Reinternações psiquiátricas no Rio Grande do Norte: implicações e impacto das novas estratégias de atenção à saúde mental

The Brazilian Psychiatric Reform based on the desinstitucionalization of the assistance, translated to the emphasis on community/territorial treatment and in the social inclusion of the mental suffering, promoted advances in the psychiatric restructuring. In the Rio Grande do Norte (RN), we can enumerate as advances of the Brazilian Psychiatric Reform the expansion of the mental health care chain and the implementation of some strategies that, together, aims to further the psychosocial attention of the individual with psych suffering and to reduce the indices of psychiatrics readmissions in the state. In the current Brazilian‟s mental health situation we were interesting in answered the following question: what the impact of the substitutes services‟ extension in the revolving door phenomenon? This search aims to analyze the revolving door phenomenon occurrences based on the news strategies of mental health care in the Rio Grande do Norte. This is a descriptive-exploratory study with a qualitative approach, oriented by the theoretical framework of critical-dialectical approach about the Brazilian Psychiatric Reform and using the thematic oral history as method of information collects. The search was realized on the Hospital João Machado (HJM), estate reference in psychiatric treatment, and the participants was 20 professionals that work on it. The collection of information had started after the approval of the UFRN Research Ethics Committee with the opinion number 216/2011 and CAAE number 0021.0.051.000-11 and was realized using the direct observation and semi-structured interview. The study‟s results were categorized in two categories and five subcategories of analysis. CATEGORY 1) Current situation of the mental health care chain in the RN, with the subcategories: 1.1 Impact of the new services of mental health care in the revolving door phenomenon in the RN; 1.2 Implications of the new services of mental health care in assisting user to the HJM; 1.3 Issues the permeate the mental health care chain in the RN. CATEORY 2) Main causes of the revolving door phenomenon in HJM, with the categories: 2.1 Family problems; 2.2 Lack of assistance after discharge from psychiatric hospital. In summary, we conclude that the extension of the mental health care chain contributed for the reduction of the psychiatrics re-hospitalization‟s indices in RN. However, we realized that territorial services of mental health care are not the only responsible for the revolving door phenomenon. Factors as family problems and the disarticulation of the assistance after the discharge from hospital influence on the perpetuation of hospitalizations and re-hospitalizations in the local scenario. To study the revolving door phenomenon that occur in the psychiatrics‟ assistance considering the news strategies of mental health care allowed us to approach the advances and challenges brought by the RPb and by the desinstitucionatization in the state, indicating the need for further discussions and problem-solving strategies of psychosocial care.

Avaliação da produção de sedimento na bacia hidrográfica do rio Potengi através do modelo SWAT

Anthropic disturbances in watersheds, such as inappropriate building development, disorderly land occupation and unplanned land use, may strengthen the sediment yield and the inflow into the estuary, leading to siltation, changes in the reach channel conformation, and ecosystem/water quality problems. Faced with such context, this study aims to assess the applicability of SWAT model to estimate, even in a preliminary way, the sediment yield distribution along the Potengi River watershed, as well as its contribution to the estuary. Furthermore, an assessment of its erosion susceptibility was used for comparison. The susceptibility map was developed by overlaying rainfall erosivity, soil erodibility, the slope of the terrain and land cover. In order to overlap these maps, a multi-criteria analysis through AHP method was applied. The SWAT was run using a five year period (1997-2001), considering three different scenarios based on different sorts of human interference: a) agriculture; b) pasture; and c) no interference (background). Results were analyzed in terms of surface runoff, sediment yield and their propagation along each river section, so that it was possible to find that the regions in the extreme west of the watershed and in the downstream portions returned higher values of sediment yield, reaching respectively 2.8 e 5.1 ton/ha.year, whereas central areas, which were less susceptible, returned the lowest values, never more than 0.7 ton/ha.ano. It was also noticed that in the west sub-watersheds, where one can observe the headwaters, sediment yield was naturally forced by high declivity and weak soils. In another hand, results suggest that the eastern part would not contribute to the sediment inflow into the estuary in a significant way, and the larger part of the sediment yield in that place is due to anthropic activities. For the central region, the analysis of sediment propagation indicates deposition predominance in opposition to transport. Thus, it s not expected that isolated rain storms occurring in the upstream river portions would significantly provide the estuary with sediment. Because the model calibration process hasn t been done yet, it becomes essential to emphasize that values presented here as results should not be applied for pratical aims. Even so, this work warns about the risks of a growth in the alteration of natural land cover, mainly in areas closer to the headwaters and in the downstream Potengi River

