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

Gestão estratégica no terceiro setor: uma análise comparativa da construção de mapas estratégicos de organizações sem fins lucrativos

The strategy has an important role in organizations by identifying factors that need to be emphasized to organizational success and strategic map currently contemplates as a preview of organizational strategy, prepared from your planning. Third sector organizations need to take a competitive posture, establishing a sustainable position and maximizing the use of resources towards their social or humanitarian goals. This research aims to investigate the process of building strategic maps of two non-profit organizations by identifying and characterizing the steps common to these organizations. The research is characterized as qualitative descriptive and applied knowledge. Developed from bibliographical reviews and participant observation gathered in a case study, the data was collected in two third sector organizations and the results show that how to conduct the process may influence directly on your result lists. Among the steps identified, emphasis can be given to the formation of a team, the definition of strategy, the definition of strategic objectives, the gathering of those goals into perspective and the identification of the cause-effect relationship that relate. Marked as optional, but effective, conducting an event outside the premises of the company to complete the process, or any portion thereof. However, stands out as essential the active participation of senior management in the process, as a way to give credit to the initiative. These steps, its characteristics and its factors are described from comparisons between the processes adopted by the organizations surveyed

Uma proposição para o cálculo de mapas de disparidade de imagens estéreo usando um interpolador neural baseado em funções de base radial

This study aims to seek a more viable alternative for the calculation of differences in images of stereo vision, using a factor that reduces heel the amount of points that are considered on the captured image, and a network neural-based radial basis functions to interpolate the results. The objective to be achieved is to produce an approximate picture of disparities using algorithms with low computational cost, unlike the classical algorithms

Contribuições a técnicas de agrupamento e visualização de dados multivariados utilizando mapas auto-organizáveis

Self-organizing maps (SOM) are artificial neural networks widely used in the data mining field, mainly because they constitute a dimensionality reduction technique given the fixed grid of neurons associated with the network. In order to properly the partition and visualize the SOM network, the various methods available in the literature must be applied in a post-processing stage, that consists of inferring, through its neurons, relevant characteristics of the data set. In general, such processing applied to the network neurons, instead of the entire database, reduces the computational costs due to vector quantization. This work proposes a post-processing of the SOM neurons in the input and output spaces, combining visualization techniques with algorithms based on gravitational forces and the search for the shortest path with the greatest reward. Such methods take into account the connection strength between neighbouring neurons and characteristics of pattern density and distances among neurons, both associated with the position that the neurons occupy in the data space after training the network. Thus, the goal consists of defining more clearly the arrangement of the clusters present in the data. Experiments were carried out so as to evaluate the proposed methods using various artificially generated data sets, as well as real world data sets. The results obtained were compared with those from a number of well-known methods existent in the literature

Experimentos mentais e suas potencialidades didáticas

A review of some articles on thought experiments shows that the use of these tools as resources seems to be very useful in understanding some phenomena that are very difficult to be observed in a real laboratory. In this paper we present an analysis and discussion about the very characteristics of though experiments as a potential instrument for physics teaching.

Utilizando mapas de conectividade fuzzy no desenvolvimento de algoritmos reparadores de imagens binárias 3D

A 3D binary image is considered well-composed if, and only if, the union of the faces shared by the foreground and background voxels of the image is a surface in R3. Wellcomposed images have some desirable topological properties, which allow us to simplify and optimize algorithms that are widely used in computer graphics, computer vision and image processing. These advantages have fostered the development of algorithms to repair bi-dimensional (2D) and three-dimensional (3D) images that are not well-composed. These algorithms are known as repairing algorithms. In this dissertation, we propose two repairing algorithms, one randomized and one deterministic. Both algorithms are capable of making topological repairs in 3D binary images, producing well-composed images similar to the original images. The key idea behind both algorithms is to iteratively change the assigned color of some points in the input image from 0 (background)to 1 (foreground) until the image becomes well-composed. The points whose colors are changed by the algorithms are chosen according to their values in the fuzzy connectivity map resulting from the image segmentation process. The use of the fuzzy connectivity map ensures that a subset of points chosen by the algorithm at any given iteration is the one with the least affinity with the background among all possible choices

