Mortalidade materna no estado da Paraíba, 2000 a 2004

Esta tese articulou as áreas do conhecimento da Epidemiologia, Saúde Pública, Demografia e Estatística. Para esta investigação, traçaram-se duas estratégias: por um lado, buscou-se relatar a trajetória dos direitos femininos em saúde no Brasil a partir do período pós-guerra até os dias atuais; por outro lado, objetivou-se analisar diferenciais da morte materna e suas associações com variáveis sociodemográficas das mulheres residentes no estado da Paraíba no período de 2000 a 2004. As explorações decorrentes destes objetivos resultaram na produção de três abordagens. Na primeira, procedeu-se a um olhar retrospectivo sobre as políticas de saúde da mulher no país e seus desdobramentos regionais, enfocando a saúde materna. A análise permitiu reconhecer que, apesar de todas as conquistas adquiridas pelas mulheres desde os anos 80, a população feminina brasileira, em particular a paraibana, ainda carece de melhorias nas condições de saúde, sendo esta situação retratada pelo elevado número de mortes maternas ocorridas nos últimos anos. Também se buscou retratar os esforços dos sistemas oficiais na luta pela melhoria da qualidade dos dados reconhecida, na agenda nacional, como sendo ainda uma grande preocupação atual. Na segunda, o objetivo foi identificar o poder associativo entre a raça das mulheres residentes no estado da Paraíba e algumas variáveis sociodemográficas. Os resultados mostraram que houve indícios significativos de que as mulheres não brancas da Paraíba tiveram maiores chances de morrer que as brancas com baixa escolaridade e por morte obstétrica direta. Na terceira, centrou-se no tipo de óbito materno, cujo objetivo consistiu em analisar associações entre o tipo de óbito materno das mulheres paraibanas e as variáveis: grupo etário, escolaridade e raça, no período de 2000 a 2004. Os testes estatísticos realizados apontaram que a mulher paraibana teve cinco vezes mais chances de morrer por morte obstétrica direta ou indireta na faixa etária abaixo dos 20 anos e acima dos 34 em relação a faixa etária entre 20-34 anos

Avaliação clínica e microbiológica das condições de saúde oral dos receptores de transplante renal do Hospital Universitário Onofre Lopes, Natal RN

Introduction: The chronic immunosuppression promotes the development of changes in the oral cavity of the kidney transplant recipients (KTR), however with the exception of gingival overgrowth, little is known regarding the prevalence of oral lesions in this population. Objective: To evaluate the prevalence of clinical and microbiological conditions of the oral cavity of the recipients of kidney transplantation and the associated factors. Methods: This was a cross-sectional study which examined 96 clinical KTR and experimental where collected saliva stimulated them to identify Candida sp. Data collection consisted of evaluation stomatologic, socio-demographic, clinical aspects of transplantation, condition of oral hygiene and dental caries, yonder to questions about knowledge of oral alteration after transplantation. Results: Of the total, 66.7% of KTR had some type of oral manifestation. The most common was saburral tongue, followed by gingival overgrowth, with both oral manifestations related to gender and concomitant use of cyclosporine and nifedipine (p <0.05). Tacrolimus showed a protective effect for gingival overgrowth (OR = 0.13). The oral hygiene was associated with saburral tongue(p = 0.03) and severity of gingival overgrowth (p = 0.0001). Oral candidiasis was diagnosed in 17.7% of patients and Candida albicans was isolated most frequently in the saliva of RTR with a colonization of 58.3%. The average DMF-T increased with age. The method of oral hygiene was most used brush and toothpaste to 61.5%. Changes in the oral cavity was seen in 54.2% of KTR, citing as the main growth and gingival ulcers. Instructions for oral hygiene after transplantation were neglected for 61.5% of RTR. Dry mouth and halitosis were reported in 30.2% and 36.5% respectively. Conclusions: More the half of the KTR had at least one injury of the mouth, the immunosuppressive drugs and oral hygiene are associated with these alterations. Prospective cohort studies are needed to elucidate the relationship between oral manifestations and levels of drug and risk of oral manifestations occur over time. The kidney transplant recipients showed to be aware of oral alterations occurred after transplantation and uninformed about the oral hygiene instructions. With regard to hygiene, the incidence of caries was considered high, conditions of risk were identified and improvements in primary attention should be encouraged and reflected in the monitoring of renal transplant

Análise do óxido nítrico, perfil lipídico, resistência arterial e capacidade funcional de idosas submetidas a um treinamento aquático

