Qualidade de vida de pessoas com úlcera venosa: associação dos aspectos sociodemográficos, de saúde, assistência e clínicos da lesão

Venous ulcer (VU) is a lower limbs injury resulting from inadequate return of venous blood in feet or legs. Although it is not a deadly disease, it causes chronic wounds, which seriously undermine patients´ quality of life (QOL) and sometimes leads to drastic family, social, economic and psychological changes. In this sense, there are several aspects that may influence the venous ulcers patients´ QOL. The study´s objective aimed on the association of socio-demographic and health, health care and clinical injury on UV patients‟ QOL. Analytical studies, which consider the complexity of factors involved in changes in UV patients‟ QOL has a cross-sectional and quantitative approach. The HUOL Ethics Committee approved this project (n.279/09). The collection of data lasted a period of 3 months in 2010 and it took place at the clinic of Angiology at Hospital Universitário Onofre Lopes (HUOL). The data sample consisted of 60 patients treated by UV angiologists in the HUOL Surgical Clinic. The results were analyzed with SPSS 15.0 by descriptive and inferential statistics. The study was based on UV patients that were predominantly female, average age of 61.4 years, that had low education level and low family income, with occupations requiring long periods of standing or sitting, but mostly retired, unemployed or laid off due to the disease and/or due to chronic diseases associated with the UV. The study took also into consideration patients that used inappropriate products, that were improperly treated by a professional caregiver, that lacked of adequate guidance and compression therapy, that performed no lifting of the lower limbs and regular exercise, that the time of injury were greater than or equal to six months, that were missing specific laboratory tests. The study‟s reference were on recurrent lesions, medium to large lesions area, bed of the lesion (injuries) with fibrin and/or necrosis, with amount of exudate with medium to large, odorless and no signs of infection, with tissue loss between 1st and 2nd degree, without collecting swab or biopsy and with pain. In general, QOL of researched individuals were considered low, the maximum score was 69 points, which the areas that were mostly influenced were the total scores of QOL functional capacity (0.021), emotional (0.000) and social functioning (0.080). Of the 60 individuals, 53.3% had scores between 40 and 69 points in SF-36, and they had the best scores in sociodemographic and health variables (ρ = 0.049). In respect to the assistance and injury characteristics, patients who scored between 40 and 69 points in SF-36 had better scores on these characteristics. By combining the socio-demographic variables, health, and handling characteristics of the injury, we observed a significant difference (ρ = 0.032) when linking them with the QOL total scores. When analyzing separately the domains of the SF-36 scores on the quality of life, we find that the areas that showed statistical significance were functional ability (ρ = 0.035), appearance (ρ = 0.019), emotional (ρ = 0.000), and mental health (ρ = 0.050). Among the socio-demographic characteristics studied, gender and marital status contributed more to the reduction of QOL and among the variables of assistance and the injury, orientation, reference and area of UV contributed the most. By analyzing these five variables all together in accordance with the overall score obtained in the quality of life, we found a significant correlation (ρ = 0.002); with 6.23 times more chances of patients have better QOL in the presence of these five positive factors. By conducting the Mann Whitney U test between all the five demographic variables, health, and clinical care, we found that this combination also proved to be significant (ρ = 0.006). Therefore, patients with these five variables positive tend to have a better QOL. Based on these results, we reject the null hypothesis (H0) and accept the alternative hypothesis (H1) proposed in this study because we noted that the QOL of patients with UV is associated with sociodemographic and health, health care and clinical aspects of the injury

A oficina como método de desenvolvimento de projeto do produto aplicado à atividade jangadeira de Ponta Negra Natal-RN

