Contando histórias de cuidado à infância em unidade de terapia intensiva pediátrica

The tales of children's literature, in their plots, mark existential dilemmas belonging in human‟s lives, such as death, situations of separation, loss, abandonment, fear, challenges, achievements and other elements that make them suitable material to assist children in their developmental process. Such elements, present in children‟s storybooks, are close to the experiences lived by the children in the context of hospitalization in a special manner. With that said this study focus on the understanding of the therapeutic possibilities of the tales of children's literature in the care of hospitalized children in Pediatric Intensive Care Units (UTIPED) based on the Heidegger's concept of Care and adopting the Phenomenology as the method. The UTIPED of a state public hospital located in the municipality of Natal/RN was elected as the study site and four hospitalized children aged between six and nine years, all males, presenting different clinical conditions were selected to participate in the study following age and clinical conditions as the selective criteria. The procedure of corpus construction included eight individual sessions of storytelling accompanied by the use of ludic resources. The phenomenological understanding about the therapeutic possibilities of tales was structured under three main elements: (1) the ludic axis; (2) the reflective axis; and (3) the affective axis. The appropriateness of the proposed therapy in the context of the UTIPED and the potential of the tales as a protection factor to the child was evident. The storytelling activity framed a scenario of care unusual in the context of intensive care units, establishing a symbolic space for children‟s expression. Therefore, this study indicates this therapeutic proposal for children‟s care in the UTIPED that considers their evolutionary stage, their clinical conditions at the time and especially their emotional needs during their immersion in a diverse and foreign environment which is filled with potentially harmful elements to their full development.

Um enfoque psicológico da educação ambiental no contexto da gestão: uma experiência de Fernando de Noronha

Currently, many companies pay attention to the necessities of change of attitude in relation to the use of the natural resources and the environment quality of its products, mainly to keep a positive and competitive image in the market. This new concept of management associates the productive activities to the care with environment using the education of environment as a tool of programs of qualification directed toward the promotion of pro-environment behaviors. For effectiveness of this management it is essential the attachment of the employees and the major understanding of the importance of the preservation of the environment. This was the objective of the qualification process carried out in a lodge in Fernando de Noronha island. The purpose of this study, therefore, was to verify the power of this management system which fulfills the objectives of the environmental education. It was applied questionnaires to employees of three Inns and carried out a interview, in one Inn, with the participants of the program of qualification. The analysis of the data showed that the actions as care with the environment are strongly associates to the management system, which includes garbage control, as well water economy. It was observed that the environment accomplishment (EcoAntro) of the employees with environment decreases in proportion to their qualification. In the same way, as higher the instruction level, of the speaker and/or of the father, less is the apathy for environmental questions. It was also noticed that the knowledge about the development sustainability was very poorly used by the interviewed. The pro-environment behavior mentioned before, is not necessarily related to a local autonomy posture that could express a behavior related to job but not to environment it self. Therefore, a complete understanding about the reverberation of environment information an all the placed factors in a life stile facing a construction of sustainability remains as a question to be studied in future researches

Mães de neonatos pré-termo hospitalizados: avaliação do apoio social e da sintomatologia ansiogênica

Social support is an important factor throughout one s life, especially in times of crisis. Premature delivery can be considered a crisis, followed by neonatal hospitalization. This type of birth is associated with elevated anxiety, representing risks to maternal mental health and mother-infant relationship. This research aims to investigate whether a relationship exists between perceived social support and the expression of anxiety in mothers of premature, hospitalized newborns. This is a cross-sectional, correlational study, conducted during the period of April to October 2011, using a convenience sample. The sample consisted of seventy mothers with preterm, hospitalized newborns and seventy mothers of full-term newborns. The instruments used were the State-Trait Anxiety Inventory and the Social Support Scale. The results demonstrated a weak negative relationship between intensity-State Anxiety and emotional support as well as a negative relationship in intensity between low to moderate-Trait Anxiety, social support and its dimensions (material support, emotional, information, interaction positive social and emotional). These suggest that the better the perception of social support, the less severe anxiogenic symptoms will be, and the converse is also true. It is noteworthy, therefore, the importance of social support, as well as the importance of health professionals to be aware not only of the physical health of the newborn, but also the psychosocial aspects that pervade the context of preterm birth followed by hospitalization