A prática regular de exercício físico possibilita redução dos efeitos das disfunções hormonais e envelhecimento biológico natural que promovem desajustes hemodinâmicos, vasculares e músculo-esqueléticos, principalmente na população feminina no período pós-menopausa. Nesta fase da vida, o exercício aquático representa mais do que uma forma de ajuste funcional, é uma forma de manutenção de independência para as atividades da vida diária (AVD s) e melhoria na qualidade de vida. Este estudo teve como objetivo avaliar as modificações adquiridas pela prática regular de um programa de exercício aquático concorrente de intensidade moderada no nível de óxido nítrico (ON), no índice de resistividade arterial (IR), no perfil lipídico, na capacidade funcional e na qualidade de vida de idosas. A amostra foi formada por idosas (60 a 80 anos) selecionadas por randomização, por sorteio simples divididas em grupo controle e grupo de intervenção as quais foram submetidas a um programa de exercícios aquáticos proposto inicialmente em projeto piloto, por 12 semanas (n=34) e o ensaio clínico teve duração de 16 semanas (n=40). Foi coletada amostra sanguínea das idosas e avaliado o perfil lipídico pelo método enzimático com kit Labtest e o ON por medida indireta a partir da concentração de nitrito no sobrenadante das células em cultura em leitor de ELISA. A avaliação das artérias carótidas e vertebrais foi feita utilizando o método de ultra-som Doopler. A capacidade funcional foi avaliada por quatro testes que simulam atividades da vida diária que são: caminhar 10 metros (C10m), levantar da posição sentada (LPS), levantar da cadeira e locomover-se pela casa (LCLC) e o de levantar-se da posição decúbito ventral (LPDV). No estudo piloto foi avaliado o índice geral de autonomia funcional (IG) e a qualidade de vida através do questionário WHOQOL-100. Empregou-se a análise de variância (ANOVA) com medidas repetidas nos fatores grupo (GH e GC) e tempo (pré e pós-teste) para as comparações intra e intergrupos nas variáveis seguida do post hoc de Scheffé. Utilizou-se o teste de correlação de Pearson e adotado o valor de p<0,05 para a significância estatística. Houve aumento do ON circulante, redução nos índices de resistividade arterial, melhoria significativa nos níveis de colesterol e triglicérides e ganho na capacidade funcional das idosas após a intervenção. Existiu correlação inversa entre a resistividade da artéria vertebral direita (VERTD) e níveis de ON e entre a VERTD e os níveis plasmáticos de HDL, assim como entre estes e o teste C10m nas idosas em estudo. Não houve modificações significativas na qualidade de vida das idosas. Em conclusão, o programa de exercício proposto foi capaz de oferecer melhorias funcionais, aumentar o nível de óxido nítrico circulante, diminuindo a resistência arterial promovendo modificações no perfil lipídico de idosas

Exercícios anaeróbicos, padrão morfofuncional e os marcadores hematológicos em pessoas vivendo com hiv e aids

Estudos que relacionam a atividade física e HIV/AIDS enfatizam a perspectiva biológica, demonstrando a sua relevância, apontam a preocupação em estabelecer um tipo de atividade e intensidade que não comprometa o sistema imunológico, enfatizando as melhorias do exercício sobre os parâmetros antropométricos, na aptidão física bem como um grande aumento da capacidade funcional para o grupo testado. Objetivo: O presente estudo se caracteriza como quase-experimental e objetivou analisar o padrão morfofuncional, marcadores hematológicos em pessoas vivendo com HIV/AIDS, através da oferta intervenção com exercícios anaérobicos (exercícios resistidos em sala de musculação) para pacientes portadores de HIV/AIDS. Métodos: A amostra foi composta por 11 indivíduos do gênero masculino, com média de idade de 43,2 anos, participantes do Programa Pro-Saúde e Atividade Física da Universidade Federal do Rio grande do Norte e atendimento clínico no Hospital Giselda Trigueiro da Secretaria de Estado de Saúde Pública/RN. A coleta de dados foi composta de exames laboratoriais para medir TCD4 e Carga Viral, medidas antropométricas: Índice de Massa Corporal - IMC, Relação Cintura Quadril- RCQ, e uma annamenese sociodemográfica. Para análise dos dados utilizou-se no presente estudo a estatistica descritiva com os valores de tendecia central e seus derivados. Para as variáveis de cunho discreto utilizou-se a análise de frequencia atavés de valores percentuais de aparecimento. Resultados: Os resultados entre os Pré e o Pós teste das variáveis estudadas foram assim apresentadas: para o IMC (pré média de 24,0 Kg/m2 e pós 24,2 Kg/m2), RCQ (pré média de 0,97cm e pós 0,95 cm), Somatório de Dobras cutâneas (Pré 117,1 e Pós 102,0), Somatório da Perimetria(Pré 310,5 e Pós 313,3), Força Escapular(Pré 30,9 Kgf e Pós 30,3 Kgf), Força Pressão Manual Direita(Pre 41,2 e Pós 42,1), Força Pressão Manual esquerda(Pré 39,4 e Pos 39,9), TCD4( Pré 579 e Pós 509 céls/mm3) e Carga Viral(pré e pós <50 cópias). Esses resultados apontam para uma melhora importante das variáveis antropométricas estudadas, principalmente em relação a RCQ, na contagem dos linfócitos TCD4 e manutenção da Carga Viral em níveis abaixo do limite mínimo(<50 cópias/ml) Conclusão:O Programa de Exercícios resistidos com características anaeróbicas promove melhorias no padrão morfofuncional, manutenção das células TCD4 em níveis considerados seguros para esta população e estabilização da carga viral, não apresentando riscos à saúde dos participantes

