Uma avaliação do serviço de atenção domiciliar/programa melhor em casa: o caso do hospital Monsenhor Walfredo Gurgel

This dissertation try to understand how management actions implemented by Monsenhor Walfredo Gurgel Hospital in the city of Natal promote effectively the benefits of Home Care Services / Programa Melhor em Casa . The research is exploratory and descriptive, qualitative approach. Data were collected through document analysis and the interviews with the managers of the Program in Health Department and Hospital beyond the questionnaires with the home care teams and technical management unit of Hospital Jobs. The information were treatment trough categories that analyzed to implemented actions and program objectives. The results show that: the practices carried out by the host teams produce the humanization of care by seeking to ensure access to health services and solving human form; networks of health care are not yet finalized hindering the referral of patients to other units, the networks allow support from other institutions to minimize the problems encountered, the management unit vacancies allows the reduction of costs, mainly by regulating beds and record of health initiatives in home care assists in the monitoring and evaluation process of the Services Home Care / Programa Melhor em Casa primarily the epidemiological profile and patients individual treatment plan. Concludes that most of the actions implemented by the Hospital contribute to the effectiveness of the goals of Programa Melhor em Casa

A institucionalização do programa nacional de Educação Fiscal nos estados brasileiros e Distrito Federal

The research seeks to comprehend the development of the promoting and structuring Fiscal Education actions in the states and in the federal district, attending to the guideline and the administrative requirements established by the Escola de Administração Fazendária (ESAF) to implement the Programa Nacional de Educação Fiscal (PNEF). The study has an exploratory content with a qualitative approach. The informations were collect with a questionnaire applied through the Google-docs by the managers of the program in any federated unit. Were founded several results, as the fragility of the program in the budgeting and financial area, the low frequency of the Grupo de Educação Estadual (GEFE) in regular meetings, the absence to monitor undertaken actions and the absence of interlocution between the GEFE and the forums of national discussions, especially the Conselho Nacional de Política Fazendária (CONFAZ). Despite the fragilities, the work shows the occurrence of some actions to disseminate Fiscal Education in schools and universities, the establishment of partnerships and the participation of the GEFE‟s in the national meetings. With the study, it was possible to conclude that in spite of the weaknesses found in its structure, the PNEF s institutionalized in the states and in the federal district, observing the differences between the federal units in relation to the ripening of the program. Despite the difficulties evidenced, it appears that they are capable of resolution, as far as it recognizes the importance of the Program for the promotion of a culture of active citizenship in the society and it will gives better conditions of implementation

O desejo, o relato e a prática da cidade: de como são produzidos territórios marginais na cidade do príncipe (1880 - 1900)

The theme of this work is the study of marginal territories of the Cidade do Príncipe, sketch in time than today is constituted as the city of Caicó/RN, with the time frame the years 1880 to 1900. Our goal is to investigate the construction of these territories from multiple speech subjects practitioners of the city. Thus, we propose to discover the mapping of the deviation in the city in question, as they were drawn, those who experienced and through which practices. Investigate the construction of these spaces from the speeches, and fill a historiographical gap, allows to find stories sharp, silenced or ignored, abortions and madness in prison, repressed passions and avenged. To meet these spaces the sources are diverse, such as the newspaper O Povo, the Codes of posture, the Reports of Presidents and Heads of Provincial Police and process-crime. Regarding the methodological aspects of research, we decided by discourse analysis, discourse here conceived not only as what is said about someone or something, but as a set of statements circulating at any given time in society, articulating speech, intentions, actions and thought. The city is then considered from their territories, imagined as a space configured in/by the relations power that the dispute, but also as a space for experiences multiple, different feelings, place and non-place, the discipline and mockery, of power and resistance.

A incorporação da saúde bucal no programa saúde da família do Rio Grande do Norte: investigando a possibilidade de conversão do modelo assistencial

