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

Iniqüidade em saúde: uma extensão das desigualdades sociais no sistema público de saúde do Brasil (2003-2006)

This issue analises the unevenness in the brazilian system of public health care as an extension of socials inequities. It is a theoretical study based in a historical method, using empirical camp from academic, corporation and institution researchs, along the period 2002-2006. Equality and effectiveness in health systems are analitical basic cathegories grap in the root of the doctrine, principles and organization of the Unique Health System, in which sectorial actions are inserted. Discuss the estructural prodution and determined those inequalities through some social determiners of health system: income, land, food securitiy, nutritional situation, basic sanitation, epidemiological inequities and public management policy. Carry out a thematic review over health social production, it formlation and the goals of social policies, as well as the insertion of the equality principle in the assistance system, in the frame of the running public health regulations. It uses reflections that enlighted the correlation between the process of political-institutional actions and equity on health assistance. Analized the pertinency of sectorial reorganizational strategies on basic attendance, confronting the hipothesis that those strategies reinforce social inequities in health system, because it organize diferential assistance levels over not equal baselines. The results show up that social inequalities, even remaining, have had a small decrease; that the selectiviness of actual public policies and the duplication of the health system, increases the differences within and between the social classes and configures the assistance as inequal. The basic care system has great shortages that also appeares in middle and complex assistance levels. As conclusion, it remarks that the health assintance system, even with it integrality has limits; structural problems on material conditions of living and health system could not be reversed only with institutional legal arragements; by the contrary, in border conditions, these strategies produce policies that reinforce inequities, neglecting the equity principle of the system in which frame, they work. One patina of this tim

Escola e gênero : representações de gênero na escola

The study Escola e Gênero: representações de gênero na escola show us the social man made, starting of an analysis in the having fun time in the children´s life and how it´s an important aspect of the building childish universe simbolic. My analysis started in a children´s daily at school and how they noticed the play value od dominant society. Our propouse is think about the linking between ideology, representations and gender like the children´s knowledge in the school activities. The toy, an instrument which is noticed and exist in the funny activities, is full of cultural concepts of male and female parts. Your color, lines, functions and the way you manipulate is driven of gender cathegories. In the scool, the ideological concepts have it´s important way which is to domesticate the feelings, the desires; categorize and normalize them without be known by the educational employers. In the children´s education, the funny time is noticed by others ways and turned as important as others subjects. By the way it´s not noticed by the school, like another thing which isn´t a funny moment. And it´s exactly here in the school funny time, the school did your cultural power of separete the gender and your extencions, feed by the society, generaly, in favor of the man whose woman is your subordinate. This ways of analysis help the society and the school universe about the funny time e how they are important in the Man made life. And how the toys bring the concepts and addicted thinking, ideological which put the power in the stages, without equal, addicted feelings around the gender concepts. I read and used the theories of Kishimoto, Berger & luckmann, Brougère, Sousa Filho, Bourdieu, Badinter, Geertz, Grossi, Louro, Foucault, among others

O poder legislativo na verificação da legitimidade constitucional do processo de construção das leis

It is known that, in the Democratic State of Law paradigm, one of the most instigating themes is the legitimity of the Law. It justifies the interest in reflecting about the Legislative Process instituted by the Brasilian 1988 Constitution, more specifically field of the constitutionality control as away to guaranty of the legitimity of the Law. The research that is developed here, intents to bring to reflection the basis and the ways the Legislative Power has to proceed to Constitutionality Control of the laws and of the Legislative Process. As the focus taken here is about the Legislative Power, it starts from the presupposed that only by the adoption of legislative process which has to be connected to a rational speech, that will evidence the Democratic and Procedimental Law dimensions, guarantee the possibility of the public and private spheres of life act in complementarity that is such needed to the stabilization of the social expectatives and the concretization of the Brazilian Constitution

