Metodologia para gerenciamento de projetos em tecnologia da informação baseada no guia PMBOK: um estudo de caso na Secretaria de Estado da Saúde Pública do Rio Grande do Norte

Nowadays the search for growth makes organizations seeking competitive advantages, project management shares this goal, through techniques that assist in the search for an improved management of the various fields of knowledge through a design methodology. The world is driven by projects and the search for ways to better manage activities such as time, cost and term towards the success of a particular project is something constant. A major contribution that IT can make to the health sector is the support for the management area. IT can integrate processes, optimize the interconnection between the various sectors, make hospitals have access to inside information of good quality, as well as support in the healthcare area, sharing pictures, uniting the various aspects of nursing and nursing service. The major challenge faced by the SESAP Information Technology sector at present is in project management in IT , which does not exist makes investments in the area are increasingly difficult due to this deficiency in management develop their own systems without cost additional to the State. This study seeks to build and strengthen the Project Management within the Department of Health through the implementation of a project office that will manage the final result of this work methodology based on PMBOK, and still show the functionality applied to development the state Hospital Management System that will later be installed on all Regional Health Units and proposing measures for the sustainability and development of the sector amid the difficulties of the current public service. Such action will result in a savings of more than R$ 107,000.00 (one hundred seven thousand) regarding spending private software currently used by the assignment of invested by the State of Rio Grande do Norte user licenses, representing more than 5 % of the total budget of the State Department of Public Health of the State

Universalização do acesso à saúde e regulação dos planos privados de assistência à saúde: a atuação regulatória da ANS como instrumento de harmonia contratual e viabilização do papel suplementar da iniciativa privada na efetivação do direito social à saúde

While essential to human nature, health and life have been protected since ancient times by various areas of knowledge, particularly by the Law, given its dynamics within the regulation of social interactions. In Brazil, health has been granted major importance by the Federal Constitution of 1988, which, disrupting the dictatorial authoritarianism, inaugurating a Social State and focusing on the values of freedom and human dignity, raises health to the condition of a social right, marked predominantly by an obligational bias directed, primarily, to the State, through the enforcement of public policies. Although, given the limitation of the State action to the reserve for contingencies, it turns clear that an universalizing access to public health is impossible, seen that the high cost of medical provisions hinders the State to meet all the health needs of the rightholders. As a result of the inefficiency of the State, the effort of the Constituent Assembly of 1988 in creating a hybrid health system becomes nuclear, which, marked by the possibility of exploration of healthcare by the private initiative, assigns to the private enterprise a key role in supplementing the public health system, especially through the offer of health insurance plans. At this point, however, it becomes clear that health provisions rendered by the private agents are not unlimited, which involves discussions about services and procedures that should be excluded from the contractual coverage, for purposes of sectoral balance, situation which draws the indispensability of deliberations between Fundamental Rights on one hand, related to the protection of health and life, and contractual principles on the other hand, connected to the primacy of private autonomy. At this point, the importance of the regulation undertaken by the ANS, Brazilian National Health Agency, appears primordial, which, by means of its seized broad functions, considerable autonomy and technical discretion, has conditions to implement an effective control towards the harmonization of the regulatory triangle, the stability and development of the supplementary health system and, consequently, towards the universalization of the right to health, within constitutional contours. According to this, the present essay, resorting to a broad legislative, doctrinal and jurisprudential study, concludes that economic regulation over the private healthcare sector, when legitimately undertaken, provides progress and stability to the intervening segment and, besides, turns healthcare universalization feasible, in a way that it can not be replaced efficiently by any other State function.

