O direito coletivo prestacional à saúde e o poder judiciário: a concretização do art. 196 da Constituição de 1988 pela via jurisdicional

During the ninth century, owing to the process of industrialization, new social conflicts were showed, forcing the Government not to remain inert. The necessity of answer to these new demands requires from the State some actions that assure the new economic, cultural and social rights, able to exceed the formal equality, according to the principles of redistributive equality and well-being. Among the social rights, the right to health is showed up, which is placed at the Universal Declaration of Human Rights and the International Treaty for the Economic, Social and Cultural Rights, as a necessary term to promote the dignity and the free development of the human personality. Under the Constitutional Law, it is clear that the implementation of the right to health, placed at the 6th article of the Brazilian Constitution, demands a government activity, which usually requires a provision of material goods, depending on budgetary resources. The Legislative and Executive Branches have a very important role in compliance with the constitutional regulations about the satisfactory offer of health care services, besides the correct use of the resources at this area. The adoption of public policies is the way of Government action to the planning and realization of this right. Though, some public policies are usually made apart from the social compromises, to the detriment of the basic social rights. The government has a discretionary competence to manage the health services. That is the reason it is necessary the control of the political choices, through the popular control, the extrajudicial control by the Account Courts, or the judicial review. Owed to the constitutionalization of social rights, the constitutional justice has a very relevant role, concerning to the constitutional jurisdiction, in a way the Judiciary Branch assume your position as a player that transforms the society. On the control of the public health policies, there is a cast of official instruments, judicial or not, to the guarantee of the collective right to the public health services, and to allow the citizens to reach the real implementation of the right to health

Caminhos e descaminhos dos municípios produtores de petróleo: o papel dos royalties no desempenho das finanças públicas municipais no estado do Rio Grande do Norte

It analyzes the magnitude, the nature and the direction of public revenues and the public expenses in oil and natural gas producing municipalities in the state of Rio Grande do Norte in the post-constituent period, and, more precisely, from the approval of Law 9.478/97, called Oil Law . It argues the fiscal federalism normative theory, the typology and the role of the intergovernamental transferences in the performance of the public finances of the local governments. Shows that the economy of Rio Grande do Norte went through deep social-economic changes in the last few decades, among which includes the discovery of the oil and the natural gas and its importance for the growth of the industrial and services sectors. It points out that the increase of the production and the international price of the oil contributed for the growth in revenues of royalties and the special participation in the beneficiary cities, what did not mean an automatic increase in the resources destined to the investment and in the quality on the provision of the goods and services come back toward the local development. On the contrary, the main conclusion of the work is that the trajectory of the oil producing municipalities is marked by paths and embezzlements in the performance of the public finances and in the provision of public goods and services. Paths, that lead to the improvement of the performance of the public finances and the quality of the public goods and services. Embezzlements, that lead to the inefficiency in the provision of goods and services and the capture of the public resources. That is, the fiscal decentralization is a necessary condition, however not enough to improve the amount and the quality of the public goods and services given by these municipalities. For that it is necessary to advance in the fiscal federalism normative theories, in search of optimum model of federalism in local governments where still predominated by patrimonialism, clientelism, fiscal illusion and the capture of the public resources in benefit of the private interests

Protagonismo silencioso: a presença da OPAS na formação de recursos humanos em saúde no Brasil