Os antagonismos da integração sul-americana na ordem jurídica brasileira

The economic regional integration is a phenomenon observed in numerous occasions inside the global economic reality. Watchful to that phenomenon, the 1988 s Brazilian constitutional order establish in its 4th article, single paragraph, the commitment to seek for the Latin- American integration, as a Fundamental Principle to the Brazilian Federative Republic. Regarding the mentioned constitutional disposition s realization, the Brazilian State celebrated, specially, the 1980 s Montevideo Treaty, creating the Latin-American Integration Association, and the 1991 s Asuncion Treaty, performing the duty to establish a common market, in sub regional level, with Argentina, Paraguay and Uruguay, called Mercado Comum do Sul. However, due to an addiction to a wrong comprehension of State s Sovereignty Principle, the Constitution imposes to the international rules an incorporation process, without providing any privilege to those ones regarding the integration constitutional disposition s realization, whether original or derived. The Brazilian s Supreme Court, as matter of fact, affirmed that it is not possible, facing the actual constitutional order, to grant any character of preference. Also in the controversies solution mechanism, responsible for the law s execution in case of its noncompliance, where found malfunctions, most notably the system s open character and its excessive procedural flexibility, in addiction to restricting the access of individuals. It follows from these findings, then, the lack of legal certainty provided by the Mercosul s legal system, considering its effects both international and within the Brazilian state. Among the possible solutions to reduce or eliminate the problem are using the practice of the so-called executive agreements in the Mercosul s original rules incorporation to the Brazilian state, the creation of a Mercosul s court of law and/or a constitutional reform

Devido processo penal: uma análise acerca dos direitos fundamentais sob a perspectiva do processo eletrônico

The current study presents an analysis about the automation of the lawsuits in Brazil, which opens a new direction to be followed by the National Secretary of Justice, applied indistinctively to the civil, criminal and labor lawsuits, as well as to the special court houses at any degree of juridisdiction. It treats, specifically, about the transition from the classic lawsuit with bureaucratic aspects to the electronic one, based on the simplicity of the functions, the quality of the oral and the readiness. The light of the constitutional principle of the reasonable duration of the lawsuit, while fundamental rigth of the defendant and, under de protection of the democratic guarantee, it investigates, from the theory of the fundamental rights to the reform movement of the lawsiut, in the scenery of the alien law and national law, the latter, mostly because it has the automation as a necessary improvement claimed by modernity, yet without forgetting of the humane character inherent to the criminal lawsuit. It faces the issue of of the disruption of the paradigm of the written formality of the Brazilian lawsuit, the problem of the resistance to the new automized method, the use of the video conference for the inquest of the witnesses as well as for the questioning of the defendant, the advancements of the virtual lawsuit on the Superior Courts, Federal Supreme Court and Superior Court of Justice, it treats also about the role of the National Council of Justice - CNJ - to uniformize the legal proceedings in the country. Without neglecting the effective respect to the fundamental rights, it focuses the cultural change necessary so that the electronic technology can be, in fact, in the indictment system, the means to reach with excellency the citizenship by the simplification of the legal proceedings, transposing the baseless bureaucracy and assuring an effective judicial service assistance in order to have a better quality of life

Fiscalização difusa da constitucionalidade e o incidente de argüição de inconstitucionalidade

The present work consists of studying to diffuse control of constitutionality in Brazil, with emphasis in a procedural alternative to the evolution of that model: the incident to challenge of unconstitutionality. Starting from the discussion about the new role of constitutional jurisdiction in peripheral countries and in the globalized society, without forgetting to face inevitable doubts about its legitimacy before other powers of the State, the Brazilian control of constitutionality is revealed, under a diffuse, non-dichotomical view, through a number of inconsistencies and misunderstandings, that compromise social peace, the credibility of democratic institutions and the supremacy of juridical security. In order to achieve the goal, the study in course discussed the main difficulties of the Brazilian mixed model of constitutionality control, as well as, directing its view to the incident of challenge of unconstitutionality, which the most adequate forms to assure its appropriateness, legitimacy, processing and decisory effects are. Is was essential, in this point of view, to establish the difference between the incident of challenge of unconstitutionality conceived in article of the Brazilian Federal Constitution and the incident of challenge of unconstitutionality such as it is known in the European models. The insertion of the incident of challenge of unconstitutionality based on European models in the Brazilian control system, without jeopardizing the North-American essence the Brazilian constitutional history presents since 1981, is the hypothesis that is presented as an improvement of constitutional protection

Possibilidades de exploração da história da ciência na formação do professor de matemática: mobilizando saberes a partir da obra de Nicolau Copérnico de revolutionibus orbium coelestium

