Avaliação da função pulmonar em obesos mórbidos com sonolência diurna excessiva

Background: Obesity impairment to the pulmonary function related to the magnitude of adiposity and is associated with excessive daytime sleepiness (EDS) and snoring, among others symptoms of respiratory disorders related to sleep. It is possible that obese individuals with excessive daytime sleepiness may make changes in lung function on spirometry monitored during the day as a consequence of fragmented sleep or episodes of nocturnal hypoventilation that cause respiratory and changes that can persist throughout the day. The combination of these findings alone sleepiness observed by subjective scales with pulmonary function in obese patients is unknown. Objective: To assess the influence of EDS and snoring on pulmonary function in morbidly obese and distinguish between different anthropometric markers, the snoring and sleepiness which the best predictors of spirometric function and respiratory muscle strength and endurance of these patients. Methods: We evaluated 40 morbidly obese markers on the anthropometric, spirometric respiratory variables, maximal inspiratory and expiratory pressures (MIP and MEP) and maximal voluntary ventilation (MVV) and the measured excessive daytime sleepiness (the Epworth sleepiness scale) and snoring (snoring scale of Stanford). The data were treated when the differences between the groups of obese patients with and without sleepiness, whereas the anthropometric variables, respiratory and snoring. Pearson's correlation was performed, and multiple regression analysis assessed the predictors of pulmonary function. For this we used the software SPSS 15.0 for windows and p <0.05. Results: 39 obese patients were included (28 women), age 36.92+11.97y, body mass index (BMI) 49.3+5.1kg/m², waist-hip ratio (WHR) 0.96+0.07 and neck circumference (NC) 44.1+4.2 cm. Spirometric values and respiratory pressures were up 80% of predicted values, except for endurance (MVV <80%). Obese with EDS have lower tidal volume. Positive correlation was observed between BMI and EDS, EDS and NC and between snoring and BMI, and negative correlation between EDS and tidal volume (TV), and between snoring and snoring FVC and FEV1. In linear regression the best predictor of pulmonary function was snoring, followed by NC. NC has more obese with higher strength (MEP, p = 0.031) and endurance (MVV p = 0.018) respiratory muscle. Conclusion: Obese with EDS tend to have lower TV. In addition, snoring and NC can better predict pulmonary function in obese when compared with other anthropometric markers or EDS. Obese patients with higher NC tend to have greater capacity for overall strength of respiratory muscles, but may have low muscle endurance

A intervenção do poder judiciário no acesso a medicamentos no Rio Grande do Norte: uma análise sob a ótica das políticas nacionais de medicamento e de assistência farmacêutica

The present study aimed to evaluate the inclusion of the principles of the National Medicines Policy - PNM and the Pharmaceutical assistance - PNAF in the prosecution of lawsuits involving medicines. To fulfill this necessity , data collection was performed on the website by the Tribunal Rio Grande do Norte - TJ RN ( Rio Grande do Norte Court) , in 2012 . It was obtained 115 judgments, which were analyzed in order to generate Monitoring Indicators from lawsuits and conduct content analysis proposed by Bardin (2006). The results showed that : a) 100 % of the decisions were favorable to the author , b) 76 % of decisions were requests by the trade name of the drug , c) only one drug (eculizumabe) had not granted by ANVISA , d) 36 % of drugs were present in the list of standard medicines in SUS , 16 % of primary care block and 20 % of specialized component , e) 76 % of the decisions presented the request of at least 01 non-standard medicine. With regard to decentralization of PNM and PNAF we observed a commitment to this principle at judicial decisions, to see that municipalities and states are often forced to buy medicines of responsibility from another federal entity or other tertiary units as CACONs and UNACONS. The content analysis revealed that the argument from the judges used when you utter their decisions was that the right to health is recognized by Brazilian law as a fundamental right and should be guaranteed by the State for all its citizens. So, health is more than budgetary constraints of federal entities, which are severally liable for lawsuits , regardless the medication requested belongs or not to a particular block of a pharmaceutical assistance funding. Given these data, it is observed that there are gaps in the judgment when it comes to the insertion of the words and principles of PNM and PNAF, creating then the need for greater dialogue between the executive and judicial, so that they may consider relevant the effectiveness and application of such principles to minimize the negative consequences of the phenomenon of health judicialisation. Keywords: Judicialisation, Medicines, Public Policy, Pharmaceutical Care

