Iniqüidade em saúde: uma extensão das desigualdades sociais no sistema público de saúde do Brasil (2003-2006)

This issue analises the unevenness in the brazilian system of public health care as an extension of socials inequities. It is a theoretical study based in a historical method, using empirical camp from academic, corporation and institution researchs, along the period 2002-2006. Equality and effectiveness in health systems are analitical basic cathegories grap in the root of the doctrine, principles and organization of the Unique Health System, in which sectorial actions are inserted. Discuss the estructural prodution and determined those inequalities through some social determiners of health system: income, land, food securitiy, nutritional situation, basic sanitation, epidemiological inequities and public management policy. Carry out a thematic review over health social production, it formlation and the goals of social policies, as well as the insertion of the equality principle in the assistance system, in the frame of the running public health regulations. It uses reflections that enlighted the correlation between the process of political-institutional actions and equity on health assistance. Analized the pertinency of sectorial reorganizational strategies on basic attendance, confronting the hipothesis that those strategies reinforce social inequities in health system, because it organize diferential assistance levels over not equal baselines. The results show up that social inequalities, even remaining, have had a small decrease; that the selectiviness of actual public policies and the duplication of the health system, increases the differences within and between the social classes and configures the assistance as inequal. The basic care system has great shortages that also appeares in middle and complex assistance levels. As conclusion, it remarks that the health assintance system, even with it integrality has limits; structural problems on material conditions of living and health system could not be reversed only with institutional legal arragements; by the contrary, in border conditions, these strategies produce policies that reinforce inequities, neglecting the equity principle of the system in which frame, they work. One patina of this tim

Avaliação dos impactos do programa bolsa família na renda, na educação e no mercado de trabalho das famílias pobres do Brasil

This study aims to verify the impact of the Bolsa Família Program (BFP) in income and school attendance of poor Brazilian families. It is intended to also check the existence of a possible negative effect of the program on the labor market, titled as sloth effect. For such, microdata from the IBGE Census sample in 2010 were used. Seeking to purge possible selection biases, methodology of Quantilic Treatment Effect (QTE) was applied, in particular the estimator proposed by Firpo (2007), which assumes an exogenous and non-conditional treatment. Moreover, Foster- Greer-Thorbecke (FGT) index was calculated to check if there are fewer households below the poverty line, as well as if the inequality among the poor decreases. Human Opportunity Index (HOI) was also calculated to measure the access of young people / children education. Results showed that BFP has positively influenced the family per capita income and education (number of children aged 5-17 years old attending school). As for the labor market (worked hours and labor income), the program showed a negative effect. Thus, when compared with not benefiting families, those families who receive the BFP have: a) a higher family income (due to the shock of the transfer budget money) b) more children attending school (due to the conditionality imposed by the program); c) less worked hours (due to sloth effect in certain family groups) and d) a lower income from work. All these effects were potentiated separating the sample in the five Brazilian regions, being observed that the BFP strongly influenced the Northeast, showing a greater decrease in income inequality and poverty, and at the same time, achieved a greater negative impact on the labor market

A formação do professor alfabetizador em cursos de Pedagogia: contribuições e lacunas teórico-práticas

