Atenção à saúde mental na Estratégia Saúde da Família no Município de Parnamirim/RN: opinião dos profissionais, dos portadores de transtornos mentais e seus acompanhantes

This study aims to analyze and compare the opinion of professionals, managers and users about the mental health care in the Family Health Strategy (FHS). It is characterized as an Operations Research or Health System Research with a cross-sectional design and a descriptive quantitative nature. The study was developed from the application of the Opinion Measurement Scale allied to techniques of observation and structured interview in the city of Parnamirim / RN. The sample consists of 409 subjects, 209 professionals of the Family Health Strategy, 30 of the Oral Health Strategy, 19 of the Family Health Support Center, 24 directors of Basic Health Units, plus 68 users with mental disorders and 59 caregivers, respecting the ethical parameters of Resolution 196/96 of the National Health Council, trial registration number: CAAE 0003.0.051.000-11. Quantitative data were submitted to the Epi-info 3.5.2 for analysis. The network of mental health in Parnamirim involves the flow between the FHS, Psychosocial Care Centers, clinics and hospitals, having as main barriers the fragility of the referral and counter-referral system, of the municipal health conferences, of the FHS teams by the limitations in material and human resources as well as the population´s lack of acknowledge about the organization of the mental health network, issues that affect the integral attention. Even though the FHS professionals recognize the importance of their actions, they question their role in mental health care, experiencing difficulties in accessing psychiatric services (76.5%). Although most agree that the mentally ill is best treated in the family than in hospital (65.2%), the community health workers were the predominant category in the partial or total disagreement of this statement (40.8%), who is the professional in greater contact with the family. Nevertheless the caregivers miss the support of the FHS as the main focus of attention is on revenue control. The views of professionals, mental patients and caregivers converged in several statements, showing the main weaknesses to be focused by the mental health network of the city, as the perceptions that: (a) physical strength is needed to take care of mental patients for its tendency to aggression, requiring it to stay in the sanatorium for representing danger to society, (b) only a psychiatrist can help the person with emotional problems, (c) the user of alcohol and drugs does not necessarily develop mental illness, (d) the access barriers and doubts about the quality of psychiatric services, (e) caring of a mental health patient does not bring suffering to professionals. Therefore, the commitment to consensus building, monitoring and evaluation of the network are important mechanisms for an effective management system, reflecting in the importance of strengthening the health conferences and approximating different institutions. The results reinforce the importance of strengthening primary care through programs of continuing education focusing on the actions and functions of professionals in accordance with its competences and duties what contribute to the organization and response of mental health care, favoring user´s care and the promotion of family health

Da negatividade a positividade: possível trânsito de saberes, práticas e representações sociais sobre o estigma da hanseníase

Leprosy is a chronic infectious-contagious disease, caused by Mycobacterium leprae, manifested by dermatological and neurological signs and symptoms and has great disabling power. It was marked by a strong stigma throughout its history, since its bearers represented a threat, target of fear and social contempt. Currently, leprosy has treatment and cure, and the need to separate the diseased from family and social environment is no more necessary. However, patients still suffer prejudice and discrimination. This study aimed to understand the social representations of leprosy that interfere modifying mental health of the patient with leprosy in relation to stigma and prejudice. This is a descriptive and exploratory study, with qualitative approach, which involved 22 users of the Special Care Clinic in Infectious Diseases at the Hospital Giselda Trigueiro, located in Natal / RN. They were in use of multidrug therapy in the period of data collection, were of both sexes, aged between 16 and 80 years of age and classified as paucibacillary or multibacillary. The study was approved by the UFRN Ethics in Research Committee. Data collection was performed by filling the questionnaire identification and then for conducting the semi-structured interview, which was recorded. After the end of data collection, there was the construction of tables and graphs, using the Microsoft Excel Start 2010 for proper characterization of the research subjects; and for the treatment of the data obtained from the interviews, was used the Content Analysis and based on the Theory of Social Representations. The subjects studied were mostly male (64%), married or in a stable relationship (68%), concentrated in the age group 50-60 years (36%) and 28-38 years (23%), had at most elementary education (65%) and were low-income (59%). Of the total respondents, 64% were classified as multibacillary, with predominantly dimorfous form, and 50% had disability grade I or II, with different periods of diagnosis. The reports originate two categories: 1. The negative meanings of illness and leprosy; and 2. The positive meanings of illness in leprosy, which were subsequently subdivided into subcategories. Thus, it was found that in the group studied, the social representation of leprosy experiences a moment of transition, as regards the understanding of the disease and its way of experiencing the disease process. Such representation is anchored in the quality of information on the disease of its bearers and aimed at an attempt to face the illness of leprosy as a "normal process". It was found in this study that the transition is due to the work of combating stigma and consequences of leprosy, which is able to gradually transform reality, both regarding the team work of reference, and in relation to a broader character, of actions of health education, which favors overcoming of psychosocial disabilities