Avaliação e monitoramento de políticas públicas: criação de um modelo sistêmico aplicado ao Instituto de Assistência Técnica e Extensão Rural do Rio Grande do Norte (EMATER-RN)

The nature of this thesis is interventionist and aims to create an alternative on how to control and evaluate the public policies implementation developed at the Institute for Technical Assistance and Rural Extension of Rio Grande do Norte State. The cenarium takes place in a public institution , classified as a municipality that belongs to the Rio Grande do Norte government and adopts the design science research methodology , where it generates a set of artifacts that guide the development of a computerized information system . To ensure the decisions, the literature was reviewed aiming to bring and highlight concepts that will be used as base to build the intervention. The use of an effective methodology called Iconix systems analysis , provides a software development process in a short time . As a result of many artifacts created by the methodology there is a software computer able of running on the Internet environment with G2C behavior, it is suggested as a management tool for monitoring artifacts generated by the various methods. Moreover, it reveals barriers faced in the public companies environment such as lack of infrastructure , the strength of the workforce and the executives behavior

Assistência odontológica diferenciada para crianças de 0 a 3 anos: avaliação de impacto no Serviço Público Municipal em Natal-RN

In Brazil, 0-5 years old children just have an oral health care system since 1990 s. Innumerable experiences of implantation of the attendance to the babies in the cities had appeared throughout the years, but it hasn´t been evaluated the comparative effect between children displayed and not displayed to the program. In this regard, the main of this research was describe the Early Childhood Oral Health Care in public health service in Natal, Rio Grande do Norte, Brazil and evaluate the impact of this specific oral health care for babies by comparison of indicators between exposed and non-exposed children. It was created an experimental group, formed by children covered by program which was paired, based on sex, age and socioeconomic status, with a control group, formed by uncovered children. After filling ethical application, the parents of children were questioned about some risk factors to dental caries and, in sequence, it was accomplish an oral examination in the child. It was verified the Visible Plaque Index (VPI), Gingival Bleeding Index (GBI), dmf-s and verification of caries activity. The sample was 40 children in each group. The results showed, for VPI, a difference of 7 percentile points for the experimental group, however this difference had no statistical significance, obtained by Student s t test (p=0.314). In relation to GBI, the control group showed a low mean (0.8%) comparing with experimental group (2.77%) and this difference was statistically significant (p=0.003). The results for dmf-s and evaluation of caries activity showed no statistical difference between groups. Among the probable reasons for absence of impact of intervention, could be included: (a) the practice model was the same in two groups, or the difference was very weak and (b) the oral health care has intrinsic limitations for to impact on oral health in low income populations

A ação do psicólogo na assistência social: interiorização da profissão e combate a pobreza

