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.

O Centro de Referência da Assistência Social e a Psicanálise: efeitos de uma escuta singularizada

This paper emerged from an experience of 18 months in the CRAS – Reference Center for Social Assistance – which aroused a question about the listening of the singularity in the professional practice of Psi in the context of social assistance. The literature review revealed, on the one hand, a series of studies that aim to a discussion about of the process of professional integration of psychologists in the field of social welfare, proposing and / or analyzing practices directed towards the psychosocial assistance directed to the group and for the assurance of rights, forming citizen subjects. On the other hand, supported by a psychoanalytic perspective, we found studies that point to the importance of the singularity listening considering the subjectivity and symbolic resources of those who seek help in Basic Assistance Service. In this perspective, we aim to analyze, in a posteriori, the effects of offering a singularized listening in the context of CRAS and discuss its implications for the Psi professional practice in social institution. This is a theoretical and clinical research, based on Freudian and Lacanian psychoanalysis, in which two cases, placed as investigation boosters, are analyzed in the light of the concept of the subject. We conclude that a singularized listening allowed a significant sliding and the consequent repositioning of the subject, in each case, front to their suffering. The effects collected allowed us to affirm the importance of a singular listening in the treatment of the demands that appear within the institutional framework

O processo de inserção dos psicólogos na assistência social em Natal/RN no período de 1972-2003

Since the rules of the National Social Assistance (PNAS) and the Unified Social Assistance System (SUAS) in 2004/2005 the psychologist action as an essential professional teams in the services offered in this field. Althoug, there are indications of psychologists who worked on the assistence prior this time. This insertion had not systematized in the literature, not allowing the establishment of records of this linear trajectory. The objective of this paper is investigate the entrance and a psychologist working in social care services in Natal / RN , as well as the activities undertaken by them in the period 1972-2003 . This temporal boundary is justified because Natal initiate to have a psychologist from 1972 to 2003 was immediately prior to the landmarks of the 2004/2005 year. The research was divided into two stages: documentary and oral history. The first was through the consultation of 86 monographs of the Sector Documentation Social Service Department of the Federal University of Rio Grande do Norte , its intend identify what were the services that characterized the health care field and evidence of the presence of psychologists in these spaces. In the second stage, interviews with psychologists who worked 13 trailers to social assistance in order to investigate its performance, activities undertaken, the insertion process in the area, among other things were done. The material analysis was based on themes from a historical perspective. The results point to three major areas of integration of psychologists : in child exceptionality in which psychologists were linked to Brazilian Legion Social Assistance (LBA); the field of the minor through the State Foundation for the Well Being of Minors (center), and occupying positions of management and coordination in some welfare programs.

Fundamentos dos cuidados com crianças e adolescentes: um olhar sobre o Rio Grande do Norte entre 1964 e 1988

Childhood and adolescence care has frequently caused theoretical and methodological discussions. At national level, the way of dealing with this public has always been on the agenda, either by maintaining a paternalistic treatment, or by coercive and repressive expression with which this public is treated. Given the above, this research presents a thorough study of social policies focused on children and adolescents in Brazil, with the overall purpose of investigating how this process of implementation of public policies for poor children and adolescents in the state of Rio Grande do Norte was. In previous studies, it was identified that there are no official records regarding the policy implementation process for this population in the state of Rio Grande do Norte. A retrospective study about the care towards children and adolescents in Brazil was held. It ranged from the XXVIII century, through the period of assistance, until the historical period in which the child started to be considered from the perspective of a policy. Thus, a certain period was framed, so that, through the historical research method, this study could focus on gathering data about the attention focused on childhood and adolescence in the state of Rio Grande do Norte, between the years 1964 and 1988. Data was listed from newspaper files that circulated in the state during period mentioned above. This time framing corresponds to the regency of the National Policy of Child Welfare. In the state of Rio Grande do Norte, the implementation of institutions such as FUNBERN and then FEBEM did not differ from the national standard, since many projects and care programs for poor children and teenagers were executed in this period. The implementation of these institutions revealed the concern of the state in solving the problem of “minors” regarding to situations of abandonment or "delinquency" which they were involved with. However, the kind of protection provided by the state toward this population was based on the current ideology that supported the political system at the time: the military dictatorship. Thus, the main way to provide care to this population was through its institutionalization, through taking children to daycare centres and adolescents to “reeducational” institutes for “minors”.

