Reflexões sobre a política de descentralização em saúde: uma análise a partir do Hospital Monsenhor Walfredo Gurgel em Natal (RN)

The process of decentralization of health policy in Brazil has evolved throughout the second half of the twentieth century, advancing by leaps and bounds in the last two decades. The various public institutions have assumed the function of responding to a growing demand for medical care and hospital. Monsenhor Hospital Walfredo Gurgel - H.M.W.G. fits into this context as an institution par excellence-oriented service the demand for medium and high complexity. This paper presents some questions about the process of decentralization and devolution occurred in Brazil. To do so is a brief historical background and politics, showing the concepts of reform and counter-reform and how the processes mentioned in the Country Correlates develop local social development of the decentralization process and discusses the modifications in policies social intervention in recent decades and the state health policies. Presents the implementation of a Health System in Brazil and the state showing how the decentralization of health policy occurs in Rio Grande do Norte. Finally, it explores the role of H.M.W.G. in health policy in RN. For this, portrays the institution and is located within the decentralized structure of health policy in the state and capital. An analysis of the demand for hospital care and the budget situation is realized at the close of work, correlating the role of HMWG with the decentralization of health policy in Brazil and Rio Grande do Norte. The methodology used for the preparation of this work was based on documentary research, systematic nonparticipant observation, field diary and analysis of data, documents and content. This set shows a quantitative and qualitative methodology that strips the institution, enabling the understanding of their role, boundaries, threats and opportunities

(In)visibilidade da violência doméstica no atendimento do Sistema Público de Saúde: nos bairros das Quintas e de Felipe Camarão

It analyses the approach given by health professionals (social workers, nurses and doctors) against woman violence at the Medical Unities of Felipe Camarão and Quintas of the City of Natal and searches to identify if the domestic violence is (in)visible at the Public Health Assistance System attendance. and It refers to the grandiosity of this violence and its consequences to the women health, recognizing it as a public health problem. To the comprehension of the relationship between violent acts against women and their health serious damages, exposes the battle history of the feminist movements and the brazilian women, demonstrating the visibility acquired by theses conquests of the questions related to the women and how the gender study becomes the central category to (re) think the social relations involving women and men, specially, the violent relationships between them. It analyses, mainly, those practiced by the husbands, partners, boyfriends or lovers. It refers, at the end, about the public politics of violence combat adopted at police stations at health centers, showing the difficulties to establish the legislation that exists to combat the violence suffered by the women that look for assistance at the health unities. It intends, with this way, to give more visibility to the domestic questions at the marital relations and ask attention from the public power and health professionals between them, the social worker to the (in) visibility of this problems at the attendances practiced

O vencimento e a remuneração do magistério público municipal de Natal/RN: repercussões da implementação do Fundeb (2007-2010)

Le travail suivant discute le salaire touché par les professeurs et leur rémunération, face à l’implémentation du Fond de Mantenance du Développement de l’Éducation de Base et Valorisation des Professionnels de l’Enseignement (Fundeb), au Système d’Éducation Public de la Municipalité de la ville de Natal, entre les années de 2007 a 2010. L’objectif est l’analyse des repercussions du Funeb pour la rémuneration des enseignants dans le contexte de la politique de financement de l’Éducation de Base e ses propositions de valorisation des enseignants – revennu et rémunération. L’étude s’est utilisé la recherche bibliographique et documentale, les informations relatives à : Éducatif (inscriptions), rémunération (bulletin de salaire et bulletin de paie), budgétaires (recette et dépense) au ressource – microinformations du recensement scolaire (INEP/MEC), SIOPE/FNDE et lo PCCR de la municipalité (LC nº058/2004), et comme donné comparatif on utilise la rémunération et la valeur du salaire minimum national – actualisé par le INPC. À partir de là, les études montrent que dès la Constitution Fédeérale de 1988, il y a eu des changements dans la structure du financement de l’Éducation par la politique de Fonds, iniciée par le Fundef et continuée par le Fundeb, avec des reflets pour la valorisation des enseignants, spécialement, sur la rémunération. Par rapport au revennu, l’étude montre un réajustement à chaque année qui observe, en 2007, un pourcentage de 23,74%, c’est-à´dire, la plus grande de la série historique. Par l’analyse des donnés de revennus on peut observer que les enseignants, au début de leur carrière, présente des réajustement sur leur revennu et rémunération plus petit que celui du Salaire Minimum National, et pourtant les enseignants de niveau supérieur (N1), spécialisation et maîtrise (N2) ont présenté le même pourcentage de croissance de la rémunération pendant cet étude, qui correspond à 14,7%. Le pourcentage pour le professeur docteur a été noté en 33,9%. Par rapport aux enseignants de plus de temps de service, entre 10 et 15 ans, les pourcentages de réajustement ont été différents, car ils montrent des proportions croissantes selon le niveau de formation et le temps de carrière comme enseignant. Malgré le Fundeb présente des progressions, il ne s’est pas encore configuré comme une politique d’amélioration de salaire pour les enseignants. On remarque que pendant l’analyse, il y a une diminuition de proportion entre la valeur de rémunération e la quantité de salaires minimum composant le total, ce qui configure un procès qui exige de plus grands investissements aux salaires des enseignants.

