Reflexões sobre a política de descentralização em saúde: uma análise a partir do Hospital Monsenhor Walfredo Gurgel em Natal (RN)

The process of decentralization of health policy in Brazil has evolved throughout the second half of the twentieth century, advancing by leaps and bounds in the last two decades. The various public institutions have assumed the function of responding to a growing demand for medical care and hospital. Monsenhor Hospital Walfredo Gurgel - H.M.W.G. fits into this context as an institution par excellence-oriented service the demand for medium and high complexity. This paper presents some questions about the process of decentralization and devolution occurred in Brazil. To do so is a brief historical background and politics, showing the concepts of reform and counter-reform and how the processes mentioned in the Country Correlates develop local social development of the decentralization process and discusses the modifications in policies social intervention in recent decades and the state health policies. Presents the implementation of a Health System in Brazil and the state showing how the decentralization of health policy occurs in Rio Grande do Norte. Finally, it explores the role of H.M.W.G. in health policy in RN. For this, portrays the institution and is located within the decentralized structure of health policy in the state and capital. An analysis of the demand for hospital care and the budget situation is realized at the close of work, correlating the role of HMWG with the decentralization of health policy in Brazil and Rio Grande do Norte. The methodology used for the preparation of this work was based on documentary research, systematic nonparticipant observation, field diary and analysis of data, documents and content. This set shows a quantitative and qualitative methodology that strips the institution, enabling the understanding of their role, boundaries, threats and opportunities

Avaliação do impacto do treinamento de clínica em hanseníase e sua contribuição para o aumento da detecção da doença no Estado do Rio Grande do Norte

Hansen´s disease is considered a serious public health problem. In 2006, the Ministry of Health reported that worldwide, Brazil ranked 2nd in the number of cases of the disease, surpassed only by India. The North region is the geographical area in Brazil that presents the most cases. In the state of Rio Grande do Norte, the disease is considered to be eliminated because its prevalence has been identified as 1 per 10.000 inhabitants, criteria established by the State Elimination Letter of 2005. Training programs have been offered by the Coordination for the Control of Hansen´s Disease Program of Rio Grande do Norte, PCH-RN since 1997, with the support of the English governmental agency Leprosy Relief Association, LRA, with no evaluation having been conducted. The objective of this study was to evaluate the training programs in clinical diagnosis of Hansen´s disease and their contribution to the detection of the disease in the state of Rio Grande do Norte. The study was conducted in seven municipalities that are known as Regional Public Health Units (URSAPs): São José de Mipibu URSAP I, Mossoró URSAP II, João Câmara URSAP III, Caicó URSAP IV, Santa Cruz URSAP V, Pau dos Ferros URSAP VI and Natal, capital city of the State, in the Metropolitan Region. Physicians and nurses of the Family Health Program PSF were interviewed as to their perceptions of the implementation of the training program in clinica diagnosis of Hansen´s Disease conducted by the PCH-RN. They evaluated their own practice and the training program. These professionals presented a positive evaluation of the program and gave suggestions for future courses. The results of this study suggest the need for permanent education. Data of the disease obtained from the official records of the Secretariat of Health and from the interviews indicate that health education is the means to control Hansen´s disease effectively

Contribuição ao estudo da isonomia na tributação sob a perspectiva da ordem econômica

The study aims to investigate the limits of state intervention via induction on Economic Order, especially in cases regarding tax equality, through the analysis of their effects on economic development and on free competition from the perspective of economic efficiency and the Constitution. Thus, the work seeks to demonstrate that the achievement of equality in taxation is important in that it strengthens the economic relations in terms of efficiency, protects competition and fosters economic development to reduce regional and social inequalities and other constitutional desiderata. A dissertation is characterized by interdisciplinarity and was divided into two parts. The first is to discuss the legal meaning of equality from the doctrinal analysis of the principle and the relationship between equality and justice in the economic sense without rejecting its philosophical content. It is noteworthy that hermeneutics and the philosophy of language are useful tools for achieving equality in presenting the pragmatic methodologies applicable to the subject in terms of corrective justice. Based on these general assumptions, is going to study the tax equality and their characteristics, the corollary of the ability to pay and its relation to the economic capacity and the issue of progressivity in taxation as an ideal of distributive justice. The second part concerns the legal foundations of Economic Order and its relation to extrafiscality as a means of economic regulation in order to investigate the efficiency of this induction in order to promote economic development, free competition and tax equality itself to reduce inequalities and distributing wealth. Within this context, we investigated the scope of the constitutional principles of economic order, free enterprise and free competition, and favored differential treatment for small and medium enterprises, the issue of regional development for the reduction of regional and social inequalities, the problem the "fiscal war" and finally the efficiency from the perspective of Economic Analysis of Law

