A busca de sintomáticos respiratórios de tuberculose na prática e perspectiva do agente comunitário de saúde nos distritos sanitários de Natal

The objective of this work - which is characterized analyze the search for symptomatic tuberculosis in practice and perspective of the Community Health Agent (ACS) in the districts of Natal. Methods: This is a cross-sectional study. The study population was 646 professionals, and conducted a probabilistic random sampling, stratified by districts. The data were collected from one instrument to collect data based on Primary Care Assesment Toll (PCAT) and analyzed by descriptive statistics. The sample consisted of ACS was 87% female. Among the study participants 58% completed high school and 120 months of exercise training (95% CI 111.9 to 129.5) on average. 90% were USF. The average follow-up of cases found were 2 cases of TB since the beginning of the career of the ACS and the last three years the average is presented in a case accompanied. The ACS received satisfactory ratings on the bond of trust with the user, so as access to homes in the community. The ACS reported for denying the fear of being positive result was the biggest reason for not performing the sputum. All units have a professional that responds to the Tuberculosis Control Program. Regarding the structural capacity of primary care settings for the diagnosis of TB, we observed satisfactory levels in different districts of pots for sputum collection, however, a point that deserves attention from managers is lack of materials for packaging sputum. Fear of positive result was one of the reasons for the refusal of sputum collection, followed by alcoholism. With regard to TB suspects, all responded that ACS always suspect when the user has TB coughs, but in all districts were noticed at low delivery of requests for applications for smear. BSR in TB control, is characterized in practice as a complex action goes beyond technical expertise and contact with the family that breaks with the Cartesian. The BSR is part of the ACS can perform them from the daily visits. We conclude that the ACS is difficult to achieve. This practice should not be the privilege of this actor, but the entire team of primary care. We must rethink the practices of TB care, seeing the health surveillance while aegis of the working process of primary care teams for early diagnosis and thereby reduce TB in communities

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.

Qualidade em serviços de saúde: uma contribuição à definição de um modelo paramétrico e padrão de qualidade do tempo agendado para consulta ambulatorial

This work presents a study in quality of health care, with focus on consulting appointment. The main purpose is to define a statistical model and propose a quality grade of the consulting appointment time. The time considered is that from the day the patient get the appointment done to the day the consulting is realized. It is used reliability techniques and functions that has as main characteristic the analysis of data regarding the time of occurrence certain event. It is gathered a random sample of 1743 patients in the appointment system of a University Hospital - the Hospital Universitário Onofre Lopes - of the Federal University of Rio Grande do Norte, Brazil. The sample is randomly stratified in terms on clinical specialty. The data were analyzed against the parametric methods of the reliability statistics and the adjustment of the regression model resulted in the Weibull distribution being best fit to data. The quality grade proposed is based in the PAHO criteria for a consulting appointment and result that no clinic got the PAHO quality grade. The quality grade proposed could be used to define priority for improvement and as criteria to quality control

Qualidade em serviços de saúde: uma contribuição à definição de um modelo paramétrico e padrão de qualidade do tempo agendado para consulta ambulatorial

The knowledge management has received major attention from product designers because many of the activities within this process have to be creative and, therefore, they depend basically on the knowledge of the people who are involved in the process. Moreover, Product Development Process (PDP) is one of the activities in which knowledge management manifests in the most critical form once it had the intense application of the knowledge. As a consequence, this thesis analyzes the knowledge management aiming to improve the PDP and it also proposes a theoretical model of knowledge management. This model uses five steps (creation, maintenance, dissemination, utilization and discard) through the verification of the occurrence of four types of knowledge conversion (socialization, externalization, combination and internalization) that it will improve the knowledge management in this process. The intellectual capital in Small and Medium Enterprises (SMEs) managed efficiently and with the participation of all employees has become the mechanism of the creation and transference processes of knowledge, supporting and, consequently, improving the PDP. The expected results are an effective and efficient application of the proposed model for the creation of the knowledge base within an organization (organizational memory) aiming a better performance of the PDP. In this way, it was carried out an extensive analysis of the knowledge management (instrument of qualitative and subjective evaluation) within the Design department of a Brazilian company (SEBRAE/RN). This analysis aimed to know the state-of-the-art of the Design department regarding the use of knowledge management. This step was important in order to evaluate in the level of the evolution of the department related to the practical use of knowledge management before implementing the proposed theoretical model and its methodology. At the end of this work, based on the results of the diagnosis, a knowledge management system is suggested to facilitate the knowledge sharing within the organization, in order words, the Design department