Modelagem e desenvolvimento de um banco de dados geográficos : aplicação à elaboração de mapas de sensibilidade ambiental ao derramamento de óleo na área costeira entre galinhos e São Bento do Norte-RN

The area between Galinhos and São Bento do Norte beaches, located in the northern coast of the Rio Grande do Norte State is submitted to intense and constant processes of littoral and aeolian transport, causing erosion, alterations in the sediments balance and modifications in the shoreline. Beyond these natural factors, the human interference is huge in the surroundings due to the Guamaré Petroliferous Pole nearby, the greater terrestrial oil producing in Brazil. Before all these characteristics had been organized MAMBMARE and MARPETRO projects with the main objective to execute the geo-environmental monitoring of coastal areas on the northern portion of RN. There is a bulky amount of database from the study area such as geologic and geophysical multitemporal data, hydrodynamic measurements, remote sensing multitemporal images, thematic maps, among others; it is of extreme importance to elaborate a Geographic Database (GD), one of the main components of a Geographic Information System (GIS), to store this amount of information, allowing the access to researchers and users. The first part of this work consisted to elaborate a GD to store the data of the area between Galinhos and São Bento do Norte cities. The main goal was to use the potentiality of the GIS as a tool to support decisions in the environmental monitoring of this region, a valuable target for oil exploration, salt companies and shrimp farms. The collected data was stored as a virtual library to assist men decisions from the results presented as digital thematic maps, tables and reports, useful as source of data in the preventive planning and as guidelines to the future research themes both on regional and local context. The second stage of this work consisted on elaborate the Oil-Spill Environmental Sensitivity Maps. These maps based on the Environmental Sensitivity Index Maps to Oil Spill developed by the Ministry of Environment are cartographic products that supply full information to the decision making, contingency planning and assessment in case of an oil spilling incident in any area. They represent the sensitivity of the areas related to oil spilling, through basic data such as geology, geomorphology, oceanographic, social-economic and biology. Some parameters, as hydrodynamic data, sampling data, coastal type, declivity of the beach face, types of resources in risk (biologic, economic, human or cultural) and the land use of the area are some of the essential information used on the environmental sensitivity maps elaboration. Thus using the available data were possible to develop sensitivity maps of the study area on different dates (June/2000 and December/2000) and to perceive that there was a difference on the sensitivity index generated. The area on December presented more sensible to the oil than the June one because hydrodynamic data (wave and tide energy) allowed a faster natural cleaning on June. The use of the GIS on sensitivity maps showed to be a powerful tool, since it was possible to manipulate geographic data with correctness and to elaborate more accurate maps with a higher level of detail to the study area. This presented an medium index (3 to 4) to the long shore and a high index (10) to the mangrove areas highly vulnerable to oil spill

Estudo da dinâmica costeira da região da foz do rio Piranhas-Açu para geração de mapas de sensibilidade do litoral ao derramamento de óleo

The study area is located in the northern coast of Rio Grande do Norte State comprising the mouth of Açu-Piranhas river including the cities of Porto do Mangue e Areia Branca. The local geological setting comprises Cretaceous, Tertiary and Quaternary geological units of the Potiguar Basin. One is about a region of high morphologic instability due to action of the rigorous dynamic coastal processes, beyond the intense human activities mainly for the performance of the petroliferous industry, salt farms and tanks of shrimp industry.For the accomplishment of this work Landsat 5 TM and Landsat 7 ETM + from four distinct dates were used as cartographic base, in which one applied techniques of digital processing to elaborate thematic maps of the existing natural resources to support the geologic and geomorphologic characterization and the soil and landuse maps. The strategy applied was the interpretation of multitemporal images from aerial and orbital remote sensors alIied to the terrain truth recognition, integrated through a Geographic Information System. These activities had alIowed the production of Sensitivity Maps of the Coast to Oil Spilling for the area, on the basis of the Coastal Sensibility Index. Taking into account the seasons were created maps to distinct datas: July 2003 represents the winter months that presented a sensibility lower when compared with the month of December 2003. For the summer months greater sensitivity is due to the hydrodynamic data that suggest a lesser capacity of natural cleanness of the oil and its derivatives in spilling case.These outcomes are an important and useful database to support an assessment to a risk situation and to taking decision in the face of an environmental disaster with oil spilling in coastal area, alIowing a complete visualization of the area and identifying all portions in the area with thei environmental units and respective Coastal Sensibility Index.

