A atuação do enfermeiro no combate à dengue e a febre chikungunya: estudo comparativo nos municípios de Parnamirim e Santa Cruz/RN

The research aimed to analyze the role of nurses in the Family Health Strategy (FHS) in the control of Dengue and Chikungunya fever in the cities of Parnamirim and Santa Cruz. It is exploratory and descriptive nature of research, with a qualitative approach, which was developed with nurses of the Family Health Strategy in the municipalities of Parnamirim and Santa Cruz. All research process followed the ethical standards laid out research in Resolution No. 466/2012 of the National Health Council about research involving human beings. Data collection was performed using a semi-structured questionnaire with open and closed questions, organized into three parts: the profile of respondents, knowledge of the disease (transmission, prevention, control) and description of practices. The actions performed by nurses are punctual performed when there is growing disease of the number of cases in order to try to reduce the number of cases. The principal methodology used for them is to talk and guidelines resulting from campaigns and home visits, using leaflets and social networks. Regarding knowledge of nurses in the city of Santa Cruz on Dengue Fever and Chikungunya, is clearly some gaps. Nursing professionals know recognize a suspected case of dengue, but get confused when trying to explain to the Chikungunya fever, exhibiting the same symptoms of dengue. Although everybody had participated in a training on Chikungunya Fever and Dengue, a very limited knowledge of nurses regarding the clinical management. It is suggested that further studies are developed on the ground a few nurses have accepted to participate in the study, so that we can identify strategies, interventions, activities and nursing actions that are consistent with the reality of working in favor of coping Aedes epidemics aegypti that have positive impact on reducing the infestation rates and may be suitable and applied in other regions.

Biologia reprodutiva de Mimus gilvus (Aves: Mimidae) em área de restinga no nordeste do Brasil

The thrush beach, Mimus gilvus (Aves: Mimidae) is a passerine widely distributed in Central and South America. In Brazil occurs mainly in the areas of the resting and vegetation near the beach. In southeastern Brazil this species has disappeared, mainly due to urbanization. Many attributes of their reproductive biology are unknown, especially in relation to reproductive success. During the years 2010-2011, 2011-2012 and 2014-2015 were made visits to the area of restinga forest in Centro de Lançamento da Barreira do Inferno (CLBI), located between the cities of Natal and Parnamirim-RN (5 ° 54'S 35 ° 10'W ) where they were made systematic searches to trying describe reproductive biology of the characteristics of M. gilvus, estimate their reproductive success using the Mayfield method, and identify the main factors that influence their reproductive success in environment the resting. For this, forty fifth active nests monitored were used. Only during the breeding season of 2011-2012 and 2014-2015 were made systematic visits to the study area. The reproductive period ranged August to March. Clutch size ranged from two, three and six eggs (n = 22). Broods of two eggs were more common, with an average of eggs laid per nest of 2 ± 0,51 (n = 20 nests). The incubation period was approximately 13 ± 1,9 days (n = 11 nests). The period of stay of the nestlings was approximately 11 ± 1,6 days (n = 9 nests). With approximately 11 days old the nestlings were able to leave the nest. The apparent success was 37,8% and the success estimated by Mayfield method was 26,6%. Predation was the main cause of loss of nests in the study area. The daily survival rates (TDS) were obtained from 0,9593 incubation and 0,9313 for nestling period respectively. Survival estimates for each period was 0,5827 for incubation and 0,4571 for nestling period. The cumulative average rainfall for each month influenced negatively the hatching rates of M. gilvus nests. In addition, the number hatch eggs among the most rainy season (rainy season) and the period of lowest rainfall (dry season) were different. The number of lost nests of M. gilvus was lower in scrubs than cactus, which may account for the largest number of nests of this species found in scrubs. Survival rates in nestling period were lower compared with the incubation period. The fact that the survival rates nests of M. gilvus be lower in the nestling period compared to the incubation period may result from increased activity of adults during this phase of the nest, which in turn would increase predation rates. M. gilvus seems to avoid the rainy season during their reproduction, concentrated most of their nests in periods of low rainfall.

