Avaliação do cuidado na estratégia saúde da família em metrópoles do nordeste brasileiro

Objective: To evaluate the implementation of the Family Health Strategy (FHS) in Brazilian cities of the Northeast, expanding coverage, analyzing the progress, challenges and innovations. Methods: Multicentric Evaluation Research, Studies Baselines in urban centers, using as a case study method. Selected cases of Aracaju, being capital, advanced coverage with extended team, and Fortaleza, capital coverage incipient and minimal staff. In Fortaleza, purposive sample of 11 Units Primary (APS), 03 managers, 53 professionals and 109 users. In Aracaju, 09 units of APS, 02 managers, 36 professionals, and 90 users. Structured interviews for managers, and structured to professionals and users. Descriptive analysis focusing on the political and institutional dimensions, organization and comprehensive care. Results: There was consensus that the ESF is the preferred port users and acts as inducing changes in care. In the case of Fortaleza, the specificities were: care protocols and community activities aimed at chronic conditions (100%) , with greater participation of doctors and nurses (93%) ; conjunction with more complex services, but the teams reported difficulties with the examination center and experts, the long waits and poor access to local services were the main difficulties reported by users., As innovative practice, the therapeutic group of elderly caregivers mentioned by respondents; There was intersectoral initiatives and teams 87 % of users have participated in meetings about health problems. In the case of Aracaju, care protocols were directed to the lines of care and formulated locally, 85 % coverage of the population with FHS counterpart local financing; employees hired by public tender; 70 % of teams with expertise in public health center for continuing education acting; democratization in management; access technologies, welcoming and computerization in different integrated networks, and evaluation matrix. Conclusions: The ESF has promoted access to health care and inclusion of disadvantaged populations. Different perceptions and practices in the organization of care, with distinct trajectories of reorganization. In the case of Fortaleza, predominance of model programs valuing older, with evidence of advances in care practices and teamwork, but restricted to primary care practices and incipient in public policy perspective. In Aracaju, had network integration with technologies related to the family, in which the ESF is consolidated as public policy. It can be argued that the XII APS expanding coverage, exhibited efficacy, despite the challenges inherent to the different degrees of implementation

Mulher chefe de família, na cidade de Aracaju:dominação e poder

The research was focada in the feminine head of family, the City of Aracaju and its impacts in the nuclear familiar nucleus. Considering that, the papers of the men are in general, not valued and rewarded that the papers of the women in almost all the cultures. The women generally load the responsibility to take care of of the children and the domestic work, while the men traditionally are born with the responsibility to support the family. However, we find changes in this mainly north-eastern scene and, where through quantitative research, already one evidenced that they are majority as family support, therefore, we observe the construction of social identities of the women family heads and uncurling of the adaptativos aspects, the existing mechanism between domination and power, in the familiar nucleus. The impacts in the family if had change in the social relation for them to be family heads. One is about qualitative research that has left of the construction of a theoretical landmark, analyzing given of bibliographical sources and from interviews with women family heads, power to observe the forms of joints in the nuclear families, as they deal with the power to decide power, the financial power, the fragility, the domination and the influences of the traditional models. Analyzing the familiar relations between the woman, the children and the spouse, searching the excellent questions for the briefing of the thematic one, demystifying the dichotomy between the mother/wife and woman head of family in the residential environment

Natal como destino turístico : um estudo das imagens (re)veladas pela mídia, pelos turistas e suas implicações educacionais e culturais

