Gestão pública em saúde mental: um estudo em CAPS com gerência pública e privada do Rio Grande Do Norte

Currently, several models of management services from the public administration are in operation in Brazil following a global trend. Besides the traditional public management operated in SUS, there are ongoing experiments of privately management in the public health services. Accordingly, we have developed an investigation into two Psychosocial Care Centers operating between these two forms of financial resources management: the first is the CAPS II - PAR situated in the municipality of Parnamirim whose form is private and the second is the CAPS II West Christmas is that the municipal government. We seek to know the workings of services, planning forms and criteria for use of financial resources, identify differences between departments on ways to run and see how technicians and users participate in the planning and management of these resources. Documentary Research was conducted by the municipal Christmas and the financial administration of the CAPS service in Parnamirim. Were conducted an interview with manager (mental health coordinator of Natal) and another interview with an employee of planning department in the Health Department of Natal, an interview with the coordinator and financial administrator of CAPS - PAR and two groups of discussion taped conversation with semi structured script interviews with six technicians in CAPS PAR and six professionals crowded in CAPS - West.Differences were observed in the management of resources funded from four blocks of discussion and analysis of results, where the privately-run service for the direct management and bureaucracy without being discussed and planned spending on staff, as well as through meetings with users, the use of the financial resources available in box; already in service with municipal public administration there is a hierarchy, this answering the coordination of mental health and the local health department that centralizes resources and defines their spending. There are meetings with patients and families, but the demands are limited as to what can be sued because of the manager s authorization. Such differentiation would be related to differences in the articulation of public management with the different types of possible management in public services, where from the implementation of new public administration in the Brazilian s State Management Reform initiated in the second half of the 1990s, benefit management services with private regime, with autonomy and direct transfer of resources

Práticas interdisciplinares no ensino superior: a experiência do curso de graduação em administração da UNAMA - Pará

This work addresses the study of interdisciplinarity in higher administration education, a topic of great relevance in the present context, due to guidelines issued by Ministry of Education through the National Curriculum Guidelines -NCGs for undergraduate courses in Management. The attention on the subject emerges from the gained experience of a researcher and teacher working as manager of an undergraduate course in Business Administration who set up interdisciplinarity through interdisciplinary projects in a management course pedagogical project at a private university in State of Pará/Brazil. The work rebuilds and reports experiences, and studies the practice of lecturers involved in those interdisciplinary actions. The study aimed to identify changes in pedagogical practices of teachers involved in the searched interdisciplinary experience. To address the questions that directed the work and achieve proposed objectives, from a qualitative approach, a significant bibliographical and documentary work was conducted on the topic. In the survey carried out on secondary sources such as publications of major authors and scientific papers reporting interdisciplinary experiences in higher administration education, it was found that interdisciplinarity for its ambiguous character is still poorly understood by teachers, and reports on its application in administration teaching are incipient. This study also used data collected from primary sources, from dialogues through interviews with educational fellows - teachers and officers of the institution that served as locus of the research, who had the opportunity to experience the studied interdisciplinary experience. Data were processed and analyzed using content analysis technique. Research results showed that teachers of the institution of research have a good understanding of meaning of interdisciplinarity as a link between disciplines; it was also found substantial evidence of changes in teaching practices and actions of such teachers based on their participation in interdisciplinary projects. Although the experience studied can be considered innovative and challenging, much needs to be done in the course management for achievement of interdisciplinary actions in the course, particularly regarding to the removal of institutional, methodological, psychosocial, epistemological obstacles in operationalizing interdisciplinary practices, with emphasis on the need of a process of continuous and specific training aiming at developing skills for interdisciplinary acting, to the extent that these education professionals do not perceive themselves able to act as interdisciplinary lecturers

Práticas interdisciplinares no ensino superior: a experiência do curso de graduação em administração da UNAMA - Pará

