Análise de qualidade da atenção à criança na estratégia saúde da família: o óbito infantil evitável como referência

Alma-Ata declaration bring the Primary Attention to the Health (PAH) as first level of health attention for individuals, family and community, which considers infant group as priority. Several initiatives that gave bases to integral attention to the children health formalized in the principles of Unique Health System. Family Health Strategy (FHS) comes to strengthen this attention, instituting new ways of work organization and professional practices that gave impact in their quality indicators. One of them is children mortality, showing decline in their values. Though, studies indicates persistence of avoidable infant deaths. In Natal RN, this reality is also perceptible leading to inquietudes, mainly at the space of services production, it means, which motivated the accomplishment of the present study intending to analyse the way that the organizational and structural processes as long as the professional practices in FHS interfered in the quality of children s health attention who died by avoidable death in the year of 2007 in municipal district of Natal-RN. It treats, therefore, to an exploratory and descriptive survey of cases study type, thar had as primary sources the oficial documents of MH, the family prontuary, pregnant card, child card and testimony obt ined from instrument of research elaborated based in investigation form of infant death by MH, applied to 10 mothers of children who had avoidable death. In analysis it was appealed silmultaneous triangulation of methods and sources, allowing a bigger aproximation from obtained informations. To elucidate the cases, the aspects studied were analyzed to the light of explicative model of Social Determinants of Health. Among individual and family aspects were highlighted the related to age, schooling, family habits and customs and mother s economic condition, besides of pregnancy age, newborn weight and associated diseases, which don t differ from literature about the theme. Reffering to the factors organizational and structural processes and professionals practice, highlihgted, the treatment given by the professionals, the territorialization and adscription of areas, the difficulty of having access to the services or sleepers and the reference and counterreference. But also, the ausence or few greet, the lack of communication, few assiduity and ponctuality by professionals in service, among others. In a general way mothers considers the attendance received in the hospital good and very good , opnions that in the Basic Attention weren t so favorable, in spite of many of predictible actions in this level have been performed in the studied cases. It is observed, therefore, that the social determinants of health has a strong influence in ocurrence of infant deaths, what implicates in a large actuation by Infant Mortality Committee from municipal district. This way, it becomes fundamental the reflection and evaluation about the effectiveness and execution by the processes of vigilance to health in FHUs; the rethink about the social determinants of health in a wide and articulate way to the services quality, to permanent education, to management in service, to the given attention and to the way how it is installed the popular participation and social control. To the professionals it is presented the great challenge to review their daily practice, their values, behaviors and commitment, which ones must be guided by logical of sharing, work in team, humanescence and alterity, not only by the accomplishment of a professional duty

Ações dos agentes comunitários de saúde diante do usuário da estratégia saúde da família com estados depressivos no Município de Abaiara-CE-BR

Brazilian health public assistance is going through two Reforms, Sanitary and Psychiatric, and through these the assistance is guaranteed in the three levels: primary, secondary and tertiary. Thus, mental health assistance should be offered since preventive cares until the ones that demand larger technological apparatus. Programs like Health Community Agent's Program (HCAP) and Family Health Strategy (FHS), besides increasing the services coverage, have been making possible the system reorientation in the meaning of integrality, universalization and equity. Thus, united intervention of mental health team and FHS can offer several benefits to the population, providing assistance and follow-up to patients with mental disorder. It was aimed to assess health community agents facing the user of Family Health Strategy in depressive state. This quanti-qualitative study took place in the municipal district of Abaiara-CE. Semi-structured interview was applied with health community agents and Beck Depression Inventory with the users registered in Family Health Strategy. It was verified that among the 64 users interviewed, 12.5% didn't present symptoms of depression, 10.9% presented symptoms of light depression, 14.1% symptoms of moderate depression and 62.5% symptoms of serious depression. For the 22 health community agents interviewed, they all reported the existence of people with symptoms of depression in their personal micro-areas, being difficult to work with them, once the FHS team is not qualified to work with mental health problems. It was verified that the Municipal district doesn't have specialized professionals, making difficult the routing and treatment. Based on these results, it was concluded that in spite of the articulation of mental health with FHS is necessary and benefactor to the population, it still doesn't exist, worsening the situation, mainly in small Municipal districts, once they don't have mental health services. Thus, the population is exposed and without follow-up, which allows the identification of installed diseases and with gravity, like depression, because there are no prevention and control activities. It is recommended, due the extreme need, the elaboration and implantation of a mental health program in these municipal districts, articulated with FHS

