Papel da extensão e do trabalho junto à comunidade na formação médica

SILVA, Thiago Demétrio Nogueira Costa e; CORRÊA, Edison José; MARANHÃO, Técia Maria de Oliveira. O papel da extensão e do trabalho junto à comunidade na formação Médica. Revista Eletrônica Pesquisa Médica, v.1, n.3, p.9-13, jul./set. 2007

Violência intrafamiliar contra a criança: intervenção de enfermeiros da estratégia saúde da família

Objetivou analisar a atuação dos enfermeiros da Estratégia Saúde da Família frente à violência intrafamiliar contra a criança, visando identificar ações de prevenção do problema. Pesquisa descritiva e exploratória de cunho qualitativo, cujos dados foram analisados conforme análise de conteúdo. Participaram do estudo 14 enfermeiros da Estratégia de Saúde da Família do município de Mossoró-RN. Dados coletados utilizando-se questionário semiestruturado. As ações de promoção à saúde são atividades educativas desenvolvidas após detecção de casos. O medo de represálias do agente agressor, a sobrecarga de trabalho, a falta de apoio dos gestores e a dificuldade para a materialização da interdisciplinaridade, intersetorialidade e integralidade da atenção foram mencionadas como barreiras ao enfrentamento do problema

Vitalidade no centro antigo Teresina, Piauí Praça Marechal Deodoro: uma intervenção contemporânea em área de valor patrimonial

This study deals with the discussions of contemporary interventions in public spaces in areas of heritage value. The product of this dissertation is an Intervention Project to Marechal Deodoro Square located in Teresina/PI center. The starting point for understanding the theme of this study is to investigate the accessibility and vitality of a public space - through relationship between form and uses. The spatial properties of accessibility and visibility as well as the distribution of land use - factors were associated with distinct patterns of vitality - and compared to usage patterns observed in situ and statements from users obtained through the results of the questionnaires. In attention to questions about the building constructed, particularly in historical centers, considers the guidelines to define intervention strategies in the square, consisted in the development of simulations that after evaluation of results of redesign, was chosen the best option to meet the necessary requirements to the performance, considering the spatial properties of integration and visibility that meet these requirements. Therefore, the "Intervention Project" carried out for the Marechal Deodoro Square characterization proposed items are discussed: spatial structure, vegetation, road network, pavements, street furniture and lighting

Fatores preditivos da dor em pacientes submetidos à cirurgia cardíaca

A identificação de fatores que interferem na dor pós-operatória é útil para minimizar o sofrimento desnecessário e favorecer a uma intervenção analgésica adequada, evitando generalizações nas condutas terapêuticas. O propósito dessa investigação foi identificar os fatores preditivos da dor em pacientes submetidos à cirurgia cardíaca e a relação existente entre dor, analgesia e personalidade. Trata-se de um estudo prospectivo e analítico, aprovado pelo comitê de ética da UFRN (175/06), o qual proporcionou uma abordagem multidisciplinar ao envolver áreas distintas como: fisioterapia, psicologia, médica e enfermagem (interdisciplinaridade) na elucidação do objeto de estudo relacionado a fatores preditivos da dor. Para caracterização geral dos pacientes foi utilizada uma ficha de avaliação fisioterapêutica; a dor pós-operatória foi avaliada pela escala numérica de dor e questionário para dor McGill e o Inventário Millon de Estilos de Personalidade (MIPS) foi utilizado para identificar e avaliar as manifestações das características comportamentais e de personalidade. Foram acompanhados, do 1º ao 5º dia de pós-operatório (DPO), 160 pacientes submetidos à cirurgia cardíaca, 57,5% do sexo masculino, com idade média de 56,8±14,4 anos, sendo incluídos no estudo aqueles que se queixaram de dor no pós-operatório em pelo menos um dos dias de avaliação e assinaram termo de concentimento livre e esclarecido (TCLE). Os dados foram submetidos ao teste Qui-quadrado, regressão logística multivariada, teste de correlação de Spearman, teste t e ANOVA. Ao serem submetidos à análise de regressão foram encontrados seis fatores preditivos da dor: tempo cirúrgico > 3 horas, dreno mediastinal e lateral, tosse, vômitos, tempo de dreno > 24 horas e sexo feminino. Estes fatores apresentaram uma correlação positiva e significava com a intensidade dolorosa referida pelos pacientes na escala numérica de dor e os pacientes que apresentaram mais fatores preditivos da dor referiram mais dor. 23 Já em relação ao McGill não se obteve diferença significativa entre os pacientes com mais e menos fatores preditivos. Observou-se que foram administrados diferentes tipos de analgésicos, isolados ou associados, sendo estes: paracetamol, paracetamol associado à codeína, dipirona, tramadol, toradol e tilatil. A percepção dolorosa apresentou magnitudes variando de leve a moderada do 1º ao 5º DPO e ao ser relacionada com as características de personalidade, nos pacientes com menos dor, observou-se os fatores: preservação, individualismo, introversão e os com mais dor foram: proteção, extroversão, retraimento, discrepância, afetividade, acomodação, comunicabilidade e firmeza. Evidenciou-se que o comportamento doloroso pós-cirurgia cardíaca é multifatorial e que a determinação da existência de fatores preditivos da dor permite ao profissional da área de saúde fazer o uso adequado dos analgésicos, haja vista que o alívio da dor é responsabilidade de todos os profissionais da saúde. Os aspectos psicológicos enquanto características de personalidade podem influenciar padrões de comportamento como os observados.