O controle da tuberculose no contexto da atenção primária à saúde no Brasil

O Brasil é um dos países que concentram 80% da carga de tuberculose no mundo. No contexto da atenção primária brasileira, fatores interferem para que as equipes de saúde da família possam incorporar as atividades de controle da doença no processo de trabalho. O controle da doença depende da forma como os serviços de saúde estão organizados para garantir o acesso ao diagnóstico precoce e ao tratamento. Esse estudo tem como objetivo geral analisar o controle da tuberculose no contexto da atenção primária à saúde no Brasil. Os objetivos específicos são comparar o tratamento diretamente observado com o regime autoadministrado em pessoas com tuberculose; Verificar se o Programa Nacional de Controle da Tuberculose é avaliável e elaborar um modelo teórico e lógico para avaliação deste programa; avaliar a relação entre porte populacional dos municípios e as características de estrutura e processo de cuidado a pacientes de tuberculose na atenção primária no Brasil. Realizou-se uma revisão sistemática, seguida de um estudo de avaliabilidade e de um estudo transversal. Os achados da revisão sistemática revelam que não houve diferença significativa entre os grupos de tratamento (observado e não observado) para cura (OR 1,06. IC95% 0,75 - 1,50) e para conclusão do tratamento (OR 1,64, IC 95% 0,79 - 3,42). Menor abandono no grupo com tratamento supervisionado e não houve diferença estatisticamente significativa entre os grupos (OR 0,73, CI 95% 0,58-0,92). O risco de morte foi maior no regime de tratamento autoadministrado (OR 1,49 IC 95% 1,03 - 2,45). A hetorogeinadade entre os estudos analisados não permite afirmar que nao há diferença estatisticamente significativa para cura e tratamento concluído. A pré-avaliação do Programa de Controle de Tuberculose possibilitou a descrição do Programa, elaboração e pactuação do modelo lógico e a matriz de relevância dos indicadores. Caracterizou-se os seus elementos estruturantes, definição de indicadores de estrutura e processo, além das perguntas avaliativas. Uma avaliação somativa com enfoque na análise dos efeitos da intervenção de controle da tuberculose é recomendada. A avaliação das características de estrutura e processo de cuidado à pessoa com tuberculose revelou melhor desempenho para as equipes de atenção básica de municípios classificados como metrópole no acesso, coordenação do cuidado e qualidade técnica da atenção. Em relação ao acesso: 98,5% acolhimento a demanda espontânea; 95,8% programação de consultas. Na coordenação do cuidado, 93,2% existência de protocolo para tuberculose. Quanto a qualidade técnica da atenção à tuberculose verifica-se que 93,4% acompanhamento de tratamento diretamente observado, 95,8% com busca ativa de faltosos ao tratamento, 64,0% oferta de ações educativas, 91,3% busca ativa de sintomáticos respiratórios. Cabe destacar que metrópoles apresentaram maior tempo médio de espera para escuta/acolhimento (24,41 minutos); para consulta previamente agendada (23,52 dias); para consulta em pneumologia (87,12 dias). Percebem-se fragilidades na estrutura e processo da atenção à tuberculose, principalmente no controle especializado da doença e na qualidade técnica entre os municípios. Recomenda-se reforço, particularmente na qualidade técnica para aumentar a cobertura de acompanhamento do tratamento, busca de sintomáticos respiratórios e das ações educativas.

