Análise do perfil de encaminhamento da atenção primária para pré-natal de alto risco: desafios para o ensino de competências em saúde materno-infantil

OBJECTIVE: to identify a profile of the main causes of inappropriate referrals from primary care to specialized services, as strategy for the curriculum development of core competencies related to maternal health. METHODS: a cross-sectional study was performed using document analysis of all referrals of pregnant women from primary care to the high-risk pregnancy service, state of Rio Grande do Norte, Brazil. All pregnant women referred from June to December 2014 (n = 771) were included. According to their causes the referrals were categorized as adequate, inadequate or inconclusive. RESULTS: a total of 188 referrals were classified as inadequate (24.4%) and 93 inconclusive (12.1%) totalizing 36.5% of inappropriate referrals. The main causes identified in these inappropriate referrals were: low-risk pregnancy (12.8%), unconfirmed hypertension (12.1%), risk of abortion (8.9%), teenage pregnancy (7.1%) , toxoplasmosis (5.3%), Rh incompatibility (4.6%) and urinary tract infection (4.3%). These data contributed to the formulation of the following products: 1) a continuing education program for health professionals working in primary care, undergraduate students and residents; and 2) development of a virtual platform to support professionals who need to refer patients to high-risk pregnancy service. CONCLUSION: the results of this study are relevant in the current context of education of health professionals, with potential for positively impact not only in the development of skills related to maternal health in undergraduate and graduate education, as well as contributing for improvement of the health care of the population.

O lugar pedagógico da educação física na educação infantil: saberes (re)construídos na formação continuada do PAIDÉIA/UFRN

The present study aimed to investigate the overview of teachers in continuing education program who work in kindergarten, about the continuing education developed by the Paideia/UFRN through the Course of Specialization in Art Teaching and Physical Education in Childhood, having as key focus, the knowing / doing related to physical education in Childhood. From this general goal, it was elected some specific objectives as: to know the interests and expectations that motivated the teachers to participate of that referred training; the evaluation by teachers on regard of the continuing education proposed: boosters factors for possible changes in teaching activities regarding the practice of teaching physical education in kindergarten. The methodology took the principles and techniques of qualitative research strategy and the characteristics of descriptive and interpretive strategy. The locus of this research was the Course of Specialization in Art Education and Physical Education in childhood, having as the citizens of this research twenty three teachers taking that specialization course. For building and systematization of the data, we used the following tools and procedures: a questionnaire, a semi structured interview and documents analysis. The data was constructed based on the technique of content analysis, focusing the reflections and speech of the teachers about the creation of new meanings and senses for the knowing / doing in Physical Education. It was found, among other results, the need and quest for improvement of teacher education, in order to improve educational practice. It was also evident that the situations of dialogues (interactions with peers, with their professors and other professionals in the related area or not) were mentioned by most teachers in the course as a relevant moment of redefinition of knowledge. In relation to Physical Education, it was found that participation in the course of specialization provided the recognition of teaching practice of physical education as part of the curriculum and the importance of inclusion of its specificities in their educational planning. From these elaborations, we come to the conclusion that knowing the perspectives of the teachers about continuing education can contribute to the theoretical and methodological discussions in teachers education and the creation of new actions - projects and programs of continuing education constructing increasingly ways towards a successful teacher formation, able to provide new forms of acting in the educational context

A formação da habilidade de explicar no contexto do ensino médio: o que dizem os livros? o que pensam os professores?