This work addresses the study of interdisciplinarity in higher administration education, a topic of great relevance in the present context, due to guidelines issued by Ministry of Education through the National Curriculum Guidelines -NCGs for undergraduate courses in Management. The attention on the subject emerges from the gained experience of a researcher and teacher working as manager of an undergraduate course in Business Administration who set up interdisciplinarity through interdisciplinary projects in a management course pedagogical project at a private university in State of Pará/Brazil. The work rebuilds and reports experiences, and studies the practice of lecturers involved in those interdisciplinary actions. The study aimed to identify changes in pedagogical practices of teachers involved in the searched interdisciplinary experience. To address the questions that directed the work and achieve proposed objectives, from a qualitative approach, a significant bibliographical and documentary work was conducted on the topic. In the survey carried out on secondary sources such as publications of major authors and scientific papers reporting interdisciplinary experiences in higher administration education, it was found that interdisciplinarity for its ambiguous character is still poorly understood by teachers, and reports on its application in administration teaching are incipient. This study also used data collected from primary sources, from dialogues through interviews with educational fellows - teachers and officers of the institution that served as locus of the research, who had the opportunity to experience the studied interdisciplinary experience. Data were processed and analyzed using content analysis technique. Research results showed that teachers of the institution of research have a good understanding of meaning of interdisciplinarity as a link between disciplines; it was also found substantial evidence of changes in teaching practices and actions of such teachers based on their participation in interdisciplinary projects. Although the experience studied can be considered innovative and challenging, much needs to be done in the course management for achievement of interdisciplinary actions in the course, particularly regarding to the removal of institutional, methodological, psychosocial, epistemological obstacles in operationalizing interdisciplinary practices, with emphasis on the need of a process of continuous and specific training aiming at developing skills for interdisciplinary acting, to the extent that these education professionals do not perceive themselves able to act as interdisciplinary lecturers

Ética na pesquisa em Administração

Ethics on scientific research is approached and often discussed in several areas of knowledge connected to health. In the Administration area there are very few studies which approach the topic of ethics on research. The present paper tried to fill in this gap in the production of knowledge about the topic, investigating how the ethical principles found in the literature and in the codes of conduct are noticed and taken into account in Administration research activities developed by acting researchers in Administration Post Graduation Programs. Theoretically speaking, the study was based mainly on the approaches by Creswell (2007) and Bell and Bryman (2007), which discuss the research ethical principles. Methodologically speaking it was all about an exploratory kind of study, with qualitative research approach. Upon data collection, personal interviews were made aiming at its depth and focus groups were formed. The first stage had interviews with four experienced researchers who took part on a teaching and researching event and on the second stage we used the focus group technique. The focus groups were done in four college institutions along with the post graduation programs in Administration in the states of Rio Grande do Norte, Paraíba and Pernambuco, in Brazil. The results suggest the existence of general principles and parameters for the scientific research recommended in the literature and on official resolution. However, in the Administration area, there are only a few recommendations of good practices when it comes to submitting articles for scientific publications but we found no guidance with ethical principles and parameters which cover all the activities in the scientific research and which specifically meet the research particularities in Administration. The main ethical dilemma pointed by the researchers refers to ethical questions which arise at the time of data collection and on disclosing the results. Most researchers do not know the guidelines and the ethical norms on ethics about research that we have in our country neither do they send in their projects to the research ethics committee. When dilemma arises, they decide the ethical question based on their values and common sense. These elements confirm the thesis that the researcher s procedure in the research activities in Administration is predominantly signed by personal values or by common sense and less by ethical principles, whether by not knowing the normative instruments related to ethics or by disagreeing with any disciplining rules on ethical behavior in the research

Imagens do terceiro setor: um estudo com pais e responsáveis financeiros das organizações educacionais

The present report is the result of an applied research in the educational entities of the third sector, aiming to demonstrate whether the financial influences the perception of users on the image of those entities. For both used the prospect of integrative marketing relationship adapting to and developing a set of indicators which bore the measurement of images from the model of Machado et al (2005) and Kotler and Fox (1994). The sample included a total of 187 parents and financial responsibility in 03 (three) institutions of education in Natal / RN. These data were processed by multivariate statistical analysis, factor analysis, linear regression, analysis of cluster and discriminant analysis. The factor analysis also identified 6 images perceived by users of services. Next were the relationships of cause and effect between the financial and images formed. In discriminant analysis, was identified two distinct groups of parents and guardians with financial perceptions similar and well defined. The result of the work shows that the differential level of financial participation of parents and guardians not influence the formation of the images formed from educational institutions of the third sector

