Reinternações psiquiátricas no Rio Grande do Norte: implicações e impacto das novas estratégias de atenção à saúde mental

The Brazilian Psychiatric Reform based on the desinstitucionalization of the assistance, translated to the emphasis on community/territorial treatment and in the social inclusion of the mental suffering, promoted advances in the psychiatric restructuring. In the Rio Grande do Norte (RN), we can enumerate as advances of the Brazilian Psychiatric Reform the expansion of the mental health care chain and the implementation of some strategies that, together, aims to further the psychosocial attention of the individual with psych suffering and to reduce the indices of psychiatrics readmissions in the state. In the current Brazilian‟s mental health situation we were interesting in answered the following question: what the impact of the substitutes services‟ extension in the revolving door phenomenon? This search aims to analyze the revolving door phenomenon occurrences based on the news strategies of mental health care in the Rio Grande do Norte. This is a descriptive-exploratory study with a qualitative approach, oriented by the theoretical framework of critical-dialectical approach about the Brazilian Psychiatric Reform and using the thematic oral history as method of information collects. The search was realized on the Hospital João Machado (HJM), estate reference in psychiatric treatment, and the participants was 20 professionals that work on it. The collection of information had started after the approval of the UFRN Research Ethics Committee with the opinion number 216/2011 and CAAE number 0021.0.051.000-11 and was realized using the direct observation and semi-structured interview. The study‟s results were categorized in two categories and five subcategories of analysis. CATEGORY 1) Current situation of the mental health care chain in the RN, with the subcategories: 1.1 Impact of the new services of mental health care in the revolving door phenomenon in the RN; 1.2 Implications of the new services of mental health care in assisting user to the HJM; 1.3 Issues the permeate the mental health care chain in the RN. CATEORY 2) Main causes of the revolving door phenomenon in HJM, with the categories: 2.1 Family problems; 2.2 Lack of assistance after discharge from psychiatric hospital. In summary, we conclude that the extension of the mental health care chain contributed for the reduction of the psychiatrics re-hospitalization‟s indices in RN. However, we realized that territorial services of mental health care are not the only responsible for the revolving door phenomenon. Factors as family problems and the disarticulation of the assistance after the discharge from hospital influence on the perpetuation of hospitalizations and re-hospitalizations in the local scenario. To study the revolving door phenomenon that occur in the psychiatrics‟ assistance considering the news strategies of mental health care allowed us to approach the advances and challenges brought by the RPb and by the desinstitucionatization in the state, indicating the need for further discussions and problem-solving strategies of psychosocial care.

Estratégias de intervenção utilizadas por enfermeiros da ESF do município de Natal/RN no controle do câncer do colo de útero

Cancer of the cervix (cervical cancer) is the second most prevalent cancer among Brazilian women. The high rates of cervical cancer in Brazil justify the implementation of effective strategies to control this, which include actions to promote health, primary prevention, early detection, screening, treatment and palliative care. Despite the existence of the National Programme for Control of the CCU there was no reduction in the incidence and mortality of this disease in Brazil. The Family Health Strategy (FHS) has the potential to facilitate such control and, in this context, one should consider that nurses play a central role. The study aimed to know the general intervention strategies used by nurses FHS of Natal / RN in CCU control, and how specific: analyzing the knowledge of these nurses on the CCU, the actions developed in the ESF for the control of CCU and identify the difficulties faced by them to perform it. This is a descriptive exploratory quantitative developed through a structured interview guide with 106 nurses who have experience in controlling the CCU in FHS teams of Natal / RN. Data analysis was performed using descriptive statistic s. The results pointed to actions taken in the FHS to control the CCU, collection of cervical cancer screening, health education activities, nursing consultation, referral of suspected cases for medical monitoring and active women with abnormal test result . The actions that were not mentioned by the nurses included: forming groups of prevention and health promotion; expand coverage of exams and office hours of consultations, establishment of alternatives to end the pent-up demand in the health units, participation in treatment or rehabilitation process users with the CCU; interventions for pain management, alliances and partnerships with schools, in dustry and the use of protocols. This study can be seen that the practice nurses partially shares to the CCU in Natal / RN. The participants of this study, when asked about the CCU, specifically for signs and symptoms of disease and risk factors in general showed important gaps. Difficulties such as lack of materials for collection of Pap smear; inadequate physical space in the Health Units; pent-up demand in the service, delay in arrival of the test results; obstacles in the actions of referral and counter-referral and cultural factors make the CCU control is compromised. It is believed in this research contributed to a reflection on the importance of the role of nurses in the development of the ESF control actions CCU, pointing out the factors that affect these. It is important to involve all nurses who comprise the ESF as knowledgeable of the risk factors, signs and symptoms, and existing tools for the early detection of cervical cancer in the pursuit of quality improvement actions to promote women`s health, contributing in planning future interventions that may reduce mortality from this disease in Natal / RN.