The jangadas (brazilian fishing rafts) are rudimentary artisanal vessels intrinsic to the Northeast of Brazil. The fishery with jangadas is highly representative in the State of Rio Grande do Norte, and source of income for many families in addition to being a strong cultural icon. Is still alive despite the difficulties, bringing the history and customs of the fishermen and their people. However, is in process of extinction due to factors such as the low profitability of the activity, tourism and urbanization. From the understanding of activity involving their context and circumstances, based on identified problems regarding the conditions of use of jangadas as the unpredictability, the risk of accidents, poor working conditions, hygiene and housing, this dissertation aims to: analyzing the design of the jangada on the beach of Ponta Negra and its relationship with the activity in relation to health, safety, productivity and environment, and from such assessments, together with the results achieved during the workshops of the project, proposing a cart to move the raft, adapted to the local fisherman activity studied. To perform analysis of jangadeira activity, we used a methodology based on ergonomic work analysis - AET (WISNER, 1987; GUÈRIN, 2001; VIDAL, 2008, SALDANHA, 2004 and Carvalho, 2005). For data collection were used observational and interaction methods as a conversational action, verbalizations, photographs and video. It is emphasized that the search for solutions appropriate to the jangadeira activity was possible through the collaboration of several people, not just an informational level and understanding during the work activity, but effectively contributing to the making decisions

A influência do modelo de triplice hélice no grau de maturidade de inovação: um estudo de caso em empresas participantes do projeto PRÓ-INOVA/NAGI no estado do RIO GRANDE DO NORTE

Public investments in the development of innovation in the country, either through the rigging of public universities, either through public announcements of the promotion, increased dramatically in recent years. To analyze the efficiency and effectiveness of the use of public resources is especially in times of austerity, essential for the development of a country. In this context, this research aims to identify the influence of public investments to promote innovation in the degree of maturity of innovative companies in the state of the RN. Another goal is to identify the regional influence from the installation site - capital or countryside, in the performance of the companies studied in the degree of innovation. The theoretical basis of the understanding of the scope of the concept of innovation and its determination for the purposes of this study. Typology, degree of innovation, evaluation methodologies and mechanisms to support innovation : Still on the theme of innovation additional concepts that help the reader to a greater understanding, such as are presented. Following is approached conceptualization of the triple helix, highlighting the concepts advocated by Etzkowitz and Leydesdorff, Salomon and Silva and Ipiranga, Freitas and Paiva, among others. With regard to methodological aspects, we propose a descriptive, exploratory and explanatory research quantitative and qualitative approach with the target audience group of companies served by INOVA PRO- NAGI design - multi-institutional action from a public resource called FINEP promotes the development of innovative companies in the State of Rio Grande do Norte - in 2013. The research should provide reflection and understanding of the influence of public investment in innovation, which by means of qualitative predictive variables associated with quantitative method to explain which variables are significant variations in the degree of maturity of enterprises studied

Caracterização da qualidade de água e sedimento na UHE Americana relacionados à ocorrência de plantas aquáticas

Este trabalho foi realizado na UHE Americana, pertencente à Companhia Paulista de Força e Luz, e faz parte de um projeto de pesquisa e desenvolvimento realizado em conjunto com a Faculdade de Ciências Agronômicas (UNESP) de Botucatu. Foram realizadas amostragens de água e sedimento nos meses de outubro e dezembro de 2003 e fevereiro, abril e junho de 2004. Selecionaram-se seis pontos de coleta no reservatório, sendo cinco a montante da barragem e um a jusante. Levantamentos de flora foram realizados nos meses de dezembro de 2003 e abril e julho de 2004, sendo constatados elevados teores de nitrogênio e fósforo nas amostras de água, com valores médios de 3,867 mg L-1 para nitrato, 0,706 mg L-1 para amônia, 1,372 mg L-1 para nitrito e 151,979 µg L-1 para fosfato dissolvido na água. O sedimento apresentou elevado nível de fertilidade, com médias de 32,18 g kg-1 para matéria orgânica, 68,87 mg dm-3 para P, 36,96 mmol dm-3 para Ca e 11,88 mmol dm-3 para Mg. Espécies marginais e flutuantes foram as principais infestantes do reservatório, destacando-se Brachiaria subquadripara, Eichhornia crassipes, Pistia stratiotes e Salvinia auriculata.

