O atendimento ao idoso na unidade de saúde da família: um estudo de representações sociais

The attention to health issues in aging has increased and it becomes a challenge for public policies directed to the elderly. This study aimed at learning the social representations built by seniors about the service in the Family Health Unit. It is an exploratory study, funded by the Theory of Social Representations of Moscovici. It was held at the Health Unit of the Family Felipe Shrimp, located in the neighborhood Felipe Shrimp in the city of Natal / RN-Brazil. The participants were one hundred and two elderly / as, served by the Family Health Strategy. The data collection period was extended from July to September 2014. Data were collected through the Word Free Association Test and Interview semi-structured, and analyzed with the help of EVOC software. Interviews were conducted with 20 elderly and subjected to content analysis. The research was approved by the Ethics Committee of the University Hospital Research Onofre Lopes, in the opinion 704,323. It was possible to apprehend negative connotations regarding attendance, listing it as bad and disrespectful, and the limited hours of service, difficult to schedule appointments and tests and inadequate infrastructure, the most marked aspects. Seniors express satisfaction with the medical care, however, they understand that it is necessary that all services are properly integrated to a qualified service. The statements reveal that the service in the drive needs to implement new strategies host for users to participate more in educational and health promotion. It is noted, the need of integrated care, the host of qualified hearing in the health services that they address the elderly seeking care at the clinic of the family, so sticking to the principles of the Unified Health System.

Residência multiprofissional, desafios e compromissos na reorientação da formação para o SUS: um estudo na atenção primária

The Health Multiprofessional Residency Program of the Federal University of Rio Grande do Norte (PRMS/UFRN) adopts as guiding keystones the learning process of in-service teaching, the interdisciplinary multiprofessional work and the compliance with the principles and guidelines of the Brazilian Unified Health System (SUS). Although PRMS/UFRN have been idealized with a focus on hospital care, the training process in the insertion of residents in the Primary Health Care (PHC) has an important role because they need to experience all levels of care, taking into account that the educational process through work proposed by the Residence is based on the comprehensiveness of health care. In light of the foregoing, the present research has sought to elucidate the insertion of these residents in PHC services, through a qualitative approach of case study, where data collection was held in two different moments: firstly, a questionnaire was accomplished, through an semi-structured script, with the residents of PRMS/UFRN, Natal Campus; subsequently, the focus group technique was accomplished with a group of nine residents, and data were analyzed from the categorical thematic content analysis. From the process of empirical categorization, categories and subcategories were raised, among which, the positive aspects and potentialities of insertion of residents in PHC. We detected the articulation of actions for promoting, preventing and recovering health; training in comprehensiveness of health care, multiprofessional activities and activities aimed at doing the integration among teaching-service-community. Regarding the difficulties found in this experience, we dealt with the organization and planning of rotation activities, the preceptorship, the process of work found in the Basic Health Units (BHU), in addition to factors external to educational practice, such as the issue of safety within these communities. Accordingly, with this situational diagnosis, we became able to realize that residents have identified the importance of this rotation for their vocational training, since these are inserted in post-graduate programs in hospital care. As an immediate product of this study, we will present a report that will provide a space for discussion and assessment of this rotation by the coordination bodies of PRMS/UFRN, in order to seek organizational and pedagogical adaptations, besides the proposition of qualification courses for the actors involved with this process, aiming the implementation of improvements in the rotation of PHC toward the qualified training of professionals for SUS.