Análise da integração dos stakeholders na adoção de estratégias de marketing verde: um estudo em empresa moveleira

This master's thesis aims to ascertain how the Stakeholders interactions influence the adoption of green marketing strategies from the perspective of the Alpha Company, a furniture industry located in Rio Grande do Norte, Brazil. The methodology has a qualitative approach and uses the exploratorydescriptive case study method as model of formal and systematic study. Following the theoretical and conceptual propositions of Polonsky (1995), Michell, Angle and Wood (1997) and Frooman (1999) as a reference base. This study identifies and assesses the importance degree of the relevant stakeholders, shows their expectations and needs and describes the tactics used by the company for the implementation of green marketing strategies. The study describes the reality of a furniture industry in Rio Grande do Norte, and shows his philosophy and background; identifies present stakeholders that influence the decision process of the company and also, analyzes the degree of importance of each group showing their needs and expectations and, finally, it states the changes in the organization with the implementation of green marketing strategies. The results it s concluded that stakeholders are taken into consideration in the adoption of green marketing strategies, even without a proper strategic perception from the company, an imperative to advance towards the adoption of the green marketing philosophy. This case study explores knowledge that may be used and suited to small companies that act in the strategic segment-trend of green marketing

Estratégias de aplicações sequenciais e paralelas da metaheurística otimização por enxame de partículas ao problema do caixeiro viajante

Particle Swarm Optimization is a metaheuristic that arose in order to simulate the behavior of a number of birds in flight, with its random movement locally, but globally determined. This technique has been widely used to address non-liner continuous problems and yet little explored in discrete problems. This paper presents the operation of this metaheuristic, and propose strategies for implementation of optimization discret problems as form of execution parallel as sequential. The computational experiments were performed to instances of the TSP, selected in the library TSPLIB contenct to 3038 nodes, showing the improvement of performance of parallel methods for their sequential versions, in executation time and results

Uma avaliação comparativa de estratégias de arranjos físicos para estaleiros de construção de embarcações metálicas de pequeno porte

The present study aims to analyse, in different levels of demand, what is the best layout strategy to adopt for the small metallic shipbuilding. To achieve this purpose, three simulation models are developed for analyze these production strategies under the positional, cellular and linear layouts. By the use of a simulation tool for compare the scenarios, Chwif and Medina (2010) and Law (2009)´s methodologies were adapted that includes three phases: conception, implementation and analysis. In conception real systems were represented by process mapping according to time, material resources and human resources variables required for each step of the production process. All of this information has been transformed in the cost variable. Data were collected from three different production systems, two located in Natal RN with cellular and positional layouts and one located in Belém-PA with linear layout. In the implementation phase, the conceptual models were converted in computacional models through the tool Rockwell Software Arena ® 13.5 and then validated. In the analysis stage the production of 960 ships in a year vessels were simulated for each layout noting that, for a production of until 80 units positional layout is the most recommended, between 81 and 288 units the cellular layout and more than 289 units the linear layout

Fatores determinantes das estratégias de gestão ambiental na indústria millennium inorganic chemicals: cristal global