The aim of this study is to assess the contribution of the Pan American Health Organization (PAHO) to the field of human resources for health in Brazil. The assumption is that this organization not only influenced the development of this field, but but that it was also influenced by Brazilian institutions and by national political movements, through the interaction of its consultants with these movements. Four projects were selected, through which the contribution of PAHO was evaluated: the Program for the Strategic Preparation of Health Personnel (PPREPS), the Project for the Large Scale Formation of Middle and Low Level Personnel (Large Scale Project), the Project for Qualification in the Development of Human Resources in Health (CADRHU) and the Project for the Managerial Development of Basic Units of the National Health System (GERUS). To operacionalize the study, we used three basic complementary procedures: a bibliographic research, documental research and an interview. The time frame considered was from 1975, the year an agreement was signed between PAHO, the Ministry of Health and the Ministry of Education and Culture, establishing PPREPS. It was through this program that the first PAHO team of national human resource consultants was contracted. The period between 1975 and 1999 was marked by political and social movements that changed the course of health in the country; among these was the Movement of Sanitary Reform in Brazil, which culminated in the implementation of the National Health System (SUS). This paper shows the connections of the PAHO consultants with this movement and the implications that this had for the Program of Cooperation in the Development of Human Resources of PAHO/Brazil. It also demonstrates that as the program became contaminated by national movements of health system reorganization and of democratization of Brazilian society, it proposed, in cooperation with national institutions, an organization of determinate areas of operation of these same institutions. The manuscript further reveals that, with the Large Scale Project, the human resources program determined the pedagogical and methodological option that would be the model for various other educational projects undertaken by a number of Brazilian institutions with the technical cooperation of PAHO. And finally, the repercussions and contributions of these projects, which strengthened the the field of human resources in the public health services of the country, are identified. Data analysis was based mainly on the theories of Bourdieu, Gramsci and Freire

Apropriação da escrita por crianças em contextos sociais adversos

O presente trabalho tem origem em nossas vivências como professora alfabetizadora na escola pública em contextos de periferias urbanas, o que nos levou ao envolvimento com questões relativas à (não)aprendizagem das crianças em seu processo de alfabetização. Por outro lado, a inserção na vida acadêmica nos aproximou de perspectivas de compreensão dos processos de aprendizagem e desenvolvimento das crianças, bem como do papel que o meio sociocultural tem nesses processos. Dessas experiências, emergiram os questionamentos que guiaram nossa investigação: em que contextos/situações crianças que vivem em um meio socialmente adverso se apropriam de conhecimentos acerca da linguagem escrita? Onde, com quem, como e o que aprendem as crianças de tal meio sobre a escrita como prática cultural? Tendo como objeto de estudo os contextos/situações em que crianças que vivem em contextos sociais marcados por condições adversas de extrema pobreza se apropriam de conhecimentos pertinentes à linguagem escrita, definimos, como objetivo, Analisar contextos/situações (intra e extra-escolares) em que crianças que vivem em um meio social adverso interagem e se apropriam de conhecimentos pertinentes à linguagem escrita. O campo de estudo foi a comunidade Frei Damião, localizada na periferia do município de Caicó, RN, originária de um lixão e reconhecida na região por ser economicamente carente, com alto índice de analfabetismo e baixíssimo nível de qualidade de vida (escassez de condições sanitárias, serviços públicos de saúde, saneamento e segurança, dentre outros próprios de meios urbanos). Assumindo os princípios da pesquisa qualitativa e as características de um estudo de caso, tomamos como sujeitos do estudo, nove crianças, com idades entre sete e oito anos, residentes na comunidade e estudantes da escola no segundo ano do Ensino Fundamental. Além das crianças, foram também considerados como sujeitos, suas mães, a diretora e duas funcionárias da escola. Os dados foram construídos a partir de entrevistas semi-estruturadas, questionários e anotações em diário de campo. Da sistematização desenvolvida com base nos princípios da análise de conteúdo emergiram evidências de que, mesmo vivendo em um ambiente marcado pela escassez de bens materiais, como de práticas e materiais escritos, as crianças constroem conhecimentos significativos sobre a escrita, apresentando níveis avançados de conceitualizações sobre o funcionamento do sistema alfabético. Tais construções resultam de interações em que se envolvem em diversos contextos intra e extra-escolares em sua comunidade nos quais são mediados, tanto por seus pais, em suas casas, como pela professora, na escola. Mesmo analfabetos ou com pouca instrução escolar, verificou-se que os pais inserem as crianças em processos de letramento e alfabetização ao valorizarem a escrita e seu aprendizado. Enquanto contexto de interação e apropriação de conhecimentos destaca-se, na comunidade, a escola e suas práticas. Mediante parcos recursos e limites, a professora cria situações de aprendizado do funcionamento do sistema de escrita e de habilidades textuais, aproximando as crianças da escrita como linguagem. Esses resultados apontam para a necessidade de reflexões e reformulações acerca das possibilidades da escola pública na promoção de educação de qualidade para as crianças de meios populares

