O trabalho em equipe na atenção primária à saúde: situação de Portugal e do Brasil

Introdução: Na Atenção Primária à Saúde, nos contextos internacional e nacional, o trabalho em equipe tem sido reconhecido como estratégia decisiva para a organização de processos que visam à integralidade do cuidado, além de possibilitar melhorias na satisfação dos usuários com os serviços de saúde. Neste sentido, o objetivo, deste estudo, é analisar o trabalho em equipe na Atenção Primária à Saúde. Método: Trata-se de uma pesquisa em banco de dados secundários. Realizou-se três estudos: a) O trabalho em equipe na Atenção Primária à Saúde, em Portugal, pesquisa avaliativa, de natureza qualitativa, tipo estudo de caso descritivo, que representou um recorte dos resultados derivados da pesquisa integrada ao projeto “Implantação das Unidades de Saúde Familiar em Portugal”, que teve como procedimentos entrevistas semiestruturadas, roteiro de coleta de informações (check list) e análise documental. Foi realizada a estratégia de triangulação dos dados com análise de conteúdo; b) trabalho em equipe, acesso e qualidade na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 17202 profissionais e 65391 usuários. Utilizou-se entrevista estruturada, com análise estatística realizada pelas frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. c) satisfação dos usuários com o trabalho em equipe na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 65391 usuários. Realizou-se análise estatística das frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. Utilizou-se, ainda, o Teste X2 , com nível de significância de 5%; análise de regressão logística múltipla. O modelo final foi ajustado pelo teste de Hosmer/Lemeshow, o qual indicou um ajuste de 66%. Resultados: Sobre o trabalho em equipe na Atenção Primária à Saúde, em Portugal, destacou-se a formação das equipes de forma voluntária, por meio de afinidades pessoais, a existência de “carteira básica de serviços”, juntamente com x intervenções de vigilância, promoção da saúde e prevenção de doença, cuidados em situação de doença aguda, acompanhamento clínico de doença crônica e de patologia múltipla, cuidados domiciliares, interligação e colaboração em rede com outros serviços (cuidados hospitalares), sistemas informatizados nas unidades de saúde. Os dados revelaram dificuldades quanto ao atendimento domiciliar. No Brasil, foi destaque o processo de trabalho, com avanços relacionados a realização de planejamento e programação das ações e o apoio da gestão. Existência de território definido e de prontuários familiares. É destaque a agenda compartilhada e pactuada entre os profissionais. As equipes realizam acolhimento e reuniões, cujos temas, discutidos, giram em torno do processo de trabalho e planejamento. Os desafios, enfrentados, estão relacionados ao agendamento dos usuários; ao número de pessoas sob a responsabilidade das equipes; à existência de população descoberta nas áreas adscritas à Unidade de Saúde; à incipiência na ação intersetorial e ao pouco envolvimento da comunidade pelas equipes. Quanto aos fatores associados à satisfação do usuário foi marcante: a faixa etária; a escolaridade; a raça; se a falta de material prejudica o atendimento e se a equipe consegue marcar consulta para outros profissionais. Conclusões: Constatou-se o trabalho em equipe como elemento central no processo de mudança na Atenção Primária à Saúde, tanto no contexto de Portugal quanto no do Brasil, o qual ampliou o acesso e a qualidade na oferta de serviços de saúde e obteve, ainda, o reconhecimento social, mesmo que, em ambas as realidades, não tenha avançado na coordenação do cuidado e no estímulo à participação social. Os fatores, associados com a satisfação do usuário, estão relacionados diretamente ao cuidado prestado e refletem a expectativa, por parte do usuário, de resolução concreta de suas necessidades.

