sob a óptica do direito e economia

In the Brazilian legal scenario, the study of taxation has traditionally been restricted to positivist analysis, concerned with investigating the formal aspects of the tax legal rule. Despite its relevance to the formation of the national doctrine of tax, such formalist tradition limits the discipline, separating it from reality and the socioeconomic context in which the Tax Law is inserted. Thus, the proposal of the dissertation is to examine the fundamentals and nature of taxation and tax legal rules from the perspective of Law and Economics (Economic Analysis of Law). For this purpose, the work initially reconnects the Tax Law and Science of Finance (or Public Finance) and Fiscal Policy, undertaking not only a legal analysis, but also economic and financial analysis of the theme. The Economics of Public Sector (or Modern Public Finance) will contribute to the research through topics such as market failures and economic theory of taxation, which are essential to an economic approach to Tax Law. The core of the work lies in the application of Law and Economics instruments in the study of taxation, analyzing the effects of tax rules on the economic system. Accordingly, the dissertation examines the fundamental assumptions that make up the Economic Analysis of Law (as the concept of economic efficiency and its relation to equity), relating them to the tax phenomenon. Due to the nature of the Brazilian legal system, any worth investigation or approach, including Law and Economics, could not pass off the Constitution. Thus, the constitutional rules will serve as a limit and a prerequisite for the application of Law and Economics on taxation, particularly the rules related to property rights, freedom, equality and legal certainty. The relationship between taxation and market failures receives prominent role, particularly due to its importance to the Law and Economics, as well as to the role that taxation plays in the correction of these failures. In addition to performing a review of taxation under the approach of Economic Analysis of Law, the research also investigates the reality of Brazilian tax system, applying the concepts developed in relevant cases and issues to the national scene, such as the relationship between taxation and development, the compliance costs of taxation, the tax evasion and the tax enforcement procedure. Given the above, it is intended to lay the groundwork for a general theory of Economic Analysis of Tax Law, contextualizing it with the Brazilian tax system

A mediação como instrumento concretizador do direito fundamental à saúde: uma alternativa à judicialização de conflitos Natal 2013

In Brazil, the 1946 Constitution enshrined the right to health, having it defined as the possession of the best state of health that the individual can achieve. Already the Federal Constitution of 1988 lifted that right to the status of fundamental social right, which transcends the effectiveness and cure of the disease is based on the joint liability of public entities for the provision of a quality service, efficient and prioritize human dignity and comprehensive evaluation of patients. According to the World Health Organization, the definition of health, first characterized as the mere absence of disease, has become recognized as the need to search for preventive mechanisms to ensure the welfare and dignity of the population. Garantista this context, the growing seem lawsuits that deal with the implementation of public policies, especially in the area of the right to health, the omission of which the Government can result in the risk of death. Hence the concern of law professionals about whether or not the intervention of the judiciary in cases that deal with providing material benefits of health care. It claims to break the principle of separation of powers, disobedience to the principle of equality and the impossibility of judicial intervention in the formulation of public policy to try and exclude the liability of public entities. In contrast, the judiciary has repeatedly guardianships granted injunctions or merit determining the supply of materials indicated by the medical benefits that accompany the treatment of patients who resort to a remedy. In this context, mediation, object of study and resolution presented in this work, is presented as an instrument conciliator between the reserve clause and the right to financially possible existential minimum, as it seeks to serve all through rationalization of health services , avoidance of negativistic influence of the pharmaceutical industry, with prioritizing the welfare of the individual and the quality of relationships. This is alternative way to judicialization that in addition to encouraging and developing active citizen participation in public policy formulation also allows the manager to public knowledge of community needs. It is in this sense that affirms and defends the right to health is no longer the mere provision of medical care and prescription drugs, but a dialogue conscious existential minimum to guarantee a dignified life