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

Avaliação da prevalência de Síndrome Metabólica, Microalbuminúria e Risco Cardiovascular em mulheres com Síndrome dos Ovários Policísticos

Avaliar fatores de risco cardiovascular em mulheres brasileiras com síndrome dos ovários policísticos (SOP), através da utilização de múltiplos parâmetros, incluindo a determinação da prevalência de síndrome metabólica e seus componentes e pesquisa de microalbuminúria como marcador de um possível dano renal precoce nessas pacientes. Métodos: Foram avaliadas 102 mulheres de 20-34 anos de idade, com diagnóstico de SOP pelo Consenso de Rotterdam, tendo sido analisados parâmetros clínicos, antropométricos, bioquímicos e hormonais. Para diagnóstico de síndrome metabólica, foram adotados critérios do National Cholesterol Education Program s Adult Treatment Panel III (NCEP-ATP III). Para avaliação da microalbuminúria foi utilizada a relação albumina/creatinina (A/C), calculada a partir dos níveis de albumina e creatinina em amostra isolada de urina. Foram realizados testes estatísticos para avaliar associações e correlações entre variáveis, bem como comparação de médias ou medianas, adotando-se nível de significância de 5%. Resultados: A prevalência de síndrome metabólica foi de 28,4% (29 em 102 pacientes), estando associada ao aumento do índice de massa corporal (IMC). Quanto à análise da prevalência dos componentes individuais da síndrome metabólica, evidenciou-se: HDL-colesterol < 50 mg/dl em 69,6%, circunferência da cintura ≥ 88 cm em 57,9%, triglicerídeos ≥150 mg/dl em 31,7%, pressão arterial ≥130/85 mmHg em 18,6% e glicemia de jejum ≥110 mg/dl em 2,9%. Quando definida pelos limites convencionais para a relação A/C (3,5 35 mg/mmol), a microalbuminúria esteve presente em apenas três pacientes (3,3%). Entretanto, considerando diferentes limites de corte estabelecidos em recentes estudos que demonstraram aumento do risco cardiovascular associado a níveis muito baixos da relação A/C, a prevalência em mulheres com SOP foi alta, variando de 17,7 a 43,3% (para valores ≥ 0,58 e ≥ 0,37 mg/mmol, respectivamente). Mulheres com intolerância à glucose apresentaram nível significativamente mais elevado da relação A/C, quando comparadas às mulheres com normoglicemia. Os valores de microalbuminúria não apresentaram correlação significativa com IMC, níveis pressóricos, índices de sensibilidade insulínica ou perfil lipídico. Conclusões: Os dados evidenciam uma alta prevalência de síndrome metabólica e seus componentes individuais em mulheres brasileiras com SOP. Além do mais, observou-se elevado percentual de mulheres com níveis de excreção urinária de albumina em faixas significativamente associadas com aumento do risco para eventos cardiovasculares. Em conjunto, esses dados alertam para a necessidade da abordagem interdisciplinar e multidisciplinar das pacientes com SOP, visando à instituição de medidas voltadas para a prevenção primária cardiovascular

Influência dos aspectos clínicos e assistenciais na qualidade de vida das pessoas com doença venosa crônica com e sem úlcera venosa

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Abordagem dos aspectos psicológicos da mulher infértil :um estudo quali-quantitativo

Purpose: assess the frequency of stress and anxiety levels in infertile women, correlate these aspects with risk factors and qualitatively analyze feelings resultant from the inability to conceive, in order to obtain data for specific psychological guidance. Methods: the case-control study included a total of 302 women, 152 being infertile (case group: 30.3 ± 5.4 years), and 150 non-fertile (control group: 25.7 ± 7.9 years). The quantitative approach involved the application of Lipp s Stress Symptoms Inventory (LSSI) and State-Trait Anxiety Inventory (STAI), whereas the qualitative approach consisted of a semi-structured interview. Response variables considered were: stress frequency and anxiety scores (State and Trait). Statistical analysis compared frequencies and medians between groups, by means of qui-squared and Mann-Whitney tests, respectively, and constructed logistical regression models to test associations between response variables and risk factors considered. Qualitative data were analyzed descriptively and categorized in order to perform correspondence analysis. The level of significance was 5%. Results: in the study sample, stress frequency was higher in the case group than in the control(61.8 and 36.0%, respectively), however, significant differences were not observed between groups in relation to stress phases and predominant symptomology type. With respect to anxiety, there were no significant differences between case and control groups as to median state scores [39.5 (35.0 46.0) and 41.0 (35.7 47.0 ); respectively) and anxiety trait scores [44.0 (34.0 51.0) and 42.0 (36.0 49.2); respectively). Risk factors significantly associated with greater risk for high anxiety scores in the case group were: primary infertility, unawareness of the causal factor, diagnostic phase investigation, religion, lack of children from other marriages and the fact that the woman was previously married. The qualitative approach demonstrated that infertility provokes emotional responses, such as sadness, anxiety, anger, fear and guilt. Conclusions: it can be concluded that infertile women are more vulnerable to stress; however, they are capable of adapting to stressful events without serious physical or psychological compromising

