Sistema de teleoftalmologia para auxílio ao pré-diagnóstico de disfunções oculomotoras

The vision is one of the five senses of the human body and, in children is responsible for up to 80% of the perception of world around. Studies show that 50% of children with multiple disabilities have some visual impairment, and 4% of all children are diagnosed with strabismus. The strabismus is an eye disability associated with handling capacity of the eye, defined as any deviation from perfect ocular alignment. Besides of aesthetic aspect, the child may report blurred or double vision . Ophthalmological cases not diagnosed correctly are reasons for many school abandonments. The Ministry of Education of Brazil points to the visually impaired as a challenge to the educators of children, particularly in literacy process. The traditional eye examination for diagnosis of strabismus can be accomplished by inducing the eye movements through the doctor s instructions to the patient. This procedure can be played through the computer aided analysis of images captured on video. This paper presents a proposal for distributed system to assist health professionals in remote diagnosis of visual impairment associated with motor abilities of the eye, such as strabismus. It is hoped through this proposal to contribute improving the rates of school learning for children, allowing better diagnosis and, consequently, the student accompaniment

Eficácia do aconselhamento no tratamento das disfunções temporomandibulares

The aim of this controlled trial was to evaluate the effectiveness of counseling in pain, function and well-fare outcomes on the management of patients with temporomandibular disorder (TMD). Therefore, 51 consecutive patients were allocated to one of the research groups. In Group I, was instituted counseling therapy for Group II was conducted treatment as usual with occlusal splint. Patients were followed for returns at 7, 15, 30 and 60 days after baseline. At baseline, all patients were examined and assessed RDC/TMD form, which was administered by a single trained and calibrated examiner, in addition, the patients were referred for specific treatment according to the group to which belonged. The clinical and functional impairment was assessed at each visit through the Temporomandibular Index (TMI). In each session, the patients were also surveyed about pain intensity using a Visual Analogue Scale (VAS). To analyze the impact of pain on quality of life, OHIP-14 questionnaire was used. The results showed 26 patients in Group I with a mean age of 35.15 ± 10.79 years. 25 patients were allocated to Group II. The mean age was 27.36 ± 10.34 years. The counseling was effective in reducing the intensity of pain (VAS), with significant improvement observed at 7 day follow-up (p <0.001). The functional impairment (TMI) showed significant results at 15 days follow-up (p = 0.002). Counseling was also responsible for significant improvement in the impact of TMD on quality of life (OHIP-14) at all times of the analysis (p <0.001). When comparing research groups, no significant difference was observed for any of the analyzed indices (p> 0.05) nor in the short term (7 days) neither in long term (60 days). It was concluded therefore that, for the studied sample, counseling consisted in an effective treatment option for the control of signs and symptoms of TMD, with results in the short and long term similar to the usual treatment group.

Síndrome de ovários policísticos: enfoque psicossocial

A síndrome dos ovários policísticos (SOP) é um distúrbio endócrino-ginecológico que se caracteriza, principalmente, por anovulação crónica e hiperandrogenismo, afetando entre 5 a 10% das mulheres em idade reprodutiva. As principais manifestações da SOP incluem os seguintes sintomas: irregularidade menstrual, hirsutismo, infertilidade, acne, alopecia androgenética, obesidade e acantose nigricans. Esses sintomas apresentam- se de forma bastante heterogênea, havendo diferenças marcantes na sua prevalência e intensidade entre diferentes grupos de mulheres que apresentam SOP. Apesar da condição biológica, a SOP não é apenas um problema físico, mas também psicossocial, interferindo e comprometendo a qualidade de vida das mulheres que a apresentam. A partir de uma revisão da literatura, este estudo discute os aspectos psicossociais de mulheres com SOP, destacando o impacto dos sintomas na qualidade de vida relacionada com a saúde. Considerando que cada mulher responde de forma singular aos sintomas que apresentam, destaca-se a importância de incorporar a perspectiva individual da mulher com SOP ao seu contexto social. Nesse sentido, são discutidos achados de pesquisas utilizando abordagens metodológicas quantitativas e qualitativas, numa tentativa de melhor compreender a experiência das mulheres diante da SOP. Os sintomas da SOP podem estar associados com a ocorrência de ansiedade, disfunções sexuais e sentimentos de inadequação ao papel feminino, como também podem desencadear sintomas depressivos e isolamento social, com comprometimento significativo da qualidade de vida. Os autores destacam a importância do atendimento multidisciplinar para as mulheres com SOP, considerando essa condição como importante problema psicossocial. A atenção aos aspectos psicossociais da SOP tem aumentado nos últimos anos, no entanto, a produção científica relacionada ainda é escassa