To the we assume the disciplines of the area of Literacy of the course of Pedagogy, our intention has been the one of working the literacy, the reading and the writing as alive processes, as social practices inserted in the history, continuators of the subjectivity, done in the culture and producing of culture. The importance of the course of Pedagogy in the teachers' formation is unquestionable; however our goal is to highlight, in this work, the paper of that course in the formation of the teacher alphabetized, while mediator of the literacy process with an inclusive vision. In that to walk, it appeared us the following subject: which the contributions and the gaps theoretical-practices - of degree courses in Pedagogy - experienced for the exits of that course, in the specific pedagogic work of alphabetizing children, young adult and/or our study aims at to investigate, under the perspective of teachers alphabetizer licensed in courses of Pedagogy, the contributions and the theoretical-practical gaps of those courses, in the formation of the educator alphabetizer. In this sense, our work if it bases on the presuppositions of the qualitative investigation that leaves of the foundation that there is a dynamic relationship among the real and subjective world, an alive interdependence between subject and object, an entail indissoluble between the objective world and the subjective (CHIZZOTTI, 1998, p.79). The research is characterized as a descriptive and interpretative study and for the collection of data; the questionnaire, the semi-structured interview and the documental analysis were used. We took the following providences for the choice of Locus and of the subject of the research: it visits to the schools; compatibility of the criteria previously defined for choice of Locus and of the Subjects. For the choice of those schools, we defined the following criteria: that, in your individuality / totality, they were located in integral neighborhoods of, at least three of the four administrative areas of the city of Natal; that, in your individuality / totality, they contemplated the public spheres and private of attendance; that, in the year of accomplishment of the research - 2004 - they were offering infantile education and/or fundamental teaching; this last one gone back to the children of the initial years and/or for the youth and adult of the first levels of the modality of EJA; and that made possible the researcher's access. Front to the particularities of our study object and considering the criteria of choice of the locus, four public schools and three private schools were selected. Like this being, in those schools, we would look for the subject of our work that they would owe: 1) to be working, in 2004, with children's literacy, youths or adults: they as teacher (the), it as coordinator (the) that guides teachers alphabetizer, in public schools or peculiar of the city of the Natal-RN; 2) to be exit (the) of the degree course in Pedagogy, supplied by institutions of superior level (public or matters) of the city of the Natal-RN; 3) to have concluded your course of Pedagogy in the period of 1990-2004; 4) to have, at least, 01(one) year of experience in literacy rooms (TARDIF, 2002). The subjects interviewees concluded your courses of Pedagogy, in the period from 1990 to 2004, in institutions different from the city of Natal/RN, being five to the whole: two public IES and three deprived IES. Of the analysis of the data, the theme emerged, ' teacher's Alphabetizer Educational Formation in Courses of Pedagogy', with the following categories: contributions of the courses of Pedagogy; More important disciplines in the educational formation; Areas / Aspects lacunars of the courses of Pedagogy. The pedagogic practice of the teacher alphabetizer demands a formation from him found in you know educational, requested in the children's literacy, youths and adults. In that work, we defended the thesis that the course of Pedagogy is the locus, par excellence, for that formation, in spite of possible structural limitations and curricular of the referred course. In spite of the countless contributions of the pedagogy course for the formation of the teacher alphabetizer, our data appear for the need of a revision of the proposals curricular of that course, getting the attention for the importance of a proposal formation curricular more gone back to the literacy process / literate and for the social inclusion. We thought that, although insufficient, the teacher's formation in that perspective is a fundamental condition for a practice pedagogic alphabetizer to be promoted, in fact, inclusive and promoter of the school success

Representações sociais, relações de gênero e programas de assistência e educação à saúde da mulher no climatério em Natal/RN

Climacteric is the name of the period of the human life that it is going from the 40 years old, approximately, until the 65 years old. Though, for besides a biological phase of the woman's life, the climacteric is an object of the social world that is rendered to different apprehensions and readings on the symbolic plan. In this study, it was looked for to know the social representations, that health' professionals acting in the programs of the climacteric and the users of those same services, build in respect of that purpose. Besides, it tried to be seen that the social hegemonic representation that guides the actions and the agents' attitudes in the practices of attendance and education for the woman's health in the climacteric in the extent of the investigated institutions. The data were collected through interviews, questionnaire, focal discussion group and direct observation. The observation field was constituted by the three institutions that develop the attendance and education for the woman's health in the climacteric phase, in the city of Natal. A gender perspective was also been adopted, sought to evidence as the cognitive structures that assure the masculine power reproduction, pronounce to the social representations to build a sense to the investigated purpose. It was verified that the social representations of the climacteric are built mainly around the semantic fields old age and disease. For the health professionals, the meaning of the simbol old age carries the marks of the indentified system of the middle class employed, but also, of the feminine habitus that guides them to have an ethical and aesthetic apprehension of their own body. The climacteric, in that way, is seen as a difficult phase , a painful event that scares . For the women attended by those professionals, the sign old age means feeling emphasis from the biological climacteric aspects, in other words, the sensations and signs that forbid the body to accomplish certain linked basic life functions. Along the whole course of this thesis, it was verified that the climacteric is a complex phenomenon that needs to be faced as such. While cultural phenomenon, it is urgent to look for means to help to combat the centrality of the professional representations that face the climacteric as old age and disease, particularly in the field of health