This study aims to analyze the implications that the knowledge of an important work for the History of Science, De revolutionibus orbium coelestium , by Nicholas Copernicus, can bring for the formation of Mathematics professors. The study focuses on Book I of Copernicus s work, where, in the final part, is found the Table of the Subtense Straight Lines in a Circle, a true sine table constructed by the author. The study considers two theoretical references, the History of Science and of Mathematics, in the professor s formation searched amongst others in Miguel and Miorm, Brito, Neves and Martins, and Radford, and the necessary teaching knowledge professors mst have, on the basis of Gauthier, Schulman and Imbernón amongst others, through which it is established a net of knowledge grouped in dimensions such as mathematical, psycho pedagogical, cultural and practical diversity, that guide the study analysis. In the search for more necessary elements to enrich the analysis, beyond the theoretical research in Book I, it is carried through, with under graduation pupils, future Math professors, the construction of a sine table following the project used in De revolutionibus . The study still makes a description of the life and work of Nicholas Copernicus, detaching the historical context where the author lived and the conceptions about the Universe existing at that time. The research reveals that the studied work is an important source of culture, able to provide to the Mathematics professor in formation, beyond the conceptual and procedural mathematical knowledge, a cultural knowledge that allows him to be opened to the knowledge of other areas that not his specific area, and so to acquire knowledge about the world history, the development of sciences and of the society

Consciência corporal e educação física escolar: possibilidades de intervenção

The investigation about the body consciousness in school Physical Education had as main objective reporting a possibility of intervention, linking it directly to the contents of Physical Education and considering it as a crosscutting theme in this research. In this scope, we worked specifically with two contents of Physical Education - knowledge about the body and fights. During the study, we are going to discuss about teaching strategies for the themes of body awareness. To develop this work, we used the following study questions: how is treated the body consciousness in Physical Education and how it has been addressed in educational interventions? What are the difficulties found to the themes of body awareness on different issues of school Physical Education? How body awareness thematized in contents in Physical Education is received by the students and what are the attitudes demonstrated by them during the development of these lessons? Based from questions of study, we used the following methodological tools: participant observation, interviews, photographic records, debates, films, dramatizations and dynamics, which they were performed to stimulate students' critical thinking about their body and the other children s one. The research with ethnographic characteristics was conducted in two schools: one elementary school I, in Natal and one elementary school II, held in the municipality of the João Câmara, in the state of Rio Grande do Norte. We developed a structure in order that the three dimensions of contents conceptual, procedural and attitudinal were experienced by students. The work is structured in five chapters. At first, we made an introduction to justify the motivations that led us to write about body awareness at school. In the second chapter, we discussed reflection about the body and its possibilities of understanding, reflecting on the body and how this awareness was being treated in physical education classes at school. In the third chapter, dealing with the body awareness and dialogue with the Physical Education, we had made a theoretical approach, from authors such as CLARO (1988), NÓBREGA (2000), ARAGÃO (2004), MELO (2006), LORENZETTO and MATTHIESEN (2008) in order to situate the body consciousness and its relationship with physical education. In the fourth chapter, we talked about body awareness thematized in physical education contents: knowledge about the body and fights. We introduced the teaching experience developed in the school and we discussed with authors such as OLIVIER (2000), DARIDO AND RANGEL (2008), among others, about how was the reflection about the body leaving of these experiences. The fifth chapter was intended to closing remarks, in which we concluded that the body awareness, treated in physical education in school by sociocultural and historical aspects, it will contribute in building a man, a body and a society. Although the body consciousness is crafted in a few moments of Physical Education, based on the practices of body awareness or alternatives; in our proposal, we pointed out another perspective to work with body awareness, bringing its elements to permeate and pass through the contents of Physical Education. At work we can see a suggestion for that these experiences are carried out by other Physical Education professionals, obviously adapting the activities according to age and educational level of students

A sistematização do conteúdo jogo nas aulas de educação física do ensino fundamental e médio

Since the enactment of LDBEN 9.9394/96, Physical Education began to be understood as a curricular component in school. Thus, we see the need for systematization of content. We observed that the physical education classes at the public schools in Natal/RN from the game content, teachers did not use the existing proposals for systematization. And it was on this reality that the study occurred, aiming to present and discuss a proposal to systematization the game content in physical education classes in elementary and secondary education. Accordingly, we departed of following question: What possibilities of systematization of the game content in school physical education classes?. The methodology used was the action research, which allowed us to structure the intervention plan for the game content, directed to a reflective didactic process. The dialogue with action research provided an opportunity to understand of the proposal of systematization, the knowledge of game content, the planning and process of teaching and learning in physical education lessons developed. We use the proposed systematization the book Educação Física Escolar e Organização Curricular , to direct and organize the lesson plans. As research technique, we use the participant observation, filming, photographic records and field diary, guiding us in the debates and discussions about the field of research. The applications of the lesson plans were carried out in three schools, all located in Natal / RN: Escola Municipal Professora Ivonete Maciel, Escola Municipal Professor Ulisses de Góis e Professor Escola Estadual Josino Macedo. The members of this study were students PIBID-EF-UFRN, teachers, supervisors and school. They made the bridge between research and action, theoretical foundation and pedagogical practice, university and school. The results were advanced for beyond the propositions submitted by the above-mentioned book. For the Elementary School 1, the proposed systematization broadened experiences and learning of knowledge of the game and of playful and body manifestations. Provided an opportunity to know and learn about game of make account, rules, popular games, cooperative games, among others. For Elementary Schools 2 and Middle education, systematized lessons allowed the practical, the incorporation of knowledge of the game and its features: such as rules, origin, meaning of the name, different denominations, among others. The students experienced and learned, popular games, pre-sport games, cooperative games, with recycled material, among others. The treatment from three dimensions of contents: procedural, conceptual and attitudinal, occurred parallel to approach the game content, and in conjunction with our interventions, not being done separately during practice, but an ongoing process during class. This new perspective of work the game, in a systematized way, with applying, description and discussion the activities, allowed elaborate a summary framework of thematizations for game content, by year of teaching