A estrutura burocrática de poder no stricto sensu em administração no Brasil: o caso do mestrado profissional em administração pública em Rede Nacional - PROFIAP

This study approaches bureaucratic organizational structures with the aim to understand the adherence procedure to virtual technologies in the stricto sensu educational administrative process. Thus, the author navigates through the formation of these organizations in Brazil with the intent to demonstrate the bureaucratic organizational culture and the consequent form of domination of those who detain power. In this epistemological construction, the author explores the culture s bureaucratic environment and the organizational power. In the analyses, it was observed the technological phenomenon in the ODL s administrative environment, which can explain the adherence procedure to structures and technological instruments for stricto sensu courses that, hypothetically, dilutes the traditional inherited organizational axiom. Therefore, it was utilized as object of study the Professional Master s degree in National Scale Public Administration PROFIAP, hence analyzing the documental content and the legislation related to institutionalization as well as the positioning of professors/coordinators and of the director of CAPES/MEC. Considering this axioms, it was concluded that the bureaucratic structures can admit ODL in the stricto sensu s environment. However, this can only be done as long as the adherence does not imply in a dilution of the traditional forms of power and institutional bureaucratic inherited dominance, as well as the alleged hegemony of the governmental structure in the educational administration adopted in person by the stricto sensu courses in Brazil

Caracterização da economia solidária à luz do ambiente isonômico de guerreiro ramos: um estudo no grupo mulheres decididas a vencer

The Solidary Economy is an area that has shown unusual traits to what is preached in the traditional economic organizations, even organizations that have very similar principles, as some cooperatives. This trait is approaching the concept of isonomy proposed by Ramos (1989). Given this context, and the notion that the isonomy is like a ideal type, the objective this work was to evidence particulars of isonomic environment the in economic and solidarity experiences, taking as an empirical research area the Grupo de Mulheres Decididas a Vencer, considered a solidary economic enterprise. For this, we used the descriptive-exploratory research of qualitative nature, where the object of such research is the know enterprise, therefore, also characterized as a case study, which were taken as research subjects six associates, they being the most active in the enterprise. From the five categories that characterize isonomy - minimum standards prescribing, self-gratifying activity, activities undertaken as a vocation, wide system of making decision and primaries interpersonal relations - and from the traits of a solidary economic enterprise the data analysis was built, through content analysis, specifically the categorial analysis. Given this context and reality in which it is Grupo de Mulheres Decididas a Vencer, with minimal rules and procedures for conducting activities, comparing them to a therapy, women choosing to insert in that environment, faced with a democratic space and unfettered bureaucracy in professional interpersonal relationships, in others words, an organizational space where they were shown signs of substantive rationality was possible to conclude that the Group will share experiences and characteristics of isonomy. This disclosure meets the multidimensional social that presupposes Paraecomomic Paradigm, enabling man to enter in different social environments of the economy in order to search for self-actualization

Gestão de pessoas, fato administrativo e racionalidades: um estudo em uma ONG de Natal-RN

