Plano de carreira, cargos e salários: ferramenta favorável à valorização dos recursos humanos em saúde pública

Human recourses on Brazilian Health System (SUS) are important social points because on this form the State can guarantee the health like a right of Brazilian population, based on National Constitution Dictates. The Plan of Offices, Careers and Salaries (PCCS) is an administrative tool that should be elaborated to attendance objectives of organization. It maintain the satisfaction level of workers, with a politic of Human Recourses that allows its development and so, can get higher productivity, efficiency and objectivity of services rendered at community. The aim of this study is to contextualize the PCCS like an instrument of People Management to guide and incentive one of forms to turn no precarious the work force of Public System Dental Professionals in SUS. For them, it was realized a literature review, and official documents of Health Ministry were consulted, like governmental decrees, laws, health conference written report. It was possible to verify that, although there is legal basement on the use of PCCS-SUS by Brazilian cities like a tool to attract and maintain dental surgeon developing his profession on SUS, is often the absence of valorization of this professional, and this situation no allows his exclusive dedication at health public services. Precarious work in Dentistry is still observed on many regions of Brazil.

Doença periodontal, diabete mellitus e hipertensão em gestantes usuárias do Sistema Único de Saúde (SUS)

Purpose: To evaluate the association among periodontal disease, diabetes mellitus and arterial hypertension in pregnant women users of the Brazilian Health System (SUS). Methods: The sample consisted of 86 women, with pregnant age between the 4th and 7 th month, submitted to pre-natal attendance in Health Basic Unities (HBUs). Periodontal condition was evaluated by 2 calibrated researchers (Kappa = 0.91) through the Community Periodontal Index (CPI). A sphygmomanometer was used to check the arterial pressure, what was accomplished by the professionals from the HBUs; glycemia test was accomplished through a blood sample collected from the middle finger with a disposable lancet adapted to a lance device (Accu-Chek Softclix Pro; Roche, USA), and for checking the glycemia level, a glycemia monitor was used (Accu-Chek Advantage II, Roche, USA). Data were written on a numbered register form, avoiding patient identification. After, the same data were statistically analyzed through the Fisher Exact Test, in order to evaluate the existence of association between the variables blood glucose and periodontal disease. In this test, a significance level of 0,05 was adopted. Results – Most of the pregnant woman presented periodontal health (58,1%); 41,9% of the research subjects showed at least one sign of periodontal disease, with 31,4% presenting gingivitis and 10,5% periodontitis. Hyperglycemia was detected in 51,2% and it was not found a value of arterial pressure higher than what is considered to be normal. Conclusion: it was not verified a significant association among the presence of periodontal disease, glycemia alteration and arterial hypertension in pregnant women who comprised this research.

O princípio da integralidade no Sistema Único de Saúde (SUS): utopia?

The Brazilian Federal Constitution promulgated in 1988 created the concept of Social Welfare, which is based on the triad: Health, Social Security and Social Assistance. The Unified Health System (SUS) was then instituted. SUS is a conquest of a society that seeks social justice, integrality, equalitarian and universal access to health services. In the present essay, I succinctly discourse on the various meanings of integrality. I present the theoretical basis of complexity and transdisciplinarity by opposing to reductionism, aiming at showing that, by means of transdisciplinarity and intersectoriality, integrality can be achievable.

Acessibilidade e resolutividade em assistência oftalmológica para o SUS

Pós-graduação em Bases Gerais da Cirurgia - FMB

EFFECTS OF IMPLEMENTING EPA'S ENDANGERED SPECIES PROTECTION PROGRAM ON NATIONAL FOREST SYSTEM LANDS

In 1986, the U.S. Environmental Protection Agency (EPA) initiated an effort to comply more fully with the Endangered Species Act. This effort became their "Endangered Species Protection Program." The possibility of such a program was forecast in 1982 when Donald A. Spencer gave a presentation to the Tenth Vertebrate Pest Conference on "Vertebrate Pest Management and Changing Times." This paper focuses on current plans for implementing the EPA's Endangered Species Protection Program as it relates to the USDA Forest Service. It analyzes the potential effects this program will have on the agency, using the pocket gopher (Thomomys spp.), strychnine, and the grizzly bear (Ursus arctos horribilis) as examples of an affected pest, pesticide, and predator.

Acessibilidade e resolutividade em assistência oftalmológica para o SUS

Pós-graduação em Bases Gerais da Cirurgia - FMB

Electroconvulsive Therapy in Brazil After the "Psychiatric Reform" A Public Health Problem-Example From a University Service

Objectives: The Brazilian public health system does not provide electroconvulsive therapy (ECT), which is limited to a few academic services. National mental health policies are against ECT. Our objectives were to analyze critically the public policies toward ECT and present the current situation using statistics from the Institute of Psychiatry of the University of Sao Paulo (IPq-HCFMUSP) and summary data from the other 13 ECT services identified in the country. Methods: Data regarding ECT treatment at the IPq-HCFMUSP were collected from January 2009 to June 2010 (demographical, number of sessions, and diagnoses). All the data were analyzed using SPSS 19, Epic Info 2000, and Excel. Results: During this period, 331 patients were treated at IPq-HCFMUSP: 221 (67%) were from Sao Paulo city, 50 (15.2%) from Sao Paulo's metropolitan area, 39 (11.8%) from Sao Paulo's countryside, and 20 (6.1%) from other states; 7352 ECT treatments were delivered-63.0% (4629) devoted entirely via the public health system (although not funded by the federal government); the main diagnoses were a mood disorder in 86.4% and schizophrenia in 7.3% of the cases. Conclusions: There is an important lack of public assistance for ECT, affecting mainly the poor and severely ill patients. The university services are overcrowded and cannot handle all the referrals. The authors press for changes in the mental health policies.

