Avaliação da atenção à saúde de portadores de HIV no centro de referência para o tratamento da Aids em Natal/RN por profissionais e usuários do serviço

Objective: The aim of this study was to evaluate the health care of HIV/AIDS Reference Center for treatment of AIDS in Natal/RN for professionals and service users. Methods: This is an evaluative study with a quantitative approach, performed in the outpatient Giselda Trigueiro Hospital, in Natal (RN). The target population consisted of 313 patients with HIV and 34 professionals of the center. Data collection occurred from august 2007 to july 2008, with a structured form of interview, validated through a pilot study. The data were analyzed by descriptive and inferential statistics. Results: The evaluation of the service was considered unsatisfactory by 85.6% users. However, 58.8% of professionals considered it satisfactory. There was difference in the evaluation of the following indicators: the relationship professional users, offering support, timeliness of professional guidelines on the treatment. There was similarity in the following indicators: physical structure, respect for privacy, opportunity to make complaints, hospitality, convenience of schedules, availability of ARVs and laboratory tests, and ease of access. Conclusion: The results point to dissatisfaction of the users and professional satisfaction with the health care of people with HIV / AIDS in the service searched. It was found that the indicators used in this study may be considered relevant to evaluate the service in question, as well as monitoringparameters provide acceptable quality of health care by the National STD/AIDS

Estabilidade e robustez de um controlador adaptativo indireto por um modelo de referência e estrutura variável

In this thesis, it is developed the robustness and stability analysis of a variable structure model reference adaptive controller considering the presence of disturbances and unmodeled dynamics. The controller is applied to uncertain, monovariable, linear time-invariant plants with relative degree one, and its development is based on the indirect adaptive control. In the direct approach, well known in the literature, the switching laws are designed for the controller parameters. In the indirect one, they are designed for the plant parameters and, thus, the selection of the relays upper bounds becomes more intuitive, whereas they are related to physical parameters, which present uncertainties that can be known easier, such as resistances, capacitances, inertia moments and friction coefficients. Two versions for the controller algorithm with the stability analysis are presented. The global asymptotic stability with respect to a compact set is guaranteed for both cases. Simulation results under adverse operation conditions in order to verify the theoretical results and to show the performance and robustness of the proposed controller are showed. Moreover, for practical purposes, some simplifications on the original algorithm are developed

Referência ao discurso do outro: uma análise de problemas de relações de sentido entre discurso citado direto e indireto citante no gênero monográfico

In this study we investigate the reference to other s discourse done it through the resource of direct cited discourse at background section in monographic texts produced by university students at the last phase of final work in their graduate Letras course. This work is guided in cited/related discourse studies in Bakhtin (2004), Authier-Revuz (1990, 1998, 2004), Maingueneau (1996, 2002), Charaudeau and Maingueneau (2004); in genre approaches developed by Bakhtin (2000); Maingueneau (1996, 2002); socio-discursive interaction (BRONCKART, 1999, 2003; SCHNEUWLY, 2004; DOLZ e SCHNEUWLY, 2004) and Bazerman (2005); and also in presuppositions of Textual Linguistics presented by Charrolles (1988), Van Dijk (1997), Beaugrande and Dressier (1981), Koch and Travaglia (1993, 1995), Koch (2002, 2004) and Val (2000, 2004). We have established as aims to analyze and interpret meaning relations problems in how to articulate direct cited discourse with citing discourse and at the same time explain semantic implications that comes from that articulation that compromise text meaning, at background section in that monographic genre. The analysis, by qualitative and quantitative basis in eleven monographic works that form our corpus, gave us the opportunity to achieve and see that meaning relationships in the articulation of direct cited discourse with citing discourse show problems that may be categorized into three different groups: problems related to meaning relationships with citing discourse that comes before it, problems of meaning relationships with citing discourse that comes after it, and problems with of meaning relationships with citing discourse that come before it and at the same time with citing discourse that comes after it (i.e. in relation to both). These analysis also allow us assert that, these problems, just because they occur frequently, they affect the micro level text coherence, and they also compromise the text global meaning. The results show that students at Letras Course, even in the ending process of their course do not show the real domain in relation to some ways of direct cited discourse organization and working, and also how the ideas articulation work in the construction of relations between direct cited discourse and the citing discourse that can turn those students able to produce a text that enhance acceptable patterns

