Referência e contra referência em saúde bucal: regulação do acesso aos centros de especialidades odontológicas

Objective Based on the system of reference and counter-reference and comprehensiveness in oral health care, we aimed to examine ways of refering users to Specialized Dental Care Centers (SDCC) and the interface between them and Primary Care. Methods This is a cross-sectional study carried out with users and dentists of SDCC in a metropolitan region of Northeast of Brazil. Analyses were descriptive, and the association test was done with chi-square. Results Six forms of entry to specialized service were identified: free demand (13.8 %) and reference by the Primary Care dentist (63.2 %) were most frequent. Users referred by the basic health unit dentist had more interest in making a counter-reference than the others (p<0.001, PR=4.65, 95 % CI: 2.74 to 7.91), while individuals without this referral had 1.49 times more difficulty obtaining care (95 % CI: 1.02 to 2.17). Referral procedures are a decisive factor for counter-references. However, the high demand for primary care services and the short supply these services can offer in the face of needs make SDCC performance difficult. Conclusion The analysis of oral health practices from the perspective of network modeling points to the service's need to establish protocols for regulation in a bid to improve access to and the quality of care provided.

Referência e contra referência em saúde bucal: regulação do acesso aos centros de especialidades odontológicas

Objective Based on the system of reference and counter-reference and comprehensiveness in oral health care, we aimed to examine ways of refering users to Specialized Dental Care Centers (SDCC) and the interface between them and Primary Care. Methods This is a cross-sectional study carried out with users and dentists of SDCC in a metropolitan region of Northeast of Brazil. Analyses were descriptive, and the association test was done with chi-square. Results Six forms of entry to specialized service were identified: free demand (13.8 %) and reference by the Primary Care dentist (63.2 %) were most frequent. Users referred by the basic health unit dentist had more interest in making a counter-reference than the others (p<0.001, PR=4.65, 95 % CI: 2.74 to 7.91), while individuals without this referral had 1.49 times more difficulty obtaining care (95 % CI: 1.02 to 2.17). Referral procedures are a decisive factor for counter-references. However, the high demand for primary care services and the short supply these services can offer in the face of needs make SDCC performance difficult. Conclusion The analysis of oral health practices from the perspective of network modeling points to the service's need to establish protocols for regulation in a bid to improve access to and the quality of care provided.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem falta de adesão em pessoas vivendo com AIDS

In the early 1990s, a major milestone in the treatment of Acquired Immune Deficiency Syndrome was the development of highly active combination antiretroviral therapy. The great benefit generated by the use of this therapy was prolonging the survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Despite improvements generated by this therapy, there are still many difficulties to be overcome. One is the patient adherence to their treatment, bringing challenges to services and health professionals. Hence the need for early identification of nursing diagnosis Lack of Accession so that solutions are sought by the nurse with the patient and his family. With this problem, adds to the difficulty of hospital nurses in inferring that diagnosis, especially in identifying their defining characteristics. In this context, the objective was to evaluate the accuracy of clinical indicators of nursing diagnosis Lack of Adherence to antiretroviral treatment for people living with the Acquired Immunodeficiency Syndrome. The research took place in two stages. The first consists of the evaluation of the diagnostic indicators in the study; and second, the diagnostic inference performed by specialist nurses. The first step took place in a referral hospital in the treatment of infectious diseases in the Northeast of Brazil, and data were collected through an instrument for carrying out history and physical examination and analyzed for the presence or absence of the diagnostic indicators. In the second stage, the data were sent to experts, who judged the presence or absence of the diagnosis in the studied clientele. The project was submitted to the Ethics Committee of the Federal University of Rio Grande do Norte, obtaining approval with the General Certificate for Ethics Assessment (CAAE) No 46206215.3.0000.5537. Data were analyzed using descriptive and inferential statistics. Test were used Fisher's exact, chi-square test of Pearson and logistic regression. Since the accuracy of clinical indicators was measured by sensitivity, specificity, predictive values, likelihood ratios. As a result, we identified the presence of diagnosis Lack of Accession on 69% (n = 78) of the study patients. The defining characteristics that showed statistically significant association with the diagnosis studied were: lack of adherence behavior, complications related to development, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. The characteristic with greater sensitivity was missing scheduled appointments and the highest specificity behavior of noncompliance. The logistic regression showed as predictors for the diagnosis Lack of Accession: lack of adherence behavior, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. It was concluded that the identification of clinical indicators accurately enabled a good prediction of the nursing diagnosis Lack of Accession on people living with the Acquired Immune Deficiency Syndrome, helping nurses develop early on strategies for promoting adherence to the use of antiretrovirals.

