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

Princípios da construção enxuta no processo de planejamento de uma construtora de grande porte de Natal (RN)

Considered as one of the oldest activities done by men, the civil construction represents one of the most important sectors for the economic growth of a country, in spite of the low results of growth in the past few years and also in the current year. To make this industry grow, even with an unfavourable economic scenario, it is necessary to implement an effective planning in its activities. This is one of the most important concepts brought by the Lean Construction philosophy, which had its origin through the adaptation of the concepts established by the Toyota Production System (TPS) or Lean Production. By having as a scenario the city of Natal\RN, the main goal of this dissertation consists in investigating how the 11 principles of the lean construction influenced the schedule of a construction field that started to implement its lean concepts. As a methodology, it was used the case study of a big enterprise located in Natal (RN). During the execution of the method, documents related to the short-term, midterm and long-term planning were analysed , aiming to describe its planning process; it was also described the factors that caused the delays at the enterprises’ field ;in addition, a comparison was made between the results obtained at the case study and the ones presented at the literature; in the end, the actions were listed by the company, which had the purpose to solve the main causes of delays, verifying if they were linked to the lean construction principles. This research finds its reason of existence in the relevance of its theme at the nowadays reality of the construction industry, since the principles of the lean construction uphold the reduction of processes that are useless, diminishing wastes as well as costs in construction. The relevance is perceived for the academy, in terms of the possibility to discuss if the concepts established by the lean production are being adapted to the civil construction sector and how this adaptation is influencing at the buildings planning project. Economic importance, because with the reduction of the wastes and costs, the companies may reduce the building´s value into a more accessible value, even with the sector´s lower growth. And social significance, because lean construction gives a better participation of the labour at the planning activity. Among the main results, the high frequency of planning errors stands out, mainly the programming deviations and not the task programming, as well as the execution errors, low productivity and activities executed by the workers. Amongst the 11 principles of lean construction, only five were related with the 12 actions analysed by the author. From the 12 actions, four were completely cohesive to one or more from these five principles. Some improvement proposals were also highlighted and established by the research.

Sustentabilidade e gestão da pesca artesanal na costa do Semiárido Potiguar (RN), Brasil

T he socio - economy of the coastal municipalities of Rio Grande do Norte semiarid coast was analyzed th r ou g h by the actors, ant hropogenic implications, fishing environment and composition of its fish fauna, as well as the trend of product ion landed by the artisanal fleet with the aim of identifying the sustainability and management. In this study, were used participatory methodologies, monthly data of rainfall between September 2001 and December 2010; landings of the artisanal fleet during January 2001 to December 2010; and socioeconomic (IBGE, 2002/2010), (IDEMA, 2011/2012), (MPA, 2010; 2012), UNDP and MS (2013). Based on these data, we performed analysis of variance were performed using the method of Analytic Hierarchy Process (HAP) and s tatistical models of multiple regression and time series. It was identified that the occupation of the coastal and marine zone through salt industry, tourism, shrimp farming, oil and gas and wind energy reconfigured the environment and attracted new actors . Rainfall influenced the catches, of which 35% occur in the rainy season, 40% in the dry season and 25% independent. Production increased 55%, in the period analyzed , being landed in 31 ports spread over 11 municipalities, cap tured in environments mangrov e/ estuarine (23%), coastal (46%) and oceanic (31%). Despite market up 41 species, were commercialized in the region production concentrated in eight, mainly landed in Macau and Caiçara North, by vessels of small and medium - sized (motorized and sailboats) . Highlights included three species ( Hirundichthys affins , Coryphaena hippurus and Opisthonema oglinum ), which together accounted for 63.3% of the whole volume. It was found that the motorized vessels tripled in number while sailboats reduced by half. Landin gs by different types of vessels tend to increase over time, while the small sailboats vessels, decrease. The introduction of more new motorized vessels and sailboats also tend to increase production. The study concluded that GDP and HDI of coastal countie s increased however inequality persisted. The potential of artisanal fishing is in the stage “ unfavorable ” of development and the trend in fish production is to grow over time and with the entry of more vessels. However, it is urgent that the state actions to promote and enhance planning to restore fish stocks in a sustainable and profitable fisheries standards. Therefore, it is recommend the strategic use of natural resources in a sustainable development perspective.

Criminalização do porte de drogas para consumo pessoal: uma perspectiva jurídico-constitucional

This dissertation has the main objective to assess the legal and constitutional legitimacy of the legislative state act that criminalizes the conduct of carrying drugs for own consumption - in the case of Brazil, art. 28 of the Federal Law n.º 11.343 of August 23rd, 2006. Therefore, it is done, initially, a contextualization, pointing the main regulatory frameworks, internal and external, of what is conventionally called prohibition in the matter of drugs, as well as the different species of liberalizing initiatives today on an upward trend in the international scenario. Then analyzes the state intervention in question in the light of references of human dignity, freedom and privacy, emphasizing, in the point, among other contributions, the various precedents of foreign constitutional jurisdiction over the theme. Immediately thereafter, confronts the policy in screen with what is perhaps, these days, the main control mechanism of the restrictive measures of fundamental rights, namely the proportionality test, here represented by classical elements of appropriateness, necessity and proportionality in the strict sense. After that, it examines the criminalization on the agenda before the parameter of equality and the general interests of health and public safety. Based on theory and empirical enrolled in the development, it is concluded, finally, the unconstitutionality of the option of the ordinary legislature to impose criminal penalties on users - problematic or not - of substances or products capable of causing physical or psychological dependence.

