Estratégias de cuidado integral à saúde: os CAPS no processo de implementação do apoio matricial em Natal/RN

This study aims to analyzing the implementation of the Matrix Support proposal with professionals of Substitutive Services in Mental Health in the city of Natal/RN. The Matrix Support (MS) is an institutional arrangement which has been recently adopted by the Health Ministry, as an administrative strategy, for the construction of a wide care net in Mental Health, deviating the logic of indiscriminate follow-through changed by one of co-responsibility. In addition to this, its goal is to promote a major resolution as regards health assistance. Integral attention, as it is intended by the unique health system, may be reached by means of knowledge and practices interchange, establishing an interdisciplinary work logic, through an interconnected net of health services. For the accomplishment of this study, individual interviews of semi-structured character were used as instrument, with the coordinators and technical staff of the CAPs. The data collection was done in the following services: CAPS II ( East and West) and CAPS ad ( North and East), in the city of Natal/RN. The results point out that the CAPs to initiate of the discussion the process in the implementation of the MS aiming, to promote the reorganization and redefinition of the flow in the net, thus not acting in a fragmented way. Nevertheless, there is no effective articulation concerning the basic attention services, there is a major focus of the attention in mental health on the specialized services, little insertion in the territory and in the everyday life of the community

A atenção à crise e o apoio matricial: analisadores da estratégia atenção psicossocial

The National Policy on Mental Health is characterized as a territorial - political community , and it has the Psychoso cial Care Strategy (Eaps) as guideline for the proposal and the development of their actions. In its design, CAPS is idealized to be a strategic equipment within the Psychoso cial Care Network/RAPS. Matricial support and at tention to the crisis constitute strategic areas of action of CAPS in its replacement mission , and as it is g uided by the scope of deinstitutionalization, those are essential to the success of these services. We argue that sustain crises in existential territories of life is a condition for the effectiveness of psychosocial care and, ultimately, to the sustainability of its Reform. In this direction, the matricial support tool reveals a territorial supporter, intercessory and powerful in building a psychosocial care to the crisis. Recognized as one of the major challenges by the Brazilian Ministry of Health, forward these fronts materializes for workers in their mi cropolitical crafts. Our research arises as an investment toward empower them , and aimed to understand the operationalization of attention to the crisis and matricial support in a CAPS II, in the view of its workers . Besides, it aims to examine such practi ces forward the principles and purposes of Psychosocial Care Strategy. Inspired by the research - intervention and by the political and social ideas of Institutiona l Analysis, we offer a space for reflection and exchange, by implicational interviews , enablin g workers to launch them in analysis of practices in the EAPs view. We have done a documentary consulting CAPS Technical Project, and a return stage to the institution, by organizing workshop and conversation groups with CAPS workers. The results have show n that there are institutional logics in competition on that service. When operating the logic risk, some difficulties in sustaining most intense crisis situations were identified, the psychiatric hospital internment is used as a facility, particularly in view of some cases, in which the aggressiveness of the person in crises becomes aggressive, and when the brackets SAMU, the CAPS III and Comprehensive Care Beds do not respond satisfactorily to their users requests. Order weaknesses were indicated in this thesis as macropolitical and micropolitical interfering in network support. The matricial actions were identified as a powerful intercessor resource in crisis care appeared weakened, and indicates little porosity in the relationship between the Service and the territory where it takes place. Noticed by the logic of home care, without operate primarily as a knowledge exchange device, we saw capture points in the logic of assistance with ambulatoriza tion production of CAPS, welfare practices and "ext empore " . T he E APs , although it emerge s as a guiding, it is not seen to workers as effective practice. On the one hand, the results signaled that the attention to the crisis and the matricial actions are developed without tenacious connection with the purposes of EA Ps, on the other hand, successful cases were indicated with the main leads to conducting wire of intersectoral actions to the powerful bonds and to the participation of user in their care process es , indicating insurgent forces tha t intend by traditional lo gic .