Avaliação do tratamento eletroquímico (direto e indireto) como alternativa de degradação do corante azul de metileno

Textile industry has been a cause of environmental pollution, mainly due to the generation of large volumes of waste containing high organic loading and intense color. In this context, this study evaluated the electrochemical degradation of synthetic effluents from textile industry containing Methylene Blue (AM) dye, using Ti/IrO2-Ta2O5 and Ti/Pt anodes, by direct and indirect (active chlorine) electrooxidation. We evaluated the influence of applied current density (20, 40 and 60 mA/cm2 ), and the presence of different concentrations of electrolyte (NaCl and Na2SO4), as well as the neutral and alkaline pH media. The electrochemical treatment was conducted in a continuous flow reactor, in which the electrolysis time of the AM 100 ppm was 6 hours. The performance of electrochemical process was evaluated by UV-vis spectrophotometry, chemical oxygen demand (COD) and total organic carbon (TOC). The results showed that with increasing current density, it was possible to obtain 100 % of color removal at Ti/IrO2-Ta2O5 and Ti/Pt electrodes. Regarding the color removal efficiency, increasing the concentration of electrolyte promotes a higher percentage of removal using 0,02 M Na2SO4 and 0,017 M NaCl. Concerning to the aqueous medium, the best color removal results were obtained in alkaline medium using Ti/Pt. In terms of organic matter, 86 % was achieved in neutral pH medium for Ti/Pt; while a 30 % in an alkaline medium. To understand the electrochemical behavior due to the oxygen evolution reaction, polarization curves were registered, determining that the presence of NaCl in the solution favored the production of active chlorine species. The best results in energy consumption and cost were obtained by applying lower current density (20 mA/cm2 ) in 6 hours of electrolysis.

Racionalidade substantiva no processo decisório: um estudo em instituições que lidam com o tratamento oncológico infantojuvenil na cidade de Natal-RN

The present study regards an applied social research (qualitative) performed in two institutions which lead children s cancer treatment in Natal, Rio Grande do Norte. The main goal of this study is, as of a literature review at works which characterizes the first generations of study about substantive rationality, to detect Decision Making process related aspects that may serve as a basis to elaborate analysis categories from decision making process, aggregating them into a new study that may provide an advance to the theme in administrative science. The academic works based on the analysis model created by Mauricio Serva served as a basis to deep research into such theme, which verifies the predominant rationality in eleven administrative internal processes in productive organizations. This dissertation intends to go beyond the identification of the predominant rationality by elaborating new categories of analysis, and making possible the continuity of the subject in administrative science. Based on Guerreiro Ramos s work, which sees a kind of ideal organization, as known as isonomies, this study still calls upon Karl Polanyi s thoughts, which with the objective of comprehending the independent economic phenomenon of the value that allows considering non-market economies, find that the economy of the men is submerged in his social relations; it also rescues the studies from Max Weber who investigates the meaning of social action to better understand the rationality, and refers to the study of Jürgen Habermas, who proposes a broader conception about rationality, within the theory of communicative action. As a result of this theme s review, seven analysis categories of the decision making process have been formulated. They were applied in the institutions that had been chosen and helped to detect the type of predominant rationality in the categories of the decision making process. The results confirm that, although the decisions making process involves rational elements, such as information, identification of alternatives, there are also specific values of each individual with his experience and view oh the world, permeated not only by instrumental rationality, but also by substantive rationality. The study has verified that two similar institutions may show different types of rationality in the decision making process, when decision factors may tend to instrumental rationality, according to administration classic way, as well as they may emerge from substantive rationality, thus contributing to the process of emancipation of the human being in his sphere of work

Atenção ao usuário em um centro de referência HIV/Aids: perspectiva de profissionais e usuários