The discussion about explanation in knowledge has been made for decades. Through this course, we present different ways of understanding about what is to explain the history: the primitive ethnographic description, the chronicler, the positivist construction of a historical science and historiography of the second half of twentieth century. Nowadays this discussion needs to be continued both in the general framework of scientific practice as within educational institutions as cognitive - linguistic ability. The focus of our research is by the second approach, which is the explanation as cognitive - linguistic ability. The formation of skills, among them, the explaining one, has been studied by the authors as: (NÚÑEZ 2012; JORBA et al, 2000; SANMARTÍ and IZQUIERDO 2000). This research had as general purpose: to study the processes of formation of the ability to explain social revolution in history classes in high school, by teachers opinion and by content as this theme among history books, in order to support the continuing education of history teachers for high school. Th e qualitative based research used instruments of data collection and analysis protocol for the books prepared for this study, and interviews with teachers. For this, the techniques of content analysis and discourse referenced in Bardin and Orlandi , respec tively were used. At first, the instruments for data collection were developed and validated, while in the second, the data were collected, organized and analyzed. From the answers to the questions of the study results shows that: a) in the analyzed books - do not express the work with the definition of Social Revolution, considering the processes for the formation of this definition, the predominant type of explanation has characteristics of multicausality; proposals for teaching are characterized as eclec tic; b) while teachers speech - it is important the students know the definition of Social Revolution, the ability to explain is more linked to didactic explanation in the classroom than the explanation through epistemological sense. These results indicate that the formation of the ability to explain Social Revolution based in Cultural History approach, are not expressed in the analyzed books, but they can serve as an important resource for this purpose. The discourse of teachers has a potential pointing to the possibility of teaching organization and learning process, based on training or upgrading the explanation skill from the theory of stepwise formation of mental actions and concepts by P.Ya. Galperin. For this purpose, the research constitutes a contri bution to support the continued education of history teachers in high school.

Atenção à saúde mental na Estratégia Saúde da Família no Município de Parnamirim/RN: opinião dos profissionais, dos portadores de transtornos mentais e seus acompanhantes

This study aims to analyze and compare the opinion of professionals, managers and users about the mental health care in the Family Health Strategy (FHS). It is characterized as an Operations Research or Health System Research with a cross-sectional design and a descriptive quantitative nature. The study was developed from the application of the Opinion Measurement Scale allied to techniques of observation and structured interview in the city of Parnamirim / RN. The sample consists of 409 subjects, 209 professionals of the Family Health Strategy, 30 of the Oral Health Strategy, 19 of the Family Health Support Center, 24 directors of Basic Health Units, plus 68 users with mental disorders and 59 caregivers, respecting the ethical parameters of Resolution 196/96 of the National Health Council, trial registration number: CAAE 0003.0.051.000-11. Quantitative data were submitted to the Epi-info 3.5.2 for analysis. The network of mental health in Parnamirim involves the flow between the FHS, Psychosocial Care Centers, clinics and hospitals, having as main barriers the fragility of the referral and counter-referral system, of the municipal health conferences, of the FHS teams by the limitations in material and human resources as well as the population´s lack of acknowledge about the organization of the mental health network, issues that affect the integral attention. Even though the FHS professionals recognize the importance of their actions, they question their role in mental health care, experiencing difficulties in accessing psychiatric services (76.5%). Although most agree that the mentally ill is best treated in the family than in hospital (65.2%), the community health workers were the predominant category in the partial or total disagreement of this statement (40.8%), who is the professional in greater contact with the family. Nevertheless the caregivers miss the support of the FHS as the main focus of attention is on revenue control. The views of professionals, mental patients and caregivers converged in several statements, showing the main weaknesses to be focused by the mental health network of the city, as the perceptions that: (a) physical strength is needed to take care of mental patients for its tendency to aggression, requiring it to stay in the sanatorium for representing danger to society, (b) only a psychiatrist can help the person with emotional problems, (c) the user of alcohol and drugs does not necessarily develop mental illness, (d) the access barriers and doubts about the quality of psychiatric services, (e) caring of a mental health patient does not bring suffering to professionals. Therefore, the commitment to consensus building, monitoring and evaluation of the network are important mechanisms for an effective management system, reflecting in the importance of strengthening the health conferences and approximating different institutions. The results reinforce the importance of strengthening primary care through programs of continuing education focusing on the actions and functions of professionals in accordance with its competences and duties what contribute to the organization and response of mental health care, favoring user´s care and the promotion of family health

Educação corporativa para Micro e Pequenas empresas: aplicação do MADEC em empresas do setor supermercadista

