Use of public oral health services by the adult population: a multilevel analysis

Background It is important to assess context to explain inequalities in oral health, particularly with regard to the type of service used; thus, this study aimed to identify the social determinants of public dental service use by adults and to assess whether, beyond the level individual, existing inequalities are also expressed in the context in which individuals are embedded. Methods A multilevel analysis with three levels of aggregation of variables was performed. The individual variables were derived from the database of the SB Minas Gerais project—a survey of oral health status of the population of Minas Gerais, a state of the Brazilian Southeast region. The variable at the neighborhood level came from the Census of 2010. The variables at the municipal level were obtained from available public databases relating to oral health services. At the municipal level, the Human Development Index (HDI) variable was chosen to represent quality of life in the municipalities. Results In the final model, the following individual variables were associated with greater use of public dental services: lower income (PR = 1.98, 95% CI = 1.53; 2.58), higher number of residents at home (PR = 1.37, 95% CI = 1.11; 1.68) and higher number of teeth requiring treatment (PR = 1.49, 95% CI = 1.20; 1.84). With regard to context variables, a poorer infrastructure (PR = 0.62, 95% CI = 0.40; 0.96) leads to a lower use of public services. Conclusion The use of public services is associated with family income, how this income is divided in households, the need for treatment presented by the individual and the organization of the existing oral health service infrastructure in the municipality.

Fatores de longevidade do programa Central do Cidadão no Rio Grande do Norte

The public management reform in Brazil, since 1995, provoked new experiences in public administration. Among the new models of public service the one-stop shopping has distinguished and was adopted at Rio Grande do Norte with the Citizens Center Program. The one-stop shopping assembles in the same place many public services with appropriate structure, enabled human resources and citizens focus processes. The goal of this research was understand how citizens focus processes help to explain Citizens Center Program s longevity. It was made a case study and the research tools were applied with Citizen Center Programs workers and citizen-users at South Unit of Citizen Center Program placed at Via Direta Mall, Natal. The major contributions for Citizen Center Program s longevity were imputed to Basic Operation Processes. The most spoken features in Citizen Center Program mentioned were quality, efficiency, celerity e personal appearance, what demonstrate concern and care with citizen-users. Worker s personal appearance, accommodation, celerity, politeness and attending capacity planning were high evaluated by citizen-users revealing the wisely choice of use a large quality concept and citizenship concept in public administration. Citizen-users also pointed the necessity of refine and enlarge the communication ways that form an essential mechanism to public citizen focus administration. Not ignoring the policy aspect citizen focus processes were noticed like especial management actions that make easier citizen s activities and public service access, what generate satisfaction to citizen-users. It s possible to conclude that the high level approving evaluation of Citizen Center Program consolidates it an especial public policy that serves citizen s necessities e create appropriate legitimacy conditions of the public policy making harder the choice of ending the policy even in more fragile moments strongly contributing for its longevity

Intervenções urbanas em espaços de desvalia. Transformar para valorizar.

The worldwide transformations that took place in the 20th century redefined the cities fate in this new century. The consolidation of urbanization, the technological revolution that fostered globalization, the economic restructuration and informalization, modified space and time concepts, bringing populations closer together and provoking political transformations. They made contemporaries cities protagonists of world events and as a consequence of such processes, worthlessness spaces appeared and cities all over the world started to bet on the strategy of acting in this problematic areas through initiatives aimed at promoting intentional transformations to obtain a multidimensional valorization urban, financial, environmental, cultural and social. In short, such urban initiatives intend to make cities more competitive, sustainable, creative, productive and fair. Also in Brazil, countless worthless spaces appeared in waterfronts, central areas, and deactivated industrial/urbanized areas, as well as in sub-used or misused areas lacking infrastructure and public services where it is imperative and urgent to perform urban initiatives. This research proposes as a thesis that urban initiatives, when carried out based on an adequate politicalinstitutional model, transform and give value to worthless spaces in their multiple dimensions, offering better quality of life to their residents and helping to fulfill the social role of the city. We intend to prove this thesis through the analysis of national and international cases and by introducing thoughts, critique and guidelines as a contribution to the improvement of the urban initiatives implementation processes, in particular to those regarding worthless areas of Brazilian cities