As fontes de desgaste físico e emocional e a Síndrome de Burnout no setor de transporte coletivo urbano de Natal

Recognizing the importance the workplace has on mental health of the individual, the objective of this study was to investigate the relationship between the burnout syndrome and the sources of physical and emotional wear which permeate the work conditions of the urban public transport system of the city of Natal. Although existent in international literature, research on burnout in the professional transport category and studies directed to this category are not a tradition in Brazil. The research was carried out using 412 drivers and money-changers of two transport companies of Natal. To collect the data, two questionnaires and a semi-structured interview were used. The first instrument, developed and validated during the research, investigated the sources of wear and the second, the syndrome of burnout. As its main results, two sources of empirical wear were identified as follows: (1) the Conflict of Values and the Lack of Justice at the Workplace, (2) Union and Reward. Besides these, it was observed that there is an incidence of the syndrome of burnout among the drivers and money-changers of urban transport by bus, not only in the caring occupations studied before in Natal and Brazil and that this incidence is related to the sources of wear which permeate the work conditions of these professionals

Suporte ao uso de álcool e drogas na atenção primária: um estudo com equipes de Natal/RN

National surveys indicate that 6.8 % of the brazilian population is dependent on alcohol and 1 % dependent on illicit drugs, representing a significant portion of the population affected by this issue . Primary Care becomes instrumental in expanding the coverage of this demand and in reducing unnecessary referrals for specialized care. This study aimed to investigate the responsiveness and institutional support of Primary Care Teams in relation to the demands of alcohol and drugs users. The research was conducted in a Family Health Unit in West Sanitary District of Natal City. With quantitative and qualitative nature, our study consisted of two stages. At first, we performed a mapping of alcohol and other drugs abusive use in a sample of the population assisted by Family Heath Teams, using sociodemographic questionnaire and ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). 406 questionnaires were completed. Of these questionnaires, 27.8% are men and 72.2% women, of which 56% are between 20 and 39 years-old, they are housewives, have a stable relationship and are consumers of tobacco (37.6%), marijuana (13%) and especially alcohol (57%). In second stage, two Conversation Circles with Family Health Teams and the referential Family Health Support Center were formed to discuss the data of the mapping realized in the previous phase. The circles, which had participation of 20 of the 37 professional teams from Family Health and 2 from Family Health Support Center, showed a lack of professional training in the subject; inability of the healthcare network in the user embracement; belief of professionals that nothing can be done when matter is alcohol and drugs; and referencing as the only care action performed by teams. Thus we point out the need to support an approach on issues of alcohol and drugs which consider gender issues, investing in Harm Reduction Policy as a possibility of working in this context for recognizing each user in their uniqueness and strategizing with them to promote health in a broad and contextualized way

Alquilação redutiva da quitosana a partir do glutaraldeído e 3-amino-1-pr

Chitosan derivatives were prepared by reductive alkylation using glutaraldehyde and 3-amino-1-propanol. The reducing agent used was the sodium borohydride. Tests of solubility, stability and viscosity were performed in order to evaluate these parameters effects in the reaction conditions (molar ratio of the reactants and presence of nitrogen in the reaction system). The molecular structure of commercial chitosan was determined by infrared (IR) and hydrogen nuclear magnetic resonance spectroscopy (1H NMR). The intrinsic viscosity and average molecular weight of the chitosan were determined by viscosimetry in 0.3 M acetic acid aqueous solution 0.2 M sodium acetate at 25 ºC. The derivatives of chitosan soluble in aqueous acidic medium were characterized by 1H NMR. The rheological behavior of the chitosan and of the derivative of chitosan (sample QV), which presented the largest viscosity, were studied as a function of polymer concentration, temperature and ionic strength of the medium. The results of characterization of the commercial chitosan (the degree of deacetylation obtained equal 78.45 %) used in this work confirmed a sample of low molar weight (Mv = 3.57 x 104 g/mol) and low viscosity (intrinsic viscosity = 213.56 mL/g). The chemical modification of the chitosan resulted in derivatives with thickening action. The spectra of 1H NMR of the soluble derivatives in acid aqueous medium suggested the presence of hydrophobic groups grafted into chitosan in function of the chemical modification. The solubility of the derivatives of chitosan in 0.25 M acetic acid aqueous solution decreased with increase of the molar ratio of the glutaraldehyde and 3-amino-1-propanol in relation to the chitosan. The presence of nitrogen and larger amount of reducing agent in reaction system contributed to the increase of the solubility, the stability and the viscosity of the systems. The viscosity of the polymeric suspensions in function of the shear rate increased significantly with polymer concentration, suggesting the formation of strong intermolecular associations. The chitosan presented pseudoplastic behavior with the increase in polymer concentration at a low shear rate. The derivative QV presented pseudoplastic behavior at all concentrations used and in a large range of shear rate. The viscosity of chitosan in solution decreased with an increase of the temperature and with the presence of salt. However, there was an increase of the viscosity of the chitosan solution at higher temperature (65 ºC) and ionic strength of the medium which were promoted by hydrophobic associating of the acetamide groups. The solutions of the chitosan derivatives (sample QV) were significantly more viscous than chitosan solution and showed higher thermal stability in the presence of salt as a function of the hydrophobic groups grafted into chitosan backbone