Aprendendo e ensinando o sistema de numeração decimal: uma contribuição à prática pedagógica do professor

The central question of the present study is to identify the epistemological knowledge that the teachers-trainees possess regarding the characteristics (properties) of the decimal numbering system; its purpose is to offer a contribution to the pedagogic practice of the teachers who work within the Basic Literacy Cycle, in terms of what concerns both the acquisition of contents and the development of the knowledge that helps them in the elaboration of adequate strategies to working with the Decimal Numbering System in the classroom. The study is based on the constructivist sociointeractionist approach to teaching Mathematics and it constitutes, in itself, a methodological intervention with the teachers-trainees engaged in the Professional Qualification Program in Basic Education of the Federal University of Rio Grande do Norte. The foundations of the study were found in investigations of researchers who had carried out studies on the construction of numerical writing, showing, for instance, that the construction process of ideas and procedures involved in groupings and changes to base 10 take a lot longer to be accomplished than one can imagine. A set of activities was then elaborated which could not only contribute to the acquisition of contents but that could also make the teachers-trainees reflect upon their teaching practices in the classroom so that in this way they will be able to elaborate more consistent didactic approaches, taking into consideration the previous knowledge of the students and also some obstacles that often appear along the way. Even when teachers have access to the most appropriate dicactic resources, the lack of knowledge of the content and of the real meaning of that content make the Decimal Numbering System, a subject of fundamental importance, be taught most times in a mechanical way. The analisys of the discussions and behaviours of the teachers-trainees during the activities reavealed that they made them reflect upon their current practices in the classroom and that, as a whole, the aims of each of the activities carried out with the teachers-trainers were reached

Diagnóstico do usuário no aprimoramento dos serviços de tecnologia da informação: um projeto de intervenção para o Ministério Público do Estado do Rio Grande do Norte

The information tecnology (IT) has, over the years, gaining prominence as a strategic element and competitive edge in organizations, public or private. In the judiciary, with the implementation of actions related to Judiciário Eletrônico, information technology (IT), definitely earns its status as a strategic element and significantly raises the level of dependence of the organs of their services and products. Increasingly, the quality of services provided by IT has direct impact on the quality of services provided by the agency as a whole. The Ministério Público do Estado do Rio Grande do Norte (MPRN) deployments shares of Electronic Government, along with an administrative reform, beyond these issues raised, caused a large increase in institutional demand for products and services provided by the Diretoria de Tecnologia da Informação (DTI), a sector responsible for the provision of IT services. Taking as starting point strategic goal set by MPRN to reach a 85% level of user satisfaction in four years, we seek to propose a method that assists in meeting the goal, respecting the capacity constraints of the IT sector. To achieve the proposed objective, we conducted a work in two distinct and complementary stages. In the first step we conducted a case study in MPRN, in which, through an internal and external diagnosis of DTI, accomplished by an action of internal consulting and one research of the user satisfaction, we seek to identify opportunities of change seeking to raise the quality perceived of the services provided by the DTI , from the viewpoint of their customers. The situational report, drawn from the data collected, fostered changes in DTI, which were then evaluated with the managers. In the second stage, with the results obtained in the initial process, empirical observation, evaluation of side projects of quality improvement in the sector, and validation with the managers, of the initial model, we developed an improved process, gazing beyond the identification of gaps in service a strategy for the selection of best management practices and deployment of these, in a incremental and adaptive way, allowing the application of the process in organs with little staff allocated to the provision of information technology services

Ausência do pai ao longo do desenvolvimento ontogenético e indicadores de desconto de futuro: uma contribuição da psicologia evolucionista

The new Evolutionary Psychology (E. P.) paradigm has been trying to understand how the human beings make their decisions over time regarding the most diverse variables, always bearing in mind that such a cognitive process is due to a complex natural selection process that occurred millions of years ago. One of the main topics discussed by this new paradigm is the issue of parental investment, i.e., the care the parents provide to an offspring at the expense of the investment into a new one. The present work sought to integrate these two topics, trying to understand how some variables modulate the process of decision making in a sample of the city of Natal, Rio Grande do Norte state. It was investigated the hypothesis that the presence of both parents, along the individual development, could signal a more favorable environment, providing clues to the individual that he could assume a competitive position at the socio-biological market. His decisions, therefore, could be guided by long-term investments with aims to obtain more robust rewards. On the contrary, those who has suffered for some moment the absence of one the parents could develop theirselves in a not so competitive way, starting to choose immediate benefits - but lesser ones -, since the future would be less predictable due to their worse development conditions. This study involved 152 individuals from three higher education institutions, one of them being public and the others being private ones. In the results found, there was no difference between children of coupled parents and children of deceased or divorced parents concerning discount rates. The levels of hopelessness did not affect the discount rates of children of single parents when compared to children of coupled parents. Not having one of the parents because of divorce made the child to tend to present lower scores in the domain of social relations of WHOQOL - Bref, whilst the absence of the father by death made the scores lower in the domain of environment. The results indicate that loosing one of the parents along the development influences the individual's quality of life perception, but the measurement method of future discounting rates by means of financial choices is not sensitive to this variation