Os estados no SUAS: uma análise da capacidade institucional dos governos estaduais na assistência social

This paper deals of the effects generated by institutional designs in the behavior of political actors. The literature that discusses the implications of federal arrangements in the production of public policies to dock at two opposing arguments: (1) the federal configuration would cause dispersion and variation in service provision between subnational governments; and (2) the central government would own mechanisms to induce the provision of national policies in more homogeneous levels, similar to unitary states. The research is part of this discussion because it analyzes the effects of the institutional design of the Sistema Único de Assistência Social (SUAS) in the decisions of states in Brazil. Therefore, we analyzed the institutional capacity built by the 26 state governments after the implementation of SUAS, conceiving this system as defined mechanism of government functions and federative cooperation.It is argued that the existence of a heterogeneous institutional capacity of state governments in social assistance is a result of the autonomy contained in the institutional design of SUAS to this level of government. This freedom of action relativize the idea that the implementation of national public policy systems would generate positive (or homogeneous) effects in all subnational governments, at the same time as it preclude to generalize the premise of fragility of the states in the brazilian federal plan.

A gestão do programa saúde na escola no município de Natal/RN: um estudo de caso

The current conception of health deals with several influential factors, having education among them. Intersectoral organization is essential for Young and adult healthcare services. In this context the Healthcare in School Program was created which foresees a continuous articulation between health and education aiding the effectuation of the Healthcare Single System. The objective of this research is analyze the Healthcare in School Program (HSP) in Natal city in Rio Grande do Norte State taking into consideration the Intersectoriality of actions from the standpoint of the management. The chosen method was the case study, with qualitative approach. The sample was of the intentional kind including all components of the Natal city Intersectorial work group, composed by representatives of the Municipal Education Bureau, the State Education Bureau and Healthcare Municipal Bureau. The collecting data technique was the semi-structured interview. The data analysis was performed through the analysis of contents technique. For Data Show the following analysis categories were considered: Meaning of Intersectoriality; Actions Planning; Permanent and ongoing training for autonomy regarding to Healthcare Promotion; Difficulties and Potentials for actions operationalization. The outcomes allow us to indentify in Natal HSP intersectoral practices not developed yet. The manager professionals of Healthcare and Education do not get to acknowledge the power of Intersectoriality yet. The lack of commitment of some professionals stands out, planning is performed in a sectorial basis and without active participation of learners and community, there is duties accumulation and discouragement group, structural inadequacy and difficulty on the ongoing of the program actions. Despite the existing fragmentation, the program has contributed to the professional qualification and development of education actions regarding to healthcare along with learners. Therefore we conclude that healthcare, education and society have lots of challenges to face in order to consolidate Intersectoriality and the Healthcare in School Program and the and the implementation of the guidelines of the Healthcare Single System in Natal city in the state of Rio Grande do Norte.

Gasto com a internação de idosos em unidades de terapia intensiva

Introduction: Population aging in Brazil underscores the need to discuss the proper management of the budget allocated in health field, especially in the sectors of high complexity, where coexist costly procedures, limited resources and the need for cost containment. In the other hand, demand is growing in a way directly proportional to the increase in the number of elderly in country. Objective: In this way, this research had as main objective to analyze the costs resulting from the admission of elderly in intensive care units (ICU) and its associated factors. Methods: This is a cross-sectional study with a quantitative approach and featured as a descriptive and exploratory research. Data were collected from medical records of elderly hospitalized in ICU from a brazilian city called Natal-RN, between november first, 2013 and january, 31 of 2014. The variables collected relate to the socio demographic profile, morbidity framework and characterization of hospitalization. The dependent variable was categorized by quartile 75 in high and low expense of hospitalization and submitted to chi-square test with the independent variables of the survey. Associations with p value <0.20 in the bivariate analysis were submitted to the technique of multiple logistic regression. We opted for the construction of three regression models from the above algorithm: general regression model, composed by all 493 hospitalizations in the study, other made with 181 individuals admitted in health public system (SUS) and a third one related to 312 cases from private service in health area. Results: In the general regression model, the variables respiratory diseases, hospitalizations in the private system, disoriented patient and previous stroke were associated with greater probability of high spending in the ICU. In the other hand, in SUS kind of hospitalizations, this probability was associated with disoriented patient, 80 years old or more, sepsis and admission for clinical reason. In the cases from the private network health, the high expenditure was associated with respiratory disease, mechanical ventilation, hospitalization for clinical reason and disoriented patients. Conclusion: The increased expenditure on hospitalization of elderly in intensive care depends on the clinical conditions of individuals. This highlights the importance of avoiding hospitalizations due to diseases sensitive to primary care by health preventive actions and providing comprehensive care to the elderly. In addition, obtaining different explanatory models, according to kind hospital funding, demonstrates the importance of the organization in health services related to composition of costs of hospitalization among the elderly. Another question founded was the need that to improve the funding, we must use rationally the available resources by avoiding unnecessary hospitalizations of elderly people in the extremes of severity. On this kind of precarious funding, ICU hospitalization of elderly non-critical or in a terminal state can compromise the quality of services provided to those who really need intensive care.