Travestis na atenção primária: o cuidado em saúde na cidade de Natal

Among the deviant a heteronormative ideal, transvestites are the ones that suffer abuse and discrimination. Have been found that health services often present themselves as places that maintains and reproduce such discrimination, which makes transvestites only sought medical care in the latter case. Based on the guidelines of the SUS and the National Humanization Policy as well as the inclusion and leadership of the users, we conducted a qualitative study seeking to understand the experience of transvestites in seeking health care within primary care in Natal-RN. We use as techno-methodological instruments in depth interview and workshop with use of "scenes". For interpretative analysis of the narratives we use to Hermeneutics-Dialectic. From the dialogue with the narrative we come to the following themes: 1) Understanding the meaning of being a transvestite; 2) The experience transvestite in search of health; 3) Transvestites and humanized health care. In the first point they reveal the daily struggle of transvestites between prejudice and the search for respect, as well as the meanings of being a transvestite, who appeared as: Being gay, being feminine, not transsexual and accept themselves as they are. In the second axis, expressed difficulties in access to and use of health services: the embarrassment by not using the social name; fear of going out during the day; the association of transvestites to HIV; and pain caused by discrimination from health professionals. It was also possible to identify simple demands such as illnesses from day to day, the demand for hormone therapy, which involves treatment needs as well as the vital need to have their rights XVII respected. The third axis, for the range of a humanized care identified that the respectful gaze guarantee their dignity and their right to health in a humane way, but it identified some necessary changes: Training of professionals, dialogue with the social movement, publicity campaigns and rapprochement with the transvestite. Finally, it is expected that the research will contribute to the field of knowledge know-how in health care transvestites, inside and outside of the university

Análise do perfil de encaminhamento da atenção primária para pré-natal de alto risco: desafios para o ensino de competências em saúde materno-infantil

OBJECTIVE: to identify a profile of the main causes of inappropriate referrals from primary care to specialized services, as strategy for the curriculum development of core competencies related to maternal health. METHODS: a cross-sectional study was performed using document analysis of all referrals of pregnant women from primary care to the high-risk pregnancy service, state of Rio Grande do Norte, Brazil. All pregnant women referred from June to December 2014 (n = 771) were included. According to their causes the referrals were categorized as adequate, inadequate or inconclusive. RESULTS: a total of 188 referrals were classified as inadequate (24.4%) and 93 inconclusive (12.1%) totalizing 36.5% of inappropriate referrals. The main causes identified in these inappropriate referrals were: low-risk pregnancy (12.8%), unconfirmed hypertension (12.1%), risk of abortion (8.9%), teenage pregnancy (7.1%) , toxoplasmosis (5.3%), Rh incompatibility (4.6%) and urinary tract infection (4.3%). These data contributed to the formulation of the following products: 1) a continuing education program for health professionals working in primary care, undergraduate students and residents; and 2) development of a virtual platform to support professionals who need to refer patients to high-risk pregnancy service. CONCLUSION: the results of this study are relevant in the current context of education of health professionals, with potential for positively impact not only in the development of skills related to maternal health in undergraduate and graduate education, as well as contributing for improvement of the health care of the population.

Concepção de ser humano subjacente à discussão sobre saúde na psicologia: uma proposta de orientação heideggeriana

A reading method (Cervo & Bervian, 1983) was applied to select psychology publications on health. The rejection of the biomedical model is a recurring theme in these publications. Its point of view is that the model is reductionistic because it emphasizes (1) the disease (2) as a body dysfunction and by consequence health is understood as the absence of disease. The implications of the biomedical model for health are biological materialism and physiological mechanicism. Psychology publications counterpoint to biomedicine is to include attention to life contexts and consider the role of individual behavior and lifestyle in the health-disease process. Those thoughts about the nature of health imply a conception of man, especially when some articles claim that Descartes’ ideas are the ground to biomedicine development. Psychology publications reviewed highlight health characteristics related to a different view of the human mode of being. The thesis presented develops an understanding that Martin Heidegger’s Dasein Analytic is a conception of human being consistent with the selected psychology works’ view of health. It means psychology’s discussion about what is health is based on an implicit approach to the human being, one that allows the rethinking of health. The heideggerian Dasein is a vision of man in tune with the comprehension of health presented in the selected publications. It is understood that the manner a human phenomenon is conceptualized is related even implicitly to a conception of man. To take into account health’s contextual aspects like society, environment, and culture call attention to the man world relationship to which Heidegger calls being in the world. To highlight the role of behavior on one’s own health makes a point of the relationship man has with her/his own being, which Heidegger calls mineness.