A banalização da injustiça social no cotidiano de trabalho : a propósito da violência no trabalho e ameaça à saúde do trabalhador

Analyzes the factors that unleash violence by banalization of the problems and health questions of workers in a federal public institution, in Natal/RN. It analyzes transformations in the world of the work, with its politic, social and economic determinatives and its relation to the worker health. Boarding the violence in the work enviroment and its implications to the worker health, focusing on the banalization of problems faced by the workers as a kind of violence in and with the work. It was chosen an analitic methodology with qualitative approach, through the collection tecnic and information analyzes according to the thematic oral history, with recorders of authorized personal narratives, through individual interview with a semi-structured guide. In the analyzis of results it were made empiric cathegories: the daily work enviroment and its influence to the worker profession and life; the violence presents in the work enviroment and its consequences to the worker life and health; the banalization of the social injustice, due to violence against the worker that broked their dreams concerned to the nursing contribution. The results revealed the ordinary work of these workers showing enviromental and organizational unhealthy conditions, caracterized by physical and tecnical insecurity; absence and disqualification of instrumental and human supplies; overload and complexity service; bad distribution of the duties and pressure to the deadline and productivity, producing tension, conflict and anxiety related to the users, colleagues, superiors and to the duties. In the work enviroment, it were identified a external violence, caracterized by physical and verbal aggresion, psychic suffering, worker depreciation; and internal, caracterized by: moral and psychological molestations and accupational structural violence. These kinds of violence bring consequences to the life, that is, professional, economic and moral order of factors and to the health by biological, mental and emocional factors. The banalization of social injustice during the daily work was discussed in the aspects of banalization of problems and work conditions, the health, qualification banalizations and professional valorization. The workers expectatives pointed out to the necessity of: secure conditions of work; trainning and tecnical assistance; politics of attention to the physical, mental and social health to the workers and their family. We conclude the enviromental and organizational conditions of the workers interviewed do not offer physical and tecnical security that they need to the execution of their activities, neither offer comfort or physical and psychological satisfactions. The politic the instituition has used points out to the depreciation and inhumanization of them producing feelings as unsatisfaction, frustation and indignation related to the institution and the work, bringing suffering and physical and mental sicking. We noticed the most terrible violence found in the work enviroment is the banalization of social injustice related do the problems and health of these workers, producing a slowly debility and simbolic death of their lifes. Therefore, it is necessary the implementation of a politic that promotes assurance, health and integral education, valorization and humanization of these workers

A fazenda pública em juízo: a anulação de decisão administrativa definitiva a favorável ao contribuinte