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.

Serviços-escola de psicologia do Rio Grande do Norte: formação profissional e política pública de saúde em debate

The Psychology University Services is stablished normatively as an indispensable equipment to the recognition of the graduation courses of psychologists by the Brazilian Education Ministery. The Public Healthcare Policies (Universal Health System/SUS) constitutes itself as a input field of the professional category, but shows huge challenges in the formation of these professionals. The objective of this work is to analyse the functioning of the Psychology University Services (SEP) and the Superior Educational Institutions from Natal, understood as important formation devices to attend the actual demands of the psychologist's work on SUS. For this, it sought a) characterize the psychological practices developed in the SEP; b) relate the National Curricular Lines of Direction of the psychology courses to the skills and competences developed in the SEP to the performance on the public healthcare policies; c) mapping ways of including the SEP in the network designed by the healthcare policy. Interviews were performed with 13 academic supervisors, 8 field supervisors and technicians of superior level (TNC), along with 9 managers, being for of the Psychology University Services and 5 of the graduation programs. Questionnaires were also applied to 57 interns and 24 graduates. Besides that, two conversation circles were performed with the faculty and technician members from two of the Educational Institutions that were participating of the research, as well as a workshop with students and psychologists, promoted by the CRP 17. We observed that most part of the faculty members and managers know the DCN and comprehend that the formation is in process of change in what concerns to the extension of the formation to the performance of the psychologists in various contexts. However, most part of the TNC don't know about them. Moreover, the results point to the predominance of the assisting model based on the traditional clinic psychology, although the articulation with the public healthcare and social assistance networks can already be timidly visualized. Different modalities of practices in theses Psychology University Services were also detected, such as conversation groups, thematic workshops, organizational consultancies, team meetings with the interns and TNS in a daily basis, matriciament in mental health, therapeutic monitoring, among others. Yet, the SEP in Rio Grande do Norte are still isolated from the other courses that perform in the healthcare area and also from the services that compose the public healthcare and public policies.

iSalud: uma arquitetura para publicação e distribuição de sistemas de informação para o SUS

The Brazil Telehealth Networks Program was established by the Ministry of Health in 2007. Its main objective is to support professionals in Primary Health Care (PHC) by offering educational qualification, resulting in more favorable conditions to fixate the professional in remote areas. The formulation and management of telehealth services are performed by scientific and technical centers that are operated by public institutions of higher education and responsible for providing tools and services in the context of the regions where they are. However, one of the problems generated by this decentralization is the development of various tools with different types of language, architecture and without any regulation and integration of information with the Ministry of Health. Aiming to solve the above problem, we propose the specification, implementation and validation of an architectural model in the development and distribution of the Unified Health System software tools. This proposed architecture enables tools developed in telehealth center to be shared among the other centers, thereby preventing the unnecessary use of resources.