Impacto da cárie precoce severa na infância na qualidade de vida relacionada à saúde bucal de pré-escolares sob privação social

Early childhood caries, especially in its severe form, which is characterized by an acute and aggressive nature, can have negative impacts on thequality of life of a child, due to effects such as difficulty in chewing, decreased appetite, weight loss, insomnia, changes in behavior and a decreased performance in school, among others. Moreover, the quality of life of the child`s family can also be affected, as the pain and discomfort caused by this type of caries result in loss of working days of parents, spending on dental treatments, changes in sleep patterns and stress. The aim of this study was to evaluate the impact of severe early childhood caries in the Oral Health-Related Quality of Life (OHRQoL) of public daycares`s preschool children through the Escala de Impacto da Saúde Bucal na Primeira Infância, a Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). A single calibrated examiner (kappa=1.0) evaluated, through the dmfs index, the oral health of 116 children aged between 3 and 5, which were included in one of three study groups: "caries-free", "not-severe early childhood caries" and "severe early childhood caries". The parents responded to ECOHIS, to assess their perception regarding the OHRQoL of their children, and a questionnaire on socioeconomic conditions. The OHRQoL was measured through the total scores and domains of ECOHIS. Descriptive analysis, Mann-Whitney test, Kruskal-Wallis test, chi-square test and Poisson multiple regression with robust variance were used. Among the children observed, 38.8% were caries-free, 27.6% showed not-severe early childhood caries and 33.6% showed severe early childhood caries. Regarding the total score of ECOHIS, severe early childhood caries had a greater negative impact on OHRQoL, compared to caries-free and not-severe early childhood caries groups (p <0.001). Regarding the child subscale, there was significant difference between the "severe early childhood caries" group and the other groups in all domains, except for theone of self-image / social interaction. In the family subscale domains, there was statistical significance between the severe early childhood caries and the caries-free groups in all domains (p <0.001), whereas between the "severe early childhood caries and not-severe early childhood caries groups there was a statistically significant difference only in the domain of parental anguish (p <0.001). Multivariate analysis showed that early childhood caries and the parent`s age were significantly associated to OHRQoL (p <0.05), independently of the other variables in the model. The presence of severe early childhood caries resulted in greater negative impact on OHRQoL (AdjPR= 6.016; 95%CI = 3.12 11.56; p<0.001), while older parents reported better OHRQoL (AdjPR = 0.603; 95%CI = 0.428 - 0.850; p = 0.004). The presence of severe early childhood caries had a negative impact on OHRQoL of preschool children and their families.

Influência do pré-aquecimento na adaptação marginal de dois materiais seladores de fóssulas e fissuras, analisada através de tomografia de coerência ótica

