60 resultados para Organização da prestação de cuidados


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In current upbringing production, children are often conceived as rightful subjects, and concrete and singular people, marked by specificities that schools must respect, mainly their personal wholeness, their care and attention needs, as well as their abilities to learn and produce culture. In the educational practices frame, routine is considered to have a definitive roll in time, space and activities structuring, as with actions and relations of subjects involved. In that perspective, this research aims to analyze routines of zero to two years old children in the upbringing context, relating to their childish specificities. Anchored in the qualitative approach, a Case Study was developed, according the procedures of daily routine observation and semi-structured interviews with six nursery teachers of CMEI Centro Municipal de Educação Infantil, Natal-RN, the research field. The data analysis was based in Speech Analysis principles. The teachers utterances regarding routine and it s roll in the frame revealed significances related to control/regulation of actions theirs and students aiming to streamline tasks; learning relative to routine itself, time and school practices. Thus, prospects of discipline and exercise of power of teachers over students surges, reducing their possibilities to participate. These conceptions reflect the daily routine of the kids and their teachers. By analyzing the methods of routine operation in the time/space/activities frame of CMEI, it was possible to perceive its homogenization of actions and rhythms, not only of the group s children, but the whole institution, which creates, many times, a controlling character that contains/prevents children s initiative. However, it was also possible to observe that in routine recesses, when it s relaxed, and other spaces, times and actions are provided, kids have the opportunity to experience and create different ways of action and relation with time, materials, other kids and teachers, being, as such, respected their specificities. We highlight the importance of reflections regarding routine in upbringing context, as to comprehend it s functions and the need for it s construction to take a multiple character that respects the plurality of situations and singularities of children as persons

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Tuberculosis is an ancient disease that remains a serious problem of Public Health, requiring a pressing attention. Advances in the knowledge and technology available to control it has not been sufficient to significantly impact on morbidity and mortality, especially in developing countries. To enable patient compliance with TB treatment, preventing the abandonment of this to ensure the correct use of medicines has been suggested the DOTS (Directly Observed Treatment - Short course) or directly Observable Short Course Treatment. This study focuses on the incorporation of two technical components of the DOTS strategy at the Family Health, namely, active search for respiratoy symptoms and Supervisioned Treatment (ST). The West Sanitary District was considered best suited to be the focus of study because it is assumed that those sites that were better structured would provide better information about the situation of the strategy in the municipality. Its purpose is to analyze the organization of DOTS as the active search for respiratory symptoms and Directly Observed Therapy in Health Teams Family belonging to a Health District in the city of Natal, Brazil. An exploratory descriptive study with a quantitative approach which involved health professionals from 11 units of Family Health, West Sanitary District, Natal, Rio Grande do Norte. We interviewed 62 professionals on the professional category, their involvement in the DOTS strategy, managers' contributions to the sustainability of the strategy, actions Search for symptomatic diagnosis and supervised treatment of TB cases and difficulties and facilities for the sustainability of the DOTS strategy. It is concluded that the actions taken by the professionals of the FHS West Health District are organized in more supervised treatment, a fact noted in their perceptions about DOTS