This study searches to supply an existing gap in the empirical research about the performance of controllers of Micron and Small Companies (MSCs) in the context of corporative education (EC) through the Method of Support of Decision in Corporative Education (MSDCE). In the context of MCSs, this is a pioneering work, for other works related to this thematic searched in literature are limited to conjecture the possibility of its implantation via cooperation between companies; moreover, they do not apply any type of diagnosis method or viability. The object of study is an association of supermarkets of the city of Natal/RN, composed by 16 stores, of what 14 had been searched. The main objective of this work was to apply the first stage of the MSDCE and to verify the possibility of implanting the Corporative Education in the searched MSCs. As a result, it was obtained the profile of the companies and the validation of the above-mentioned Method. The phase of diagnosis conceived through the implantation of the first stage occurred through visits to the stores, interviews, application of questionnaires and place observation. The first stage - strategical analysis for professional education - was divided in two phases: analysis of the current corporative situation and available identification of the involved difficulties and resources. The implantation of the first stage of the MSDCE in the Association of Supermarkets Parceiros da Economia demanded a mapping of abilities and demonstrated how the education management works, the main difficulties and limitations of the MCSs of the supermerket branch of Natal/RN. Beyond the technological aspects, it was verified that cultural and educational aspects need to be worked to reach efficiency in the process of implantation of a corporative education program

O oncologista clínico diante da morte: implicações para a produção do cuidado

It is undeniable that all the extraordinary technological advances in contemporary society have increased the severe patients expectation and quality of life, especially cancer patients. On the other hand, it is easily verifiable by many researches that it was not possible to advance in the same proportion in caring for the human experience of death. Much is said about the anguish of a man facing death, of cancer patients in terminal stage, about their families, and very little about the feelings, anxieties and ways of coping with the medical professional who deals with this situation, specifically the clinical oncologist. Little is known about the experience of the doctor who has learned to take death as an enemy to be defeated, and increasingly is compelled to live at length with his advertisement. However, we started to watch in recent years a growing interest of researchers in this issue. This study seeks to add to this interest in order to understand the experience of clinical oncologists that accompany dying patients, the meanings they attach to death, ways of coping and the implications for providing care. This is a qualitative study in which was used as a tool for data collection an in-depth interview with the projective using script and scenes. Gadameriana Hermeneutics was used for analysis and interpretation of narratives. The subjects were 10 clinical oncologists who work at two institutions from cancer treatments in the state of Rio Grande do Norte, chosen from a variation in the time working in the specialty (minimum of one year, even old ones). However, you can bring some initial results for the dialogue. It was found that the death is still a topic that causes many difficulties in the daily lives of these professionals, the choice for oncology involves dealing with death without preparation in medical education; being close to the patient in the final moment, supporting the family, coping with own pain of loss and the inability to heal. These are central elements of the narratives. We also have investment in medical training and continuing education in setting up a demand that permeates the discourse of participants. Being able to listen to the subjective world of clinical oncologists will support the work not only for them as other professionals who deal with patients with advanced cancer, providing evidence to understand to what extent the meanings attributed to its know-how before patients on the verge of death interfere with the production of care and allow identify coping strategies in everyday life of these professionals that hinder or facilitate coping with death, promote or preclude the care with others and with themselves. It is hoped that research can contribute to the field of knowledge about the know-how in clinical oncology and their terminal-care-death oncologist-patient relationships, bringing runways capable of promoting a better quality of care in the production of all involved in this process: professionals, patients and families

O laboratório de ensino de matemática temático centrado nos instrumentos de navegação: uma proposta para o IFRN de Mossoró-RN

This work presents a proposal to build a Mathematics Teaching Laboratory (MTL) whose main theme is the study, construction and use of instruments for navigation and location of mathematical content in an interdisciplinary way approach, and develop a notebook of activities focused on navigational instruments. For this it was necessary a literature review to understand the different conceptions of MTL and its pedagogical implications. The methodology used was literature research, construction and handling of instruments, and pedagogical experimentation. Lorenzato (2006) highlights the importance of an environment and suitable for a professional who can do a good job instruments. The implementation of an LEM can find some obstacles. The lack of support from other teachers or the management, the lack of a suitable place to store the materials produced, the lack of time in the workload of the teacher to prepare the lab activity, etc. Even in unfavorable or adverse conditions, according Lorenzato (2006), its implementation will benefit teachers and students. The lack of teacher training in their initial and continuing education, to use materials, and the lack of manuals with lab activities are also mentioned as factors that keep teachers from MTL. With propóposito assist the teacher of elementary or middle school in building a theme MTL prepared and we are providing a notebook of activities that provides a didactic sequence involving History and Mathematics. The book consists of four accompanied by suggestions for teachers activities, however the teacher has full autonomy to adapt the activities to the reality of your school. Among the instruments of navigation presented in this study chose to build the quadrant due to its simplicity, low cost of material and great teaching potential that this instrument has. But a theme lab is always being built and rebuilt as it is a research environment