Acesso aos serviços odontológicos e incidência de cárie em adolescentes e fatores de risco em município do Nordeste Brasileiro, 2006

The aims of this study were to analyze the access of dental services by child population, to determine the prevalence of dental caries, gingivitis and malocclusion in resident children from the municipal district of Sobral Ceará and to evaluate the incidence of the dental decay in adolescents associated with the factors related to socioeconomic condition, access to health services and self-perception. This study had as main factor the multidisciplinary represented by the participation of health professional (doctors, dentists, nurses) in the development of the survey's initial reference; student from Human Sciences area to apply the structured questionnaire in domiciliary visits; statistics professionals in the orientation of the analysis to be held and family health team (community health agents, dentists and dental clinic assistants) in the scheduling of domiciliary visits and the accomplishment of oral exam. The sample was determined from the domicile record that included children born between 1990 and 1994 to develop the research Children health conditions in the municipal district of Sobral Ceará . The first sample comprised 3425 parents of children from 5 to 9 years old, living in the urban area at the municipal district of Sobral Ceará, aiming at identifying the most important factors associated to the access to dental service. From this sample, 1021 children were selected in a systematic way, for the accomplishment to the epidemiological study of decay, gingivitis and malocclusion. In the study's third phase, in order to arrange the group to be followed, 688 adolescents were examined and interviewed, by means of the active search from the 1021 individuals that had been previously examined. It was observed that 50.9% of the children had access to dental service at least once in a lifetime. Of this total, 65.3% accomplished it during the last year, and 85.4% of these did in public services, what allows to identify the importance of this sector in the access to dental services. It was observed that the factors that most affected the access to dental 129 services were related to socioeconomic condition, such as the access to health plan, the possession of toothbrush, garbage collecting, mother s schooling, sewerage treatment and malnutrition. In relation to oral diseases, an increase in the DMF-T index according the age was observed, from 0.10 in five years old to 1.66 in the nine years old, while with the dmf-t index, the inverse happened, since the index decreased from 3.59 in five years old to 2.69 in nine years old. In relation to gingivitis, an average 32.7% of the children presented gum bleeding. In what concerns malocclusion, it was observed that 60.3% of the children didn't present any problem, 30.17% had light malocclusion and 9.5% severe malocclusion. The average incidence of dental caries was 1.86 teeth per youngster. Among the studied variables, tooth pain in the last six months, mother's income and school snack, adjusted by the perception about the need of treatment, the mother's schooling and the dentist's appointment at least once in a lifetime, were the variables that presented positive relationship with the high incidence of dental caries on this population by logistic regression. Variables of socioeconomic nature, related to the access to health services and behavior and biological variables presented a relationship with the high caries incidence. The study point out to the need of developing health actions in a humanized way, by an oral health team effectively bound to the population's interest, with the great objective to provide, with the public health services managers, adequate conditions to improve oral health

Avaliação de efetividade do centro de reabilitação de adultos - CRA/NATAL/RN

Public services with an emphasis on rehabilitation treatment of disabled people, as established law, have aimed to ensure quality and equity assistance in a rehabilitation way to the segment highlighted. As for people with physical disabilities, the Unified Health System (hereby SUS) through the directive GM/ MS No. 818 of 2001, requires the creation of hierarchical and regionalized services networks at different levels of complexity to ensure appropriate assistance. This study whose title is Evaluation of effectiveness of the Adult Rehabilitation Center in Rn: elements for a discussion aimed to evaluate the effectiveness of rehabilitation services that institution, reference in the State of Rio Grande do Norte, has directed its patients, more specifically those who have had a stroke and therefore are disabled ones. From the standpoint of methodological conduction, it was prioritized a qualitative and empirical theoretical research which was carried out from the following courses: literature references with authors who are the themes pertaining to rehabilitation, inclusion, public policy evaluation, health policy and disability; documentary research through Regulation of Technical Procedures, files, records, informative booklets that were of great importance to the knowledge of the institution, as well as its functioning and dynamics of field research that was materialized with the managers, rehabilitation staff and Center s users, through the application of semi-structured interviews as a tool for data collection. The information obtained was analyzed from the critical analysis of discourse. As a result, it was identified some technical, administrative and financial difficulties which have obliterated the effectiveness of services provided, such as: lack of many professionals to meet existing demand, poor quality of equipment and the physical structure, limits on autonomy management as a result of dependence along with the SESAP/RN; besides the excessive bureaucratization in the administrative processes compromising Center s problem-solving needs. However, in the narratives of managers, rehabilitation staff of patients, despite the difficulties, treatment made by Centre has effectiveness to the extent that has been contributing even in a limited way to improve their quality of life