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The present study is based on an analysis of professional work relationships in the nursing team from the task/skills of its members as a contribution to understanding the work process in nursing. It is aimed to identify the skills of the nursing team members through the vision of nurses, technicians and nursing assistants, thus it attempts to find strategies to improve the health assistance to patients. It is a descriptive and analytical study with a qualitative approach grounded in theoretical and methodological framework of Symbolic Interactionism. The research was carried out in the participant work place, a Public Hospital of Reference for the SUS, located in the eastern health district of Natal/RN. Nineteen nursing professionals participated in the study, which seven was nurse and twelve nursing technician. As procedure to collect data we used an unstructured interview accompanied by a standard topic guide which was recorded and later transcribed. The content analysis was chosen as the main methodology to analyze the discussion, which gave rise to thematic categories that were considered relevant based on the theoretical framework of this study, and the interactionist theory. This study was in accordance with the ethical principles of the Resolution nº. 196/96, it has obtained an appropriate consent of the UFRN Research Ethics Committee. The results indicate that the professionals seen the nursing as a profession strongly attached to the health care process and as a profession that acquired a scientific status very recently. Regarding to the nursing functions in the work process in nursing, the professionals they identified the manage/administer category as the main activities developed by these professionals, thus the education and complex care in nursing categories. Concerning to the technicians and nursing assistants functions, it was figured out in the professional s opinion that there is not distinction among the attribution of these categories. The interviewed were unanimous in report that these professionals are more involved in direct patient health care through performance of basic duties in nursing care. Finally, with regard to the work relationship among nursing team members, the majority of those interviewed see this relationship as disharmony and quarrelsome and in general, there is not bond between categories that comprise the process of work in nursing. On the basis of our results we consider the importance of knowing the meaning of nursing given by these professionals; also their skills could be useful as basis to identify problems, which source could be detected in the power relationship, deviations of functions, gap between design (knowledge) and performance (doing) work, besides the loss of the global activities view in the process of nursing work

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O envelhecimento é um processo multidimensional que envolve entre outros os aspectos físico-biológicos, sociais, econômicos e psicológicos. Ao avaliar essa fase da vida dentro de uma visão social e cultural, percebe-se que ser idoso ou não varia com as concepções culturais, sendo necessário investigar as variações que atuam no processo e rege o fenômeno sociocultural da realidade em que se está inserido. Com o aumento da população idosa mundial, esse processo tende a se intensificar. Estima-se que até em 2050 existam cerca de dois bilhões de pessoas com mais de 60 anos no mundo, e a maioria delas vivendo em países em desenvolvimento. No Brasil, acredita-se que existam, atualmente, cerca de 20 milhões de idosos. A normatização e legislação brasileira de amparo ao idoso em relação à saúde iniciaram-se a partir da Constituição Federal de 1988 e da Lei 8080 que regulamenta o Sistema Único de Saúde em 1990, em seus níveis de complexidade: atenção básica, média e alta complexidade. Para auxiliar nessa prestação dos serviços na atenção básica de saúde é importante observar as condições sociais, culturais, econômicas e de saúde dos idosos e seus familiares. Nesse sentido, a visita ao domicílio e a avaliação deste idoso em seu ambiente doméstico torna-se fundamental para acompanhar o cuidar prestado e o quanto esse processo irá interferir no sistema de saúde, na família e na qualidade de vida dos idosos. Neste contexto, o enfermeiro como integrante da Equipe de Saúde da Família, presta assistência à saúde do idoso no domicílio. Nesse sentido, o objetivo do estudo é analisar o cuidado de enfermagem e da família à pessoa idosa no domicílio com vistas à identificação das influências socioculturais. Trata-se de um estudo do tipo descritivo e de abordagem qualitativa, norteados por princípios teórico-metodológicos da etnografia com vistas ao estudo da influência dos aspectos culturais e sociais na assistência da família e do enfermeiro à idosos em domicílio. Foi realizado no município de Santana do Matos, RN, tendo como participantes, idosos, familiares e enfermeiros da equipe da ESF, definidos a partir da população do município e obtendo-se uma amostra intencional de 25 participantes: 6 enfermeiras, 10 idosos e 9 grupos familiares. Para a coleta de informações, utilizou-se observação, entrevista, diário de campo e grupo focal. Os resultados foram apresentados em forma de narrativa descritiva, na perspectiva dos conceitos de Boris Cyrulnik, com análise interpretativa cultural de Geertz, na busca dos significados e símbolos próprios da cultura da velhice de idosos e dos seus familiares, sobre cuidados que são realizados, tanto pela família, como pelos enfermeiros em domicílio. Observou-se que a família e o cuidador, dentro de sua realidade social e cultural, precisam ser mais compreendidos pela equipe de saúde para ser melhor orientados e capacitados na realização do cuidar de forma adequada. Por sua vez, os profissionais de saúde, em especial o enfermeiro, enfrentam dificuldades para realizar o cuidado ao idoso no domicílio como a grande demanda de atribuições na unidade de saúde como consultas e atendimentos; falta de transporte até os domicílios; extensão territorial do município e das áreas assistidas; número de pessoas atendidas por cada equipe; falta de compreensão dos profissionais de saúde quanto à importância da visita domiciliária na atenção básica. Entendem a necessidade de realizar ações de promoção em saúde, prevenção de agravos e de educação em saúde, além de reconhecerem a importância de uma melhor formação acadêmica para atuar nessa perspectiva e contribuírem para as mudanças necessárias na prática dos cuidados ao idoso em domicílio