This present work aimed to investigate, through the structuring element Fato Administrativo , the way rationality guides the processes of personnel management at the Associação Companhia TerrAmar , which operates in the district of Felipe Camarão in Natal/RN. This paper is characterized by a descriptive study, as it sought to establish the relationship between the materialization of the studied phenomenon - by means of a theoretical framework consisting of the following theories: Fato Administrativo (GUERREIRO RAMOS, 1983), Substantive and Instrumental Rationality (GUERREIRO RAMOS, 1981) and Proceedings of Personnel Management proposed by Joel Dutra (2004). As the main research findings, time as an intrinsic element of the Fato Administrativo - suffers much interference from external factors, especially from the sponsors of the researched organization and also from their bureaucratic control tools; not directly relating to the processes of Personnel Management, though. Among these, it was noticed that there isn‟t a dialogue between the sponsors and the theory, due to incompatibilities regarding the structure and nature of each organization. Both movement and development have stood out. These are processes that are guided by elements of substantive rationality, literally speaking, including personal, emancipatory and solidarity values. Thus, it is stated that for future research a compatible model of Personnel Management should be built and explored (compatible with the nature of nonprofit organizations). Understanding, in depth, the processes separately aiming to understand each work is also advised. Trying to fully understand the ways of overcoming the lack of skilled workers to perform activities in similar organizations needs to be considered as well

Burocracia e comércio exterior: os desafios à exportação sob a ótica das micro e pequenas empresas exportadoras do rio grande do norte

As micro e pequenas empresas, ao mesmo tempo em que exercem um papel extremamente relevante na estrutura produtiva da economia brasileira pelo grande número de empreendedores existentes e expressivo volume de pessoal ocupado, perdem competitividade ao se deparar com entraves ao seu desenvolvimento, sejam eles em âmbito gerencial, financeiro, burocrático ou estrutural. Com base nesse contexto, o estudo procura identificar em que medida, na percepção das MPEs exportadoras do Rio Grande do Norte, as exigências burocráticas do processo exportador afetam o seu desempenho no comércio exterior. Como exigências burocráticas compreende-se o conjunto de normas, regras e procedimentos e documentos que disciplinam o processo exportador, enquanto desempenho é entendido como os resultados da atividade econômica medido através do crescimento das vendas para o mercado externo; das demandas de produtos exportados não atendidas e da ampliação do mercado internacional. A pesquisa realizada é de caráter censitário, desenvolvida junto a quatorze MPEs do estado, atuantes regularmente no comércio exterior nos últimos três anos (2009-2011), utilizando aplicação de questionário, assim como uma consulta a dados secundários disponíveis. A análise dos dados levantados revelou que, efetivamente, na percepção dos respondentes, fatores externos como o custo do processo de exportação, falta de incentivo do governo, excesso de controle dos órgãos públicos e a infraestrutura logística do estado exercem influência na pequena participação das MPEs nas exportações do Brasil e do Nordeste, enquanto o bom desempenho exportador destas relaciona-se a fatores gerenciais, com destaque para investimentos na estrutura organizacional da empresa, conhecimento do mercado internacional e bom relacionamento com clientes e mercados

Avaliação das pressões respiratórias máximas em crianças e adolescentes da grande Natal: elaboração de uma equação preditiva

The human respiratory system was so designed that would allow efficient ventilation, regardless of variations in the external environment that may hinder the act of breathing, such an act involves dozens of variables, among them we find the respiratory depression, which is nothing more than respiratory muscle strength. The pressures are widely used in several cases: Neuro-muscular; evolution of pulmonary dysfunction and a predictor for discontinuation of mechanical ventilation. Therefore it was proposed to carry out evaluations of these respiratory pressures for children and adolescents aged 10 to 16 years and propose a predictive equation that involves the anthropometric variables age (A, years), body mass (BM, kilograms) and height (H, meters) with maximal respiratory pressures (maximum inspiratory and expiratory pressure). Evaluations were performed in this age group of students in public and private schools of the Grande Natal , measurements were performed using the analogue manometer, were children and adolescents and their parents gave informed consent. 517 samples were taken, and 250 for males (M), 255 for females (F) and 12 were excluded according to our exclusion criteria. The sample was subdivided into three age groups (10-11, 12-13 and 14 to 16 years old). It was found through the student s t test (p ≤ 0.05) for all variables studied, children and male adolescents had higher means than females, except for the MC. For the correlation between the variables found significant correlation (p <0.05) among all the variables when analyzed as pairs except between MIP and height for females. The development of predictive equations (for p ≤ 0.05) based on three types of strategies adopted were restricted to two association between anthropometric variables isolated, resulting in: for males: MIP = -32.29 + (-2.11*A) + (-0.52*BM), MIP = 9.99 + (-0.36*BM) + (-49.40*H); MEP = 18.54 + 3.53*A + 0, 42*BM, MEP = -33.37 + 2.78*A + 52.18* H, MEP = -17.39 + 0.33*BM + 55.04*H; and, for females we find: MEP = 24.32 + 2.59 * A + 0.24*BM

