A organização da demanda em serviços públicos de saúde bucal: universalidade, eqüidade e integralidade em saúde bucal coletiva

RONCALLI, Angelo Giuseppe. A organização da demanda em serviços públicos de saúde bucal: universalidade, eqüidade e integralidade em Saúde Bucal Coletiva. raçatuba, 2000. 238p. Tese (Doutorado em Odontologia Preventiva e Social). Faculdade de Odontologia, Universidade Estadual Paulista “Júlio de Mesquita Filho”

Metodologias de serviços públicos de ater: estudo em instituições do Rio Grande do Norte

Due to the appreciation of family farming by the Brazilian Federal Government, the Technical Assistance and Rural Extension was induced to restructure and act in a more participative way, culminating in the National Policy of Technical Assistance and Rural Extension (PNATER), changing the profile of technology transfer and knowledge (diffusionism) for an action that uses participatory methodologies focused on exchange of knowledge between farmers and technicians. The process of discussion of the trends of ATER brought the New ATER , with the recognition of agroecology as the main guidance. This research aimed to analyze methods of public ATER developed by institutions of Rio Grande do Norte, under the guidance of New ATER. The research is qualitative. Secondary data were collected through documental research and literature. Primary data were collected through a set of interviews applied to representatives of public institutions ATER, namely EMATER-RN, Diaconia and AACC and representatives of organizations that receive public ATER. The research showed the difficulties of EMATER-RN in implementing of New ATER due to lack of infrastructure and low adherence of the new form of technical assistance and rural extension. It was shown also that the AACC and Diaconia act with ATER through projects with implementation deadlines set, often interrupting ATER while communities are still in need of assistance

A produção do cuidado no período gravídico-puerperal: experiência de mulheres usuárias de serviços públicos de saúde

Despite numerous government projects aimed at reorganizing and qualifying obstetric and neonatal care in Brazil, it remains problematic, with repercussions for maternal and newborn mortality and humanized care of both the mother and child. The objective of this study was to analyze the care provided to women during the pregnancy-puerperium cycle, based on reports of public health service users regarding their pregnancy and delivery experiences, using comprehensiveness and humanization as reference. The study applied a qualitative approach and the methodological strategy consisted of listening to the women, in order to identify, based on the meanings of their discourse concerning their experiences with health services, continuities and discontinuities of care during the pregnancy-puerperium cycle. Study participants were women who gave birth at a municipal public maternity, residents of Natal, Brazil, who at the time of the interviews, were between 10 and 42 days postpartum. Seven women reported their pregnancy and delivery experiences at public services. As interviews and observation took place, the material produced was also analyzed, in order to achieve simultaneous production and data analysis. Using systematization, a dialogue was established between the women’s discourses and production in the field of Collective Health, with respect to concepts and discussion about obstetric and neonatal care as well as the Comprehensiveness and Humanization of such care. Participant discourses underscored aspects related to prenatal care starting at pregnancy and its repercussions as well as prenatal monitoring by health services; aspects associated with care during labor and delivery, as well as those involved in postpartum in the maternity, both with respect to newborn and maternal careç and lastly, puerperium care after discharge from the maternity. Analysis of results sought to identify lines of continuity and discontinuity in the comprehensiveness and humanization of care. Based on these lines and as final contributions of the study, the following paths were proposed to achieve comprehensive and humanized production of health care for women during the pregnancy-puerperium cycle: Path 1- Reassess care in the maternal and newborn health network, aimed at comprehensiveness in terms of guaranteeing access to the various services and technological resources available to enhance health and life. Path 2- Reorganize work processes in order to attain comprehensive and humanized care for women in the pregnancy-puerperium cycle. Path 3 – Qualify the professional-user relationship in care management during the pregnancy-puerperium cycle. Path 4 – Invest in the qualification of communication processes in the different dimensions of care during the pregnancy-puerperium cycle.