Para uma andragogia do esporte:discutindo as diretrizes e a formação profissional para a Educação Física de Jovens e Adultos

For the development of this research the following general objective has been formulated, indicator of the process of inquiry: To discuss the relation between the attitudinal and the sportive contents presented in the proposal of Curricular Lines for the Physical Education of Young and Adults in Brazil. According to the corporeity and the ludicity, questioning the formation of the professional of Physical Education and delineating the perspective for a sport andragogy that values the Being and the Life. From this general objective, the following objectives, which had given greater specificity to the investigative process, were defined: 1. To create the theoretical context from the corporeity/ludicity axis, articulating transversally sportive knowledge, aiming to contribute for a sport Andragogy; 2. To analyze the objectives proposed for the Physical Education of Young and Adults according to an elaborated theoretical reference and to the testimonies of the egresses of 2005 of the Physical Education course of the UFRN. 3. To interpret the relation between attitudinal and educative content from the academic reality lived by the egresses of the Physical Education course of the UFRN. 4. To understand the most urgent necessities of sustained formation of the egresses of 2005 for satisfactory performance with the Physical Education of Young and Adults. 5. To propose perspectives for the construction of a sport Andragogy from the corporeity/ludicity axis. In attendance to the nature of this research and as form of guiding ourselves in this epistemological adventure, the following ones had been basically and theoretically estimated. 1. Corporeity is a radiant focus, prime and main of educational criteria; 2. The task of the education must be carried through with men and not for men; 3. Man must only play with the beauty and with the beauty he only must play. ; 4. The sportive education must be based on esthetic and fair play. The adopted research approach is of a qualitative nature, using the interview procedure with a group consisting of twelve egresses of the Physical Education Course of the UFRN of the year of 2005.2 After the discussion of the results on the attitudinal objectives and content for the Physical Education for Adults and Young, the study shows nine themes presented by the investigated group as priorities for their sustained formation, aiming at the performance of the professional of Physical Education with the EJA: inclusive experiences; leisure and quality of life; relationships; body and personal care; social values; self esteem; sportive phenomenon; EJA training; attitudinal contents. As a contribution to the construction of knowledge for a Andragogy of Sports, the study presents a metaphorical structure called Galaxy of Knowledge righteous Glamor of integrating nine elements inspired by the Ode to the Sport of Pierre de Coubertin: life, beauty, justice, daring, honesty, joy; Fertility; progress; peace. At the heart of the structure of knowledge is righteous install a system that articulates five principles ludopoiético epistemological function of connecting with the righteous knowledge of the sport that must integrate the content attitudinal proposed for Fitness for Youth and Adults in order to facilitate the realization of their objectives proposed for this method of teaching

Políticas públicas de atendimento à criança: desafio da ação articulada no Projeto Belém Criança (2001-2004)

Public politics of Service to the Child: The Challenge of the Action Articulated in the Project Belém Criança (2001-2004) if it constitutes in a study on the politics directed toward the children of 0 the 6 years. It has as objective to analyze the configuration of the politics of integral attention to the child, evidencing the form as the same ones they had been redimensioned by the neoliberal ideas and by the lines of direction of the international organisms. The work has like empiric reference the project Belém Criança, developed by county of Belém from a partnership with the Deep of United Nations for Infancy (UNICEF), in the period of 2001 and 2004. The project intends to develop an articulated action among the several county departments which offer assistance to the children looking for to rationalize the resources and to optimize the services. Amongst the methodological procedures that materialized the research distinguished: The bibliographical review and documental allowed to analyze the contextualization of the public politics and, between them, the social politics of attendance to the child; the historical revolution this attendance; the paper of the UNICEF how articulator of the politics in municipal scope; and the paper of county how executer these politics. Still it was utilized, the half-structuralized interview, Having like subjects: the representative of the UNICEF in Belém, the municipal co-managers and actors of community in which the project was implemented. The result of the analyzes review that, historically, the politics destined to the child they had been being dimensioned having like support the fight of social movements vindictive for publics politic which guarantee the fundamentals rights these citizen. Although legal dimension of current politics of attendance to the child, to assume a vision of completeness and the guarantee of the rights, it still has a great exaggeration between the speech and the practical one. Actually, the same one are elaborate inside the neoliberal optics, with ruled actions by the beginning in combat to the poverty, implanted with low costs and with practice which to lead to the excessive fragmentation, generating inadequate actions and punctual programs which don t guarantee the social quality of the attendance. This perspective was evidenced to the most of the actors which the Project Belém Criança don t constitute itself a real public politic toward the child of 0 the 6 years, although present innovating aspects, how the mobilization and participation. It was demonstrated yet, in the participant s depositions of the research, that the bureau had numberless of difficulty to develop the action preview in the project, it has seen the great complexity of articulation between the several organism responsible by politics of attendance