Trajetória do hospital dia Dr. Elger nunes: um recorte histórico da psiquiatria e saúde mental no Rio Grande do Norte

In Brazil, the mental health network proposed by the Psychiatric Reform inserts the intermediate and replacement services in the pursuit of alignment or resocialization of patients with mental and behavioral disorder in the community. Was adopted, among other services, the Center for Psychosocial Care, Home Therapy, Sheltered Home, Day Hospital and psychiatric beds in general hospital. In this context, the State of Rio Grande do Norte implanted the Day Hospital Dr. Elger Nunes (HDEN) in Natal / RN in 1996, linked to State Department of Public Health. At HDEN happened a multi and interdisciplinary therapeutic work, besides being the scene of disciplinary practices, and extension projects for graduate courses in Higher Education Institutions in the city. However, with the process of decentralization of local services, the hospital was terminated by an administrative state act in 2006, leaving damage to the activities provided to users, disciplinary practices and extension activities. From this breakdown, the objective was to narrate the trajectory of HDEN through a multidisciplinary team of professionals and teachers who used it as a field of disciplinary practices. It is characterized as a documental and qualitative, backed in the technique of thematic oral history, following the phases: authorization of the interviewee, interview recording, transcription, textualization and transcreation of the material obtained. We used documents, ordinances, general reports of activities, among others, plus interviews to fifteen employees who used this service, being thirteen part of the multidisciplinary team of professionals and two graduation professors of health care area, nursing and medicine. The stories collected were organized according to the technique chosen, respecting its steps. In preparing the body subjected to ALCESTE computer program, priority was given to the vital tone for the formation of categories and classes elected by the program, structured in three thematic areas. In the first axis, called Trajectory of HDEN, were recalled the beginning of its activities, the steps of that time, their activities, and its actors - users, families, professionals, and teaching practices. The second axis has dealt with the process of extinction of HDEN, rescuing the feelings of employees, the main reasons given at the time and immediate postextinction scenario. And the third axis revealed in an articulated form the situation of mental health in Natal / RN, listing to the challenges and prospects for the psychosocial care, starting from the trajectory of HDEN with emphasis on activities. Moreover, the trajectory of HDEN provides recognition of the historical basis outlined in the constitution of the network of substitute services present in the current scenario of psychosocial care in the city of Natal and in RN.

Diagnóstco geoambiental e avaliação de uso e ocupação do campo de dunas da zona especial de interesse turístco II (ZET-II) Natal/RN

The accelerated pressure of use and occupation of Rio Grande do Norte coastline in the last two decades presented the tourism as its main vector, having as a consequence a strong, articulated and growing real estate speculation of this area. In the Natal County there is a Zona Especial de Interesse Turistico II (Special Zone of Tourism Interest II) (ZET-II), consisted of urban beaches with approximately 8.5 km that is an important seashore of the city. The purpose of this research was identification, characterization and assessment of the process of use and occupation of dunes fields emphasizing the role of ZET-II, whereas the specific goals was the analysis of weather, geology and geomorphology, characterization of use and occupation of soil, and elaboration of an environmental diagnosis with identification and description of its mains consequences. The result of this work was the delineation of geologic-geomorphological map of the area with identification of principals units, determining its use and occupation, the measurement of the area already occupied by equipments, besides the description of the environmental impacts on dune fields: devastation, coastline erosion, ocean pollution by sewer and pluvial waters, contamination of groundwater, distribution inadequate of solid residues, landscape degradation, and occupation of seashore through the privatization of public areas. Concluding that the degrading changes occurred in this areas are resulting from the nature of use and urban seashore regulations, which have been diminishing the natural aspect, altering the landscape definitely, compromising the quality of hydro resources and altering its use, privatizing the areas between tides, complicating the population access and obstructing the scenery visualization of dunes and ocean. There is an urgent necessity of improvement of public politics in order to improve the strategies and organization of use and occupation of space urban-coastline