We study the health care focused on care in an intercessor and dialogical relationship with the User, which involves the construction of therapeutic projects essential to the quality of the treatment of the user in health services, and it is necessary individual and collective actions. It is intended to acknowledge and analyze the perception of social subjects, users and professionals on the treatment given to a user of a Specialized Outpatient Service (Serviço Ambulatorial Especializado SAE) in STD/HIV/AIDS state reference in Natal, RN. The study is structured in a transdisciplinary vision of science and knowledge, theoretical and methodological principles that give meaning to the expression of the institutional features of care and health care reconnecting them to the social context. As a research strategy we seek the expressions of 56 subjects of social research, which agreed to participate in the sample, from a symbolic map of the attention, coupled with the techniques of observation and semi-structured interview. For the analysis of the results, five categories of analysis were established: the meaning of the service, care perception, process of communication and interaction, treatment perception and organization and evaluation of the service. It is argued that the attention and care are developed in a technical health care assistance to the disease, focusing on attention based on treatment, on diagnostic and drug therapy of antiretroviral drugs, reflecting the traditional biomedical paradigm of attention to the disease. This is also the mode of organization of practical actions in daily SAE: the therapy proves to be fragmented in several specialties, vertical and feeds the same model, generating tension and overload for professionals; showing impersonal care focused on structured and informative technology, unrelated to an interactive dialogic. From the speech of the subjects, the SAE is understood as the place of confrontation with the disease, but also enables greater elaboration of the illness by meeting their peers. Living with HIV and AIDS is living with concern, apprehension and fear, but mainly with the stigma, prejudice and exclusion, which require that the disease is kept in secret. There is a movement of forces and power, expressed in the knowledge-power of those who dominate the technical and administrative capabilities, devices that concentrate the maintenance of the medicalization of care, rapid consultations and with little attention, making it difficult to interact with and listen to, combined with structural failures, organizational and inadequate management of the service. We conclude that there are dimensions that are not considered in the internal dynamics of the care service multiple forms, characterized by care conflicting models, marked by individual interventions related to the disease. The subject is not considered together with his speech as technical discourse is imposed and care production based on material technology is observed

Assistência a mulher com câncer de mama em um cenro de referência no Estado da Paraíba

The assistance to women who have breast cancer is studied in a Reference Center in Paraiba and also the way this assistance is performed in a School Hospital maintained by SUS (Single Health System) is questioned. Breast cancer demands institutional organization, provision of financial, material and human resources, requiring, from the health system, effective assistance with new technologies which make it possible for the population their access to specialized medical services although it not always is able to guarantee those services nor the rights which the legislation granted them, inhibiting a proper relationship between the health professional and the patient. The theme is discussed through a transdisciplinary knowledge view and has as its theoretical referential the contribution of classical and contemporary authors from the human and social sciences and, as an empirical research strategy, the structured interview. The objectives of the research were: identify how the assistance to women with breast cancer is carried on at a Reference Center on Oncology in Campina Grande, Paraiba, identifying their difficulties and their satisfaction with the received assistance; draw up a profile of the women with breast cancer who were assisted in this Reference Center; understand their gynecological and obstetric antecedents, life styles, age group and stage of the disease when the treatment started; check their knowledge about their rights and which benefits they had received. Most women ranged between 40 and 59 years old (63%), which corresponds to the risk range of developing breast cancer. As to their occupations, 38.3% were housewives and 30.1% retired, whose family income was among those who received between less than a minimum salary and one minimum salary (58.2%). This population was mainly constituted of married women (60.2%), whose most frequent schooling was an incomplete elementary school (27.6%) and complete elementary school (24.1%), which added up to 51.6%. It was observed that the majority of the women seemed to be satisfied with the assistance received, noting that a minimum care was enough to define this satisfaction, although it is perceived that the access to the health system does not ensure the ideal attention conditions they need; it was verified that the availability of the services and the assistance itself are seen (in the local culture) as a favor and not as a right. It is also observed that only 30% of the women mentioned that they knew about their rights and the most mentioned ones were the disease assistance (13%), the medicines (13%) and the treatment (12%), which represent the most important triad to face the disease and around which the oncologic assistance most focus on. It is concluded that the condition of the users´ minimum existential of a public health unit and the condition of belonging to a lower social stratum were variables that influenced the respondents´ satisfaction in relation to the assistance received but the importance of the Reference Center for the women with breast cancer´s assistance for the whole region cannot be denied as well as the need to broaden the way the policy of the oncologic assistance in Brazil in the local realm is seen