Variação da qualidade da água do escoamento superficial de duas bacias de drenagem de Natal/RN - Brasil

The urban drainage is one of the powers of environmental sanitation and its scope is the quantitative and qualitative aspects. In decision making of managers and the engineering aspects of design are almost always taken into account only the quantitative aspects. However, the waters of the runoff have the highest concentrations of pollutants at the beginning of precipitation. Thus, if the plot pollution removed, the remaining portion can be used for other purposes. This work has aimed to present the variation of water quality of two drainage basins in the city of Natal / RN-Brazil to support the implementation of drainage to consider the qualitative aspect, and identify potential for the use of water. The basins (M and C) are analyzed closed-type, are in the urban area, are predominantly residential occupation and its waters are used for detention ponds and infiltration. The samples were divided into three phases, the first two direct to final points in a basin and the third in traps distributed over the surface drainage. The parameters had been analyzed were pH, conductivity, dissolved oxygen, Color, Turbidity, COD, Ammonia, nitrite, nitrate, total phosphorus, orthophosphate, Sediments solids, total solids, chloride, sulfate, alkalinity, calcium, magnesium, sodium, potassium, Heavy Metals (Chromium, Cadmium, Lead, Zinc and Copper), Eschichia coli and total coliforms. The parameters studied showed high initial pollution load, events and located in different proportions, except nitrite, heavy metals and biological indicators. The size of the surface drainage and topographic its features influence the quality of water. However, the form of sampling is crucial in the qualitative study in the basin. The samplers developed at work, were generated economic and representative results. The urban rainwater presents organic faecal indicators. The runoff of water from both basins shows no risk of salinity and sodicity for use in irrigation, should be noted the content of chloride in the choice of method of irrigation

Controle sanitário e ambiental de um projeto de reúso em um complexo de prédios corporativos

The study that resulted in this dissertation was developed at OU RNCE PETROBRAS, in Natal, which implemented a project of rational use and reuse of water, including use of wastewater from a Sewage Treatment Plant (STP) already in place, diluted with water from own wells for irrigation of green area of the building complex corporate enterprise. Establish a methodology that can serve as guidelines for future projects controlled reuse of water like this was the objective of this research. Been proposed, implemented and evaluated three instruments of sanitary and environmental control: 1) adaptation of sewage treatment plant and quality control of the treated effluent 2) analysis of soil-nutrient interaction in the irrigated area, 3) knowledge of the local hydrogeology, especially with regard to the direction of flow of the aquifer and location of collection wells of Companhia de Águas e Esgotos do Rio Grande do Norte (CAERN) situated in the surroundings. These instruments have proven sufficient and appropriate to ensure the levels of sanitary and environmental control proposed and studied, which were: a) control of water quality off the STP and the output of the irrigation reservoir, b) control of water quality sub surface soil and assessment of progress on soil composition, c) assessment of water quality in the aquifer. For this, we must: 1) establishing the monitoring plan of the STP and its effluent quality sampling points and defining the parameters of analysis, improve the functioning of that identifying the adequacy of flow and screening as the main factors of operational control, and increase the efficiency of the station to a relatively low cost, using additional filters, 2) propose, implement and adapt simple collectors to assess the quality of water percolating into the soil of the irrigated area, 3) determine the direction of groundwater flow in the area study and select the wells for monitoring of the aquifer.