This thesis is a result of a research on Natal/RN as a tourist destination. We understand that cities are chosen as tourist destinations beyond its cartographic localization, from other dimensions of meanings that, in its set, constitute images. These images are, probably, very different of the images constructed by native and resident populations, who possess relations of identity with the place. The knowledge of the meanings that others attribute to this city as tourist destination, bring us near to the symbolic bonds established by individuals or social groups on the act of their choices, as well as bring us near to the interaction process city-tourists where the expectations are confirmed or not. The images divulgated by the media also participate of the complex formation of the tourist image that is being constructed and available for the different public, in different social contexts. The tourism constitutes a symbolic asset of the modern society, being considered by the studious, as one of the most expressive phenomena of the modernity, for involving each year displacement and the interaction of thousand of people of different cultures in the entire world. All this people s mobilization points to practical social related to personal motivations, to the entailed desired to the idea to travel and to exceed borders. It is already consensus that tourism is a phenomenon of economic growth, generating jobs, income, professional, qualification, bringing improvements for the host cities. Since 1995, in Brazil, the tourism as a sector of the economy, passed to be considered one of the national priorities, and in this perspective, the national politics of the tourism invested in infrastructure of Brazilian cities with high tourist potential, objecting to increase the flows of Brazilian and foreign tourists. Owing to this fact, the country still invests in programs of tourist marketing, mainly divulging the images of the natural beauties of Brazil abroad. And for Brazilians, the campaigns appeal to rescue the feeling to be Brazilian, associating the idea to travel and know its country. Natal city possesses an excellent positioning in the tourist marketing, being predominantly divulgated in national and international level, for its naturalistic singularity, where the images of its natural enchantments as warm water beaches, white dunes, warm weather, constant breeze and an always blue sky are shown as the favorite scene on this city. From what was viewed above that the choice of a tourist destination articulates from a determined imaginary of a place, already constructed or in process of construction, we consider the knowledge of this imaginary a basic learning for the population of the city and especially, for educators, in the formation of professionals in this area and for tourism managers, elaborators of public politics. Based on this estimative, we developed this research that had as a general objective to identify the images that illustrate Natal city as a tourist destination - our objective of study, particularly the meanings and senses attributed by the tourist marketing (hotel s folders) and by the tourists that visited the city during this study. The discussions and reflections that had guided this research had been given from the theoretical link between imaginary and social representation, also considering some interfaces between the fields of communication and symbol. From the studied authors, Baczko (1985) clarifies that the study of social imaginary is directed for the mechanisms and structures of the social life, especially for the intervention accomplishes and efficient of the representations and symbols in the practical collectives, as well as in its direction and orientation . Following this same thought, Moscovici (1978) says that the social representation are produced in communicational and symbolic contexts, and these representations once that already constituted circulate socially as almost tangible entities. Based on this fundament and on the analyze of Barthes (1990), particularly in the approach given to the reading of photographic image, we could observe on hotel s folders that each page evidences senses and meanings of functionality of internal and external spaces, pointing to the way of leisure offered by the keepers of city which is the hotels. About, the leisure that they offer, it is directed to young public, giving meaning to the young myth of personalized leisure tourism on children, young and adults images. The image about security that hotels offer and the singular image of Natal city as a paradise place, provide an idealization of pleasure through the sun, dunes, and beaches and also due to the hospitability of the natives who are assigned as educated . For the tourist that participated on this research, Natal city is tied only by the imaginary of leisure and nature which constitute the emotional link of the relation media-city-tourist. And with such force and fullness of directions the city discloses without tensions and contradictions as a place protected by a mythical and sacred aura. The study also demonstrates us that the potiguar culture remains (almost) forgotten, due to the silenced in this imaginary. In this perspective, we highlight that this culture silence is very close related to the disvalue of education in its general meaning. We defend that the imaginary apprehended constitutes a new reading and a new looking and understanding the tourist reality that comes historically consolidating in this city. In this direction, we glimpse that this study and its future dismemberments can collaborate with the process of rescue the cultural values of the potiguar people, in the way that the meaning of tourist may be redefined, and the tourist image of the city can be also disclosed for its identities particularities of its culture