Análise de qualidade da atenção à criança na estratégia saúde da família: o óbito infantil evitável como referência

Alma-Ata declaration bring the Primary Attention to the Health (PAH) as first level of health attention for individuals, family and community, which considers infant group as priority. Several initiatives that gave bases to integral attention to the children health formalized in the principles of Unique Health System. Family Health Strategy (FHS) comes to strengthen this attention, instituting new ways of work organization and professional practices that gave impact in their quality indicators. One of them is children mortality, showing decline in their values. Though, studies indicates persistence of avoidable infant deaths. In Natal RN, this reality is also perceptible leading to inquietudes, mainly at the space of services production, it means, which motivated the accomplishment of the present study intending to analyse the way that the organizational and structural processes as long as the professional practices in FHS interfered in the quality of children s health attention who died by avoidable death in the year of 2007 in municipal district of Natal-RN. It treats, therefore, to an exploratory and descriptive survey of cases study type, thar had as primary sources the oficial documents of MH, the family prontuary, pregnant card, child card and testimony obt ined from instrument of research elaborated based in investigation form of infant death by MH, applied to 10 mothers of children who had avoidable death. In analysis it was appealed silmultaneous triangulation of methods and sources, allowing a bigger aproximation from obtained informations. To elucidate the cases, the aspects studied were analyzed to the light of explicative model of Social Determinants of Health. Among individual and family aspects were highlighted the related to age, schooling, family habits and customs and mother s economic condition, besides of pregnancy age, newborn weight and associated diseases, which don t differ from literature about the theme. Reffering to the factors organizational and structural processes and professionals practice, highlihgted, the treatment given by the professionals, the territorialization and adscription of areas, the difficulty of having access to the services or sleepers and the reference and counterreference. But also, the ausence or few greet, the lack of communication, few assiduity and ponctuality by professionals in service, among others. In a general way mothers considers the attendance received in the hospital good and very good , opnions that in the Basic Attention weren t so favorable, in spite of many of predictible actions in this level have been performed in the studied cases. It is observed, therefore, that the social determinants of health has a strong influence in ocurrence of infant deaths, what implicates in a large actuation by Infant Mortality Committee from municipal district. This way, it becomes fundamental the reflection and evaluation about the effectiveness and execution by the processes of vigilance to health in FHUs; the rethink about the social determinants of health in a wide and articulate way to the services quality, to permanent education, to management in service, to the given attention and to the way how it is installed the popular participation and social control. To the professionals it is presented the great challenge to review their daily practice, their values, behaviors and commitment, which ones must be guided by logical of sharing, work in team, humanescence and alterity, not only by the accomplishment of a professional duty

Desistência ao tratamento de usuários de crack no centro de atenção pssicosocial em Campina Grande/PB

This study aimed to analyze the phenomenon of abdication of monitoring/treatment of crack users in a CAPS AD in Campina Grande-PB. That s an exploratory , description approach ,whose theoretical focus was historical-dialect of public politics on alcohol and drugs. The information collected was realized by using the technique of semi-structured interviews, combined with the crack users registered in CAPS AD in Campina Grande between 2007 and 2011.The material collected was subjected to thematic analysis method, obtaining the extraction of the following categories and subcategories of analysis: CATEGORY 1: Factors of abdication of monitoring/treatment in CAPS AD in Campina Grande PB with subcategory 1.1. Abdication on their own , 1.2. To take work/employment, 1.3 . Search for more intensive treatment , 1.4. Due to relapse; CATEGORY 2 : Treatment/monitoring in CAPS AD to the subcategory, 2.1. The dependence of crack and family support as reasons that led to frequent CAPS AD. CATEGORY 3: Living with crack addiction without treatment/monitoring in CAPS AD with the subcategory, 3.1. Religiosity as a therapeutic tool .The results showed a distance between priority for community treatment and the reality where there is lack of information about this kind of treatment and the admission as a solution. The discourse about the abdication of treatment of crack users make reference to the importance of family support, to the influence for the phenomenon of relapse and the affection to religious conceptions. Although the subjects recognize the qualifications of CAPS AD treatment, they try by themselves or by family influence, another ways of hospitalization. This leads us to conclude that it is necessary reflection and assessment of the work of CAPS AD. Counting on the social changes and the need of answers that the phenomenon requires