The general aim of this research was to analyze the factors that determine the environmental management strategies in the industry Millennium Inorganic Chemicals: Crystal Global, but also analyze which environmental management strategies are used by industry. For the achievement of the proposed objective, we conducted a case study organization based in twenty-eight environmental management strategies raised in the literature. Following this survey, it was possible to ascertain which of these strategies are used in the industry studied, as well as which factors are decisive for the implementation of these. The research is characterized as qualitative and applied, as the goals is exploratory and descriptive, with regard to the data, these were obtained through interviews with the directors of the organization and also documents made available by the industry. As a main result, it was realized that the industry practices twenty-eight twenty of environmental management strategies proposed in this study, the scale Waste Management that encompasses more strategies. Regarding the determinants realized that the endogenous factors that are most pressing for the organization creating environmental strategies, and these determinants, since the exogenous, with the exception of environmental legislation, not put pressure on the organization

Estratégias de avaliação de desempenho dos propagandistas de medicamentos utilizados pela indústria farmacêutica no nordeste do Brasil

A Indústria Farmacêutica é uma das mais competitivas indústrias do mundo contemporâneo, e um dos seus principais desafios está na comercialização de seus medicamentos, que na sua maioria depende da prescrição médica. O objetivo deste estudo é identificar as estratégias de avaliação de desempenho utilizadas pela Indústria Farmacêutica de origem multinacional que atua no nordeste Brasileiro e o papel dos seus gerentes, para avaliar os propagandistas vendedores de medicamentos. Para tanto, buscouse reunir elementos para uma abordagem satisfatória que contemple a complexidade da temática pesquisada: Avaliação de Desempenho, Estratégias da Indústria Farmacêutica, Propaganda Médica e Competências dos Propagandistas de Medicamentos. A temática justifica-se em razão da importância estratégica dos propagandistas de medicamentos para a indústria farmacêutica, que é uma das indústrias que mais investe em pesquisa na atualidade, e contribui para melhorar a qualidade de vida e a saúde humana. A metodologia é caracterizada como um survey, de natureza quali-quantitativa. O objeto de estudo é composto pelas empresas farmacêuticas multinacionais de origem Americanas, Europeias e Asiáticas, associadas à INTERFARMA que atuam no Nordeste do Brasil. A coleta de dados foi realizada através de um questionário fechado (instrumento de pesquisa), composto por 5 perguntas fechadas que abordam a temática central dessa dissertação, 27 afirmativas para medir a concordância(escala likert) e 1 tabela contendo 46 competências, aplicado junto a gerentes da indústria farmacêutica. A análise dos dados foi feita por meio das técnicas de estatística descritiva e uma análise quantitativa para estabelecer o Ranking Médio (RM) para a parte do questionário que utilizou escala tipo Likert de 5 pontos para mensurar o grau de concordância dos respondestes. Através dos resultados desta pesquisa foi possível identificar as estratégias de avaliação de desempenho, utilizadas pelas empresas farmacêuticas, que atuam no Nordeste do Brasil, na gestão dos propagandistas vendedores de medicamentos, e identificar as competências essenciais dos propagandistas de medicamentos, na percepção dos gestores. Os resultados demonstraram que a Indústria Farmacêutica desenvolve e utiliza várias estratégias para medir e avaliar o desempenho dos propagandistas de medicamentos no Brasil, assim como em outros países, e que na percepção dos gerentes da Indústria Farmacêutica existem competências consideradas essenciais ao bom desempenho profissional dos propagandistas de medicamentos da indústria farmacêutica, contribuindo de para avanço do conhecimento deste tema

Estratégias acadêmicas na avaliação de desempenho dos cursos de ciências contábeis no enade em NATAL - RN