As relações de poder na gestão da Escola Estadual Presidente Kennedy em Natal/RN: as ações decisórias dos órgãos colegiados - o conselho de escola e o caixa escolar

The present study examined the relations of power in the management of the Escola Estadual Presidente Kennedy, including the deliberate decisions on the School Council and School Fund, which guided the organization of the school. We sought to understand the management models that influenced the school organization, promoting contradictions in the decision making process. The school management is intensely marked by management models from the business logics as in the case of managerialism of bureaucracy. The formulation of educational policies based on managerialism has proposed a school-centered management with intense accountability of the school community in planning and monitoring the public services. The influences of these models subsidize hierarchical power relations that undermine the actions of decision-making of the collegiate bodies for the democratization of school management. To develop a research on the power, the investigation was based on studies of Bourdieu and Foucault. These authors understand the power in a relational system in a double sense, both in terms of discipline and the possibility of resistance. A theoreticalmethodological matrix was developed focusing on literature review, document analysis, structured interviews with twelve representatives of the segments belonging to the School Council and School Fund, as well as observations in meetings with the production of field notes. It was found that power relations experienced in the organization and activities of the school boards are marked by changes in public management over the years, promoting the contradictions between the concepts of corporate management originated in the business logics and the perspective of democratic management subsidized by official legislative documents at the national and state levels. The observations in meetings and analysis of the records showed that representatives related to management (president and manager of the school) have a privileged position with regard to exposure of their propositions, and are more likely to take a position in the political game of the collegiate bodies of work. It was also seen that the irregularity of meetings, particularly of the School Fund meetings, limits the experience of operation of the representatives in discussions concerning the planning and monitoring the actions of school management. Reports from representatives of the School Council showed that certain segments related to the management recognize their power of decision, however others have little interfere in the decision-making process in order to expound the desires of those who are represented by them. In the School Fund, the analysis of the records and interviews showed restricted moments of the meeting of representatives, and these only being aimed at choice or approval of the implementation plan prepared by the school management. The results showed no indications of moments of reflection to study the best chance for applicability of resources. This collegiate body (School Fund) has a questionable action when planning and monitoring the applicability of the financial resources of the School. To sum up, it was found that the Escola Estadual Presidente Kennedy still lives hierarchical power relations that undermine the institutionalization of democratic management in the various representative segments may take place in the game of political decision-making processes necessary for the organization of the school

Cargos comissionados da administração pública direta do Rio Grande do Norte: análise comparativa entre o perfil profissional dos cargos comissionados com vínculo funcional e sem vínculo funcional

The professional profile of public administrators in Brazil is changing very rapidly in recent years, seeking to meet the principle of efficiency by public agencies at all levels. The admission of the permanent government employee under the Public Administration is by competition, however, commissioned positions are free appointment of managers, which allows effective participation of external experts according to their respective standards and norms. In this context, this dissertation seeks to understand the main characteristics of the profile of the occupants of commissioned positions in Direct Public Administration of the State of Rio Grande do Norte, noting the differences between those with functional link with the have nots. For this study, by data collection and content analysis, a mapping of the administrative structure of the Government of the State of Rio Grande do Norte was done, i.e., the organization of the Executive Branch, which is regulated by the Complementary Law no. 163/1999 and its amendments, which consists of 53 (fifty three) entities, these 29 (twenty nine) are agencies of the direct administration and the remaining 24 (twenty four) comprises the indirect administration. With the collected data, analysis on the number of commissioned positions of each organ of the State of Rio Grande do Norte and information on education, age, length of service, gender and functional link with the direct administration was carried out. Data were available from SEARH in June/2013, when they totaled 58,733 (fifty-eight thousand seven hundred thirty-three) servers, these 2.15% (two point fifteen percent) occupy commissioned positions, corresponding to 1,262 commissioned positions under the Direct Administration, below the national average of 4% (four percent). Of total commissioned positions 64.7% (sixty-four point seven percent) have no functional link with the direct administration, while only 35.3% (thirty -five point three percent) have functional link. It was noticed that there are no clear and specific criteria for the appointments of commissioned positions in the State. They occur freely, as provided in the State Constitution. Another conclusion is the importance of Public Administration define and improve their capacity, competence and efficiency in the delivery of public services. For that it is necessary to invest in their workforce composed of permanent employees and commissioned positions to define the appropriate professional profile