Níveis de homocisteína e desempenho cognitivo em uma amostra populacional de idosos da cidade do Natal-RN

The imprecision of the frontier that separates those cognitive deficits inherent to the human physiological aging process from those which represent the early signs of nervous system degenerative pathologies ,very prevalent among the elderly, has brought attention to the need of studies aiming to establish clinical and/or laboratorial criteria to allow this differentiation. Elderly people living in poor and developing countries are frequently exposed to precarious socioeconomic conditions which facilitate the development of an array of pathologies which have metabolic and nutritional dysfunctions as the established or proposed etiological agents. The levels of certain micronutrients, such as the vitamins B12 and B9 (folic acid), and of some intermediary metabolites, such as homocysteine are being thought of as etiological factors and/or as biological markers of a group of alterations which affect the normal functioning of the nervous system with important reflexes upon cognitive performance. This study aims to investigate the influence of homocysteine, B12 vitamin and folic acid levels on the cognitive performance of the low income elderly population. This transversal study took place in Natal, Rio Grande do Norte State, Brazil, and involved 205 dwelling elderly people, users of the Programa de Saúde da Família, a public healthcare program, maintained by the city s health authorities. A multidimensional questionnaire was used to assess the socio-demographic aspects and the overall health and nutrition conditions. The cognitive performance was measured by the use of the Portuguese version of the Mini Mental State Exam (MMSE). The serum levels of homocysteine, B12 vitamin and folic acid were determined by chemiluminescence. The association between the socio-demographic and serum levels of Hcy, B12 vitamin and folic acid was determined by multiple linear regression. Serum levels higher than 13.5 μmol/l, indicative of hyperhomocysteinemia (HHcy), were found on 25.4% of the sample, being more prevalent in men (p<0.05). Deficitary levels of folic acid (<5ng/mol) and of B12 vitamin (<193 pg/ml) were found on 3.9% and 10.2% of the sample respectively. A negative correlation was found between cognitive performance with both age and HHcy and a positive correlation was found between cognitive performance and schooling. The isolated HHcy R2 values were an explanation to only 4% of the variance of the MMSE scores. However, when associated with schooling and age, this model explains about 25% of this association

Prevalência e fatores associados da síndrome de Osgood-Schlatter em uma amostra populacional de adolescentes brasileiros

Osgood-Schlatter (O-S) syndrome, a pathology of the musculoskeletal system, exhibits high incidence in adolescence, a phase of accelerated bone growth. Detection of physiopathological mechanisms that may cause disorders and dysfunctions in bone growth must be taken into account when planning physical activities, in order to promote normal physiological growth patterns. The aim of this epidemiological investigation was to identify and analyze the relationships between sociodemographic, anthropometric and clinical aspects and O-S. A cross-sectional design was used, with a representative sample of 956 subjects: 474 (49.6%) males and 482 (50.4%) females. Age range varied between 12 and 15 years (mean = 13.7±1.04). We used a battery of tests, previously applied in a pilot study, which met the aims of the investigation. Descriptive statistics (frequency, mean and standard deviation) were used and the odds ratio was calculated from bivariate and multivariate logistic regression (p<0.05). A prevalence of 9.8% was found (n = 94 cases): 11% males and 8.3% females. Hierarchized multivariate analysis showed a significant association between regular physical activities (OR= 1.94; CI 95%, 1.22-3.10) and shortening of the rectus femoris muscle (OR= 7.15; CI 95%, 2.86-17.86). The results may serve as a basis for therapeutic and prophylactic measures, in addition to increasing our knowledge of this syndrome in Brazilian adolescents. This investigation used a multidisciplinary approach, involving elements of anatomy, nutrition, physical education and physical therapy to elucidate the object under study related to Osgood-Schlatter syndrome