Estratégias de intervenção utilizadas por enfermeiros da ESF do município de Natal/RN no controle do câncer do colo de útero

Cancer of the cervix (cervical cancer) is the second most prevalent cancer among Brazilian women. The high rates of cervical cancer in Brazil justify the implementation of effective strategies to control this, which include actions to promote health, primary prevention, early detection, screening, treatment and palliative care. Despite the existence of the National Programme for Control of the CCU there was no reduction in the incidence and mortality of this disease in Brazil. The Family Health Strategy (FHS) has the potential to facilitate such control and, in this context, one should consider that nurses play a central role. The study aimed to know the general intervention strategies used by nurses FHS of Natal / RN in CCU control, and how specific: analyzing the knowledge of these nurses on the CCU, the actions developed in the ESF for the control of CCU and identify the difficulties faced by them to perform it. This is a descriptive exploratory quantitative developed through a structured interview guide with 106 nurses who have experience in controlling the CCU in FHS teams of Natal / RN. Data analysis was performed using descriptive statistic s. The results pointed to actions taken in the FHS to control the CCU, collection of cervical cancer screening, health education activities, nursing consultation, referral of suspected cases for medical monitoring and active women with abnormal test result . The actions that were not mentioned by the nurses included: forming groups of prevention and health promotion; expand coverage of exams and office hours of consultations, establishment of alternatives to end the pent-up demand in the health units, participation in treatment or rehabilitation process users with the CCU; interventions for pain management, alliances and partnerships with schools, in dustry and the use of protocols. This study can be seen that the practice nurses partially shares to the CCU in Natal / RN. The participants of this study, when asked about the CCU, specifically for signs and symptoms of disease and risk factors in general showed important gaps. Difficulties such as lack of materials for collection of Pap smear; inadequate physical space in the Health Units; pent-up demand in the service, delay in arrival of the test results; obstacles in the actions of referral and counter-referral and cultural factors make the CCU control is compromised. It is believed in this research contributed to a reflection on the importance of the role of nurses in the development of the ESF control actions CCU, pointing out the factors that affect these. It is important to involve all nurses who comprise the ESF as knowledgeable of the risk factors, signs and symptoms, and existing tools for the early detection of cervical cancer in the pursuit of quality improvement actions to promote women`s health, contributing in planning future interventions that may reduce mortality from this disease in Natal / RN.

Enfermagem na atenção primária em saúde no screening de adolescentes com excesso de peso

One of the Primary Health Care strategies for adolescent health is the growth and development follow-up and the early detection of overweight adolescents. Even though the School Health Program in Brazil proposes to evaluate the nutritional state of the school population in the corresponding community health units, not all cities have adhered to the Program and many nurses do not recognize overweight as a problem in their territory. The objective of the study was to identify the nurse´s participation in the screening of overweight adolescent students in their work territory. Cross sectional study conducted in eight state supported schools of the municipality of Natal/RN and in four Primary Health Units. The total student population was 27.277. A stratified sample was statistically calculated based on the student population of the four city geographical zones: 112 North , 74 West; 108 East; and 78 South, totalizing 372 adolescents. The students were selected by a probability process where eight schools were first selected, two per district, until the number per subsample in each district was reached. Four primary health nurses, responsible for the health units were included. Two instruments were used for data collection, a screening questionnaire and a semi-structured interview form for questioning of the nurses. The content of both instruments was validated. Anthropometric and health data were collected from the students and analyzed with descriptive and analytical statistics. Interview data were transcribed and submitted to content analysis. The nursing diagnosis of overweight was identified in 50 (13,5%) of the adolescents and its association with consumption of foods that have cardiovascular risk (canned foods, pasta and fried food). An association of the nursing diagnosis was identified with family history (diabetes, hypertension, obesity, and kidney disease). The nurses judged that care of overweight adolescents was important but noted difficulties because of the absence of this population in the health units, because of their work overload, and the lack of school articulation. The nurses do not have impacting actions with this population and delegate the responsibility to other professionals. It is concluded that overweight is a nutritional problem relevant to the adolescent school population in Natal/RN, with a 13,5% prevalence and that it is related to food consumption with cardiovascular risk and family health history. The nurses consider overweight as an important public health problem but do not envision ways to maintain linkage with adolescents and with the school to promote the needed care