A pobreza, como uma das manifestações da questão social , é elemento constitutivo do padrão de desenvolvimento capitalista, extremamente desigual, em que convivem acumulação e miséria. Nas últimas décadas, sob a égide do ideário neoliberal, verifica-se um incremento em políticas de combate à pobreza no Brasil, de caráter focalizado e compensatório, tanto por meio de ações diretas de transferência de renda, quanto pelo fortalecimento de serviços e programas voltados às populações pobres, com a estruturação do Sistema Único de Assistência Social, hierarquizado em Proteção Social Básica e Especial. A participação do psicólogo nas equipes profissionais do CRAS constitui um importante elemento para a discussão da inserção desse profissional no campo das políticas sociais no Brasil, considerando os limites estruturais postos pelo caráter compensatório dessas políticas, e a construção de estratégias que possam resultar em uma mudança efetiva nas condições de vida das camadas mais pobres da sociedade. Aliado a isso, por meio do ingresso na política de assistência social, um número significativo de profissionais psicólogos passa a atuar em cidades pequenas e médias, fora dos tradicionais centros urbanos, constituindo um movimento de interiorização da profissão . O objetivo do presente trabalho é analisar a ação profissional do psicólogo na assistência social no contexto nas políticas de combate à pobreza em municípios do interior do Rio Grande do Norte. Realizou-se entrevistas semiestruturadas com psicólogos atuantes nos CRAS de 17 municípios de pequeno e médio porte do estado. As informações foram sistematizadas com auxílio do software QDA Miner v. 3.2. A perspectiva defendida neste trabalho refere-se à funcionalidade das práticas psicológicas no contexto das políticas de combate à pobreza brasileiras na atualidade, ao reforçar os ideais neoliberais de naturalização da questão social e responsabilização dos indivíduos pela sua condição social, além de, em grande parte, desconsiderar as particularidades e singularidades que marcam os territórios de ação. Todavia, é possível depreender alguns modos de ação profissional que estão na contramão dos mais frequentemente encontrados nesse campo. Esses modos se revelam no cotidiano do CRAS como formas diferentes de compreensão do saber fazer profissional, resultados de um posicionamento político e de uma formação profissional que buscam romper com o tradicionalismo e conservadorismo da Psicologia e do campo da assistência social

O Psicólogo no campo do Bem-Estar: cartografias de práticas na saúde e assistência social

The study focuses on the psychology and Social Well-being Policy encounters. The objective is to understand how the psychologists in the health services of Natal, RN, specifically in the Basic Health Units and social assistance, experience their daily practices. The methodology included observation and interviews of 13 psychologists regarding their daily activities and forms of practice in these services. We utilized an interview protocol directed at the affective memory and the professional life history of these technicians. Field notes were used to produce a cartography of the encounter intensities experienced by the researcher in the investigated context. The data analysis enabled the construction of the following analytic axes: 1) Work processes and proximity/ distancing points between these fields; 2) Forms of government and life management in the well-being context; 3) Experiments of self in the daily services. The first axis showed the precariousness of working conditions (remuneration issues, lack of structure, of training and autonomy for the activities). In the second axis the identified care forms produced in these fields indicated an adherence to the production of ideal subjects characterized as autonomous, productive, healthy and aware of own rights . These were considered normative insofar as they express attempts to break with the established patterns. In the third axis, many technicians experienced constraint with the daily activities because they found themselves in contexts that were adverse to the habitual forms of action. This situation provoked two distinct forms of positioning: a) action expressed by compassion, pity and resentment; b) investment in the practices themselves, so as to overcome its limits and to respond innovatively to the difficulties and/or challenges that these contexts provoke

Caminhos e descaminhos da adesão ao tratamento anti-hipertensivo :um estudo com usuários do Pacha (Programa de Assistência e Cuidado da Hipertensão Arterial) do Hospital Universitário Onofre Lopes

The high blood pressure is a multifactorial chronic disease which possesses emotional and social features in the illness appearance and evolution and in the adherence to the treatment which involves a decision-making through patient so that he or she process the necessary changes on harmful living habits. Adhesion, traditionally, it is referred to the patient to answer to the doctor orientations or of other health professional, about the appearance to the appointment with a doctor, about the use of medicine or lifestyle changes and maintaining this adhesion is the main problem to be overcame. It is expected the adhesion will ever be a continual, stable and satisfactory action, disregarding the complexity of subjectivity processes which permeate the sicken. This research aimed to investigate the difficulties which the person with high blood pressure has to adhere to the treatment, from the signification processes which give sense to the actions dealing with the adhesion. The study was carried out with 48 users of assistance program to the high blood pressure patient from Hospital Universitário from Natal RN, between 40-65 age. The answers were submitted to a double analysis process: 1) answer systematization in categories and codes and admission in statistical program SPSS (Statistical Package of Social Science), for generation of descriptive statistics; 2) Sense and signification analysis which permeated the deepener statement and interpretatively. The greater difficulties found are present on low-salt and law-calorie diets, in the dealing with everyday feeling and stress, being these factors cited as direct motive to the high blood pressure, regardless of interviewee s sex. It is observed there is not adhesion, but adhering, as an experienced everyday process. This work contributes with its results, assessing the used strategies by program with the aim of increasing the adhesion rates