O pedagogo como agente de transformação social para além dos muros escolares

This thesis concerns the problem about the pedagogue actuation in the social education into no scholars places. It search to understand the context and the social pedagogue role to his praxis and formation that enlarger the possibilities of the social educative practices into no scholars places. In this direction, we developed an investigation about the actuation of the pedagogues-educators in Natal city, in the 2007-2010 periods, into Municipal Secretary of the Labor and Social Assistance (SEMTAS). Considering that pedagogues are regularly attached in social educators profession as municipals public employees, we re the objective to evaluate their role into the social executed in the no scholars places, with the focus in the environmental dimensions of theirs work s places, pedagogical organization, institutional management and the professional formation. It privileged in this research the Specialized Reference Center of Social Assistance II (CREAS II), the Passages Houses I, II and III, the Social-Educative Measures in Open Environment Execution Program of Natal city (PENSEMA) and the Pitimbú Educational Center (CEDUC-Pitimbú). To realize this study it developed a research with qualitative nature by critic ethnography approach privileging those information collected with the social pedagogue-educators of the mentioned places. Through the methodological procedures adopted; beyond the bibliographical review we remarked the documental research, the semi-structured interview, the questionnaires-routes and the field observations. The analytical results revealed that the politics to the social education in Brazil historically came been dimensioned by the fight of social movements demanding the fundamental rights to the excluded people; that the SEMTAS politics of social education present a relative basic social protection to the excluded children and young people specially into law view; that the politics of social education in Natal city it s close of the logic of sanitarian attention about the disadvantaged groups; that the conceptual, methodological and formatives fragilities needs to the social pedagogues-educators praxis into non scholars places made difficult the operation capacity of a educative proposition anchored in a institutional action guided by the idea of emancipator education; that the SEMTAS take face several difficulties to developed a web assistance as preview in the reception proposition elaborated by the social pedagogues-educators. However in despite the tensions we remarked the value of this potentiality to the non scholar social education in her attempt to constitute herself in a legitimate space to the pedagogue professional actuation. In despite the obstacles to work and formation quotidian, across those non scholar spaces in the municipalities institutes to the social politics, it demonstrated personal sensibility and professional creativity in learning mediations and educative action to the children and younger derived from exclusion process and the social iniquities

Literatura e educação: um caso/uma casa de inclusão

O estudo investiga as contribuições da literatura para a inclusão social na escola, explorando o potencial inclusivo do texto literário. Sua relevância consiste em fornecer ao professor subsídios para ampliar suas competências no ensino de literatura a partir do (re)conhecimento da função inclusiva do texto literário e da construção de uma comunidade de leitores que atenda à diversidade de interesses, necessidades e sentimentos dos aprendizes. Entende-se que a literatura é inclusiva em sua natureza pois, inclui o leitor no texto e permite práticas socializadoras de leitura. O estudo alinha-se à vertente qualitativa caracterizando-se como pesquisa-ação participante. Adotaram-se como procedimentos metodológicos a observação participante e a intervenção pedagógica. O estudo realizou-se em uma turma de 4º ano do ensino fundamental com 43 alunos, de faixa etária entre 8 e 13 anos, matriculados na Casa do Menor Trabalhador CMT, escola pública do município de Natal-RN (Brasil). Os instrumentos utilizados foram: gravação em áudio; diário de campo; entrevistas. Na intervenção pedagógica, realizaram-se 20 aulas de leitura de literatura de contos, fábulas, poemas e adivinhas com diferentes estratégias didáticas. As sessões de leitura foram desenvolvidas conforme os moldes da andaimagem (scaffolding) descritos por Graves e Graves (1995). Tomou-se como referencial teórico os estudos de Aiscow, Porter e Wang (1997), Amarilha (1997; 2006), Aquino (1998), Eco (2003), Caldin (2004; 2003), Cazden (1991), Chartier (1994), Culler (1999), Iser (1996), Manguel (1997), Paulino (2001), Perrenoud (2001), Petit (2008), Sartre (2006), Stainback e Stainback (1999), Stierle (1979) e Zilberman (2005). A análise aponta a relevância do diálogo entre literatura e inclusão social para democratizar a leitura literária e tornar o ambiente escolar mais inclusivo. Confirma a natureza inclusiva do texto literário, no modo como promove a entrada cooperativa do leitor no texto literário em prática socializadora de aprendizado, de compartilhamento de sentimentos, sensações, subjetividades e de acolhimento das diferenças. O estudo revela e consolida a leitura de literatura como uma atividade intelectual significativa, prazerosa e democrática, na qual o leitor, ao colaborar com a construção de sentidos e ao estabelecer relações interativas, passa por transformações que favorecem a inclusão. Ressalta-se a importância do mediador de leitura na seleção de estratégias que viabilizem a democratização da literatura e pela literatura, no pequeno universo da sala de aula, que atendam às necessidades dos educandos, desenvolvendo habilidades leitoras, incentivando o gosto pelo texto literário que educa e convida à inclusão

Uma odisséia em busca de Héstia: do turismo à hospitalidade pelos caminhos das representações sociais