O número de instituições de ensino superior no Brasil vem crescendo bastante nos últimos anos. Com isso a preocupação com a qualidade dos cursos ofertados também tem aumentado. Para avaliar essa qualidade do ensino o governo instituiu formas de avaliação e vem aperfeiçoando a cada ano. As instituições, por sua vez, buscam bons resultados nessas avaliações a fim de utilizar como item de vantagem competitiva, uma vez que as notas obtidas por elas chamam atenção de novos clientes. Dessa forma, o presente trabalho buscou analisar as principais estratégias acadêmicas utilizadas na avaliação de desempenho dos cursos de Ciências Contábeis, da região de Natal-RN, no ENADE. Trata-se de uma pesquisa de abordagem qualitativa e quantitativa, e foi aplicado um estudo de caso complementado por um survey. A parte qualitativa foi obtida através de entrevistas semiestruturadas realizadas com os coordenadores dos cursos e a quantitativa foi obtida através da aplicação de um questionário fechado aos alunos aptos a participarem do ENADE no ano de 2012. Foram estudadas todas as instituições em Natal que possuem o curso de Ciências Contábeis, modelo presencial, sendo ao todo 10 (dez) instituições identificadas. Os dados foram analisados por meio da análise de conteúdo (entrevistas) e do software SPSS® 18 (survey). Foram utilizados os métodos de análise fatorial, através da análise de componentes principais, com rotação Varimax e normalização Kaiser. Em relação à análise da importância do ENADE sob a perspectiva dos estudantes, foi utilizado o teste não paramétrico de Mann-Whitney. Como resultados da pesquisa, foi identificado que tanto os discentes como os coordenadores de curso entendem a importância do ENADE, também observou-se que a satisfação dos discentes com a instituição refletiu nos resultados obtidos por esta, bem como, o momento em que foi iniciada a preparação para o exame também refletiu nas notas recebidas pelas instituições

Estudo de estratégias de otimização para poços de petróleo com elevação por bombeio de cavidades progressivas

The progressing cavity pump artificial lift system, PCP, is a main lift system used in oil production industry. As this artificial lift application grows the knowledge of it s dynamics behavior, the application of automatic control and the developing of equipment selection design specialist systems are more useful. This work presents tools for dynamic analysis, control technics and a specialist system for selecting lift equipments for this artificial lift technology. The PCP artificial lift system consists of a progressing cavity pump installed downhole in the production tubing edge. The pump consists of two parts, a stator and a rotor, and is set in motion by the rotation of the rotor transmitted through a rod string installed in the tubing. The surface equipment generates and transmits the rotation to the rod string. First, is presented the developing of a complete mathematical dynamic model of PCP system. This model is simplified for use in several conditions, including steady state for sizing PCP equipments, like pump, rod string and drive head. This model is used to implement a computer simulator able to help in system analysis and to operates as a well with a controller and allows testing and developing of control algorithms. The next developing applies control technics to PCP system to optimize pumping velocity to achieve productivity and durability of downhole components. The mathematical model is linearized to apply conventional control technics including observability and controllability of the system and develop design rules for PI controller. Stability conditions are stated for operation point of the system. A fuzzy rule-based control system are developed from a PI controller using a inference machine based on Mandami operators. The fuzzy logic is applied to develop a specialist system that selects PCP equipments too. The developed technics to simulate and the linearized model was used in an actual well where a control system is installed. This control system consists of a pump intake pressure sensor, an industrial controller and a variable speed drive. The PI control was applied and fuzzy controller was applied to optimize simulated and actual well operation and the results was compared. The simulated and actual open loop response was compared to validate simulation. A case study was accomplished to validate equipment selection specialist system

Estudo do efeito de dipolos em arranjos de antenas adaptativas de sistemas de comunicação DS-CDMA

This master dissertation introduces a study about some aspects that determine the aplication of adaptative arrays in DS-CDMA cellular systems. Some basics concepts and your evolution in the time about celular systems was detailed here, meanly the CDMA tecnique, specialy about spread-codes and funtionaly principies. Since this, the mobile radio enviroment, with your own caracteristcs, and the basics concepts about adaptive arrays, as powerfull spacial filter was aborded. Some adaptative algorithms was introduced too, these are integrants of the signals processing, and are answerable for weights update that influency directly in the radiation pattern of array. This study is based in a numerical analysis of adaptative array system behaviors related to the used antenna and array geometry types. All the simulations was done by Mathematica 4.0 software. The results for weights convergency, square mean error, gain, array pattern and supression capacity based the analisis made here, using RLS (supervisioned) and LSDRMTA (blind) algorithms