Mental Disorders in Megacities: Findings from the Sao Paulo Megacity Mental Health Survey, Brazil

Background: World population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. Sao Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders. Methods and Results: A representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year. Discussion: Adults living in Sao Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries.

The relationship between obesity, autoimmune disease, and C-reactive protein: A secondary data analysis of the National Health and Nutrition Examination Survey (NHANES) 2009--2010

Autoimmune diseases are a group of inflammatory conditions in which the body's immune system attacks its own cells. There are over 80 diseases classified as autoimmune disorders, affecting up to 23.5 million Americans. Obesity affects 32.3% of the US adult population, and could also be considered an inflammatory condition, as indicated by the presence of chronic low-grade inflammation. C-reactive protein (CRP) is a marker of inflammation, and is associated with both adiposity and autoimmune inflammation. This study sought to determine the cross-sectional association between obesity and autoimmune diseases in a large, nationally representative population derived from NHANES 2009–10 data, and the role CRP might play in this relationship. Overall, the results determined that individuals with autoimmune disease were 2.11 times more likely to report being overweight than individuals without autoimmune disease and that CRP had a mediating affect on the obesity-autoimmune relationship. ^

Applying the WHO recommendations on health-sector response to violence against women to assess the Spanish health system. A mixed methods approach

This methodological note describes the development and application of a mixed-methods protocol to assess the responsiveness of Spanish health systems to violence against women in Spain, based on the World Health Organization (WHO) recommendations. Five areas for exploration were identified based on the WHO recommendations: policy environment, protocols, training, accountability/monitoring, and prevention/promotion. Two data collection instruments were developed to assess the situation of 17 Spanish regional health systems (RHS) with respect to these areas: 1) a set of indicators to guide a systematic review of secondary sources, and 2) an interview guide to be used with 26 key informants at the regional and national levels. We found differences between RHSs in the five areas assessed. The progress of RHSs on the WHO recommendations was notable at the level of policies, moderate in terms of health service delivery, and very limited in terms of preventive actions. Using a mixed-methods approach was useful for triangulation and complementarity during instrument design, data collection and interpretation.

Drug program report : the National Training System, a year of transition, 1981-1982.

"Written for the Training Division, National Institute on Drug Abuse by the Career Development Center, HCS, Inc., ... under contract number 271-80-4807"--T.p. verso.

The evaluation of information systems in the organisational context of the National Health Service. Available in 2 volumes.

This thesis describes a project which has investigated the evaluation of information systems. The work took place in, and is related to, a specific organisational context, that of the National Health Service (NHS). It aims to increase understanding of the evaluation which takes place in the service and the way in which this is affected by the NHS environment. It also investigates the issues which surround some important types of evaluation and their use in this context. The first stage of the project was a postal survey in which respondents were asked to describe the evaluation which took place in their authorities and to give their opinions about it. This was used to give an overview of the practice of IS evaluation in the NHS and to identify its uses and the problems experienced. Three important types of evaluation were then examined in more detail by means of action research studies. One of these dealt with the selection and purchase of a large hospital information system. The study took the form of an evaluation of the procurement process, and examined the methods used and the influence of organisational factors. The other studies are concerned with post-implementation evaluation, and examine the choice of an evaluation approach as well as its application. One was an evaluation of a community health system which had been operational for some time but was of doubtful value, and suffered from a number of problems. The situation was explored by means of a study of the costs and benefits of the system. The remaining study was the initial review of a system which was used in the administration of a Breast Screening Service. The service itself was also newly operational and the relationship between the service and the system was of interest.

Rede de atendimento socioeducativo: possibilidades e limites da garantia de direitos