The Health Family Program (HFP) was founded in the 1990s with the objective of changing the health care model through a restructuring of primary care. Oral health was officially incorporated into HFP mainly through the efforts of dental professionals, and was seen as a way to break from oral health care models based on curative, technical biological and inequity methods. Despite the fast expansion of HFP oral health teams, it is essential to ask if changes are really occurring in the oral health model of municipalities. Therefore, the purpose of this study is to evaluate the incorporation of oral health teams into the Health Family Program by analyzing the factors that may interfere positively or negatively in the implementation of this strategy and consequently in the process of changing oral health care models in the National Health System in the state of Rio Grande do Norte, Brazil. This evaluation involves three dimensions: access, work organization and strategies of planning. For this purpose,19 municipalities, geographically distributed according to Regional Public Health Units (RPHU), were randomly selected. The data collection instruments used were: structured interview of supervisors and dentists, structured observation, documental research and data from national health data banks. It was possible to identify critical points that may be impeding the implementation of oral health into HFP, such as, low incomes, no legal employment contract, difficulty in referring patients for high-complexity procedures, in developing intersectoral actions and program strategies such as epidemiologic diagnosis and evaluation of the new actions. The majority of municipalities showed little or no improvement in oral health care after incorporating the new model into HFP. All of them had failures in most of the aspects mentioned above. Furthermore, these municipalities are similar in other areas, such as low educational levels in children from 7 to 14 years of age, high child mortality rates and wide social inequalities. On the other hand, the five municipalities that had improved oral health, according to the categories analyzed, offered better living conditions to the population, with higher life expectancy, low infant mortality rates, per capita income among the highest in the state as well as high Human Development Index (HDI) means. Therefore, it is possible to conclude that public policies that include aspects beyond the health sector are decisive for a real change in health care models

Avaliação longitudinal do impacto da saúde bucal na estratégia saúde da família em Natal

As a result of the financial incentive provided by the GM / MS 1.444, since 2000, Brazil has experienced a substantial increase in the number of oral health services at the Family Health Strategy. There is, however, evidence that these teams have produced qualitatively different experiences which do not translate necessarily into improved quality of life and health. Thus, evaluative research of great importance. This study aims to assess the impact of the Family Health Strategy in oral health in a longitudinal perspective natalense the years 2006 and 2009. This is an intervention study whose design is a community trial in parallel, nearly randomized. The sample consisted of census tracts covered by oral health teams in the Family Health and the Traditional Model (Basic Health Units and non-FHS Program of Community Health Agents and areas not covered.) The sample was determined by drawing ten census tracts to form the experimental group and ten other sectors for the control group by pairing intentional based on socio-economic and geographic. To check the net effect of the intervention was performed multivariate analysis by Poisson regression. As a result of cross-sectional analysis of year 2009, it was found that the effects of the ESF in Natal were satisfactory only for the variables of injuries and for other purposes without and with negative impact on stock coverage reclaimers. However, the longitudinal analysis revealed that the ESB / ESF improved their performance in dealing with grievances, access and coverage of the type of actions and this fact is independent of age, sex and social and economic conditions. In other employees' words are related to the presence of the Family Health Strategy in the region. However it does not say that both models under study (the Family Health Strategy Model and Traditional) are different in terms of performance and it is pertinent to reflect on the need for further development of evaluation studies that use other approaches able to clarify the dynamics of the process whose results can come to the knowledge of the actors responsible for leading the ESF and encourage them to incorporate the assessment in their routine

Atividades preventivas realizadas pelos cirurgiões-dentistas do PSF de Natal-RN

Family Health Program (FHP) presents itself as a restructured model on basic cares besides having prevention practices and promotion in health as essential parts. According to that, the purpose of this study is to perceive which prevention practices in oral health are accomplished by the dentists from the FHP of Natal-RN as well as the way they have been developed, the knowledge basis to execute the procedure and the use of evaluation instruments by the dentists and by the Oral Health Co-Ordinator. A list of dentists participating on the FHP of Natal in March, 2006 (n= 91) was obtained so it was possible to formulate a structured interview. After excluding those with less than six months attending to the program, and considering the loss, eighty dentists got to be interviewed. It had questions about individual and group preventive procedures, sources of basement to develop the activities and to verify the impact and evaluation instruments. Besides that, an interview was made with the Oral Health Co-Ordinator about the evaluating process and the existence of a protocol as well as about document analysis in the Ambulatory Informations System Unique Health System (AIS-UHS), Information of Basic Care System and Pact of Recorder. The main individual activities consist on Oral Hygiene Orientation (87,5%) and Fluoridization (95%). Group activities remain at scholar groups acts(91,25%) being fluoridization done by 91,25% and educative activities by 86,25% mainly through speeches (61,25%).Orientations about oral cancer were detached on the aged group (39,96%)and hypertensive and diabetic group (19,51%), as well as integration with the health team was respectively 21,93% and 39,02%. Speeches and talk rounds are the main activities for aged, hypertensive and diabetics, and are also expressive to pregnant women. For pregnant women and babies group predominate hygiene and diet orientation. About the evaluation instruments 73,75% of the dentists do not consider their existence, despite 73,75% consider that actions have impact specially due to a increase of hygiene and decrease of caries index on the children. The main sources of basement are clinical experience (42,5%) and preparative courses (33,75%), only 7,5% mentioned population need and local reality. The Oral Health Co-Ordinator related the Attention Pact Recorder and records from the AIS - UHS as evaluation source but also detached the lack of epidemiologic surveying. She mentioned the increase of supervised brushing as a positive result and detached the hardness of the professional to act inside the family and as a team. The AIS-UHS records showed that fluoridization is more used individually and the supervised brushing is predominant as a group action, besides that educative activities at the Health Establishment predominate due to actions at the community. Facing the results, it was verified the act in different groups, special attention given to scholars, as well as focus the activities on caries giving less emphasis to other oral problems. Despite that, there was no epidemiologic instruments or data of the local reality to guide the actions and to be part of the planning and evaluation process