Ssitema integrado de gestão pública: proposta de implantação de um sistema integrado de gestão, autuação e distribuição de termos circunstanciados e inquéritos policiais entre os juizados especiais criminais e delegacias de Natal

Universidade Federal do Rio Grande do Norte

Perspectivados cirurgiões-dentistas sobre a inserção da fisioterapia na atenção básica de saúde

This work aims at investigating the surgeons-dentists acceptability in the field of public health in the city of Natal, State of Rio Grande do Norte, about the possibility of medicinal plants insertion in basic attencion of health. Moreover, it searchs to know if during their professinal formation it had some theoretician-pratical basement on this subject, as well as investigating their confidence on the medicinal plants. The basic motivation for developing this study is the possibility of contributing to the insertion of a tradicional health pratical at public assistance scope, endorsed by popular use, but now scientifically proven. For in a such way, the medicinal plants use is emphasized as a way to be followed to increase basic pharmaceutical assistance, improving the acess to the medicine and diminish expenses. Following this logic, family health program constitutes the way through which this pratical will be available to the users of health services. The research was done over thirty surgeonsdentists, all ofthem pertaining to public service ofNatal, state ofRio Grande do Norte. It was used, as research instrument, semi-estructured interview associated with methodological analysis user s speeches. On this form, this work is inserted in a trend observed nowadays not only in Brazil, where the use of the medicinal plants has been stimulated and defended to be inserted at programs ofprimary attenction of health

Gestão pública em saúde mental: um estudo em CAPS com gerência pública e privada do Rio Grande Do Norte

Currently, several models of management services from the public administration are in operation in Brazil following a global trend. Besides the traditional public management operated in SUS, there are ongoing experiments of privately management in the public health services. Accordingly, we have developed an investigation into two Psychosocial Care Centers operating between these two forms of financial resources management: the first is the CAPS II - PAR situated in the municipality of Parnamirim whose form is private and the second is the CAPS II West Christmas is that the municipal government. We seek to know the workings of services, planning forms and criteria for use of financial resources, identify differences between departments on ways to run and see how technicians and users participate in the planning and management of these resources. Documentary Research was conducted by the municipal Christmas and the financial administration of the CAPS service in Parnamirim. Were conducted an interview with manager (mental health coordinator of Natal) and another interview with an employee of planning department in the Health Department of Natal, an interview with the coordinator and financial administrator of CAPS - PAR and two groups of discussion taped conversation with semi structured script interviews with six technicians in CAPS PAR and six professionals crowded in CAPS - West.Differences were observed in the management of resources funded from four blocks of discussion and analysis of results, where the privately-run service for the direct management and bureaucracy without being discussed and planned spending on staff, as well as through meetings with users, the use of the financial resources available in box; already in service with municipal public administration there is a hierarchy, this answering the coordination of mental health and the local health department that centralizes resources and defines their spending. There are meetings with patients and families, but the demands are limited as to what can be sued because of the manager s authorization. Such differentiation would be related to differences in the articulation of public management with the different types of possible management in public services, where from the implementation of new public administration in the Brazilian s State Management Reform initiated in the second half of the 1990s, benefit management services with private regime, with autonomy and direct transfer of resources

Avaliação das habilidades neurocognitivas em crianças e adolescentes sobreviventes da Leucemia Linfoide Aguda - LLA

The present study investigated the impact of the treatment modalities of Acute Lymphoblastic Leukemia on neurocognitive abilities of children and adolescents survivors, aged between 6 and 16 years of age, accompanied in pediatric oncology sectors of public health services in the cities of Campina Grande-PB and Natal-RN. The study included 52 children, 13 of these being children and adolescents diagnosed with leukemia and 39 healthy children matched in relation to the study group considering gender, age, school type and level of maternal education. Later the group of children with leukemia was subdivided into two subgroups depending on treatment modality which were submitted: Group 1A (only chemotherapy) and 1B (chemotherapy and radiotherapy). All participants were subjected to a battery of neuropsychological tests that investigated the following neurocognitive abilities: intellectual ability, memory system, attention, visuospatiality and visuoconstruction, processing speed and executive functions. Data were analyzed using descriptive and inferential measurements with the aid of the U test of Mann-Whitney and T test, considering the influence of the variables: sex, age at diagnosis, time since completion of treatment and level of schooling mothers, on the performance of children. Overall, it is concluded that the illness and the treatment of acute lymphoblastic leukemia significantly favors the emergence of cognitive deficits, particularly in terms of visuospatial skills, and executive skills visoconstrutivas. In turn, the treatment modality of radiotherapy is associated with the presence of more severe deficits, highlighting the significant impact on the speed of information processing. It is hoped that the results presented here will contribute to a better understanding of the nature and extent of neurocognitive effects arising ALL treatment