O fazer do psicólogo no núcleo de apoio à saúde da família

The Brazilian Ministry of Health regulated in 2008 the Family Health Support Nucleus (FHSN) as a device for support and complementarity to the Family Health Strategy. The FHSN, through the matrix support, potentiates the Family Health teams on dealing with a great variety of demands and activities that are under their responsibilities. It is structured in teams of professionals from various health specialties, among which is the mental health. In preliminary studies we noticed that the psychologists have been the main representatives of mental health professionals at the FHSN from Rio Grande do Norte (RN-Brazil). On this scenario, this study intends to problematize the professional practice of the psychologists who work at the FHSN teams in RN, regarding how their work is done, discussing it under the perspective of collective health and the directions for the basic health care on Brazilian s health system. Still as a goal, in more specific ways: identify the forms of professional insertion of the psychologists in this field; characterize the work done by the psychologist at the FHSN (developed activities); and produce an analysis of the characteristics and limits of those actions, from theoretical and methodological references based on Marxian ontology. Were performed semistructured interviews with psychologists working in the oldest FHSN teams form RN. We conducted the analysis of the material following the blocks of information: determinants of the psychologist entry at the services, training for current practice; operation of FHSN; activities performed by FHSN team and the psychologist; joint actions; and limits of psychology practice in the FHSN. An important result, we observed the little articulation of practicing between the psychology and other professionals and teams, further indicating the prevalence of the traditional medical model (individual and outpatient) as guidance of their performance instead of the matrix logic that is the foundation of the proposed action for the FHSN. We also emphasize the potential of psychologists actions at the FHSN on contributing to the achievement of comprehensive care

As ações em saúde mental nos Núcleos de Apoio à Saúde da Família - NASF

The National Police for Basic Care (PNAB), regulated by ordinance nº2488 from October 2011, restates the Family Health Strategy (ESF) as a priority to the expansion, consolidation and qualification of basic attention to health matters in Brazil. In order to bring it about, city counsellors along with other federal entities ought to ordinate their work process deepening principals, directions and fundaments of Basic Care (AB). Besides ESF, the new PNAB expatiates on the Family Health Support Centres (NASF), reaffirming their role on broadening the scope of basic care actions and their improvements, ratifying their ability to share knowledge and support Basic Care professionals. All this considered, the purpose of this work is to investigate how NASF is currently structured in João Pessoa and what has been achieved by it on what concerns to mental health. Its main objectives are to analyse the practices of mental health professionals that are part of NASF teams and if they differ from what has been developed by the other members of the teams; to discuss the articulation of NASF in managing mental health measures on what concerns to internal organisatio n and to the city health network; to identify strategies used to organise such measures on mental health in Basic Care. To reach such goals, individual interviews have taken place two city health managers and four of NASF professionals that participated on the Mental Health Office as representatives of their sanitary districts. Also a focal group formed by various supporters of NASF was created, contemplating the diversity of professional categories involved with the teams and sanitary districts. It was possible to identify in NASF, in João Pessoa, an organisation based by the matrix support in which both management and basic care demands reflect a series of actions developed alongside with ESF. Amongst such actions, matrixing, home visits and the Singular Therapeutic Project (PTS) stand out. These activities have been discussed on the focal group and integrate the daily work of all NASF supporters despite their professional categories. NASF presents itself as a powerful strategy to SUS proper qualification and support to strengthen Basic Care and broaden family health teams‟actions.

Matriciamento em saúde mental: atuação de núcleos de apoio à saúde da família

In the context of break with psychiatric hospitals, the Brazilian Psychiatric Reform is a historical process of reformulation of knowledge and mental health practices. In this way, the Centers of Support for Family Health (NASF) have been acting in the supply of matrix support in mental health. So, the present research aims to analyze the actions which the NASF is taking for the matrix support in mental health in the city of Natal/RN. This is a kind of research descriptive, exploratory and qualitative. The data collection, was made by a direct observation of the professional pratices and semi-structured interviews with health professionals NASF's. The Data were analyzed according to thematic analysis technique, with the support of the content analysis method, which is a way to investigate clusters of meanings which make up the communication of the investigated object. Three analytical categories were organized by this method, whose titles were inspired in two theories in the health field called “Health to Paidéia” and “Expanded Clinic”. The name of the categories are: 1. “Mental illness in brackets: working dimensions of the Centers of Support for Family Health interfaces with the concrete subject”, which is about the work process of NASF; 2. “Freedom and engagement in the arrangement of matrix support in mental health”, which explore the matrix support limitations in mental health in Natal/RN from the professionals interviewed at the NASF’s; 3. “Between the desire and interest: influence of expert orientation in mental health in Psychosocial Care Network” (RAPS), which is related to matrix support in mental health, as an organizational arrangement responsible to ensure intersectoral and comprehensive care, strategies inside of context of the constitution of RAPS. We can extract and say that the actions of NASF teams in the brazilian city called Natal/RN, still not part of a structured link with health care networks, as happens with the absence of discussions and lack of professionals in the matrix support. In addition, there is a difficulty to do an specialized orientation in mental health because of the lack of human resources in this area and of the insufficient number of the replacement services for psychiatric hospital pratices, bringing up the discussion about the consolidation and expansion of RAPS in fact investigated.