Análise de desempenho de estratégias de retransmissão para o mecanismo HCCA do padrão de redes sem fio IEEE 802.11e

This paper presents the performanee analysis of traffie retransmission algorithms pro¬posed to the HCCA medium aeeess meehanism of IEEE 802.11 e standard applied to industrial environmen1. Due to the nature of this kind of environment, whieh has eleetro¬magnetic interferenee, and the wireless medium of IEEE 802.11 standard, suseeptible to such interferenee, plus the lack of retransmission meehanisms, refers to an impraetieable situation to ensure quality of service for real-time traffic, to whieh the IEEE 802.11 e stan¬dard is proposed and this environment requires. Thus, to solve this problem, this paper proposes a new approach that involves the ereation and evaluation of retransmission al-gorithms in order to ensure a levei of robustness, reliability and quality of serviee to the wireless communication in such environments. Thus, according to this approaeh, if there is a transmission error, the traffie scheduler is able to manage retransmissions to reeo¬ver data 10s1. The evaluation of the proposed approaeh is performed through simulations, where the retransmission algorithms are applied to different seenarios, whieh are abstrae¬tions of an industrial environment, and the results are obtained by using an own-developed network simulator and compared with eaeh other to assess whieh of the algorithms has better performanee in a pre-defined applieation

Estudo do efeito de dipolos em arranjos de antenas adaptativas de sistemas de comunicação DS-CDMA

This master dissertation introduces a study about some aspects that determine the aplication of adaptative arrays in DS-CDMA cellular systems. Some basics concepts and your evolution in the time about celular systems was detailed here, meanly the CDMA tecnique, specialy about spread-codes and funtionaly principies. Since this, the mobile radio enviroment, with your own caracteristcs, and the basics concepts about adaptive arrays, as powerfull spacial filter was aborded. Some adaptative algorithms was introduced too, these are integrants of the signals processing, and are answerable for weights update that influency directly in the radiation pattern of array. This study is based in a numerical analysis of adaptative array system behaviors related to the used antenna and array geometry types. All the simulations was done by Mathematica 4.0 software. The results for weights convergency, square mean error, gain, array pattern and supression capacity based the analisis made here, using RLS (supervisioned) and LSDRMTA (blind) algorithms.

Estratégias baseadas em aprendizado para coordenação de uma frota de robôs em tarefas cooperativas

In multi-robot systems, both control architecture and work strategy represent a challenge for researchers. It is important to have a robust architecture that can be easily adapted to requirement changes. It is also important that work strategy allows robots to complete tasks efficiently, considering that robots interact directly in environments with humans. In this context, this work explores two approaches for robot soccer team coordination for cooperative tasks development. Both approaches are based on a combination of imitation learning and reinforcement learning. Thus, in the first approach was developed a control architecture, a fuzzy inference engine for recognizing situations in robot soccer games, a software for narration of robot soccer games based on the inference engine and the implementation of learning by imitation from observation and analysis of others robotic teams. Moreover, state abstraction was efficiently implemented in reinforcement learning applied to the robot soccer standard problem. Finally, reinforcement learning was implemented in a form where actions are explored only in some states (for example, states where an specialist robot system used them) differently to the traditional form, where actions have to be tested in all states. In the second approach reinforcement learning was implemented with function approximation, for which an algorithm called RBF-Sarsa($lambda$) was created. In both approaches batch reinforcement learning algorithms were implemented and imitation learning was used as a seed for reinforcement learning. Moreover, learning from robotic teams controlled by humans was explored. The proposal in this work had revealed efficient in the robot soccer standard problem and, when implemented in other robotics systems, they will allow that these robotics systems can efficiently and effectively develop assigned tasks. These approaches will give high adaptation capabilities to requirements and environment changes.