Uma análise dos questionamentos dos alunos nas aulas de números complexos

This work presents a contribution for the studies reffering to the use of the History of Mathematics focusing on the improvement of the Teaching and Learning Process. It considers that the History of Matematics, as a way of giving meaning to the discipline and improve the quality of the Teaching and Learning Process. This research focuses on the questions of the students, classified in three categories of whys: the chronological, the logical and the pedagogical ones. Therefore, it is investigated the teaching of the Complex Numbers, from the questions of the students of the Centro Federal de Educação Tecnológica do Rio Grande do Norte (Educational Institution of Professional and Technology Education from Rio Grande do Norte). The work has the following goals: To classify and to analyse the questions of the students about the Complex Numbers in the classes of second grade of the High School, and to collate with the pointed categories used by Jones; To disccus what are the possible guidings that teachers of Mathematics can give to these questions; To present the resources needed to give support to the teacher in all things involving the History of Mathematics. Finally, to present a bibliographic research, trying to reveal supporting material to the teacher, with contents that articulate the Teaching of Mathematics with the History of Mathematics. It was found that the questionings of the pupils reffers more to the pedagogical whys, and the didatic books little contemplate other aspects of the history and little say about the sprouting and the evolution of methods of calculations used by us as well

Despertando responsabilidade social no ensino médio por meio de temáticas associadas à física nuclear

Many discussions about the role of the school are on the agenda, in an increasingly complex society. Sociologists, educators, anthropologists, researchers of different areas seek that role. The objective of this dissertation is to contribute what we can consider the central role for the physics teaching, citizenship training. We have elaborated a didactic proposal to increase the interest of high school students on issues of social relevance and, throughout it, to promote the formation of attitudes of social responsibility, enhancing the formation of a more politically and socially active citizen. For the preparation of the proposal, studies were made on education for citizenship and on attitudes change, using as its main theoretical foundation the researches on the Science, Technology and Society curricular emphasis. The teaching of Nuclear Physics was integrated to our proposal, due to its pedagogical potential for the discussion of social, political and economic subjects related to scientific concepts and associated technologies. The educational proposal we have produced was applied on a high school class of a private school at Natal-RN. It was composed from the controversial issue involving the installation of nuclear power plants in Brazilian northeast. The methodology of role playing, in which students assumed social roles and produced specific subsidies for a public hearing and a later referendum, both simulated. In the analysis of the implementation of the proposal, we highlighted the difficulties but also the possibilities and the relevance of exercising skills such as reasoning, finding information, and arguing about of social problems. The results of the research showed the possibility of meaningful learning on Nuclear Physics contents, through this social, political, economic, scientific and technological contextualization using a controversial and real issue together with mechanisms that trigger for greater popular participation, as public hearing. It has also been identified changes in attitude by some students about issues related to Nuclear Physics. We hope, through this dissertation, to contribute to the formation of future citizens as well as to the initiative of teachers-researchers with pedagogical aims similar to those in the present work

Fontes primárias da história do vácuo e da pressão atmosférica na sala de aula: cartas e jornais históricos em articulação com o livro-texto do ensino médio