A gestão da qualidade nos cursos de graduação a distância da UFRN/SEDIS : a percepção dos discentes

The management of water resources in the river basin level, as it defines the Law nº 9433/97, requires the effective knowledge of the processes of hydrological basin, resulting from studies based on consistent series of hydrological data that reflect the characteristics of the basin. In this context, the objective of this work was to develop the modeling of catchment basin of the river Jundiaí - RN and carry out the study of attenuation of a flood of the dam Tabatinga, by means of a monitoring project of hydrological data and climatology of the basin, with a view to promoting the development of research activities by applying methodologies unified and appropriate for the assessment of hydrological studies in the transition region of the semiarid and the forest zone on the coast of Rio Grande do Norte. For the study of the hydrological characteristics of the basin was conducted the automatic design of the basin of the river Jundiaí, with the aid of programs of geoprocessing, was adopted a hydrological model daily, the NRCS, which is a model determined and concentrated. For the use of this model was necessary to determine some parameters that are used in this model, as the Curve Number. Having in mind that this is the first study that is being conducted in the basin with the employment of this model, it was made sensitivity analysis of the results of this model from the adoption of different values of CN, situated within a range appropriate to the conditions of use, occupation and the nature of the soil of this basin. As the objective of this study was also developing a simulation model of the operation of the Tabatinga dam and with this flood control caused in the city of Macaíba, it was developed a mathematical model of fluid balance, developed to be used in Microsoft Excel. The simulation was conducted in two phases: the first step was promoted the water balance daily that allowed the analysis of the sensitivity of the model in relation to the volume of waiting, as well as the determination of the period of greatest discharges daily averages. From this point, it was assumed for the second stage, which was in the determination of the hydrograph of discharges effluent slots, that was determined by means of the fluid balance time, on the basis of the discharges effluents generated by a mathematical equation whose parameters were adjusted according to the hydrograph daily. Through the analyzes it was realized that the dam Tabatinga only has how to carry out the attenuation of floods through the regularization of the volume of waiting, with this there is a loss of approximately 56.5% on storage capacity of this dam, because for causing the attenuation effect of filled the shell of this dam has to remain more than 5m below the level of the sill, representing at least 50.582.927m3. The results obtained with the modeling represents a first step in the direction of improving the level of hydrological information about the behavior of the basins of the semiarid. In order to monitor quantitatively the hydrographic basin of the river Jundiaí will be necessary to install a rain gauge register, next to the Tabatinga dam and a pressure transducer, for regular measurements of flow in the reservoir of the dam. The climatological data will be collected in full automatic weather station installed in Agricultural School Jundiaí

Lazer na terceira idade: desenvolvimento humano e qualidade de vida

The article aimed to understand the concept of leisure and understanding that older people have about their benefits to the quality of life as part of the idleness of the population. We used a sample of subjects living in the city of Bauru, SP, aged less than fifty years, of both sexes and economically disadvantaged class. It was used in literature, documentary and field. We developed an intervention project that aimed to education for leisure. It was the conclusion that public policies are necessary and qualified professionals for construction projects and equipment to expand the Recreation, spreading it and reaching the people of old age since previous stages of life. Materials with simple and low cost, the project of intervention, it reached the recreation-education and education for leisure satisfactorily.

Diagnóstico do usuário no aprimoramento dos serviços de tecnologia da informação: um projeto de intervenção para o Ministério Público do Estado do Rio Grande do Norte

The information tecnology (IT) has, over the years, gaining prominence as a strategic element and competitive edge in organizations, public or private. In the judiciary, with the implementation of actions related to Judiciário Eletrônico, information technology (IT), definitely earns its status as a strategic element and significantly raises the level of dependence of the organs of their services and products. Increasingly, the quality of services provided by IT has direct impact on the quality of services provided by the agency as a whole. The Ministério Público do Estado do Rio Grande do Norte (MPRN) deployments shares of Electronic Government, along with an administrative reform, beyond these issues raised, caused a large increase in institutional demand for products and services provided by the Diretoria de Tecnologia da Informação (DTI), a sector responsible for the provision of IT services. Taking as starting point strategic goal set by MPRN to reach a 85% level of user satisfaction in four years, we seek to propose a method that assists in meeting the goal, respecting the capacity constraints of the IT sector. To achieve the proposed objective, we conducted a work in two distinct and complementary stages. In the first step we conducted a case study in MPRN, in which, through an internal and external diagnosis of DTI, accomplished by an action of internal consulting and one research of the user satisfaction, we seek to identify opportunities of change seeking to raise the quality perceived of the services provided by the DTI , from the viewpoint of their customers. The situational report, drawn from the data collected, fostered changes in DTI, which were then evaluated with the managers. In the second stage, with the results obtained in the initial process, empirical observation, evaluation of side projects of quality improvement in the sector, and validation with the managers, of the initial model, we developed an improved process, gazing beyond the identification of gaps in service a strategy for the selection of best management practices and deployment of these, in a incremental and adaptive way, allowing the application of the process in organs with little staff allocated to the provision of information technology services