This thesis is the result of a piece of research on hospitality social representations between tourism professionals and academics in the city of Natal. The reasearch s corner stone is the point of the view that the notion of hospitality, with all its theoretical and practical implications, is essential to the success of any tourist destination. Is there any relevance in the growing use of the word, almost as a synonym for tourism? How is this notion, first learned in the domestic context and then exercised in the contact with the city and especially with visitors, represented in the learning process for professional practice and in the exercise of professional tourist reception itself? In order to answer this question, initially we chose to study the concept of hospitality in their current academic view, with reference to the French school, which binds hospitality to the maussian perspective of donation, and other scholars of the current theme, with emphasis on the research performed in the program of Master of Hospitality at the Anhembi Morumbi University, whose philosophy imprints in the hospitality concept the same sense we want to give this study. Then we chose to analyze the notion of hospitality, by the Social Representations Theory, in light of Moscovici s methodology, as well as the analysis of the core of this concept among tourism professionals and students. It was found that hospitality is still a very diffuse reference to representations of these two groups and that academic education, if accepted both theoretical and practical implications of this research s starting point, will still have a long way to go. Cities such as Natal, "naturally" hospitable, according to its dwellers, where tourism is relevant to their economies, need (re)thinking and (re)organizing, continuously, their actions towards quality and performance of their professional training especially those concerned with receptive structure

Um estudante cego no curso de licenciatura em musica da ufrn: questões de acessibilidade curricular e física

This work aims to discuss and analyze the process of school inclusion of a blind person in the Bachelor's Degree in Music, at the School of Music at the Federal University of Rio Grande do Norte, as well as reflect on the importance of establishing systems of support and to ensure university inclusive process of people with visual impairments. In pursuit to achieve these objectives, this research chose a qualitative methodological approach, the case study, using as procedures for data construction an interview, observation, analysis of documents and photographs. Joined the group of participants in this study, a blind student in the class of 2009.1of the EMUFRN Bachelor's Degree in Music, teachers from two disciplines complied by the student, two classmates, a monitor support in music theory, the course coordinator and school principal, and two other individuals who contributed to the inclusion process in actions not formalized institutionally. The results indicate UFRN proposed initiatives that contribute to inclusion of students with disabilities in this institution, the main one is the creation of the Standing Committee of Support for Students with Special Educational Needs (CAENE), a group that guides administrative sectors, teachers, principals, coordinators and students on the measures needed to enter and remain in quality education for all. Physical accessibility is still under construction at UFRN, and many access and sectors see it being adapted for students with physical or visual disabilities, and those with mobility impairments, have access to various parts of the university, however, as shown in this study, some points need to be reconsidered, as there are several places where the installation of tactile floor does not fully follow the guidelines proposed in the legislation. The proposals for access to the curriculum, mediated by EMUFRN, are actions that propose the inclusion of the blind student, as the existence of an educational monitor to help in the study of music theory, however, we need to rethink these proposals to not became actions of reactive intervention. Assuming a more proactive posture, the EMUFRN will be prepared to receive the diversity of students that expects. The study also points out that the blind student is part of a group of students that are practical musicians, who must work in events and evening shows, and who have little knowledge in music theory, leading, respectively, in low frequency classes and learning difficulties in certain curricular components, which may cause the closing of such components. In this case, the challenge of EMUFRN, considering the inclusive perspective, it is not specifically fit for the academic host a blind student, but to develop an accessibility project curriculum to consider effectively the diversity of all its students, taking into account mainly the economic and cultural conditions. This implies a process of resizing academic practices that be guided for collaborative and coordinated actions involving the various educational actors at EMUFRN and UFRN

Interação entre a equipe de enfermagem e a gestante com diagnóstico de pré-eclâmpsia

The objective of this exploratory descriptive study with a qualitative approach was to analyze the perception of the nursing team and the pregnant women hospitalized with pre-eclampsia regarding the interactive process occurring in the care relationship. Data were collected by semi-structured interview with twenty nursing professionals that work in the high-risk ward and ten pregnant women with the diagnosis of pre-eclampsia. The discourses were analyzed using the content analysis method, in the modality of thematic identification. Three categories were identified that describe the perception of the interaction by the nursing professionals: recognizing the needs of the hospitalized pregnant woman, understanding the woman with pre-eclampsia, and presenting difficulties in the interactive process. With regards to the pregnant women, four categories emerged: recognizing the clinical care, feeling the lack of information, experiencing feelings during the hospitalization, and envisioning the interaction process. The meaning of the discourses was analyzed according to the principles of symbolic interactionism. The results indicate that both, the nursing professionals and the pregnant women, have a limited perception of their interaction, suggesting a need for further reflection about this reality in the health service units and in the nursing education environment