Parâmetros biológicos de Herpsilochmus pectoralis Sclater 1857 (Aves: Thamnophilidae) em fragmentos de mata atlântica do Nordeste do Brasil

The study of birds represents an important tool for the understanding of the processes involved in behavioral and morphological patterns. The species we have studied belongs to Thamnophilidae family, the third largest family restricted to the Neotropic ecozone. They are popularly known as antbirds and comprise 209 species. A large portion of the species has cryptic behavior, making the acoustic communication an important tool for maintaining contact among birds. Herpsilochmus pectoralis Sclater 1857 has evident sexual dimorphism, measured between 10 and 12 cm height and it is found in forest fragments in the Northeast and it is also categorized as vulnerable to extinction process. This study was conducted in three sandbank fragments on the east coast of the state of Rio Grande do Norte, Brazil. With the help of tape recordings between 2006 and 2012 it was possible to describe and characterize the sing of H. pectoralis. The sing from male birds has more and longer length than the female sing (16% of dimorphism). No differences were found in the dominant frequency between the sexes. We describe four types of calls from this species repertoire. Through capturing with ornithological nets between 2009 and 2012 it was possible to describe and compare the morphology of H. pectoralis. The species have shown lower corporal mass in the dry season. The young birds showed morphometric similarities in comparison to adults. The species has no accentuated dimorphism in their morphometric characteristics. The young ones with flying capabilities have morphometric characteristics of adults, even though they do not show a characteristic adult plumage. The moult pattern in the species is a characteristic of tropical birds, but it shows short reproductive period, typical of temperate species. Even being in the tropical region, the species suffers with seasonal rainfall, which influences their reproductive phenology and moult (remex and rectrix) cycle. Thus, this dissertation provides information on the biology of H. pectoralis to support the understanding of the relationship of this species to the environment and also to know the variations of morphology and vocal aspects, in order to understand patterns and general characteristics of Thamnophilidae.

Análise de tendência e caracterização sazonal e interanual da evapotranspiração de referência para o sudoeste da amazônia brasileira: Acre, Brasil

The objective of this research was to investigate monthly climatological, seasonal, annual and interdecadal of the reference evapotranspiration (ETo) in Acre state in order to better understand its spatial and temporal variability and identify possible trends in the region. The study was conducted with data from Rio Branco municipalities, the state capital, Tarauacá and Cruzeiro do Sul considering a 30-year period (1985-2014), from monthly data from weather stations surface of the National Institute of Meteorology. The methodology was held, first, the consistency of meteorological data. Thus, it was made the gap filling in the time series by means of multivariate techniques. Subsequently were performed statistical tests trend (Mann-Kendall) and homogeneity, by Sen's estimator of the magnitude of this trend is estimated, as well as computational algorithms containing parametric and non-parametric tests for two samples to identify from that year the trend has become significant. Finally, analysis of variance technique (ANOVA) was adopted in order to verify whether there were significant differences in average annual evapotranspiration between locations. The indirect method of Penman-Montheith parameterized by FAO was used to calculate the ETo. The results of this work through examination of the descriptive statistics showed that the ETo the annual average was 3.80, 2.92 and 2.86 mm day-1 year, to Rio Branco, Tarauacá and Cruzeiro do Sul, respectively. Featuring quite remarkable seasonal pattern with a minimum in June and a maximum in October, with Rio Branco to town one with the strongest signal (amplitudes) on the other hand, the Southern Cross presented the highest variability among the studied locations. By ANOVA it was found that the average annual statistically different for a significance level of 1% between locations, but the annual average between Cruzeiro do Sul and Tarauacá no statistically significant differences. For the three locations, the 2000s was the one with the highest ETo values associated with warmer waters of the North Atlantic basin and the 80s to lower values, associated with cooler waters of this basin. By analyzing the Mann-kendall and Sen estimator test, there was a trend of increasing the seasonal reference evapotranspiration (fall, winter and spring) on the order of 0.11 mm per decade and that from the years of 1990, 1996 and 2001 became statistically significant to the localities of Cruzeiro do Sul Tarauacá and Rio Branco, respectively. For trend analysis of meteorological parameters was observed positive trend in the 5% level of significance, for average temperature, minimum temperature and solar radiation.