Prevalence of the metabolic syndrome and its components in Brazilian women with polycystic ovary syndrome

SOARES, Elvira Maria Mafaldo et al. Prevalence of the metabolic syndrome and its components in Brazilian women with polycystic ovary syndrome. Fertility and Sterility, v.89, n.3, p.649-655, mar. 2008

Agregação familiar e resultados maternos e perinatais da pré-eclâmpsia severa em população do Rio Grande do Norte

To determine whether there is familiar aggregation of severe preeclampsia in a Brazilian population from Rio Grande do Norte and to characterize the maternal and perinatal outcomes in the studied population. Methods: A case control study was performed with 412 participants who were admitted at Maternidade Escola Januário Cicco (MEJC) for medical care. Of these, 264 subjects presented normal blood pressure and 148 were cases. Cases were composed of eclampsia (n=47), HELLP Syndrome (n=85) and Eclampsia associated with HELLP syndrome (n=16). The diagnosis of these illness were based on the citeria developed by National High Blood Pressure Education Program Working (2000). An interview was performed with each subject and questions related to personal and familiar history of hypertension, preeclampsia, HELLP syndrome and eclampsia. Statistical analysis was performed and comparison of median and mean between cases and controls were performed, with the level of significance of 5%. The Odds-Ratio was determined to estimate the risk of preeclampsia within the families. Results: There were no difference in the demographic data between cases and controls. Previous history of chronic hypertension and preeclampsia was more frequent in the case group. Headaches were more frequent in eclampsia and epigastric pain in the HELLP syndrome cases. Bleeding and oliguria were more frequently found in the eclampsia associated with HELLP syndrome cases. Acute Renal insufficiency was a common complication in the case group, but these cases did not evolve to chronic renal insufficiency. The maternal mortality was 0.4% and the perinatal mortality was high, 223 per 1,000 live births. The 111 risk of a woman to develop preeclampsia whose mother has hypertension or had preeclampsia was respectively 2.5 and 3.5. This risk was increased 5 times, when a sibling has hypertension and 6 times when both sibling and mother had previous history of preeclampsia. Conclusions: This study confirms that there is familiar aggregation of preeclampsia in this Brazilian population. The potential for cardiovascular complications due to development of chronic hypertension indicates the need of closely follow up of women who develop preeclampsia

O domínio da leitura e da escrita : por que não eu?

The study and research field of Education is wide and rich, mainly when it goes towards the empirical area of social reality. This research focuses on young and adult subjects who cannot read or write, although they had had access to and attended schools in Natal/RN. The locus of the research are the Municipal Schools that develop the Youth and Adults Education program EJA, having representatives from the North, South, East and West zones of the city, in a total of 6 municipal schools. It analyzes these subjects' replies to the questions: "Why are there young and adults who attended school but still cannot read or write?", What are the exclusion situations they face by not being able to read or write?". From a dialectic view on the subject, the research's strategy for data collection is the semi-structured interview to collect the replies given by the interviewees; replies that are separated by analysis categories presented charts of ideas. The research's results are analyzed and lead us to the conclusion that the affective, organic, cognitive, social, political and pedagogical factors are mentioned by the subjects as reasons why they can not dominate the reading or writing skills. The youth and adults interviewed are not happy with their school failure; the reading and writing learning is something that eases their social inclusion into a society that privileges such abilities, and that with it they could avoid the social exclusion they faced at school, in the work place, at home, in church, at health centers, on the street, at their children's school and in public assistance institutions

Navegando nas ondas dos saberes do ser: uma conversa com a sexualidade à luz da corporeidade.