Conhecimentos alternativos e ecologia dos saberes: o difícil diálogo do sistema de saúde oficial

Le present travail a pour objectif, discuter le dialogue entre deux des formes de penser le processos santé-maladie: la médécine traditionnelle et celle scientifique. Et cette dernière représentée par le Système Unique de Santé, particulièrement par une Équipe de Santé de la Famille. Partant du questionnement “quel est le rôle de chaque système de santé dans les problèmes sanitaires ainsi que dans la prévention des maladies?”, il s‟agit de vérifier si l‟ ”Écologie des Savoirs” discutée par Santos (2007) a été appliquée dans les deux manières de penser et pratiquer les politiques de santé; tenant em compte que chacune d‟elles ayant son champ de possibilites et d‟impossibilités agit directement sur le quotidien des aires géographiques concernés par la recherche: le District de São João do Abade dans le Municipe de Curuçá/PA et l‟Équipe de Santé de la Famille Abade localisée dans ce même district. Cette étude fut réalisée à partir d‟instruments de collecte de données comme la recherche de terrain, l‟observation directe et les interviews semi-structurés (HAGUETTE, 1997) e apports théoriques à partir de certains des concepts clés les plus utilisés par les Épistémologies du Sud où nous mettons en relief l' “Écologie des Savoirs” (Santos, 2007); le “travail de Traduction” (SANTOS, 2008); la “Sociologie des Absences et la Sociologie des Émergences” (SANTOS, 2004); le concept de “Santé-Maladie” (MINAYO, 1988); ainsi que les discussions autor des “Savoirs de la Tradition” (ALMEIDA, 2010; RAMALHO et ALMEIDA, 2011). La stratégie “Santé de la Famille fut pensée à travers la vision de Guedelha (2008) et Vilar et al. (2011) où à partir de cette dernière la discussion sur le concept de “Médécine Communautaire” (DONNANGELO e PEREIRA, 1976) comme recours importante dans la recherche de l‟ “Écologie des Savoirs” dans la Stratégie Santé de la Famille a été possible.

Os rumos do fundo público no capitalismo contemporâneo: uma análise sobre o financiamento da Política de saúde no estado do Rio Grande do Norte

This work analizes the financing of Health Policies on the state of Rio Grande Do Norte, starting at the presumption that SUS is “Bombarded” by fiscal ajustments, as a neoliberal strategy to face capital crises.The trafectory of the financing of SUS demands the comprehension of two principles which are, in essence, contradictory: the “principle of universatility”, which is caracterized by the uncompromising defence of the fundaments of the Sanitary Reform, and the “principle of containment of social costs”, articulating the macroeconomic policy that has being developed in Brazil since the 1990s and which substantiantes itself on the 2000s.This last defends the reduction of the social costs, the maintanance of primary surplus and the privatization of public social services. Considering these determinations, the objective of this research constitues in bringing a critical reflection sorrounding the financing of the Health Policies on the state of Rio Grande do Norte, on the period from 2004 to 2012.Starting from a bibliografic and documentary research, it sought out to analyze the budget planning forseen on the Budget Guideline Law (LDO) and on the Multiannual Plans (PPA), investigating the reports of the Court of Auditors of the State of RN and gathering information about expenses with health, available on the System of Information About Public Budgeting in Health (SIOPS).The Analises of the data obtained, in light of the theoretic referece chosen, reveals trends in the public budget setting for health on the State of Rio Grande do Norte, which are: a tiny share of investment expenditure on health, when compared to other expenses, the amount used in daily fees and advertising; the high expense in personnel expenses, especially for hiring medical cooperatives;the strong dependence of the state on revenue transferences from the Union; the aplication of resources in actions of other nature considered as health, in exemple of the expenditures undertaken by the budgeting unit Supplying Center S/A (CEASA) on the function of health and subfunction of prophylactic and therapeutic and on the Popular Pharmacy program. Since 2006, expenses refering to Regime Security Servers (RPPA) on the area of health also have being considered as public actions and services in health for constitutional limit ends, beyond the inconsistencies on the PPAs with the actions performed efectively.