Processo de trabalho em saúde: uma análise das condições de trabalho dos assistentes sociais no âmbito hospitalar

This paper presents the survey results: PROCEDURE FOR WORK IN HEALTH: an analysis of working conditions of social workers in hospitals. Analyzes the inclusion of social workers in work processes in healthcare, specifically in the public hospital, from the objective conditions of work, according to which materializes professional action. The aim is to understand them from the point of view of its relationship with users and other health professionals through the privatization of health, which prevents the Unified Health System (SUS), limiting the operation of the services and the guarantee of rights. The approach to the reality studied was through theoretical and methodological procedures based on the qualitative and quantitative research, focusing on documentary research, observation, semi-structured interview and the theoretical foundation. It is observed that the inclusion of social workers in this context arises from the demands derived from expressions of social issues, "raw material" of professional work, and the gaps resulting from contradictions in the process of rationalization / reorganization of the SUS, meaning that the needs the population are confronted with the content and form of organization of services. At the hospital, the professional actions are developed through the shift, space contradictory clash between the collective and individual, in which individual activities are prioritized and ad hoc unplanned and reduced to the solution of "problems" of users, through actions assistance in an emergency and bureaucratic. These findings emphasize the inadequacy of space and lack of minimum conditions of service to users, which undertakes the professional with regard to ethical and political principles of the profession, since it is the responsibility and duty of the social guarantee the secrecy and privacy of users what is revealed during the process of professional intervention. The professional social workers is permeated by the diversity of skills and competence; lack of planning activities, by incorporating the institutional discourse at the expense of professional goals, by knowing the Code of Professional Ethics, for small number of professionals, the increasing number informality; by poor working conditions and wages; by discouraging research and participation in social policy councils, as well as professional training

Caracterizando os fluxos excepcionais em linhas de produto de software: um estudo exploratório

The Exception Handling (EH) is a widely used mechanism for building robust systems. In Software Product Line (SPL) context it is not different. As EH mechanisms are embedded in most of mainstream programming languages (like Java, C# and C++), we can find exception signalers and handlers spread over code assets associated to common and variable SPL features. When exception signalers and handlers are added to an SPL in an unplanned way, one of the possible consequences is the generation of faulty family instances (i.e., instances on which common or variable features signal exceptions that are mistakenly caught inside the system). In this context, some questions arise: How exceptions flow between the optional and alternative features an LPS? Aiming at providing answers to these questions, this master thesis conducted an exploratory study, based on code inspection and static analysis code, whose goal was to categorize the main ways which exceptions flow in LPSs. To support the study, we developed an static analysis tool called PLEA (Product Line Exception Analyzer) that calculates the exceptional flows of LPSs, and categorize these flows according to the features associated with handlers and signalers. Preliminary results showed that some types of exceptional flows have more potential to yield failures in exceptional behavior of SLPs

Os farofeiros em excursão nas lagoas de Arituba, Boágua e Carcará (Nísia Floresta/RN): análise de uma outra face do turismo potiguar

This thesis analyzes another side of Potiguar tourism , the unplanned side, neglected and kept out of touristic activities: excursionism, a leisure practice enjoyed by tourists with low consumer power, and who are commonly referred by the pejorative term farofeiros (picnic lovers). The geographic research sites considered for this study include Arituba, Boágua and Carcará lakes in Nísia Florest, Rio Grande do Norte, where on Sundays and holidays the arrival of hundreds of excursionists, from around the metropolitan region of Natal, from surrounding municipalities, and neighboring States, such as Paraíba and Pernambuco, can be observed. The objective of this study is to analyze the appropriation of the physical site by the practice of excursionism, focusing on its relation to other social agents that also appropriate a designated touristic area. The theoretical discussion considers the use of the space by the touristic leisure practice and the appropriation by distinct social agents, using categories of analysis, such as, production of the space, territory and leisure. The field work was completed with interviews and questionnaires administered to excursionists, excursion organizers, local merchants, representatives of the public setor from the municipalities, and professional dune buggy drivers; besides this, photos, informal dialogue and field observations were important methodological instruments used. From the data, statistical analysis and the development of thematic maps demonstrating the established flux between excursionists and the segregated activity were done. With this research, one can affirm that the practice of excursionism is neglected by the public sector, contrary to the intention of the hegemonic agent‟s intentionality present in this touristic territory which aim at the development of a lucrative activity, geared toward tourists with greater spending power. This ignored and neglected faction of Potiguar tourism is considered poor or dirty , and generate conflicts among the distinct social agents: tourists, the market and the public sector, simultaneously peaking interest, which is then appropriated by the informal sector and formal economy. Excursionism is an expressive phenomenon, a socially relevant practice, enjoyed by citizens of the working class who, in order to have a day of leisure, use alternative consumer practices and subvert various strategies of segregation that are imposed within these tourist areas, behavior that, in part, justifies the nickname, picnic lovers , given to these tourists