Exercício físico, saúde e qualidade de vida em pessoas com HIV/AIDS em Natal/Rio Grande do Norte

A sobrevida das pessoas com AIDS tem aumentado com o uso das terapias com antiretrovirais (TARV), esses, entretanto, possuem efeitos colaterais que interferem no padrão morfofuncional e hematológico, o que pode levar a alterações na qualidade de vida (QV). Este estudo quase-experimental objetivou avaliar parâmetros antropométricos, funcionais, hematológicos e de QV em pessoas com HIV/AIDS submetidas a um programa de exercícios de 16 semanas. Os participantes tinham idade entre 35 e 51 anos (n=15), eram registrados no Núcleo de atendimento do Hospital Giselda Trigueiro em Natal/Rio Grande do Norte e apresentaram CD4350cel/mm3, lipodistrofia e estavam em TARV. Foram avaliados o índice de massa corpórea (IMC), a relação cintura-quadril (RCQ), o percentual de gordura (%G), a força escapular e manual, a contagem de CD4, carga viral e QV, antes e após a intervenção. Essa foi realizada com exercícios de aquecimento e utilizou como base os exercícios resistidos, realizados 3x/semana, com 1h e intensidade de 60 a 75% de 1RM. Observaram-se modificações significativas no %G (p=0,031), força escapular (p=0,007) e preensão manual (p=0,039). Houve aumento no CD4 e a carga viral manteve-se indetectável. Nos domínios da QV, houve mudança significativa no do meio ambiente (p=0,021), espiritualidade, religiosidade e crenças pessoais (p=0,032) e na percepção da qualidade de vida e saúde geral (p=0,005). Os resultados sugerem que os exercícios resistidos para essa população constituem agente terapêutico coadjuvante no controle dos efeitos colaterais advindos da TARV, promovendo modificações na composição corporal, aumento da capacidade funcional e dos níveis de CD4, mantendo estável a carga viral e melhorando a QV. Sugerimos novos estudos com maior tempo de intervenção e com o acompanhamento de equipes multidisciplinares, o que poderá promover melhorias mais significativas na qualidade de vida e efetuar maior controle nas variáveis intervenientes

UMA FONTE DE ÁGUA VIVA: A participação das mulheres no assentamento Arizona São Miguel do Gostoso-RN

Cette étude cherche á comprendre la signification sociale de La participation des féminine dans le contexte de l organisation des périmétres de réforme agraire. Elle est construite autour de la mise en évidence des effets de cette participation dans la vie des femmes et dans les relations qu elles établissent avec leurs familles et avec la communauté du périmétre. Les données ont été obtenues á partir d observations participatives, entretiens et discussions. Elles ont permis d identifier les relations de genre et de pouvoir, construites autour du processus d organisation du périmétre de Arizona, dans la préfecture de São Miguel do Gostoso, Rio Grande do Norte, région de l étude. L analyse s est concentrée sur lês dynamiques liées á la lutte pour l accés á la terre, pour identifier différentes formes de participation de femmes et d hommes, en recherche d alternatives pour s installer dans ce contexte. On constate la participation des femmes á diverses formes d activités inhérentes á l organisation du quotidien en milieu rural, principalement pour la recherche d améliorations des conditions de vies, pour elles et leurs familles. Pour cela elles tissent des liens de solidarité et d amitié, occupent les espaces politiques et de décision, dans le périmétre de réforme agraire et de façon plus large, au niveau de la préfecture. Elles pratiquent le travail en groupe, comme forme d organisation et développent des activités productives dans le domaine de l agroécologie. On constate que les femmes ont une place essentielle dans l économie domestique et s affirment comme des acteurs productifs et sociaux. Il faut noter enfin, que cette étude est une invitation au débat, sur le quotidien de l acteur féminin dans les périmétres de réforme agraire, dans la mesure oú le substrat symbolique est avancé comme un support pour expliquer la participation différenciée de la femme dans la lutte pour la terre et dans son quotidien