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The attention with safety of the patients is important in the quality of the nursing and health care. In the pre-hospital care, such care is essential on site with the purpose of avoiding possible consequences to the individual, ensuring a fast and appropriate care, with improvement of the morbidity and reduction of the mortality. This medical attention is equally associated with the significant risks of adverse events and serious mistakes, which can be reduced with the awareness of the professionals, organization and quality management. It is a descriptive, transversal research, of quantitative approach, with the objective of identifying the risks for the safety of the patient during the mobile pre-hospital care under the view of the nurses, in a city of the Brazilian Northeast. The sample was formed by 23 nurses. The inclusion criteria: to have at least two years of experience and accept to participate on the research. The data collection was done in two steps, first photo collection, through the adapted method of photographic analysis, and the second with the application of questionnaire, divide in two parts: socio-professional data and digital photo punctuation instrument of the patient s safety. The majority of the nurses had an average working time in the mobile pre-hospital care of six years and six months, in the age group of 38 to 53 years old (69,56%) and with Lato sensu specialization (73,91%), being (29,41%) emergency and (29,41%) in intensive care. The (74%) have the Advance Cardiac Life Support (ACLS) and (100%) have the Pre-Hospital Trauma Life Support (PHTLS); (91, 30%) know the thematic safety of the patient. On the pictures it was observed a bigger variability of the categories (risks) where 44% of variance emerged on the first picture of the research. The pictures 4 and 9 with the average below 5 were classified as very insecure, while pictures 7 and 3 with an average above 7, very secure. On the results of risks observed for the patient s safety in the mobile pre-hospital care five categories emerged: organization and packaging of the equipment and materials, routines and specificities in the mobile pre-hospital care, risks on the management of medications, for traumas and infections. Starting from the analysis of these risks, it was proposed ten steps for the safety in the mobile pre-hospital care: 1- Identify the patient; 2- Safety related to prevention of infection; 3- Safety in the management of medications; 4- Safety and standardization of the packaging of equipment and materials; 5- Attention to the specificities of the mobile pre-hospital care; 6- Incentive and value the participation of the patient and family; 7- Promote the communication with the central of regulation; 8- Prevention of traumas and falls; 9- Protect the skin from additional injuries; 10- Understand the benefit of all the equipment in the ambulance. The multiple risks and their emerged combinations on the research indicate a variety of actions to be developed and stimulated, like the use of steps for the patient s safety in the mobile pre-hospital care which contributes with the aid and management of risks, reduction of mistakes, disabilities and death