Protocolo multiciclos para automação hospitalar sobre Multicast com IEEE 802.3 utilizando

The concepts of the industrial automation are being incorporated in the medical area, in other words, they also pass to be applied in the hospital automation. In this sense, researches have been developed and have usually been approached several of the problems that are pertinent to the processes that can be automated in the hospital environment. Considering that in the automation processes, an imperative factor is the communication, because the systems are usually distributed, the network for data transference becomes itself an important point in these processes. Because this network should be capable to provide the exchange of data and to guarantee the demands that are imposed by the automation process. In this context, this doctorate thesis proposed, specified, analyzed and validated the Multicycles Protocol for Hospital Automation (MP-HA), which is customized to assist the demands in these automation processes, seeking to guarantee the determinism in the communications and to optimize the factor of use of the mean of transmission

WI-BIO: redes de monitoramento de pacientes em ambientes de automação hospitalar utilizando o padrão IEEE 802.11

The monitoring of patients performed in hospitals is usually done either in a manual or semiautomated way, where the members of the healthcare team must constantly visit the patients to ascertain the health condition in which they are. The adoption of this procedure, however, compromises the quality of the monitoring conducted since the shortage of physical and human resources in hospitals tends to overwhelm members of the healthcare team, preventing them from moving to patients with adequate frequency. Given this, many existing works in the literature specify alternatives aimed at improving this monitoring through the use of wireless networks. In these works, the network is only intended for data traffic generated by medical sensors and there is no possibility of it being allocated for the transmission of data from applications present in existing user stations in the hospital. However, in the case of hospital automation environments, this aspect is a negative point, considering that the data generated in such applications can be directly related to the patient monitoring conducted. Thus, this thesis defines Wi-Bio as a communication protocol aimed at the establishment of IEEE 802.11 networks for patient monitoring, capable of enabling the harmonious coexistence among the traffic generated by medical sensors and user stations. The formal specification and verification of Wi-Bio were made through the design and analysis of Petri net models. Its validation was performed through simulations with the Network Simulator 2 (NS2) tool. The simulations of NS2 were designed to portray a real patient monitoring environment corresponding to a floor of the nursing wards sector of the University Hospital Onofre Lopes (HUOL), located at Natal, Rio Grande do Norte. Moreover, in order to verify the feasibility of Wi-Bio in terms of wireless networks standards prevailing in the market, the testing scenario was also simulated under a perspective in which the network elements used the HCCA access mechanism described in the IEEE 802.11e amendment. The results confirmed the validity of the designed Petri nets and showed that Wi-Bio, in addition to presenting a superior performance compared to HCCA on most items analyzed, was also able to promote efficient integration between the data generated by medical sensors and user applications on the same wireless network

Fibras de licuri: um reforço vegetal alternativo de compósitos poliméricos

This research is based, at first, on the seeking of alternatives naturals reinforced in place of polymeric composites, also named reinforced plastics. Therein, this work starts with a whole licuri fiber micro structural characterization, as alternative proposal to polymeric composites. Licuri fiber is abundant on the Bahia state flora, native from a palm tree called Syagrus Coronata (Martius) Beccari. After, it was done only licuri fiber laminar composite developing studies, in order to know its behavior when impregnated with thermofix resin. The composite was developed in laminar structure shape (plate with a single layer of reinforcement) and produced industrially. The layer of reinforcement is a fabric-fiber unidirectional of licuri up in a manual loom. Their structure was made of polyester resin ortofitálica (unsaturated) only reinforced with licuri fibers. Fiber characterization studies were based on physical chemistry properties and their constitution. It was made by tension, scanning electron microscopy (SEM), x-ray diffraction (RDX) and thermal analyses (TG and DTA) tests, besides fiber chemistry analyses. Relating their mechanical properties of strength and hardness testing, they were determined through unit axial tension test and flexion in three points. A study in order to know fiber/matrix interface effects, in the final composites results, was required. To better understand the mechanical behavior of the composite, macroscopic and microscopic optical analysis of the fracture was performed