This study aimed to provide a continuing education towards raising teachers for reflection and effective sexual education within the school environment as a possible route of self-education and training of teachers of elementary school. More specifically aim to facilitate through the Continuing Education to discuss the knowledge of the body and knowledge of human sexuality, presenting them as core knowledge in the integral formation of individuals and promote discussion of a Human-centered education Teaching in a vocational training and human .In this sense, we dialogue with the human teaching preconized by Arroyo (2002, 2004) along with the humanization (hominization) of the individuals through education, under Freire´s perspective of the being more (2003) as well as his ideas, Pineau´s (2003) and Josso´s (2004) about the educational practice understanding as a way to build up the autonomy of the individuals who we intend to educate. We defend the inclusion of the body as an essential learning element according to the principles of corporeity presented by Assman (2001), whose comprehension is that every learning experience has a corporal inscription. Furthermore, the knowledge about human sexuality cannot be excluded from this process since the sexuality is inherent of individuals and is constructed and reconstructed during their existence. Our view of the world and of man is supported by the knowledge of the complexity (Morim, 2004) trying to surpass the mechanist view that sees them through the duality view, fragmenting them. For the discussion and construction of knowledge that search for the confluence of these knowledges about the being and the educational practice, aiming at the individual integral formation starting from the process of self-formation/self-knowledge, we´ve directed our research-action-formation having as compass the theoretical-methodological postulate of the research-action (Barbier, 2002; Morin, 2004; Thiollent, 2004) because it makes the participation of all the involved people in the process of resolution or surpassing of problem solving possible. We´ve used the continuing formation as a way of access for data collection, applying a questionnaire with open questions for the ones involved in the research. Based on the findings it´s been possible to infer that for the teaching formation it is necessary the inclusion of the Human sexuality and corporeity theme, so that the teacher can surpass the biological view of sexuality and also the expansion of the mechanist view of the body. To do so, we suggest that the teaching formation happens supported by the teaching capacitation and formation according to Maturana (2004), bringing teaching knowledges (Tardiff, 2002), which contribute effectively for the responsibility to educate people for life.

Como se fora brincadeira de roda: a ciranda da ludopoiese para uma educação musical humanescente

The present work concerns an auto-ethnographic study based on life experiences and reflections of an educator at Escola Viva Preschool and Elementary-Middle School, located in the city center of Natal, Rio Grande do Norte. As a cognitive model of operation, we use the metaphor of the Circle Dance. The objective of this study is to identify, interpret and describe the ludopoetics that are achieved through a Musical Education program, which we denominate, Humanescent. The data of this investigation was derived from the music making by Preschool and Elementary-Middle School students at Escola Viva during 2007, 2008 and 2009, from which 20 learners were selected to form the corpus, along with the description and interpretation of photos of their experiences and sand tray scenes. We justify the methodological systemization of the research based on our own pedagogical practice, which supports Musical Education in the schools based on the principals of Embodiment, Autopoesis and Flow. The methodological systemization was developed through an Action Research model and on the concepts of Systemic Development, with the goal of re-reading the context investigated through the structuring of categories of Ludopoesis: Self-esteem, Self-territory, Self-connectivity, Self-realization and Selfworth. We used an observant-participant research approach with regard to the perception of emergent knowledge, the surroundings, the experience lived and the contextual and vibration of the circumstances. Besides this, we used projection to interpret the experiences lived, in the form of drawings, short poems, letters or sand tray scenes as symbolic interpretations of experience. In the unfolding of the Ludopoetic Process (Selfesteem, Self-territory, Self-connectivity, Self-realization and Selfworth) we draw conclusions about the relevance of the ludic musical experience, which foments the formation of the self based on music learning, and which is demonstrated in the Embodiment of the learners. In the auto-formative process (of learners and educators) we observe the importance of pedagogical work based on Musical Humanescent Education that gives value to the music making path to the construction of music and performance in play, creativity, and sensibility. The experience of making music in a playful way allows for organization of the self and its autonomous production in the joy of living within a ludopoetic process. These findings highlight the educator as in a permanent state of selfformation, which generates moments of flow. However, in Musical Humanescent Education, music is learned collectively, doing a circle dance, experiencing love, fostering an expansion of the creative spirit, and giving recognition to playfulness as a necessary condition for education and to the value of music made with the true nature and sensibilities of the educators

Formação continuada e representação social: implicações para a educação inclusiva