O Serviço Social nas operadoras de planos privados de assistência à saúde: demandas, atribuições e respostas profissionais

The present study deals with the exercise of professional social workers in private health care plans registered with the Regional Council of Medicine/RN, in the city of Natal/RN, with regards to the demands/tasks, work conditions, and the professional response, given the climate of restructuring the capital. The set of socio-historical transformations, as a results of the dynamic capitalist, is a process of new configurations in relation to state and society that interfere directly in relation to working conditions, social rights historically won by workers. In this context, the operator of health plans arises as a possibilities to provide services in health, through the logic of the market, in which the subjects of law, become consumers contributing to the displacement of the responsibilities of the State. Obligating workers to lessen the burden with the reproduction of their workforce. This involves changing societal context for social service, since it is one of the professions that are active in terms of the immediate social issue, and come as part of the collective worker. From qualitative research based on a theoretical and methodological perspective and critical dialectics, it was possible to unveil some features and trends of the exercise of(a) social operators in private health care plans. The survey results indicated that : a) the demands and duties for certain social service, are associated with the redevelopment of the capital, whose requirements and responsibilities professionals have with their needs, particularly the guarantee of profit, services rendered; b) in the conditions of work there is a trend of insecurity uncertainty and dismantling of professionals; c) the answers professionals suffer the limits and contradictions present in the daily training, mainly depending one the characteristics of management and operation of the operators, which has professional relative autonomy

A assistência técnica e extensão rural no assentamento modelo: proposição e realidade

This discourse analyzes the technical assistance concerning the rural settlement, which is seen as a demand of the social movement that claims for agrarian reformation, and is a goal of II PNRA, launched in may 2004, as a essential national public politics on process of building and consolidation of settlement and familiar agriculture, proposing the return of technical assistance service and rural extension in Brazil, which were started in the and of 1940 s. We analyze, in particular, the technical assistance program, social and environmental agrarian reformation, on model settlement, a program created, especially, to the rural settlements, coordinated by INCRA. Based on the documental analyze and local study, it is noticed that the experience of technical assistance implemented on model settlement shows the non continuation and fragility on technical assistance actions to rural workers. This context goes against the lately technical assistance governmental apparatus, which ensures to make settlements stronger, to support and to get important the familiar agriculture system. This way, technical assistance execution, trough the tertiary service, follows the neoliberal strategy and, the State, besides decreases the estimate to public politics, takes its actions control from the State to the shared control through partnership and transferring of responsibility, expressing its historic lack of attention to the worker class demands. In spite of workers resistance, expectative and hope, the lack of these services, as well as the other politics deficiencies, which are necessary to the settlements, are endangering its activities and threatening its survival in the settlement

Programa de Erradicação do Trabalho Infantil (PETI) em Natal: uma avaliação na perspectiva da Assistência Social

This research deals with children and teenagers who are in childish work situation like juridical and institutional conquests connected with public politics in order to effects rights and social support about childish work eradication program (PETI) in terms of evaluation context under social work. The analysis of this research records the PETI implantation process at social nucleus in Cidade Nova (Natal/RN) to absorb children and teenagers who come from lixão . It does this based on the two thousands (2005) and presents the program importance linking users and their families such as the investigation of PETI actions, intending to give a contribution in the childish work combat and how they have been developed social-education protection for children and teenagers (seven to fifteens). About quality and quantity it was make a survey of social-economical characterization of the people benefits (to families) through interviews with users. This study (make us) sure brings new subventions which can cooperate to the childish work eradication by others public politics articulations