Nervos: rede de discursos e práticas de cuidado na atenção básica no município de Natal/RN

The Primary Health Care and one of its main strategies, the Family Health Strategy (ESF), are framed as the gateway to the Public Health System (SUS). Thus, most of the incident and prevalent health problems in the population attended should be solved at this level of care, including psychological suffering, and the so-called complaint of nerves. Nerves and nervous denote a complexity that is not always well comprehended by health workers, in such a way that the care to this kind of problem is usually inadequate. In this line of thought, the general objective of this study is to analyze the network of discourses and the care to the psychological suffering, expressed as nerves, in SUS daily Primary Health Care. Besides and more specifically, it aims at identifying the principles and guidelines of the Primary Health Care in mental health; to investigate health workers positioning before psychological suffering and complaints of nerves, and also analyze different actions and practices of care carried out in different Health Units towards complaints like nerves. Institutional Ethnography was the theoreticalmethodological perspective adopted for the work. This approach seeks to understand and analyze the institutional relationships in a particular context considering sociostructural influences and power relations, as well as daily discourses and practices. Based on interviews with health professionals, informal conversations and observations in six Health Units with ESF teams from different sanitary districts in Natal/RN, it was possible to check that the index of complaint of nerves is high. The referral to psychologists and psychiatrists, as well as the prescription of psychotropic drugs appear as the most common intervention at this level of care. In general, the participants complain that they have poor specialized knowledge about the theme of mental health. They face the problem of bad work conditions and the lack of institutional support, which make actions of illnesses prevention and health promotion even more difficult. Besides, there are different ongoing practices such as meetings for hypertensive and aged people, walk, visit, round-table discussions and community therapy. However, not all of these actions are aimed at the care of psychological suffering. It is observed that the Matrix Support, which is a methodological strategy of supervision and follow up forcases of mental health, hasn t been totally implemented in the municipal system, although it is a tool that has been used by psychologists in some Health Units in the city. It was also verified that the health care practices to the problem of nerves strongly depend on the professional s commitment with the PSF guidelines and on mental health policies, in addition to continued support, when available, from other professional who works as matrix supporter

Articulação entre saúde mental infanto-juvenil e atenção básica em Natal-RN: limites e possibilidades

In the case of Brazilian Psychiatric Reformation, mental health juvenile reveals itself as a great challenge, with major gaps in terms of needs, services and actions on mental illness in children and adolescents. This research is a qualitative study of descriptive and exploratory, having to analyze the actions and practices of mental health juvenile articulated between the Psychosocial Care Center juvenile (Caps i) and the basic care in Natal-RN, and specific, identify the limits and possibilities for an important precedent of the care network. After submission to the Research Ethics Committee (CEP) of the University Hospital Onofre Lopes (HUOL) of the Federal University of Rio Grande do Norte (UFRN) obtained approval contained in opinion number 777.067 / 2014. For the data collection, it was initially carried out a documentary research in the Municipal Health Department of Christmas about the phenomenon under study, and subsequently, applied semi-structured interviews with the subjects of the research, which were workers Caps i of Natal-RN. The analysis was woven as the thematic analysis technique, understood within the method of content analysis. The results and discussions were organized by categories and subcategories, namely: CATEGORY 1: Limits and weaknesses in the linkage between the Caps i and basic care, with the subcategories: 1.1 Lack of specialized services and devices articulators in network, 1.2 The diversity of situations in the demand juvenile assisted; CATEGORY 2: possibilities for an effective network, with the subcategory: 2.1 Intersectoral collaboration as a strategy for solving attention. The analysis revealed that the integration and coordination of mental health services juvenile and primary care in the city of Natal-RN, has incipient initiatives and/or inadequate for the resolvability intersectoral, where the devices of attention to health involved cannot establish bonds effective and long-lasting in the perspective of co-responsibility and sharing of care. On the other hand, it appears that the existing shares and practiced, configure an exercise in approximation to the dialog between mental health juvenile and basic care. It is highlighted that the shared care and the establishment of intersectoral collaboration within and outside of the health sector is possibility of facilitating the necessary dialog between the services and professionals involved, thus, enabling a better prospect of resolvability of the Network of Psychosocial Care for the youth in reality being investigated.