O Centro de Referência da Assistência Social e a Psicanálise: efeitos de uma escuta singularizada

This paper emerged from an experience of 18 months in the CRAS – Reference Center for Social Assistance – which aroused a question about the listening of the singularity in the professional practice of Psi in the context of social assistance. The literature review revealed, on the one hand, a series of studies that aim to a discussion about of the process of professional integration of psychologists in the field of social welfare, proposing and / or analyzing practices directed towards the psychosocial assistance directed to the group and for the assurance of rights, forming citizen subjects. On the other hand, supported by a psychoanalytic perspective, we found studies that point to the importance of the singularity listening considering the subjectivity and symbolic resources of those who seek help in Basic Assistance Service. In this perspective, we aim to analyze, in a posteriori, the effects of offering a singularized listening in the context of CRAS and discuss its implications for the Psi professional practice in social institution. This is a theoretical and clinical research, based on Freudian and Lacanian psychoanalysis, in which two cases, placed as investigation boosters, are analyzed in the light of the concept of the subject. We conclude that a singularized listening allowed a significant sliding and the consequent repositioning of the subject, in each case, front to their suffering. The effects collected allowed us to affirm the importance of a singular listening in the treatment of the demands that appear within the institutional framework

Análise de tendência e caracterização sazonal e interanual da evapotranspiração de referência para o sudoeste da amazônia brasileira: Acre, Brasil

The objective of this research was to investigate monthly climatological, seasonal, annual and interdecadal of the reference evapotranspiration (ETo) in Acre state in order to better understand its spatial and temporal variability and identify possible trends in the region. The study was conducted with data from Rio Branco municipalities, the state capital, Tarauacá and Cruzeiro do Sul considering a 30-year period (1985-2014), from monthly data from weather stations surface of the National Institute of Meteorology. The methodology was held, first, the consistency of meteorological data. Thus, it was made the gap filling in the time series by means of multivariate techniques. Subsequently were performed statistical tests trend (Mann-Kendall) and homogeneity, by Sen's estimator of the magnitude of this trend is estimated, as well as computational algorithms containing parametric and non-parametric tests for two samples to identify from that year the trend has become significant. Finally, analysis of variance technique (ANOVA) was adopted in order to verify whether there were significant differences in average annual evapotranspiration between locations. The indirect method of Penman-Montheith parameterized by FAO was used to calculate the ETo. The results of this work through examination of the descriptive statistics showed that the ETo the annual average was 3.80, 2.92 and 2.86 mm day-1 year, to Rio Branco, Tarauacá and Cruzeiro do Sul, respectively. Featuring quite remarkable seasonal pattern with a minimum in June and a maximum in October, with Rio Branco to town one with the strongest signal (amplitudes) on the other hand, the Southern Cross presented the highest variability among the studied locations. By ANOVA it was found that the average annual statistically different for a significance level of 1% between locations, but the annual average between Cruzeiro do Sul and Tarauacá no statistically significant differences. For the three locations, the 2000s was the one with the highest ETo values associated with warmer waters of the North Atlantic basin and the 80s to lower values, associated with cooler waters of this basin. By analyzing the Mann-kendall and Sen estimator test, there was a trend of increasing the seasonal reference evapotranspiration (fall, winter and spring) on the order of 0.11 mm per decade and that from the years of 1990, 1996 and 2001 became statistically significant to the localities of Cruzeiro do Sul Tarauacá and Rio Branco, respectively. For trend analysis of meteorological parameters was observed positive trend in the 5% level of significance, for average temperature, minimum temperature and solar radiation.