O processo de institucionalização do curso de administração a distância da UFRN

This work aims to describe how is occurring through the process of institutionalizing the Administration distance course of UFRN. To this end, structured into two parts: through research and analysis of content, sought to impound as if gave historic process of creation, as well as identify variables isomórficas, proposed by Powell and DiMaggio (1991), on the actions undertaken, and still present, institutional actors-having been found three typologies; then investigated the process itself, analyzing the factors of institutionalization suggested Esman (1966-1972), internal structure doctrine, leadership programme, resources, links and exchanges, from the political plan educational course. As the research methodology was defined as qualitative, even though I used survey to collect, reviewed the second ANOVA. The results found in this step pointed out that only the doctrine and internal structure variables are consistent with the assumptions of model; we found for other, discharged indicated a gap between the political acts contemplated in teaching and the actions taken so far, unfavourable element to its legitimacy. However, although the implications found in the analysis of these factors suggest that this course can derive one more discontinuous Government proposal of distance course, this study believes that are still reasonable assistance to facilitate and promote the process aimed at strengthening the progress achieved so far in the success of its institutionalization

Política pública e educação digital no ensino fundamental em Natal/RN: análise de eficácia da atuação dos objetivos do Proinfo Municipal

The present work turns on the public politics of digital inclusion and of the impact of the Technologies of the Information and Communication in the formation of the citizenship. For this, it was opted for doing an analysis of effectiveness of the performance of the objectives of the Proinfo (National Program of Computer Science in the Education) municipal district of Natal-RN. As instrument of collection of data, three types of questionnaires were used. The collected data were analyzed and discussed starting from it analyzes it descriptive of averages and analyze of multiple regression. The results of the research pointed that the teachers and the students use the computer science in a restricted way. On the other hand, the digital education is not still totally contemplated in the schools beneficiaries' digital rérumé by Proinfo municipal and thus, the inefficacy of the program was verified with relationship the educational training and the students' digital inclusion

Auto-eficácia de alunos de administração: um estudo com concluintes do curso de graduação em Administração no Estado do Pará

The current study presents the characteristics of self-efficacy of students of Administration course, who work and do not work. The study was conducted through a field research, descriptive, addressed quantitatively using statistical procedures. Was studied a population composed of 394 students distributed in three Higher Education Institutions, in the metropolitan region of Belém, in the State of Pará. The sampling was not probabilistic by accessibility, with a sample of 254 subjects. The instrument for data collection was a questionnaire composed of a set of questions divided into three sections: the first related to sociodemographic data, the second section was built to identify the work situation of the respondent and the third section was built with issues related to General Perceived Self-Efficacy Scale proposed by Schwarzer and Jerusalem (1999). Sociodemographic data were processed using methods of descriptive statistics. This procedure allowed characterizing the subjects of the sample. To identify the work situation, the analysis of frequency and percentage was used, which allowed to classify in percentage, the respondents who worked and those that did not work, and the data related to the scale of self-efficacy were processed quantitatively by the method of multivariate statistics using the software of program Statistical Package for Social Sciences for Windows - SPSS, version 17 from the process of Exploratory Factor Analysis. This procedure allowed characterizing the students who worked and the students who did not worked. The results were discussed based on Social Cognitive Theory from the construct of self-efficacy of Albert Bandura (1977). The study results showed a young sample, composed the majority of single women with work experience, and indicated that the characteristics of self-efficacy of students who work and students who do not work are different. The self-efficacy beliefs of students who do not work are based on psychological expectations, whereas the students who work demonstrated that their efficacy beliefs are sustained by previous experiences. A student who does not work proved to be reliant in their abilities to achieve a successful performance in their activities, believing it to be easy to achieve your goals and to face difficult situations at work, simply by invest a necessary effort and trust in their abilities. One who has experience working proved to be reliant in their abilities to conduct courses of action, although know that it is not easy to achieve your goals, and in unexpected situations showed its ability to solve difficult problems

Relações entre mecanismos de coordenação e controle com desempenho organizacional: um estudo nas instituições públicas de ensino médio de Natal