Análise do óxido nítrico, perfil lipídico, resistência arterial e capacidade funcional de idosas submetidas a um treinamento aquático

A prática regular de exercício físico possibilita redução dos efeitos das disfunções hormonais e envelhecimento biológico natural que promovem desajustes hemodinâmicos, vasculares e músculo-esqueléticos, principalmente na população feminina no período pós-menopausa. Nesta fase da vida, o exercício aquático representa mais do que uma forma de ajuste funcional, é uma forma de manutenção de independência para as atividades da vida diária (AVD s) e melhoria na qualidade de vida. Este estudo teve como objetivo avaliar as modificações adquiridas pela prática regular de um programa de exercício aquático concorrente de intensidade moderada no nível de óxido nítrico (ON), no índice de resistividade arterial (IR), no perfil lipídico, na capacidade funcional e na qualidade de vida de idosas. A amostra foi formada por idosas (60 a 80 anos) selecionadas por randomização, por sorteio simples divididas em grupo controle e grupo de intervenção as quais foram submetidas a um programa de exercícios aquáticos proposto inicialmente em projeto piloto, por 12 semanas (n=34) e o ensaio clínico teve duração de 16 semanas (n=40). Foi coletada amostra sanguínea das idosas e avaliado o perfil lipídico pelo método enzimático com kit Labtest e o ON por medida indireta a partir da concentração de nitrito no sobrenadante das células em cultura em leitor de ELISA. A avaliação das artérias carótidas e vertebrais foi feita utilizando o método de ultra-som Doopler. A capacidade funcional foi avaliada por quatro testes que simulam atividades da vida diária que são: caminhar 10 metros (C10m), levantar da posição sentada (LPS), levantar da cadeira e locomover-se pela casa (LCLC) e o de levantar-se da posição decúbito ventral (LPDV). No estudo piloto foi avaliado o índice geral de autonomia funcional (IG) e a qualidade de vida através do questionário WHOQOL-100. Empregou-se a análise de variância (ANOVA) com medidas repetidas nos fatores grupo (GH e GC) e tempo (pré e pós-teste) para as comparações intra e intergrupos nas variáveis seguida do post hoc de Scheffé. Utilizou-se o teste de correlação de Pearson e adotado o valor de p<0,05 para a significância estatística. Houve aumento do ON circulante, redução nos índices de resistividade arterial, melhoria significativa nos níveis de colesterol e triglicérides e ganho na capacidade funcional das idosas após a intervenção. Existiu correlação inversa entre a resistividade da artéria vertebral direita (VERTD) e níveis de ON e entre a VERTD e os níveis plasmáticos de HDL, assim como entre estes e o teste C10m nas idosas em estudo. Não houve modificações significativas na qualidade de vida das idosas. Em conclusão, o programa de exercício proposto foi capaz de oferecer melhorias funcionais, aumentar o nível de óxido nítrico circulante, diminuindo a resistência arterial promovendo modificações no perfil lipídico de idosas

Construção e validação de instrumento simplificado para diagnóstico de disfunção temporomandibular em pacientes adultos