Para uma gestão social no programa minha casa, minha vida: reflexões acerca da organização comunitária em empreendimentos da faixa 1

A política habitacional teve importante avanço na década de 2000, principalmente com a criação do Ministério das Cidades. A estruturação do Plano Nacional de Habitação ocasionou inclusão do tema na agenda governamental, permitindo a produção de habitação de interesse social voltada à população em situação vulnerável, através do Programa Minha Casa Minha Vida (PMCMV). Assim, a presente dissertação tem como objetivo compreender atributos de gestão social para a organização comunitária em empreendimentos da faixa 1 do Programa. Para tanto, realizou-se pesquisa quantitativa, por meio da aplicação de formulários, e qualitativa, por meio de grupo focal, ambos com beneficiários do Programa. No tocante aos resultados, observou-se debilidade do papel do Estado, caracterizado principalmente pelos frágeis Projetos Técnicos de Trabalho Social. Os elementos de gestão social igualmente foram frágeis, distanciando os empreendimentos de condições ideias de habitabilidade e convívio coletivo. A ausência de compreensão da relevância de bem-estar coletivo e a precariedade da esfera pública, conduzem ao afastamento da finalidade emancipatória da gestão social. Destacou-se, ainda, o papel de associações de moradores e de iniciativas de trabalho coletivo no atendimento de demandas sociais da comunidade.

Organização nuclear do sistema serotonérgico no encéfalo de morcegos Artibeus planirostris

Serotonin or 5-hydroxytryptamine (5-HT) is a substance found in many tissues of the body, including the nervous system acting as a neurotransmitter. Within the neuro-axis, the location of the majority of the 5-HT neurons is superimposed with raphe nuclei of the brain stem, in the median line or its vicinity, so that neuronal 5-HT can be considered a marker of the raphe nuclei. Serotonergic neurons are projected to almost all areas of the brain. Studies show the participation of serotonin in regulating the temperature, feeding behavior, sexual behavior, biological rhythms, sleep, locomotor function, learning, among others. The anatomy of these groups has been revised in many species, including mouse, rabbit, cat and primates, but never before in a bat species from South America. This study aimed to characterize the serotonergic clusters in the brain of the bat Artibeus planirostris through immunohistochemistry for serotonin. Seven adult bat males of Artibeus planirostris species (Microchiroptera, Mammalia) were used in this study. The animals were anesthetized, transcardially perfused and their brains were removed. Coronal sections of the frozen brain of bats were obtained in sliding microtome and subjected to immunohistochemistry for 5-HT. Delimit the caudal linear (CLi), dorsal (DR), median (MnR), paramedian (PMnR), pontine (PNR), magnus (MgR), pallidus (RPA) and obscurus (ROb) raphe nucleus, in addition to the groups B9 and rostral and caudal ventrolateral (RVL/CVL). The serotonergic groups of this kind of cheiroptera present morphology and cytoarchitecture relatively similar to that described in rodents and primates, confirming the phylogenetic stability of these cell clusters.

Projeto ético-político do serviço social e organização política da categoria: dilemas e tensões contemporâneas

The present study was to apprehend the controversies that underlie the political organization of the category nowadays. The research established time frame as the decade from 2003 to 2013, more precisely the situation that opens with Lula's election to the Presidency and its repercussions for the Brazilian left, social movements and for the category. Through documentary research, we studied the professional aspects that are organized politically in different fields , notably the Federal Council of Social Service (CFESS) and the National Federation of Social Workers (FENAS). Seeking to understand their relationship with the Ethical - Political Project of the profession, public documents were analyzed expressing the political positions of these entities, placing the controversies and political differences between them and understanding the political organization as a means to building professionals and corporate projects many.

Direitos fundamentais sociais no Brasil: desafios e mecanismos para sua concretização