This research aimed at relating coordination and control forms to organizational performance. The multicase study was applied in two public high schools: Centro Federal de Educação Tecnológica do Rio Grande do Norte and Floriano Cavalcanti. In order to accomplish these objectives, it was developed a qualitative analysis and considered coordination and control forms of several authors. Also was considered Sander´s (1984) model of organizational performance. The mentioned model considers two criteria to analyze organizational performance: one instrumental (efficiency and efficacy) and other substantive (effectiveness e relevance). The research attempts to show the importance of balancing these criteria in a way that effectiveness and relevance becomes more important at schools. It was proven that the use of bureaucratic coordination forms has the power to influence the evaluation on the instrumental technique. At the same time, it was observed that the use of mechanisms based on the autonomy of the school is related to efficiency and efficacy. The object of this research can be considered successful

Democratização do acesso ao ensino superior: os cursos de graduação à distância na UFRN

This thesis pursuits to contextualize the theoretical debate between the implementation of public education policy of the Federal Government focused in a distance learning and legal foundations for its enforcement, in order to raise questions and comments on the topic in question. Its importance is back to provide scientific input and can offer to the academy, particularly in the UFRN, and elements of society to question and rethink the complex relationship between the socio-economic and geographic access to higher education. It consists of a descriptive study on the institutionalization of distance education in UFRN as a mechanism for expanding access to higher education, for both, the research seeks to understand if the distance undergraduate courses offered by the UAB system and implemented at UFRN, promote expanding access to higher education, as it is during implementation that the rules, routines and social processes are converted from intentions to action. The discussion of this study lasted between two opposing views of Implementation models: Top-down and Bottom-up. It is worth noting that the documents PNE, PDE and programs and UAB MEETING reflect positively in improving the educational level of the population of the country It is a qualitative study, using the means Bibliographic, Document and Field Study, where they were performed 04 (four) in 2010 interviews with the management framework SEDIS / UAB in UFRN. The data were analyzed and addressed through techniques: Document Analysis and Content Analysis. The results show that the process of implementation of distance education at UFRN is in progress. According to our results, the research objective is achieved, but there was a need to rethink the conditions of the infrastructure of poles, the structure of the academic calendar, the management of the SEDIS UFRN, regarding the expansion of existing vacancies and the supply of new courses by the need for a redesign as the Secretariat's ability to hold the offerings of undergraduate courses offered by the Federal Government to be implemented in the institution. It was also found that levels of evasion still presents a challenge to the teaching model. Given the context, we concluded that the greatest contribution of UAB and consequently UFRN by distance learning for undergraduate courses (Bachelor in Mathematics, Physics, Chemistry, Geography and Biological Sciences, beyond the bachelor's degrees in Business and Public Administration ) is related to increasing the number of vacancies and accessibility of a population that was previously deprived of access to university

Relações entre perfil de valores e perfil de uso da tecnologia: Um estudo com os docentes que atuam na modalidade presencial e/ou no ensino a distância

O advento das novas tecnologias e a dinamicidade das mudanças que estas provocam, impactam diretamente em vários aspectos da sociedade, dentre estes, na educação. Novas metodologias e mudanças no processo de ensino-aprendizagem tornam-se práticas cada vez mais frequentes neste campo. O elemento basilar desta nova constituição é o docente, capaz de transformar a utilização desses recursos em ferramentas que favoreçam o processo educativo. Essa readequação do comportamento exigida por essas constantes mudanças é orientada pelos valores pessoais dos sujeitos que vivenciam a situação. Os valores são idealizados como critérios que interferem diretamente nas atitudes, preferências e até mesmo no comportamento humano, influenciando no modo como o indivíduo interpreta as suas próprias atitudes e as dos outros, inclusive no âmbito profissional. Dessa forma, o objetivo geral da presente pesquisa é analisar as relações entre o perfil de uso da tecnologia e os valores dos docentes da UFRN Universidade Federal do Rio Grande do Norte, baseado na escala de valores de Schwartz. Para isso foram utilizados os tipos motivacionais que compõem a teoria de valores de Schwartz, através de questionário aplicado junto aos docentes. Trata-se de uma pesquisa de enfoque analítico quantitativo que utiliza um questionário da escala de valores desenvolvida por Schwartz et al. (2001) conhecida como PVQ (Portrait Values Questionnaire). A pesquisa foi desenvolvida a partir de uma amostra de 200 docentes entre atuantes da modalidade presencial e/ou na modalidade de ensino a distância. A estratégia de análise dos dados utilizou técnicas de estatística descritiva, análise de gráficos, análise das frequências relativas e a técnica estatística MANOVA (Análise Multivariada de Variância). Os resultados apontaram que os docentes utilizam moderadamente os recursos tecnológicos avaliados nesta pesquisa, como ferramenta de apoio pedagógico. Com relação ao perfil de valores, os docentes apresentaram prioridade entre os tipos motivacionais Autodeterminação, Benevolência e Universalismo, enquanto os menos priorizados foram os de Tradição, Realização e Poder, respectivamente. Contudo, não foram identificadas relações significativas entre o perfil de valores e o perfil de uso da tecnologia entre os docentes estudados nesta pesquisa