Morfometria, variação anual no peso e demografia do Tico-tico-rei-cinza (Lanio pileatus: thraupidae) em dois ambientes de caatinga no nordeste do Brasil

The caatinga is considered the only exclusively Brazilian biome, with a total area of 735.000km². It is estimated that about 59% of this area has already been removed and only 2% are protected in conservations units. The region is characteristic by strong seasonality and heterogeneity in their environments. This paper sets generate information on morphological and population patterns Lanio pilatus in two areas of caatinga of Estação Ecológica do Seridó (ESEC – Seridó), Serra Negra do Norte - RN. Data collection was performed in six phases between July 2012 and December 2014, covering the end of the dry and rainy seasons in the region. The captures were performed with nets and individuals captured were marked with metal rings and measured (weight, wing length, tail, tarsus, culmen and tip of the bill to nostril). Through these measures, we observed that only males of open area range in weight during the dry and rainy season, youngs were significantly lower for all parameters measured, and males were larger than females in three characteristics (weight, wing length and tail) in open area and only one (wing length) in the closed area. The population parameters were generated from the mark-capture-recapture technique by program MARK, using the techniques of robust design and CJS. The survival probability of detection and population estimates varied with time. Only individuals of open area fluctuated in their estimates during the study. Overall, the environment was a great mediator of results which increases the need for more studies on the life history of the species in the region.

Os estados no SUAS: uma análise da capacidade institucional dos governos estaduais na assistência social

This paper deals of the effects generated by institutional designs in the behavior of political actors. The literature that discusses the implications of federal arrangements in the production of public policies to dock at two opposing arguments: (1) the federal configuration would cause dispersion and variation in service provision between subnational governments; and (2) the central government would own mechanisms to induce the provision of national policies in more homogeneous levels, similar to unitary states. The research is part of this discussion because it analyzes the effects of the institutional design of the Sistema Único de Assistência Social (SUAS) in the decisions of states in Brazil. Therefore, we analyzed the institutional capacity built by the 26 state governments after the implementation of SUAS, conceiving this system as defined mechanism of government functions and federative cooperation.It is argued that the existence of a heterogeneous institutional capacity of state governments in social assistance is a result of the autonomy contained in the institutional design of SUAS to this level of government. This freedom of action relativize the idea that the implementation of national public policy systems would generate positive (or homogeneous) effects in all subnational governments, at the same time as it preclude to generalize the premise of fragility of the states in the brazilian federal plan.

Diversidade cromossômica e padrões ecomorfológicos em Gobiidae (Perciformes) no litoral e ilhas oceânicas do Brasil

A família Gobiidae é a mais diversificada no ambiente marinho, onde tamanha diversidade parece ter sido acompanhada por alterações cromossômicas significativas, a tornando um modelo biológico importante. Em geral apresentam ampla distribuição geográfica com características comportamentais e reprodutivas que as tornam propícias aos efeitos de barreiras biogeográficas. Comparados a outros representantes da ordem Perciformes apresenta características morfológicas reduzidas, com simplificações e perdas que dificultam estudos filogenéticos e tornam imprescindível a associação de novas metodologias para melhor entendimento dos processos ecológicos e evolutivos que garantiram tamanha diversificação. Dados citogenéticos para espécies presentes no litoral brasileiro são ínfimos. Os resultados aqui apresentados, abrangendo um maior espectro taxonômico e profundidade de análises, identificaram marcante diversidade cariotípica estrutural interespecífica para Coryphopterus glaucofraenum, Bathygobius mystacium, Bathygobius soporator, Bathygobius sp., Ctenogobius smaragdus, Ctenogobius boleosoma, Gobionellus oceanicus, Gobionellus stomatus, Microgobius meeki e Evorthodus lyricus. As espécies estudadas fazem parte de uma fauna críptica pouco percebida e estudada, frequentemente impactadas, mesmo por eventos locais estocásticos. Análises por morfometria geométrica indicaram variação significante na morfologia corporal de espécies do gênero Bathygobius e o reconhecimento de padrões de variação de forma corporal referentes ao sexo, com populações mais dimórficas em menores latitudes. Técnicas citogenéticas moleculares resolutivas aplicadas em estudos populacionais no litoral e em ilhas oceânicas identificaram diferenciações locais e reconheceram uma nova espécie para o gênero Bathygobius, residente no Atol das Rocas e Arquipélago de Fernando de Noronha. As análises ainda possibilitaram a descrição de cromossomos sexuais XY nas duas espécies do gênero Gobionellus e a participação de elementos repetitivos na diferenciação deste sistema. Os dados aqui apresentados dão suporte ao alto grau de diversificação evolutiva da família, ampliam o conhecimento citogenético para o grupo, permitem identificar estruturações populacionais e respostas evolutivas das espécies às variações geográficas. Como modelo biológico a família Gobiidae representa um útil contraponto evolutivo em relação aos padrões genéticos vigentes às espécies de grande vagilidade.