Hepatite C crônica em serviço de referência no nordeste do Brasil: um estudo retrospectivo de dezoito anos de acompanhamento

Chronic Hepatitis C is the leading cause of chronic liver disease in advanced final stage of hepatocellular carcinoma (HCC) and of death related to liver disease. Evolves progressively in time 20-30 years. Evolutionary rates vary depending on factors virus, host and behavior. This study evaluated the impact of hepatitis C on the lives of patients treated at a referral service in Hepatology of the University Hospital Onofre Lopes - Liver Study Group - from May 1995 to December 2013. A retrospective evaluation was performed on 10,304 records, in order to build a cohort of patients with hepatitis C, in which all individuals had their diagnosis confirmed by gold standard molecular biological test. Data were obtained directly from patient charts and recorded in an Excel spreadsheet, previously built, following an elaborate encoding with the study variables, which constitute individual data and prognostic factors defined in the literature in the progression of chronic hepatitis C. The Research Ethics Committee approved the project. The results were statistically analyzed with the Chi-square test and Fisher's exact used to verify the association between variable for the multivariate analysis, we used the Binomial Logistic regression method. For both tests, it was assumed significance p < 0.05 and 95%. The results showed that the prevalence of chronic hepatitis C in NEF was 4.96 %. The prevalence of cirrhosis due to hepatitis C was 13.7%. The prevalence of diabetes in patients with Hepatitis C was 8.78 % and diabetes in cirrhotic patients with hepatitis C 38.0 %. The prevalence of HCC was 5.45%. The clinical follow-up discontinuation rates were 67.5 %. The mortality in confirmed cases without cirrhosis was 4.10% and 32.1% in cirrhotic patients. The factors associated with the development of cirrhosis were genotype 1 (p = 0.0015) and bilirubin > 1.3 mg % (p = 0.0017). Factors associated with mortality were age over 35 years, abandon treatment, diabetes, insulin use, AST> 60 IU, ALT> 60 IU, high total bilirubin, extended TAP, INR high, low albumin, treatment withdrawal, cirrhosis and hepatocarcinoma. The occurrence of diabetes mellitus increased mortality of patients with hepatitis C in 6 times. Variables associated with the diagnosis of cirrhosis by us were blood donor (odds ratio 0.24, p = 0.044) and professional athlete (odds ratio 0.18, p = 0.35). It is reasonable to consider a revaluation in screening models for CHC currently proposed. The condition of cirrhosis and diabetes modifies the clinical course of patients with chronical hepatitis C, making it a disease more mortality. However, being a blood donor or professional athlete is a protective factor that reduces the risk of cirrhosis, independent of alcohol consumption. Public policies to better efficient access, hosting and resolution are needed for this population.

Racionalidade substantiva no processo decisório: um estudo em instituições que lidam com o tratamento oncológico infantojuvenil na cidade de Natal-RN

The present study regards an applied social research (qualitative) performed in two institutions which lead children s cancer treatment in Natal, Rio Grande do Norte. The main goal of this study is, as of a literature review at works which characterizes the first generations of study about substantive rationality, to detect Decision Making process related aspects that may serve as a basis to elaborate analysis categories from decision making process, aggregating them into a new study that may provide an advance to the theme in administrative science. The academic works based on the analysis model created by Mauricio Serva served as a basis to deep research into such theme, which verifies the predominant rationality in eleven administrative internal processes in productive organizations. This dissertation intends to go beyond the identification of the predominant rationality by elaborating new categories of analysis, and making possible the continuity of the subject in administrative science. Based on Guerreiro Ramos s work, which sees a kind of ideal organization, as known as isonomies, this study still calls upon Karl Polanyi s thoughts, which with the objective of comprehending the independent economic phenomenon of the value that allows considering non-market economies, find that the economy of the men is submerged in his social relations; it also rescues the studies from Max Weber who investigates the meaning of social action to better understand the rationality, and refers to the study of Jürgen Habermas, who proposes a broader conception about rationality, within the theory of communicative action. As a result of this theme s review, seven analysis categories of the decision making process have been formulated. They were applied in the institutions that had been chosen and helped to detect the type of predominant rationality in the categories of the decision making process. The results confirm that, although the decisions making process involves rational elements, such as information, identification of alternatives, there are also specific values of each individual with his experience and view oh the world, permeated not only by instrumental rationality, but also by substantive rationality. The study has verified that two similar institutions may show different types of rationality in the decision making process, when decision factors may tend to instrumental rationality, according to administration classic way, as well as they may emerge from substantive rationality, thus contributing to the process of emancipation of the human being in his sphere of work