Prospecção e formação no domínio das competências e habilidades em tecnologia da informação: o caso do projeto metrópole digital em Natal/RN

This study deals with cognitive competences and abilities that are relevant to selection and education regarding Information Technology (IT). These competences relate to problem solving, decision making, and practical intelligence that regard scholar and extracurricular knowledge mobilization. The research aimed to contribute for the improvement of a selection instrument, consisting of five arrays of skills (dealing with objectives and prospection), as well as the development and comprehension of those skills that are involved in IT education. This is done by means of an analysis on the selection instrument used in the first selective process that occurred at Metropole Digital an Institute at the Federal University of Rio Grande do Norte in Brazil. This was evaluated aiming to acknowledge IT education (with basic training and emphasis on Web programming and electronics). The methodology used was of quantitative method involving performance scores relating education delivery. An Anova analysis of variance was done along with descriptive analysis involving socioeconomic data that was not observed in the meaningful relations between parental instruction and student performance in the graduate course. These analyses were able to point out the importance and need of the policies for vacancy reservation on behalf of public school students. A Spearman correlation analysis was done considering the instrument selection performance in the training course. The instrument is presented as a predictor that is significantly moderate and presents a good performance in the course as a whole. A Cluster and Regression analysis was also realized in the process. The first analysis allowed finding performance groups (Clusters) that ranged from medium and inferior. The regression analysis was able to point out association amongst criterion variables and the (average performance in basic and advanced modules) and explanatory (five matrixes). Regression analysis indicated that matrix 1 and matrix 3 were pointed out as being the strongest ones. In all the above analysis, the correlation between the instrument and the course was considered moderate. Thus this can be related in some of the aspects present in the course such as emphasis on evaluation itself as well as in technical contents and practical skills (educational ones) and competences and selection skills. It is known that the mediation of technological artifact in cultural context can foster the development of skills and abilities relevant to IT training. This study provides subsidies to reflect on the adoption of selection instrument and IT training in the Institute. Thus the research offers means to achieve a interdisciplinary discussion and enriching of areas such as Psychology and Information Technology; all of which regarding competencies and skills relevant in IT training

Satisfaçã dos Usuários e a qualidade da atenção primária à saúde no Rio Grande do Norte