El tema elegido para este estudio la materia disertación sobre la viabilidad de la Tesorería a buscar refugio a la corte anuló la decisión administrativa firme, dictada en lugar del procedimiento administrativo, fiscal, cuando tal decisión no es favorable a la Administración Pública Fiscal, o favorable para el contribuyente . El cálculo de la cuota a pagar se debe a las actividades administrativas relacionadas jurisdicción de la Administración Pública de la finca conocida como la evaluación de impuestos. En este sentido, la puesta en marcha, analizados desde la perspectiva del derecho administrativo, puede calificarse de acto jurídico administrativo. Para la constitución de la puesta en marcha es posible realizar tres pasos: a) un acto en la preparación para el tema de los impuestos - la revisión y evaluación, b) el acto administrativo de la liquidación del impuesto en sí o la aplicación de sanciones administrativas, el procedimiento c) el impuesto administrativo. Realizó la inspección y la investigación se ha iniciado para formalizar el acto administrativo del propio lanzamiento. Después de la puesta en marcha, con el homenaje que se está abierto a los contribuyentes dentro de la composición del tributo rechazo en libertad, que ofrecerá desafío para lanzar. Este paso es iniciar el "procedimiento administrativo tributario." La etapa procesal se caracteriza por ser un procedimiento de investigación o control de la legalidad de los actos administrativos en los que el contribuyente para mostrar su descontento con el lanzamiento de lo ya realizado. La evolución de los actos que lleva a cuestiones de procedimiento de especial importancia para esta tesis es que la decisión final sobre el procedimiento administrativo de impuestos o el control de la legalidad del acto administrativo de la liberación. Idea que se debe tener es que la decisión final es poner fin a fin o destino del impuesto procedimiento administrativo. Aquí están las preguntas de la tesis doctoral, por ejemplo, usted puede cancelar la corte real hacienda de la decisión administrativa dictada por el Consejo Administrativo de Apelación Reder, cuando decisum que conduzca a la privada? ¿Cuáles son los efectos de la decisión final? Con fuerza de cosa juzgada o impedimento administrativo? Se opone a la revisión por el poder judicial? La decisión administrativa es un acto administrativo? Puede ser cancelada o revocada por el Poder Judicial? Dada la divergencia en la doctrina y la jurisprudencia trata de resolver el problema que lo llevan a la solución definitiva al respecto. El autor llega a la conclusión de la imposibilidad, por regla general, y la oportunidad, como excepción a la Tesorería para solicitar la anulación del impuesto de la decisión administrativa final ante el Poder Judicial

Desenvolvimento e avaliação do emprego de dispositivo ajustável ao corpo para treinamento de habilidade de acesso venoso periférico no membro superior

OBJECTIVE: To dev elop and evaluate the use of a body adjustable device for training of peripheral venous catheterization for healthcare undergraduate students . METHODS: This study involved two phases: I) development of the innovative simulator and II) a controlled trial co mparing the performance of the body adjustable device in relation to the commercial simulator for the training of venipuncture skills. A total of 79 first - year medical students participated in the intervention phase, which consisted of pretest assessment, lecture on peripheral venous access, randomization into two groups according to the simulator used for training (Commercial Simulator and Experimental Simulator), real venipuncture procedure, post - test assessment and evaluation of satisfaction. RESULTS: Gr oups were homogeneous in age, sex, pre - test and post - test scores, attitudinal assessment and performance in performing the real venipuncture. Students from the Experimental Simulator group performed better on the filling of simulated records. At the end of the study, cognitive gain significantly increased in both groups. The degree of realism perceived by students was equivalent for two groups. A total of 85.7% of students rated the Experimental Simulator as good or excellent. CONCLUSIONS: Experimental simu lator proved to be a low cost alternative for the training of venipuncture skills in upper limb. The cognitive procedural and attitudinal performances of students who used the experimental simulator were similar to those observed in the group trained with commercial simulator.

A democracia participativa na jurisdição constitucional brasileira: o amicus curiae enquanto mediador democrático no controle concentrado de constitucionalidade no Supremo Tribunal Federal

This master thesis aims to research the tension established between the judicial review and democratic theory which was always present in the constitutional doctrine of separation of powers. In this regard, the expansion of the Brazilian constitutional jurisdiction checked after the occurrence of the Federal Constitution of 1988 and the inertia of the Legislature in disciplinary relevant legal aspects of Brazilian society contributed to a hyperactivity of the Supreme Court. However, in a complex society of context, as is the Brazilian society, there are contained demands and political controversies that hardly would be well represented or resolved through the action of the Court of ministers at the expense of other government bodies. Among the supremacy of Parliament and the legitimacy deficit of these magistrates, is the constitutional text and the social fabric that makes this legal status of the political. Participatory democracy established by the guidelines of the Federal Constitution requires this perspective when the Supreme Court acting in place of concentrated constitutionality control. In a plural society, there is no reason to get rid of state decision moments popular participation. Lack the Supreme Court, this time, the democratizing perception that the institute brings to the interior of the Court, as state determination of space in which to come together and meet the aspirations of society and state claims. The dissertation investigates thus the possibility of amicus curiae Institute serve as a mediator of the democratic debate, to assist the Supreme Court in the preparation of the decision is, historically, that which is of greater legitimacy, from the perspective of a theory participatory democracy. Analyzes, likewise, the unfolding of abstract judicial review in the context of Brazilian law. Proposes, incidentally, a rereading of the separation of powers, with the call for the Judiciary be careful not to become the protagonist of national political decisions. It maintains, finally, that procedural opening the interpreters of the constitution, through the amicus curiae Institute, shows up as able to decrease the legitimacy deficit in the performance of the Brazilian Supreme Court.