Fisioterapia e sociedade: ações do Sistema Único de Saúde no Rio Grande do Norte

The work has objective to present actions of Physiotherapy, developed by SUS in the State of Rio Grande do Norte; discuss under the humanization point of view such actions of health; discuss the importance of physioterapy to the Norte-Riograndense, or maybe its role in the perpetuation of actions of health centered in the binomial cause/efect. The study was done in the State of Rio Grande do Norte. The data were obtained through public sources gathered in the health secretrary ship of this State. The collected data talks about physiotherapy sections developed by SUS in several areas of the State; such data was collected and analysed after the aproval of Ethic and Resarch Committee of Federal University of Rio Grande do Norte. Concerning the physiotherapy, along with the State Health Secretaryship of the State fo Rio Grande do Norte, there were only records of attending based on cure/rehabillitation, not being observed during the curse of study, any record or action of prevention, promotion and protection towards health. It s possible to notice that there is a highligth to the interventions focusing on the treatment of illness of rheumatic origin and general complaints related to the vertebral column. Such research evidenced that the Physiotherapy in the SUS in the State priorizes the individualized attending centered in the carteziano health/illness model, where the developde actions are turned to the curative and rehabilliting attention, with role fo some or no highligth in the primary attention

Determinação de parâmetros de qualidade para formas farmacêuticas homeopáticas

All medicine, whether allopathic or homeopathic, must go through strict quality control, which must ratify their characteristics throughout the period of validity. During the time of preparation and storage, solutions of the drugs are in permanent contact with packaging materials that can release undesirable substances to the solution. Several factors may influence the release of packing materials, and factorial design (FD) is a useful tool for analyzing the phenomenon. The aim of this study was the determination of quality parameters for Homeopathic solid (globules) and liquid (drops) dosage forms. It was carried out analysis in homeopathic globules for weight variation, mechanical strength, and moisture content uniformity. For liquid preparations, standard solutions were prepared from natural rubber bulbs, which were subjected to exhaustive extraction with two ethanol solutions (30 and 70%) in the ultrasonic bath for 20 minutes at 25°C and 50°C in three successive cycles. Studies of transfer have been made within five days, by spectrophotometric analysis in the UV region at 312 nm with λmáx and 323 nm for samples in 70% ethanol and 30% respectively. PH values were analyzed. We also conducted two FD studies, where the first, the three-level variables were solvent (chloroform, ethanol and nhexane), sample mass (30, 60 and 90mg), particle size (large disk, small disk and powder sample). In the second study, the solvent level variables were different ethanolic degrees (EtOH 30%, 70% and pure). The percentage of lending in the solutions was 5.5%, 12.4%, 24.2% and 41% of the total estimated in the reference solution. The values of rate constants of transfer were determined in the order of 0.0134 days-1 and 0.0232 days-1 in absorbance values, the solutions in ethanol at 30% and 70% respectively. These results suggest that the speed of transfer of materials from rubber is affected both by the nature of the vehicle as by the temperature

Campo e contracampo : o encontro com o outro no filme Lavoura Arcaica

This dissertation aims to comprehend how we meet with the other at cinema. For this, it receives the doubt, the uncertainty, the way that the human being is unfinished as stance of observation. It takes into consideration the multiples social vectors, historical, subjective, temporal and cultural which constitute these phenomena. The cinema is used as a cognitive resource in order to incorporate the poetic and the imaginary, making possible not forgetting gestures and knowledge that hatch from sounds, colours, remembrances, images, words, social exchanges, cognitive reciprocity that allow us to think about the culture, the society and the communication. For this, it has as theoretical prerequisites ideas of double (myselfthe other) and effective participation (projection-identification) developed by Edgar Morin, as well as the idea of communication as possibility/impossibility of constructions of bonds with the other through the body, our primary media, concepts developed by Harry Pross and Norval Baitello Jr. The chosen film to analysis is Lavoura Arcaica, it is an emblematic movie in the discussion of the human condition and in the relationship between the man and its body, its desires, with its nature/culture ambivalence. About this film are made reflections about the process of activation of the double (myself-the other) in the searching for the other through cinematographically elements of construction, as: montage, direction, screenplay, actors, scenography, costumes and soundtrack. In conclusion, the cinema, when it allows the effective participation and provides t e experiment of the double, becomes a gateway line in the path to development of the alterity