Nesta terra, em se plantando tudo dá? Política de Soberania e Segurança Alimentar e Nutricional no meio rural paranaense, o caso do PAA

O tema proposto nesta tese vai ao encontro do atual debate em curso no Brasil e no mundo acerca de duas dimensões da cadeia agroalimentar: produção e consumo. Desse modo, as questões de como se dá essa relação frente às estratégias locais por diferentes atores, terá ênfase. Para isso, como campo empírico foram escolhidos três municípios localizados no território Centro-Sul do estado do Paraná: Irati, Inácio Martins e Fernandes Pinheiro que desde 2004 estão inseridos no Programa de Aquisição de Alimentos (PAA), mais especificamente na modalidade Compra com Doação Simultânea (CDS). A hipótese que embasa este estudo é de que o PAA poderá ser capaz de assumir um caráter estruturante - a partir do seu viés pedagógico, capacidade organizativa de produção, manutenção da diversidade ou resgate da policultura (e aqui se privilegia a agroecologia), bem como uma alternativa viável de acesso a um tipo de mercado (mercado institucional) -, não por altruísmo dos atores, mas por ser mais vantajoso ser parte integrante, do que estar à parte do processo, aliando a isso melhorias nas condições alimentares tanto das suas famílias, quanto das entidades receptoras. O objetivo principal foi analisar as relações sociais e as práticas alimentares de um grupo de agricultores(as) agroecológicos entre as responsáveis pelo recebimento dos alimentos doados buscando compreender se o PAA possibilita a Soberania e Segurança Alimentar e Nutricional (SSAN) de grupos sociais (como das famílias rurais) e das pessoas atendidas por estas entidades. A metodologia utilizada foi a de estudo de caso. Como procedimentos foram empregados entrevistas semi-estruturadas e aplicação de questionários como: Escala Brasileira de Insegurança Alimentar(EBIA) e Questionário de Frequência de Consumo Alimentar(QFCA). A amostra foi composta por agricultores(as)/ fornecedores(as) do PAA, nutricionistas e, coordenadora de uma das entidade dos seus produtos é, de fato, o que os mobiliza a continuar produzindo em maior diversidade e quantidade. Após a vivência dos(as) agricultores(as) /fornecedores de estarem inseridos no Programa foi possível para estes atores se sentirem parte do processo e, assim, repensar suas práticas de produção de alimentos, seja ela destinada ao autoconsumo, seja voltada à comercialização. Para além da discussão acerca da produção destinada ao autoconsumo, ficou claro o processo de recampesinização entre as famílias de agricultores(as). O processo de (re)conexão se apresenta de forma frágil, considerando, sobretudo, as considerações feitas pelas mediadoras. Trazer à tona o debate acerca da produção-consumo de alimentos, tanto na perspectiva de quem produz, como na de quem consome, e tomando por referência a operacionalização de políticas públicas, viabiliza a ampliação de debates e a concretização de ações mais contundentes numa perspectiva de minorar a situação de vulnerabilidade (social e alimentar) e de pobreza rural

Estimativas de mortalidade para a região nordeste do Brasil em 2010: uma associação do método demográfico equação geral de balanceamento, com o estimador bayesiano empírico

One of the greatest challenges of demography, nowadays, is to obtain estimates of mortality, in a consistent manner, mainly in small areas. The lack of this information, hinders public health actions and leads to impairment of quality of classification of deaths, generating concern on the part of demographers and epidemiologists in obtaining reliable statistics of mortality in the country. In this context, the objective of this work is to obtain estimates of deaths adjustment factors for correction of adult mortality, by States, meso-regions and age groups in the northeastern region, in 2010. The proposal is based on two lines of observation: a demographic one and a statistical one, considering also two areas of coverage in the States of the Northeast region, the meso-regions, as larger areas and counties, as small areas. The methodological principle is to use the General Equation and Balancing demographic method or General Growth Balance to correct the observed deaths, in larger areas (meso-regions) of the states, since they are less prone to breakage of methodological assumptions. In the sequence, it will be applied the statistical empirical Bayesian estimator method, considering as sum of deaths in the meso-regions, the death value corrected by the demographic method, and as reference of observation of smaller area, the observed deaths in small areas (counties). As results of this combination, a smoothing effect on the degree of coverage of deaths is obtained, due to the association with the empirical Bayesian Estimator, and the possibility of evaluating the degree of coverage of deaths by age groups at counties, meso-regions and states levels, with the advantage of estimete adjustment factors, according to the desired level of aggregation. The results grouped by State, point to a significant improvement of the degree of coverage of deaths, according to the combination of the methods with values above 80%. Alagoas (0.88), Bahia (0.90), Ceará (0.90), Maranhão (0.84), Paraíba (0.88), Pernambuco (0.93), Piauí (0.85), Rio Grande do Norte (0.89) and Sergipe (0.92). Advances in the control of the registry information in the health system, linked to improvements in socioeconomic conditions and urbanization of the counties, in the last decade, provided a better quality of information registry of deaths in small areas

