Elaboração e avaliação de indicadores comportamentais de aderência ao tratamento hemodialítico

Introduction: This work intents to characterize behavioral indicators of tack to the hemodialysis treatment in a sample of carrying patients of chronic kidney failure (CKF) in the great Natal/RN. The therapeutical adherence represents the agreement degree between the patient behavior and the health team lapsings. The CKF is the gradual and irreversible loss of the renal function, being the hemodialysis treatment an important alternative to assist or to substitute the kidneys. Method: The sample consisted in 80 chronic kidney patients in hemodialysis treatment in two located clinical centers in the region of the great Natal, RN. It was used as instruments (a) a protocol of clinical data collection, (b) the Millon Index of Personality Styles (MIPS) and (c) a script of halfstructuralized interview. Results: The results show a balance between the genders (51% of female and 48.8% of the male sex), average age and equal average time of dialysis respectively to the 43,4 years (±13,25 years) and 22,04 years (±4,24 years). The marital status of half of the sample is married, predominating basic education (43.6%) and a familiar income until a minimum wage (43.8%). It had been defined six physicianlaboratorial indicators to evaluate the therapeutical adherence, further the use of the evaluation of the health team and the patient themselves. Thus, there was an average adherence around 55.97% of the sample ±18.37%). However only between selfassessment of the patients about the adherence and the assessment made by blood pressure post-dialysis indicated a significant association (p=0,029, qui-square test). On the other hand, there was a significant association (p <0.05, chi-square test) among the criteria for treatment adherence and issues investigated in the interview - the perception on the quality of the health services provided to patients, the difficulties following the prescribed diet, the characterization of the days between dialysis sessions and the perception of patients about the dialysis sessions. It was also noted a significant association (p <0.05, Levene test) between adherence to therapy and scales that constitute the MIPS. The health team characterized the patients more adherent behavior as an attitude of acceptance of the treatment, looking actively for their implementation, for more information and knowledge, and establishing a positive communication with the team and with other patients. Similar results were confirmed by the MIPS evaluation. According to that assessment the more compliant patients adopt a more optimistic attitude, trying to act or adapt themselves to their environment, processing cognitively both concrete and objective information, such as more speculative and symbolic information. In addition they establish a gregarious, cooperative, submissive and flexibly pattern of interpersonal relationships to social demands. These characteristics managed to explain 55.7% of the adherence variation according the health team and 23.3% of the variation according the CaxP laboratory indicator. Conclusions: The MIPS shown to be able to identify the most and least adherent to therapy patients. The use of different adherence indicators is important for an evaluation covering the different facets of this process. The adhesion levels are observed within registered by the relevant literature. There is need for further studies with a larger sample to deepen the data findings in this work

Princípios da construção enxuta no processo de planejamento de uma construtora de grande porte de Natal (RN)

Considered as one of the oldest activities done by men, the civil construction represents one of the most important sectors for the economic growth of a country, in spite of the low results of growth in the past few years and also in the current year. To make this industry grow, even with an unfavourable economic scenario, it is necessary to implement an effective planning in its activities. This is one of the most important concepts brought by the Lean Construction philosophy, which had its origin through the adaptation of the concepts established by the Toyota Production System (TPS) or Lean Production. By having as a scenario the city of Natal\RN, the main goal of this dissertation consists in investigating how the 11 principles of the lean construction influenced the schedule of a construction field that started to implement its lean concepts. As a methodology, it was used the case study of a big enterprise located in Natal (RN). During the execution of the method, documents related to the short-term, midterm and long-term planning were analysed , aiming to describe its planning process; it was also described the factors that caused the delays at the enterprises’ field ;in addition, a comparison was made between the results obtained at the case study and the ones presented at the literature; in the end, the actions were listed by the company, which had the purpose to solve the main causes of delays, verifying if they were linked to the lean construction principles. This research finds its reason of existence in the relevance of its theme at the nowadays reality of the construction industry, since the principles of the lean construction uphold the reduction of processes that are useless, diminishing wastes as well as costs in construction. The relevance is perceived for the academy, in terms of the possibility to discuss if the concepts established by the lean production are being adapted to the civil construction sector and how this adaptation is influencing at the buildings planning project. Economic importance, because with the reduction of the wastes and costs, the companies may reduce the building´s value into a more accessible value, even with the sector´s lower growth. And social significance, because lean construction gives a better participation of the labour at the planning activity. Among the main results, the high frequency of planning errors stands out, mainly the programming deviations and not the task programming, as well as the execution errors, low productivity and activities executed by the workers. Amongst the 11 principles of lean construction, only five were related with the 12 actions analysed by the author. From the 12 actions, four were completely cohesive to one or more from these five principles. Some improvement proposals were also highlighted and established by the research.