Condições de trabalho e saúde psíquica de servidores técnico-administrativos da UFRN

Unfavorable working conditions constitute one of the factors that may contribute to cause psychic suffering and behavioral disorders in workers. This research aimed to characterize the working conditions public servant technical- administrative , specifically the auxiliaries and assistants in administration of the Federal University of Rio Grande do Norte – UFRN, Natal, Brasil, as well to identify the incidence of psychic suffering in this group of public servants. As a strategy, we chose a case study of multi-method type, descriptive with quantitative and qualitative sequential steps. For this, it initially performed desk research by surveying epidemiological data for these public servants working in central campus, to identify the major diseases presented in the period from January 2011 to June 2014. Then, we proceeded to diagnostic step of the aspects related to work, by applying online and in loco of Working Conditions Survey (already validated by Borges et al., 2013a) in 11 sectors selected according to the following criteria: high number of workers public servants and major and minor percentage of absences for health care for ICD-F (according to records of Sector of Workers Health Care - DAS). In the treatment of the data the spreadsheet editor software Microsoft Office Excel and statistical SPSS Statistical Package for Social Sciences were used and made qualifying type of content analysis of open questions. Applied to this study 174 public servants and the results show a predominance of absenteeism due to mental or behavioral disorders (ICD F), musculoskeletal diseases (ICD M) and respiratory system (ICD J). Among the factors that were significant are the working hours (contractual and legal); Physical Effort (M = 2.59) and workspace (M = 2.58) - physical and material conditions; encouraging collaboration (M = 3.5) - processes and characteristics of the work; and participation (M = 1.78) - social-management environment. Therefore, it infers the existence of a relationship between these factors and some of the reasons for absenteeism reported by participants. It is suggested the expansion of this research with studies involving other professionals (including scholarship workers and contractors) and specific sectors.

Serviços-escola de psicologia do Rio Grande do Norte: formação profissional e política pública de saúde em debate

The Psychology University Services is stablished normatively as an indispensable equipment to the recognition of the graduation courses of psychologists by the Brazilian Education Ministery. The Public Healthcare Policies (Universal Health System/SUS) constitutes itself as a input field of the professional category, but shows huge challenges in the formation of these professionals. The objective of this work is to analyse the functioning of the Psychology University Services (SEP) and the Superior Educational Institutions from Natal, understood as important formation devices to attend the actual demands of the psychologist's work on SUS. For this, it sought a) characterize the psychological practices developed in the SEP; b) relate the National Curricular Lines of Direction of the psychology courses to the skills and competences developed in the SEP to the performance on the public healthcare policies; c) mapping ways of including the SEP in the network designed by the healthcare policy. Interviews were performed with 13 academic supervisors, 8 field supervisors and technicians of superior level (TNC), along with 9 managers, being for of the Psychology University Services and 5 of the graduation programs. Questionnaires were also applied to 57 interns and 24 graduates. Besides that, two conversation circles were performed with the faculty and technician members from two of the Educational Institutions that were participating of the research, as well as a workshop with students and psychologists, promoted by the CRP 17. We observed that most part of the faculty members and managers know the DCN and comprehend that the formation is in process of change in what concerns to the extension of the formation to the performance of the psychologists in various contexts. However, most part of the TNC don't know about them. Moreover, the results point to the predominance of the assisting model based on the traditional clinic psychology, although the articulation with the public healthcare and social assistance networks can already be timidly visualized. Different modalities of practices in theses Psychology University Services were also detected, such as conversation groups, thematic workshops, organizational consultancies, team meetings with the interns and TNS in a daily basis, matriciament in mental health, therapeutic monitoring, among others. Yet, the SEP in Rio Grande do Norte are still isolated from the other courses that perform in the healthcare area and also from the services that compose the public healthcare and public policies.