Desenvolvimento energético e energia eólica na ordem jurídica do Brasil: aspectos Institucionais e Socioambientais

A conformação do desenvolvimento propugnado pela Constituição Federal de 1988 como objetivo fundamental da república, certamente perpassa pela racionalização das questões energéticas e pela diversificação da matriz nacional enquanto estratégia de aprovisionamento. O desenvolvimento energético em toda a sua complexidade deve ser alicerçado não em uma relação de contraposição à sustentabilidade, mas cooperativismo normativo e de projetos sociais que objetivam a melhorias para a população nestes dois seguimentos. O advento das energias renováveis nesse contexto se consolida como uma alternativa viável, apesar do tratamento dado pela Lei Maior ao tema ter sido apenas com relação à geração em pequena escala. A interpretação sistemática dos postulados da ordem econômica e as exigências da sociedade estimulam o aproveitamento dos potenciais renováveis em escala comercial e regional, além do fortalecimento nos segmentos de autoprodução e produção independente. Dentre as energias tratadas como prioritárias neste contexto, a eólica revela-se como carecedora de aprofundamento das estruturas dogmáticas de sua positivação, que envolve um vasto manancial de regras pulverizadas na regulação econômica do setor elétrico e no controle ambiental. Esta textura submete os empreendimentos elioelétricos aos instrumentos da política nacional do meio ambiente e às determinações do poder concedente dos serviços de energia elétrica, responsável pela pormenorização da geração, transmissão, distribuição e comercialização de energia, independentemente da fonte primária utilizada no processo de transformação. Tratar destas questões com o compromisso na formulação de raciocínios críticos e propositivos, especialmente acerca de temas como a liberdade energética e controle de mercado, é imperioso para superar juridicamente as limitações presentes inclusive no discurso da delimitação de marcos normativos adequados. Havendo vantagens ambientais, tecnológicas e comerciais na exploração da energia cinética do vento como propulsora do desenvolvimento no modelo civilizatório estabelecido, cumpre também ao Estado dar a sua contribuição setorial na forma de incentivos, desburocratização e aprimoramento do modelo concorrencial. O estudo adota os métodos histórico-evolutivo, dialético e sistêmico de abordagem, encarando as hipóteses formuladas no aspecto das consequências multilaterais que as soluções encontradas apontam, exigindo que a estabilização de expectativas sociais por parte do ordenamento jurídico não ignorem o sentido material cognitivamente aberto do desenvolvimento. Hodiernamente, a perspectiva de desenvolvimento energético alia tendências econômicas e tecnológicas em favor das fontes alternativas mais eficientes, revelando a energia eólica como uma representante adequada em termos pragmáticos de normatização e preservação ambiental

Emprego formal na região nordeste brasileira: seus efeitos na inclusão social

This work aims to study the problem of the formal job in the Brazilian Northeast region and its effect in the social inclusion, taking for base the analysis of variables defined in the Atlas of Social Exclusion, which is based on the 2000 Brazilian Census, choosing the county as unit of analysis. As methodological options, an exploratory data analysis was performed, followed by multivariate statistical techniques, such as weighted multiple regression analysis, cluster analysis and exploratory analysis of spatial data. The results pointed out to low rates of formal job for the active age population as well as low indexes of social inclusion in the Northeast region of Brazil. A strong association of the formal job with the indicators of social inclusion under investigation, was evidenced (schooling, inequality, poverty, youth and income form government transfers), as well as a strong association of the formal job with the new index of social inclusion (IIS), modified from the IES. At the Federative Units, in which better levels of formal job had been found, good indexes of social inclusion are also observed. Highlights for the state of the Rio Grande do Norte, with the best conditions of life, and for the states of the Maranhão and Piauí, with the worst conditions. The situation of the Northeast region, facing the indicators under study, is very precarious, claiming for the necessity of emphasizing programs and governmental actions, specially directed to the raise of formal job levels of the region, reflecting, thus, in improvements on the income inequality, as well as in the social inclusion of the population of Northeastern natives.