Hanseníase: a implicação da educação em saúde para o autocuidado

A hanseníase é um problema de saúde em nível mundial devido principalmente ao seu potencial incapacitante. A estratégia de combate à doença adotada pelo Ministério de Saúde é o diagnóstico e tratamento precoces, prevenção e tratamento de incapacidades físicas e vigilância dos contatos domiciliares. Tudo isso fundamentado na educação em saúde como sustentáculo para compreensão do processo de adoecimento, da doença em si, sua aceitação e, principalmente, das ações de autocuidado para prevenção de sequelas. Nesse contexto, questiona-se: Qual a implicação da assistência de enfermagem focada na educação em saúde para o autocuidado em portadores de hanseníase? O objetivo geral desse estudo é avaliar os conhecimentos adquiridos pelos portadores de hanseníase sobre a doença, o tratamento e autocuidado abordados durante a consulta de enfermagem. Trata-se de um estudo exploratório-descritivo com abordagem qualitativa, realizado no Hospital Universitário Onofre Lopes. Respeitou a resolução 466/12 do Conselho Nacional de Saúde e foi aprovado pelo comitê de ética sob nº 387.769 e CAAE 17468213.0.0000.5537. Envolveu 14 portadores de hanseníase em tratamento no ambulatório de dermatologia do HUOL. Os dados foram coletados no período de 23 de setembro a 04 de novembro de 2013 por meio de entrevista semi-estruturada; e analisados a partir da analise de conteúdo de Bardin. Os resultados e discussões são apresentados através de um artigo, o qual atende os objetivos propostos, denominado O autocuidado realizado por portadores de hanseníase . Esse objetivou identificar as ações de autocuidado de portadores de hanseníase em uma unidade de referência a partir de três eixos temáticos emersos dos discursos dos sujeitos: 1.as complicações/sequelas da hanseníase conhecidas pelos portadores da doença; 2. as ações de autocuidado adotadas pelos portadores de hanseníase; 3. as possíveis contribuições de um grupo de autocuidado para os portadores de hanseníase. Constou-se aparente superficialidade no conhecimento dos pacientes sobre as complicações da hanseníase, como também, das ações de autocuidado realizadas por eles. Verificou-se também a importância da assistência de enfermagem ao portador de hanseníase, tanto na atenção primária, quanto nos demais níveis de complexidade 11 da assistência. Considera-se que o enfermeiro é um potencial colaborador da educação em saúde como alicerce para o controle e eliminação da hanseníase

Avaliação da assistência à saúde dos portadores de úlceras venosas atendidos no programa saúde da família do município de Natal/RN