Autoavaliação institucional na dimensão do SINAES comunicação com a sociedade : estudo de múltiplos casos em instituições de ensino superior do Rio Grande do Norte

This study is about the institutional self-evaluation in Dimension 4, "Communication with Society", from the National System of Higher Education Evaluation SINAES, mandatory for all universities in Brazil. A multiple cases study was conducted with three institutions from Rio Grande do Norte, and the goal was to know how this evaluation is made, describing the concept for the evaluation of communication proposed by them, identifying controllers or emancipator aspects, categorizing methodological procedures and discussing the difficulties reported in the communication evaluation process. Coordinators of the institutions Evaluating Committees were interviewed and data categorized by means of qualitative content analysis. It was noted characteristics of the current controller, emancipator and hybrid designs in the three institutions for evaluation of communication, revealing the lack of a theoretical corpus that transits in accordance with the systemic perspective and epistemology of complexity from SINAES. It was found that the most frequently reported difficulties in the evaluation processes of communication are in the preparation stage, especially in the definition of indicators and tools and awareness work. The weakness in planning makes their own activities in the sector of communication become targets of assessment, forming goals poorly related with broader organizational goals. It was also concluded that the technical evaluation cannot override the issues associated with the broader issue of the complexity surrounding the assessment paradigm proposed by SINAES because contradictions and imperfections are part of the evaluation process and several references are current in the literature to support this view. Finally, it is said that objectives such as transparency and behavioral changes can rely on methodologies and techniques for research on the question of the construction of meaning

Desempenho e background familiar: um estudo no acesso a uma instituição de ensino técnico federal no Brasil

This paper comprises an investigation on the influence of the variable family backgrounds (father school level, mother school level and family income) over the pupil s performance in admissions examination (entrance test or PROITEC) at Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Norte (IFRN). From that point of view, the main goal of this research is to analyze the influence of the family background as a determiner of the pupil´s performance in the access to Technical and Professional education at IFRN. Secondary data were used from two databases (entrance test and PROITEC) adding up to 19.226 observations to the vacancies offered in the year of 2013. Aiming at achieving the proposed goal, a conceptual model composed of three hypothesis was developed. The results were presented in four stages: stage I presentation of the descriptive statistical results of the two databases; stage II separation of the campi in clusters; stage III analysis of multiple regressions; stage IV analysis of the logistics regressions. Two statistical tests were used to validate the hypothesis: T-test and Wald test. Hypothesis 1 and 2 were confirmed and H3 was refused. The results presented favorable causal connections to the family income and the father school level variables (with bigger effect for fathers with a higher education degree). The mother school level variable did not provide statistical significance for this research. Based on this result, after this work, this institution is to develop a strategic plan to assist in the success rate of students preparing diagnoses in order to diminish the effects of the variables that impacted negatively

Educação ambiental: mediações sociais e políticas e a indolência do Poder Público à sua inclusão no ensino formal