A Humanização e a Formação Médica na Perspectiva dos Estudantes de Medicina da Universidade Federal do Rio Grande do Norte

The aim of this study is to understand the perception of medical students at the Federal University of Rio Grande do Norte (UFRN) about humanization in the context of their medical formation, using a qualitative approach. The focus group and participant observation techniques were used, involving a multidisciplinary team composed of professionals from the areas of anthropology and psychology, as well as professors from the medical course, who studied two groups of nine students in their final year. The data were analyzed using the categorical thematic content analysis technique, from which emerged three categories: student/patient relationship, teaching/learning and student/professor relationship. The first allows us to identify that student-patient contact is an essential experience for adopting a more humanized view of the disease process. The second category shows that unqualified professors in the pedagogic practices inherent to the teaching profession and the theory the practical dichotomy hinder the autonomous and holistic formation of knowledge. Similarly, the lack of practices outside the academic environment and the absence of multiprofessional stimulation interfere in the construction of an integral view of the individual. From the third category, the student/professor relationship, emerge two opposing subcategories (professor model and assymetric relationships), which reflect the importance of the professor`s ethical humanist position, as opposed to an authoritarian attitude, to form the professional attitude of the student. The results point important aspects of the medical formation that may open a discussion about humanization, in the context of new national curricular guidelines

Intervenção dietoterápica em portadores de lipodistrofia generalizada congênita do Rio Grande do Norte

Congenital generalized lipodystrophy is a rare genetic disease with autosomal recessive inheritance characterized by the generalized absence of subcutaneous adipose tissue and insulin resistance. The aim of our study was to determine the profile of patients with congenital generalized lipodystrophy (Berardinelli-Seip syndrome) through their clinical history, eating habits, and socioeconomic and cultural aspects; assess food consumption and nutritional status of the study group; propose and evaluate a diet therapy model associated to oral supplementation with zinc to help in the control and prevention of metabolic complications associated to the pathology. Initial assessment of food consumption indicated a voracious appetite in all the patients studied. The introduction of zinc reduced appetite, contributing to patient adherence to the food plan proposed. It was also observed that the proposed diet contributed mainly to glycidic control, specifically with respect to HbA1c. The nutritional status of the patients investigated was adequate in terms of body mass index (BMI), arm muscle circumference (AMC), arm muscle area AMA, but triceps skinfold (TSF) indicated serious malnutrition. Our study is unique in the literature and provides important information to the field of nutrition and to individuals with this pathology. Furthermore, it contemplates the interdisciplinary and multidisciplinary requirements of the Postgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte (UFRN), Natal, Brazil

Avaliação do conhecimento e de habilidades clínicas em saúde sexual e reprodutiva na graduação de medicina