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A ausência de cuidados do homem com a saúde representa um fenômeno significativo, pois contribui para o aumento da morbidade e mortalidade masculina por causas evitáveis. Essa realidade torna-se mais relevante quando se trata do policial militar, devido às peculiaridades do seu processo de trabalho. Visto isso, considera-se que os cuidados de saúde adotados por policiais militares atrelam-se ao entendimento de que possuem sobre os agravos à saúde, o qual perpassa por concepções de gênero e da profissão. Isso levou ao seguinte questionamento: Como o policial militar concebe os cuidados com a saúde. Objetivou-se analisar concepções de policiais militares sobre cuidados com a saúde. Trata-se de um estudo exploratório e descritivo, com abordagem qualitativa, desenvolvido junto a um Batalhão Militar do Comando de Policiamento de Natal, Rio Grande do Norte, Brasil. A coleta de dados foi realizada no período de junho a julho de 2013. Essa etapa foi antecedida pela anuência do Comandante Geral da Polícia Militar do Rio Grande do Norte, sob a aprovação do Comitê de Ética em Pesquisa da Universidade Federal do Rio Grande do Norte, com o CAAE nº 15449713.7.0000.5537, e autorização formal dos entrevistados mediante a assinatura do Termo de Consentimento Livre e Esclarecido (TCLE), atendendo às exigências da Resolução 466/2012, do Conselho Nacional de Saúde, no que se refere à pesquisa com seres humanos. Participaram do estudo 21 policiais militares, do sexo masculino, que trabalhavam no policiamento ostensivo, não estavam de licença médica e apresentaram condições psicológicas e/ou físicas favoráveis para responder aos questionamentos. Os dados foram coletados por meio de entrevista semiestruturada mediante um roteiro constituído de duas partes: a primeira com questões sociodemográficas com vistas à caracterização dos participantes da pesquisa e a segunda com duas questões norteadoras relativas ao objeto de estudo. Os depoimentos foram tratados conforme o método de análise de conteúdo na modalidade de análise temática segundo Bardin. Desse processo, emergiram três categorias: hábitos de vida de policiais militares, repercussão do trabalho na saúde de policiais militares e atitudes de policiais militares em frente dos problemas de saúde. A análise dos dados foi subsidiada pelo referencial teórico do Modelo de Crenças em Saúde (Health Belief Model), de acordo com as variáveis vulnerabilidade e barreiras . Para respaldar a discussão dos resultados, buscou-se na literatura conhecimentos acerca da saúde do homem e do policial militar. Os resultados apontaram que os entrevistados procuram cuidar da saúde com práticas de exercícios físicos, alimentos saudáveis e preservação do sono. No entanto, vivenciam dores de coluna, ganho de peso, dificuldades para dormir, estresse e sofrimento psicológico. Diante disso, eles buscam apoio quando acometidos por agravos à saúde e reconhecem a necessidade de medidas de segurança durante o serviço. Portanto, notam a sua condição de vulnerabilidade em decorrência de seu ofício, porém enfrentam dificuldades na adoção de práticas preventivas de agravos a saúde. Mediante os resultados, faz-se necessário que o enfermeiro atuante junto a este público elabore, implemente e acompanhe estratégias de atenção a sua saúde

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The changes that have taken place in the organizational environment in recent decades have led to new performance measurement systems being proposed, given the inadequacy of traditional models. The Balanced Scorecard (BSC) emerged as an instrument to translate financial and non-financial assets into real values for all interested parties in the organization, allowing the introduction of strategies to achieve the desired goals. Research shows that most errors committed with the use of this method are related to the implementation process. Thus, the aim of this dissertation is to analyze the process of building and implementing the BSC in an organization. This empirical exploratory study is based on the classic case study method, which enables the researcher to work with a set of evidence, including direct observation, interviews and document analysis. The results show that the use of BSC in the company investigated posed problems during the process of building and implementing the method. These problems were caused mainly by the lack of involvement on the part of upper management and the team s scant knowledge of Balanced Scorecard. One of the gains obtained from adopting the system was the introduction and/or consolidation of a culture of strategic planning and participative management. The continuous implementation phase was highlighted in the monitoring program, created by the organization in an attempt to reverse existing problems, using the BSC as a third generation strategic management system, which led to significant gains, better use of the system and stronger management practices

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The commitment assumed by Brazil to ILO in order to pursue actions toward the ILO/OSH-2001 adoption in the country poses the issue of modeling the institutional arrangement the set roles and relationship between government, standards organizations, health and safety organizations, professionals and other institutions to deploy the ILO/OSH-2001. This Thesis develop institutional arrangement models based on the current model and also in the ISO 9000 scheme and others. It is studied the US case with OSHA and VPP, the OHSAS 18001 and ANSI/AIHA Z-10, in addition to actual context of the regulating norms NR s. The scenarios developed are put to evaluation on feasibility, potential changes and effects on current MTE auditors work scheme. The main results are five scenarios developed and that the MTE auditors tend to be reactive to the change toward the ILO/OSH-2001.