A produção do cuidado no período gravídico-puerperal: experiência de mulheres usuárias de serviços públicos de saúde

Despite numerous government projects aimed at reorganizing and qualifying obstetric and neonatal care in Brazil, it remains problematic, with repercussions for maternal and newborn mortality and humanized care of both the mother and child. The objective of this study was to analyze the care provided to women during the pregnancy-puerperium cycle, based on reports of public health service users regarding their pregnancy and delivery experiences, using comprehensiveness and humanization as reference. The study applied a qualitative approach and the methodological strategy consisted of listening to the women, in order to identify, based on the meanings of their discourse concerning their experiences with health services, continuities and discontinuities of care during the pregnancy-puerperium cycle. Study participants were women who gave birth at a municipal public maternity, residents of Natal, Brazil, who at the time of the interviews, were between 10 and 42 days postpartum. Seven women reported their pregnancy and delivery experiences at public services. As interviews and observation took place, the material produced was also analyzed, in order to achieve simultaneous production and data analysis. Using systematization, a dialogue was established between the women’s discourses and production in the field of Collective Health, with respect to concepts and discussion about obstetric and neonatal care as well as the Comprehensiveness and Humanization of such care. Participant discourses underscored aspects related to prenatal care starting at pregnancy and its repercussions as well as prenatal monitoring by health services; aspects associated with care during labor and delivery, as well as those involved in postpartum in the maternity, both with respect to newborn and maternal careç and lastly, puerperium care after discharge from the maternity. Analysis of results sought to identify lines of continuity and discontinuity in the comprehensiveness and humanization of care. Based on these lines and as final contributions of the study, the following paths were proposed to achieve comprehensive and humanized production of health care for women during the pregnancy-puerperium cycle: Path 1- Reassess care in the maternal and newborn health network, aimed at comprehensiveness in terms of guaranteeing access to the various services and technological resources available to enhance health and life. Path 2- Reorganize work processes in order to attain comprehensive and humanized care for women in the pregnancy-puerperium cycle. Path 3 – Qualify the professional-user relationship in care management during the pregnancy-puerperium cycle. Path 4 – Invest in the qualification of communication processes in the different dimensions of care during the pregnancy-puerperium cycle.

A responsabilidade civil extracontratual do estado na prestação de serviços públicos de saúde

This study aims to examine the Brazilian legal model for the non-contractual liability of the state in providing public health services, from the perspective of threedimensional theory of law. Up based on bibliographical and documentary research, with emphasis on legislation, doctrine and Brazilian jurisprudence, the following conclusions were reached. The right to health is typified in the Constitution as a social fundamental right, and understands the pretension to obtain from the State, the supply of goods or the provision of services that reduce the risk of disease and other health problems; or promote, protect and recover the physical and mental well-being. Once violated the fundamental right to health, provides the managed, among other fundamental guarantees, the non-contractual liability of the state. The provision of public services by the state can be made directly through the Direct or Indirect Public Administration, or by recourse to private entities. In any case, the provision of public health services is entirely subordinate to the principles of administrative law and should be fully funded by tax revenues. As the provision of public health services is part of the administrative activity of the State, there is no way to exclude the application of the guarantee of non-contractual liability of the state in the face of the damage suffered by administered as users of these services. Therefore, it applies the theory of administrative risk, even in the event of harmful and illegal state failure.

A organização da demanda em serviços públicos de saúde bucal: universalidade, eqüidade e integralidade em saúde bucal coletiva

RONCALLI, Angelo Giuseppe. A organização da demanda em serviços públicos de saúde bucal: universalidade, eqüidade e integralidade em Saúde Bucal Coletiva. raçatuba, 2000. 238p. Tese (Doutorado em Odontologia Preventiva e Social). Faculdade de Odontologia, Universidade Estadual Paulista “Júlio de Mesquita Filho”

Metodologias de serviços públicos de ATER: estudo em instituições do Rio Grande do Norte