Otimização de forma aplicando B-splines sob critério integral de tensões

This work proposes a computational methodology to solve problems of optimization in structural design. The application develops, implements and integrates methods for structural analysis, geometric modeling, design sensitivity analysis and optimization. So, the optimum design problem is particularized for plane stress case, with the objective to minimize the structural mass subject to a stress criterion. Notice that, these constraints must be evaluated at a series of discrete points, whose distribution should be dense enough in order to minimize the chance of any significant constraint violation between specified points. Therefore, the local stress constraints are transformed into a global stress measure reducing the computational cost in deriving the optimal shape design. The problem is approximated by Finite Element Method using Lagrangian triangular elements with six nodes, and use a automatic mesh generation with a mesh quality criterion of geometric element. The geometric modeling, i.e., the contour is defined by parametric curves of type B-splines, these curves hold suitable characteristics to implement the Shape Optimization Method, that uses the key points like design variables to determine the solution of minimum problem. A reliable tool for design sensitivity analysis is a prerequisite for performing interactive structural design, synthesis and optimization. General expressions for design sensitivity analysis are derived with respect to key points of B-splines. The method of design sensitivity analysis used is the adjoin approach and the analytical method. The formulation of the optimization problem applies the Augmented Lagrangian Method, which convert an optimization problem constrained problem in an unconstrained. The solution of the Augmented Lagrangian function is achieved by determining the analysis of sensitivity. Therefore, the optimization problem reduces to the solution of a sequence of problems with lateral limits constraints, which is solved by the Memoryless Quasi-Newton Method It is demonstrated by several examples that this new approach of analytical design sensitivity analysis of integrated shape design optimization with a global stress criterion purpose is computationally efficient

Estudo do efeito do óxido de bário no comportamento de massas para porcelanato

In this work, it is proposed the study of the effect of barium oxide acting as synthetic flow in the behavior of masses for stoneware from the use of raw materials found in the deposits of minerals of the Rio Grande do Norte that it makes use of a great natural potential for the industrialization of the product. The porcelanato is a sophisticated product with excellent final properties being applied as ceramic coating in buildings of high standard of engineering. The raw materials selected for the development of the study had been two types of argilas, two types of feldspatos, dolomita, talco, barium carbonate and silica, being characterized by X-ray fluorescence, X-ray diffraction, granulometric analysis, dilatometric analysis and thermal analysis. Thus, it is intended to define four formulations using the cited raw materials that will be processed, conformed and sintered in the temperatures of 1150 °C, 1175 °C, 1200 °C, 1225 °C e 1250 °C. From the physical characterizations, chemical and morphologic of the formed formulations, the effect of barium oxide is determined in the physical and mechanical properties of the studied system carrying water absorption tests, linear retraction, apparent porosity, apparent specific mass, compacting curve, flexural strength and microstructural analysis by XRD and SEM. After analyzing the results, indicated that barium oxide acts as a flux of high temperature and as the ordering of structure, where the embedded glass phase has the nucleating effect phase potassium silico-aluminum reacting with free silica which together with the high content of potassium concentrated form a new crystalline phase called microcline. The masses studied with the addition of barium oxide present physical-mechanical properties highly satisfactory in reduced firing temperatures, which implies a saving in energy given off in the production and increased productivity

Estudo das variáveis de processamento das matérias-primas da região do crato - ce na fabricação de produtos cerâmicos por extrusão e por prensagem

The limits to inform is about the character stico of basic, quimica, mineralogical and mechaniques of matlaughed material used in the manufacturing process the product certified in economic region the Cariri, specifically in the city of Crato, Ceará state, motivated the development of this work, since in this region the exist ing economic context that a general appear as important in the production chains. Were made twentyfive soils-test specimen collection and the study was performed to differentiate the mat laugh materials of variaveis processing of mathing raw materials in the factory The product mica monkeys by extrusion and pressing. The results were obtained ap s as analyzes: grain size, index of plasticity, fluoresce incidence X-ray difration the X-ray, and analyzes thermicals and properties technological. through s of curves gresifica returned to was a comparison between the retro the linear, absorb to water, porosity and bulk density. the results show that the excellent distribution and character acceptable available for the processing of the structure color dark red. needing, therefore, of the mixture of a less plastic clay with thick granulation, that works as plasticity reducer. In spite of the different resignation forms for prensagem and extrusion, the characteristics of absorption of water and rupture tension the flexing was shown inside of the patterns of ABNT

Monitoramento por dgps e análise dos processos erosivos da linha de costa na praia de Pirangi do Norte - Parnamirim / RN