Batidas intensas : corpo e sociabilidade nas festas de música eletrônica em Natal

The significance of the body in electronic music parties as a sign for communicating and socializing among participants is the focus of this work. Qualitative research undertaken in this study seeks to investigate how sociability happens at raves and nightclubs in Natal/RN. Sociability is understood here as a play expression involving the dimensions of music, dance and party; the body, seen from a transdisciplinary approach, is understood as a symbolic instance, with its own meanings, as a result and a producer of social and as a cross between the cultural and the biological. The body has a communicative potential, is primary media. An intersection point between nature and culture, it serves as the seat of emotions and sociability, since it is through it that social relations are made. In electronic music parties, the body is interpreted based on its communication signs: clothing, accessories, body movements, tactile contact, body language, interactions between the public and dj, the dj and the public, gestures, expressive speech of emotions. Through such signs, body communication and a sense of community among participants develop sociability in the festive place and change the mood of the dancers. The Natal s electronic music parties young goer interacts on parties, adopts cheerful and receptive positions towards the other, maintains physical contact, values dance as a form of communication and lists happiness as the main feeling aroused in electronic music festivals. To achieve this result, a plurimetodological approach was used, which consisted of various methodological devices and various techniques of investigation: ethnographic observation, individual and informal interview techniques, photographic record of the scene, in-depth interview and application thirty questionnaires to patrons of electronic music parties

Caminho possível para o desenvolvimento do RN: a utopia do Polo Gás Sal

La présente étude sur la modernisation économique qui s est opérée dans le Rio Grande do Norte, constitue un débat concernant les tentatives de faire aboutir un projet de développement industriel fondé sur l exploitation des matières premières locales telles que le sel, le calcaire, les eaux mères et le pétrole, entre les années 70 et 90 du XXe siècle. Elle cherche à montrer, à partir de l observation de l action planifiée de l État national et régional, soutenu par le capital international et par les groupes économiques et politiques locaux, comment on a tenté d implanter, dans des conjonctures économiques distinctes, une industrie d intrants de base moyennant la création de deux pôles de développement : le Pólo Químico Industrial (1974) et le Pólo Gás Sal (1996). Elle est centrée sur l analyse des actions orientées vers la concrétisation de ces pôles, et prendra pour objet les politiques de développement émanant de l État national, en particulier celles qui relevaient du II PND et qui visaient, au cours des années 70, à l implantation d une industrie décentralisée dans la région Nordeste ; les règles fixées par le Plano Nacional de Desestatizações, destinées à promouvoir les privatisations des entreprises publiques brésiliennes, lesquelles ont rendu possible la vente d Alcanorte au groupe industriel commandé par Fragoso Pires, et les politiques définies par l État national et régional, rassemblées sous le titre de « guerre fiscale » afin d attirer des capitaux internationaux susceptibles de rendre viable le Pólo Gás Sal. Il y est démontré que l État a coordonné un ensemble d actions dans les domaines de l infrastructure et des exonérations fiscales et financières, dans le but d accélérer la transition d une économie primaire et exportatrice vers une économie moderne, industrialisée. Et que le concours simultané de forces économiques et sociales particulièrement expressives le capital national et international, les élites locales n a pas suffi pour promouvoir la modernisation industrielle escomptée des secteurs chimique et pétrochimique. Parmi les différentes raisons qui ont contribué à un tel échec, on peut mentionner : l absence d une accumulation interne préalable de capital ; la dépendance de l économie locale par rapport à la technologie et au capital des groupes économiques internationaux ; l inconsistance des stratégies de développement relevant de la politique qui caractérisait la « guerre fiscale », et la fragilité de la représentation politique locale