Due to the appreciation of family farming by the Brazilian Federal Government, the Technical Assistance and Rural Extension was induced to restructure and act in a more participative way, culminating in the National Policy of Technical Assistance and Rural Extension (PNATER), changing the profile of technology transfer and knowledge (diffusionism) for an action that uses participatory methodologies focused on exchange of knowledge between farmers and technicians. The process of discussion of the trends of ATER brought the New ATER , with the recognition of agroecology as the main guidance. This research aimed to analyze methods of public ATER developed by institutions of Rio Grande do Norte, under the guidance of New ATER. The research is qualitative. Secondary data were collected through documental research and literature. Primary data were collected through a set of interviews applied to representatives of public institutions ATER, namely EMATER-RN, Diaconia and AACC and representatives of organizations that receive public ATER. The research showed the difficulties of EMATER-RN in implementing of New ATER due to lack of infrastructure and low adherence of the new form of technical assistance and rural extension. It was shown also that the AACC and Diaconia act with ATER through projects with implementation deadlines set, often interrupting ATER while communities are still in need of assistance

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

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

PROEJA FIC/Fundamental no IFRN-Campus Mossoró: das intenções declaradas ao funcionamento de um curso em espaço prisional

This research aims to analyze the FIC Course of Assistant Technician in Service Management and Quality, integrated to elementary education / EJA form developed by IFRN MO Campus between 2011 and 2013 in the form of a PROEJA FIC / AT ELEMENTARY SCHOOL LEVEL. We seek to understand the adhesion between the national guidelines postulated for the Program, established in PPC and mediations with the process conceived in the run of the course. Guiding by the socio-critical approach and the dialogical paradigm, the theoretical-epistemological mark is especially buoyed by the theoretical contributions of Ciavatta (2005) , Rock (2011) , Haddad and Di Pierro (2000), Freire (2005), Marx (1982), Ramos (2005), Frigotto; Ciavatta; Ramos (2005), Moura (2012), and also on education in prisons by Onofre (2007, 2011), Bueno (2007), Julião (2011) and Foucault (2001). We assume that an action that enables professional qualification as FIC courses articulated to the EJA in the context of education in prisons have conceptual, methodological, political and pedagogical implications for it focuses challenges, weaknesses and opportunities on the same area of education., We have developed four techniques of data collection based on procedures and tools of qualitative research, such as document analysis, a student survey, the conduction of focus groups with teachers and administrators of the course and on-site observation. Mediated by the investigated context, results showed that the consolidation of PROEJA FIC / AT ELEMENTARY SCHOOL LEVEL goes beyond the intentions officially declared. It is inferred that after seven years of its creation, even though it keeps some potential, this program is not being satisfactorily developed and it shows weaknesses national and locally, it is set at low capillarity, it has a limited scope, and dissolved essential public commitments to the course development. The effectiveness of PROEJA FIC / AT ELEMENTARY SCHOOL LEVEL as part of an emancipatory inclusion social policy, according to official statement, entails approximating the legal logic with social logic, so as not only to propagate discourses and enforce worship to specific and successful experiences that reach only a minority, but to provide actual and necessary conditions to promote the breadth and social quality of the offered deals in this program format

Lazer e urbanização: a dinâmica do setor de serviços no litoral de Parnamirim e Nísia Floresta - RN