Condutas de profissionais que realizam a consulta pré-natal na Estratégia Saúde da Família quanto à detecção, tratamento e acompanhamento da gestante com sífilis

The objective of this exploratory descriptive quantitative study was to analyze the behaviors in the detection, treatment and followup of the pregnant woman with syphilis, by health professionals that conduct the pre-natal consultation in the Family Health Strategy, as to the adherence to the recommendations of the Ministry of Health. The study was conducted in nine municipalites of the Trairi region in the state of Rio Grande do Norte. Data were collected during the months of July through September 2007, by means of a questionnaire with a population of 53 health professionals, 30 nurses and 23 physicians. Data were analyzed by descriptive statistics. The results were organized in three major items: knowledge of the health professionals about the symptomatology of syphilis and their actions in the detection of the disease; actions in the treatment of the pregnant woman with syphilis; and the actions of followup of the desease. We identified that 81,2% of the professionals have knowledge about the symptomatology of syphilis in the pregnant woman;79,2% request the VDRL exam in the adequate intervals and approximately 50% conduct the treatment in conformity with the recommendations of the Ministry of Health. For the followup care of the infected woman, 79,2% request a monthly VDRL examination, 69,8% explain the disease to the pregnant woman, and 20,7% affirm that they conduct a proper reception to the woman.We conclude that the majority of the health professionals have knowledge of the detection, treatment and followup of the pregnant woman with syphilis. However, the actions of some professionals diverge from the conduct procedures recommended by the Ministry of Health, as to the requesting of the examinations, medication prescription and notification of the iesease. This indicates the need for improved

Saúde da família: uma estratégia de mudança no processo de produção dos serviços de saúde

The purpose of this study is to analyze, from the point of view of nurses, changes that took place in the process of providing health services after the introduction of the Family Health Program (FHP). It is na investigation of qualitative nature that uses semi-structured interviews as a main empirical approach tool. Six nurses from the city of Caicó, Rio Grande do Norte, who were working with basic care before the introduction of the FHP, within basic care, were: adscription and ties with the community; hospitality and the humanizacion of care-giving; decrease in cases of inpatient treatment; strengthening of the prevention of injuries and health promotion; improvemente of health indicatiors, finally, actions that point towads meeting the principles of wholeness, equity and universality as a declaration of the Brazilian National Health Care System (SUS). Nevertheless, in spite of all recognizable positive aspects, the FHP has some weaknesses, such as: the difficulty posed by colletive work; the mismatch between professional education and the demands of the current health standard; a poor physical infrastructure of the Basic Health Units; a high heath staff turnover and precarious work conditions. In addition to this, some strategies that can be used to help improve the process of providing health services have been pointed out, such as, coordination between sectors, continuous education, making work conditions less precarious and improving the means whereby heathy service management is conveyed,Tthus, finally, we understand that the FHP does bring forward meaningful changes to the process of provinding health services to strengthen the Brasilian National Health Care System (SUS), in spite of the fact that it lies within a scenario of adversities that can be overcome through the collective endeavor of the several social actors

Análise de qualidade da atenção à criança na estratégia saúde da família: o óbito infantil evitável como referência