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

O ambulatório de Saúde Mental no contexto da Reforma Psiquiátrica em Natal/RN

The years 1990 disclose the consolidation of the Brazilian Psychiatric Reform project, assumed as official politics by the Health Department, also stirring up discussions, lines of direction and new ways of care. Substitutive services to the psychiatric hospital as CAPS, conviviality centers, therapeutical residences and ambulatory clinics are implemented. This work analyzes the relations that the Specialized Ambulatory Clinic of Ribeira establishes to the services of Mental Health of the public system in the city of Natal/RN, as well as its adjustment to the proposal of the Psychiatric Reform. Through semi-structured interviews and observation, it was possible to gather data which allowed picturing a general characterization of the service: activities, technical group, joint with other institutions, daily routine organization. Such institution develops activities that surpass the traditional character of a clinic- in other words, the psychological/medical appointments - and it mainly greets the ones proceeding from CAPS and psychiatric hospitals. It offers group activities, psychiatric appointments, therapeutical workshops, sheltering and strolls, among others. The institution is composed by a multi-professional team of psychiatrists, psychologists, occupational therapists, nurse s aide and art-educator. The joint of this service with others that make part of the Mental Health Assistance network in Natal is incipient. Due to this fact, some actions and activities that could and should be developed together are just not. Although facing difficulties, the professionals of the Ambulatory Clinic of Ribeira are able to achieve good results and establish care in Mental Health that prioritize sheltering, listening and respect to the user s individuality. The Ambulatory Clinic of Ribeira is organized according to the paradigm of the Psychiatric Reform. Therefore, it offers an attention that stimulates the re-socialization of the users and the exercise of the citizenship and autonomy of those

Adolescentes e jovens e suas bases de apoio :relações de amizade como suporte social no enfrentamento à violência

The purpose of this work is to map the family and community social supports for adolescents and young students from Bom Pastor Distric, West Zone of Natal/RN, as well as to describe how such resources are used by these individuaIs in that community. Social support refers not only to formal activities or organizations, but also to spontaneous or informal forms of support - friendship and solidarity nets available in the community, affective relations that are meaningful in the lives of children and young people. Our discussion is based on a research performed with 382 adolescents and young students from Jean Mermoz Public School (students from 5th to 11th grades, aged 13 to 14). We emphasized the situations of violence derived from family or community spheres faced by these students. In relation to this specific aspect, we observed the participants more frequently look for help from the informal social supports, mostly from their friends, which indicates that the formal ones are not considered to be effective instruments for social assistance. The search for informal social supports shows the relations informally established in the streets (for instance when they look for help from friends, rei atives or neighbors) have more effect and play an important role in which there are values and affections exchange. Thinking the strengthening of these social links is of extreme importance and leads to the weakening of the hegemonic logics focused on the production of subjects as private identities, and to the amplification of an ethics committed to the disassembly of a sociability anchored to fear, impotence, intolerance, discrimination, and reduction of spaces for circulating and confronting mechanisms of social exclusion. It is crucial that we concentrate our attention to building friendship as a system of reciprocity and affective exchanges, as a space for political actions and production of forms of lives that are potent against social anesthesia

O Bullying sob o olhar dos educadores: um estudo em escolas da rede privada de Natal/RN