The use of the History and the Philosophy of Science (HPS) for the teaching of science and scientific subjects has been advocated in recent decades. It has been pointed out that the History of Science could make for a deeper learning of scientific concepts, since it would promote a contact with the problems which that knowledge has set out to solve. Furthermore, historical episodes would serve to put the discussions about the nature of scientific knowledge into context. With a view to explore those potentialities, the literature in the field has sought to identify the challenges and obstacles for the didactic transposition of subjects from the History of Science. Amongst many aspects, the deficiencies in the training of teachers, so that they can work with the insertion of HPS in the classroom have been highlighted. Another aspect that has been mentioned to be a challenge has to do with the didactic transposition of the Primary Sources, that is, of the original texts on the History of Science. The Primary Sources have significant potentialities: making a connection possible between scientists and concepts, showing the difficulties faced during scientific endeavors, perceiving the role of mistakes as obstacles to be surpassed, not as defeat, etc. On the other hand, there has been little exploration of these concepts in an educational context, due to their own peculiarities. The original texts are often hard to understand and their interpretation demands knowledge of the historical and scientific context in which they were written, as well as skills pertaining to the conduction of research in the field of the History of Science. With this scenario in mind, the research towards this Professional MSc degree starts from the challenge of elaborating and discussing proposals which could enable the didactical transposition of the Primary Sources. We have worked specifically with Primary Sources on the History of the Vacuum and of the Atmospheric Pressure, because of the insertion of these subjects in the Brazilian High School curriculum, in connection with the didactical textbooks. "Historic Journals" were made up from clippings of the original historical texts, as was a Didactical Unit, which takes the usual textbooks as a basis and contemplates using the Journals and the entire Primary Sources in High School. At last, we have elaborated and implemented a course designed for the preparation of teachers and for being an opportunity for the discussion of the feasibility of putting these kinds of proposal into practice

Luís Natal ou Câmara Cascudo: o autor da cidade e o espaço como autoria

The objective of this work is to problematize a strong identification of Luís da Câmara Cascudo (1898-1986), a norte-riograndense author, to the city of Natal, analyzing the constitution of a spaciality that takes this author as this city s intellectual exponent and cultural monument, which I name as Natal cascudiana. In this sense, I investigate the process of Câmara Cascudo s monumentalization by the city of Natal, questioning the way his life has been articulated to the site of his production. Bearing this in mind, I have structured the work in three parts: on the first one, I examine the emerging of this identity relationship considering the intellectual formation of young Cascudinho and the beginnings of his literary activities, verifying the reasons that led him to remain in Natal; on the second part I investigate his appointment as Natal s historian in 1948, discussing the ways through which this intellectual function institutionalized the works of Cascudo and conferred the city with a historical knowledge of itself; and finally, I analyze the constitution of a city memory regarding Cascudo, that has transformed him into spatial marks and urban toponym: names of streets, museum, library, bookstores etc. On these terms, I deal with the biographic gender to achieve a history of the city s spaces, problematizing the monumentalization of Cascudo in Natal, interrogating the emerging of this Natal cascudiana

Maus ares e malária: entre os pântanos de Natal e o feroz mosquito africano (1892-1932)

The development of epidemiological practices in the last years of the nineteenth and early twentieth century was characterized by both an influence of medical geography and the emergence of microbes and vectors of diseases. Both theories were used to explain outbreaks in Rio Grande do Norte specially in Natal. In this process were organized new institutions linked to public health, unhealthy spaces and prescribed hygiene measures. The redefinitions of the spaces were linked to updated elements of Hippocratic medicine such as aerism and emphasis on medical topography. How the physicians of the town were organized in the face of new meanings and fields of expertise in the demarcation of diseases and regulation of their own practices against the illegal medical practitioners? Likewise, the very occurrence of epidemics mobilized people, urban institutions and apparatuses. But how the Hippocratic legacy that leads to the idea of bad air originated by swamps from the eighteenth and nineteenth century has been linked to new microbial assumptions and disease vectors in the early twentieth century? How an invader from Africa, (the mosquito A. gambiae) mobilized transnational efforts to combat malaria and redefined the epidemiological practices? The aim of this work is to understand how epidemiological practices redefine the way we define spaces, practices and disease from both an approach influenced by a relational history of spaces and a theoretical synergy which includes topics in Science Studies, Post Structuralist Geography and some elements of Feminist Studies. Documentary research were surveyed in the reports of the provincial presidents, government posts to the Provincial Assembly, specialized medical articles and theses, and documents from the Rockefeller Foundation and national and international journals. In this regard shall be given to both material and discursive aspects of space-related practical epidemiological that Natal as much (in general) Rio Grande do Norte between bad air and malaria.