Descriptive research aimed at evaluating the assistance offered to patients with venous ulcers, on lower limbs, attended by the Family Health Program (FHP) team, from the municipality of Natal/RN. The target population was composed of 74 patients with venous ulcers (VU), attended by the FHP teams in the 31 FHUs. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (protocol n.55/05). The data collection was performed in patients homes and in the FHUs, through structured interviews and physical examinations of patients with VU and non-participant observation during the changing of wound dressings in these Units and in users homes. The data was organized into an Excel electronic table and transported into the SPSS 14.0 program, for descriptive analysis on 2x2 contingency tables and inferential (Qui-Square χ2, Spearman Correlation, Binomial Proportion Test and p-value <0.05). The prevalence of VU (0.36/1000) in the target population (over 20 years of age) was greater than in the population registered in FHP (0.25/1000). We detected a greater prevalence in the age area of over 60 years (2.22/1000), with 2.98/1000 for females and 1.3/1000 for males (p-value=0.008). The sociodemographical and health characteristics of patients with VU revealed predominance of females (74.5%), elders over 60 years of age (67.6%), with fundamental education (74.3%), family earnings of up to 2 minimum wages (68.9%), retired (90.5%), ortostatic position (23.0%), inadequate sleep (59,9%), presence of CVI (100.0%), hypertension (44.6%) and diabetes (25.7%). As for the time of existence of the VU, 64.9% had over 1 year, and 35.1% less than 1 year), with predominance of one wound (67.6%). The changing of wound dressings is performed mostly at home, in and inadequate way, especially with incorrect cleaning techniques, likewise incorrect use of products and substances, and reduced participation of the FHP team on the evaluation and application of the dressing and choosing of products and substances. The compressive therapy is not part of therapeutic conducts for treatment in the FHUs. As for the evaluation of assistance to patients with VU, 90.5% were inadequate and only 9.5% adequate. The main inadequacy factors were the absence of: diagnosis (47.3%), consultation with and angiologist (63.5%), compressive treatment (100.0%), adequate optical therapy (98.62%), adequate dressing kit (70.3%), training for the changing of dressings (67.6%), following by the FHP team (51.4%) and performed exams (55.4%). We ve concluded that patients with VU mostly present now socioeconomical level and associated chronic diseases. Considering that assistance offered by FHP is non-systematic, fragmented, with no diagnosis planning, continual evaluation and evolution, we qualify the assistance as inadequate and with low level of solution, directly interfering on the maintenance of the VUs chronic state

Nascimento de um filho :o significado para o pai

Qualitative study on the meaning of a child s birth to the father. Its general purpose was to comprehend the significance the man attaches to his child s birth and its specific objectives were to identify the man s feelings with regard to his child s birth as well as to verify his attitude toward a child s birth. The study was founded on the theoretical reference system about the man in the gravid-puerperal cycle and the humanization of the assistance. The data were obtained through semistructured interview performed with men accompanying their children s birth whose wives were in the immediate puerperium. This stage occurred in two maternity hospitals in Natal-RN, both of which adopt the principle of safe notherhood in the attendance of women in the process of parturition. The material apprehended from the statements was treated in conformity with the content analysis method in the mode of thematic analysis according to Bardin. Three thematic categories emerged from this process: the father s attitude toward his child s birth, the father s feelings in respect of his child s birth, and the informations received by the father in the course of his child s birth. The speech content was analyzed in accordance with the principles of symbolic interactionism according to Blumer. The results showed that the husbands interact with their respective wives and respond with attitudes of care, help, support, and encouragement within the principles of humanization intermingled with feelings of happiness, restlessness, and suffering leading them to appraise and exalt their consorts. Besides, we verified that the father s attitudes and feelings in the delivery room in the light of symbolic interactionism tend to be influenced by the interaction between him and the attending professionals

Balanced Scorecard: fatores relevantes de sua implantação na diretoria de mercado de capitais do Banco do Brasil

Este trabalho objetiva determinar que características do corpo funcional da DIMEC (Diretoria de Mercado de Capitais do Banco do Brasil) estão associadas aos principais entraves considerados relevantes pelos funcionários da área durante a implementação do Balanced Scorecard (BSC). Pretende-se salientar como entraves tais como a falta de apoio de Tecnologia de Informação e a falta de hábito dos funcionários em lidar com indicadores não financeiros podem se relacionar com as características de interesse do corpo funcional, tais como nível hierárquico , formação acadêmica e nível de conhecimento da ferramenta BSC , de forma a influenciar na implementação do modelo. Para tanto foi realizada revisão de literatura e estudo de caso no qual figuraram, como instrumentos de coleta de dados, a aplicação de questionários e a entrevista não-estruturada através dos quais funcionários da DIMEC demonstraram as relações entre as variáveis descritas de forma a destacar fatores de relevância para o desenrolar do processo de implantação da ferramenta BSC na referida empresa

Práticas pedagógicas das escolas de ensino médio que contribuem para a escolha do aluno pelo curso de Engenharia de Produção da UFRN

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Analise SWOT do gerenciamento de resíduos do coco verde em duas agroindústrias do estado do Rio Grande do Norte