The school bullying involves all aggressive, intentional, repetitive attitudes, occurring without apparent motivation, adopted by one or more students against another (s) causing pain and anguish, and implemented within an unequal relationship of power, making possible the intimidation of the victim. Its expressions involve defamatory rumors, discrimination, theft or damage to property, harassment, threats, beatings, isolation, exclusion of a person or group, intimidation, intolerance and disrespect. In this study, we sought to identify the design educators have about the bullying, and are known by what means are aware of the problem, is involved when identifying cases of bullying and how to give this speech. This study used for data collection a questionnaire applied to 107 educators from 14 private schools in Natal / RN, who received statistical treatment in the program SPSS and the results analyzed in the light outside of a social and historical reference. Among the results, we found that 83% of the interviewed educators has at least heard about bullying, and the information about the problem are mainly the media, like television, newspapers and magazines. The educators said that the surname and physical attacks are more frequent outbreaks of violence among students and also the most common complaints when they look for help. The necessity for intervention when it identifies a case of bullying is present in 97.03% of respondents and 73.27% of educators are also called by students or school officials to remedy the situations of bullying among students. On the forms of intervention employed, the most common is the conversation and warning the students involved. It is suggested that the intensification of studies related to the subject and the development of actions and programs antibullying involving the school community (educators, parents, students, employees), in partnership with social segments like Tutelar Council and others related to the protection of children and adolescent

A eliminação do mosquito do dengue em ambientes residenciais: uma questão de cuidado ambiental?

Dengue is currently considered one of the most relevant public health problems worldwide. Studies indicate the surroundings of the houses as the preferred sites for the proliferation of Aedes aegypti. The residential areas are privileged environments for human development and contribute to the formation of the individual s identity and for the establishment of affective, social and cultural bonds. The purpose of this study was to investigate possible links between psychological indicators of pro-environmentalism and conservation status of residential backyards. Data collection was performed in 147 homes and methodological strategy involved the use of interview, the Scale of Ecocentric and Anthropocentric Environmentalism, Scale of Consideration of Future Consequences and a tool for environmental evaluation. It was found that the participants expressed as environmental practices the garbage recycling, besides they had the knowledge of how the transmission of dengue occurs. These residents showed ecofriendly motivated commitment: pro-environmentalist ecocentric and anthropocentric. In evaluating the backyard it was verified that the conservation conditions, in almost half of the homes, appeared as carelessness on the part of residents and those conditions are conducive to the proliferation of Aedes aegypti. The pro-environmentalists and guidance for the future identified by the scales were not associated with the conservation status of the backyards. However, it was found that the trends of reduction and stability of infestation levels are associated with self-reported environmental care. These results can contribute to the discussion and design of new mosquito control actions and practices of education and health information among the population

Mudanças climáticas globais e o compromisso pró-ecológico de adolescentes natalenses

In recent years, much has been discussed about global climate changes (GCCs), popularly known as global warming. The scientific evidences point out to the influence of human actions for its drastic intensification. Therefore, studies of the psychological aspects involved become relevant. This study aimed at the investigation of the views of adolescents concerning GCCs, and the possible relations between those views and their pro-ecological commitment. Such commitment is measured by willingness for engagement in pro-environmental behaviors; environmentalism attitudes, like ecocentric and anthropocentric; consideration of future consequences; and ecological worldviews. Participants were 348 adolescents who answered a questionnaire containing questions about socio-demographic data, open questions about the practice of environmental care, and about GCCs, and the scales of Ecocentric and Anthropocentric Environmentalism, the Consideration of Future Consequences and the Ecological Worldviews assessment scale. From the inter-relationships between variables, procedures carried out by means of descriptive and correlacional statistics, it was observed that 55% of teenagers said that they did not engage in actions of environmental care, which was associated with apathyanthropocentric, immediatism, and individualism. The consideration of future consequences joined the practice of environmental care, corroborating evidence from the literature. It was evident that views concerning GCCs were superficial; adolescents perceive it as a generic environmental problem, and are confused with other problems such as pollution. This study found no association between views about GCCs and the indicators of pro-ecological commitment, perhaps due to the conceptual confusion about the subject. However, the lack of environmental care actions and other indicators of non-commitment (apathy-anthropocentric, individualism and immediatism) were associated with conceptually poor or incomplete responses (with no indication of cause, consequence or responsibility for the problem), demonstrating diminished knowledge and the failure to consider these issues