Programa Liberdade assistida em Natal/RN: adolescentes em conflito com a lei e a violação de direitos

This work shows the results of the research: Attended Liberty Program Adolescents in Conflict with the Law and the Disapproval of Rights, effected in the community of Natal, Rio Grande do Norte, in period of august 2007 to September 2008. It aims to analyze the social-educative attendance directed to adolescents in conflict with the law through the state, since the Social-educative Measure Attended Liberty, known, as an idoneous way of confrontation to the practice of infraction acts imputed to the adolescent, that needs to give emphasis, in disadvantage of the Social-educative Measurement of Internment, to be proposed (ECA, art 118 and 199) to follow the adolescent in this quotidian, close to his family and community, proposing him through social-educative work, the access to education and occupancy, as well other public services, that help him to surpass the context of privation and disapproval of rights in which lives joined to his family. In our study, it was observed in sequence of approaching, subsidized for theoretical-methodological procedures justified in quantity and quality research, that were privileged to the documental research, the observation and the interview almost structured, besides a theoretical basis about the subject, that the relation of category and inequality in which the capitalist society sustains itself, does the practice of infraction acts imputed to the adolescent, acquires a classist character, in which the property of the money defines the access of the justice. And more, many of the poor adolescents that get into conflict with the law, dweller of the periphery districts of Natal/RN, becomes evident as for segment that has been attended in the Jurisdiction of the Infancy and Youth and in the LAN of Social-educative Attendance, becoming individual the infraction act and its confrontation. We hope in this work, to contribute for the care of the reality of the adolescent in conflict with the law in the Attended Liberty Program, without pretension to exhaust it, as well as later studies about the theme

As condições de trabalho na área de saúde e o processo de adoecimento da (o) assistente social

The requirements in the world of work in the contemporary impact on quality of life, health workers in their relations with users and other professionals of the healthcare team. Given this reality, this study discusses the working conditions in health and disease process of (a) having social goals as analyze the implications of working conditions in the disease (the) social workers in state hospitals Metropolitan Region Christmas (NMR); identify the main diseases affecting social workers in hospitals in the SESAP NMR and reveal the relationship between the disease processes of social and working conditions in hospitals in the state NMR. The research was guiding questions to reveal how to configure the work, conditions of work and of the disease process (the) social worker. To grasp the socioeconomic profile of (the) social workers, the characterization of the work, duties and responsibilities in the sociooccupational, factors that interfere with the disease process of (the) social workers of RMN, and actions and investments Policy on Occupational Health RN correlating to illness today is that we set for the unveiling of the movement of the object of study through the methodological approach with documentary research aimed at literature review; extensive direct observation correlated to real life observation and application of 66 (sixty-six) questionnaires. The data from the closed questions were treated using the Statistical Package for the Social Sciences (SPSS). The open questions were transcribed and then analyzed the light of theoretical work on the subject. The research reveals that social workers are subject to conditions and labor relations precarious illness causing health problems because some of these professionals, among them are: stress, allergies and skin conditions or, Read / WMSD among other diseases. Thus, we understand the need for debates about the relationship work (the) social worker and worker health before the contradictions of capital also present in public health services