In the current conjuncture, the environmental factor has been changing the position of companies that are practicing or minimally adopting environmental management. Such tool has been used by companies to face the problems caused by solid waste, in particular green coconut waste, which is constantly among the material discarded by society (companies/ consumer). It is a typical tropical fruit whose fresh water is very benefic for human health, and its popularization has caused a progressive increase of its consumption. Following this stream of thought, this present work came up with an analysis of strengths, weaknesses, threats, and opportunities SWOT analysis on green coconut solid waste management at two agribusiness companies in the state of Rio Grande do Norte (RN), Brazil, aiming to know the challenges and the potentials of this kind of waste. According to the approach of the problem, this work fits a descriptive, exploratory, and qualitative research. The data collection was obtained by a questionnaire and a structured interview, in order to evaluate the strategic posture of agribusiness companies through SWOT analysis, which is an English acronym for Strengths, Weaknesses, Opportunities and Threats. The SWOT analysis is an effective tool to analyze the internal and external environment of an organization. This tool contributes to locate the company at the environment in question and when well applied it enables the detection of mistakes, the strengthening of correct procedures, the avoidance of threats, and the bet on opportunities. The studied agribusiness industries have very similar profiles, such as a long business life span, and a strategy that extends the useful life of the fruit, by using its waste for the manufacturing of new subproducts. In both, the daily quantity of waste resulted of this process reaches approximately 20 thousand units of the fruit in high season, being necessary a focus directed at use and/or treatment of these waste. Further to SWOT analysis, it was ascertained that the agribusiness company A works through a defensive marketing strategy and acts vulnerably, in other words, unable of acting before this market segment, for it has decided to stop using the waste due to a lack of equipment and technology. On the other hand, the agribusiness company B has incorporated an offensive marketing strategy because even not possessing equipments, technology, and appropriated internal installations, it still insists on use and benefits of green coconut waste in its agribusiness. Thus, it is considered that the potential of green coconut waste management for the production of several subproducts reduces the impacts produced by inappropriate placement and generates profits in a short, medium and long term. Such profits being tangible and intangible, as the interest for sustainability actions is not only a matter of obtaining return on capital, but it is an important question in order to move on into business, since it is not enough to have quality on products and process nowadays. It is necessary to establish socio-environmental practices aiming the image of the company as the prevailing role on consumers buying decision

Uma Aplicação de Redes Neurais Auto-Organizaveis à Reconstrução Tridimensional de Superfícies

We propose a multi-resolution approach for surface reconstruction from clouds of unorganized points representing an object surface in 3D space. The proposed method uses a set of mesh operators and simple rules for selective mesh refinement, with a strategy based on Kohonen s self-organizing map. Basically, a self-adaptive scheme is used for iteratively moving vertices of an initial simple mesh in the direction of the set of points, ideally the object boundary. Successive refinement and motion of vertices are applied leading to a more detailed surface, in a multi-resolution, iterative scheme. Reconstruction was experimented with several point sets, induding different shapes and sizes. Results show generated meshes very dose to object final shapes. We include measures of performance and discuss robustness.

Técnica de controle adaptativo robusto aplicada a filtros ativos de potência e paralelo

The Methods for compensation of harmonic currents and voltages have been widely used since these methods allow to reduce to acceptable levels the harmonic distortion in the voltages or currents in a power system, and also compensate reactive. The reduction of harmonics and reactive contributes to the reduction of losses in transmission lines and electrical machinery, increasing the power factor, reduce the occurrence of overvoltage and overcurrent. The active power filter is the most efficient method for compensation of harmonic currents and voltages. The active power filter is necessary to use current and voltage controllers loop. Conventionally, the current and voltage control loop of active filter has been done by proportional controllers integrative. This work, investigated the use of a robust adaptive control technique on the shunt active power filter current and voltage control loop to increase robustness and improve the performance of active filter to compensate for harmonics. The proposed control scheme is based on a combination of techniques for adaptive control pole placement and variable structure. The advantages of the proposed method over conventional ones are: lower total harmonic distortion, more flexibility, adaptability and robustness to the system. Moreover, the proposed control scheme improves the performance and improves the transient of active filter. The validation of the proposed technique was verified initially by a simulation program implemented in C++ language and then experimental results were obtained using a prototype three-phase active filter of 1 kVA