As múltiplas dimensões da garantia dos direitos do paciente idoso internado: o caso de uma instituição hospitalar pública no município de Natal/RN

In the context of current capitalist society, marked by the logic that restricts the human person their status as workforce, in order to generate profits, old age is often treated as an underprivileged life stage. This reality becomes more intense considering the sharp aging process that affects brazilian society is accompanied by the country's entry into a globalized world and tensioned by the dictates of capital. Thus, despite the increasing development of policies to strengthen the guarantee of elderly rights, it is necessary to establish effective strategies of these measures to ensure a higher quality of life to these subjects. Therefore, it is necessary to develop studies that problematize the issue of the elderly, which represent a growing portion of the population, and hence have more visible demands, including in health. With the increase in the elderly population in Brazil it is possible to realize the country is going through a demographic transition and epidemiological changes that contribute to change the landscape of health care of the elderly, especially the hospitalization. Thus, this study aimed to analyze the multiple aspects of ensuring the rights of elderly patients admitted to the State Hospital Dr. Ruy Pereira dos Santos (HRPS), located in Natal / RN, whose most patients are elderly. Specifically sought to understand the aging process, its social consequences and the vulnerability to which it is exposed, especially during the disease situation; understand the process of construction of the Brazilian public health and their actions for older people; learn the expressions of citizenship formation in Brazil with regard to policies for older people; and investigate the design of health professionals about the guarantee of the right of hospitalized elderly. Starting from an integrated coordinated theoretical and practical possibilities, a qualitative research and literature character, documentary and field was held. For this, there were four semi-structured interviews with health research locus Hospital professionals - namely, two social workers, a doctor and a nurse - as well as life stories with the hospitalized elderly patients, one in each deck the said Hospital, totaling three. The results pointed to the difficulty of health policy become effective as law and stressed one historical scenario violation of the rights of elderly hospitalized patients, which persists due to the precarious situation and the difficulty of effective implementation of the Unified Health System (SUS ) and other public policies to that end.

Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.

Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.

Projeto SB Brasil 2010 - pesquisa nacional de saúde bucal revela importante redução da cárie dentária no país

O Projeto SB Brasil 2010, planejado e executado por órgãos do SUS, nos âmbitos federal, estadual e municipal, e de universidades brasileiras, por meio de Centros Colaboradores do Ministério da Saúde se constitui em recurso de valor estratégico para aprofundar os conhecimentos sobre os agravos bucais no país, e dá contribuição inestimável para orientar os rumos da PNSB e avançar na construção de um modelo de atenção pautado na Vigilância à Saúde

Projeto SB Brasil 2010 - pesquisa nacional de saúde bucal revela importante redução da cárie dentária no país

O Projeto SB Brasil 2010, planejado e executado por órgãos do SUS, nos âmbitos federal, estadual e municipal, e de universidades brasileiras, por meio de Centros Colaboradores do Ministério da Saúde se constitui em recurso de valor estratégico para aprofundar os conhecimentos sobre os agravos bucais no país, e dá contribuição inestimável para orientar os rumos da PNSB e avançar na construção de um modelo de atenção pautado na Vigilância à Saúde

Projeto SB Brasil 2010: elemento estratégico na construção de um modelo de vigilância em saúde bucal

O projeto começou a ser pensado no âmbito do Comitê Técnico Assessor (CTA) em Vigilância em Saúde Bucal do Ministério da Saúde desde abril de 2009. Foi submetido à consulta pública durante o mês de junho de 2009, resultando em uma participação significativa de diversos setores em seu processo de construção. Desde então, foi formado um Grupo Gestor que, por intermédio de oito Centros Colaboradores localizados nas diversas regiões do país, tem conduzido o projeto a partir de oficinas de trabalho nos estados e treinamento das equipes de campo.

Projeto SB Brasil 2010: elemento estratégico na construção de um modelo de vigilância em saúde bucal

O projeto começou a ser pensado no âmbito do Comitê Técnico Assessor (CTA) em Vigilância em Saúde Bucal do Ministério da Saúde desde abril de 2009. Foi submetido à consulta pública durante o mês de junho de 2009, resultando em uma participação significativa de diversos setores em seu processo de construção. Desde então, foi formado um Grupo Gestor que, por intermédio de oito Centros Colaboradores localizados nas diversas regiões do país, tem conduzido o projeto a partir de oficinas de trabalho nos estados e treinamento das equipes de campo.