Análise e monitoramento geoambiental da praia de Genipabu/RN

Issues concerning coastal regions, especially the beaches have sparked quite complex because studies are there that most people in the world has secured housing, mainly from the half of the last century, without concern for the natural dynamics of these environments, which have complex interactions of continental and oceanic, coastal responsible for changes in locations that can be perceived in a few years and sometimes even a few days or hours. The search took as main goal, analyze the Genipabu Beach, in the municipality of Extremoz/RN, fragile environment and rapid momentum, which has been occupied in a disorderly and unplanned. Carried out a beach monitoring through profiles beach environments: defined stages morphodynamics; realization of characterize hydrodynamic processes; identification of changes in the landscape. To this end, made necessary a survey from the bibliographic collection for theoretical and conceptual rationale. An empirical step for conducting the environmental characterization of hydrodynamics, leveling and topographic analysis of sediments (in laboratory), for observation of changes in features, influenced, and natural dynamics, anthropic action that increasingly comes taking the characteristics from the natural landscape. Underlines therefore the importance of academic studies in several areas in these environments, for setting up a coastal zoning giving public subsidies for managers for managing and planning the use and occupation of the coast in their areas

Evidências de validade do Millon Behavioral Medicine Diagnostic na avaliação de aderência terapêutica em pacientes com insuficiência cardíaca crônica

Chronic heart failure (CHF) is the final common pathway of most diseases affecting the heart, being responsible for a high level of mortality and hospitalization, as well as significant reduction in quality of life of those affected. Interventions that claim to optimize patient adherence to their medical regimen, and improve self-care behavior, have proven effective in preventing unplanned admissions and improves the outcome for patients, however, studies have shown the problem of non-adherence, and some psychological instruments have been used to show that traces indicate difficulties with treatment adherence. Having shown this, the aim of this work is to evaluate the evidence of validity of the Millon Behavioral Medicine Diagnostic (MBMD) in a population of patients with CHF. The study included individuals with CHF, males and females, between the age of 18 and 85 years, treated in a reference hospital in the city of NatalRN. A total of 120 patients answered, in addition to the MBMD, another questionnaire structured with sociodemographic aspects and clinical itens. The results indicated that the parameter of the MBMD reliability was satisfactory the most of extracted factors, and some scale. In terms of the population studied, we could verify that the disease was more prevalent in men, but women had the highest average in indicators related to negative health habits and depressed mood. Younger pacients and those who had no partner had the highest averages in groups of items that dealt with feelings of sadness and discouragement. Hasn’t been observed differences related to negative health habits and problematic adherence among patients in different functional classes. More studies in this research line, with a larger population and from other regions of the country, are needed in order to expand the data presented here

Perfis e práticas dos profissionais de saúde mental em dois hospitais psiquiátricos de grande porte