A utilização da informação contábil na atividade pecuária do Estado do Rio Grande do Norte: um enfoque nos demonstrativos gerados para tomada de decisão

This work deals with the cattle raising activity in Brasil, it´s importance for the stete of Rio Grande do Norte. A conceptual review is done regarding accounting information and considering it as an essencial input for economical and finantial decision making, related to the state cattle rainsing environment. It also aims to expose visions related to the role and the importance of Accounting as system that colects, treats and supplies managerial information. A brief historic of Accounting is done, emphasizing the Accounting Demonstration Structure and its use in the decision making process, as well as the contribution it has node for the cattle raising activity in Brazil. The research´s results show that accounting information is used partially in the finantial decision making process, and it is pointed out that the Inventory was the most relevant tool with 95,% of the cases, followed by the Income and Outlay reports with 85.0%,Production with 82,0% and Cost reports with 80,0%, the Demonstrative of the Cash Flow (DFC) with 82.5%, the Patrimonial Balance (PB) with 22.5%, and the Demonstrative of the Exercise Result (DER) with 20.0% of use. The research concludes that Accounting information is not throughly used in the economic and finantial decision making of the managers of cattle raising in the Rio Grande do Norte State, although, 95% of the sample consider then important. This may imply that there are diffilculties in measurement of the managerial decisions as well as the business whole

A contribuição da asstênia técnica no desenvolvimento desenvolvimento de projetos de assentamento no estado do Rio Grande do Norte

The public policies must have as their aimed the primordial at improving quality of life of families of a given population, however, its performance must be constantly monitored and evaluated scoped to ascertain whether these policies are reaching those goals. This work consisted in search of bibliographies and analysis that addressed the historical evolution of the debate on the subject of agrarian reform in Brazil as public policy and on the policy of technical assistance and rural extension, and collecting data in loco, in order to assess whether the actions implemented under this latter contribute to improvements in local development of settlements projects (PA) land reform in the state of Rio Grande do Norte (RN), this given the constant presented criticisms regarding their effectiveness, considering that it is difficult to empirically differentiate settlements they received of those who did not receive the technical assistance services. In this way, was held the data collection for comparison of characteristics (social organization, relationship with the local environment, form of producing and evaluation of technical assistance services) of two settlements in RN, being one you have received the technical assistance services and another who has not had access to these services in the past five years, at least, to confirm whether those who had access to the above services presents best features of social organization and the relationship with the local environment, mainly, which was confirmed in the results obtained, which still demonstrated that no significant differences on the forma to produce and of commercialization in PA studied. It was also found that the problems faced by families settled in PA studied resemble those seen verified in many other Brazilian states, especially as to how to use natural resources in the areas of land reform and the instability of the availability of technical assistance services. Should be guaranteed at continuity and universality of technical assistance services to settlements, seeking a higher focus on productive issues, which provide the income necessary for families settled can have a better quality of life

O processo de acumulação na economia política clássica: uma interpretação não convencional a partir da leitura dos ricos detalhes comumente inexplorados

LOURENÇO, André Luís Cabral de ; Macedo, Luziene Dantas de ; SILVA,Marconi Gomes da ; BEZERRA, Márcia Maria de Oliveira ; PEREIRA, W. E. N. . O processo de acumulação na economia política clássica: uma interpretação não-convencional a partir da leitura dos ricos detalhes comumente inexplorados. In: Encontro Nacional de Economia Política, 14., 2009, São Paulo. Anais... São Paulo, 2009.