The work referred to above, in order to contribute to the legal issues, economic, political and social of the violation of social rights, performs even firmer approach to various implementation mechanisms of social rights in Brazil. Therefore, it begins the study dealing with aspects and important characters of the rights under discussion, as its normative forecast, concept, classifications; respect of social rights with the existential minimum; the principle of reservation of the possible and the need to use this principle as optimization commandment of state resources and the deficit of the realization of social rights in the country. This, in later chapters, in an interdisciplinary approach, challenges and proposals for the realization of social rights by bringing in each chapter, mechanisms for such implementation. That way, as a general objective, it has been to contribute to the discussed problems, when present proposals for the realization of social rights in the Brazilian context. As specific objectives, as well as record the key aspects of the rights in allusion, the one has to promote the perspective of economic development and taxation as posts instruments that the State must be focused on the promotion of social rights by registering in this context that nonexistent economic development without reducing poverty, misery and social inequality and adding that there should be a directly proportional relationship between the tax burden in the country and the human and social development index; analyze the achievement of budget control as essential and healthy measure for the realization of social rights; highlight the importance of society to the achievement of unavailable social interests, affirming the need for the implementation of participatory democracy and, in this line, brings knowledge of the Constitution and the constitutional sense as elements that provide the constitutional progress. Finally, it presents a study on public policies, considering that these are equivalent to the primary means of the promotion of social rights. That way it analyzes the stages that integrate public policies, ranging from the perception of social problems for evaluation and control of the policies implemented; debate about the administrative discretion in when it comes to public policies; brings the classification of essential public policies, the relationship of these with the existential minimum, control parameters and, finally, the legalization of public policy, regarded as legitimate to remedy the unconstitutional state failure and give normative effectiveness and strength to the defining constitutional rules for fundamental social rights. It uses to achieve the objectives outlined, the bibliographic and normative approach method and performs an analysis of jurisprudence related understandings to matter. In the conclusions, it rescues the most important aspects elucidated at work, with the aim of giving emphasis to the proposals and mechanisms that contribute to the solution of the discussed problems.

Gasto com a internação de idosos em unidades de terapia intensiva

Introduction: Population aging in Brazil underscores the need to discuss the proper management of the budget allocated in health field, especially in the sectors of high complexity, where coexist costly procedures, limited resources and the need for cost containment. In the other hand, demand is growing in a way directly proportional to the increase in the number of elderly in country. Objective: In this way, this research had as main objective to analyze the costs resulting from the admission of elderly in intensive care units (ICU) and its associated factors. Methods: This is a cross-sectional study with a quantitative approach and featured as a descriptive and exploratory research. Data were collected from medical records of elderly hospitalized in ICU from a brazilian city called Natal-RN, between november first, 2013 and january, 31 of 2014. The variables collected relate to the socio demographic profile, morbidity framework and characterization of hospitalization. The dependent variable was categorized by quartile 75 in high and low expense of hospitalization and submitted to chi-square test with the independent variables of the survey. Associations with p value <0.20 in the bivariate analysis were submitted to the technique of multiple logistic regression. We opted for the construction of three regression models from the above algorithm: general regression model, composed by all 493 hospitalizations in the study, other made with 181 individuals admitted in health public system (SUS) and a third one related to 312 cases from private service in health area. Results: In the general regression model, the variables respiratory diseases, hospitalizations in the private system, disoriented patient and previous stroke were associated with greater probability of high spending in the ICU. In the other hand, in SUS kind of hospitalizations, this probability was associated with disoriented patient, 80 years old or more, sepsis and admission for clinical reason. In the cases from the private network health, the high expenditure was associated with respiratory disease, mechanical ventilation, hospitalization for clinical reason and disoriented patients. Conclusion: The increased expenditure on hospitalization of elderly in intensive care depends on the clinical conditions of individuals. This highlights the importance of avoiding hospitalizations due to diseases sensitive to primary care by health preventive actions and providing comprehensive care to the elderly. In addition, obtaining different explanatory models, according to kind hospital funding, demonstrates the importance of the organization in health services related to composition of costs of hospitalization among the elderly. Another question founded was the need that to improve the funding, we must use rationally the available resources by avoiding unnecessary hospitalizations of elderly people in the extremes of severity. On this kind of precarious funding, ICU hospitalization of elderly non-critical or in a terminal state can compromise the quality of services provided to those who really need intensive care.