Um estudo sobre a variabilidade do vento no nordeste do Brasil através de métodos estatísticos e via modelos dinâmicos de meso e micro escala

The objective of this study was to determine the seasonal and interannual variability and calculate the trends of wind speed in NEB and then validate the mesoscale numerical model for after engage with the microscale numerical model in order to get the wind resource at some locations in the NEB. For this we use two data sets of wind speed (weather stations and anemometric towers) and two dynamic models; one of mesoscale and another of microscale. We use statistical tools to evaluate and validate the data obtained. The simulations of the dynamic mesoscale model were made using data assimilation methods (Newtonian Relaxation and Kalman filter). The main results show: (i) Five homogeneous groups of wind speed in the NEB with higher values in winter and spring and with lower in summer and fall; (ii) The interannual variability of the wind speed in some groups stood out with higher values; (iii) The large-scale circulation modified by the El Niño and La Niña intensified wind speed for the groups with higher values; (iv) The trend analysis showed more significant negative values for G3, G4 and G5 in all seasons and in the annual average; (v) The performance of dynamic mesoscale model showed smaller errors in the locations Paracuru and São João and major errors were observed in Triunfo; (vi) Application of the Kalman filter significantly reduce the systematic errors shown in the simulations of the dynamic mesoscale model; (vii) The wind resource indicate that Paracuru and Triunfo are favorable areas for the generation of energy, and the coupling technique after validation showed better results for Paracuru. We conclude that the objective was achieved, making it possible to identify trends in homogeneous groups of wind behavior, and to evaluate the quality of both simulations with the dynamic model of mesoscale and microscale to answer questions as necessary before planning research projects in Wind-Energy area in the NEB

Gato-do-mato-pequeno (Leopardus tigrinus) na Caatinga: ocupação e padrão de atividade de um felídeo ameaçado e pouco conhecido na floresta tropical seca do nordeste do Brasil

While the carnivores are considered regulators and structuring of natural communities are also extremely threatened by human activities. Endangered little-spotted-cat (Leopardus tigrinus) is one of the lesser known species from the Neotropical cats. In this work we investigate the occupancy and the activity pattern of L. tigrinus in Caatinga of Rio Grande do Norte testing: 1) how environmental and anthropogenic factors influence their occupation and 2) how biotic and abiotic factors influence their activity pattern. For this we raised occurrence data of species in 10 priority areas for conservation. We built hierarchical models of occupancy based on maximum likelihood to represent biological hypotheses which were ranked using the Akaike Information Criterion (AIC). According to the results the feline occupancy is more likely away from rural settlements and in areas with a higher proportion of woody vegetation. The opportunistic killing of L. tigrinus and in retaliation for poultry predation close to residential areas can explain this result; as well as more complex vegetation structure can better serve as refuge and ensure more food. Analyzing the records of the species through circular statistics we conclude that the activity pattern is mostly nocturnal, although considerable crepuscular and a small diurnal activity. L. tigrinus activity was directly affected by the availability of small terrestrial mammals, which are essentially nocturnal. In addition, the temperatures recorded in the environment directly and indirectly affect the activity of the little-spotted-cat, as also influence the activity of their potential prey. Generally, the cats were more active when possible prey were active, and this happened at night when lower temperatures are recorded. Moreover, the different lunar phases did not affect the activity pattern. The results improve the understanding of an endangered feline inhabiting the Caatinga biome, and thus can help develop conservation and management strategies, as well as in planning future research in this semi-arid ecosystem.

Análise da atuação do Ministério Público Estadual na assistência materno infantil do Rio Grande do Norte

Maternal and infant mortality have become a serious public health problem in Brazil, especially in northeasternand northern regions.In RioGrande do Norte, the high rates ofdeathsofmothersandbabies haveconcerned not onlythehealthauthorities andjusticeagenciessuch as the prosecution service. In 2011, State Public Ministry (MPE) has developed a proposition which was called “Nascer com Dignidade”, focused on the monitoring ofcare givenin prenatal, childbirth andpost childbirthin the cities. The aim of thisstudy was toinvestigate how the intervention of MPE works in maternal and child care. The method adopted to survey data was the case study by analyzing the skills of the reports which were carried out in four of the eight Public Health Regional Units (URSAP).A total of 26municipalities were chosenand the results showfragilityparticularly inprenatal care which can result in complicationsin childbirthand postpartumlike:incomplete health family teams(in05cities), lack of access orinaccessibility to laboratory tests(16 cities) and lack of the pregnant woman'sattachment to thebirthing place(in26 cities). Based on this reality, MPE has adopted relevant attitudes as filing public civil suits, compliance of Conduct Adjustment Declaration in the municipal management and performing interventions in heath care centers and maternity clinics of the state. Thereforeit is known thatPublic Ministryis of paramount importanceto indicatethe necessaryadjustmentsto addressinfant and maternalmortalityin the state (mean of 65/100,000 and16/100,000respectively) and give the city hall the responsibility for the health care quality provided to their citizens. These factors demand theprinciples ofuniversality and integrality to be performed in order to reduce social inequities.