The research here undertaken analyzes the process of urbanization on the coast of Panamirim - RN and Nísia Floresta - RN, arising from leisure, the main leisure expression was considered the second residence and coastal tourism. The leisure promoted the growth of businesses and public and private services to meet consumer demand in that area, which initially occurred with users of second home, and which also gradually begin to occupy the coastline of these municipalities in 1980 and more recently with the development of tourism in the 1990s until now. To undertake such an analysis, we did the georeferencing about the trade and also public and private services of that coast, characterizing them; evaluated the extent to which services deployed in this area meets the demands of tourists and users of second residence; it was also identified how the centrality of Natal interferes in the expansion of services in these locations. The spatial area of research includes the coastal municipalities of Parnamirim and Nísia Floresta, considering the limits of the census of the Instituto Brasileiro de Geografia e Estatística- IBGE, and about the time frame, it was considered the 1990s to the present day. The methodology consists of: 1. survey and reading of the literature related to the researched topic, serving as the theoretical analysis in the construction of the object studied; 2. collection and organization of secondary data by the IBGE and tourism sectors of the State of Rio Grande do Norte, Natal and main municipalities of the research; 3. Questionnaires and / or interviews with the traders, service providers, tourists, users of second homes, local residents, and government. The analysis of such data collected allowed the preparation of graphs, maps and tables that illustrate the results obtained in the research field, basing so the study. The relevance of the study is shown by the extensive survey data involving agents of the research, including tourists, users of second homes and, above all, the data for the service sector that did not exist in the analyzed area. The study results identified in the area analyzed the emergence of three new centers, arising from the urbanization process from leisure, one of them located in the municipality of Nísia Foresta Beach in Barra de Tabatinga, and two in Parnamirim, more specifically in locality Pium and Beach Pirangi do Norte. It was further observed that, being located in tourist areas, the main feature of these new centers is seasonality

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.

Avaliação do acesso aos serviços de reabilitação física para vítimas de acidentes de trânsito: caminhos para melhoria da qualidade do sistema de saúde

The Physical Rehabilitation services (PR) are of fundamental importance in combating the global epidemic of Traffic Accidents (TA). Considering the numerous physical and social consequences of the survivors, quality problems in access to PR are a hazard to recovery of victims. It is necessary to improve the management of quality of services, assessing priority dimensions and intervening in their causes, to ensure rehabilitation available in time and suitable conditions. This study aimed to identify barriers to access to rehabilitation considering the perception of TA victims and professionals. The aim is also to estimate the access to rehabilitation and their associated factors. This is a qualitative and quantitative study of exploratory nature developed in Natal / RN with semi-structured interviews with 19 health professionals and telephone survey to 155 victims of traffic accidents. To explore barriers to access the speeches were transcribed and analyzed using the Alceste software (version 4.9). During the interviews used the following guiding question: “What barriers hinder or prevent access to physical rehabilitation for victims of traffic accidents?”. The names of classes and axes resulting from Alceste was performed by ad hoc query to three external researchers with subsequent consensus of the most representative name of analysis. We conducted multivariate analysis of the influence of the variables of the accident, sociodemographic, clinical and assistance on access to rehabilitation. Associations with p <0.20 in the bivariate analysis were submitted to logistic regression, step by step, with p <0.05 and confidence interval (CI) of 95%. The main barriers identified were: “Bureaucratic regulation”, “Long time to start rehabilitation”, “No post-surgery referral” and “inefficiency of public services”. These barriers were divided into a theoretical model built from the cause-effect diagram, in which we observed that insufficient access to rehabilitation is the product of causes related to organizational structure, work processes, professional and patients. Was constructed two logistic regression models: “General access to rehabilitation” and “Access to rehabilitation to public service”. 51.6% of patients had access to rehabilitation, and 32.9% in public and 17.9% in the private sector. The regression model “General access to rehabilitation” included the variables Income (OR:3.7), Informal Employment (OR:0.11), Unemployment (OR:0.15), Perceived Need for PR (OR:10) and Referral (OR: 27.5). The model “Access to rehabilitation in the public service” was represented by the “Referral to Public Service” (OR: 23.0) and “Private Health Plan” (OR: 0.07). Despite the known influence of social determinants on access to health services, a situation difficult to control by the public administration, this study found that the organizational and bureaucratic procedures established in health care greatly determine access to rehabilitation. Access difficulties show the seriousness of the problem and the factors suggest the need for improvements in comprehensive care for TA survivors and avoid unnecessary prolongation of the suffering of the victims of this epidemic.

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