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The Balanced Scorecard (BSC) has been used as a communication tool and strategy monitoring, helping organizations alignment, inserting a new vision with integrated use of performance indicators nonfinancial together with some financial measures. Their proper use leads to a new management style, focused on management strategies, using for this, basically three dimensions: strategy, which should be translated as the primary responsibility for the organizational agenda, the focus that should be concentrated, and the organization with the mobilization of employees. This paper deals with theoretical considerations about strategies, strategic planning, BSC and principles of the organization focused on strategy (OFE). Describes a study of four companies that won the National Quality Award - PNQ, among which, three have adopted the BSC and adopts a particular model of strategic management. The research aimed to make an analysis of the companies regarding adherence to the five principles of OFE, proposed by the BSC, seeking to answer whether the use of BSC is a prerequisite for accession to the Principles of OFE. The results showed that the BSC is a strategic management model that promotes focus and organizational alignment and is a major facilitator in the process, however, cannot be considered a prerequisite for accession to the principles of the OFE, because the four companies studied, including the one that adopt its own model of strategic management, have great levels of adherence to such principles. Making the organization focused on strategy can be considered a natural movement essential for the strategic management, which is not necessarily conditioned by the use of BSC

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The technology of anaerobic reactors for sanitary wastewater treatment has been extensively developed in Brazil, and today it is practically consolidated. They present several advantages, such as low construction and operating costs, and low sludge production, the anaerobic reactors are an attractive alternative to minimize problematic lack of basic sanitation in urban areas, and also of the rural areas. The anaerobic filters have been widely used in Brazil. It produces an effluent with low concentration of organic matter and solids suspended, besides conserving the nutrients, therefore, it is good for use in irrigation, but the practice must be associated with knowledge of the pathogens presence. The main objective of this study was to evaluate the efficiency of anaerobic filters in removal faecal coliforms and helminth eggs, and to verify if the effluent can be used for agricultural purposes, according to the World Organization of Health (WHO, 1989). The protocol used to enumerate helminths eggs was the modified Bailenger method, (Ayres and Mara, 1996) recommended by WHO for evaluation of raw effluent and treated effluent. The membrane filtration method was utilized to determine the concentrations of faecal coliforms. Three different systems of sewer treatment composed by anaerobic filters were analyzed. The results, in a general analysis, showed that all the researched systems reached a larger removal than 93% to helminth eggs, resulting in an effluent with smaller average than 1 egg/L. One of these systems, Sistema RN, reached a larger removal than 99%, confirming the good performance of the anaerobic filters in removal helminths eggs. Even with low concentrations of eggs in the influent, the filters were capable to remove this parameter efficiently. About faecal coliforms, it was observed for all the researched systems an effluent with 106 CFU/100mL. The high concentrations to faecal coliforms in the effluent just allow reuse for restricted irrigation, in agreement with the guidelines of WHO. Although the researched systems have not removed faecal coliforms efficiently, the results indicated a good efficiency of the anaerobic filters in removal helminth eggs