Desenvolvimento de um sistema computacional para geração automática de mapas de vulnerabilidade como ferramenta de auxílio às ações de prevenção ao derramamento de óleo em áreas costeiras

The northern portion of the Rio Grande do Norte State is characterized by intense coastal dynamics affecting areas with ecosystems of moderate to high environmental sensitivity. In this region are installed the main socioeconomic activities of RN State: salt industry, shrimp farm, fruit industry and oil industry. The oil industry suffers the effects of coastal dynamic action promoting problems such as erosion and exposure of wells and pipelines along the shore. Thus came the improvement of such modifications, in search of understanding of the changes which causes environmental impacts with the purpose of detecting and assessing areas with greater vulnerability to variations. Coastal areas under influence oil industry are highly vulnerable and sensitive in case of accidents involving oil spill in the vicinity. Therefore, it was established the geoenvironmental monitoring of the region with the aim of evaluating the entire coastal area evolution and check the sensitivity of the site on the presence of oil. The goal of this work was the implementation of a computer system that combines the needs of insertion and visualization of thematic maps for the generation of Environmental Vulnerability maps, using techniques of Business Intelligence (BI), from vector information previously stored in the database. The fundamental design interest was to implement a more scalable system that meets the diverse fields of study and make the appropriate system for generating online vulnerability maps, automating the methodology so as to facilitate data manipulation and fast results in cases of real time operational decision-making. In database development a geographic area was established the conceptual model of the selected data and Web system was done using the template database PostgreSQL, PostGis spatial extension, Glassfish Web server and the viewer maps Web environment, the GeoServer. To develop a geographic database it was necessary to generate the conceptual model of the selected data and the Web system development was done using the PostgreSQL database system, its spatial extension PostGIS, the web server Glassfish and GeoServer to display maps in Web

Prevalência e fatores de risco para transtornos mentais comuns entre estudantes de medicina

OBJETIVO: Estimar a prevalência de transtornos mentais comuns entre estudantes de medicina e respectivos fatores de risco. MÉTODOS: Estudo transversal realizado com 551 universitários de um curso de medicina de Botucatu, SP. Utilizou-se questionário auto-aplicável investigando aspectos sócio demográficos, relacionados ao curso e o Self Reporting Questionnaire. Para análise dos dados empregaram-se os testes de qui-quadrado e regressão logística. RESULTADOS: Participaram 82,6% dos alunos matriculados no curso, predominando mulheres (61%), jovens (60% 20-23 anos), procedentes de outros municípios (99%). A prevalência de transtornos mentais comuns foi de 44,7% associando-se independentemente a: dificuldade para fazer amigos (RC=2,0), avaliação ruim sobre desempenho escolar (RC=1,7), pensar em abandonar o curso (RC=5,0), não receber o apoio emocional de que necessita (RC=4,6). Embora na primeira análise a prevalência tenha se mostrado associada ao ano do curso, esta associação não se manteve na análise multivariada. CONCLUSÕES: A prevalência de transtornos mentais comuns mostrou-se elevada entre os estudantes de medicina, associando-se a variáveis relacionadas à rede de apoio. As experiências emocionalmente tensas como o contato com pacientes graves, formação de grupos, entre outras, vividas nos últimos anos do curso, são provavelmente potentes estressores, especialmente para sujeitos com uma rede de apoio considerada deficiente. Sugere-se que instituições formadoras estejam atentas a esse fato, estabelecendo intervenções voltadas ao acolhimento e ao cuidado com o sofrimento dos estudantes.