O controle da tuberculose no contexto da atenção primária à saúde no Brasil

O Brasil é um dos países que concentram 80% da carga de tuberculose no mundo. No contexto da atenção primária brasileira, fatores interferem para que as equipes de saúde da família possam incorporar as atividades de controle da doença no processo de trabalho. O controle da doença depende da forma como os serviços de saúde estão organizados para garantir o acesso ao diagnóstico precoce e ao tratamento. Esse estudo tem como objetivo geral analisar o controle da tuberculose no contexto da atenção primária à saúde no Brasil. Os objetivos específicos são comparar o tratamento diretamente observado com o regime autoadministrado em pessoas com tuberculose; Verificar se o Programa Nacional de Controle da Tuberculose é avaliável e elaborar um modelo teórico e lógico para avaliação deste programa; avaliar a relação entre porte populacional dos municípios e as características de estrutura e processo de cuidado a pacientes de tuberculose na atenção primária no Brasil. Realizou-se uma revisão sistemática, seguida de um estudo de avaliabilidade e de um estudo transversal. Os achados da revisão sistemática revelam que não houve diferença significativa entre os grupos de tratamento (observado e não observado) para cura (OR 1,06. IC95% 0,75 - 1,50) e para conclusão do tratamento (OR 1,64, IC 95% 0,79 - 3,42). Menor abandono no grupo com tratamento supervisionado e não houve diferença estatisticamente significativa entre os grupos (OR 0,73, CI 95% 0,58-0,92). O risco de morte foi maior no regime de tratamento autoadministrado (OR 1,49 IC 95% 1,03 - 2,45). A hetorogeinadade entre os estudos analisados não permite afirmar que nao há diferença estatisticamente significativa para cura e tratamento concluído. A pré-avaliação do Programa de Controle de Tuberculose possibilitou a descrição do Programa, elaboração e pactuação do modelo lógico e a matriz de relevância dos indicadores. Caracterizou-se os seus elementos estruturantes, definição de indicadores de estrutura e processo, além das perguntas avaliativas. Uma avaliação somativa com enfoque na análise dos efeitos da intervenção de controle da tuberculose é recomendada. A avaliação das características de estrutura e processo de cuidado à pessoa com tuberculose revelou melhor desempenho para as equipes de atenção básica de municípios classificados como metrópole no acesso, coordenação do cuidado e qualidade técnica da atenção. Em relação ao acesso: 98,5% acolhimento a demanda espontânea; 95,8% programação de consultas. Na coordenação do cuidado, 93,2% existência de protocolo para tuberculose. Quanto a qualidade técnica da atenção à tuberculose verifica-se que 93,4% acompanhamento de tratamento diretamente observado, 95,8% com busca ativa de faltosos ao tratamento, 64,0% oferta de ações educativas, 91,3% busca ativa de sintomáticos respiratórios. Cabe destacar que metrópoles apresentaram maior tempo médio de espera para escuta/acolhimento (24,41 minutos); para consulta previamente agendada (23,52 dias); para consulta em pneumologia (87,12 dias). Percebem-se fragilidades na estrutura e processo da atenção à tuberculose, principalmente no controle especializado da doença e na qualidade técnica entre os municípios. Recomenda-se reforço, particularmente na qualidade técnica para aumentar a cobertura de acompanhamento do tratamento, busca de sintomáticos respiratórios e das ações educativas.

Ajustes de coeficientes integrantes de processos físicos e bioquímicos na autedepuração em curso de água de médio porte

The mathematical modeling in the simulation of self-purification capacity in lotic environment is an important tool in the planning and management of hydric resources in hydrographic basin scale. It satisfactorily deals with the self-purification process when the coefficients of physical and biochemical processes are calibrated from monitorated water quality data, which was the main focus of this study. The present study was conducted to simulate the behavior of the parameters OD, BOD5, total phosphorus, E. coli, ammonia, nitrite, nitrate and the total metals cadmium, chromium, copper, lead and zinc in the Uberabinha’s lower course (with an approximate annual growth flow between 4-35 m3/s), in a stretch of 19 km downstream of the treated effluent release by the WWTP of the city. The modelings, on the present study, show the importance of constant water quality parameters monitoration over the water course, based on the comparison of the simulations from calibrated coefficients and coefficients obtained in the literature for the period of June until November 2015. After coefficients calibration, there were good adjustments between simulated and measured data for the parameters OD, BOD, Ptotal, ammonia and nitrate and unsatisfactory adjust for the parameters nitrite and E. coli. About the total metals, the adjustments were not satisfactory on the reservoir’s vicinity of the Small Hydropower Plant Martins, due the considerable increase of the bottom sediment in lentic region. The greatest scientific contribution of this study was to calibrate the decay coefficient K and the quantification of the release by the fund S of total metals in watercourse midsize WWTP pollutant load receptor, justified by the lack of studies in the literature about the subject. For the metals cadmium, chromium, copper, lead and zinc, the borderline for K and S calibrated were: 0.0 to 13.0 day-1 and 0.0 to 1.7 g/m3.day; 0.0 to 0.9 day-1 and 0.0 to 7.3 g/m3.day; 0.0 to 25.0 day-1 and 0.0 to 1.8 g/m3.day; 0.0 to 7.0 day-1 and 0.0 to 40.3 g/m3.day; 0.0 to 30.0 day-1 and 0.0 to 70.1 g/m3.day.