Registro da atuação do movimento dos atingidos por barragens nos reassentamentos de Acauã: a alfabetização de jovens e adultos

This work contains the problematic of sub-education among the population that was excluded from school attendance in the regular time, contributing to knowledge production about educational practices developed in EJA (the Young and Adult Education). It focuses on the Pedagogical proposal and on the experience in young and adult literacy in the context of the mobilization of people affected by dam building. It depicts the international, national and regional mobilization against huge dams building and the emergence of the Movement of Dam Affected People (MAB), highlighting their general project and registering their teaching performance, particularly in young and adult literacy. In methodological and theoretical approaches, two interconnected categories are considered: the historical entirety, essentially theoretical, and the young and adult education practice. Based on the entirety, it outlines a contextualized explanation about the stakeholder s situation and, respecting the second category, which is part of the first one, places literacy as one of the basic aspects of an omnilateral man upbringing. The study broaches a wide context of dams in the world, placing the socio-environmental effects resulting from dams building in Brazil, in Northeast region and in Paraíba, and emphasizing the consequences of Acauã Dam building in the Paraíba cities of Aroeiras, Itatuba and Natuba. It presents the particular context of the population affected by Acauã, summarizing a panoramic view about the involved Paraíba cities and learning the conditions of residents relocation. It appraises the educational project and the National-MAB literacy proposal, operationalized by Paraíba-MAB in resettlements sited on Acauã s surroundings. It ensures that, besides public policies including financing, the feasibility of literacy problem solution can be completed with Pedagogical actions attached to the target people peculiarities and immediate necessities, respecting actions connected through one comprehensive and contextualized educational project. It evaluates the young and adult literacy project developed in the restricted Paraíba-MAB area, as an example of a Pedagogical action minimally contextualized. Eventually, it recommends researchers and teachers in general, that are committed to this work perspective, to pay attention to the way they articulate discussions and participation, so as to contemplate these communities expectations and necessities in Pedagogical projects and spaces based on discussion, dialogue and collective reflection

Por trás de links, sempre existem pessoas: o anonimato como fator de pertencimento no uso de redes sociais on-line em projetos educacionais

The thesis investigated how social networks online that allows anonymous postings can be used by teachers and students to promote the meeting between the sexual education and the needs and expectations of young people face a crosscutting theme, remarkably a taboo. It needs teaching strategies more efficient than those traditionally defended. With this experience, found in a short course about sexuality and health, we sought to go beyond the use of social networks for social entertainment, showing they can be an field that favors the process of teaching and learning. The research was based on the convergence of the communication concepts from Paulo Frere and another from Jürgen Habermas, as well as the philosophical concepts of utopia, ideology and dialectic are interrelated not only among themselves, but also inside an education field. Methodologically in this thesis, we adopted the category of qualitative research; the method is a combination of case study with action research. The technique was the use of questionnaires, data collection was in attendance and the types of data were primary. Finally, we present, then, the idea the communication is not in the middle, but in the trusty relationship established between the interlocutors. In this way, we can think when a student has met their need to be able answer his questions about sex with their teacher through an online social network that allows anonymity and through which the student knows who responds is their teacher, but the teacher can not distinguish the identity of his students, this dialogic relationship serves to get claims of the validity that are characterized as potential communicative action

Apoio pedagógico, ação coletiva e diálogo: tramas da formação continuada em educação inclusiva