Acurácia dos indicadores clínicos do diagnóstico de enfermagem falta de adesão em pessoas vivendo com AIDS

In the early 1990s, a major milestone in the treatment of Acquired Immune Deficiency Syndrome was the development of highly active combination antiretroviral therapy. The great benefit generated by the use of this therapy was prolonging the survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Despite improvements generated by this therapy, there are still many difficulties to be overcome. One is the patient adherence to their treatment, bringing challenges to services and health professionals. Hence the need for early identification of nursing diagnosis Lack of Accession so that solutions are sought by the nurse with the patient and his family. With this problem, adds to the difficulty of hospital nurses in inferring that diagnosis, especially in identifying their defining characteristics. In this context, the objective was to evaluate the accuracy of clinical indicators of nursing diagnosis Lack of Adherence to antiretroviral treatment for people living with the Acquired Immunodeficiency Syndrome. The research took place in two stages. The first consists of the evaluation of the diagnostic indicators in the study; and second, the diagnostic inference performed by specialist nurses. The first step took place in a referral hospital in the treatment of infectious diseases in the Northeast of Brazil, and data were collected through an instrument for carrying out history and physical examination and analyzed for the presence or absence of the diagnostic indicators. In the second stage, the data were sent to experts, who judged the presence or absence of the diagnosis in the studied clientele. The project was submitted to the Ethics Committee of the Federal University of Rio Grande do Norte, obtaining approval with the General Certificate for Ethics Assessment (CAAE) No 46206215.3.0000.5537. Data were analyzed using descriptive and inferential statistics. Test were used Fisher's exact, chi-square test of Pearson and logistic regression. Since the accuracy of clinical indicators was measured by sensitivity, specificity, predictive values, likelihood ratios. As a result, we identified the presence of diagnosis Lack of Accession on 69% (n = 78) of the study patients. The defining characteristics that showed statistically significant association with the diagnosis studied were: lack of adherence behavior, complications related to development, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. The characteristic with greater sensitivity was missing scheduled appointments and the highest specificity behavior of noncompliance. The logistic regression showed as predictors for the diagnosis Lack of Accession: lack of adherence behavior, missing scheduled appointments, failure to achieve results, and exacerbation of symptoms. It was concluded that the identification of clinical indicators accurately enabled a good prediction of the nursing diagnosis Lack of Accession on people living with the Acquired Immune Deficiency Syndrome, helping nurses develop early on strategies for promoting adherence to the use of antiretrovirals.

Mapeamento das Instituições Federais de Ensino Superior da Região Nordeste do Brasil na Web

VANTI, Nadia. Mapeamento das Instituições Federais de Ensino Superior da Região Nordeste do Brasil na Web. Informação & informação, Londrina, v. 15, p. 55-67, 2010

Desempenho internacional de empresas exportadoras: um modelo estrutural baseado em capacidades organizacionais e ambiente

The internationalization as an organizational phenomenon fundamentally strategic had as theoretical contributions some Schools that throughout the decades 60, 70, and 80 developed behavioral and economic approaches in order to explain the process. The behavioral approach deals with the perception of phenomenon as a gradual process from the perspective of the executives behavior (JOHANSON and VAHLNE, 1977; HALLÉN and WIEDERSHEIM - PAUL, 1979; CZINKOTA, 1985). This phenomenon in permanent theoretical and managerial evolution made an opportunity to build this investigation, whose goal is to analyse the impact comes from organizational capabilities and the external environment on the international performance of exporting firms. For both, were used as theoretical basis two types of analysis for the comprehension of international performance: Strategic Management - Industrial Organization and Resource-Based View and International Businesses - Current Economic and Behavioral. It was made a cross-sectional survey-based explanatory research, including 150 exporting companies with operations in the Northeast of Brazil. A conceptual model was made with eight constructs and eight research hypotheses, representative of the effects of external factors on international performance. The data were processed using the Exploratory Factor Analysis and Structural Equation Modeling. The structural equations model was reespecified and estimated through the use of the maximum-likelihood method up to achieve adequated values of indexes of adjustment. As the main theoretical contribution, were identified organizational and physical resources which shows the importance of the management skills development, of the learning capability and capability to establish strategic alliances abroad. That because the knowledge, as the operational point of view as in its strategic application, offers to organization conditions of market positioning which can create opportunities sustainable competitive advantages and which impact the performance of international companies