A Eficácia dos direitos fundamentais nos contratos civis e de consumo: uma teoria contratual baseada na colisão dos direitos ou bens constitucionalmente protegidos

The apparent virtuosity that if could wait of the globalization and the neoliberalism has given signals of deterioration in the contractual relations, especially in contracts of mass consumption, generating innumerable offensive situations to the basic rights and the goods constitutionally protected of the contractors. In the world of today, still that it does not reveal any desire, the individual practically is compelled to contract, for force of necessities and customs completely imposed, mainly in face of the essentiality of the services or agreed to goods. Ahead of as much and unexpected changes in the civil liames and of consumption, dictated for the globalization, it comes to surface the reflection if the private law e, more specifically, the civil law, meet prepared adequately to deal with these new parameters of the economy. The present dissertation has the intention to investigate if the globalization and the consequent neoliberalism, in this beginning of third millennium, will imply to revive of the principles and the basics paradigms of the contracts that consolidated and had kept, for more than two centuries, the liberal State. One notices that the study of this phenomenon it gains importance to the measure where if it aggravates the decline of the social State (Welfare State), with the embrittlement and the loss of the autonomy of the state authority, over all in countries of delayed modernity, as it is the case of Brazil, that presents deep deficiencies to give or to promote, with a minimum of quality and efficiency, essential considered public services to the collective and that if they find consecrated in the Federal Constitution, as basic rights or as goods constitutionally protecting, the example of the health, the education, the housing, the security, the providence, the insurance, the protection the maternity, the infancy and of aged and deficient. To the end, the incidence of constant basic rights of the man in the Constitution is concluded that, in the process of interpretation of the right contractual conflicts that have as object rights or goods constitutionally proteges, in the universe of the globalized perhaps economy and of the neoliberalismo, it consists in one of the few ways - unless the only one - that still they remain to over all deal with more adequately the contractual relations, exactly that if considers the presence of clauses generalities in the scope of the legislation infraconstitutional civil and of consumption, front the private detainers of social-economic power. To be able that it matters necessarily in disequilibrium between the parts, whose realignment depends on the effect and the graduation that if it intends to confer to the basic right in game in the private relation. The Constitution, when allowing the entailing of the basic rights in the privates relations, would be assuming contours of a statute basic of all the collective, giving protection to the man against the power, if public or independently private

O direito social fundamental de acesso à energia elétrica e a atuação estatal

Electrical energy today is an essential element in the life of any human being. Through the access to electrical energy it is possible to enjoy dignified conditions of life, having in mind the possibility of making use of minimal material conditions of life. The lack of access to electricity is directly linked to poverty and degrading conditions of life, in which are some communities in Brazil, especially the more isolated from urban centers. Access to the electric service is a determining factor for the preservation of human dignity, constitutional principle inscribe in the art.1 of the Federal Constitution, and the promotion of development, being a right of everyone and a duty of the State to promote universal access. For that reason, focuses mainly on the analysis of their setting as a fundamental social right and its importance for national development. For this, the theoretical and descriptive method was used, with normative and literary analysis, in particular the Constitution of 1988. This study also discusses the form of action of the State in the energy sector, to give effect to the fundamental social right of access to electricity, the characteristics of public service and the principles that guide it, in addition to the role of public policies in universalization of access, in particular the analysis of the Program Luz para Todos, and the function of regulation in the implementation of these policies and the provision of adequate public services.