This study is part of the line of research on Teacher Education, circumscribed to the Graduate Program in Education of Federal University Rio Grande do Norte. In it, we have a qualitative research, whose object returned to the influence of continued education in social representation of inclusive education of Elementary School teachers. The same was done in an Elementary School of Cruzeiro do Sul city (Brasil/Acre) and performed with the participation of 11 teachers. We assume that thinking a continuing education inclusive presupposes reflect on the redefinition and resignification of practices undertaken by the teacher. Therefore, the teacher education is conceived as a continuum in which the teacher will be graduating in forming, shaping their way of being in social situations. We argue that in the context of interactions, we are going to reconstruct social representations that guide actions and attitudes about the objects that have meaning for the group. It was with the aim of identify the influence of these social representations and at the same time submit a proposal for continuing training in structured formative needs teachers who made use of collaborative action research. Since we believe that this can either meet the assumptions of a research and vocational training to enable that researcher and other teachers, collectively, problematizing situations of practice and, at the same time able to intervene in the same it. As procedures for obtaining information and analysis of the data, we performed, respectively, semi-structured interviews (individual and collective); reflective studies sessions and the analysis of content. The path of research revealed two social representations integrated one of inclusive education and another for student with disabilities. We noticed that although the teachers criticize the character sealed and limited of continued education courses that have frequented, reveal social representations of inclusive education and students with disabilities based on theories and concepts originated from such courses. As a result, represent inclusive education as an "education for all" and student with disabilities as someone "abnormal, different, but able to learn something . It is possible to state that from the moment the teachers approched theories about the principles of inclusive education and on the possibilities of student with disabilities took new discourses, and showed signs of change in the social representations before presented. In addition, we evidenced in this production that a proposal for training within the school, fomented by the needs teachers and having as methodology to collaborative action research, provides the (re)construction of collective knowledges and practices, sharing of experiences, hopes, discoveries and concerns and the development of cooperation and attitude for the (re)development of strategies to overcome the difficulties present in everyday teaching

Formação continuada de professores de ciências para o ensino de astronomia nos anos iniciais do ensino fundamental

Situated at the intersection of Continuing Formation, Science Teaching and content of astronomy, the research aims to discuss this problematic : What are the challenges encountered in a continuous formation in service of science teachers of the early years of elementary school with contents of astronomy? Aiming to answer this question, we carried out a collaborative action research in a school of Natal / RN, with 6 teachers who teach or lectured Natural Sciences in the early years of elementary school. The study involved 14 encounters of continuos formation in service, to enable a better understanding criticism and propositive concerning the teaching science, especially some content of astronomy for the initial years, through a shared discussion. To this end, we consider that more profound understanding of astronomical knowledge allows the establishment of relationships and connections between theoretical knowledge and the daily teaching practice. All discussions were recorded on audio and transcripts. This research was realized using questionnaires and diary, however, the audio recording was its principal working instrument. About the data collected, several issues emerged as the little field of conceptual content, several misconceptions among teachers about the content of astronomy, lack of adequate space in the school environment to study and the need for collective reflection on the practice. Finally, is indicated that the contents of astronomy should be used in classrooms of Sciences, provided that teaching plan of action consider the existence of diverse alternative conceptions about the subject, among both teachers and students, and the need of permanente continuing education in the teaching

Valorização do servidor no Programa Nacional de Humanização: estudo em um hospital universitário

It is at the work environment where value of the health professional is realized, according to the National Humanization Policy (PNH) from a Pediatric Hospital connected to an institution of higher education. Among the guiding principles of PNH it is highlighted the commitment to the democratization of labor relations and enhancement of health professionals, stimulating the continuing education process. For this research, a qualitative approach was chosen, using a semistructured interview as a tool to collect data. In a perspective of identifying the appreciation and humanization into interpersonal relations between workers, information from the theory of communicative action of Habermas was analyzed, considering cultural values goes beyond the practice in action, where the prospects of moral arguments in the universal truisms of life pervade original cultural moral, cognitive and expressive, imbued on ethics. This reasearch had the collaboration 29 employees with a regular contract labor to a teaching hospital in Natal, Brazil. The data was obtained through interviews which all participants signed a consent term. After data analysis the results shows the existance of a satisfaction of all workers on performing duties. The workers perceive its role valorization through kudos received as a consequence of a work done, others believe that it occurs when the institution or the group itself is concerned to enhance the work. Thus, in general, they feel valued. Regarding the interpersonal relationship, the most highlighted point was the fact that in the employees versus general directors item, respondents indicated the existence of a distance between these two categories, which can affect a participatory management. Therefore, the results of this study showed the necessity to develop actions that provide a healthy work environment. The joint guidelines of the PNH and the Employee Health Care Policy, represent some directions with some similarities in their purpose to the theory of communicative action, where there is a mutual respect, tolerance and coexistence of differences, considering the constructive conflict among health workers within the perspective of communication and interaction among individuals