Relação entre ciclo de vida do produto turístico e estratégias de cooperação na faixa litorânea urbana do município de Natal

Tourism in the Northeast of Brazil was introduced as an alternative economic development for the Region by federal promoting policies that focused primarily in structuring the local geographic area. With the completion of these structuring actions, mass tourism expanding the area, as well as spread actions based on cooperation and formalization of governance institutions. This study aimed to examine the relationship between the life cycle of the tourism product 'Coastal Cities of Natal and the cooperation strategies in a historical perspective. Thus was submitted to the life cycle of the tourism product 'Coastal Cities of Natal ; the major projects of tourism development were mapped, the existing cooperation strategies were characterized, and investigated the influence of the cooperation actions for the current stage of product. The specific theoretical support to tourism was built on the perspective of the Theory of Population Ecology, System of Tourism and Touristic Product Life Cycle. Regarding to cooperation the theoretical foundation addressed issues of strategy, New Forms and Collective Efficiency. The survey consisted of a causal descriptive study, using a case study. We used the qualitative and quantitative methodological approaches, and data collected by consulting of secondary data and semistructured interviews with twelve staff working in tourism in Natal. Results showed that the life cycle graph of product 'Coastal Cities of Natal is moving from one stage of growth to a stage of maturity, with a primary upward trend and with crises that are up over the graph. They have been mapped six of tourism development projects of relevance to the product: The Politics of Mega Projects, PRODETUR/NE, Municipalization National Program of Tourism, Regionalization Program, Urbanization Project Beach do Meio and Actions for the Promotion of Destiny. They have been identified sixty-four participating players in process of tourism development, which twenty were considered relevant to the respondents. The main strategies identified for cooperation were the consortium, collective strategy and clusters. Results indicated that co-operation strategies were adopted so that the benefits were obtained at the collective level, dedicated to the strengthening of Natal Destiny and its products. The main reasons were the need of cooperative marketing, international market entry and actions inducing the state. Finally, it was concluded that strategies for cooperation related to product life cycle 'Coastal Cities of Natal' as that work in the consolidation of projects for development of tourism, when the efficiency of collective action is achieved

Tributos indiretos na cadeia produtiva do camarão

The state of Rio Grande do Norte counts with a relevant potential in the shrimp farming supply chain. In the larviculture step the state responds for more than half of the national production. In the farming step it is the second largest producer. In the industrial step, its industries have almost 40% of the shrimp processing capacity of the northeast of Brazil. However, this country has the highest tax rate comparing with the main shrimp producer countries. Considering the influence of taxes in the competition among companies, the main goal of this research is to analyze the impact of indirect taxes in the above steps of the supply chain. To achieve it, it will be used the data of the 2011 Census of the Shrimp Farming and it will be applied the Herfindahl-Hirschman Index to identify the market form of those steps. In order to contribute with the characterization of the supply chain, CEO´s of farms and industries will be interviewed. The price-elasticity of the shrimp larvae, the in natura shrimp and the processed shrimp will be analyzed in order to verify the possibility that each one of those three steps has to pass-through the onus of the end of benefit over the ICMS. The data analysis shows that the larviculture step functions as a duopoly and, facing the end of that benefit, it will be able to pass-through most its onus to the farming step. On the other hand, this step functions similar to a perfect competing market, which diminishes its capacity to pass-through that onus to the processing step. This step operates as oligopoly with a lower concentration than the larviculture step but, due to the fact that it faces an oligopsony, it will end up assuming most of that onus, which will cause a decrease in the amount of processed shrimp. It is concluded that the end of that benefit would impact negatively, in this state, the supply chain at all, but mainly the farming and the industrial steps

Um olhar sobre a obra de Acácio Gil Borsoi obras e projetos residenciais 1953-1970