Natal como destino turístico : um estudo das imagens (re)veladas pela mídia, pelos turistas e suas implicações educacionais e culturais

This thesis is a result of a research on Natal/RN as a tourist destination. We understand that cities are chosen as tourist destinations beyond its cartographic localization, from other dimensions of meanings that, in its set, constitute images. These images are, probably, very different of the images constructed by native and resident populations, who possess relations of identity with the place. The knowledge of the meanings that others attribute to this city as tourist destination, bring us near to the symbolic bonds established by individuals or social groups on the act of their choices, as well as bring us near to the interaction process city-tourists where the expectations are confirmed or not. The images divulgated by the media also participate of the complex formation of the tourist image that is being constructed and available for the different public, in different social contexts. The tourism constitutes a symbolic asset of the modern society, being considered by the studious, as one of the most expressive phenomena of the modernity, for involving each year displacement and the interaction of thousand of people of different cultures in the entire world. All this people s mobilization points to practical social related to personal motivations, to the entailed desired to the idea to travel and to exceed borders. It is already consensus that tourism is a phenomenon of economic growth, generating jobs, income, professional, qualification, bringing improvements for the host cities. Since 1995, in Brazil, the tourism as a sector of the economy, passed to be considered one of the national priorities, and in this perspective, the national politics of the tourism invested in infrastructure of Brazilian cities with high tourist potential, objecting to increase the flows of Brazilian and foreign tourists. Owing to this fact, the country still invests in programs of tourist marketing, mainly divulging the images of the natural beauties of Brazil abroad. And for Brazilians, the campaigns appeal to rescue the feeling to be Brazilian, associating the idea to travel and know its country. Natal city possesses an excellent positioning in the tourist marketing, being predominantly divulgated in national and international level, for its naturalistic singularity, where the images of its natural enchantments as warm water beaches, white dunes, warm weather, constant breeze and an always blue sky are shown as the favorite scene on this city. From what was viewed above that the choice of a tourist destination articulates from a determined imaginary of a place, already constructed or in process of construction, we consider the knowledge of this imaginary a basic learning for the population of the city and especially, for educators, in the formation of professionals in this area and for tourism managers, elaborators of public politics. Based on this estimative, we developed this research that had as a general objective to identify the images that illustrate Natal city as a tourist destination - our objective of study, particularly the meanings and senses attributed by the tourist marketing (hotel s folders) and by the tourists that visited the city during this study. The discussions and reflections that had guided this research had been given from the theoretical link between imaginary and social representation, also considering some interfaces between the fields of communication and symbol. From the studied authors, Baczko (1985) clarifies that the study of social imaginary is directed for the mechanisms and structures of the social life, especially for the intervention accomplishes and efficient of the representations and symbols in the practical collectives, as well as in its direction and orientation . Following this same thought, Moscovici (1978) says that the social representation are produced in communicational and symbolic contexts, and these representations once that already constituted circulate socially as almost tangible entities. Based on this fundament and on the analyze of Barthes (1990), particularly in the approach given to the reading of photographic image, we could observe on hotel s folders that each page evidences senses and meanings of functionality of internal and external spaces, pointing to the way of leisure offered by the keepers of city which is the hotels. About, the leisure that they offer, it is directed to young public, giving meaning to the young myth of personalized leisure tourism on children, young and adults images. The image about security that hotels offer and the singular image of Natal city as a paradise place, provide an idealization of pleasure through the sun, dunes, and beaches and also due to the hospitability of the natives who are assigned as educated . For the tourist that participated on this research, Natal city is tied only by the imaginary of leisure and nature which constitute the emotional link of the relation media-city-tourist. And with such force and fullness of directions the city discloses without tensions and contradictions as a place protected by a mythical and sacred aura. The study also demonstrates us that the potiguar culture remains (almost) forgotten, due to the silenced in this imaginary. In this perspective, we highlight that this culture silence is very close related to the disvalue of education in its general meaning. We defend that the imaginary apprehended constitutes a new reading and a new looking and understanding the tourist reality that comes historically consolidating in this city. In this direction, we glimpse that this study and its future dismemberments can collaborate with the process of rescue the cultural values of the potiguar people, in the way that the meaning of tourist may be redefined, and the tourist image of the city can be also disclosed for its identities particularities of its culture

Estudo representacional da participação familiar nas atividades dos centros de atenção psicossocial no município de Natal-RN