Transtornos mentais comuns e uso de psicofármacos: impacto das condições socioeconômicas

OBJETIVO: Avaliar a influência das condições socioeconômicas na associação entre transtornos mentais comuns, uso de serviços de saúde e de psicofármacos. MÉTODOS: Estudo transversal populacional conduzido na cidade de Botucatu, SP, com amostragem probabilística, estratificada e por conglomerados. Foram realizadas entrevistas domiciliares com 1.023 sujeitos de 15 anos ou mais de idade, entre 2001 e 2002. Transtorno mental comum foi avaliado utilizando o Self Reporting Questionnaire (SRQ-20). O uso de serviços foi investigado com relação à quinzena anterior à entrevista e uso de psicotrópicos, nos três dias anteriores. Utilizou-se regressão logística para análise multivariável, considerando o efeito do desenho. RESULTADOS: No total da amostra, 13,4% (IC 95%: 10,7;16,0) procuraram serviços de saúde na quinzena anterior à entrevista. A procura de serviços de saúde se associou ao sexo feminino (OR=2,0) e à presença de transtorno mental comum (OR=2,2). Na amostra 13,3% (IC 95%: 9,2;17,5) referiram ter usado ao menos um psicotrópico, destacando-se os antidepressivos (5,0%) e os benzodiazepínicos (3,1%). Na análise multivariável, sexo feminino e presença de transtorno mental comum mantiveram-se associados ao uso de benzodiazepínicos. Renda per capita mostrou-se direta e independentemente associada ao uso de psicofármacos, conforme aumento da renda. CONCLUSÕES: Menor renda associou-se à presença de transtorno mental comum, mas não ao uso de psicotrópicos. A associação entre transtorno mental comum e uso de psicotrópicos e maior renda reforça a hipótese da existência de iniqüidades no acesso à assistência médica na população estudada.

Desinstitucionalização dos cuidados a pessoas com transtornos mentais na atenção básica: aportes para a implementação de ações

Parte-se do interesse dispensado contemporaneamente às articulações entre saúde mental e atenção básica. Após uma breve síntese histórica e conceitual neste campo, discutem-se aspectos operativos da desinstitucionalização dos cuidados a pessoas com transtornos mentais na atenção básica. Com a análise de alguns estudos e experiências são destacados, a seguir, componentes fundamentais para avançar neste sentido: (1) desenvolver processos de comunicação que visem ampliar a legibilidade profissional, (2) superar a centralização em ações restritas aos enquadres tradicionais, (3) manter questionamento permanente com relação ao risco de psiquiatrização do cuidado em saúde mental, (4) superar concepções culpabilizantes do grupo familiar, e (5) investir na formação das equipes de atenção básica para as múltiplas dimensões do cuidado em saúde mental. Apontam-se, desta forma, alguns caminhos e direções possíveis para o desenho de ações de saúde mental na atenção básica que tenham, no horizonte, a perspectiva antimanicomial.

Mapas de dor corporal aprimoram os relatos das queixas dolorosas em pacientes com dor orofacial