This essay studies the contribution of architect Acácio Gil Borsoi (1924-), who played an important role in the consolidation of Modern Architecture in the Northeast of Brazil. The universe analyzed is constituted of 48 residential projects, houses and apartment buildings, both built and unbuilt, dating from 1953 to 1970. Considering an analogy between architecture and language, the selected projects were analyzed focusing in the process of creation

Mapeamento das Instituições Federais de Ensino Superior da Região Nordeste do Brasil na Web

VANTI, Nadia. Mapeamento das Instituições Federais de Ensino Superior da Região Nordeste do Brasil na Web. Informação & informação, Londrina, v. 15, p. 55-67, 2010

Projeto raia de fogo: aspectos populacionais da raia de fogo (Dasyatis marianae Gomes, Rosa & Gadig, 2000) e pesca de elasmobrânquios no complexo recifal do Parracho de Maracajaú

The species Dasyatis marianae inhabits coastal areas associated with coral reefs, considered endemic to the northeast of Brazil, occurring from the State of Maranhão to the south of Bahia. Specimens of this species are commonly sighted by divers and fishermen in the area of Maracajaú reefs, a complex reef that is part of the Environmental Protection Area of Coral Reefs (EPACR), which was developed in this study about the ecology and biology of the D. marianae, in order to characterize aspects of population structure in the area of the reef complex of Parracho de Maracajaú. We analyzed 120 specimens caught by artisanal fishing site of the size, weight, sex, stage of maturity and stomach contents. Most subjects were adult males (1.7:1) and was more abundant for rays with lengths between 25 and 29cm of LD, where females reach larger sizes, a feature common to other rays. The largest specimens were captured in the area of seagrass, which is preferred for the species. The distribution of species in the area showed an ontogenetic and sexual segregation, where the youthful occur near the beach, which is a likely area for nursery and growth of the adult females prevail in the seagrass, which apparently has a high prey availability, and Adult males are more distant, a higher proportion occurring in outlying areas, suggesting a habit more exploratory than the females. The evaluation of the reproductive system indicated 3 reproductive cycles per year, one young per pregnancy, and showed that the mature males were smaller than females. The cubs of D. marianae size at birth 12 to 15cm LD. As for diet, the species was characterized as carnivorous crustacean specialist. The performance of visual censuses in different localities allowed to evaluate the density of D. marianae in different environments of the complex. The species occurs in greater numbers in seagrass, environment very important for the conservation of the species. 100 individuals of D. marianae marked in reef complex area enrolled in a recapture rate of 3%. Some behavioral aspects were evaluated, as diurnal pattern of activity, interaction with cleaning and fish Pomacanthus paru followers as Lutjanus analis and Carangoides bartholomaei. Overall, much of the information obtained should be used for management of the species

Influência da alimentação sobre os níveis de retinol no leite caprino

The caprine milk is a product of high biological value and high digestibility. Due to these characteristics it is quite used by newly born children that are not breastfed or that are intolerant to the bovine milk. The vitamin deficiency is a public health problem in underdeveloped areas as the Northeast of Brazil and where areas the caprine ones adapt very well. The present study was led to analyze the influence of the feeding in the vitamin levels in the caprine milk. The animals used were the races Saanen and Murciana, divided in three groups. The first group with 38 animals of race Saanen and the second with 30 animals of race Murciana were, fed with concentrated and voluminous. A third group with 20 animals of the race Saanen was fed exclusively with voluminous. The four group was added with 10. 000 UI of retinol palmitato, administered directly, like capsule, in the mouth of animal. Parallel it was verified the level of retinol of milk in the beginning and final of the sucked, in the goats of the second group (race Murciana n =30). The retinol of caprine milk was determined through the system of liquid cromatografia of high efficiency (HPLC). The retinol levels in the studied groups were respectively: first (38. 5 ± 12. 7 μg/100ml), second (40. 5 ± 9. 7 μg/100ml); third, with 20 animals of race Saanen fed exclusively with voluminous (23. 1 ± 6. 7 μg/100ml) and in the group a, suplementation with 10. 000 UI of retinol palmitato (43,7 ± 18,8 μg/100ml) before, and (61,9 ± 26,9 μg/100ml) after the supplementation. It was not found significant difference between the averages from animals of the first and second group, that were fed with the same concentrate diet and voluminous, showing that the retinol levels in the milk of these two races are equivalent. Already in the animals of the first and third group that they were fed with different diets, in those which diet was just voluminous, a drastic reduction was verified in the retinol levels. In relation to the retinol of the milk in different moments from the same sucked, it was observed in the beginning of the breast-feeding (22. 6 ± 9. 8 μg/100ml) and at the end of the sucked (49. 6 ± 14. 7μg/100ml), being the difference between the averages, statistically significant (p < 0,0001). Already in the animals that were supplemented, a significant increase was observed in the retinol concentration, being obtained a medium response of 41,85%