Through out the course of a steady increase in search and recovery of space in the coastal zone, there is also an expanding concern about the erosion processes of this area. The main problem in coastal areas is that urbanization occurs in a disorderly fashion and unsustainable, further aggravating the problems of coastal dynamics. The study area of this work is located on the southern coast of Pirangi do Norte beach to about 20km south of Natal, capital of Rio Grande do Norte in the Parnamirim City. This area has the length of approximately 1km, divided into three sections (Western, Central and Eastern) with a morphology consisting of a tableland at the top, sea cliffs in the West and Central parts and sand dunes in the Eastern section, both vegetated, and a coastal plain on the inferior part associated with the presence of beach rocks. This study aimed to analyze the erosion processes operating in the excerpt of Pirangi do Norte beach and assess the feasibility of their monitoring making use of DGPS (Global Positioning System Differential mode). During the work it was carried out a physical description of the area through photo-interpretation and site survey after measurement of the shoreline in the period between November 2004 and November 2009 and beach profiles between August 2005 and July 2006. The analysis of the results of the annual surveys showed the occurrence of variations of the shoreline along the stretch traveled. Sites are identified in advancement coast from the sea and it was verified in loco the presence of erosion with deposition of materials on the lower part of the coastal bluff, the former position of the shoreline, showing a false notion of advancing it. This leads to the conclusion that the data collected in a survey of the shoreline should always be accompanied by photographic records of the local area and with the highest rate of erosion, thus avoiding the mistake of treating the deposit materials as evidence of progress coast. At the end of the study, after a review of various works to mitigate the erosion in the coastal zone, it is recommended to the area of study the adoption of an artificial feeding of the beach, aiming the minimization of the erosive effects of the tides. Moreover, it is suggested that even the continuity of monitoring, maintenance of existing vegetation and control of the occupation on the edge of sea cliffs

Aspectos dinâmicos da água versus álcool e acetona por técnicas de congelamento

Water still represents, on its critical properties and phase transitions, a problem of current scientific interest, as a consequence of the countless open questions and of the inadequacy of the existent theoretical models, mainly related to the different solid and liquid phases that this substance possesses. For example, there are 13 known crystalline forms of water, and also amorphous phases. One of them, the amorphous ice of very high density (VHDA), was just recently observed. Other example is the anomalous behavior in the macroscopic density, which presents a maximum at the temperature of 277 K. In order to experimentally investigate the behavior of one of the liquid-solid phase transitions, the anomaly in its density and also the metastability, we used three different cooling techniques and, as comparison systems, we made use of the solvents: acetone and ethyl alcohol. The first studied cooling system employ a Peltier plate, a device recently developed, which makes use of small cubes made up of semiconductors to change heat among two surfaces; the second system is a commercial refrigerator, similar to the residential ones. Finally, the liquid nitrogen technique, which is used to refrigerate the samples in a container, in two ways: a very fast and other one, almost static. In those three systems, three Beckers of aluminum were used (with a volume of 80 ml, each), containing water, alcohol and acetone. They were closed and maintained at atmospheric pressure. Inside of each Becker were installed three thermocouples, disposed along the vertical axis of the Beckers, one close to the inferior surface, other to the medium level and the last one close the superior surface. A system of data acquisition was built via virtual instrumentation using as a central equipment a Data-Acquisition board. The temperature data were collected by the three thermocouples in the three Beckers, simultaneously, in function of freezing time. We will present the behavior of temperature versus freezing time for the three substances. The results show the characterization of the transitions of the liquid

Validação do questionário Internacional de Atividade Física (IPAQ) através da acelerometria em idosas

Physical activity is one of the main components of a healthy lifestyle, responsible for many health benefits. Despite being considered important for both disease prevention and health promotion there is high prevalence of sedentary behavior in the elderly population. Questionnaires are practical and feasible instruments for assessing levels of physical activity. However, they may have limitations in older age ranges. Accelerometers, movement sensors that make physical activity data more objective, emerge as reliable measuring devices. Aim: Determine the validity of the International Physical Activity Questionnaire (IPAQ) adapted for elderly with accelerometry in elderly women. Methods: 57 elderly women, with mean age of 66.05 ± 5.98 years who took part in hypertension control and physical activity incentive programs were assessed in relation to objective and subjective measures of physical activity. The accelerometer was used for 07 consecutive days, 24 hours per day before the IPAQ was applied. Data were analyzed using measures of central tendency and dispersion to characterize the sample according to variables collected. To check the validity of the data we used the Spearman correlation test, considering a significance level of p <0.05. Results: With respect to the categories of physical activity obtained by IPAQ, 46.4% developed moderate physical activity, followed by a high (30.3%) and low level (23.2%). There was a negative correlation only between self-reported time spent sitting and time spent on light activities as measured by accelerometry (r = - 0.408; p = 0.003) and mean activity level (counts/min) with physical activity levels evaluated by IPAQ (r = 0.297; p = 0.036). Conclusion: The IPAQ used in elderly women shows moderate to low validity levels according to accelerometry measures. Assessment of sedentary activities exhibited acceptable levels compared to accelerometry; however, moderate (r = 0.096; p > 0.05) to vigorous (r = 0.098; p > 0.05) activities were not correlated, demonstrating the inability of IPAQ to evaluate this type of activity in elderly women