O presente estudo tem por objetivo avaliar a satisfação dos usuários em relação à qualidade da Atenção Primária à Saúde no Rio Grande do Norte. Trata-se de Pesquisa Avaliativa observacional transversal, com abordagem quantitativa, a qual faz parte da Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ), da Universidade Federal do Rio Grande do Norte. Foram utilizados dados secundários de todas as entrevistas com usuários das equipes que participaram da Avaliação Externa do PMAQ no Estado do RN. A pesquisa foi realizada em 167 municípios do Estado do Rio Grande do Norte, na qual a população foi composta por 1.650 usuários. A amostra se deu por conveniência a partir dos seguintes critérios: usuários que estavam presentes na Unidade Básica de Saúde (UBS) para realizar qualquer tipo de procedimento e que consentisse em participar da avaliação. Foram excluídos os que tinham ido pela primeira vez na unidade e aqueles que não frequentaram há mais de 12 meses. A coleta dos dados foi realizada no período de setembro a novembro de 2013. Para tanto, foi elaborado um protocolo de pesquisa contendo as seguintes dimensões: organizacional, interpessoal e estrutural. Em relação à dimensão organizacional os resultados mostram que a marcação de consultas tem se configurado em empecilho ao acesso do usuário ao serviço de saúde, uma vez que se faz necessário para o atendimento, enfrentar filas, antes da abertura da unidade para pegar fichas. No tocante ao funcionamento da unidade, se destaca o fato dos usuários referirem que o horário de funcionamento da unidade atende à suas necessidades, apesar de funcionar 5 (cinco) dias por semana, a maioria das unidades permanece fechada no horário de almoço. Outro dado importante refere-se à coordenação do cuidado, cujos resultados apresentam diferenças maiores entre os usuários da região metropolitana e do interior do Estado em relação à Capital. Essa diferença se expressa principalmente em relação de marcação de consulta com outros profissionais especialistas. A dimensão interpessoal, no que diz respeito à categorias interação usuário-serviço-equipe e vínculo, demonstraram alguns avanços, contudo os melhores resultados foram observados em relação a satisfação com o cuidado, onde mais de 50% dos usuários se mostraram satisfeitos com o cuidado recebido nas unidades. Em contrapartida, o estudo mostrou que, na opinião de 56% dos usuários da capital, a falta de materiais e equipamentos influencia negativamente no cuidado. Por fim, o estudo contribuiu para reforçar a ideia de que a avaliação da satisfação dos usuários dos serviços de saúde pode ser uma ferramenta importante para subsidiar o processo de decisão compartilhada, de forma a se repensar as práticas profissionais, reorganizar o processo de trabalho desenvolvido, realocar recursos, readequar ações e redefinir objetivos que estejam coerentes com o projeto de saúde estabelecido

Horticultura no baixo curso do Rio Doce, zona norte do Natal/RN: avaliação da qualidade da água por meio de ensaios ecotoxicológicos

The research is developed in areas of horticulture in the city of Natal, in the neighborhoods of Lagoa Azul, Pajuçara and Redinha, along the Doce River, border area with Extremoz city, Rio Grande do Norte State. The region of the fluvial plain of Doce River is located in an Environmental Protection Zone (ZPA-9). This is one of the ZPA which is not under the regulatory marks and there are several environmental problems caused by use and land occupation, featuring an evident disregard of environmental laws and whose protection is hindered by the lack of specific legal mechanisms. This study aims to provide an overview of the use of pesticides in the lower course of the Doce River, in Natal, Rio Grande do Norte, and to assess environmental degradation in the area through chronic toxicity tests using the microcrustaceous Ceriodaphnia dubia Richard 1894 (Cladocera, Crustacea) as test organism. Visits were made to the area in 2009 and 2010. To obtain information a diagnosis of the local situation was accomplished based on personal observation and non-participatory photographic record, with the aim of assessing the environmental characteristics, population diversity and work processes of horticulturists. During the visits four different points of the Doce River were chosen to collect water for ecotoxicological tests and survey of physico-chemical parameters (dissolved oxygen, pH, chloride, turbidity, conductivity and temperature), which were measured in the field using Multiparameter Probe (TROLL 9500). The adverse effects of pesticide use in the lower course of the Doce River is a major problem for both the environmental and human health, since many of the substances and active principles that enter in the composition of the products are synthesized molecules whose effects can only be evaluated through different studies on their actions and behavior at short, medium or long term

