Avaliação da qualidade da atenção primária à saúde da criança no Rio Grande do Norte: visão das usuárias

The study aims to evaluate the quality of the work processes of the teams from the Family Health Strategy regarding the comprehensive health care for children, in the view of users in the state of Rio Grande do Norte. This is a cross-sectional observational evaluative research with quantitative approach. The primary data are part of the External Review from the Program of Improving Access and Quality of Primary Care (PMAQ) in 2012. 190 women were interviewed. The inclusion criteria was the presence in the clinic at the time of the survey, have attended the service in the last 12 months and be a mother or companion of a child up to two years old. A research protocol was developed in the dimensions of Growth and Development, Breastfeeding and nutrition, and health problems and its variables. The results revealed that mothers / companions who responded to the questionnaire 71% were aged between 18 and 35 years, 92.1% were literate, 96.3% had a monthly income and 62.6% received financial assistance from the government. As for the children, 39.4% were aged between 13 to 24 months. In promotion and prevention actions for children, 64.2% had consultation up to the 7th day of life, 91.1% underwent the screening test, 95.3% had a health handbook, 98.9% had a vaccine, 17.9% breastfed or breastfeed from 6 to 24 months. As for link and continuity of care, 86.8% of the children were accompanied by the same professional staff and 59.5% left with next consultation scheduled. In acute situations 42.4% of the children went to the health unit and 64% of these were attended. It is concluded that the actions involving prevention and health promotion of children in RN, are evaluated positively by the service users and meet the requirements of MS, as well as link and continuity of care. The weakness in access and reception of users is evident, indicating the need to adapt the service to the demand of health and planning actions to welcome all who seeks basic health unit-UBS

Dinâmica Costeira dos Campos petrolíferos Macau/Serra, litoral setentrional do Estado do Rio Grande do Norte

This thesis describes the general behavior of the northern shore of the State of Rio Grande do Norte relating beach profile morphology with hydrodynamic and sedimentological parameters. The Macau and Serra Oil Field are inserted on this area and are under accelerated coastal erosion. At these oil fields are installed oil wells from PETROBRAS, nowadays located directly in the shoreline, under constant attacks of coastal processes (e.g. waves, tides and currents), which promote an intense morphodynamic variability of this sandy coast. The area was monitored for 24 months in three different stations (P01, P02 and P03). The methodology applied involved current techniques of beach profiles, hydrodynamical processes, remote sensing and geophysics. A synthesis of results obtained through the use of different time scales (monthly, lunar cycle, seasonal, annual) from a coastal dynamics study is presented. The average wind direction corresponded to 77ºAz (NE). The steepness of the berm and of the shoreface, as well as coastal current direction, do not present major changes, with an average of 36º for the steepness of the berm, 15º for the shoreface and 15º for the coastal current direction. This data set allows us to infer that the months of larger coastal erosion were November/2000 and April/2001, because of the largest wave parameter during this time. The months of worse coastal erosion in this area are related with the increasing wavy energy. This in turn, seems to be related to seasonal climatic variations, with the wave energy and tide currents speed increasing during months of minor precipitations (June to January). The months of worse coastal erosion were September and November, when the largest wave parameters and speed currents are measured in the area. Since these months are included on the period of minor precipitations, we related the coastal erosion to seasonal climatic variations. The results obtained during these 24 months of monitoring confirms a situation of accentuated erosion, mainly in Profile 03 (Barra do Corta-Cachorro), where the wave height, period, and coastal current speed are always larger than the values found in Profile 02 (Macau5). Probably these values are more expressive in Profile 03, because it does not present any natural structure of protection against the wave impacts, as the barrier island located at Ponta do Tubarão, or the sand banks in front of Macau5. The transport of the sediments occurs from East to West, and the sand accumulation is more pronounced on Profile 03 intertidal zone, where there are embrionary dunes in dryer months. The tidal currents speed, on the other hand, is more accentuated in the Macau5 area (Profile 02). At Ponta do Tubarão, the tidal currents presented a preferential direction for NE, at times of flood, currents and for NW, at times of ebb current; at Barra do Corta-Cachorro the direction of the currents were predominantly for NW, independent of the tide phase, coinciding with the preferential direction of the longshore current. This currents inversion at Ponta do Tubarão is attributed to the presence of the Ponta do Tubarão island barrier and by the communication channel of the lagoon with the sea. The tide currents are better observed in protected areas, as in the Ponta do Tubarão, when they present inversion in their direction accordingly to the flood and ebb tide. In open areas, as in Barra do Corta-Cachorro, the tide currents are overprinted by the longshore currents. Sediment analysis does not show important modifications in grain size related to seasonality (dry- and rainy seasons). On the foreshore and backshore zones, the sediments vary from fine to medium sand, while in the shoreface they very from fine to very sands. The grains are mostly spheres, varying from sub rounded to sub angled. Quartz is the main component alongside Feldspat and heavy minerals as accessory components. Biogenic content is also present and mainly represented by mollusks fragments. The calculated sediment transport show values around 100 m3/day. The morphodynamic studies indicated that this is a reflexive area from October to April, and intermediate from May to September. The Relative Tide Range-RTR for this area is 4 < RTR < 15, and so classified in the mixed wave-tide group. Having this exposed we can affirm that the more active natural factors in this area are the currents, followed by the tides and the winds. The anthropic factors are exclusively local and punctual (Macau and Serra Oil Field). Taking in account the economic importance of the area, as well as the intensity of coastal processes acting on this shore, it is important a continuity of the monthly environmental monitoring looking for variations on longer-period cycles. These data have been stored on the geo-referenced database of the projects MARPETRO and PETRORISCO (REDE 05), aiming to model the coastal and sea environment, susceptible to oil spills and their derivatives