No Brasil, a despeito das conquistas obtidas a partir da implantação do Sistema Único de Saúde e dos avanços legais e institucionais na atenção a diversos problemas relacionados ao gênero, a incorporação de temas relacionados aos direitos humanos, sexuais e reprodutivos no contexto da formação profissional em saúde permanece deficiente. Este trabalho teve como objetivos avaliar a inserção da temática saúde sexual e reprodutiva no currículo do curso de graduação em Medicina, por meio do emprego de avaliações de conteúdo cognitivo, procedimental e atitudinal. Trata-se de estudo de intervenção educacional envolvendo alunos do internato do curso de Medicina da UFRN. Foram utilizados os seguintes métodos avaliativos: prova escrita, exame clínico objetivo estruturado (OSCE) e Mini-CEX. Como variáveis explicativas foram consideradas o sexo, idade e participação prévia no componente curricular optativo Saúde Reprodutiva . A avaliação do processo constou da aplicação de questionários de satisfação e entrevistas acerca dos métodos avaliativos utilizados. Considerando os três métodos avaliativos empregados, 183 estudantes participaram do estudo, com média de idade de 24,5 ± 2,2 anos, sendo 52,5% do sexo masculino e 47,5% do sexo feminino. No contexto geral, observamos concordância entre os desempenhos dos estudantes nas avaliações de conteúdo cognitivo, procedimental e atitudinal. A participação dos estudantes no componente curricular eletivo Saúde Reprodutiva mostrou-se associada com melhor desempenho em algumas dimensões da avaliação cognitiva e na avaliação com o Mini-CEX, em relação às competências de anamnese, profissionalismo e qualidades humanísticas, relação médico paciente e desempenho global. A análise da fidedignidade entre os avaliadores na avaliação com o método OSCE mostrou-se adequada (alfa de Cronbach superior a 70%) em relação ao desempenho global e aos aspectos técnicos das competências avaliadas, observando-se baixa confiabilidade na avaliação da comunicação médico-paciente. O presente trabalho constitui-se numa experiência educacional inovadora e pioneira no âmbito da educação médica brasileira no que tange à inserção da temática de saúde sexual e reprodutiva na graduação, sugerindo-se um impacto positivo da iniciativa na formação do médico generalista na UFRN. A avaliação de conhecimentos, habilidades e atitudes em saúde sexual e reprodutiva na graduação de Medicina mostrou-se factível, com alta concordância entre os diferentes métodos empregados. Os métodos OSCE e Mini-CEX podem ser aplicados ao contexto da saúde sexual e reprodutiva, possibilitando a avaliação de competências clínicas relevantes para a formação do médico generalista e que habitualmente não são contempladas nas avaliações rotineiramente realizadas na graduação

Da escala médica de saúde à experiência social do saudável :diálogo entre os espaços dos bares e das academias fisiculturistas na cidade do Natal-RN

Currently, we attend a reverence of concepts ahead as health, life, youth and body. In we widen amount the ideals concerned to the healthful life, to the quality of life, the longevity and joviality and the extremities of the body represented by the illness, for the virus infection, the physical deficiency and the aging. Of the historical shades of the plague, of the hunger and the war that gagged the defenseless individual and its body, in the current days we increase the search for a full and powerful life, independent of a religious imaginary to predict the epidemic curse, the threat represented for the sick people and the incarnate divine anger in the death; or of medical science presented in the spaces of the technology and the physiology, being left fragile the social and psychological dimensions of the human confined to the patient issue and, finally, the commanded urban health politics in quantitative goals of hygienic cleaning, of the medical techniques and the education citizen. For beyond these instances, emerges in our days a plural, close and biographical agreement well of the body and welfare. On the other hand, an understanding of the healthful life and well-being that more certifies the presence of something the one that clear landmarks amongst normality and the irregularity, the esteem and the destructive vice: it has a projection of healthful life measures without conceptual models of body and health under the doctor-scientific standard occidental. This thematic one will confide in way to the enclosure for spaces to the muscles and fitness exercises and the bars from the city of Natal, in the state of Rio Grande do Norte, Brazil, while comprehensive interchange concerning as the individual comes dealing with the notion the body and health and, mainly, if perceiving inside of its body and its health. Amongst these two spaces of typical leisure of the modern urban phenomenon, the hedonism bodily with its muscles and salience and one another form of hedonism in the fruition of allowed drugs will be across itself in a dialogue about which social s relationships are really in game in an imaginary construction amongst an doctor-aesthetic ideal of health and the social and subjective experience in the option for a healthful life