JUSTIFICATIVA E OBJETIVOS: Identificar as queixas dolorosas dos pacientes é essencial para determinar diagnósticos e intervenções terapêuticas adequadas em dor orofacial (DOF). Assim, o objetivo deste estudo foi verificar a frequência das queixas de dor relatadas comparando-as àquelas marcadas pelos pacientes em mapas de dor. MÉTODO: Os dados foram coletados dos prontuários de 532 pacientes da Clínica de Dor Orofacial da Faculdade de Odontologia de Araraquara. Os indivíduos responderam a um questionário informando suas queixas de dor e completaram um mapa corporal indicando as áreas dolorosas. A frequência dos relatos foi comparada à frequência dos locais identificados nos mapas. Foram consideradas nove regiões anatômicas: cabeça, face, pescoço, ombros, braços, tórax, abdômen, costas e pernas. Também foram calculados sensibilidade, especificidade e valores kappa comparando os relatos de dor aos mapas, os últimos considerados padrão-ouro. RESULTADOS: A média etária da amostra foi de 33,5 ± 13,8 anos, 33,9 ± 13,9 anos para as mulheres e 31,7 ± 13,1 anos para os homens. Foi observada maior prevalência de dor entre as mulheres. em ambos os gêneros, as regiões com mais queixas de dor estavam localizadas na parte superior do corpo e uma diferença significativa entre os relatos de dor e os desenhos de dor foi observada para as regiões abaixo do pescoço. Os mapas de dor corporal demonstraram superioridade sobre os relatos de dor na identificação das queixas dolorosas durante a anamnese. CONCLUSÃO: O relato da queixa principal não foi um método eficiente para conhecer todas as queixas dolorosas, pois os mapas corporais evidenciaram a presença de dores adicionais em pacientes com DOF.

Condições de trabalho e transtornos mentais comuns em trabalhadores da rede básica de saúde de Botucatu (SP)

Os transtornos mentais comuns (TMC) apresentam elevada prevalência em populações gerais e de trabalhadores, com consequências individuais e sociais importantes. Este estudo, transversal e descritivo, explora a relação entre demandas psicológicas, grau de controle e presença de suporte social no trabalho e prevalência de TMC em trabalhadores da rede básica de saúde de Botucatu (SP). A coleta de dados foi feita por meio de questionário autoaplicável, não identificado, com destaque para itens relativos à demanda-controle-suporte e presença de TMC (Self Reporting Questionnaire, SRQ-20). As informações foram inseridas em banco de dados construído com Excel/Office XP 2003 e a análise estatística, efetuada com o programa SAS. Constatou-se que 42,6% dos trabalhadores apresentavam TMC. A observação de associação - alta prevalência de TMC com elevado desgaste (classificação de Karasek) e baixa prevalência de TMC com baixo desgaste - indica que, no município estudado, as condições de trabalho na atenção básica constituem fator contributivo não negligenciável ao adoecimento dos trabalhadores. Revela-se a necessidade de intervenções direcionadas ao cuidado aos trabalhadores, melhoria das condições de trabalho e aumento do suporte social no trabalho.

Aspectos físicos e mentais na qualidade de vida de pacientes com doença de Parkinson idiopática

A doença de Parkinson (DP) é um distúrbio crônico e progressivo, caracterizado pela degeneração de neurônios dopaminérgicos da substantia nigra mesencefálica. A lesão das vias subcorticais, em especial a nigro-estriato-palidal, é particularmente comum e ocasiona uma série de sinais e sintomas incapacitantes. O objetivo deste trabalho foi analisar a qualidade de vida (QV) relacionada à saúde de sujeitos com DP e compará-la à de indivíduos controles saudáveis. Foram avaliados 40 sujeitos com idades entre 61 e 83 anos, de ambos os sexos, que foram divididos em dois grupos: grupo Parkinson (n=21), composto por sujeitos com DP idiopática, e grupo controle (n=19), de indivíduos sem distúrbios neurodegenerativos. Para a coleta de dados, foi utilizada a versão brasileira do questionário Brasil SF-36. Os resultados foram analisados estatisticamente, com nível de significância fixado em 1%. Os sujeitos do grupo Parkinson apresentaram escores significativamente mais baixos do que os do grupo controle, tanto no domínio físico quanto no mental, medidos pelo SF-36. Essa baixa QV provavelmente é explicada pela co-ocorrência de fenômenos neurodegenerativos e do sofrimento psíquico gerado pela doença e pelo estigma que ela produz. Abordagens interdisciplinares devem ser estimuladas a pacientes com DP, com o objetivo de melhorar sua qualidade de vida e postergar o declínio físico e mental inerente às condições degenerativas.