A dimensão educativa do serviço social: uma análise do processo interventivo da profissão no âmbito da política de assistência social do município do Natal/RN

Can be declared that throughout the historical trajectory of the Brazilian Social Work, the men in the Social Work profession, women in the Social Work profession in his/her professional activity, present an educational dimension that runs through various social and occupational spaces, particularly in the area of Social Assistance Policy. Based on this premise, this present Dissertation, problematize the educational dimension present on the interventional process, in Social Work on the ambit of the Social Assistance Policy in Natal / RN city Brazil in the contemporary scene. Having thus, specific objectives that orientate the research of the interventional process of Social Work in the social assistance policy, analyzing of the apprehension of Social Work professionals on the educational dimension, in their daily work professional and the verification of the relationship between the educational dimension, to the professional action of both men in the Social Work profession and women in the Social Work profession and the concretization of social rights on the ambit of the social assistance policy. In this sense, the theoretical and methodological procedures used for this research, are substantiated on a critical-dialectical perspective and a qualitative and quantitative approach, from of the application of field research, of the non-participant observation, of the semi-structure, of the review of literature bibliographic and documental. Thus, considering that both women in the social work profession and men in the social work profession are an organic intellectuals who in their daily professional work promotes an intellectual and moral reform of their users, the results of this research, synthesize and show that the educational dimension in both professional work and social assistance, which have partner-historics, whose imbrication allows, contradictorily, by a side, a reaffirmation of the dominant culture, and by other side, a direction linked to the construction of an emancipatory culture in the pursuit of the materializing of social rights and a new sociability

O financiamento da política de assistência social no contexto do SUAS: tendências e particularidades do município do Natal-RN

This dissertation analyzes the configuration of the financing of Social assistance in the municipality of Natal-RN in the context of their particular expressions of the problematizando municipal budget against neoliberal adjustment macroeconomic policy. The current trends of "disclaimer" and "desfinanciamento" of social protection by the State, in the context of contemporary capitalism, bring strong implications for Social Security, especially through the redirection of public resources to the international capital, which highlights the overlapping economic interests on social needs. Whereas the changes and innovations occurring in connection with the financing of Social assistance policy, the goal of this documentary research is to identify the characteristics and trends of funding this policy in Natal-RN, from the secondary data analysis from the City of Natal, the Ministry of Social development and hunger and Portal of transparency. In the light of the theoretical, research now presented, shows trends of investment in Social assistance in the municipality of Natal-RN, in the period 2005 to 2009, which are: the tiny role membership (08) Social assistance in the municipal budget; the dispersion and fragmentation of the resources of Social assistance in other organs and/or secretariats of municipal administration; the participation of just 47.5% in expenditure from own organ Manager; the low percentage of implementation of resources foreseen in the Annual Budget Laws; the low allocation of resources in Municipal Social Assistance Fund (FUMAS), which contradicts the national policy for Social Assistance-PNAS/2004; and the predominance of government transfers in the composition of the resources of Social assistance in the municipality. The results of this research suggest that the process of financing of Social assistance in Natal is distant from the principles and guidelines pointed by PNAS/2004. In addition to the effort to understand the complexity of the financing of Social assistance in Natal, this work seeks to contribute to a political analysis in the direction of strengthening social control and the struggle for the expansion of investment in social spending

A gestão do Sistema Único de Assistência Social em Currais Novos (RN)