O regime constitucional da contribuição de intervenção do domínio econômico aplicável ao setor de combustíveis

The performance of the State in the economic area is only legitimized when to be given in virtue of the protection of the principles established constitutionally. Thus, the economic intervention of the State prioritizes the formation of a joust economic order and in this context, it fulfills to us to define, to the long one of this work, the contours of the intervention of the State in the economic domain in the presence of the Federal Constitution of the Republic of 05 of October of 1988, and, more specifically, in the petroliferous economic sector by means of the interventive contribution instituted after the Constitutional amendment 33/2001, with Law 10.336/2001. With the creation of this institute, in Brazil, emerged innumerable quarrels concerning its constitutional legitimacy, directing uncurling of the research to the study of the state intervention through this contribution and its constitutional limits, in the purpose to demonstrate the parameters for its institution and application. In this way, the interventive contribution in the fuel sector (CIDE-Combustíveis) shows itself as an intervention instrument on the economic domain, acting in way to finance the indirect performance of the State, specially in what concerns to the promotion of the principle of sustainable development principle. Therefore, CIDE-Combustíveis is an able instrument to concretizes the mentioned constitutional principle. Thus, the division of its incomes promotes the consolidation of the principle of the cooperative federalism. In this direction, from premises of the environmental tax law, this intends to demonstrate the utility and constitutionality of this exaction tax, primordially with regard to the realization of the basic right to the balanced environment

A intervenção estatal no domínio econômico privado através da nova lei de recuperação de empresas e falências (lei 11.101/05)

Analysis of the elements of the Constitutional Order of the letter 1988 politics, with emphasis in the principles of this, a study on the intervention of the State in the private initiative by means of the Law of Recovery of Companies and Bankruptcies (law 11.101/05). New enterprise vision is admitted, over all in the interdependence between economic and social factors. Study on the globalization and the interdependence of economic and legal sciences in the construction of a legal optics in the search for the economic and social development, with the recognition of the interference of the Economy in the Right and its uneven importance. Still, we delineate the state intervention in the economic scope, of company and in the judicial recovery, as well as the consequences of such intervention in the involved credits in the judicial recovery and patrimony of the debtor in recovery. For such task, the elements of the Judicial Recovery, its principles and adequacy of these to the related ones in the chapter had been analyzed that turns on the national economic Order, describing the formal procedure for concession of the benefit of the Judicial Recovery and the principles in existing them. The forms of intervention of the State in the private economy were not disrespected, relating its direct and indirect performance as half of preservation of interests writings in the constitutional scope as public interest and preservation of the National economic Order. The regulating agencies as of direct state intervention were half not disrespected of the study for the relevance of the subject. It is revised national bibliography with incursions in French, Portuguese and North American comparative jurisprudence. One contributes in the aspect of the paper of the Judiciary Power in the protection of the companies in crisis and the social and economic impacts, over all in relation to the rights of the worked ones, credit and enterprise

Intervenção judicial nas sociedades limitadas em face da liberdade de iniciativa

The judicial intervention in limited liability company goes through several issues of legislative and hermeneutics origin, based considerably on the small importance given to freedom of economic initiative by the participants in the process of formation and application of the law. In addition, Brazilian law, due to incompleteness, inconsistency or lack of valid grounds, put the judge in a procedural delicate situation. Being forced to judge, the judiciary faces severe uncomfortable interpretive situations, of which derive solutions of dubious constitutionality and affecting, significantly, the dynamics of business activity. In this context, and considering the limited liability company as an expression of free enterprise, corresponding to a lawful association of people in order to undertake economically, in exercise of his freedom of contracting and professional action, intended to be offered safe parameters of constitutionality for judicial intervention in limited liability company in the hypothesis of (i) transfer of corporate shares, (ii) attachment of corporate shares, (iii) dismissal of directors, (iv) appointment of judicial stakeholders, (v) exclusion of shareholders and (vi ) trespass. The hypothetical-deductive approach was adopted, building hypotheses to overcome the gaps and unconstitutionality of the law and subjecting them to tests, reviews, and comparisons with hypothetical facts and case law in order to determine the constitutional validity of the proposed solutions. The procedure aimed to reconcile the historical, comparative, dialectical and scientific methods. The roots of temporal institutes were researched as well as current solutions provided by national and compared law. From problematizations point, addressed by the constitutional interpretation of the law and jurisprudence, responses that bring out the unconstitutionality of certain conceptions were headed