Comprehending social representations of users relatives of Psychosocial Care Centers (CAPS) from Natal-RN, about their participation in the activities of these services, was the purpose of this study. The research instrument used was a semi-structured interview, led to 28 relatives of users of East and West CAPS II, East and North CAPS-ad, involved in the Relative Therapeutic Group, in Relative Meeting, in the Assembly of Users, Technicians and Relatives, according to the therapeutic schedule of each health services, between August to November 2007. Data obtained in family and users identification were characterized with the aid of charts and boards in absolute and/or percentage values. The discursive material from the guide from interviews was submitted to the informational resource ALCESTE (Analyse Lexicale par Contexte d'un Ensemble of Segments of Texte), and analyzed on the basis of the Theory of Social Representations and Central Nucleus Theory. Most of the relatives were women, married, aged over 50 years, who participated for more than two years in CAPS activities, and a coexistence of more than 11 years with the user. From the classification system of ALCESTE were selected categories, identified by: Category 1, Treatment Improvements and Expectations; Category 2, Living User Before and After; Category 3, Activities Relevance, Contradictions and Suggestions; Category 4, Guidelines -- Psychopharmacology and Medicalization; Category 5, Family Participation and Activities; and Category 6, Therapeutic Conditions Thanks, Tips and Vulnerability. The social representation of the family exists in the desire for change, identifying that we need to promote change by the continuity of therapeutic activities and overcome the detected inconsistencies, targeted by strengthening and by the stability of improvements in living and health conditions of users, experienced in CAPS treatment. The central nucleus had corresponded to positive changes in health and living conditions of users, and the peripheral elements were constituted by family conducts before and during treatment, and the expectations of changes in activities, especially in workshops. Despite this family participation be considered important, it still does not meet conditions to promote the inclusion of family, under an emancipating point of view, capable of causing in subject the hope for autonomy, initiative, individual and collective growths, a closer and active involvement in therapeutic activities, in workshops and discussions

Sistematização da assistência de enfermagem (SAE) em um hospital pediátrico de ensino: uma pesquisa-ação

The incessant search if nurse for qualify nursing care makes the Nursing Assistance Systematization, a current topic of discussion throughout the country, not only in order to comply the legal requirements of their practice, but especially by the expected benefits of its application. In this meaning, this research had a qualitative approach, developed for a way of research-action. The general purpose was to analyze the change in the nursing practices in a pediatric teaching hospital, based on construction and implementation of Nursing Assistance Systematization by the nursing team. The results had the thematic analysis of Paulo Freire and were shown in the form of reports. To achieve these purposes, it began by steps pre-trial, to review the charts of the institution and an approach with the managers. In the situational diagnosis of nursing practices without the systematization followed by applying a questionnaire with a nursing team and a focal group with nurses. These ways supported the implementation stage of the Nursing Assistance Systematization which developed actions associate such as focal group with the nurses about the nursing history, capacity with the nursing team about the Nursing Assistance Systematization, development, application and reworking of printed, and discussions in the small groups. The evaluations of the changes after the actions of the research occurred through individual interview with the nurses, to check the results. The charts review confirmed the deficit in the records performed by the nurse on the chart, which reinforced the need for implementation of Nursing Assistance Systematization, an argument used on the meeting with the managers, who promptly agree with the search. The questionnaire and the focal group with the nurses reveal a process of nursing work without systematization, showing gaps in practices, but also obtained relate of expectations of improvements in quality of care as of Nursing Assistance Systematization, furnishing data to the development of ways following-up. The prints were gradually used and modified as the team understood the Nursing Assistance Systematization and its purposes through capacity course. The final evaluation pointed to the partial implementation of the stages of Nursing Assistance Systematization had been institutionalized at the history and the development of nursing, beyond difficulties with diagnosis and prescription of nursing, in later representing a paradigm shift. This search collaborated to change the view about the Nursing Assistance Systematization by nursing team at the institution had been revealed through introduction of new practices in the process of nursing work, as examination of physical exam of the patient, the interview in the admission of customers on service and the daily monitoring by nursing through development of nursing. Before addition, it was noted which the purposes of this search were achieved, since were analyzed the changes in the nursing practices with the systematization. The research-action achieved proposes of the involvement of nursing team in changing their practices. This search contributed to the implementation of the Nursing Assistance Systematization in a pediatric teaching hospital and showed which is possible to seek resolution of problems when the objective is of the group and gave access for further searches within this theme

Desempenho dos serviços de atenção primária do município de Natal/RN para o diagnóstico e controle da tuberculose