Perfil de fumantes atendidos em serviço público para tratamento do tabagismo

OBJETIVO: Avaliar o perfil dos fumantes que procuraram serviço público de cessação do tabagismo. MÉTODOS: Foram avaliados retrospectivamente os dados coletados durante a avaliação para a admissão no programa de cessação do tabagismo do Ambulatório de Tabagismo da Faculdade de Medicina de Botucatu/Universidade Estadual Paulista, na cidade de Botucatu (SP) entre abril de 2003 e abril de 2007. Variáveis demográficas, uso prévio de abordagem comportamental e/ou farmacológica e/ou tratamentos alternativos para o tabagismo, grau de dependência à nicotina e comorbidades foram avaliados em 387 fumantes. RESULTADOS: em nossa casuística, 63% dos tabagistas eram do sexo feminino. A idade média dos sujeitos foi de 50 ± 25 anos. Mais da metade dos fumantes (61%) não tinha cursado o ensino médio, e 66% tinham renda mensal menor que dois salários mínimos. O grau de dependência foi elevado/muito elevado em 59%, médio em 17% e baixo/muito baixo em 24%. Embora 95% dos pacientes apresentavam comorbidades, apenas 35% foram encaminhados ao programa por um médico. Mais da metade (68%) tinha feito pelo menos uma tentativa de cessação, 83% sem um programa de tratamento estruturado. CONCLUSÕES: Os tabagistas que procuraram assistência para cessar o tabagismo apresentaram desvantagem social, dependência à nicotina alta e tentativas anteriores de cessação sem tratamento estruturado. Portanto, a intervenção para o controle do tabagismo deve contemplar as características gerais dos fumantes nos serviços públicos para que seja eficaz.

Identificação de indivíduos vulneráveis no entorno de um hospital universitário: conectando vulnerabilidade, solidariedade e saúde

No entorno de um hospital universitário do interior do estado de São Paulo há pessoas dormindo, se alimentando ou descansando nos gramados e arredores, permanecendo nestes locais durante horas. Este estudo objetivou identificar e caracterizar indivíduos vulneráveis em área externa deste hospital, oferecendo ajuda. A coleta dos dados foi realizada no período de novembro de 2007 a outubro de 2008, semanalmente, em dias e horários sorteados. Identificaram-se pessoas que permaneciam nesses locais, sendo entrevistados 52 sujeitos. Esses indivíduos são, predominantemente, do sexo feminino (67,3%), brancos (51,9%), casados (59,6%), com escolaridade de até quatro anos de estudo (44,2%) e sem profissão definida (84,6%). A maioria aguardava o horário do ônibus da prefeitura de seu município de origem; o tempo médio de espera foi de aproximadamente 90 minutos e grande parte dos sujeitos apresentou necessidades durante os períodos de espera. Foi oferecida ajuda a 15 pessoas que referiram necessidades no momento da entrevista. Concluiu-se que esses indivíduos se encontram em situação de vulnerabilidade individual, social e programática, destacando-se a vulnerabilidade sócio-econômica, apresentam capacidade de autodeterminação reduzida, submetendo-se a condições desfavoráveis por dependerem dos serviços públicos.

Intoxicação por chumbo e saúde infantil: ações intersetoriais para o enfrentamento da questão

Inquérito epidemiológico realizado pela Secretaria de Estado da Saúde de São Paulo e Secretaria Municipal de Saúde de Bauru visou à realização de exames de plumbemia em 853 crianças de 0 a 12 anos, em Bauru, São Paulo, Brasil (2002), a partir de indícios de chumbo oriundo de resíduos industriais nas proximidades de uma fábrica de baterias. Os níveis sangüíneos de chumbo no grupo controle foram inferiores aos apresentados pelo grupo exposto (p < 0,05). Mediante a existência de 314 crianças com taxas de plumbemia superiores àquelas aceitáveis pelo Centers for Disease Control and Prevention (10µgPb/dl sangue), foi desencadeado um conjunto de ações com participação dos serviços públicos, universidades e voluntariado, para promover o diagnóstico e a assistência à saúde da população atingida. Ações emergenciais, visando a reduzir riscos de recontaminação, incluíram a raspagem de camada superficial das vias públicas, resultando em 1.392m³ de terra contendo material tóxico, que permanece depositada nas dependências da fábrica. Foi promovida a aspiração de poeira do interior das residências e a lavagem e vedamento das caixas d'água. O Grupo de Estudo e Pesquisa da Intoxicação por Chumbo em Crianças de Bauru, por meio deste trabalho, faz o compartilhamento de uma experiência intersetorial, multidisciplinar e interinstitucional.