A mediação como instrumento concretizador do direito fundamental à saúde: uma alternativa à judicialização de conflitos Natal 2013

In Brazil, the 1946 Constitution enshrined the right to health, having it defined as the possession of the best state of health that the individual can achieve. Already the Federal Constitution of 1988 lifted that right to the status of fundamental social right, which transcends the effectiveness and cure of the disease is based on the joint liability of public entities for the provision of a quality service, efficient and prioritize human dignity and comprehensive evaluation of patients. According to the World Health Organization, the definition of health, first characterized as the mere absence of disease, has become recognized as the need to search for preventive mechanisms to ensure the welfare and dignity of the population. Garantista this context, the growing seem lawsuits that deal with the implementation of public policies, especially in the area of the right to health, the omission of which the Government can result in the risk of death. Hence the concern of law professionals about whether or not the intervention of the judiciary in cases that deal with providing material benefits of health care. It claims to break the principle of separation of powers, disobedience to the principle of equality and the impossibility of judicial intervention in the formulation of public policy to try and exclude the liability of public entities. In contrast, the judiciary has repeatedly guardianships granted injunctions or merit determining the supply of materials indicated by the medical benefits that accompany the treatment of patients who resort to a remedy. In this context, mediation, object of study and resolution presented in this work, is presented as an instrument conciliator between the reserve clause and the right to financially possible existential minimum, as it seeks to serve all through rationalization of health services , avoidance of negativistic influence of the pharmaceutical industry, with prioritizing the welfare of the individual and the quality of relationships. This is alternative way to judicialization that in addition to encouraging and developing active citizen participation in public policy formulation also allows the manager to public knowledge of community needs. It is in this sense that affirms and defends the right to health is no longer the mere provision of medical care and prescription drugs, but a dialogue conscious existential minimum to guarantee a dignified life

As sanções políticas, mecanismo de intervenção do estado na ordem econômica e tributária

This work pursues to analyze the sanctions of restrictive nature, which are characterized by impeding the business of the contributor in debt. Such sanctions known as political sanctions, are truly understood as an indirect way of tax enforcement, liable to cause problems to the private entity in curtailing, the initiative freedom, opposing the Article 5°, item XIII and Article 170, single paragraph of CF/88. As the State gets the several means to assure the economic order effective performance, it is up to the State to restrain the economic power abuse that objects to the marketing domination, to the ending of competition, and arbitrary increasing of profits (CF Article 173, § 4ª.) Therefore, it depends on the state, besides maintaining the economic order, to ensure a fair distribution of tax burden and act under the command of the Democratic State of Law principles. In order to make the tax collection effective, specific in some cases, the administrative fiscal agent uses coercive, excessive, and institutional, in imposing sanctions which causes constraint, maculating the contributor s essential rights, that matters of the necessity to force the tax credit ending. The principle of the free initiative and free competition, which are intended to be analyzed in this study, comes from a constitutional context and it will be reviewed in its systematic relations and with another rules, in order to evidence, at the end, the occurrence of an intervention towards the economic order when the State makes do of political sanctions as a tool for the tax credit effectiveness, infringing the Tax and Constitutional principles

Do olhar inquieto ao olhar comprometido: uma experiência de intervenção voltada para a atuação com alunos que apresentam paralisia cerebral