This work detaches the importance of the continued formation of the educators in terms of the inclusive educational process, pointing as basic elements the continued formation of the educational professionals. In this direction, it points and it defends the dialogue in the perspective of David Bohm, with interfaces of the freireanas ideas, as a methodological resource of action that allows the organization of strategies of collective and effective pedagogical support in inclusive schools, in the same time articulates the continued formation of the professionals in education. Characterized as research in a dialogical action with collective participation and collaboration, it counted with the participation of 87 educators, between professors, pedagogical, managing coordinators and specialists of special education in two schools of the state and municipal public system of Natal/RN. The results had pointed with respect to the viability of the dialogue as articulated methodological tool of the continued formation in service, when providing the establishment of personal and professional relationship between the educators, favoring the discursive enjoyment of the lived experiences, allows the organization of strategies of collective and effective pedagogical support in the scholar environment. On the basis of these results, this work also points to some items to reflections as the reorganization of the Secretariats and the schools, in the direction to brighten up the fragmentation and the discontinuity of the pedagogical actions evidenced and to instigate a process of changes that has glimpsed the professional development of the educators through its continued formation in service and the improvement of the school in the way of the concretization of an education directed toward the acceptance, respect and attendance the diversity of its pupils, as detaches the official documents and the studies on the inclusive education

Representações sociais e práticas discursivas de profissionais do programa saúde da família sobre o pré-natal

The present study had the objective to identify to the Social Representations of the professionals of medicine and nursing superior level of the Program Health of the Family concerning the assistance for the gestation. The research was qualitative under the optics of the Theory of the Social Representations of Serge Moscovici, of the Central Nucleus of Jean-Claude Abric and of the Analysis of Content of Laurence Bardin. We worked with the following instruments for the collection of data: Questionnaires, with social-demographic data; Free association of Words, with the inductive terms Pregnancy, Assistance for Gestation and Care; Production of mental image and half-structuralized Interview, with the following question: What does the assistance for the gestation represent for you? . We interviewed all the professionals of nursing and medicine of the Program Health of the Family in the city of Santa Cruz /RN (ten for each profession) in the period of February and March of 2007. From the analysis of the social-demographics data, we respectively identified the following percentages for nursing and medicine: the feminine sex for nursing predominated (90%); the age between 24 and 33 (70 and 60%); the religion catholic (80 and 50%) and 50% of the two groups has up to two years of formation and work in the score of the research. The analysis of the others instruments resulted in two categories: Institutionalized vision and Vision of the Common-sense. In the free association of words, the category institutionalized vision is configured as Central Nucleus and of the common sense one as nucleus Peripheral, demonstrating that the Social Representations of the assistance for the gestation attendance are in the universes consensual. In the mental images, we identified to this same construction. In the content of the interviews, the institutionalized vision is permeated by the responsibility of making and the availability of having - assistance for the gestation is recommended by the Health department and necessary genders - while the vision of the common-sense can be represented by the category sort, whose role of professionals of the assistance for the gestation is to strengthen the responsibility for the woman of a maternity socially constructed. In short, the analyzed speeches reflect that, to the knowledge acquired in the academy, are incorporated in the knowledge of the daily professional, and conducted by popular myths. Medicine and nursing recognize the importance of the attendance in such a way for the chance to educate the women for the maternity as for the possibility to prevent complications, but in its speeches they had excluded from this process the masculine figure. We conclude that the meaning of the inductive term take care, part of the common-sense and is incorporated the institutionalized speech to humanize the assistance. However, the pregnancy ceases from being seen in its natural biological direction and starts to be analyzed as a moment of fragility and predisposition the illnesses. Finally, the social nursing and the central nucleus representations for the assistance in gestation for medicine is anchored in the speeches institutionalized and of the common-sense, reflecting the concern in establishing a humanized assistance with quality

Análise de qualidade da atenção à criança na estratégia saúde da família: o óbito infantil evitável como referência