A política de humanização e a estratégia saúde da família: visões e vivências

This study approaches the topic of humanization in health that involves the set of policies implemented by the Ministry of Health in Brazil. Its aims are directed towards a reflection on the guiding theoretical and organizing axes of the National Humanization Policy (NHP) and their repercussions on municipal health policy of Natal, Brazil; an analysis of the results of the policy at the local level; knowledge of the views and experiences of the humanization agents in the daily work process and identification of the main challenges of the policy. The empirical field of investigation was the Family Health Strategy (FHS) of the city of Natal. The assumption of the study is that the FHS has produced local experiences with potentialities that must not be wasted, in which there are difficulties and discrepancies between the real and proposed model. The contradictions and challenges in the social and political context of Brazil in the early XXI century and their consequences in the field of health reflect anti-utilitarian aspects anchored strongly in the theoretical concepts of Boaventura de Sousa Santos about the sociology of privations and emergencies as well as of the work of translating. The predominantly qualitative approach collects some complementary quantitative data. The study procedures used were the following: bibliographic research; documental research; interviews; and direct observation. Interpretation of the information obtained was based on documental analysis and on the symbolic cartography of the social representations. Cartographic evidence suggests that practices still take place under dehumanizing conditions that compromise the quality of care given. However, there is a movement aimed at changing the work process that has been strengthening the link and widening the measures developed, incorporating new directions in diversity, integrality and solidarity. The map drawn shows a reality manifested by explicit intentions in a political agenda, by concrete solutions marked by an assortment of difficulties and expressed in the words of the agents and by latent clues identified in successful local experiences, posing many challenges for the consolidation of the proposed changes

A política pública de segurança em Mossoró-RN: uma avaliação de processo da implantação da guarda civil (2009-2013)

The subject of public safety is part of the academic and popular discussions, due to several factors that act in society culminating in an increasing criminality. The importance of the evaluation of public policies in this context consists in a possible control tool, monitoring and necessary adjustments to the government to make the necessary changes. Given this reality, it is thought the research problem: how Mossoró (RN) city has implemented his public security policy? In general guideline of the research, we work with the following hypothesis: the own formulation of the National Policy of Public Safety there are elements that hinder the implementation of a public policy of municipal security in Mossoró. The objective of this research is to evaluate the existing security public policy in the city of Mossoró, by the elements that facilitate and/or hamper its implementation, through the actions of municipal government in the activities of the Mossoro Civil Guard (GCM). For this, a review of the implementation process was conducted, specifically its subprocesses of selection, training, and logistical or operational. Was used bibliographical research, documental primary and secondary, and field research, with conducting of interviews. It was found that with a staff of 197 guards, and with five years of creation, the actions developed by this institution refer to an early implementation of the municipal security policy. The guard has the basic pattern selection, part of function relocation and part of public tender. The formation occurs in an introductory way, however, not complete and specific, for the function performance. Its operability is limited by the number of existing effective and by the physical structure that has not matching the demand yet, which touches on the municipal budgetary reality of direct resource intended to safety. It was found the absence of a municipal plan of public security with principles, guidelines and goals that could direct the actions of the guard. It is concluded that despite of the implementation of the GCM Mossoró have not achieved, within the parameters of efficiency, efficacy and effectiveness have played their actions, projects and programs, it could trigger a process of opening for construction of a municipal security policy. As well as break with the paradigm of municipal actions just meant for surveillance of public property, interaction affirmative for the prevention of violence and crime

Desejo, preconceito e morte: assassinatos de LGBT em Segipe 1980 a 2010

This study examines the phenomenon of the murders of LGBT in Sergipe, between 1980 and 2010. Data were collected from newspapers, police, and judicial proceedings in the Courts with family members and friends of victims. The data show that despite the existence of death for involvement with drugs (crack), crimes of passion, among others, homophobia is one of its most characteristic elements. The victim profile also differs greatly from the aggressor, while the first is made up of individuals aged 25 to 44 years, the offender is between 15 and 29 years. Added to this the sensationalism of the press, the limits of police and justice in dealing with such events. The results seem to be forgetting some of the cases that do not reach the jury. It is an extensive study that combines statistical and qualitative data with a view to offering a closer look at the issue. The result is a mapping of brutal crimes, which, in part, has homophobia as the primary cause for its implementation

Nas sombras da família coelho: a dinâmica de uma dominação política

As one of the most important cities in the state of Pernambuco, Petrolina is settled in the Pernabucanian backwoods, a place that still holds its own traditions and manners. Petrolina s economy is mainly based on primary activities. It s politics is run by Family groups which preserve themselves and remain in power, using the clientelism, which could be said as a give and get practice. That means that the suffrage is a currency to exchange benefits. The present study analyses facts occurred in the political history of the Coelho s Family, which still dominates the local Politics. They persist as heirs of the old system of Coronelism that is maintaining their power structuring a political machine, which is able to make them unbeatable for over fifty years. Despite of a family internal division, it benefits all of them, directly or indirectly. Based on empirical observation, we set a brief historical of the Coelho s family facts, in order to demonstrate the range of their power through the ancestry, which is to say we ve described the local political labyrinths. Our metodological choices were driven by the comprehensive sociology, through the Weberian ideal types, in order to find the answers for the historical, social and political conformation of the facts, in consonance with the reality. According to that, we ve studied the Coelho s political trajectory from 1968 to 2012, considering the election periods. Commonplace: where a new generation becomes active subjects on a new apprenticeship, moral and intellectual. After all, they are all family heirs