Estratégias de obtenção do corante do jambo vermelho (Syzygium malaccense) e avaliação de sua funcionalidade

The food industry is interested in natural products. Anthocyanins are phenolic antioxidants of great importance with health-relevant applications. Several studies have linked the intake of fruits and vegetables with reduced risk of chronic degenerative diseases because of its antioxidant properties. This study aimed to compare different strategies for obtaining natural pigments from red jambo (Syzygium malaccence) and analyze its functional potential. Two different strategies were studied: (1) solid-liquid extraction (SLE) in reactor with controlled parameters, (2) powder obtention. The investigation of the functional potential was conducted taking into account the total phenolic content (TPC), the antioxidant activity (AA), the total anthocyanins concentration (TA) and α-amylase and α-glucosidase inhibition. The best extracts obtained by SLE showed TPC of 174.15 mg GAE/100g, AA of 3.56 μmol Trolox eq/g and TA of 133.59 mg cyd-3-glu/100 g. The best results for the second strategy were TPC of 1024.22 mg GAE/100 g, AA of 29.03 μmol Trolox eq/g and TA of 1193.41 mg cyd-3- glu/100 g. It was observed moderate amylase inhibition (26.30%) and high glucosidase inhibitory activity (97.47%). Skin extracts showed, in general, superior results when compared to whole red jambo, with superior values for dehydrated products. Based on our result, red jambo can be considered as a rich source of phenolic antioxidants, as well on amylase and glucosidase inhibitors

Estudo da funcionalidade de espécies comestíveis do semiárido nordestino e estratégias para sua utilização como ingredientes para fins alimentícios

The Brazilian caatinga is characterized by low annual rainfall and arid soils. Several cactaceae, either native or adapted species, grow in this semi-arid region, including the prickly pear (Opuntia fícus indica) and facheiro ((Philosocereus pachycladus Ritter) which produce underexploited edible fruits. In addition to these species, the algaroba is a leguminous with little studied technological applications and bioactive potential so far. Therefore, this research aims to investigate the physicochemical, bioactive and functional attributes of the prickly pear and facheiro fruit pulps and the algaroba flour. Specifically, this study approaches the physicochemical characterization, total phenolic compounds (TPC) and the betalain identification and quantification by HPLC-DAD-ESI-MS. It is also investigated the DPPH antioxidant capacity and the antienzymatic activities against alpha-amylase and alphaglucosidase of water and ethanolic extracts of these food material. In order to address their potential to be used as food ingredients, juice blends prepared with mixtures of cajá and prickly pear, biofilms with facheiro and cereal bars with algaroba flour were elaborated and analyzed. The prickly pear fruits presented low acidity and high sugar content when compared to facheiro. The Philosocereus pachycladus Ritter fruits had higher protein and ash content, but the algaroba flour was the species with higher protein and sugar content among all. The algaroba flour also presented outstanding food fiber content, which reveals its potentiality to be used as a natural intestinal regulator. The TPC of water and ethanol extracts ranged from 3.87 to 16.21 mg GAE/100g for algaroba flour, 79.24 to 110.20 GAE/ 100g for prickly pear and 412.23 to 539.14 mg GAE/100g for facheiro. The 70% (w/v) ethanol extract reached the highest DPPH antioxidant activity, which was linearly correlated to its high TPC content. In regard to the enzymatic inhibitory activities, the best performance was observed for the prickly pear extracts which presented a moderate inhibition for both investigated enzymes, but interestingly, no alpha-glucosidase inhibition was observed for facheiro extracts. This work shows, for the first time in the literature, the functional attributes of facheiro fruits, as well as the presence of betacianins and isobetanin in the pulp of this exotic fruit. When it comes to the food products developed here, the sensory attributes that better described the juice blend cajá-prickly pear were sweetness, acidity, color yellow-orange, body, turbidity and cajá flavor. The discriminative test applied for cereal bars produced with and without algaroba revealed that the texture was the only sensory attribute that differed (p<0.05) between these two samples. It was also observed that the addition of facheiro extracts did not influence the visual characteristics of the biofilms. Overall, this work unveils the physicochemical and bioactive attributes of these commercial and technologically underexploited species widely found in the Brazilian caatinga and presents alternatives for their rational use