Alma-Ata declaration bring the Primary Attention to the Health (PAH) as first level of health attention for individuals, family and community, which considers infant group as priority. Several initiatives that gave bases to integral attention to the children health formalized in the principles of Unique Health System. Family Health Strategy (FHS) comes to strengthen this attention, instituting new ways of work organization and professional practices that gave impact in their quality indicators. One of them is children mortality, showing decline in their values. Though, studies indicates persistence of avoidable infant deaths. In Natal RN, this reality is also perceptible leading to inquietudes, mainly at the space of services production, it means, which motivated the accomplishment of the present study intending to analyse the way that the organizational and structural processes as long as the professional practices in FHS interfered in the quality of children s health attention who died by avoidable death in the year of 2007 in municipal district of Natal-RN. It treats, therefore, to an exploratory and descriptive survey of cases study type, thar had as primary sources the oficial documents of MH, the family prontuary, pregnant card, child card and testimony obt ined from instrument of research elaborated based in investigation form of infant death by MH, applied to 10 mothers of children who had avoidable death. In analysis it was appealed silmultaneous triangulation of methods and sources, allowing a bigger aproximation from obtained informations. To elucidate the cases, the aspects studied were analyzed to the light of explicative model of Social Determinants of Health. Among individual and family aspects were highlighted the related to age, schooling, family habits and customs and mother s economic condition, besides of pregnancy age, newborn weight and associated diseases, which don t differ from literature about the theme. Reffering to the factors organizational and structural processes and professionals practice, highlihgted, the treatment given by the professionals, the territorialization and adscription of areas, the difficulty of having access to the services or sleepers and the reference and counterreference. But also, the ausence or few greet, the lack of communication, few assiduity and ponctuality by professionals in service, among others. In a general way mothers considers the attendance received in the hospital good and very good , opnions that in the Basic Attention weren t so favorable, in spite of many of predictible actions in this level have been performed in the studied cases. It is observed, therefore, that the social determinants of health has a strong influence in ocurrence of infant deaths, what implicates in a large actuation by Infant Mortality Committee from municipal district. This way, it becomes fundamental the reflection and evaluation about the effectiveness and execution by the processes of vigilance to health in FHUs; the rethink about the social determinants of health in a wide and articulate way to the services quality, to permanent education, to management in service, to the given attention and to the way how it is installed the popular participation and social control. To the professionals it is presented the great challenge to review their daily practice, their values, behaviors and commitment, which ones must be guided by logical of sharing, work in team, humanescence and alterity, not only by the accomplishment of a professional duty

Prática do acolhimento à pessoa idosa na atenção básica: uma estratégia de humanização

The aging of the population already is a fact, before considered a phenomenon, today, is part of the reality of the majority of the societies in the world. The present study it has as objective to analyze the practical one of the shelter developed for the team to multidiscipline for the elderly in the Strategy of Health of the Family. One is about a descriptive and exploratória inquiry, developed by means of quantitative boarding. The population of this study consisted of nineteen teams that work in the inserted ESF in the urban zone of the city of Sousa-PB, understanding a complete of 133 professionals. The collection of date was carried through through a questionnaire contends closed questions, referring to the partner-demographic date e, specific open questions. The main results indicate that the professionals of Health of the city of Sousa, PB, that had participated of this study had consisted in a complete of 76. Amongst these, 20% are nurses, followed of the odontólogos in 6%; 35% are ACS and technician of nursing with 19%. The age of the interviewed ones meets in the age band enters, 21 and 30 years, in 43%. The majority is of the feminine sex with a 84% total. Already in accordance with civil state 34% is married. If treating to the wage, the doctor has of greater of 12 wages. The participants present the percentile greater of formed time of with referring 33% of 1 the 3 years of formation. E finally, the changeable time of performance, if had detached 39% of the participants with 08 the 11 years. With regard to as if it processes the reception and attendance to the person in the ESF, we can observe that, with priority attendance was prominence with 27% of the participants, followed of a considerate attendance with 26%. Already in relation to the actions that are developed daily in the ESF, these they are come back toward the HIPERDIA with 40%, followed of actions ruled in orientation with 27%. Some actions they are carried through in accordance with the aged necessity of each (13%) and through visits domiciliary (9%). It was asked to them as the shelter was facilitated in the UBS, these had told that it is through the attention that is excused the aged one (35%), and finally, as this made it difficult age, in its majority with 37% they had not wanted to answer, followed of the lack of understanding with 26%. With this study it was possible to conclude that the practical one developed for the professionals of the ESF of the city of Sousa, PB with the elderly, is characterized by an assistance ruled in the clinical aspect, little focused in the actions that to permeate the PNH