Among the non-invasive techniques employed in the prevention of caries highlights the sealing pits and fissures which is a conservative maneuver, in order to obliterate them to protect them from attack acid bacteria. Influenced by the studies of pre-heating composite resin, which has experienced great improvement in some of their physical properties, this study aimed to evaluate in vitro the superficial and internal marginal adaptation of different materials and sealants in pre-heating or not. A total of 40 extracted human third molars (n=10) that had their occlusal surfaces prepared to receive sealant. We tested two types of sealing materials: resin sealant (Fluoroshield) and low-viscosity resin (Permaflo), where 50% of previously received heated material and the other half received sealant material at room temperature. All samples were subjected to thermal cycling and pH, simulating a cariogenic oral environment, and later were analyzed appliance OCT (optical coherence tomography). The images obtained alterations were recorded and analyzed statistically. Change was considered as the emergence of bubbles, gaps and cracks in the sealant. Comparisons of the same material, assessing the fact that it is not sealed or preheated material, as well as comparisons between different materials subjected to the same temperature were carried out. The nonparametric Tukey test was used (p < 0,05). The results showed that there was statistically significant difference between both the materials analyzed, as between the situations in which the sealant material was submitted (preheated or not). On the issue of marginal adaptation and internal surface, seen through Optical coherence tomography, may suggest that there is a difference between the use of one type or another of the sealing material analyzed, with superiority attributed to resin Permaflo compared to sealant Fluroshield, telling is the same for the different techniques used

Efeitos de tempestades magnéticas em sinais de gps, em Natal, Brasil

Satellites signals present disturbances (scintillations), due to presence of irregularities in the ionospheric plasma. In the present work, we dedicate to the study of the attenuation of these scintillations that is, an improvement in the signal, during the main magnetic storm phase during the period of October 2006 to February 2007. Using amplitude of scintillation 1.5GHz (L1) data of the net of satellites GPS, in the ionospheric station of Natal (5.84o S, 35.20o O, -20o dip) and geomagnetic indices, during the minimum solar cycle (referred to as cycle 23), demonstrating its anti-correlation between magnetic activity (Kp) and index of scintillation () (Bonelli2005 method, that works for solar maximum, Bonelli(2005)). These results show that these storms correspond to category I of Aarons (1991). The magnetic storms can generate irregularities when the electric feld of penetration eastward on the pre-reversal hour intensificating that and can too generate irregularities on midnight and sunlight period. The limitation of the method applied here is that it is not considering some storms that had also occurred during equinox and summer in the Brazilian region. For this reason, we will use additional data of the stations of São João de Cariri (Imager and Photometer) and of the station at Fortaleza (Digissonde data), as aid to analyze these storms. The storms that had been left out by the applied method, fit in the other two categories of Aarons, with one only exception (storm of January, 02). We show that in the day of the main phase of the magnetic storm, and with presence of bubbles (according to data of the Imager and Photometer), the speed of vertical drift ~E ~B (hF=t) is below 20m/s, that is the threshold found for Anderson al., (2004) (>20m/s as condition favorable to the formation of irregularities and increase in the scintillation index). This reduction of the speed is due to solar minimum

Conhecimento sobre energia eólica: um estudo exploratório a partir das redes semânticas naturais de estudantes da cidade de Natal

The human being has a fundamental role in issues concerning scarcity of energy resources as well as in the success of technologies which favor the use of renewable sources, such as wind energy. But what does wind energy mean for people? What are the psychological meanings concerning this term? Aiming to answer these questions, the general objective of this dissertation was to identify and to analyze the knowledge about wind energy taking into account a network of psychological meanings. One hundred and ninety one (191) university students from Natal-RN participated in the study, being male the majority (53%); aged between 17 and 51 years old (M=23.3 years; SD=5.7). Participants responded to self reports using the Natural Semantic Networks (NSW) technique, as well as to several sociodemographic questions. The results showed a consistent, positive and useful general semantic network. In this semantic network, knowledge about wind energy was represented by words that correspond to the appeal of (pro) environmental stance (e.g., clean and nature), that evinced both the technological aspect (e.g., force) and the economic aspect (e.g., economy). Results from different groups were also analyzed. The first set of groups (non-environemental and environmental) was divided considering the course (e.g., ecology and economy). The second set of groups(non-caretaker and caretaker) was divided based on the practice of environmental care expressed. Subtle differences were observed in the semantic networks of caretakers, who emphasized environment, an attribute not mentioned by non-caretakes. This indicates a construction of knowledge that is influenced by the presence or absence of the environmental commitment. Such findings may be useful in the construction of instruments for surveys and in the development of public and educational policies. Additionally, they may assist the media towards a more objective performance concerning wind energy