A contribuição de técnicas modernas de reabilitação estrutural para autenticidade e integridade de edificações patrimoniais

This work discusses the study of the application of structural reinforcement and rehabilitation using modern techniques for interventions in repair works of historical buildings as well as the verification of the behavior of works that have already undergone different structural intervention techniques, with the objective of obtaining data to allow a comparative analysis of the advantages/disadvantages of techniques adapted in each case, regarding the interferences related the authenticity and integrity of the buildings belong to the constructed patrimony so as to obtain a basis for the theoretical foundation for choosing the best solution to be adopted in the case study which consists in an intervention of structural rehabilitation of the old historic building in the primary school "Augusto Severo"

Análise da contribuição de fatores genéticos e ambientais na manutenção da hanseniase nos estados do Rio Grande do Norte e Pará

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Contribuição da catodoluminescência para o entendimento da diagênese da formação Jandaíra: áreas do campo de petróleo da fazenda Belém e Lajedo do Rosário

The general objective of this study was to contribute to the understanding of the chemical evolution of fluids that percolate through carbonate rocks of the Jandaíra Formation. The oxidation and reduction conditions in which grains, source and cement were formed was investigated using the cathodoluminescence technique (CL). The study area is located in the west part of the Potiguar Basin (Fazenda Belém field) and Rosário Ledge (Felipe Guerra municipality, State of Rio Grande do Norte, Brazil). The analysis of thin sections of carbonate rocks under CL revealed that grains (allochemical or not) and diagenetic products (micritization, dolomitization, neomorphism and cementation) exhibit since absence of luminescence the various luminescence colors (yellow, orange, red, brown, and blue) in a variety of intensities. As pure calcite shows dark blue luminescence, the occurrence of different luminescence colors in calcite crystals suggest one or more punctual crystal defects such as free electron, free space and impurity. The dyeing of thin sections with alizarin and potassium ferrocyanide revealed the absence of ferrous carbonate in the different lithotypes of Jandaíra Formation. Therefore, the different colors and intensities of CL observed in these rocks are probably caused by the presence of ion activators such as Mn2+ and is not an activator/inhibitor combination. In the same way, the absence of luminescence is very probably caused by the absence of activator ions and not due to the low concentration of inhibitor ions such as Fe2+. The incorporation of Mn2+ in the different members of the Jandaíra Formation must have been controlled by the redox state of the depositional environment and diagenesis. Therefore, it is possible that the luminescent members have been formed (e.g.,ooids) or have been modified (gastropod neomorphism) under reduction conditions in the depositional environments, in subsurface during the burial, or, in the case of Rosario Ledge samples , during the post-burial return to surface conditions. As regards the sudden changes from low to moderate and to strong luminescence, these features should indicate the precipitation of a fluid with chemical fluctuations, which formed the frequent zonations in the block cement of the Rosario Ledge samples. This study suggests that the different intensities and colors of CL should be correlated with the Mn2+ and Fe2+ contents, and stable isotopes of samples to determine the salinity, temperature, pH e Eh conditions during deposition

Contribuição da Geodésia ao monitoramento costeiro do Litoral Setentrional do Rio Grande do Norte, área de influência da indústria petrolífera

The general objective of this thesis has been seasonal monitoring (quarterly time scale) of coastal and estuarine areas of a section of the Northern Coast of Rio Grande do Norte, Brazil, environmentally sensitive and with intense sediment erosion in the oil activities to underpin the implementation of projects for containment of erosion and mitigate the impacts of coastal dynamics. In order to achieve the general objective, the work was done systematically in three stages which consisted the specific objectives. The first stage was the implementation of geodetic reference infrastructure for carrying out the geodetic survey of the study area. This process included the implementation of RGLS (Northern Coast of the RN GPS Network), consisting of stations with geodetic coordinates and orthometric heights of precision; positioning of Benchmarks and evaluation of the gravimetric geoid available, for use in GPS altimetry of precision; and development of software for GPS altimetry of precision. The second stage was the development and improvement of methodologies for collection, processing, representation, integration and analysis of CoastLine (CL) and Digital Elevation Models (DEM) obtained by geodetic positioning techniques. As part of this stage have been made since, the choice of equipment and positioning methods to be used, depending on the required precision and structure implanted, and the definition of the LC indicator and of the geodesic references best suited, to coastal monitoring of precision. The third step was the seasonal geodesic monitoring of the study area. It was defined the execution times of the geodetic surveys by analyzing the pattern of sediment dynamics of the study area; the performing of surveys in order to calculate and locate areas and volumes of erosion and accretion (sandy and volumetric sedimentary balance) occurred on CL and on the beaches and islands surfaces throughout the year, and study of correlations between the measured variations (in area and volume) between each survey and the action of the coastal dynamic agents. The results allowed an integrated study of spatial and temporal interrelationships of the causes and consequences of intensive coastal processes operating in the area, especially to the measurement of variability of erosion, transport, balance and supply sedimentary over the annual cycle of construction and destruction of beaches. In the analysis of the results, it was possible to identify the causes and consequences of severe coastal erosion occurred on beaches exposed, to analyze the recovery of beaches and the accretion occurring in tidal inlets and estuaries. From the optics of seasonal variations in the CL, human interventions to erosion contention have been proposed with the aim of restoring the previous situation of the beaches in the process of erosion.