Violência doméstica contra adolescentes: o olhar dos educadores sociais

Domestic violence as a specific expression of violence against adolescents, is historically constructed from phenomenon of power relations that permeate the gender, ethnicity and social class, requiring differentiated attention. Sorting in A mass grave of what is understood by a child and teenager under the doctrines of the law of the minor and of irregular situation resulted, in General, in the preparation for the teenage audience, of policies and actions, fragile and inefficient with regard to domestic violence. Despite the status of children and adolescents clearly define what is meant by child and teenager, break with the menoristas doctrines and embrace the doctrine of integral protection, even if there is little guidance for the public actions and policies geared to the theme. Such deficiency contributes to characterize the current practice of social educators about domestic violence, marked by the absence of specific training; by inadequate working conditions; lack of preparation of the network of care. Thus, with the objective to start the discussion regarding the elements that make up the practice focused on this issue, the present study proposes to problematizing the design held by social educators working in public Social assistance of the city of Natal/RN, regarding the issue of domestic violence against adolescents, by paying attention to such things as their vocational integration, their training and their working conditions. Adopts norteadoras references as having its roots in the Pedagogia Problematizadora, Paulo Freire, and socio-historical perspective. The methodological procedure of nature quali-quantitative was lifting censitário and psychosocial characterization of educators together to State and local Departments of assistance; the application of questionnaire to educators, composed of open and closed issues; and observation and field journaling activities of their work. Of network professionals, 111 64 replied to the questionnaire, which represents more than 50% of the total. Psychosocial characterization exposes data as the predominance of low family income and female professionals; the note identified that do not have a professional technical parameter, and the activities carried out in accordance with the representations of each professional the respect of labour, problematic and adolescents involved, revealing an individual perspective of action. And a preliminary analysis of responses to the questionnaire pointed out that such professionals are subjected to precarious working conditions, as well as one realizes a relative ignorance about the network of care for adolescents at risk and ACE, all this resulting in restricted marginalizantes conceptions, and misleading information regarding domestic violence against teenagers.

Atenção precoce do câncer de mama :um olhar sobre o cotidiano institucional de uma unidade de saúde de Natal

Breast cancer has been considered a grave global public health problem due to its increase in incidence, in women s mortality and in the amount of financial resources spent on the therapeutic interventions used in the treatment of this neoplasia. However, this scenario presents some variations. In developing countries, the incidence of breast cancer is increasing but, on the other hand, the mortality is declining among patients because of public health actions toward early diagnostic that also result in cure of patients and decreasing levels of physical and psychosocial stress. In Brazil, we face of both the increasing number of breast cancer incidence and number of mortalities. Almost always the reason for that is a delayed detection that will provide a late diagnostic. The early detection of breast cancer has been studied in several researches. Some of them are concerned with women s experiences. Despite that, there is a lack of researches on dynamic comprehension of early attention to breast cancer from the health professionals points of view. The present research was carried out at the Unidade Mista de Felipe Camarão (UMFC) and it was conducted with 11 professionals who work in the Family Health Program (PSF). The aim was to understand how early diagnostic and attention to breast cancer is being planned, discussed and accomplished by health professionals in their day-to-day actions. Semi-structure interviews were held individually with each professional, in a way that they could feel free to express their ideas about several issues. All the information from these interviews was analyzed and discussed using an Institutional Ethnographic approach. It was observed that the actions of health professionals working with early detection of breast cancer does not take place in a vacuum; they occur within institutional, relational and social ways. This interdependence influences their actions and points of view on the theme

O fazer do psicólogo no núcleo de apoio à saúde da família

The Brazilian Ministry of Health regulated in 2008 the Family Health Support Nucleus (FHSN) as a device for support and complementarity to the Family Health Strategy. The FHSN, through the matrix support, potentiates the Family Health teams on dealing with a great variety of demands and activities that are under their responsibilities. It is structured in teams of professionals from various health specialties, among which is the mental health. In preliminary studies we noticed that the psychologists have been the main representatives of mental health professionals at the FHSN from Rio Grande do Norte (RN-Brazil). On this scenario, this study intends to problematize the professional practice of the psychologists who work at the FHSN teams in RN, regarding how their work is done, discussing it under the perspective of collective health and the directions for the basic health care on Brazilian s health system. Still as a goal, in more specific ways: identify the forms of professional insertion of the psychologists in this field; characterize the work done by the psychologist at the FHSN (developed activities); and produce an analysis of the characteristics and limits of those actions, from theoretical and methodological references based on Marxian ontology. Were performed semistructured interviews with psychologists working in the oldest FHSN teams form RN. We conducted the analysis of the material following the blocks of information: determinants of the psychologist entry at the services, training for current practice; operation of FHSN; activities performed by FHSN team and the psychologist; joint actions; and limits of psychology practice in the FHSN. An important result, we observed the little articulation of practicing between the psychology and other professionals and teams, further indicating the prevalence of the traditional medical model (individual and outpatient) as guidance of their performance instead of the matrix logic that is the foundation of the proposed action for the FHSN. We also emphasize the potential of psychologists actions at the FHSN on contributing to the achievement of comprehensive care