Tuberculosis (TB) is one of the most important health problems being faced worldwide. In Brazil, the responsibility for the actions of to diagnosis and control of this disease was transferred to the municipalities within the Primary Health Care (PHC), aiming at improvement in epidemiological indicators, requiring reorientation of the practice of family health teams and requiring methodologies to analyze the extent to which components of the PHC are being achieved. Thus, this study aims to analyze the performance of primary care services in the city of Natal-RN for the diagnosis and control of TB, from the perspective of health professionals (doctors and nurses). The study is descriptive, cross-sectional and quantitative. Data collection was conducted from March to July 2011 and involved 121 health professionals working in 52 health units (family health unit, basic health unit and mixed units). The instrument is structured based on the Primary Care Assessment Tool (PCAT), validated and adapted to assess attention to TB in Brazil, and includes questions regarding the Structure and Process components of health services. For quantitative analysis, it was constructed indicators, whose response patterns are followed according to the Likert scale between one and five, which meant the degree of preference relation (or agreement) of the claims. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. With regard to inputs and equipment, the units had satisfactory condition for form (  = 4.26), consultation (  = 4.02) and basic basket (  = 4.24); regular condition to pot (  = 3.56) and unsatisfactory conditions for transportation tickets (  = 1.50) and sputum smear microscopy (  = 2.42) and X-rays (  = 1.07). In relation to actions, there was satisfactory development for those focused on the individual patient. Actions aimed at the collective level, as the search for respiratory symptoms (RS), monitoring of contacts and guidelines for the community ranged from regular to unsatisfactory (  = 3.16 -  = 1.34). With regard to training, 94,2% received training to identify RS. As regards the time for diagnosis, the median time elapsed between the identification of RS and the beginning of treatment it was 22 days. In relation to the difficulties faced by professionals in the diagnosis of TB, 56,2% reported that they are related only to health services, especially for the failure in the rearguard laboratory and in the specialized services reference, the lack of human and material resources and low performing an active search. The professionals perceive the performance of diagnosis and control of TB, permeated with limitations and barriers to organizational and operational character of various sizes, emerging the need for effective coordination of various sectors and key stakeholders of TB care, to adoption of a new intersectoral strategies that aim to increase the responsiveness of the PHC, providing the best performance in service delivery to the user, family and community, and ensuring effective action and resolving the needs of this population group.

Protocolo de avaliação do cuidado de enfermagem e da segurança do paciente em unidades de terapia intensiva

The reports of adverse events date from 1990 up to the present day. Conceptually, these adverse events are unintentional injuries unrelated to the underlying disease, causing measurable lesions in patients, extending the period of hospitalization, or leading to death. These issues require discussions with regard to patient safety, improved quality of service, and preventing medical errors. In the Intensive Care Units, this concern is greater because these are sectors of intensive care to individuals with hemodynamic changes and imminent risk of death. Therefore, it is essential to conduct evaluation processes to investigate aspects of quality of nursing care and patient safety in these spaces. For that reason, we aimed to propose the Evaluation protocol of nursing care and patient safety in Intensive Care Units. For its achievement, we needed to: 1) analyze the evolution of the patient safety concept used in scientific productions, under Rodgers evolutionary concept; 2) identify the necessary items to build the evaluation protocol of nursing care and patient safety in the Intensive Care Unit, from the available evidence in literature; 3) construct an instrument for content validation of the evaluation protocol of nursing care and patient safety in the Intensive Care Unit; and 4) describe and evaluate the appropriateness of the content for an evaluation protocol of nursing care and patient safety in the Intensive Care Unit. This is a methodological study for the content validation of the abovementioned protocol. To meet the first three specific objectives, we used the integrative literature review in Theses Database of the Coordination for the Improvement of Higher Education Personnel and the portal of the Collaborating Centre for Quality of Care and Patient Safety. The fourth specific objective happened through the participation of judges, located from the Lattes curricula, in the content validation process developed in two stages: Delphi 1 and Delphi 2. As instrument, we used the electronic form of Google docs. We present in tables the answers from the evaluation instruments by Delphi consensus and Content Validity Index (CVI) of the entire protocol. We summarized the results in articles entitled Analysis of the patient safety concept: Rodgers evolutionary concept ; Scientific evidence regarding patient safety in the Intensive Care Unit ; Technological device for the content validation process: experience report ; and Evaluation protocol of nursing care and patient safety in Intensive Care Units. The Embodied Opinion of the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte, No. 461,246, under CAAE 19586813.2.0000.5537, approved the study. Thus, we conclude the protocol valid in its content, constituting an important tool for evaluating the quality of nursing care and patient safety in Intensive Care Units