Desenvolvimento energético e energia eólica na ordem jurídica do Brasil: aspectos Institucionais e Socioambientais

A conformação do desenvolvimento propugnado pela Constituição Federal de 1988 como objetivo fundamental da república, certamente perpassa pela racionalização das questões energéticas e pela diversificação da matriz nacional enquanto estratégia de aprovisionamento. O desenvolvimento energético em toda a sua complexidade deve ser alicerçado não em uma relação de contraposição à sustentabilidade, mas cooperativismo normativo e de projetos sociais que objetivam a melhorias para a população nestes dois seguimentos. O advento das energias renováveis nesse contexto se consolida como uma alternativa viável, apesar do tratamento dado pela Lei Maior ao tema ter sido apenas com relação à geração em pequena escala. A interpretação sistemática dos postulados da ordem econômica e as exigências da sociedade estimulam o aproveitamento dos potenciais renováveis em escala comercial e regional, além do fortalecimento nos segmentos de autoprodução e produção independente. Dentre as energias tratadas como prioritárias neste contexto, a eólica revela-se como carecedora de aprofundamento das estruturas dogmáticas de sua positivação, que envolve um vasto manancial de regras pulverizadas na regulação econômica do setor elétrico e no controle ambiental. Esta textura submete os empreendimentos elioelétricos aos instrumentos da política nacional do meio ambiente e às determinações do poder concedente dos serviços de energia elétrica, responsável pela pormenorização da geração, transmissão, distribuição e comercialização de energia, independentemente da fonte primária utilizada no processo de transformação. Tratar destas questões com o compromisso na formulação de raciocínios críticos e propositivos, especialmente acerca de temas como a liberdade energética e controle de mercado, é imperioso para superar juridicamente as limitações presentes inclusive no discurso da delimitação de marcos normativos adequados. Havendo vantagens ambientais, tecnológicas e comerciais na exploração da energia cinética do vento como propulsora do desenvolvimento no modelo civilizatório estabelecido, cumpre também ao Estado dar a sua contribuição setorial na forma de incentivos, desburocratização e aprimoramento do modelo concorrencial. O estudo adota os métodos histórico-evolutivo, dialético e sistêmico de abordagem, encarando as hipóteses formuladas no aspecto das consequências multilaterais que as soluções encontradas apontam, exigindo que a estabilização de expectativas sociais por parte do ordenamento jurídico não ignorem o sentido material cognitivamente aberto do desenvolvimento. Hodiernamente, a perspectiva de desenvolvimento energético alia tendências econômicas e tecnológicas em favor das fontes alternativas mais eficientes, revelando a energia eólica como uma representante adequada em termos pragmáticos de normatização e preservação ambiental

Educação profissional: a expansão recente do IFRN e a absorção local dos egressos no mercado de trabalho

This study aims to analyze how IFRN s process of interiorization contributes to endogenization of local and territorial development, more precisely in terms of graduates absorption into the labor market, form of inclusion and increase of income and welfare. The research premise is that the policy of interiorization and expansion of professional and technology education, by decentralizing opportunities, create a differential for the educational and professional trajectory of part of the graduates. This training, however, retain a relative connection with the productive potentialities in the coverage territories. This study includes a review of the literature on education and labor market and a discussion about the role of technical and professional formation for the local development versus the logic of the free market, considering the expansion of public spending for this purpose. For this study two sets of information and data have been collected primarily, with qualitative and quantitative nature. The research with qualitative focus, entitled Pesquisa de Avaliação da Expansão (PAEX), is constituted by series of open interviews applied to institutional representatives, with the purpose of knowing aspects of the interiorization repercussion in the local development process. The research designed to quantity analysis, entitled of the Pesquisa de Acompanhamento de Egressos (PAE), have been put in practice by applying online questionnaire with closed questions to IFRN s former students, aiming to know the form of insertion of the graduates in the labor market and the formation capacity of increasing the welfare, among other things. Empirical data and information fully confirmed the hypothesis of this study, for they really demonstrated that the expansion policy decentralizes opportunities and constitutes an important differential for the professional trajectory of a significant portion of the graduates. However, the graduates employability in the labor market in their territories of coverage is below expectations, due to structural problems of the local economy related to scarcity of jobs, difficulty in wage growth and in professional development. Complementarily, it has been observed institutional difficulties related to the recent implantation process of the policy of professional and technical education in the various campuses of the Institution