A Servidão Administrativa e o Estado Regulador: Compatibilidade com o Princípio Constitucional da Legalidade e a Limitação ao Direito Real de Propriedade

The economic changes occurred in the 90s, with the restructuring and privatization of various sectors of the economy have led to a redefinition of the State role, assuming a position of regulator and supervisor of public services in place to direct its role as straight intervenor. It is through the regulatory agencies, autarchies with special legal personality under public law, that the Regulator State will act. In this context, the first objective of this research is to analyze the legality of easements imposed by entities of the Direct Administration and Regulatory Agencies, whose execution is delegated to legal persons of private law, being those public service companies or mixed-economy societies. This examination in question the limits of servitude as a restrictive institute of property rights, observing the principles of function, supremacy of the public interests over the private ones, legality and the separation of powers. Defend the property rights like a fundamental right and your insurance as determining factor of economic development and social justice. Use the procedure in use will be the historiccomparative procedure, in order to demonstrate the legality of the public act as a maximum attempt to preserve the balance between the expansion of public services in various sectors of the economy, and the preservation of property rights, through regulation

As relações de poder na gestão da Escola Estadual Presidente Kennedy em Natal/RN: as ações decisórias dos órgãos colegiados - o conselho de escola e o caixa escolar

The present study examined the relations of power in the management of the Escola Estadual Presidente Kennedy, including the deliberate decisions on the School Council and School Fund, which guided the organization of the school. We sought to understand the management models that influenced the school organization, promoting contradictions in the decision making process. The school management is intensely marked by management models from the business logics as in the case of managerialism of bureaucracy. The formulation of educational policies based on managerialism has proposed a school-centered management with intense accountability of the school community in planning and monitoring the public services. The influences of these models subsidize hierarchical power relations that undermine the actions of decision-making of the collegiate bodies for the democratization of school management. To develop a research on the power, the investigation was based on studies of Bourdieu and Foucault. These authors understand the power in a relational system in a double sense, both in terms of discipline and the possibility of resistance. A theoreticalmethodological matrix was developed focusing on literature review, document analysis, structured interviews with twelve representatives of the segments belonging to the School Council and School Fund, as well as observations in meetings with the production of field notes. It was found that power relations experienced in the organization and activities of the school boards are marked by changes in public management over the years, promoting the contradictions between the concepts of corporate management originated in the business logics and the perspective of democratic management subsidized by official legislative documents at the national and state levels. The observations in meetings and analysis of the records showed that representatives related to management (president and manager of the school) have a privileged position with regard to exposure of their propositions, and are more likely to take a position in the political game of the collegiate bodies of work. It was also seen that the irregularity of meetings, particularly of the School Fund meetings, limits the experience of operation of the representatives in discussions concerning the planning and monitoring the actions of school management. Reports from representatives of the School Council showed that certain segments related to the management recognize their power of decision, however others have little interfere in the decision-making process in order to expound the desires of those who are represented by them. In the School Fund, the analysis of the records and interviews showed restricted moments of the meeting of representatives, and these only being aimed at choice or approval of the implementation plan prepared by the school management. The results showed no indications of moments of reflection to study the best chance for applicability of resources. This collegiate body (School Fund) has a questionable action when planning and monitoring the applicability of the financial resources of the School. To sum up, it was found that the Escola Estadual Presidente Kennedy still lives hierarchical power relations that undermine the institutionalization of democratic management in the various representative segments may take place in the game of political decision-making processes necessary for the organization of the school

Cargos comissionados da administração pública direta do Rio Grande do Norte: análise comparativa entre o perfil profissional dos cargos comissionados com vínculo funcional e sem vínculo funcional

The professional profile of public administrators in Brazil is changing very rapidly in recent years, seeking to meet the principle of efficiency by public agencies at all levels. The admission of the permanent government employee under the Public Administration is by competition, however, commissioned positions are free appointment of managers, which allows effective participation of external experts according to their respective standards and norms. In this context, this dissertation seeks to understand the main characteristics of the profile of the occupants of commissioned positions in Direct Public Administration of the State of Rio Grande do Norte, noting the differences between those with functional link with the have nots. For this study, by data collection and content analysis, a mapping of the administrative structure of the Government of the State of Rio Grande do Norte was done, i.e., the organization of the Executive Branch, which is regulated by the Complementary Law no. 163/1999 and its amendments, which consists of 53 (fifty three) entities, these 29 (twenty nine) are agencies of the direct administration and the remaining 24 (twenty four) comprises the indirect administration. With the collected data, analysis on the number of commissioned positions of each organ of the State of Rio Grande do Norte and information on education, age, length of service, gender and functional link with the direct administration was carried out. Data were available from SEARH in June/2013, when they totaled 58,733 (fifty-eight thousand seven hundred thirty-three) servers, these 2.15% (two point fifteen percent) occupy commissioned positions, corresponding to 1,262 commissioned positions under the Direct Administration, below the national average of 4% (four percent). Of total commissioned positions 64.7% (sixty-four point seven percent) have no functional link with the direct administration, while only 35.3% (thirty -five point three percent) have functional link. It was noticed that there are no clear and specific criteria for the appointments of commissioned positions in the State. They occur freely, as provided in the State Constitution. Another conclusion is the importance of Public Administration define and improve their capacity, competence and efficiency in the delivery of public services. For that it is necessary to invest in their workforce composed of permanent employees and commissioned positions to define the appropriate professional profile