As ações em saúde mental nos Núcleos de Apoio à Saúde da Família - NASF

The National Police for Basic Care (PNAB), regulated by ordinance nº2488 from October 2011, restates the Family Health Strategy (ESF) as a priority to the expansion, consolidation and qualification of basic attention to health matters in Brazil. In order to bring it about, city counsellors along with other federal entities ought to ordinate their work process deepening principals, directions and fundaments of Basic Care (AB). Besides ESF, the new PNAB expatiates on the Family Health Support Centres (NASF), reaffirming their role on broadening the scope of basic care actions and their improvements, ratifying their ability to share knowledge and support Basic Care professionals. All this considered, the purpose of this work is to investigate how NASF is currently structured in João Pessoa and what has been achieved by it on what concerns to mental health. Its main objectives are to analyse the practices of mental health professionals that are part of NASF teams and if they differ from what has been developed by the other members of the teams; to discuss the articulation of NASF in managing mental health measures on what concerns to internal organisatio n and to the city health network; to identify strategies used to organise such measures on mental health in Basic Care. To reach such goals, individual interviews have taken place two city health managers and four of NASF professionals that participated on the Mental Health Office as representatives of their sanitary districts. Also a focal group formed by various supporters of NASF was created, contemplating the diversity of professional categories involved with the teams and sanitary districts. It was possible to identify in NASF, in João Pessoa, an organisation based by the matrix support in which both management and basic care demands reflect a series of actions developed alongside with ESF. Amongst such actions, matrixing, home visits and the Singular Therapeutic Project (PTS) stand out. These activities have been discussed on the focal group and integrate the daily work of all NASF supporters despite their professional categories. NASF presents itself as a powerful strategy to SUS proper qualification and support to strengthen Basic Care and broaden family health teams‟actions.

Cuidado psicossocial em saúde mental: estudo em assentamentos rurais do Rio Grande do Norte

Dwellers of agrarian reform settlements have a life conditioned by poor living and work conditions, difficulties accessing health programs, social assistance and other public policies and by this exacerbating their psychosocial and environmental vulnerability, which has an impact on their mental health. This research investigates the availability of support by the health and social assistance staff, regarding the demands of common mental disorders and alcohol abuse of dwellers of nine settlements in Rio Grande do Norte. Fifty three experts from different professional categories were interviewed individually or in groups. The results indicate that the workers suffer from poor working conditions, attributes of patrimonial heritage and welfare, which still survives in Brazilian social policies and particularly at local administrations of the countryside. The staffs have little knowledge of the local conditions and of the mental health needs, which has a negative impact on the reception and offered care. The implemented health care still corresponds to the biomedical logic, characterized by ethnocentrism, technicality, biology, cure, individualism and specialization, with little participation of the dwellers and disregarding the traditional knowledge and practices of local health care and by this not achieving the expected results. The psychosocial attendance is not well coordinated, presenting problems with the follow-up and continuity of care. The psychosocial mental health care in rural context has to face the challenge of the reorganization of the health care networks, the establishment of primary health care close to the people’s everyday life, building intersectional practices considering a health multidetermination and health education connected to these specific contexts. Due to the lack of knowledge of the specifics of the life conditions of the dwellers and the fragmentation of the psychosocial health care network, these staffs do not abide and are not ready to face the mental health needs in order to interfere with these health iniquities.

Cuidado psicossocial em saúde mental: estudo em assentamentos rurais do Rio Grande do Norte

Dwellers of agrarian reform settlements have a life conditioned by poor living and work conditions, difficulties accessing health programs, social assistance and other public policies and by this exacerbating their psychosocial and environmental vulnerability, which has an impact on their mental health. This research investigates the availability of support by the health and social assistance staff, regarding the demands of common mental disorders and alcohol abuse of dwellers of nine settlements in Rio Grande do Norte. Fifty three experts from different professional categories were interviewed individually or in groups. The results indicate that the workers suffer from poor working conditions, attributes of patrimonial heritage and welfare, which still survives in Brazilian social policies and particularly at local administrations of the countryside. The staffs have little knowledge of the local conditions and of the mental health needs, which has a negative impact on the reception and offered care. The implemented health care still corresponds to the biomedical logic, characterized by ethnocentrism, technicality, biology, cure, individualism and specialization, with little participation of the dwellers and disregarding the traditional knowledge and practices of local health care and by this not achieving the expected results. The psychosocial attendance is not well coordinated, presenting problems with the follow-up and continuity of care. The psychosocial mental health care in rural context has to face the challenge of the reorganization of the health care networks, the establishment of primary health care close to the people’s everyday life, building intersectional practices considering a health multidetermination and health education connected to these specific contexts. Due to the lack of knowledge of the specifics of the life conditions of the dwellers and the fragmentation of the psychosocial health care network, these staffs do not abide and are not ready to face the mental health needs in order to interfere with these health iniquities.