Análise do estado da arte dos aspectos diagnóticos, periciais e jurisprudenciais das LER/DORT no contexto previdenciário das doenças do trabalho no Brasil

Objetivo: analisar o estado da arte dos aspectos diagnósticos, periciais e jurisprudenciais das LER/DORT (Lesões por Esforços Repetitivos / Distúrbios Osteomusculares Relacionados ao Trabalho) no Brasil. Materiais e Método: trata-se de pesquisa descritiva, de natureza qualitativa, com formato documental, utilizando-se a técnica de análise de conteúdo. A avaliação evolutiva da legislação previdenciária relacionada as LER/DORT foi realizada através da pesquisa no banco de dados disponibilizado pelo Governo Federal e mediante a consulta ao DATAPREV/Sislex. A avaliação dos aspectos diagnósticos foi instrumentalizada através, principalmente, de artigos científicos publicados entre 2003 e 2008, nas línguas portuguesa, inglesa, espanhola e francesa, relacionados com os métodos de diagnósticos complementares das LER-DORT (ressonância magnética, tomografia computadorizada, ultrassonografia e eletroneuromiografia). As jurisprudências foram obtidas através da busca dos julgados sobre o tema, entre 2003 e 2008, pertencentes ao Supremo Tribunal Federal, Superior Tribunal de Justiça, Tribunais Regionais Federais, Tribunal Superior do Trabalho e Tribunais Regionais do Trabalho. Resultados: foram identificados 48 artigos abordando os aspectos diagnósticos das LER-DORT, observando-se que os exames por ressonância magnética, ultrassonografia e eletromiografia demonstraram ser mais efetivos, dentro das suas especificidades, para a complementação do exame clínico de patologias relacionadas às LER-DORT. A análise das 123 jurisprudências selecionadas demonstrou, de forma geral, que as LER-DORT equiparam-se ao acidente de trabalho, devendo apresentar nexo de causalidade (atestado através de laudo médico-pericial) e, ainda, ensejam a ação por danos morais, a qual, devido à EC nº 45 passou a ser competência da Justiça do Trabalho. O Estado da arte dos aspectos periciais encontra-se representado pela vigência da Instrução Normativa n. 98/2003, a qual traz como aspecto fundamental a determinação de novos parâmetros a serem considerados na definição de um quadro de LER-DORT, dispondo, ainda, sobre a conduta ética que deve ser adotada pelo médico perito, bem como chama a atenção para a necessidade dessas doenças do trabalho serem comunicadas às autoridadades competentes, através da emissão da Comunicação de Acidente de Trabalho (CAT). Conclusão: as LER-DORT representam, hoje, um problema de importante impacto, não apenas previdenciário, mas também econômico em diversos países, nos quais o Brasil encontra-se inserido. Estudos sobre o estado da arte relacionados às LER-DORT são fundamentais para auxiliar na construção de um modelo crítico e consciente que colabore com a garantia de sustentabilidade do sistema previdenciário no Brasil

Intervenção dietoterápica em portadores de lipodistrofia generalizada congênita do Rio Grande do Norte

Congenital generalized lipodystrophy is a rare genetic disease with autosomal recessive inheritance characterized by the generalized absence of subcutaneous adipose tissue and insulin resistance. The aim of our study was to determine the profile of patients with congenital generalized lipodystrophy (Berardinelli-Seip syndrome) through their clinical history, eating habits, and socioeconomic and cultural aspects; assess food consumption and nutritional status of the study group; propose and evaluate a diet therapy model associated to oral supplementation with zinc to help in the control and prevention of metabolic complications associated to the pathology. Initial assessment of food consumption indicated a voracious appetite in all the patients studied. The introduction of zinc reduced appetite, contributing to patient adherence to the food plan proposed. It was also observed that the proposed diet contributed mainly to glycidic control, specifically with respect to HbA1c. The nutritional status of the patients investigated was adequate in terms of body mass index (BMI), arm muscle circumference (AMC), arm muscle area AMA, but triceps skinfold (TSF) indicated serious malnutrition. Our study is unique in the literature and provides important information to the field of nutrition and to individuals with this pathology. Furthermore, it contemplates the interdisciplinary and multidisciplinary requirements of the Postgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte (UFRN), Natal, Brazil