Avaliação do ensino da obstretícia e da assistência ao parto sob a percepção dos graduandos em medicina e enfermagem na Universidade Federal do Rio Grande do Norte

OBJETIVE: To evaluate the perception of Medical and Nursing students of Medicine and Nursing graduation courses at the Federal University of Rio Grande do Norte (UFRN), on obstetrics teaching and labor assistance in the context of the maternal care provided by the Maternity Hospital Januário Cicco (MEJC) and contribute to curricular updating planning of teaching obstetrics, in accordance with the principles of humanization. METHODS: It was conducted a study of cross-cutting approach and qualitative and quantitative descriptive method, with students in medicine and nursing of UFRN, who were attending or had been attended the midwifery disciplines medicine; and women's health in nursing. The data were collected through a questionnaire with objective and subjective questions, and stored in a database, spreadsheet software Excel / Office 2010 with all the variables. RESULTS: We interviewed 169 students, 118 of medical school and 51 from the nursing program, of which 46.75% were male and 53.25% female. The largest number of medical respondents is the 11th period (40.67%), and nursing, on 10, (43.15%). These students witnessed 1,073 births, and (61.8%) vaginal deliveries. The obstetricians were the most performed vaginal deliveries (40%). Nurses performed only (8.13%). The assistance provided to women during the process of labor and delivery, was configured as suitable for 87.58% of respondents and these glimpsed humane conduct. Students who performed deliveries, 76.27% were medical and 11.76% were nursing. All had guidance while doing them. A total of 19.50% medical students reported that there is a prejudice against vaginal delivery, particularly for the humanized birth, unlike all nursing students (100%) who reported that there is this prejudice. Most students (73%) showed preference for vaginal delivery, especially nursing students. On the knowledge of myths in relation to vaginal delivery, 60.35% answered that they know some. CONCLUSION: This study presents itself as a highly relevant, since the results may contribute to curricular changing and updating related to obstetrics teaching, but also serve as a resource for analysis of humanization practices that should be developed in educational institutions and which are recommended by the Ministry of Health.

Atuação de psicólogos em Centros de Referência de Assistência Social na região amazônica do Marajó

This study investigated the role of psychologists in Social Assistance Reference Centres in the Amazon region of Marajó, considering its specificities: extensive territory, spread population and presence of native communities. Eleven interviews were conducted in 10 out of the total 16 cities. There’s a context of fragile economies and poor housing; incomplete or disarticulated public services; bad working conditions. The activities are ad hoc or asystematic. Promising experiences bet on decentralized and intersectoral services. Experiences from other groups point to the importance of long-term work. We conclude that a powerful way of action is to strengthen the sociability that is characteristic of the native peoples, valuing their knowledge and developing their social protagonism.

Assistência em cuidados paliativos a pessoa idosa na atenção primária a saúde

This study aims to understand the significance of palliative care for the elder health care professionals working in primary health care. Descriptive study of qualitative approach. Conducted in three health units of the Family and a core of support for Health, the Felipe Camarão neighborhood, District of Natal Health West, RN. Of the 25 participants, 19 are professionals of the Family Health Strategy and six of the Center for Support to Health, the majority being women, with minimal professional work experience, a year in primary health care. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte, under CAAE no. 43895815.4.0000.5537. There were individual interviews between July and September 2015, with the use of questionnaire containing open and closed questions on the topic of study. Our results were recorded in MP4 and transcribed into written language, and analyzed using the open coding process medium in which the categories were interpreted and identified, followed by axial coding, where categories were developed and systematically related. Three categories emerged: enhancement of elder health professionals in palliative care, behavioral health professionals across care in palliative care in primary care and disjointed Meaning between palliative care and health professionals. The categories were interpreted and analyzed by the theoretical framework of social phenomenology of Alfred Schütz. Regarding the valuation of subjective perception of professionals, it is clear the issue of the complexity of multiple relationships through various aspects of his central task: focus a philosophy of the world's reality, namely a phenomenology of natural attitude; Before the professional behavior were identified: the discovery and depth of assumptions through the structure, and meaning in a common sense, and at the meaning of the disconnection between the health professionals-including that reality imminent can be represented by individuality special interest of the experience. It follows that health professionals understand there is a difficulty facing the assistance in palliative care to the elderly in primary care, and this difficulty, characterized by the complexity of social interactions across the joint teamwork. Although, I believe that the articulation between the teams, work and family, is essential for the subsequent improvement of care in palliative care favoring the health context surrounding the Elder.