O Partido Comunista (1922-1962): lugar de memória, espaço de disputa

This work studies the dispute by Party Communist s memory in Brazil during and after division which it resulted in the appearance of two parties entitled communists, in the brazilian political context, in the final of the fifties and beginning of the sixties: the Brazilian Communist Party (in Portuguese, Partido Comunista Brasileiro) and the Communist Party of Brazil (in portuguese, Partido Comunista do Brasil). Along of yours three chapters, the author tries to answer some questions as: what were the elements which constituted the Communist Party s memory, in the period from 1922 to 1956? At which moment did this memory pass to be fiercely contested? Who and which documents reveal this? How did it happen the dispute by this memory? The approach to topic consider which the production of memory by Communist Party and the dispute for your possession by communists of PCB and of PCdoB happened in scope of national reality and of party, spaces notions understand from concept of memory developed for authors as Halbwachs, Le Goff, Pollack and Pierre Nora. To explain the objectives of historical research it has used as methodology the exam and the interpretation of documentary and bibliographical sources, with priority for the party s documents then it was depicted a collective interpretation about the events considered more importants. The sites of Partido Comunista do Brasil (www.pcdob.org.br or vermelho.org.br) and of Partido Popular Socialista (www.pps.org.br) also went consulted

Análise de redes do cotidiano a partir do encontro entre usuários e profissionais da estratégia saúde da família

O presente estudo discute a formação de Redes Sociais no cotidiano da Estratégia Saúde da Família, a partir de aportes da teoria sociológica sobre redes, interações, dádiva e reconhecimento. O objetivo geral é analisar as redes sociais locais em saúde a partir da interação de usuários e profissionais da Estratégia Saúde da Família na Unidade de Saúde de Ligéia, em Natal, RN. Seus objetivos específicos são: Mapear as redes sociais locais em saúde existentes no território adscrito; Identificar os tipos de interações cotidianas entre os sujeitos; Compreender a percepção dos sujeitos sobre o processo de formação de redes sociais a partir das interações. Caracteriza-se enquanto pesquisa qualitativa exploratória cujos sujeitos foram profissionais e usuários vinculados à referida unidade de saúde. Para a coleta de dados foram utilizadas entrevistas individuais semiestruturadas e debates em grupos focais, estimulados pela Metodologia de Análise de Redes do Cotidiano (MARES), pertinente para abordar a complexidade das relações sociais e mapear os diferentes conteúdos expressos e as formas de mobilização coletiva. A análise dos dados foi realizada através da Técnica de Análise Temática de Conteúdo, proposta por Minayo. Os resultados foram interpretados à luz das Teorias da Dádiva (Mauss) e do Reconhecimento (Honneth). Os sujeitos visualizaram: Rede Virtual (28,20%); Rede de Atenção à Saúde (25,64%); Redes de Usuários (17,95%); Rede Pessoal (10,26%); Conselho Comunitário (10,26%); Escolas (7,69%). Os participantes não perceberam os arranjos familiares enquanto Redes Sociais. Os tipos de interações sociais identificadas foram: Confrontação/Negociação (41.02%); Harmônicas (25,70%); Correlativas (17,90%); Definidas pela Organização (15,38%). A formação de redes sociais ocorre a partir de interações cotidianas entre pessoas, pela articulação inseparável de conteúdos e formas, catalisadas pelo contexto, experiência e cognição, valorizando a liberdade, a expressividade e a diversidade dos parceiros de significação. Foram encontradas duas categorias, na percepção dos sujeitos, sobre a formação de redes sociais do cotidiano: Diálogo e Encontro. Validamos e recomendamos o uso da metodologia MARES: Na formação, para despertar uma visão mais tolerante e humana de si e do outro; Na avaliação qualitativa dos serviços, por facilitar a reflexão sobre a prática e (re)organização do processo de trabalho; Na comunidade, para estimular movimentos sociais existentes ou emergentes. A aposta no circuito da dádiva e do reconhecimento recíproco, durante o trânsito nas redes sociais em saúde, pode ser capaz de tecer uma práxis transformadora, pela busca e alcance de confiança, respeito e estima, nos espaços de encontro entre usuários e profissionais da Estratégia Saúde da Família