Alma-Ata declaration bring the Primary Attention to the Health (PAH) as first level of health attention for individuals, family and community, which considers infant group as priority. Several initiatives that gave bases to integral attention to the children health formalized in the principles of Unique Health System. Family Health Strategy (FHS) comes to strengthen this attention, instituting new ways of work organization and professional practices that gave impact in their quality indicators. One of them is children mortality, showing decline in their values. Though, studies indicates persistence of avoidable infant deaths. In Natal RN, this reality is also perceptible leading to inquietudes, mainly at the space of services production, it means, which motivated the accomplishment of the present study intending to analyse the way that the organizational and structural processes as long as the professional practices in FHS interfered in the quality of children s health attention who died by avoidable death in the year of 2007 in municipal district of Natal-RN. It treats, therefore, to an exploratory and descriptive survey of cases study type, thar had as primary sources the oficial documents of MH, the family prontuary, pregnant card, child card and testimony obt ined from instrument of research elaborated based in investigation form of infant death by MH, applied to 10 mothers of children who had avoidable death. In analysis it was appealed silmultaneous triangulation of methods and sources, allowing a bigger aproximation from obtained informations. To elucidate the cases, the aspects studied were analyzed to the light of explicative model of Social Determinants of Health. Among individual and family aspects were highlighted the related to age, schooling, family habits and customs and mother s economic condition, besides of pregnancy age, newborn weight and associated diseases, which don t differ from literature about the theme. Reffering to the factors organizational and structural processes and professionals practice, highlihgted, the treatment given by the professionals, the territorialization and adscription of areas, the difficulty of having access to the services or sleepers and the reference and counterreference. But also, the ausence or few greet, the lack of communication, few assiduity and ponctuality by professionals in service, among others. In a general way mothers considers the attendance received in the hospital good and very good , opnions that in the Basic Attention weren t so favorable, in spite of many of predictible actions in this level have been performed in the studied cases. It is observed, therefore, that the social determinants of health has a strong influence in ocurrence of infant deaths, what implicates in a large actuation by Infant Mortality Committee from municipal district. This way, it becomes fundamental the reflection and evaluation about the effectiveness and execution by the processes of vigilance to health in FHUs; the rethink about the social determinants of health in a wide and articulate way to the services quality, to permanent education, to management in service, to the given attention and to the way how it is installed the popular participation and social control. To the professionals it is presented the great challenge to review their daily practice, their values, behaviors and commitment, which ones must be guided by logical of sharing, work in team, humanescence and alterity, not only by the accomplishment of a professional duty

A violência no contexto de um serviço de urgência: análise do processo de cuidar na visão das vítimas e profissionais de saúde em Natal/RN

Exploratory descriptive study, with a quantitative approach and prospective data, performed in Pronto Socorro Clóvis Sarinho (PSCS), in Natal/RN, aiming to analyze care given by the nursing and medical staff to victims of violence attended to in an emergency hospital in Natal/RN; to identify care given by the nursing and medical staff as viewed by the victims; to compare data observed during the process of care with the victim s view on the care given by the nursing and medical staff; to identify the existing knowledge on violence and the process of caring for victims and its relation with prejudice; to identify obstacles and perspectives for prevention during the process of caring for victims in the emergency services. The population consisted of 97 physicians, 16 nurses, 75 nursing technicians and assistants and 365 victims of violence, with data collected from April to May 2009. Out of 188 professionals, 52.1% are female; 32% were aged 41 to 50; 99.5% had given care to a victim of violence; 90.4% reported to have given care to patients under custody; among these, 17.3% felt prejudice; 55.3% stated they don t provide different care for assaulted victims and assailants, however 44.7% stated they do; 86.7% feel their workplace is unsafe; 61.7% denied the existence of any obstacle and 38.3% reported the existence of obstacles; among these, 26.1% referred to inadequate facilities; 37.8% believe reinforcing security and professional training are the main solutions. Among the 365 researched violence victims, 82.2% were assaulted; male (69.6%); aged 18 to 24 (24.9%); hailing from the Greater Natal area (89.9%); on 19.7% the event happened on Saturday; during the night (48.8%); victim of physical assault (61.4%); produced by body force (27.7%); 24.4% were injured in the head and neck. 57% had used some drug, among which alcohol was predominant (75.5%). On 621 observations performed during the victim care process, when compared to the report of assaulted victims, there was a statistical difference, at 5% significance level, regarding reception, resistance from the professionals, questioning about the violent event, providing of guidance, interaction with the patient and the understanding of receiving proper care, and care resolution. In comparisons involving the observed and the assailant victims reports, there was a statistical difference regarding the resence of resistance from the professionals, performance of necessary procedures and the nteraction with the patient and the understanding of receiving proper care and 58.1% reported the nursing team was the one that provided the best care. We conclude that professionals had lready given care to assailant patients, acknowledge the importance of knowing how the vent took place and acquired this preparation during their practice. The most often referred bstacles that hinder assistance were: inadequate facilities, material deficit and lack of rofessional preparation. As solutions for these problems, they cited the reinforcement of ecurity and professional training

As ações de controle da tuberculose na atenção primária à saúde: a visão do doente

Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health.