As a result of the prediction of irreversible changes on necessary conditions to maintain life, including human, on the planet, environmental education got the spotlight in the political scenario, due to social pressure for the development of individual and collective values, knowledge, skills, attitudes and competences towards environmental preservation. In Brazil, only in 1999 the right for environmental education was officially granted to people, having the status of essential and permanent component in the country s education. Since then, it has been Government s duty, in each federal branch, to plan actions to make it happen, in an articulate way in all levels and modalities of the education process, both formally and informally. This work of research has environmental education in the school as subject matter, and aims on analyzing social and political mediations established between this National Environmental Education policy and the contexts associated to the legislative production process, the political nature of the conceptions about environmental education that underlie Law 9.795/99 (Brazil, 2009c) and also Rio Grande do Norte Government s actions and omissions related to the imperative nature of the insertion of environmental education in the schools ran by the state, during the ten years this law has been in force. The investigation of the subject matter was led by a social and historical understanding of the social and environmental phenomena, as well as of the education system as a whole, considering that only through a dialectical view we can see the real world, by destroying the pseudo-concreteness that surrounds the topic. While analyzing, we assumed that in face of the dominance of a social organization in which market regulations rule on environmental ones, by developing individual and collective critical conscience, environmental education can become a threat to dominant economical interests in exploiting natural resources. The results of this research suggest that as an educational practice to be developed in an integrated, continuous and permanent fashion in all levels and modalities of formal education, environmental education has not yet come to pass in the state of Rio Grande do Norte, due to the neglect and disrespect of the government when facing the need of promoting the necessary and legally appointed measures to make it present in the basic education provided by the state. The legislators silence when it comes to approving a regulation on environmental education essential to define policies, rules and criteria to teaching the subject in the state and the omission from the public administration regarding critical actions in order to integrate in public schools the activities related to the National Environmental Education Policy, represent a political decision for not doing anything, despite the legal demand for an active position. This neglecting attitude for the actualizing of strategically concrete actions, urgent and properly planned for the implementation of environmental education in schools in a multidisciplinary way, exposes the lack of interest the predominant classes have in such kind of education being made available, as it could be developed based on a critic political view, becoming a political and educational action against dominance. When analyzing the basic principles and fundamental goals in Law 9.795/99 (Brazil, 2009c) the development of a critic environmental education is really possible and concurs with the National Environmental Education Policy, reflecting the social and political mediations established between this public policy and the contexts associated to its legislative production process, which are responsible for approving a regulation which also represents the mind of the people about environmental protection above anything else

Segurança do paciente no sistema de medicação: análise de enfermeiros de um hospital de ensino

This study aimed to identify and describe the factors related to Patient Safety in a medication system according to the nurses analysis in a teaching hospital from the photographic analysis method. This was a cross-sectional, descriptive study with mixed approach in a teaching hospital in Rio Grande do Norte. The population consisted of 42 nurses from inpatient units, of which 34 composed the study sample. As eligibility criteria, we defined nurses from public service and nurses who agreed to participate. Ethical determinations were observed, the study was submitted to the Ethics and Research of the University Hospital Onofre Lopes, obtaining the assent with ethical assessment certificate (CAAE 0098.0.051.294-11). For data collection, we used the photographic method (Photographic Analysis Technique) by Patricia Marck (Canada). It was developed in two phases: at first, we randomly captured photos from the medication system, resulting in 282 images; then we selected/processed the photographs, which were reduced to 10 images in Microsoft Excel 2010; in the second phase, the nurses answered the questionnaire divided into socio-professional profile and Digital Photography Scoring Tool (questions a and b ). For analysis of the question a , we used the content analysis technique, and for b , we used the Statistical Package for the Social Sciences 20.0 (temporary license). The socio-professional profile revealed the predominance of females; age group 34-43 years; professionals with specialization; 10-18 years of length of service; and nurses working exclusively in the hospital and who know the Patient Safety. The photographic analysis in relation to Patient Safety resulted in specific categories for each stage of the medication system. Regarding disposal, we identified Proper verification ; Improper verification ; Correct identification ; Disposal in single doses ; and Improper Environment , with predominance of that last category. As for storage: Proper storage ; Improper storage ; Risk of exchange/disappearance ; and Poor hygiene , with special reference to improper storage. In preparation: Risk of exchanging medication/patient ; Inappropriate physical space ; and Inadequate 9 preparation of controlled drugs , highlighting the first category. In drug administration: Lack of Personal Protective Equipment ; Use of Personal Protective Equipment ; Improper administration technique ; Proper administration technique ; Correct drug identification ; Incorrect drug identification ; and Peripheral venous access without identification . From the safety assessment of 10 photographs, by adapting the scores (1-10) to the Likert Scale, we identified three Totally Unsafe (Level 1), three Unsafe (Level 2), three Partially Safe (Level 3), one Safe (Level 4), and no photograph considered Totally Safe. This study identified the prevalence of unsafety in the medication system in the nurses opinion. We were also able to understand that, although nurses identify safety aspects, the most prevalent categories characterize an unsafe assessment. Nursing needs to reflect on its practice, identifying gaps in the medication system in order to achieve a proper and safe care