In the Brazilian network of psychosocial care, health professionals are important actors in the process of transformation of mental health public policies among various services. In the reality of psychiatric hospitals, one should understand the need to expand the debate about the current context of practices developed. This study aimed at analyzing the process of psychiatric reform and the mental health policy in the State of Rio Grande do Norte (RN) from the profiles and practices of higher-level professionals in two psychiatric hospitals. This is a cross-sectional and descriptive research, with quantitative and qualitative data, conducted in two psychiatric hospitals of RN. The universe of the target population was 95 professionals, taking into account the margin of error of 8%, non-response rate and the inclusion criteria: holding effective link with the institution by means of approval in public examination for, at least, six months, being state or municipal servant; having a minimum weekly workload of 20 hours in service; participating in care and/or activities with patients and families in a direct way. The final sample consisted of 60 professionals. The tool for data collection was a questionnaire with closed and semi-open questions about socioeconomic profile, and mental health policies, practices and training. Quantitative data were tabulated in the statistical software SPSS, and simple and bivariate statistics, chi-square type, was used for analysis by adopting the significance level with the value p<0,05. In order to analyze data, the content analysis of Bardin was used. The qualitative findings obtained with the semi-open questions in Analyse Lexicale par Context d'un Ensemble de Segments de Texte (ALCESTE) were grouped into four thematic axes: Professional action in mental health; Mental health training; Scenarios of psychiatric reform and psychiatric hospitals; Mental health policies and practices: challenges for professionals in hospitals. The profile of professionals has revealed the majority of women (89,7%), nurses (36,7%), aged 50-59 years (42,9%), weekly workload of 40 hours (52,4% ), time of completion of graduation from six to 15 years (57%), and 21,4% reported to have specialization in mental health. Regarding the practices developed in individual care, it was found an association between those who do not build or partially conducts the therapeutic project and those who conduct care related to observation and annotation. In family care, it was obtained care consultation during crisis; and, in group care, recreational activities. In the analysis of thematic axes, it was noted that, despite changes identified in the profiles and practices of higher-level professionals in care services for mental health, with the implementation of new public policies for this field, the findings indicate the confluence of asymmetries and divergences in the actions of the teams in psychiatric hospitals, difficulties in managing services, frequent readmissions, reduced quantitative of available services and equipment, high demand of users, disarticulation of the network of psychosocial care, and the very shortage of skilled human resources to compose these services. Accordingly, the evidenced scenarios partially outline the current political and ideological mismatch of the national process of psychiatric reform that denies the role of care actions conducted within hospitals, although it has not gone far enough with the creation of new services that justify the total extinction of this institution

Avaliação da atenção humanizada ao abortamento em maternidade-escola, em Natal, Rio Grande do Norte

Unplanned pregnancy is experienced by millions of women worldwide. Such fact increases the risk of abortion-related morbimortality, which represents a serious public health problem. This study aims to evaluate the advances and challenges of the implementation of Humanized Abortion Care at the Maternity-School in Natal, state of Rio Grande do Norte. The research was evaluative, was preceded by an Evaluative Study, and resulted in a Case Study. The intentional sample totaled 102 subjects (60 users, 39 professionals and 3 managers). The collection techniques included documental analysis, semi-structured interview and observation with a field diary. The documental analysis was descriptive, while the Content Analysis by Bardin was used for semi-structured interviews and field diary. The Evaluative Study observed that Humanized Abortion Care is an evaluative program with preparation and pact of the logical model, of the matrix of indicators and evaluative questions. The Case Study showed that users were satisfied with the problem-solving capacity and access to the service; however, is also showed that they pointed out inadequacy in terms of environment, qualified hearing and reproductive planning. Professionals reported that the inefficiency of service consists of infrastructure and environment, which are considered inefficient and inadequate to humanized care, especially regarding patient accommodation, the lack of hospital beds, the reduced number of rooms in the surgical center and the lack of laboratory inside the maternity. Moreover, reproductive planning does not consist of an institutionalized practice in the service, and integrality with other services or partnership with the community is not in place. The Maternity Board emphasizes that the excessive demand of patients is one of the reasons that hinders the appropriate implementation of the technical standard. We then conclude that although satisfied regarding problem-solving capacity in terms of service and ease of access, there is room for improvement in qualified hearing systems, in the creation of a system to promote team work, implementation of ombudsman and satisfaction surveys. The right of shared choice did not prevail among users and health professionals with regard to the option of uterine evacuation procedure. Environment was the most mentioned category as that requiring more changes, seeing as a limited factor for the development of humanized and welcoming practices. Health professionals do not establish a periodic routine of planning practices, and such practices are not aligned with the Technical Standard. Incorporation of guidelines and availability of a plurality of methods and possibilities of choices for family planning are required. There is no institutionalization of reference and counter-reference, or partnerships with the community, which makes integrality of care not viable. The Standard needs to be included in the action plans of managers as one of the priorities in the construction of care strategies for women's health, in order to enable, allied to other initiatives, the real integration among safe conduct service, primary care network and social organizations. As a result, respect for human rights and adequate humanized care, as a way of attention and prevention of abortion, can be secured.