The results of the research systematized on this analysis sought apprehend the linkage of the socio-educational service network, destined to adolescents who comply with socioeducational measure of confinement, in the region of the Seridó of the state of the Rio Grande do Norte, especially in the city of Caicó, central town of this region. The achievement of this study was stimulated by the interest in unraveling the contradictory reality imposed by neoliberal State, sparing the guarantee of rights, especially to these teens, who are seen as authors of violations and are stigmatized by capitalist society. The research was carried in the period July-September 2013, under critical perspective, using the documental analysis and the observational techniques and interviews with professionals of the Educational Center (CEDUC), of the Unified Health System (SUS), of the Social Policies of Social Assistance, and of the State Department of Education, which should make the service network that gravitates around the National System of Socio-educational Services (SINASE). The Statute of Children and Adolescents (ECA) and SINASE define that the application of socioeducational measures cannot occur isolated of the public policies, becoming indispensable the linkages of the system with the social policies of social assistance, education and health. However, it was observed that the neoliberal logic of the capitalist State has developed broken, disconnected, focal and superficial social policies, who fail give effect to the rights acquired beyond the legal sphere. In this perspective, it is possible affirm that the everyday of the Brazilian poor teens is marked by the action of the State, which aims to control those who disturb the order of capital, who threaten the production, the market, the consume and the private property. This way, actions are promoted criminalizing poverty and imprint a legal action over this expression of the social issue to the detriment of social policies that meet the real needs of adolescents. Face of this reality, it becomes necessary to put on the agenda of the here and now to fight for rights, aiming at a broad public debate involving professionals, researchers and social movements in support of the viability of rights, which aims to support reflections and to strengthen ways to confront this social problem. With the approximations of this study, it was learned that the struggle for rights is a fight for another project of society, beyond what is laid.

A formação do nutricionista para atuação no SUS: um olhar sobre a produção científica obrigatória dos cursos do Rio Grande do Norte

The National Curricular Guidelines for nutrition course predict training directed to the work in the Unified Health System (SUS) and the mandatory completion of course work. The aim of this study was to analyze the formation of dieticians in Rio Grande do Norte state/Brazil to work in the SUS, from the compulsory scientific production provided for training. This is a bibliometric study, quantitative approach, performed with completion of course works of five nutrition undergraduate courses in Rio Grande do Norte state in the years 2013/2013. From the reading of the works, the following variables were collected: nature of the institution, institution administrative category, location, work title, number of authors, work format, titration of the teacher advisor, study type, area of interest, scenery of accomplishment, submission to the ethics committee, suitability of descriptors and, as pertaining to the field of public health, the subfield of public health and the theme. The pedagogical projects of the courses were read and were identified opportunities to develop research in the graduation. For detection of significant categories we applied the Pearson chisquare test. We analyzed 195 works, coming mostly belonging to universities courses (79.0%) and private institutions (56.4%). A higher frequency of articles (68.2%), developed by one student (65.6%), guided by master teachers (57.9%), with cross-sectional study design (49.2%), conducted in laboratory (25%) and without submission to the ethics committee in research (49.2%) was find. The median adequacy of descriptors was 50%. As for the interest of the study, there was a higher frequency of work in the field of public health (p <0.001), within this subfield highlighting the nutritional epidemiology (63.0%) (p <0.001) and the subject nutrition assessment (57, 4%) (p <0.001). In cut on three major areas of dietician performance, was significant performing work in the field of public health in public institutions (p <0.05). The presence of complementary activities was unanimous in the pedagogical projects of the courses. The results of the study showed some methodological weaknesses in the research approaches, as well as a hegemonic positivist training. Despite the emphasis on public health, it was noticed little approximation of policies and nutrition programs in the context of the mandatory recearch of Rio Grande do Norte state nutrition courses.

Serviços-escola de psicologia do Rio Grande do Norte: formação profissional e política pública de saúde em debate

The Psychology University Services is stablished normatively as an indispensable equipment to the recognition of the graduation courses of psychologists by the Brazilian Education Ministery. The Public Healthcare Policies (Universal Health System/SUS) constitutes itself as a input field of the professional category, but shows huge challenges in the formation of these professionals. The objective of this work is to analyse the functioning of the Psychology University Services (SEP) and the Superior Educational Institutions from Natal, understood as important formation devices to attend the actual demands of the psychologist's work on SUS. For this, it sought a) characterize the psychological practices developed in the SEP; b) relate the National Curricular Lines of Direction of the psychology courses to the skills and competences developed in the SEP to the performance on the public healthcare policies; c) mapping ways of including the SEP in the network designed by the healthcare policy. Interviews were performed with 13 academic supervisors, 8 field supervisors and technicians of superior level (TNC), along with 9 managers, being for of the Psychology University Services and 5 of the graduation programs. Questionnaires were also applied to 57 interns and 24 graduates. Besides that, two conversation circles were performed with the faculty and technician members from two of the Educational Institutions that were participating of the research, as well as a workshop with students and psychologists, promoted by the CRP 17. We observed that most part of the faculty members and managers know the DCN and comprehend that the formation is in process of change in what concerns to the extension of the formation to the performance of the psychologists in various contexts. However, most part of the TNC don't know about them. Moreover, the results point to the predominance of the assisting model based on the traditional clinic psychology, although the articulation with the public healthcare and social assistance networks can already be timidly visualized. Different modalities of practices in theses Psychology University Services were also detected, such as conversation groups, thematic workshops, organizational consultancies, team meetings with the interns and TNS in a daily basis, matriciament in mental health, therapeutic monitoring, among others. Yet, the SEP in Rio Grande do Norte are still isolated from the other courses that perform in the healthcare area and also from the services that compose the public healthcare and public policies.