Nervos: rede de discursos e práticas de cuidado na atenção básica no município de Natal/RN

The Primary Health Care and one of its main strategies, the Family Health Strategy (ESF), are framed as the gateway to the Public Health System (SUS). Thus, most of the incident and prevalent health problems in the population attended should be solved at this level of care, including psychological suffering, and the so-called complaint of nerves. Nerves and nervous denote a complexity that is not always well comprehended by health workers, in such a way that the care to this kind of problem is usually inadequate. In this line of thought, the general objective of this study is to analyze the network of discourses and the care to the psychological suffering, expressed as nerves, in SUS daily Primary Health Care. Besides and more specifically, it aims at identifying the principles and guidelines of the Primary Health Care in mental health; to investigate health workers positioning before psychological suffering and complaints of nerves, and also analyze different actions and practices of care carried out in different Health Units towards complaints like nerves. Institutional Ethnography was the theoreticalmethodological perspective adopted for the work. This approach seeks to understand and analyze the institutional relationships in a particular context considering sociostructural influences and power relations, as well as daily discourses and practices. Based on interviews with health professionals, informal conversations and observations in six Health Units with ESF teams from different sanitary districts in Natal/RN, it was possible to check that the index of complaint of nerves is high. The referral to psychologists and psychiatrists, as well as the prescription of psychotropic drugs appear as the most common intervention at this level of care. In general, the participants complain that they have poor specialized knowledge about the theme of mental health. They face the problem of bad work conditions and the lack of institutional support, which make actions of illnesses prevention and health promotion even more difficult. Besides, there are different ongoing practices such as meetings for hypertensive and aged people, walk, visit, round-table discussions and community therapy. However, not all of these actions are aimed at the care of psychological suffering. It is observed that the Matrix Support, which is a methodological strategy of supervision and follow up forcases of mental health, hasn t been totally implemented in the municipal system, although it is a tool that has been used by psychologists in some Health Units in the city. It was also verified that the health care practices to the problem of nerves strongly depend on the professional s commitment with the PSF guidelines and on mental health policies, in addition to continued support, when available, from other professional who works as matrix supporter

A infância no âmbito do discurso dos parâmetros curriculares nacionais

The educational institution, committed to the production and transmission of knowledge, has increasingly revealed a specific dimension of that commitment, which is to form people und to produce certain kinds of subjectivity. The child is involved in a context of subjectivity production becoming the object of expectations; expectations arising from the demands of a globalized world, and based upon a discourse of specialized fields of scientific knowledge relative to childhood. The purpose of the present work is to analyse the discourse found in the Parâmetros Curriculares Nacionais - PCNs (National Curriculum Guidelines) as concerns the first four years of Elementary education, trying to disclose its ideas and conceptions about the subject-child. Conceiving this discourse as an ideological phenomenon in which the word becomes the central stage where contradictory values are confronted, according to Bakhtin thinking, the analysis constitutes an effort to point out the voices which supply its basis, in what it reveals about the child. Assertions such as "preparing children for the working market", or for "exercising their citizenship", among others which can be found in the institutionalized pedagogical discourse, are stated in a universalized and normative sense, and have become the object of doubt and criticism. The investigation on the implicit and explicit conceptions about childhood as revealed in the PCNs, whose spokesperson has been the school, serves as the starting point for a series of other studies and reflections intended to pave the way for the implementation of educational processes which allow for singular manifestations of the subject-child

Participação de moradores no programa de coleta seletiva em três bairros de Natal/RN: explorando determinantes psico-socio-ambientais

The general purpose of the study was the analysis of residents' participation in the program of door-by-door collection of recyclable residuals in Natal, Rio Grande do Norte. Even though the conception of such program by municipal managers was basically aimed at providing job opportunities and income for the collectors, the main objective of the investigation was to verify whether residents' participation could be attributed to their environmental commitment. Data collection involved three municipal districts and was performed in three stages, with complementary methodological strategies (observation, questionnaire, and interview), and characterized by selfevaluation, by residents, and hetero-evaluation, by collectors. Social, demographic, situational/contextual, and dispositional data were identified to help in the analysis of residents' adherence to the program. Separating and delivering recyclable residuals was the most frequent type of residents' participation, which demonstrates their low level of appropriation of decisions related to the program, taking part on it as passive agents. Two forms of motivation towards participating in the program were found: environmental and social. Despite the first being more frequent, it was associated to lack of environmental awareness related to the process, which may very well imply a mere reproduction of pro-environmental discourse. Motivation towards social issues was strongly connected to philanthropic forms of help. Knowledge was revealed as na important predictor for participation, as well as social networks, formed by neighbors, relatives and friends. Despite the social emphasis in the design of the program, it is possible to conclude that some residents also perceive its environmental benefits, possibly as consequence of a knowledge originated outside the program. Initiatives of environmental education should be promoted in order to minimize the allegation of lack of knowledge as justification for non-participation. Similarly, actions to put together municipal management and population would be welcome, to promote joint decisions towards sustainable styles of life

Avaliação do programa de atenção à saúde do trabalhador: uma abordagem da atenção primária

The accelerated industrialization, coming with the Industrial Revolution, caused profound changes in the working world. These changes led to the households risks from work environment. Trying to assist comprehensively the health of workers, Brazil has a program of Health Care Workers in the Primary Care, and the Family Health Strategy is the main entrance for this system. The study sought to determine if the actions of the health care worker have been developed in primary care through the Family Health Strategy. This is a quantitative study with a methodological evaluation, focusing on normative assessment. The sample was formed by professionals from Team Family Health Strategy, in the municipalities of Pau dos Ferros, Caicó and Natal in Rio Grande do Norte state. The sample consists of 202 professionals (Doctors, Nurses, Assistant / Technician Nursing and Community Health Workers) in 52 Health Family Units from the 3 municipalities cited. The instrument used consists of a checklist, from Manual of Primary Care 5 - Family Health - Occupational Health, Ministry of Health. The data were analyzed describing the variables by its frequency and doing a classification of cities from the scores obtained by each. It was observed that the Family Health professionals know the program of health care worker, however do not know the Manual of Primary Care 5, which is a guidance tool. As a result of non-appropriation of the FHT professionals with worker health, these activities are not performed, mainly surveillance in occupational health and health education labor