Os rumos do fundo público no capitalismo contemporâneo: uma análise sobre o financiamento da Política de saúde no estado do Rio Grande do Norte

This work analizes the financing of Health Policies on the state of Rio Grande Do Norte, starting at the presumption that SUS is “Bombarded” by fiscal ajustments, as a neoliberal strategy to face capital crises.The trafectory of the financing of SUS demands the comprehension of two principles which are, in essence, contradictory: the “principle of universatility”, which is caracterized by the uncompromising defence of the fundaments of the Sanitary Reform, and the “principle of containment of social costs”, articulating the macroeconomic policy that has being developed in Brazil since the 1990s and which substantiantes itself on the 2000s.This last defends the reduction of the social costs, the maintanance of primary surplus and the privatization of public social services. Considering these determinations, the objective of this research constitues in bringing a critical reflection sorrounding the financing of the Health Policies on the state of Rio Grande do Norte, on the period from 2004 to 2012.Starting from a bibliografic and documentary research, it sought out to analyze the budget planning forseen on the Budget Guideline Law (LDO) and on the Multiannual Plans (PPA), investigating the reports of the Court of Auditors of the State of RN and gathering information about expenses with health, available on the System of Information About Public Budgeting in Health (SIOPS).The Analises of the data obtained, in light of the theoretic referece chosen, reveals trends in the public budget setting for health on the State of Rio Grande do Norte, which are: a tiny share of investment expenditure on health, when compared to other expenses, the amount used in daily fees and advertising; the high expense in personnel expenses, especially for hiring medical cooperatives;the strong dependence of the state on revenue transferences from the Union; the aplication of resources in actions of other nature considered as health, in exemple of the expenditures undertaken by the budgeting unit Supplying Center S/A (CEASA) on the function of health and subfunction of prophylactic and therapeutic and on the Popular Pharmacy program. Since 2006, expenses refering to Regime Security Servers (RPPA) on the area of health also have being considered as public actions and services in health for constitutional limit ends, beyond the inconsistencies on the PPAs with the actions performed efectively.

Da voz que cala ao corpo que fala: o assédio moral no ambiente de trabalho como desafio para o serviço social

The changes ocurred in the world of capitalist labor, especially from the last decades of the 20th century, accentuated the process of manipulation and domination of the working class, materialized mainly through naturalization and / or trivialization of violence, conducted in the work environment. From this process, emerge the elements of bullying, that is, the embarrassing and humiliating practices which extend through time, degrading human race, and becoming fruitful object for study, debate and the intervention of the professionals of the Social Service area. Thus, we assume the perspective of analyzing the concepts and the work of social workers, whom work at people management area before the bullying in the workplace. We propose the following objectives: apprehend the settings of bullying, in the contemporary context of competitiveness and flexibility of work, as well as its implications for workers' health; characterize the background of this expression of violence at work in the municipality of Natal- RN; and analyze the powers and duties of the social worker in the process of prevention, identification and addressing of bullying in the context of work. This study consisted of a qualitative approach, based on the dialectical-critical method as soon as we adopt methodological procedures such as: theoretical knowledge, documental and field research, and performed using semi-structured interviews. The subjects of this research were nine (09) the Social Service professionals working in personnel management area, in five (5) institutions with legal and branches of different activities, located in Natal-RN. Even interviewed one (01) representative of the Public Ministry of Rio Grande do Norte Office (MPT-RN). The findings of this analysis indicate that bullying is a contemporary expression of "social question", which is presented as a demand for the Social-assistants – covered up and / or camuflage – under the guise of problems related to workers' health or mere conflicts of interpersonal relationships, that is, without any causal connection with the organization of work. The fear of losing job, not to be inserted in the labor market, and / or suffering reprisals, deepens the subject levels of the victims of bullying. Hence the importance of Social Workers are capable to understand the social reality, by preventing and combating the elements of bullying.