Turismo e terceiro setor: o papel e atuação de organizações não-governamentais no polo costa das dunas/RN

O tema deste estudo visa pesquisar o papel e atuação das Organizações Não Governamentais - ONGs, terceiro setor do turismo, no estado do Rio Grande do Norte - RN, identificando a atuação e participação no turismo, para, assim, elencar suas contribuições e benefícios para as populações locais, para o usuário dos serviços e para o incremento da economia no Estado. Analisando as que atuam no turismo do Rio Grande do Norte, procurou-se identificar suas contribuições, características e estruturas, descrever as suas formas de atuação e os respectivos resultados e influências. Buscou-se verificar se a organização atua na área de turismo e local adequado para o desenvolvimento das atividades turísticas nos seus projetos, na gestão administrativa e operacional. Para tal, utilizamos a teoria do livro “Análise Estrutural do Turismo” (Beni), bem como o Modelo Referencial do Sistema de Turismo (SISTUR). Avaliando se o tempo em que essa instituição atua na área propiciará às pessoas, de acordo com seus perfis, assimilarem conhecimento como gestoras no processo dos projetos. Observamos como funciona a Gestão de ONGs, a fim de identificarmos se as ONGs trabalham adequadamente as funções gerenciais. Se há envolvimento da organização nos projetos e nas suas fases de processo, assim como, sua importância e dificuldades encontradas na relação estabelecida entre as ONGs e a sociedade. A partir disso, poderemos identificar o envolvimento da comunidade que se beneficia.

Levantamentos epidemiológicos em saúde bucal: análise da metodologia proposta pela Organização Mundial da Saúde

Epidemiological surveys are important for obtaining information on the prevalence and etiology of mouth diseases, since the data collected permit health actions to be planned, performed, and assessed. Methodological uniformity is necessary, however, to maintain reproductibility, validity, and reliability, and to allow national and international comparisons. The initiative of the World Health Organization (WHO) as an advisor in ongoing surveys has been extremely useful, stimulating standardization in all countries. In 1991, a Portuguese version of the 1987 third edition of Oral Health Surveys - basic methods, an instruction manual for performing epidemiological surveys, was published and became a reference for many parts of Brazil and the World. The present analysis found conflicting points in relation to the sample size, calibration of the examiners, and criteria for evaluating oral health and treatment needs. In conclusion, due to the dynamic characteristics of scientific knowledge and, considering the regional differences in relation to the development of oral diseases, we recommend that proposals for standardizing surveys be checked periodically. Other important issues may have not been detected in this analysis, urging a thorough discussion within the dentistry community as a whole.

Levantamentos epidemiológicos em saúde bucal: análise da metodologia proposta pela Organização Mundial da Saúde

Epidemiological surveys are important for obtaining information on the prevalence and etiology of mouth diseases, since the data collected permit health actions to be planned, performed, and assessed. Methodological uniformity is necessary, however, to maintain reproductibility, validity, and reliability, and to allow national and international comparisons. The initiative of the World Health Organization (WHO) as an advisor in ongoing surveys has been extremely useful, stimulating standardization in all countries. In 1991, a Portuguese version of the 1987 third edition of Oral Health Surveys - basic methods, an instruction manual for performing epidemiological surveys, was published and became a reference for many parts of Brazil and the World. The present analysis found conflicting points in relation to the sample size, calibration of the examiners, and criteria for evaluating oral health and treatment needs. In conclusion, due to the dynamic characteristics of scientific knowledge and, considering the regional differences in relation to the development of oral diseases, we recommend that proposals for standardizing surveys be checked periodically. Other important issues may have not been detected in this analysis, urging a thorough discussion within the dentistry community as a whole.

Preferência e competição alimentar em um grupo de Sapajus flavius em fragmento de Mata Atlântica em Caaporã – Paraíba – Brasil