Avaliação de políticas públicas para arranjos produtivos locais: a eficácia da terceira edição do PROCOMPI no apoio ao APL de água mineral da grande Natal

This study has the objective examine the mechanisms of programs oriented fort cluster development, focusing on the analysis of the effectiveness of Procompi on support to APL of Mineral Water in Natal/RN. Search on the theory on public policy and support on apps for the theoretical and methodological reasons for the success of the program. In the document analysis was used reports from SEBRAE, IEL and SINCRAMIRN and was realized survey in the companies. The research indicates that not reaching the goals set. It is concluded that a poor definition of objectives and lack of orientation to the external economies are the causes of the failure

Apoio governamental à inovação Tecnológica: análise da indústria farmacêutica paraense

The transformations economical, cultural and social that happen in world ambit they are associated to the intense progress and expansion of new technologies, forcing governments, people, companies and nations to the introduction of new patterns of behavior, forcing, in that way, to the continuous renewal of products and technological processes to maintain the competitiveness, so much among nations, as in the managerial world. In that matter, the technological innovation is recognized as basic factor of maintainable economical competitiveness, being the responsible for the breaking and/or improvement of the techniques and production processes, what presupposes the systematization varied institutional arrangements that they involve firms, interaction nets among companies, government agencies, universities, research institutes, laboratories of companies and scientists and engineers activities. Those arrangements, to the if they articulate with the educational system, with the industrial and managerial section and, also, with the financial institutions, they take the form that Freeman (1987) it coined of national system of innovation, promoted through public politics of CT&I, which seek to induce and to support innovative initiatives in the companies, as well as to establish demands and to prioritize vocations and regional potentialities. In that context of government support to the technological innovation interferes this study, that it looked for to know the reasons of the fragility innovative in the pharmaceutical industry of State of Pará in Brazil, pointed for PINTEC (2005), starting from the point of view of the businessmen of that section. For such, the qualitative approach was used - with interviews directing semi and the technique of the content analysis. The results of the research pointed that the fragilities innovative of the section links to the ignorance of the government support to the technological innovation on the part of the businessmen of the pharmaceutical industry of State of Pará in Brazil

Fatores críticos de sucesso para sistemas de informação de apoio ao gerenciamento de projetos: o caso SEBRAE/RN

Universidade Federal do Rio Grande do Norte

Tecendo vivências e sentidos do câncer infantil : família, doença e redes de apoio social em Natal-RN

This paper discusses the experiences related to the treatment of children´s cancer which had children, their mothers and families as their main characters. They were mainly originated from areas in the countryside and urban poor areas in the State of Rio Grande do Norte. The non-governmental organization Grupo de Apoio à Criança com Câncer (GACC) was the privileged ethnographic location. In this setting, the mother, which was called acompanhante (companion), and the children, defined as pacientes (patients), were often sheltered in reason of therapeutic practices and the treatment undertaken by children in a nearby hospital. This study aims to focus on the therapeutic itinerary, beyond the children´s suffering, dealing with the family as a whole, since the moral values from these popular families imply the complete involvement of the family in relation to the illness and its treatment. Therefore, it is experienced as a family problem. We also intend to understand the construction of meanings to the illness, dealing with the ideological continuity in the relationships between the families and the GACC. These meanings were built in the intersection of these two spheres, which refer particularly to medical, religious and emotional explanations. Ethnographic methods were applied in this research at the entity and another social contexts, such as the family households. I also tried to retrieve the process of treatment outside the GACC, visiting the family context, when doing dense interviews or just having conversations with informants. It was found that the GACC, as a non-governmental organization, generates a negotiation of identities, which develops, then, through the family as a whole, but also through the child and especially the mother, affecting, in some way, their internal organization. Furthermore, the meanings of the experience of illness appeared to be shaped by the family sphere as well as by the logic of public health structures

Sistema inteligente para apoio à decisão na operação de uma malha de escoamento de petróleo

The petroleum production pipeline networks are inherently complex, usually decentralized systems. Strict operational constraints are applied in order to prevent serious problems like environmental disasters or production losses. This paper describes an intelligent system to support decisions in the operation of these networks, proposing a staggering for the pumps of transfer stations that compose them. The intelligent system is formed by blocks which interconnect to process the information and generate the suggestions to the operator. The main block of the system uses fuzzy logic to provide a control based on rules, which incorporate knowledge from experts. Tests performed in the simulation environment provided good results, indicating the applicability of the system in a real oil production environment. The use of the stagger proposed by the system allows a prioritization of the transfer in the network and a flow programming