Avaliação da satisfação das usuárias sobre a atenção à saúde da mulher no Rio Grande do Norte

This work discusses the evaluation of the satisfaction of the users on the women health care focusing on the quality of the primary care in the State of Rio Grande do Norte-BR. The main objective of this research is evaluate the satisfaction of the users about the actions applied to women health in the primary health care in Rio Grande do Norte, observing the information available through the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). The specific objectives are: the evaluation of aspects related to women health; the evaluation of the specific actions related to welcoming the pregnant and; the evaluation of the information related to the postpartum. This dissertation is characterized as an evaluative research made through a multicentric transversal study, using a quantitative approach, which is part of the External Evaluation of the PMAQ-AB in the State of Rio Grande do Norte, made by the Federal University of Rio Grande do Norte. Some secondary data of the interviews with the users who were in the Basic Health Units were used during the External Evaluation of the PMAQ-AB in Rio Grande do Norte. The sample was collected following these criteria: the users that were in the Basic Health Units to attend to any procedure; they must had used the services for at least one year; and they must had agreed to participate the research. The ones that were attending to the services for the first time and the ones that did not use the services for at least 12 months were excluded from the sample. To the data collection it was used a chart of variables/indicators with the following information to the analysis: Women Health Care, Specific Care of the Pregnant and Information about he postpartum. The descriptive analysis of the data were made through absolute and relative frequencies of the variables using the software Statistic Package for Social Sciences (SPSS) for Windows, version 22.0.0. The results show a positive picture of the satisfaction of the users about the actions of the primary healthcare in women health in the State of the Rio Grande do Norte. Another important analysis is the integration of the primary health care with other points of the Healthcare System aiming to reorient the Model of Healthcare as a starter of the access and quality of the services given to the users. Therefore, the evaluation of the satisfaction of the users in health care is essential among all the agents involved in the process of consolidation of the Unified Health System SUS. Also having the need of rethinking the professional practice, reorganizing the processes of work of the multiprofessional teams in health care, enabling financial resources, inputs and materials, planning and systematizing new actions of healthcare aiming to ensure a perfect health care to the people

A incorporação de preceitos ambientais no sistema de gestão de resíduos sólidos do município de João Câmara - RN Brasil

The reality points to the global environmental sustainability as the only viable option for addressing the crisis at hand. The move towards sustainability calls for the generation / evaluation systems in their direction, through the incorporation of environmental requirements and in line with the National Policy on Solid Waste. Therefore, the proposed research supports the importance of social and environmental vision, complementing the technical view, the system for management of solid waste from East London, which is a municipality that has a system whose inadequacies are configured in environmental risk and health. Therefore, by observing, applying the model of sustainability indicators and content analysis of interviews, this research proposes to investigate the principles of sustainability and social participation are presented and what is the perception of risk about the inadequacies in the system. The results confirmed the hypotheses of the study and draw a picture of worrying data, such as very unfavorable indicators of sustainability, lack of channels of participation, uncommitted investments with the management system, devaluation of the collector of waste and differing perceptions about the risk by making actors act in isolation. This worrying situation is eased by the appearance of a series of elements are configured as opportunities for the integration of environmental principles in the system. And despite the inability of managers to participate in the research system, yet it behaves as an opportunity to implement public policies in the area of solid waste such as: the preparation of the municipal waste, the institutionalization of selective collection and organization of cooperative with the support of companies present in the city and educational institutions as the Federal Institute. The research is an opportunity for the implementation of policies in the area of solid waste and will collaborate with the building instruments for the quality of life of residents, for the socioeconomic conditions of collectors and the move towards a sustainable society

Ativação das células hepáticas estreladas e fibrose hepática em crianças portadoras de hepatite autoimune tipo 1: estudo imuno-histoquímico de biópsias hepáticas pareadas antes do tratamento e após a remissão clínica

The activation of hepatic stellate cells (HSC) is considered the most important event in hepatic fibrogenesis. The precise mechanism of this process is unknown in autoimmune hepatitis (AIH), and more evidence is needed on the evolution of fibrosis. The aim of this study was to assess these aspects in children with type 1 AIH. We analyzed 16 liver biopsy samples from eight patients, paired before treatment and after clinical remission, performed an immunohistochemical study with anti-actin smooth muscle antibody and graded fibrosisand inflammation on a scale of 0:4 (Batts and Ludwig scoring system). We observedthere was no significant reduction in fibrosis scores after 24± 18 months (2.5 ± 0.93 vs. 2.0± 0.53, P = 0.2012). There was an important decrease in inflammation: portal (2.6 ±0.74 vs. 1.3± 0.89, P = 0.0277), periportal/periseptal (3.0 ±0.76 vs. 1.4 ± 1.06, P = 0.0277), and lobular (2.8 ± 1.04 vs. 0.9± 0.99, P =0.0179). Anti-actin smooth muscle antibodies were expressed in the HSC of the initial biopsies (3491.93 ±2051.48 lm2), showing a significant reduction after remission (377.91 ±439.47 lm2) (P = 0.0117). HSC activation was demonstrated in the AIH of children. The reduction of this activation after clinical remission, which may precede a decrease in fibrosis, opens important perspectives in the follow-up of AIH.