A CRONIFICAÇÃO NOS SERVIÇOS SUBSTITUTIVOS NA REDE DE SAÚDE MENTAL DE NATAL/RN

Brazilian Psychiatry Reform, through Psychosocial Care Strategy, has intended to build insane people care practices from community care services which contemplates the subjects complete lives. However, to change the traditional care ways demands the facing of a series of epistemological, political and cultural obstacles. One of the current challenges deals with patients aggravation processes, with management ways, with devices and with professionals, as well as with the assistance network. The purpose of this thesis was to investigate how these aggravation processes has been constituted in Natal mental healthcare network, understanding its effects in the work teams and patients. Theoretical and methodological perspective used was Institutional analysis was, subsidizing the usage of concept-tools as the implication analysis, selfmanagement and self-analysis, and restitution. The research was carried out at the Natal East Sanitary District Mental Healthcare Clinic, with the participation of technicians and patients. The research procedures were: literature and document research on the attendance and the analyzed theme; attendance registers analysis; participating observation of the institutional routine for three months and field log entries; talking groups, one with the team and one with the patients. Two main discussion points are shown: 1. The mental healthcare clinic organization logic and the intersector politics; 2. The work and management processes developed at the mental healthcare clinic. The analysis show diversity in the attended demands in the service, which has favored the patients aggravation, this device and the substitute network processes. The work processes are apart from the political sphere and from the managements processes. In this sense, we show the need to reevaluate the clinic device as well as the management models adopted in the Brazilian Psychiatry Reform context

Arquitetura deposicional e evolução tectono-estratigráfica das sequências pré-rifte e rifte, na porção central do Vale do Cariri, Bacia do Araripe, NE do Brasil

A complex depositional history, related to Atlantic rifting, demonstrates the geological evolution during the late Jurassic and early Neocomian periods in the Araripe Basin NE Brazil. Based on outcrop, seismic and remote sensing data, a new model of the tectono-stratigraphic evolution of the section that covers the stages Dom João, Rio da Serra and Aratu (Brejo Santo, Missão Velha and Abaiara formations) is presented in this paper. In the stratigraphic section studied, ten sedimentary facies genetically linked to nine architectural elements were described, representing depositional systems associated with fluvial, aeolian and deltaic environments. Based on the relationship between the rates of creation of accommodation space and sediment influx (A / S) it was possible to associate these depositional systems with High and Low accommodation system tracks. These system tracks represent two tectono-sequences, separated by regional unconformities. The Tectono-sequence I, which includes lithotypes from the Brejo Santo Formation and is related to the pre-rift stage, is bounded at the base by the Paleozoic unconformity. This unit represents only a High Accommodation System Track, composed by a succession of pelitic levels interbedded with sandstones and limestones, from a large fluvial floodplain origin, developed under arid climatic conditions. The Tectono-sequence II, separated from the underlying unit by an erosional unconformity, is related to the rift stage, and is composed by the Missão Velha and Abaiara Formation lithotypes. Changes in depositional style that reflect variations in the A / S ratio, and the presence of hydroplastic deformation bands, make it possible to divide this tectonosequence into two internal sequences. Sequence IIA, which includes the lower portion of the Missão Velha Formation and sequence IIB, is composed by the upper section of the Missão Velha and Abaiara Formations The Sequence IIA below, composed only by the Low Accommodation System Track, includes crossbedding sandstones interbedded with massive mudstones, which are interpreted as deposits of sandy gravel beds wandering rivers. Sequence IIB, above, is more complex, showing a basal Low Accommodation System Track and a High Accommodation System Track at the top, separated by an expansion surface. The lower System Track, related to the upper portion of the Missão Velha Formation, is composed by a series of amalgamated channels, separated by erosion surfaces, interpreted as deposits of a belt of braided channels. The High Accommodation System Track, correlated with the Abaiara Unit, is marked by a significant increase in the A / S, resulting in the progradation of a system of braided river deltas with aeolic influence. Regarding tectonic evolution, the stratigraphic study indicates that the Tectonosequence Rift in the Araripe basin was developed in two phases: first characterized by a beginning of rifting, related to Sequence IIA, followed by a phase of syndepositional deformation, represented by sequence IIB. The first phase was not influenced by the development of large faults, but was influenced by a sharp and continuous decrease of accommodation space that permitted a change in depositional patterns, establishing a new depositional architecture. In turn, the stage of syndepositional deformation allowed for the generation of enough accommodation space for the preservation of fluvial-lacustrine deposits and conditioned the progradation of a braided river-dominated delta system.