Aplicação do método B ao projeto formal de software embarcado

This work shows a project method proposed to design and build software components from the software functional m del up to assembly code level in a rigorous fashion. This method is based on the B method, which was developed with support and interest of British Petroleum (BP). One goal of this methodology is to contribute to solve an important problem, known as The Verifying Compiler. Besides, this work describes a formal model of Z80 microcontroller and a real system of petroleum area. To achieve this goal, the formal model of Z80 was developed and documented, as it is one key component for the verification upto the assembly level. In order to improve the mentioned methodology, it was applied on a petroleum production test system, which is presented in this work. Part of this technique is performed manually. However, almost of these activities can be automated by a specific compiler. To build such compiler, the formal modelling of microcontroller and modelling of production test system should provide relevant knowledge and experiences to the design of a new compiler. In ummary, this work should improve the viability of one of the most stringent criteria for formal verification: speeding up the verification process, reducing design time and increasing the quality and reliability of the product of the final software. All these qualities are very important for systems that involve serious risks or in need of a high confidence, which is very common in the petroleum industry

Avaliação da qualidade da atenção básica em 37 municípios do centro-oeste paulista: características da organização da assistência

No Estado de São Paulo, existe uma rede extensiva de serviços de Atenção Básica (AB) com perfil organizacional heterogêneo e pouco conhecido. Este estudo objetiva caracterizar a organização dos serviços de AB em 37 municípios do Centro-oeste paulista, como primeira etapa de um projeto de avaliação da qualidade desses serviços. Trata-se de um estudo transversal conduzido mediante questionário estruturado, autorrespondido pelos gerentes e equipes locais, com questões que abordam características institucionais e de organização e gerência do trabalho. Esses questionários foram enviados para 131 UBS, distribuídas em 37 municípios. Obteve-se resposta de 113 unidades (87%) localizadas em 32 municípios (86,4%). do total de unidades, 57 (50%) são UBS tradicionais, 26 (22,8%), Unidades de Saúde da Família, e 31, (27,2%) organizadas segundo formas mistas. A maioria dos serviços (62%, 70/113) não trabalha com área de abrangência delimitada de modo planejado. Os serviços se polarizam entre aqueles que realizam entre 70 e 100% de consultas médicas agendadas (37,6%, 41/109), e aqueles que realizam entre 70 e 100% de não agendadas (39,4%, 43/109). Não possuem conselhos locais organizados 65 unidades (63,7%, 65/102). Os dados coletados permitem discutir as características dos principais programas, procedimentos e ações realizados pelos serviços. Os perfis organizacionais predominantes apontam a presença de deficiências de estrutura e processo em relação às diretrizes do SUS. O desenvolvimento de instrumentos de autoavaliação permite que as equipes se apropriem, de forma crítica, de seu trabalho, e possam elaborar novos arranjos tecnológicos para melhoria da qualidade.

Adesão ao tratamento, acesso e qualidade da assistência em Aids no Brasil

A adesão à terapia antirretroviral (TARV) é crucial para a efetividade e o impacto do tratamento da Aids. Este artigo discute as relações entre adesão e qualidade dos serviços de assistência a pessoas vivendo com Aids (PVA), evidenciando a qualidade como elo central entre adesão e acesso. Está baseado nos resultados de pesquisas que conduzimos sobre a atenção a PVA no Brasil. Nossos estudos apontam que os grupos de pacientes acompanhados em serviços com número inferior a 100 pacientes apresentam risco estimado de não adesão maior do que os grupos acompanhados em serviços com mais de 500 pacientes. Apontam também que serviços com menos de 100 pacientes têm risco estimado maior de pertencer a grupos de má qualidade. Isto está relacionado à baixa complexidade observada nos serviços de menor porte caracterizada por: dificuldades em manter uma estrutura mínima de recursos humanos e materiais, simplificação da organização dos processos de trabalho, centramento no trabalho autônomo do profissional médico e gerenciamento sem projeto técnico. Há necessidade de pautar novos estudos sobre adesão e qualidade. As evidências existentes já apontam, porém, a necessidade de revisão na alocação dos serviços de assistência a PVA, bem como a de homogeneizar a qualificação destes serviços, condições necessárias para a manutenção de taxas aceitáveis de adesão à TARV no país.