Serviço de atendimento móvel de urgência (SAMU) e a assistência às urgências psiquiátricas

The objective of this work which is characterized as an applied research, with a qualitative exploratory approach and has case study character has been the analysis of the conceptions and dealings of health professionals of SAMU in Natal RN about the attendance of psychiatric urgencies. The information was collected between the months of March and April of 2010, by means of semi-structured interviews, performed with 24 health professionals integrating of SAMU-Natal as well as the usage of direct observation technique, performed in the institution's medical regulation room. Both the number of professionals involved in the interviews and the bringing about of the observations, were determined by saturation methods in qualitative research's information collecting. The interviews and observations were transcribed and submitted to contents analysis technique , more specifically, to thematic analysis, which made possible to reach the deepest levels, that go beyond what has simply been manifest in the speech of the interviewed, getting to the relations among the categories and social structures of the issue of the research. Keeping this in mind, three analysis categories have been built, namely: conceptions and concepts of psychiatric urgencies shared by health professionals in SAMU-Natal; attendances to psychiatric urgencies in SAMU-Natal; and the Brazilian Psychiatric Reformation under the view of the SAMU-Natal's health professionals. Reflection about the analyzed information revealed discussions pertaining to the stigma and prejudice on mental illness, and also, pointed out to some hindrances which impair the attendance to individuals in mental suffering in SAMU-Natal. The interviewed health professionals' conceptions on the individual in psychical crisis involve concepts of unpredictability, aggressiveness and risk, stigmatizing elements and historically associated to the social hazard ideology and need for mentally sicks' segregation. The predominance of these conceptions, seen in health professionals speech, had identifiable reflexes on assistance to psychiatric demands performed by SAMU-Natal, namely: indiscriminate request for military police's presence during psychic crisis intervention, neglect about occasions that involve mental health patients, as well as repetitive assisting practice directed on physical contention, and transportation to psychiatric hospital. Associated to it, the professionals have shown distorted and reductionist understanding about Brazilian Psychiatric Reformation, and, in the majority, haven't lent credibility to present model of attention to mental health, based on psycho-social treatment, pointing their speech to a need for psychiatric patient's internment. In this sense, we notice that the hospital-centered and excluding model conceived by classical psychiatry still remains alive in these health professionals' mentality as a reference to psychiatric urgency's assistance. Therefore, the research revealed a sequence of elements, that make us think about the challenges that health sector and society must face to realize Brazilian Psychiatric Reformation's principles and guidelines

As ações de controle da tuberculose na atenção primária à saúde: a visão do doente