Planejamento cooperativo de tarefas em um ambiente de futebol de robôs

Este trabalho apresenta o desenvolvimento de um método de coordenação e cooperação para uma frota de mini-robôs móveis. O escopo do desenvolvimento é o futebol de robôs. Trata-se de uma plataforma bem estruturada, dinâmica e desenvolvida no mundo inteiro. O futebol de robôs envolve diversos campos do conhecimento incluindo: visão computacional, teoria de controle, desenvolvimento de circuitos microcontrolados, planejamento cooperativo, entre outros. A título de organização os sistema foi dividido em cinco módulos: robô, visão, localização, planejamento e controle. O foco do trabalho se limita ao módulo de planejamento. Para auxiliar seu desenvolvimento um simulador do sistema foi implementado. O simulador funciona em tempo real e substitui os robôs reais. Dessa forma os outros módulos permanecem praticamente inalterados durante uma simulação ou execução com robôs reais. Para organizar o comportamento dos robôs e produzir a cooperação entre eles foi adotada uma arquitetura hierarquizada: no mais alto nível está a escolha do estilo de jogo do time; logo abaixo decide-se o papel que cada jogador deve assumir; associado ao papel temos uma ação específica e finalmente calcula-se a referência de movimento do robô. O papel de um robô dita o comportamento do robô na dada ocasião. Os papéis são alocados dinamicamente durante o jogo de forma que um mesmo robô pode assumir diferentes papéis no decorrer da partida

Aplicação prática do método de sintonia de controladores PID utilizando o método do relé com histerese

The area of research and development involving the PID tune of controllers is an active area in the academic and industrial sectors yet. All this due to the wide use of PID controllers in the industry (96% of all controllers in the industry is still PID). Controllers well tuned and tools to monitor their performance over time with the possibility of selftuning, become an item almost obligatory to maintain processes with high productivity and low cost. In a globalized world, it is essential for their self survival. Although there are several new tools and techniques that make PID tune, in this paper will explore the PID tune using the relay method, due its good acceptance in the industrial environment. In addition, we will discuss some techniques for evaluation of control loops, as IAE, ISE, Goodhart, the variation of the control signal and index Harris, which are necessary to propose new tuning for control loops that have a low performance. Will be proposed in this paper a tool for tuning and self tuning PID. Will be proposed in this paper a PID auto-tuning software using a relay method. In particular, will be highlighted the relay method with hysteresis. This method has shown tunings with satisfactory performance when applied to the didactic, simulated and real plants

Otimização de forma aplicando B-splines sob critério integral de tensões

This work proposes a computational methodology to solve problems of optimization in structural design. The application develops, implements and integrates methods for structural analysis, geometric modeling, design sensitivity analysis and optimization. So, the optimum design problem is particularized for plane stress case, with the objective to minimize the structural mass subject to a stress criterion. Notice that, these constraints must be evaluated at a series of discrete points, whose distribution should be dense enough in order to minimize the chance of any significant constraint violation between specified points. Therefore, the local stress constraints are transformed into a global stress measure reducing the computational cost in deriving the optimal shape design. The problem is approximated by Finite Element Method using Lagrangian triangular elements with six nodes, and use a automatic mesh generation with a mesh quality criterion of geometric element. The geometric modeling, i.e., the contour is defined by parametric curves of type B-splines, these curves hold suitable characteristics to implement the Shape Optimization Method, that uses the key points like design variables to determine the solution of minimum problem. A reliable tool for design sensitivity analysis is a prerequisite for performing interactive structural design, synthesis and optimization. General expressions for design sensitivity analysis are derived with respect to key points of B-splines. The method of design sensitivity analysis used is the adjoin approach and the analytical method. The formulation of the optimization problem applies the Augmented Lagrangian Method, which convert an optimization problem constrained problem in an unconstrained. The solution of the Augmented Lagrangian function is achieved by determining the analysis of sensitivity. Therefore, the optimization problem reduces to the solution of a sequence of problems with lateral limits constraints, which is solved by the Memoryless Quasi-Newton Method It is demonstrated by several examples that this new approach of analytical design sensitivity analysis of integrated shape design optimization with a global stress criterion purpose is computationally efficient