Feeding is the primary selective pressure in all forms of animals. Nutritional ecological models predict consequences of preferred and non-preferred food consumption on behavioural, physiological and morphological adaptations. At same time, socioecological models infer socio-organizarion patterns based on feeding competition faced by animals. A list of preferred foods, and inferences regarding the intensity of feeding competition and its behavioural consequences are information of much importance for management of populations in fragments. In this work we observed the feeding behavior and spatial positioning of a group of more than 100 blond capuchin monkeys (Sapajus flavius) that inhabit a fragment of Atlantic forest, surrounded by sugarcane plantation. We compared the consumption of different food items with their monthly availability in the area to define the preferred and fallback food items. We recorded the vocalizations of aggression and the inter-individual distance (area of Minimum Convex Polygon/n individuals) to infer the type of food competition experienced by animals. In the year studied the fruit feeding time correlated with top consumed fruit productivity, indicating preference for fruits. Our data indicate that the species Elaeis sp., Cecropia palmata, Inga spp. and Simarouba amara are the preferred food items in the diet. Available all year round and uniformly distributed, sugarcane was a regular item in the diet and its was characterized as a staple fallback food for this group. Although fruits are preferential food items, direct competition rate did not correlate to fruit productivity in the area, maintaining the high rates throughout the year (2.45 events/ hour). The inter-individual distance index positively correlated with rain fall indicating scramble food competition. The number of neighbours of females carrying infants was smaller when fruit productivity is low, indicating that females carrying infants are suffering increased indirect competition. Our data indicates that blond capuchins in this fragment make use of sugar cane as a staple fallback food, which evidence the importance of sugar cane landscape for the survival of this critically endangered capuchin species in fragmented habitats in Northeast Brazil. A preliminary list of preferred and important foods is offered, and can assist in the choice of trees for reforestation, better fragments to be preserved and areas of release and translocation of animals. We did not observe an increase of contest competition while using preferred foods, but when using staple FBF. This may be due the altered environment, which results in high competition food throughout the year. Both the food preference as the social and behavioral consequences of high food competition experienced by animals in this fragment must be accompanied over the years to ensure the survival of this population.

Preferência e competição alimentar em um grupo de Sapajus flavius em fragmento de Mata Atlântica em Caaporã – Paraíba – Brasil

Feeding is the primary selective pressure in all forms of animals. Nutritional ecological models predict consequences of preferred and non-preferred food consumption on behavioural, physiological and morphological adaptations. At same time, socioecological models infer socio-organizarion patterns based on feeding competition faced by animals. A list of preferred foods, and inferences regarding the intensity of feeding competition and its behavioural consequences are information of much importance for management of populations in fragments. In this work we observed the feeding behavior and spatial positioning of a group of more than 100 blond capuchin monkeys (Sapajus flavius) that inhabit a fragment of Atlantic forest, surrounded by sugarcane plantation. We compared the consumption of different food items with their monthly availability in the area to define the preferred and fallback food items. We recorded the vocalizations of aggression and the inter-individual distance (area of Minimum Convex Polygon/n individuals) to infer the type of food competition experienced by animals. In the year studied the fruit feeding time correlated with top consumed fruit productivity, indicating preference for fruits. Our data indicate that the species Elaeis sp., Cecropia palmata, Inga spp. and Simarouba amara are the preferred food items in the diet. Available all year round and uniformly distributed, sugarcane was a regular item in the diet and its was characterized as a staple fallback food for this group. Although fruits are preferential food items, direct competition rate did not correlate to fruit productivity in the area, maintaining the high rates throughout the year (2.45 events/ hour). The inter-individual distance index positively correlated with rain fall indicating scramble food competition. The number of neighbours of females carrying infants was smaller when fruit productivity is low, indicating that females carrying infants are suffering increased indirect competition. Our data indicates that blond capuchins in this fragment make use of sugar cane as a staple fallback food, which evidence the importance of sugar cane landscape for the survival of this critically endangered capuchin species in fragmented habitats in Northeast Brazil. A preliminary list of preferred and important foods is offered, and can assist in the choice of trees for reforestation, better fragments to be preserved and areas of release and translocation of animals. We did not observe an increase of contest competition while using preferred foods, but when using staple FBF. This may be due the altered environment, which results in high competition food throughout the year. Both the food preference as the social and behavioral consequences of high food competition experienced by animals in this fragment must be accompanied over the years to ensure the survival of this population.