Tuberculosis is a disease of great impact on the world context today. In Brazil, the disease management was directed to the Primary Health Care, due to the determination of the Ministry of Health to decentralize health actions for primary care. Thus, since the actions of diagnosis, treatment and control of the disease should happen in this context, however, there are still many barriers that may hinder the realization of these determinations. This study aims to analyze the development of tuberculosis control activities conducted in the services of primary health care from the patient's vision. This is a descriptive, cross-sectional and quantitative study. The population consists of 517 tuberculosis patients treated in units of Primary Health Care in the city of Natal-RN; the sample consists of 93 TB patients. The collect instrument is structured, based in The Primary Care Assessment Tool (PCAT), validated in Brazil and adapted to assess attention to TB in Brazil, with modifications. This instrument was divided into blocks: the first one describes the socio-demographic information of patients with TB and the second one describes the health services working in control, diagnosis and treatment of TB, and includes issues related to the dimensions of primary care: access, bond, services, coordination of care, guidance to the community and family focus. For quantitative analysis, were built indicators for each item of the instrument. The response patterns are followed according to the Likert scale, which was assigned a value between one and five meant that the degree of preference relation (or agreement) of the statements. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. The results indicate that 62.37% of patients are male, 27.96% aged 41 to 50 years old, and 34.41% unemployed, with low education and low family income. It was found that the reference hospital services are the front door to the patient (59.14%), and are also the local diagnosis of the disease (72.04%). On access, the conditions satisfactory found are: the number of times the patients need to pick up the health care issue, the marking and the facility to get a consultancy in the HS, assistance provided without harm to the individual's attendance labor and facilities related to the proximity between the residence and services; were considered unsatisfactory conditions related to travel to the HS, and on hours and days of operation of services. As for the cast of services were satisfactory and regular actions related to the request for examination to become viable in the first HS, the availability of pot to perform smear and medicines for the treatment, as well as consultations control and receiving information about the disease and the treatment performed; it is considered unsatisfactory the performance of the home care for patients with TB by the HS that acts as a front door, for implementation of the Directly Observed Treatment (DOT), home visits during treatment, the provision of transportation allowance to the patient and the existence of groups for TB patients. Regarding the coordination of care, resulted in regular the action of referring the patient to other HS to obtain examinations, and as unsatisfactory referral to obtain medications. The relationship bond between patient and health team were considered satisfactory in the majority or regular. As for the family and community focus, is satisfactory only the indicator relating to questions from professionals to the patient about the existence of respiratory symptoms in the family. It is considered that there is need for greater commitment from government entities to the incentives required to TB control, as well as the availability of necessary inputs and training of human resources working in the PHC in the ongoing quest to strengthen primary care, as a place of broader host needs to contact the user with the actions and health professionals. It is recommended the adoption of management mechanisms possible to expand the capacity of the health PHC, promoting the service delivery to the user and ensuring attention to population health.

Aconselhamento em HIV/AIDS: ações e reflexões dos profissionais do Centro de Testagem e Aconselhamento (CTA)

The counseling on HIV/Aids consists in a prevention strategy that contributes to increase the diagnosis of HIV and start earlier the treatment. The counseling has as pillars the emotional and educational support, risks evaluation that aim at the adoption of safe practices and the individual s responsibility for his own health. To accomplish these results, it is necessary that health workers understand counseling as a unique educational moment that stimulates the user s critical-reflection when it comes to his role as an active subject in this process. This study aimed to analyze the counseling on HIV/Aids conducted by the professionals of the Testing and Counseling Center (CTA), based on the educational perspective of Paulo Freire . This is a descriptive qualitative study with a critical reflexive design based on the principles of Action-Science. All the professionals acting as counselors in the Joao Pessoa, PB CTA, eight in total, took part in the study. Data were collected during the month of March, 2011, through non participative observation and semi-structured interviews with a critical-reflexive focus, analyzed according to the tenets of the critical-reflexive methodology, and discussed taking into consideration the Paulo Freire s pedagogy and pertinent literature. It was observed that most of the professionals expressed the work philosophy of CTA as the diagnosis and prevention of the disease, associated with the utilization and demonstration of condoms. However, upon observation of their counseling sessions, these ideas were not converted in actions. Educational themes were not covered and the condom wasn t offered at any time. The counseling actions focused on the provision of information and filling out the paper forms which are necessary for attendance. The sessions were conducted with brief dialogues and little opportunity for the users to expose or complement their thoughts and needs. The professionals mentioned as facilitating conditions for counseling, the team interaction and physical structure. The difficulties focused on the users low cognition, the large demand for attendance, aspects related to the service organization, and the counselors absences and delays. After reflecting about the actions observed in the counseling, the majority of professionals admitted the need to modify their practice in the incorporation of educational principles for the achievement of a broader prevention, and seemed to be willing to work in this perspective. In conclusion, although the counselors show ideas consistent with the purposes of CTA, these ideas are limited when it comes to the understanding of the meaning of prevention in HIV/Aids. Taking into consideration that they express a certain comprehension and act differently during the counseling, they demonstrate a lack of bond between the theories in use and the proposed ones, in accordance with the contribution of the action-science theory. The counseling, as an educative practice, doesn t materialize in the counseling itself and the orientation for reflection is not given during the attendance. These findings suggest the need to include the process of reflection in the execution of the actions of counseling, so that these practices are guided by reflexive practice, aiming at transforming the way of thinking and acting into a more educational perspective toward a more democratic and holistic assistance.