As disfunções temporomandibulares (DTM) representam a maior causa de dor não dentária da região orofacial. Dada sua alta prevalência na população em geral e a existência de inúmeros instrumentos diagnósticos não padronizados, buscou-se elaborar e validar um questionário simples, de acessibilidade ampla e aplicação prática, com vistas a contribuir para o diagnóstico e o estudo epidemiológico das mesmas. A estratégia utilizada na montagem do instrumento foi estabelecida com base na avaliação criteriosa de questionários já existentes na literatura, validação de expertos na área de DTM, validação fatorial, de face (na primeira fase do estudo) e, frente ao padrão ouro (RDC/TMD), na segunda fase do estudo. Na primeira fase, participaram 160 indivíduos. A consistência interna resultou num Coeficiente Alfa de Cronbach de 0,752 para o questionário com sete itens; enquanto que para o questionário com cinco itens, este resultado foi de 0,694, não sendo o mesmo, considerado baixo por avaliar apenas cinco questões e ainda, em razão do tema central da pesquisa ser bastante subjetivo. A análise fatorial confirmatória apontou para uma variância total dos fatores extraídos do questionário com sete itens, de 58,2 % e do questionário com cinco itens de 70,04%. Portanto, o questionário com cinco questões, apresentou resultados estatísticos superiores ao de sete questões. Na validação frente ao padrão ouro (RDC/TMD), foram avaliados 99 indivíduos tendo sido testados os dois questionários, com sete e com cinco questões. Na estrutura com sete questões, ao se categorizar as mesmas por totais de pontos obtidos, em quatro condições, obteve-se o melhor resultado quando se considerou com DTM a faixa entre 10 e 21 pontos, sendo 85,1% positivos também no RDC/TMD, com acurácia de 90,1% e Kappa 0,817. Nesta condição, a sensibilidade encontrada foi de 95% (IC 95%, 91 a 99), especificidade de 87% (IC 95%, 81 a 93), VPP 85%, VPN 96%, LR+ 7,3 e LR- 17,4. Quando os dados foram avaliados para o questionário com cinco questões (QST/DTM), pode-se observar que o melhor ponto de corte foi quando se considerou como portadores de DTM, os indivíduos na faixa entre 7 e 15 pontos, com acurácia de 85,8% e Kappa 0,817. Nesta condição, a sensibilidade foi 88% (IC 95%, 81,6 a 94,4), especificidade 84% (IC 95%, 76,8 a 91,2), VPP 80%, VPN 90,5%, LR+ 5,5 e LR- 7,0. A simplicidade do presente questionário (QST/DTM) com apenas cinco questões, possibilita seu uso como elemento de triagem inicial na área da dor orofacial em disfunção temporomandibular, com boa compreensibilidade, confiabilidade, reprodutibilidade e possibilidade de aplicação em pesquisas epidemiológicas. Concluiu-se que o questionário aqui validado, permite sua aplicação de forma simples tanto por profissionais e pesquisadores da Odontologia como de outras áreas da saúde

Análise do processo judicial eletrônico (PJe) sob os parâmetros da discursividade processual e do acesso democrático à justiça

The conceptions of the judicial function, the process and the factors of legitimacy of the norm of decision are changed according to the model of State (liberal, social democratic and constitutional). The right of access to justice, likewise, follows the ideals present in constitutional movements experienced in different historical moments. The deficit of legitimacy of the judiciary is recurring subject of study in the doctrine, especially in the face of democratic standards that permeate the current paradigm of state. Under the process law, the essential element for the distinction of the states based on the rule of law (formal and material) and the democratic constitutional state lies in the democratic guarantee of participation to the litigants in the process of elaborating the norm of decision. The concern about the participatory democracy and the concretion of fundamental rights has as presupposition the conception of popular sovereignty. Keeping this effort in mind, the civil procedure cannot be oblivious to such considerations, especially when it justifies its constitutional conformation from the institutionalization of discourse within the procedural field (democratic principle) and of the democratization of access to justice, leading to the necessary contestation of the theory of instrumentality of the process. The democratic prospects of civil procedure and the concern about the legitimacy of the rule of decision cannot be moved away from the analysis of the judicial function and the elements that influence the legal suit s progress. The computerization of the judicial process entails extensive modification in the way the judicial function is developed, in view of automation of activities held, of the eliminating of bureaucratic tasks, manual and repetitive, and of streamlining the procedure. The objective of this study is to analyze the dogmatic changes and resulting practices from the implementation of the Judicial Electronic Process (JEP), prepared by the National Council of Justice, under the parameters of procedural discourse and democratic access to justice. Two hypotheses are raised, which, based on a bibliographic-documentary, applied and exploratory research, are contested dialectically. The expansion of publicity of procedural acts and the facilitating of communication and practice of such acts are elements that contribute to the effective participation of the recipients of the norm of decision in its making process and, therefore, the democratic principle in the procedural field. Ensuring access (to the parts) to the case files and reasonable duration of the process along with the preservation of its founding principles (contradictory, legal defense and isonomy) are essential to ensure democratic access to justice within the virtual system