A gestão educacional das secretarias municipais de educação de municípios maranhenses a partir do plano de ações articuladas 2007-2011

The main purpose of this thesis was to analyze educational management of Municipal Departments of Education (SEMED’s) of cities in Maranhão inserted in the Plan of Articulated Actions (2007- 2011). We evidence the role of Union in that public policy. The leading argument is that Brazilian federal government is not demos constraining in relation to its national sub-governments, what makes the central government to enforce, primarily, educational politics like PAR. This kind of politics interferes in the educational management by national sub-governments, turning them into mere executors. By turning them into mere executors, PAR limits their autonomy and over imposes the results-based management as a parameter to improve the education quality. In order to develop the hypothesis, we adopted Political Science as theoretical basis, represented by Federalism Theory as pact which premise is the cooperative pattern of federalism as being the best form of government because it allows a joint decision-making process from the idea of no centralization of power. The methodology was historical materialism, which assumes the totality and contradiction as a form to understand the phenomenon that does not express in direct way its existence, but can be analyzed from such categories that made possible to interpret the reality. So, we used as tools the semistructured interview and documental analyses with triangulation of data. The empirical basis of the research is 04 (four) cities in Maranhão that obey the following criteria: 1. The municipality has to be assigned on the FNDE Resolution nº 29/2007; 2. To present the lowest educational management indexes from the diagnosis made in loco by PAR; 3. To present the lowest financial management indexes based on the diagnosis in loco by PAR. The results suggest that PAR does not effect a resultbased management which are proposed in its legal rules neither the SEMEDs can propose their conception of educational management. That situation creates a hybridism that sometimes turns to managerialism and performativity, sometimes to bureaucracy, sometimes to a total uncoordinated and unarticulated action. In relation to SEMEDs management, this thesis shows that these institutions have no own conception about educational management and end up acting in an uncoordinated and unarticulated way. The thesis concludes that PAR is an over imposition by federal government towards national sub-governments that conflicts with management patterns of those institutions that are used to a less managerial logic. This over imposition makes the Central government to be the center of Brazilian federalism, which is in reality an incomplete pact.

Resposta imune à saliva de flebotomíneos (diptera: psychodidae) em indivíduos residentes em áreas urbana e periurbana no nordeste do brasil

Visceral leishmaniasis (VL) has a wide geographical distribution in tropical and subtropical areas of the planet, which is a protozoan parasite of the genus Leishmania. This pathogen is transmitted to the host through the sandflies bite, with its saliva, the immune response that leads to both. In the state of Rio Grande do Norte, 85% of the sand flies captured is Lutzomyia longipalpis, but the second most abundant, Lutzomyia evandroi, it deserves emphasis because its wide distribution and eclectic behavior. The exposure of people living in endemic areas for the insect vector VL greatly increases the chances of infection. This study aimed to evaluate aspects of the epidemiological profile of VL in endemic areas of human and nonendemic in the metropolitan area of Natal, as well as verify the abundance and seasonal fluctuations of sandflies species in two counties endemic for VL. Were collected in the municipalities of Nísia Floresta, Parnamirim, São Gonçalo do Amarante and Macaíba, of which groups of females were separated for further dissection of the salivary glands and identification of species. The blood samples used were from individuals of two Natal s districts where it has never been reported cases of VL and neighborhoods of Parnamirim applicants who present cases of VL. In the municipality of Nísia Floresta, the most abundant species was L. evandroi with 38.39%, followed by L. longipalpis with 36.22%, L. walkeri 19.67% L. lenti 3.81%, L. wellcomei 1.39% and L. whitmani 0.52%. Already in Parnamirim the proportions were L. walkeri with 73.15%, L. evandroi with 10.55%, L. wellcomei 7.63%, L. longipalpis 6.37%, L. whitmani 1.46%, L. sordellii 0.52%, L. intermedia 0.21 and L. shanonni 0.1%. In both municipalities was observed higher abundance of species distributed in the initial months of the year, as February and March. The study showed that no difference in exposure to the vector of VL among individuals from endemic and non endemic area for this disease. But there are differences in exposure between individuals of L. longipalpis and L. evandroi, confirming the great powers of the first vector. It was also characterized as predominant phenotype in the population of endemic areas who had negative serologic responses to antigens of Leishmania and result in negative Montenegro skin test (DTH), indicating that much of the population hasn t been bitten by infected insects