Compte tenu de l importance de la formation des enseignants pour répondre, de nos jours, aux besoins des élèves dont les caractéristiques marquantes sont la diversité et la différentiation, desquels nécessairement font partie , à un échelon croissant, des personnes atteintes d une déficience quelconque ; devant le constat que les actuelles politiques d éducation, en fonction de leurs limitations, peuvent être considérées comme un des principaux facteurs qui entravent la concrétisation d un vrai processus d inclusion de ces personnes ; compte tenu, encore, que le confront des situations éducatives concernant le processus d inclusion de ceux ayant des déficiences physiques, notamment lorsqu il s agit d élèves atteints de paralysie cérébrale, engendre chez les enseignants un état de troublante inquiétude du fait de ne se sentir convenablement préparés pour se confronter avec des situations pareilles, cette recherche, centrée sur cette problématique, a chosi comme objectif planifier, mettre en marche et analyser un programme d intervention pédagogique dans une école régulière de la ville de Natal/RN, auprès de quatre enseignants de l école fondamentale (7e Série) qui avaient reçu, dans leur classe, deux élèves atteints de paralysie cérébrale. S utilisant comme recours méthodologique de la recherche-action, le programme d intervention s est structuré autour de troix axes thématiques : l attitudinal, le pédagogique et le vécu en milieu scolaire, sous la forme de discussions théoriques et la mise en oeuvre de ces thématiques. Les données qui devraient être soumises à l analyse ont été collectées à partir des procédés d observation, d entretiens avant et après l intervention, du régistre de photos et d un questionnaire. Les interprétations faites, basées dans la comparaison du discours des sujets ont signalé que les enseignants ont progressé dans la maîtrise des savoirs scienfiques concernant la paralysie cérébrale et dans la connaissance des personnes atteintes par cette déficience. Par rapport aux valeurs et significations attribuées par les enseignants à ce programme d intervention à partir de leur choix des photos dans l ensemble du déroulement de ce processus formatif, elles s expriment par une prise de conscience très marquée, de la part des enseignants, par rapport :aux besoins éducatifs des élèves atteints de paralysie cérébrale ; à l importance et au vrai rôle que l école doit jouer face aux politiques d éducation inclusive ; aux difficultés vécues par ces personnes, qui réclament le plus profond respect de leurs ingularités ; la reconstruction d une nouvelle image concernant ces personnes ; la constatation qu il est possible aux enseignants d adapter et même de créer à l école des ressources et matériaux pédagogiques envisageant la qualité du processus d enseignement et apprentissage de l élève atteint de paralysie cérébrale ; finalement, la perception de l importance du travail en équipe, d un milieu scolaire accessible à ces personnes et de l appuis de la famille dans le contexte de l éducation inclusive. Les résultats obtenus, issus de ce programme d intervention, d après l évaluation finale des sujets, de part de témoigner de son efficacité, montrent que l intervention a été une excellente opportunité d habiliter ces enseignants et d améliorer le processus d enseignement à l école choisie comme le locus de cette recherche

Geometrizando no segundo ciclo :relato de uma intervenção pedagógica voltada à construção de conceitos geométricos no ensino fundamental

This work has proposed to relate the experience product of a pedagogical intervention, performed in a public institution of teaching situated in this capital. It had as objective to validade the applying of a teaching module of geometry, more specifically about the conceptions of perimeter and área in the second cycle of fundamental teaching. This dissertation has presented the problematic which involves the teaching of geometry in different contexts. It has adopted the broach of the radical constructivism while methodological theoretical referencial through which it has tried to explain the phenomena that involves the teaching and the apprenticeship. It appropriates Jean s Piaget contributions related to the development stages, while referencial that will dialogue in the search by sense and comprehension of the geometric apprenticeship process and it runs over Richard s Skemp (1980) theory in order to explicit the student s apprenticeship according to the levels of instrumental comprehesion and relacional comprehension . The research has presented datum related to initial diagnosis evaluantion, the pedagogical intervention and analysis of the activities and students perfomance displaying still the results of the final evaluation. According to the results got, we could check the students group growth front to the acquisition of the concepts of perimeter and área in comparison with the previous knowledges presented in the initial diagnosis evoluation of the students participants of the research. We have concluded evaluating the objectives of the research, connecting the strategies and reasoning employed by the students in order to resolve the questions and then to reach the objectives proposed by the teaching module. We have presented still the main obstacles to the apprenticeship of such concepts