The present paper analyses the social assistance management in small cities, starting from the reality of Currais Novos City. Its main objective is to analyse the management of this politic in the context of the Nacional Sistem of Social Assistance (SUAS) through the management instruments materialized in the city: Social Assistance Plan, Budget, Management Report, Information Management, Monitorizing and Evaluation. It reveals a discrepancy between the instruments purpose and their concretude, and it identifies the main challenges in order to make them real, revealing the contradictions of such politic, through which the advances relate with the retrocesses. It remarks, in this context, the debate about Public Management and some aspects of the trajetory of the Social Assistance management in the brazilian context and the configurations of (SUAS) and of the politics in Currais Novos city. Such path allows us to identify the feebleness in the city ways to adopt the (SUAS) criteria, which is much more effective in burocratic aspects than in the change of the Social Assistance conception and in the effective incorporation of the (SUAS) principles and guidelines. Thus, problems are identified in what concerns to the important aspects for its effectivation, with the human resources, financing and social control mechanisms. It makes possible to reafirm the importance of the analysed management instruments for the effectivation of one participative and democratic management, as well as the urgency of its materialization as one of the important ellements for this politic to happen as a right and to make a stop to the unconformities between the (SUAS) determinations and its materialization

Violência contra a mulher:uma análise do trabalho do Centro de Referência da Assistência Social-CREAS/Parnamirim-RN.

This work demonstrates the results obtained from research on violence against women: an analysis of the work from reference center of the Social Assistance-CREAS, held in the city of Parnamirim/RN from September 2008 extending through the february of 2009. Having as goal to investigate and examine in a longitudinal cut, which specifically covers the period from 2006 to 2007, find out extent the actions taken by the Reference Center Specialized Social Assistance- CREAS, contributed to the change of women who were there, by checking if there was any change in their positions ahead of the violence and if they began to realize how social subjects, able to control their living conditions and interfere in the orientation of social dynamics Have a particular emphasis on the presence of work and schooling or lack of them is also a factor to be allied to the barriers and rules imposed on women in contemporary society. In this study it was found through a qualitative research guided by dialectical and implemented through the use of documentary research, observation, semi-structured interview and an extensive theoretical background on the subject in question that the woman victim of violence is in a complex and contradictory context where there is both the construction and deconstruction of rights, a view that there are strong influences of patriarchal culture and the consequences of social issues that specifically searched for the public, focuses on social, economic , political, social and cultural. In this sense, the National Policy to Combat Violence against Women, operated by CREASE Parnamirim, is also reflected in its early stages in the life of these women are to nurture a real chance for these victims of violence, to perceive themselves as social subjects can control their lives and interfere in their own destinies. We want this study to add more knowledge to help and most appropriate intervention in this reality, but without the intention of reaching exhaustion, but to subsidize future studies on the topic of women victims of violence

Violência contra a mulher: uma análise do trabalho do centro de referência da assistência social-CREAS/Parnamirim

This work demonstrates the results obtained from research on violence against women: an analysis of the work from reference center of the Social Assistance-CREAS, held in the city of Parnamirim/RN from September 2008 extending through the february of 2009. Having as goal to investigate and examine in a longitudinal cut, which specifically covers the period from 2006 to 2007, find out extent the actions taken by the Reference Center Specialized Social Assistance-CREAS, contributed to the change of women who were there, by checking if there was any change in their positions ahead of the violence and if they began to realize how social subjects, able to control their living conditions and interfere in the orientation of social dynamics Have a particular emphasis on the presence of work and schooling or lack of them is also a factor to be allied to the barriers and rules imposed on women in contemporary society. In this study it was found through a qualitative research guided by dialectical and implemented through the use of documentary research, observation, semi-structured interview and an extensive theoretical background on the subject in question that the woman victim of violence is in a complex and contradictory context where there is both the construction and deconstruction of rights, a view that there are strong influences of patriarchal culture and the consequences of social issues that specifically searched for the public, focuses on social, economic , political, social and cultural. In this sense, the National Policy to Combat Violence against Women, operated by CREASE Parnamirim, is also reflected in its early stages in the life of these women are to nurture a real chance for these victims of violence, to perceive themselves as social subjects can control their lives and interfere in their own destinies. We want this study to add more knowledge to help and most appropriate intervention in this reality, but without the intention of reaching exhaustion, but to subsidize future studies on the topic of women victims of violence