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Este trabalho tem como foco principal a interação em sala de aula, especificando aspectos da organização linguístico-discursiva, na produção conjunta da fala da professora e dos alunos, materializada em turnos, ressaltando o par pergunta-resposta na aula de Língua Portuguesa. Para alcançarmos esse objetivo, inspiramo-nos em alguns trabalhos acerca da organização da interação que adotaram a perspectiva dos estudos interacionais e a abordagem etnográfica, a fim de explicitar o conhecimento nos espaços de ensino e aprendizagem. Entre eles, citamos as pesquisas de Galvão (1996, 2004) e de Matêncio (2001). Nessa direção, descrevemos o processo de interação em sala de aula em uma escola pública, analisando e interpretando as ações de linguagem realizadas pela professora e pelos alunos. Teoricamente, embasamo-nos, principalmente, na Análise da Conversação, ancorando-nos no estudo pioneiro de Sacks, Schegloff e Jefferson ([1974] 2003); nos postulados de Marcuschi ([1986] 2007a); nas pesquisas de Kerbrat-Orecchioni (2006), dentre outros. Explicitamos uma tipologia de perguntas e respostas em sala de aula, quanto à sua forma e função, conforme os postulados teóricos de Stubbs (1987), Araújo (2003), Fávero, Andrade e Aquino (2006), Silva (2006) e Koshik (2010). Analisamos a organização da tomada de turno, seguida de uma investigação sobre perguntas e respostas no discurso desenvolvido face a face. Na tentativa de compreendermos o cotidiano dos envolvidos no cenário de sala de aula, adotamos a abordagem etnográfica e o método indutivo, nas perspectivas de André (2010) e Chizzotti (2006). Os dados foram gerados através de pesquisa de campo, por meio de gravações (em áudio) de aulas de Língua Portuguesa, posteriormente transcritas e transformadas no corpus de pesquisa. As análises demonstraram que a interação entre professora e alunos organizou-se em trocas de turnos, na maioria das vezes, controladas pela professora, evidenciando-se uma relação de assimetria entre os participantes. Esses turnos concretizados, geralmente, no par adjacente pergunta-resposta revelaram como a construção do conhecimento se realiza em sala de aula. Por fim, observamos que a interação em sala de aula de Língua Portuguesa é organizada por aspectos sociais e pedagógicos intrinsecamente imbricados

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This thesis has as its object the Markers Organization Standard Narrative Discourse (MON), from its occurrence in oral and written corpora of different realizations of narrative discourse, considering its locus of occurrence in the narrative and discursive functioning. The research is guided by the Functional Linguistic Usage-Based, approach to which the organization of language is directly linked to the user experience, so that grammar is shaped by discourse. We examined only the narrative portions of Experience Reports, Tales and Legends in the oral and written, as follows: 3 inquiries Corpus Reports Remaining Quilombo (RN); 11 Corpus Legends legends of the Amazon, 14 Tales of Corpus Tales Brazilians and 21 Reports of experiences of Corpus and Discourse Grammar, with about 10,000 words in each corpus. A total of 22 markers were identified, which were: (1) classified according to the locus of occurrence in the narrative structure, as Labov (1972), (2) associated, according to the type of pattern that occur in narrative discourse, (3) described from the discursive function they perform. The research has relevance to the extent it is based speech analysis and offers proposals for productive teaching of mother tongue in which students and teachers can, grounded in language studies, consider living language, as an object of study, based on the National Curriculum Guidelines (OCN) and making use of New Technologies of Information and Communication (NTIC)