Maternidade na adolescência: significados e repercussões

From evidence of an existing divergence of opinion among professionals and adolescents using the prenatal and delivery services at a Public Health Unit, aimed to study meanings and consequences of adolescent motherhood among 26 adolescent mothers living in Felipe Camarão, low income district of Natal, capital do Estado do Rio Grande do Norte. Living in a peripheral neighbourhood with a high rate of adolescent mothers in relation to the total new-born, those girls, with offspring among 8 and 12 months age, during interview and focus groups, expressed a different appreciation of their experience than the hegemonic idea among professionals that considers pregnancy and motherhood as unwanted or undesired. With age among 15 and 20 years old, having 53,8% initiated sexual activity before being 15 years old, revealed that the pregnancy was desired in 73,1% of cases, but showing at the same time a social context marked by strong gender oppression and lack of opportunities as consequence of social class deprivation. Life projects, almost always limited to the constitution of a traditional nuclear family, with a purveyor father and care giver mother, appears with very limited possibilities: 46,2% already lived with her partner before becoming pregnant and for 50% of the participants, the birth of the child did not provoke changes in plans and projects. Lack of economical recourses and precarious public services available, together with an idealized maternity role seems to produce extra apprehension among those girls, resulting in frustration and disillusion. As a fact, 92,3% of those adolescents would recommend other adolescent to postpone the maternity project

Gestão pública em saúde mental: um estudo em CAPS com gerência pública e privada do Rio Grande Do Norte

Currently, several models of management services from the public administration are in operation in Brazil following a global trend. Besides the traditional public management operated in SUS, there are ongoing experiments of privately management in the public health services. Accordingly, we have developed an investigation into two Psychosocial Care Centers operating between these two forms of financial resources management: the first is the CAPS II - PAR situated in the municipality of Parnamirim whose form is private and the second is the CAPS II West Christmas is that the municipal government. We seek to know the workings of services, planning forms and criteria for use of financial resources, identify differences between departments on ways to run and see how technicians and users participate in the planning and management of these resources. Documentary Research was conducted by the municipal Christmas and the financial administration of the CAPS service in Parnamirim. Were conducted an interview with manager (mental health coordinator of Natal) and another interview with an employee of planning department in the Health Department of Natal, an interview with the coordinator and financial administrator of CAPS - PAR and two groups of discussion taped conversation with semi structured script interviews with six technicians in CAPS PAR and six professionals crowded in CAPS - West.Differences were observed in the management of resources funded from four blocks of discussion and analysis of results, where the privately-run service for the direct management and bureaucracy without being discussed and planned spending on staff, as well as through meetings with users, the use of the financial resources available in box; already in service with municipal public administration there is a hierarchy, this answering the coordination of mental health and the local health department that centralizes resources and defines their spending. There are meetings with patients and families, but the demands are limited as to what can be sued because of the manager s authorization. Such differentiation would be related to differences in the articulation of public management with the different types of possible management in public services, where from the implementation of new public administration in the Brazilian s State Management Reform initiated in the second half of the 1990s, benefit management services with private regime, with autonomy and direct transfer of resources

Programa Liberdade assistida em Natal/RN: adolescentes em conflito com a lei e a violação de direitos