O trabalho do gestor escolar: intensificação e implicações administrativas e pedagógicas na gestão da escola

Analyze the work of the school manager who now faces the changes experienced in school management for the last two decades. We propose that there have been changes in school management that have generated a larger number of activities to be developed by managers, causing both the intensification of work and a greater involvement of professionals in the financial-administrative dimension of their work in opposition to the political and pedagogical dimension. This study has a historic-critic approach. That is why we performed semi-structured interviews with school managers of the city schools in Natal RN, BR as a methodological procedure. We also analyzed the literature as well as the documentation relevant to this subject. From the study it was possible to conclude that changes in the field of school management and also teaching have led to an intensification of work of school managers and that such changes have not been followed by corresponding improvement in working conditions and teaching career of these professionals. They, as a rule, are considered by controlling agencies and by the school community as the primarily responsible for the school condition and for creating actions or projects that may improve the institutional objectives and results, including even the maintenance of the institution. Moreover, the growing number of administrative activities represents for obvious reasons extra work for these managers, who, when trying to cope with the growing bureaucratic situations, end up misplacing other political and educational aspects of school work, which may undermine the final purpose of school itself. We stress that we must broaden the discussions on the functions of the school manager, so that this worker can actualize a pedagogical project more committed to an emancipatory nature, despite all the challenge in keeping the school running in often-precarious conditions

Acompanhando o crescimento e o desenvolvimento da criança : uma intervenção integrada entre enfermagem e família

The accompanying the growth and development of the child is the guiding line of basic health measures directed at this public, acting within the scope of health monitoring and inferring positively in the rate of infant morbidity and mortality, which are still a preoccupation worldwide and in Brazil. However, mostly, this practice is based on the biomedical model of care, individualized, with emphasis on the medicalization and complaints, favoring the passivity of users. Given this issue, aim to develop accompanying the growth and development of the child in a Basic Unit Family Health, through a collective approach of medical care next to a health team, especially nurses and caregivers. This is a qualitative study, with the research-action method. Involved the four nurses and twenty-six of children's caregivers of the area of Basic Unit Family Health of Cidade Nova, in Natal, in the period from February to July 2010. The results were analyzed following the direction of the thematic analysis of Freire. In the situation analysis of the current reality of the accompanying the growth and development the children in the Basic Unit Family Health, through participant observation and applying a questionnaire to the nurses, we realize that despite these professionals have a knowledge tied to the paradigm of health promotion, in practice the monitoring of child is done through individual consultations in outpatient room, based on complaints brought by caregivers, with little solvability in actions employed. Given the need for change in medical care model, we decided jointly, in the focal group, for the collective monitoring of children's the growth and development, featuring then this proposal to the multidisciplinary team, discussing the participation of professional categories and planned collectively the actions. In the implementation stage of collective action, we contemplate the execution by the caregivers of anamnesis and physical examination, recording data in the Child Health Handbook and discussion of clinical findings, under the supervision of nurses and facilitators. In the evaluation, we found that this collective accompanying strategy allowed to caregivers learn new knowledge, exchange experiences, assistance in home care, beyond reduce the waiting time for medical care and creating opportunity of more time for debate about the children‟s health situation, differing of ambulatory care. As difficulties, we face with a high rate of defaulters (53.8%), lack of motivation and passivity of the users, little participation of other health professionals and nurses' involvement in other activities, technical and bureaucratic in the moment of care. Thus, we note also a strong rooting of individual clinical model on the way of thinking and acting of nurses and caregivers