A responsabilidade civil extracontratual do estado na prestação de serviços públicos de saúde

This study aims to examine the Brazilian legal model for the non-contractual liability of the state in providing public health services, from the perspective of threedimensional theory of law. Up based on bibliographical and documentary research, with emphasis on legislation, doctrine and Brazilian jurisprudence, the following conclusions were reached. The right to health is typified in the Constitution as a social fundamental right, and understands the pretension to obtain from the State, the supply of goods or the provision of services that reduce the risk of disease and other health problems; or promote, protect and recover the physical and mental well-being. Once violated the fundamental right to health, provides the managed, among other fundamental guarantees, the non-contractual liability of the state. The provision of public services by the state can be made directly through the Direct or Indirect Public Administration, or by recourse to private entities. In any case, the provision of public health services is entirely subordinate to the principles of administrative law and should be fully funded by tax revenues. As the provision of public health services is part of the administrative activity of the State, there is no way to exclude the application of the guarantee of non-contractual liability of the state in the face of the damage suffered by administered as users of these services. Therefore, it applies the theory of administrative risk, even in the event of harmful and illegal state failure.

Relatório de estágio : Centro de Apoio ao Desenvolvimento Infantil, CADin

O trabalho apresentado enquadra-se na realização do estágio curricular no âmbito do 2º ciclo de reabilitação psicomotora. O estágio curricular decorreu no Centro de Apoio ao Desenvolvimento Infantil durante o ano letivo 2012/2013. Nesta instituição a estagiária desenvolveu o seu trabalho dentro de problemáticas como a perturbação de hiperatividade e défice de atenção e os problemas de comportamento. O trabalho envolve a caraterização da instituição, a consideração da intervenção psicomotora no âmbito do desenvolvimento e aprendizagem e o aprofundamento teórico das problemáticas observadas. No sentido deste trabalho refletir as conquistas e dificuldades de todo um processo, são apresentadas as atividades realizadas no âmbito do estágio e uma reflexão crítica sobre o contributo de todo o processo para a aprendizagem e futuro profissional da estagiária.

Intervenção psicomotora em saúde mental : Casa de Saúde de São João de Deus, Funchal

No âmbito do 2º Ciclo de Reabilitação Psicomotora realizou-se o aprofundamento de competências profissionais, na área da saúde mental. O estágio teve lugar na Casa de Saúde de São João de Deus – no Funchal, instituição particular de solidariedade social. A Reabilitação Psicomotora é transdisciplinar com aplicações em diversas áreas, incidindo a aplicação prática em indivíduos com Dificuldades Intelectuais e Desenvolvimentais, e em indivíduos com Alcoolismo, respetivamente, numa Unidade de Evolução Prolongada, e no Centro de Reabilitação Alcoólica. A intervenção realizada será ilustrada mediante a descrição de estudos de caso (N=4). O objetivo da intervenção centrou-se na promoção de um funcionamento independente, sendo as atividades centradas na promoção de regras e normas, manutenção de atividades de vida diária, promoção de relações interpessoais e manutenção de capacidades sensoriomotoras e a promoção da qualidade de vida junto de um grupo de indivíduos com Dificuldades Intelectuais e Desenvolvimentais. Por sua vez, no Centro de Reabilitação Alcoólica (N=10), os objetivos da intervenção foram a tomada de consciência do problema, responsabilização e promoção de hábitos associados a um estilo de vida saudável. A avaliação inclui instrumentos de medida do funcionamento adaptativo (ECAP) e da qualidade de vida (EPR) e a bateria psicomotora (BPM), na unidade de evolução prolongada, e SF-36, e URICA no centro de recuperação de alcoologia, aplicados em dois momentos (inicial e final). Mediante os resultados obtidos a intervenção, que envolveu um conjunto de atividades de mediação corporal, teve um impacto positivo observando-se algumas melhorias no funcionamento adaptativo, qualidade de vida e competências psicomotoras.