A informática como uma ferramenta de apoio a inclusão do deficiente visual

An inclusive environment has its foundations in the belief that all people are entitled to participate, to live as normal a life as possible, without discrimination, especially in education. This is to ensure equal opportunities. For individuals with special needs, the use of computers and digital materials is not an alternative, but one of the only forms of access to information. For the visually impaired, they start from the beginning to enter the university, through the selection processes, not always accessible. For those who can, other difficulties arise, undermining the initial enthusiasm and generating a large rate of dropouts. In most cases, these students will depend on the goodwill of colleagues and volunteers for the reading of texts in the basic literature of the disciplines studied. The high cost of technology assisted allied to a lack of resources and knowledge of curricular adaptations, prevents many teachers help these students in an appropriate manner. This thesis seeks to contribute to the inclusion of the visually impaired student pointing alternatives that can help in caring education. The research was conducted specifically for the doctorate during the period 2001 to 2006, the cities of Natal, Salvador and Curitiba, and is based mainly on the methodology of action research. The objective was the construction of Virtual Teaching Support Center , structured in a Web portal that can serve as a resource to help support teachers, staff and other users concerned with the process of inclusion of people with needs special education, with the goal of assimilation of educational opportunities, with the support of resources and methods. The inclusion is for everyone because we are all different

Apoio pedagógico, ação coletiva e diálogo: tramas da formação continuada em educação inclusiva

This work detaches the importance of the continued formation of the educators in terms of the inclusive educational process, pointing as basic elements the continued formation of the educational professionals. In this direction, it points and it defends the dialogue in the perspective of David Bohm, with interfaces of the freireanas ideas, as a methodological resource of action that allows the organization of strategies of collective and effective pedagogical support in inclusive schools, in the same time articulates the continued formation of the professionals in education. Characterized as research in a dialogical action with collective participation and collaboration, it counted with the participation of 87 educators, between professors, pedagogical, managing coordinators and specialists of special education in two schools of the state and municipal public system of Natal/RN. The results had pointed with respect to the viability of the dialogue as articulated methodological tool of the continued formation in service, when providing the establishment of personal and professional relationship between the educators, favoring the discursive enjoyment of the lived experiences, allows the organization of strategies of collective and effective pedagogical support in the scholar environment. On the basis of these results, this work also points to some items to reflections as the reorganization of the Secretariats and the schools, in the direction to brighten up the fragmentation and the discontinuity of the pedagogical actions evidenced and to instigate a process of changes that has glimpsed the professional development of the educators through its continued formation in service and the improvement of the school in the way of the concretization of an education directed toward the acceptance, respect and attendance the diversity of its pupils, as detaches the official documents and the studies on the inclusive education

Programa de apoio a planos de reestruturação e expansão das Universidades Públicas Federais (REUNI): repercussões na UFRN

El presente trabajo tiene como objetivo analizar la implantación del Programa de Apoyo a Planes de Reestructuración y Expansión de las Universidades Federales (REUNI) así como su papel en la reconfiguración de la Universidade Federal do Rio Grande do Norte, resaltando sus repercusiones en la gestión y organización de la universidad. Para la realización del trabajo, entre los procedimientos técnicos, utilizamos la revisión de literatura, el análisis de documentos y las entrevistas semiestructuradas. La revisión bibliográfica ha permitido profundizar en conceptos importantes sobre la temática, priorizando los contenidos referentes a los conceptos de globalización y neoliberalismo; La reforma del Estado y sus repercusiones sobre las políticas de educación superior brasileña; directrices de documentos internacionales y nacionales que definieron la organización de este nivel de enseñanza. Los estudios indican, en relación a la expansión de la UFRN, que las metas pactadas del REUNI fueron atendidas casi en su totalidad. Sin embargo, cualitativamente, no se puede afirmar que el REUNI haya tenido un impacto positivo, pues además del incremento de plazas y de la creación de cursos nuevos, que en su mayoría fueron cursos nocturnos, ha habido un aumento sustancial en relación a la cantidad de alumnos por profesor, lo que demuestra que dicho incremento también se da por la racionalización de los recursos humanos y de la estructura físca existentes. Desde esta perspectiva, el REUNI originó varias modificaciones en la forma de gestionar los servicios en la UFRN, mereciendo especial atención la intensificación del proceso de transformaciones en la concepción de una gestión burocrática a una gestión desde la gerencia, resaltando la cultura instituída con el contrato de gestión. En ese sentido, la utilización de las metas y de los indicadores de desempeño pasa a adquirir cada vez más importancia como forma de acompañar y evaluar el cumplimiento de las acciones pactadas, pues de este cumplimiento depende la concesión de recursos financieros. Dentro de este contexto, el Programa se ha caracterizado por dar continuidad a las políticas de privatización para la expansión de la educación superior brasileña, provocando la inserción en las universidades públicas federales, de un modelo de organización fundamentado en el paradigma de la gerencia y la administración, que conlleva así, a la mercantilización de los bienes y servicios académicos