Análise da organização da rede de saúde da Paraíba a partir do modelo de regionalização

Este artigo analisa a organização da rede de saúde da Paraíba a partir do modelo de regionalização proposto pelo estado da Paraíba. Material e Métodos: Trata-se de um estudo documental que tomou por base, prioritariamente, o Plano Diretor de Regionalização da Paraíba e os documentos oficiais do Ministério da Saúde que orientam a construção dos mesmos pelos Estados. Resultados: A análise dos dados revelou alguns limites no processo de implantação do PDR/ PB, tais como a ausência de análise das características sociais, econômicas e culturais durante a escolha das sedes das regiões de saúde e a inexistente descrição da organização da assistência à saúde do território estadual. Conclusão: O processo de regionalização e a formulação do PDR da Paraíba não seguiram a Instrução Normativa do Ministério da Saúde em alguns aspectos, desconsiderando as especificidades de cada região de saúde, o que pode resultar em problemas no acesso e na articulação da rede de serviços com vistas à legitimação das regiões de saúde desse Estado

As pessoas na organização e o (re)alinhamento estratégico: o modelo de gestão da Alesat combustíveis em Natal/RN

Este trabalho consiste num estudo de caso na empresa Alesat cujo objetivo geral foi compreender o modelo de gestão de pessoas adotad por uma empresa norteriograndense à luz do modelo estratégico de gestão de pessoas. O estudo baseouse na literatura de Albuquerque (2002); Ashton, Haffenden e Lambert (2004); Fischer (2002); Legge (1995); Mascarenhas (2008); Tanure, Evans e Pucik (2007), Ulrich (2000) e Vasconcelos (2006), dentre outros, paa apreender como os profissionais que atuam no delineamento de estratégias e operacionalização das ações de recursos humanos concebem o seu posicionamento e eventual alinhamento à estratégia organizacional. O método analisou e descreveu o modelo de gestão de pessoas da empresa campo do estudo. A coleta de dados contou com a realização de entrevistas semi-estruturadas com os 05 gestores de RH que atuam na matriz (Natal/RN). Também foram coletados dados secundários, além de documentos e comunicações internas da empresa que tocam ao RH. Os dados coletados foram analisados à luz da análise de conteúdo de Bardin (1977). Através da análise, foi possível identificar políticas e práticas de RH que perpassam um modelo de gestão de pessoas bem definido e consolidado, com impactos mensuráveis no desempenho organizacional. Percebeu-se, também, a forte disseminação de uma cultura organizacional com foco no posicionamento estratégico e na informalidade e proximidade das relações, que permeiam o modelo de gestão de pessoas. Concluiuse a coerência entre as políticas estratégicas da empresa e as de recursos humanos. A pesquisa apreendeu as interfaces do modelo de gestão estratégica de pessoas da empresa; estas implicam uma alternância entre pensamentos e atitudes vinculados à versão hard, onde o papel das prática de RH é garantir que as pessoas alcancem os objetivos empresariais; e à versão soft, onde o papel do RH é desenvolver o capital intelectual e humano para diversificar os negócios e alcançar resultados sustentáveis e diferenciados. O salto qualitativo atingido pela Ale pode ser atribuído ao fato de possuir um RH situado hierarquicamente na alta cúpula da empresa, em posição de consultoria interna o que oferece perspectivas de atuação que vão muito além das rotinas operacionais desenvolvidas por boa parte das empresas no Brasil

A comunicação interna numa organização pública

The present study compose an analysis on the process of internal communication at a public organization, built on the survey data originary of administrative conduct, observation on the cultural model of the organization and how the interdepartmental and interpersonal relations shows up. The research, exploratory descriptive kind, had theoretical basis on two knowledge areas Administrative Science and Social Communication and was developed at Instituto do Desenvolvimento Econômico e Meio Ambiente IDEMA, in Rio Grande do Norte. During data collection, were conducted spontaneous and semi structured interviews with directors and coordinators, besides the application of directed questionnaire to functionaries in two unites of the institution. Through the analysis and interpretation of the data, we came to the conclusion that the process of internal communication at a public organization fall in with same challenges of private organizations, but with peculiarities that attracts the scientific look specially, in concern of the attitude assumed by the administrators in the conduction of communication functions inside the organization, the profile of social actor and the communication channels used. Although the organizational communication represents more and more a strategic function, as an administration tool, the point that research gets to shows that in public organizations the communication refrains from administrative purpose and with the major objective of giving publicity to the institutional acts and actions