Projetos políticos pedagógicos dos cursos de Odontologia do RN : formação profissional e a perspectiva da atenção à terceira idade

Brazil has been undergoing major demographic change.According to IBGE, the next 20 years the country's elderly population may reach over 30 million people. This tariff provides specifics regarding the process of health / disease. It is essential that higher education institutions are committed to this demand in view of the integrated training of health needs of society. The aim of this study is to analyze the Pedagogical Political Projects (PPP) of courses in dentistry in Rio Grande do Norte (RN), according to the national curriculum guidelines (DCNS) and training from the perspective of health care for the elderly. This is an exploratory study with a qualitative approach: with records and interviews. The study subjects were an Assistant Professor in the development of PPPs for each institution. The scenario in this study were dental training institutions in the newborns. Initially, the analysis of the PPP was by using the Alceste 4.9 software. The interpretation of the contents of interviews with teachers was done through content analysis of Bardin (2010). The PPPs are based on the DCNS, meet the characteristics of regional and seek a generalist, but still strongly directed to technical and scientific aspects of professional practice. Efforts and institutional approaches, involving teachers and students of the courses are being mobilized for training with more articulated network of health services. However, the emphasis on content pertaining to the health care of the elderly, is still limited when compared to those targeted content inherent in children and adolescents in all three curricular structures. It is reasonable to conclude that the historical, political, scientific, cultural and social, present in society, influence the formation of the dental professional RN. The greater participation of society in the process of vocational training in dentistry is needed. This can be done from the involvement of universities with health councils, bodies representing the dental profession and other segments of civil society in order to induce changes that generate ideas and educational practices integrative and interdisciplinary, with emphasis on continuing education for teachers, servants, employees and students. Containing conduct this process inherent flexibility of curriculum, teaching-service integration and coordination abilities and professional skills that are essential to understanding the human being and its complexities

No pulsar da clínica: a repetição e as produções corporais de uma criança

This study investigates the Repetition of movements shown in a stereotypical case of a child three years old. In line with the psychoanalysis model of search, this work presents fragments of the clinic process, the locus for the observation of repetitive, ritualized and choreographically movements of this child who used not to speak. The contrast between their movements and the issuance of a word verbalized at the end of the treatment caused the following question: repetition in this child production would be a reproduction of the same or would be directing for the difference? In the psychiatric speech, the stereotypes are listed as diagnostic criteria for certain mental disorders. In the psychoanalysis studies a question about the psych nature of ritualistic gestures apparently without purpose or direction is included. Thus, the route followed was the reading of the theoretical concept of repetition in the psychoanalytic works of S. Freud and J. Lacan. With Freud, the repetition is linked to the transfer and resistance. In that context, when it appears in act, in the place of the talk, it constitutes a particular way of remembering. But the existence of a force in the psychic apparatus that acts independent and involuntarily of the Principle of pleasure (the repetition compulsion) subsidizes the discovery of Freudian pulsion of death that is the tendency to return to itself. In the Lacan reading, the function of Repetition is magnified, as it fulfils two functions: the automaton - reminders of repetitive signs, and that the service of tiqué - the meeting of the subject with his lack constituent. In this sense, repetition is not simply a reproduction, but the search for new, the difference, caused by the lack of continuity that pushes the circuit. Finally, the clinic process and the theoretical readings made the comprehension of the child repetitive and choreographically movements and the pronouncement of a "good-bye", full of meaning. This repetitive scenario which is full of questions, by this very nature, insists in remains inconclusive

Atenção precoce do câncer de mama :um olhar sobre o cotidiano institucional de uma unidade de saúde de Natal

Breast cancer has been considered a grave global public health problem due to its increase in incidence, in women s mortality and in the amount of financial resources spent on the therapeutic interventions used in the treatment of this neoplasia. However, this scenario presents some variations. In developing countries, the incidence of breast cancer is increasing but, on the other hand, the mortality is declining among patients because of public health actions toward early diagnostic that also result in cure of patients and decreasing levels of physical and psychosocial stress. In Brazil, we face of both the increasing number of breast cancer incidence and number of mortalities. Almost always the reason for that is a delayed detection that will provide a late diagnostic. The early detection of breast cancer has been studied in several researches. Some of them are concerned with women s experiences. Despite that, there is a lack of researches on dynamic comprehension of early attention to breast cancer from the health professionals points of view. The present research was carried out at the Unidade Mista de Felipe Camarão (UMFC) and it was conducted with 11 professionals who work in the Family Health Program (PSF). The aim was to understand how early diagnostic and attention to breast cancer is being planned, discussed and accomplished by health professionals in their day-to-day actions. Semi-structure interviews were held individually with each professional, in a way that they could feel free to express their ideas about several issues. All the information from these interviews was analyzed and discussed using an Institutional Ethnographic approach. It was observed that the actions of health professionals working with early detection of breast cancer does not take place in a vacuum; they occur within institutional, relational and social ways. This interdependence influences their actions and points of view on the theme