Hepatite C crônica em serviço de referência no nordeste do Brasil: um estudo retrospectivo de dezoito anos de acompanhamento

Chronic Hepatitis C is the leading cause of chronic liver disease in advanced final stage of hepatocellular carcinoma (HCC) and of death related to liver disease. Evolves progressively in time 20-30 years. Evolutionary rates vary depending on factors virus, host and behavior. This study evaluated the impact of hepatitis C on the lives of patients treated at a referral service in Hepatology of the University Hospital Onofre Lopes - Liver Study Group - from May 1995 to December 2013. A retrospective evaluation was performed on 10,304 records, in order to build a cohort of patients with hepatitis C, in which all individuals had their diagnosis confirmed by gold standard molecular biological test. Data were obtained directly from patient charts and recorded in an Excel spreadsheet, previously built, following an elaborate encoding with the study variables, which constitute individual data and prognostic factors defined in the literature in the progression of chronic hepatitis C. The Research Ethics Committee approved the project. The results were statistically analyzed with the Chi-square test and Fisher's exact used to verify the association between variable for the multivariate analysis, we used the Binomial Logistic regression method. For both tests, it was assumed significance p < 0.05 and 95%. The results showed that the prevalence of chronic hepatitis C in NEF was 4.96 %. The prevalence of cirrhosis due to hepatitis C was 13.7%. The prevalence of diabetes in patients with Hepatitis C was 8.78 % and diabetes in cirrhotic patients with hepatitis C 38.0 %. The prevalence of HCC was 5.45%. The clinical follow-up discontinuation rates were 67.5 %. The mortality in confirmed cases without cirrhosis was 4.10% and 32.1% in cirrhotic patients. The factors associated with the development of cirrhosis were genotype 1 (p = 0.0015) and bilirubin > 1.3 mg % (p = 0.0017). Factors associated with mortality were age over 35 years, abandon treatment, diabetes, insulin use, AST> 60 IU, ALT> 60 IU, high total bilirubin, extended TAP, INR high, low albumin, treatment withdrawal, cirrhosis and hepatocarcinoma. The occurrence of diabetes mellitus increased mortality of patients with hepatitis C in 6 times. Variables associated with the diagnosis of cirrhosis by us were blood donor (odds ratio 0.24, p = 0.044) and professional athlete (odds ratio 0.18, p = 0.35). It is reasonable to consider a revaluation in screening models for CHC currently proposed. The condition of cirrhosis and diabetes modifies the clinical course of patients with chronical hepatitis C, making it a disease more mortality. However, being a blood donor or professional athlete is a protective factor that reduces the risk of cirrhosis, independent of alcohol consumption. Public policies to better efficient access, hosting and resolution are needed for this population.

Ajuste estrutural e educação superior no Brasil: princípios negados

SILVA, Hiran Francisco Oliveira Lopes da. A juste estruturale educação superior no Brasil: princípios negados. 206 f., 2007. Tese (Doutorado em Educação) - Universidade Federal da Paraiba, João Pessoa, 2007.

Percepção Ambiental em Museus Paisagens de Arte Contemporânea: a legibilidade dos museus Inhotim/Brasil e em Serralves/Portugal avaliada pelo público/visitante

This thesis nalyzes the wayfinding in Landscape Museum of Contemporary Art (MPAC), based on the Institute of Contemporary Art CACI, Minas Gerais, Brazil and the Museum of Contemporary Art of the Serralves Foundation, Porto, Portugal. The study focuses on the interrelationship of the public/visitors with the landscape, architecture and contemporary art museums in these, in order to understand visual perception and apprehension of such an environment for their users. For both were confronted documentation (visual and written) and people talk. The main hypothesis put forward is that the audience/visitor MPAC appreciates the interrelationship between the natural environment (park/garden) and built environment (the works of contemporary art and the galleries), giving equal value to both. To complement this, a second hypothesis is that during the visit to MPACS, visitors define their paths spontaneously, but strongly influenced by existing visual indicators (maps, signage and striking landscape elements), which facilitate the readability of space, which also contribute to the offered services and the experiences of similar institutions. The analytical basis of the research used the concepts of legibility (LYNCH, 2009), wayfinding (GIBSON, 2009; ARTHUR, PASSINI, 2002; WEISMAN, 1982), Experiential Cotinnum (TUAN, 1985), Space Bound (CRUZ PINTO, 2007) and habitus (BOURDIEU, 1992). Methodologically was used qualitative research (DEMO 2000) by means of a case study (YIN, 2005; STAKE, 1999) and participant observation (WHYTE, 2005). In the two institutions interviews with researchers and curators, behavior observation and questionnaires from employees, trainees, monitors and the public/visitor of the two museums were performed. Although partially referende the initial hypothesis, the research showed that the public/visitor value appears more natural environments, they experience a greater intensity and in addition to the factors listed in the second case, your perception and definition of paths suffer significant influence of emotional relations established with space. Generally the audience/visitor adapts easily to different demands of contemporary art exhibition in the two museums and the built environment (park/garden and museum) interferes with your reading path during the visit, perceived by the public/visitor condition as a factor that favors the enjoyment of works on different mounts (wayfinding), though often become a factor that hinders the legibility of the building and its built environment