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The professional profile of public administrators in Brazil is changing very rapidly in recent years, seeking to meet the principle of efficiency by public agencies at all levels. The admission of the permanent government employee under the Public Administration is by competition, however, commissioned positions are free appointment of managers, which allows effective participation of external experts according to their respective standards and norms. In this context, this dissertation seeks to understand the main characteristics of the profile of the occupants of commissioned positions in Direct Public Administration of the State of Rio Grande do Norte, noting the differences between those with functional link with the have nots. For this study, by data collection and content analysis, a mapping of the administrative structure of the Government of the State of Rio Grande do Norte was done, i.e., the organization of the Executive Branch, which is regulated by the Complementary Law no. 163/1999 and its amendments, which consists of 53 (fifty three) entities, these 29 (twenty nine) are agencies of the direct administration and the remaining 24 (twenty four) comprises the indirect administration. With the collected data, analysis on the number of commissioned positions of each organ of the State of Rio Grande do Norte and information on education, age, length of service, gender and functional link with the direct administration was carried out. Data were available from SEARH in June/2013, when they totaled 58,733 (fifty-eight thousand seven hundred thirty-three) servers, these 2.15% (two point fifteen percent) occupy commissioned positions, corresponding to 1,262 commissioned positions under the Direct Administration, below the national average of 4% (four percent). Of total commissioned positions 64.7% (sixty-four point seven percent) have no functional link with the direct administration, while only 35.3% (thirty -five point three percent) have functional link. It was noticed that there are no clear and specific criteria for the appointments of commissioned positions in the State. They occur freely, as provided in the State Constitution. Another conclusion is the importance of Public Administration define and improve their capacity, competence and efficiency in the delivery of public services. For that it is necessary to invest in their workforce composed of permanent employees and commissioned positions to define the appropriate professional profile

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The public dental services in Brazil were limited, practically, to the basic care, so that the specialized services acted, up to 2002, no more than 3,5% of the total of clinical procedures. That lower offer reveals the difficulty of continuity of the attention, that is, the comprehensiveness in the assistance, particulary, the reference and counter-reference system. Brasil Sorridente search to supply those needs when proposing Speciality Dental's Centers(CEOs Centros de Especialidades Odontológicas, Brazil) to compose the services of average complexity. In 2005, Ministry of Health enabled the three CEOs of Natal, located in the North II, East and West Sanitary Districts. This investigation evaluated the implantation of these CEOs, as support of the family health care teams, in the perspective of organization of the services in assistencial nets in Natal/RN. It was a study of evaluation, with qualitative approach and some quantitative data as contribution. Dentists, users and managers were interviewed to identify and to understand their perceptions, relationships and experiences in the daily of the services. The conceptual base that orientated the investigation was the principle of comprehensiveness, in its operational sense of the hierarchization in health attention levels. The collection of data was done with documental research, direct observation and semi-structured interview. The analysis was accomplished by triangulation of the extracted content from the used techniques and sources of interviewed groups depositions, looking for theoretical-conceptual support in specific bibliography. The results pointed aspects that go away from the comprehensiveness like: low resolution of problems in the basic net; little valorization of the space in the health units; traditional models of access to health services, insufficient offer for some specialties, compromising the reference and counter-reference system; practices centered in procedures in the CEO; bureaucratic directions from basic care to the specialized service; disintegrated and disjointed system among levels of attention; disrespect to the municipal protocol. On the other hand, there is an approach of compreensiveness in situations like: increase of the access and covering in the Family Health Strategy (ESF Estratégia Saúde da Família, Brazil); larger approach between professional and user; tendency to the quantitative and qualitative growth of specialized actions; punctual initiatives of relationships among levels; existence of protocol to guide professionals

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Circadian rhythms are variations in physiological processes that help living beings to adapt to environmental cycles. These rhythms are generated and are synchronized to the dark light cycle through the suprachiasmatic nucleus. The integrity of circadian rhythmicity has great implication on human health. Currently it is known that disturbances in circadian rhythms are related to some problems of today such as obesity, propensity for certain types of cancer and mental disorders for example. The circadian rhythmicity can be studied through experiments with animal models and in humans directly. In this work we use computational models to gather experimental results from the literature and explain the results of our laboratory. Another focus of this study was to analyze data rhythms of activity and rest obtained experimentally. Here we made a review on the use of variables used to analyze these data and finally propose an update on how to calculate these variables. Our models were able to reproduce the main experimental results in the literature and provided explanations for the results of experiments performed in our laboratory. The new variables used to analyze the rhythm of activity and rest in humans were more efficient to describe the fragmentation and synchronization of this rhythm. Therefore, the work contributed improving existing tools for the study of circadian rhythms in mammals