Lei Maria da Penha em Natal / RN: limites e possibilidades no combate à violência de gênero contra a mulher

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

As Mulheres e as Muralhas do Patriarcado e do Capitalismo: Terceirização e Precarização do Trabalho no Sistema do Capital

Our dissertation deals with the material living conditions of women workers and the relations of the wage who undergo in the hospital scope, taking as the locus of empirical research the Hospital Dr. João Machado, located in Natal / RN. Its purpose is to analyze the main implications of precarious work contracts in the economic and social dimensions from life of workers, explaining the main conditionings. The majority presence of women in wage relations not only in the hospital service, as well as in the service sector in general has motivated us to appreciation of the form of participation of women in health services and, in particular, at the hospital space. From the critical dialectical method, through processes of successive approximations to the reality, we analyze the patriarchal system of social relations and their repercussions for the Social and Sexual Division of Labor in the context of contemporary capitalist society, explaining the determinants of inequality, founded in social relations of sex, to the predominance of women in the hospital service and unveiling these participation trends in the labor market. The analyzes are based on bibliographic research - theoretical and methodological basis of research - combined with reflections that emerged from the field. The systematized and analyzed information reveal the uniqueness of the current social and economic situation of workers women with ties outsourced, paradoxically expresses on the expansion of the insertion in universe of labor, in overexploitation, in the precariousness of work and living conditions and persistent inequality in and in the social relations and in relations between the sexes

A política de assistência estudantil no contexto de expansão do ensino superior: as particularidades do Programa de Pós-Graduação em Serviço Social da UFRN

A dissertação versa sobre a Política de Assistência Estudantil e o processo de luta pela democratização do acesso à universidade, no contexto de expansão do ensino superior em tempos de crise estrutural do capital. Apresenta como unidade de análise as particularidades da pós-graduação em Serviço Social da UFRN e tem como objetivo principal apreender e analisar as condições de permanência disponibilizadas pela UFRN aos discentes de pós-graduação no contexto de expansão do Ensino Superior. O percurso teórico-metodológico de análise adotado na pesquisa se fundamentou numa perspectiva crítica do objeto de estudo a partir de uma concepção de totalidade, que pressupõe apreender as determinações socioeconômicas e políticas que incidem sobre a política de ensino superior e as condições de vida dos discentes do Programa de Pós-Graduação em Serviço Social (PPGSS). As análises fundamentaram-se em pesquisa bibliográfica como base teórico-metodológica da investigação, articulada com as reflexões que resultaram dos dados empíricos da pesquisa de campo na perspectiva de apreensão do objeto, em sua densidade histórica e num quadro de múltiplas determinações. Do ponto de vista metodológico foram entrevistados 26 discentes e realizada análise documental referentes a leis e documentos da política educacional em nível federal e dos organismos internacionais. A luta por ampliação do acesso à universidade está na agenda dos movimentos sociais no âmbito da educação, no entanto na conjuntura dos governos de Luis Inácio Lula da Silva (2003 a 2010) e Dilma Rousseff (2011 a 2012) a tendência tem sido seguir as orientações dos organismos internacionais e promover expansão de vagas sem assegurar estratégias de permanência compatíveis com as exigências de excelência acadêmica postas, por exemplo, na pós-graduação. Discentes entrevistados acessam o ensino superior e os cursos de pós-graduação e vivenciam dificuldades diárias para atender com qualidade às exigências acadêmicas em face de suas condições materiais de vida e de trabalho e dos limites da política de assistência estudantil que tem um perfil de programas e ações localizadas