This work shows the results of the research: Attended Liberty Program Adolescents in Conflict with the Law and the Disapproval of Rights, effected in the community of Natal, Rio Grande do Norte, in period of august 2007 to September 2008. It aims to analyze the social-educative attendance directed to adolescents in conflict with the law through the state, since the Social-educative Measure Attended Liberty, known, as an idoneous way of confrontation to the practice of infraction acts imputed to the adolescent, that needs to give emphasis, in disadvantage of the Social-educative Measurement of Internment, to be proposed (ECA, art 118 and 199) to follow the adolescent in this quotidian, close to his family and community, proposing him through social-educative work, the access to education and occupancy, as well other public services, that help him to surpass the context of privation and disapproval of rights in which lives joined to his family. In our study, it was observed in sequence of approaching, subsidized for theoretical-methodological procedures justified in quantity and quality research, that were privileged to the documental research, the observation and the interview almost structured, besides a theoretical basis about the subject, that the relation of category and inequality in which the capitalist society sustains itself, does the practice of infraction acts imputed to the adolescent, acquires a classist character, in which the property of the money defines the access of the justice. And more, many of the poor adolescents that get into conflict with the law, dweller of the periphery districts of Natal/RN, becomes evident as for segment that has been attended in the Jurisdiction of the Infancy and Youth and in the LAN of Social-educative Attendance, becoming individual the infraction act and its confrontation. We hope in this work, to contribute for the care of the reality of the adolescent in conflict with the law in the Attended Liberty Program, without pretension to exhaust it, as well as later studies about the theme

Imunidade recíproca e livre concorrência: considerações acerca de sua fruição por empresas estatais

This study begins with a brief overview of tax immu nities in general, dealing with the concept, legal, doctrinal ratings and limits. Then enters into the reciprocal immunity, since its birth in the United States, its justifica tions, until her current developments in the Brazilian Supreme Court, which has expanded it quite considerably. That Court has extended to state owned enterprises, even if pa id by public prices or rates, or if acts somewhat away from its essential functions, es pecially if they are public services provider. Given this linkage, these are also treate d in own topic, grounded in newer doctrinal proposals and less attached to historical formalisms (see such Supremacy of Public Interest over Private one). Public services are approached in its diversity, oblivious to traditional monolithic nature and accu stomed to the modern doctrine of fundamental human rights. It deals also the princip les of free enterprise and free competition, given that the public service provider s have lived intensely in this environment, be they public or private agents. In d ialectical topic, these institutes are placed in joint discussion, all in an attempt to in vestigate their interactions and propose criteria less generic and removed from real ity, to assess the legitimacy of the mutual enjoyment of immunity by certain agents. Sev eral cases of the Court are analyzed individually, checking in each one the app lication of the proposed criteria, such logical-deductive activity and theory of pract ice approach. At the end, the conclusions refer to a reciprocal immunity less rhe torical and ideological and more pragmatic and consequentialist. It is proposed the end to the general rules or abstract formulas of subsumption, with concerns on the one h and the actual maintenance of the federal pact, and on the other by a solid econo mic order without inapt advantages to certain players, which flatly contradicts the co nstitutional premises.

O princípio da eficiência administrativa na regulação da prestação do serviço de voz sobre internet - VoIP

The present work aims to demonstrate the link of the principle of efficiency - as expressed in the Constitution of 1988, by Constitutional Amendment No. 19 - with regulatory agencies, more specifically the ANATEL (National Telecommunications Agency). It also includes this principle’s importance to regulation - to monitor and manage public services - as well as when an activity will be considered efficient, keeping in mind that agencies are subjected to other principles of public administration. The increasing use of telephony has enabled further development of technologies that provide improvements in the provision of this service. The VoIP (Voice over IP), is nothing more than a technological breakthrough that directly targets the providers of conventional telephone service, both by modifying the business working for a long time with the same technology as the amount of new competitors’ dispute on market share. It also analyses the difficulty of understanding and definition of what is VoIP telephony, its growth and the threats that the traditional and mostly which is ANATEL’s role concerning this telephony technology. As regulator of the telecommunications service, ANATEL not yet regulated the voice telephony service using the IP protocol. What looks over the years is that ANATEL exercise its regulatory function to provide better conditions for competition among providers of VoIP and traditional telephone companies, obviously some difficulties are expected, given that VoIP is a technology that provides two services, through conventional telephony and using the internet.