Características psicológicas do paciente obeso grave e suas implicações pós-operatórias na cirurgia bariátrica

Obesity is a chronic disease that has multi-factorial aetiology, characterized by high degree of body fat; the degree of obesity will vary according to the Body Mass Index (BMI=m2 /kg). The severe degree of obesity is characterized by BMI>40 and it is regularly associated to endocrine-metabolic or mechanic clinical alterations, and to psychological disorders. Binge Eating (BE) results were overly high for this population. The Bariatric Surgery has been the treatment chosen by those diagnosed with severe obesity as this intervention provides prompt outcomes for loss of weight and clinical improvement conditions. However, recent research has acquiesced that after two years between 20% and 30% of people subject to this intervention gained weight. The main objective of this research is to assess the psychological and behavioral characteristics of those diagnosed with severe obesity that have been subject to Gastric Bypass Surgery in the past 24 months. Specific aspects were investigated: (1) characteristics of different personalities and diagnose of clinic and personality disorders; (2) BE and its relation with loss of weight; (2) the difference between the groups regarding post-surgery care, e.g. physical activity, psychological and dietician input. Method: 40 adults (women and men) aged 23 and 60 year-old who went through a bariatric surgery in the past 24 months, in the city of Natal-RN (Brazil); they were assembled in two groups n=20, Gain group displaying loss of < 50% of their initial surplus of weight, and the Loss group displaying loss of >50%. The research protocol is made of a socio-demographic questionnaire and 3 psychometric instruments: Rorschach – Comprehensive System; Millon Personality Inventory (MCMI-III); and the Binge Eating Scale (Escala de Compulsão Alimentar Periódica (ECAP). Through Rorschach significant differences between these groups were verified according to the kind of personality (EB) - more EB Extratensivo in Gain group and Intratensivo in Loss group – and the lack of control to express affect, increasing the answer for Color Pure at Group I. Concerning the people standardization, the sample as a whole tends to show psychic pain, denigrated selfperception, high levels of self-criticism, distorted perceptions, vulnerability to develop mood disorders and high scores regarding Suicide. MCMI-III results showed more clinic and personality disorders in Group I: Depressive Disorder and Schizotypal, Anxiety, Dysthymia, Major Depressive Disorder; Thought Disorder, Bipolar- Manic and Posttraumatic Stress Disorder. In relation to ECAP, the results indicated significant differences, showing increased BE results in Gain group. There were found significant differences between BE severity and the presence of clinic and personality disorders. Concerning the post-surgery care, the observed differences are statistically significant regarding physical activities with median-increased differences in Loss group. There is a difference between the initial weight and the time post-surgery, indicating that the higher the initial weight and the time after the surgery the higher the re-gain of weight post-surgery. Finally, the results show that the participants with more than 3 years of surgery will have Clinic and Major Depressive Disorders; Somatoform Disorder; Dysthymia. These results confirm prior studies related to BE post-surgery and re-gain of weight as well as the proneness of clinic disorders in severe obesity people. That means the results reinforce that the surgery process is a facet of the severe obesity treatment. The post-surgery process needs to be the main focus of attention and have a long-term input to sustain the care of the surgery results and the quality of life of the patients.