Caracterização multi-escalar de bandas de deformação nas tectonossequências paleozóica, pré- e sin-rifte da Bacia do Araripe, Nordeste do Brasil

Deformation bands are structures, developed in porous sandstones, that has small offsets and they are not shown on seismic section. The deformation bands of the pre and synrift sandstones of Araripe Basin were studied in outcrop, macroscopic and microscopic scales. The hierarchical, cinematic and spatial-geometric characteristics, and also the deformational mechanisms acting during its structural evolution were established too. In general, the mesoscopic scale observation allowed to discriminate deformation bands as singles or clusters in three main sets: NNE-SSW dextral; NE-SW normal (sometimes with strike-slip offset); and E-W sinistral; further a bed-parallel deformation bands as a local set. The microscopic characterization allowed to recognize the shearing and cataclastic character of such structures. Through the multi-scale study done in this work we verified that deformation bands analyzed were preferentially developed when sandstones under advanced stage of lithification. We also infer that the geometrical-spatial complexity of these bands, together with the presence of cataclastic matrix, can difficult the migration of fluids in reservoir rocks, resulting on their compartmentalization. Therefore, the study of deformation bands can aid researches about the structural evolution of sedimentary basin, as well as collaborate to understand the hydrodynamic behavior of reservoirs compartmented by these deformational structures

Evidências da herança geotectônica pré-cambriana na geração da barcia potiguar: um estudo geofísico multdisciplinar

The 3D gravity modeling of the Potiguar rift basin consisted of a digital processing of gravity and aeromagnetic data, subsidized by the results of Euler deconvolution of gravity and magnetic data and the interpretation of seismic lines and wells descriptions. The gravity database is a compilation of independent geophysical surveys conducted by several universities, research institutions and governmental agencies. The aeromagnetic data are from the Bacia Potiguar and Plataforma Continental do Nordeste projects, obtained from the Brazilian Petroleum Agency (ANP). The solutions of the Euler Deconvolution allowed the analysis of the behavior of the rift main limits. While the integrated interpretation of seismic lines provided the delimitating horizons of the sedimentary formations and the basement top. The integration of these data allowed a 3D gravity modeling of basement topography, allowing the identification of a series of internal structures of the Potiguar rift, as well intra-basement structures without the gravity effect of the rift. The proposed inversion procedure of the gravity data allowed to identify the main structural features of the Potiguar rift, elongated in the NE-SW direction, and its southern and eastern faulted edges, where the sedimentary infill reachs thicknesses up to 5500 m. The southern boundary is marked by the Apodi and Baixa Grande faults. These faults seem to be a single NW-SE oriented fault with a strong bend to NE-SW direction. In addition, the eastern boundary of the rift is conditioned by the NE-SW trending Carnaubais fault system. It was also observed NW-SE oriented faults, which acted as transfer faults to the extensional efforts during the basin formation. In the central part of the residual anomaly map without the gravity effect of the rift stands out a NW-SE trending gravity high, corresponding to the Orós-Jaguaribe belt lithotypes. We also observe a gravity maximum parallel to the Carnaubais fault system. This anomaly is aligned to the eastern limit of the rift and reflects the contact of different crustal blocks, limited by the eastern ward counterpart of the Portalegre Shear Zone

O cuidado de pessoas com transtornos mentais no cotidiano de seus familiares: investigando o papel da internação psiquiátrica

As atribuições da família no cuidado de seus membros portadores de transtornos mentais têm passado por profundas transformações nos últimos anos. A presente pesquisa investigou as modificações no cotidiano de familiares de pessoas que passaram por internação psiquiátrica e os significados implicados neste processo. Foram realizadas entrevistas semi-estruturadas com cinco familiares, cujo conteúdo foi submetido à análise temática e interpretado em perspectiva sócio-histórica. Dentre outras questões, observa-se que: (1) a concepção de cura está relacionada à recuperação da capacidade produtiva, restrita a partir do surgimento dos sintomas; (2) os recursos informais são complementares, principalmente quando os recursos públicos não são suficientes ou satisfatórios; (3) a religiosidade está presente na compreensão metafísica das causas do sofrimento psíquico; (4) a igreja, na figura dos correligionários, consiste em um grupo de suporte para o usuário e para a sua família e (5) a insuficiência de políticas adequadas de atenção à família na rede substitutiva.