Terapia comunitária integrativa: construção de um espaço de escuta para os trabalhadores na atenção básica da saúde

This research, which appears in the form of a dissertation, entitled: Integrative Therapy Community: construction of a listening space to health care workers in primary care, addresses the Integrative Community Therapy (ICT) as a tool to create meeting spaces between health professionals where they can be receptive among one another. With the completion of this study aimed to analyze the ICT as a therapeutic approach and space of listening and speaking for health professionals cited here in order to identify their anxieties, doubts, worries and uncertainties arising from the context of labor relations and the impact of therapeutic experiences under the view of the participants. It was developed as an action-science research, involving several steps. The field of research was the ICT meetings of workers from the units under the Family Health Strategy of Northern Health Districts I and II of the city of Natal, using a qualitative approach. The interpretation of data collected was based on content analysis proposed by Bardin. Finally, this study showed the ICT as a space for dialogue and sharing, with repercussions on labor relations and expansions beyond the ICT meetings, reaching out to family and social relationships, contributing to creating bonds and solidarity networks. Under the view of the participants it was recognized as an experience that optimized the socialization, promoting the alleviation of suffering and increasing the well-being. Based on the study findings, it is inferred that ICT can be considered a viable tool for the receptiveness and humanized care of health care workers.

Aconselhamento em HIV/AIDS: ações e reflexões dos profissionais do Centro de Testagem e Aconselhamento (CTA)

The counseling on HIV/Aids consists in a prevention strategy that contributes to increase the diagnosis of HIV and start earlier the treatment. The counseling has as pillars the emotional and educational support, risks evaluation that aim at the adoption of safe practices and the individual s responsibility for his own health. To accomplish these results, it is necessary that health workers understand counseling as a unique educational moment that stimulates the user s critical-reflection when it comes to his role as an active subject in this process. This study aimed to analyze the counseling on HIV/Aids conducted by the professionals of the Testing and Counseling Center (CTA), based on the educational perspective of Paulo Freire . This is a descriptive qualitative study with a critical reflexive design based on the principles of Action-Science. All the professionals acting as counselors in the Joao Pessoa, PB CTA, eight in total, took part in the study. Data were collected during the month of March, 2011, through non participative observation and semi-structured interviews with a critical-reflexive focus, analyzed according to the tenets of the critical-reflexive methodology, and discussed taking into consideration the Paulo Freire s pedagogy and pertinent literature. It was observed that most of the professionals expressed the work philosophy of CTA as the diagnosis and prevention of the disease, associated with the utilization and demonstration of condoms. However, upon observation of their counseling sessions, these ideas were not converted in actions. Educational themes were not covered and the condom wasn t offered at any time. The counseling actions focused on the provision of information and filling out the paper forms which are necessary for attendance. The sessions were conducted with brief dialogues and little opportunity for the users to expose or complement their thoughts and needs. The professionals mentioned as facilitating conditions for counseling, the team interaction and physical structure. The difficulties focused on the users low cognition, the large demand for attendance, aspects related to the service organization, and the counselors absences and delays. After reflecting about the actions observed in the counseling, the majority of professionals admitted the need to modify their practice in the incorporation of educational principles for the achievement of a broader prevention, and seemed to be willing to work in this perspective. In conclusion, although the counselors show ideas consistent with the purposes of CTA, these ideas are limited when it comes to the understanding of the meaning of prevention in HIV/Aids. Taking into consideration that they express a certain comprehension and act differently during the counseling, they demonstrate a lack of bond between the theories in use and the proposed ones, in accordance with the contribution of the action-science theory. The counseling, as an educative practice, doesn t materialize in the counseling itself and the orientation for reflection is not given during the attendance. These findings suggest the need to include the process of reflection in the execution of the actions of counseling, so that these practices are guided by reflexive practice, aiming at transforming the way of thinking and acting into a more educational perspective toward a more democratic and holistic assistance.