Desempenho internacional de empresas exportadoras: um modelo estrutural baseado em capacidades organizacionais e ambiente

The internationalization as an organizational phenomenon fundamentally strategic had as theoretical contributions some Schools that throughout the decades 60, 70, and 80 developed behavioral and economic approaches in order to explain the process. The behavioral approach deals with the perception of phenomenon as a gradual process from the perspective of the executives behavior (JOHANSON and VAHLNE, 1977; HALLÉN and WIEDERSHEIM - PAUL, 1979; CZINKOTA, 1985). This phenomenon in permanent theoretical and managerial evolution made an opportunity to build this investigation, whose goal is to analyse the impact comes from organizational capabilities and the external environment on the international performance of exporting firms. For both, were used as theoretical basis two types of analysis for the comprehension of international performance: Strategic Management - Industrial Organization and Resource-Based View and International Businesses - Current Economic and Behavioral. It was made a cross-sectional survey-based explanatory research, including 150 exporting companies with operations in the Northeast of Brazil. A conceptual model was made with eight constructs and eight research hypotheses, representative of the effects of external factors on international performance. The data were processed using the Exploratory Factor Analysis and Structural Equation Modeling. The structural equations model was reespecified and estimated through the use of the maximum-likelihood method up to achieve adequated values of indexes of adjustment. As the main theoretical contribution, were identified organizational and physical resources which shows the importance of the management skills development, of the learning capability and capability to establish strategic alliances abroad. That because the knowledge, as the operational point of view as in its strategic application, offers to organization conditions of market positioning which can create opportunities sustainable competitive advantages and which impact the performance of international companies

Relação entre ciclo de vida do produto turístico e estratégias de cooperação na faixa litorânea urbana do município de Natal

Tourism in the Northeast of Brazil was introduced as an alternative economic development for the Region by federal promoting policies that focused primarily in structuring the local geographic area. With the completion of these structuring actions, mass tourism expanding the area, as well as spread actions based on cooperation and formalization of governance institutions. This study aimed to examine the relationship between the life cycle of the tourism product 'Coastal Cities of Natal and the cooperation strategies in a historical perspective. Thus was submitted to the life cycle of the tourism product 'Coastal Cities of Natal ; the major projects of tourism development were mapped, the existing cooperation strategies were characterized, and investigated the influence of the cooperation actions for the current stage of product. The specific theoretical support to tourism was built on the perspective of the Theory of Population Ecology, System of Tourism and Touristic Product Life Cycle. Regarding to cooperation the theoretical foundation addressed issues of strategy, New Forms and Collective Efficiency. The survey consisted of a causal descriptive study, using a case study. We used the qualitative and quantitative methodological approaches, and data collected by consulting of secondary data and semistructured interviews with twelve staff working in tourism in Natal. Results showed that the life cycle graph of product 'Coastal Cities of Natal is moving from one stage of growth to a stage of maturity, with a primary upward trend and with crises that are up over the graph. They have been mapped six of tourism development projects of relevance to the product: The Politics of Mega Projects, PRODETUR/NE, Municipalization National Program of Tourism, Regionalization Program, Urbanization Project Beach do Meio and Actions for the Promotion of Destiny. They have been identified sixty-four participating players in process of tourism development, which twenty were considered relevant to the respondents. The main strategies identified for cooperation were the consortium, collective strategy and clusters. Results indicated that co-operation strategies were adopted so that the benefits were obtained at the collective level, dedicated to the strengthening of Natal Destiny and its products. The main reasons were the need of cooperative marketing, international market entry and actions inducing the state. Finally, it was concluded that strategies for cooperation related to product life cycle 'Coastal Cities of Natal' as that work in the consolidation of projects for development of tourism, when the efficiency of collective action is achieved

Da bancada ao Bureau: análise do desenvolvimento da biotecnologia no Nordeste Brasileiro sob o enfoque de Sistema Regional de Inovação

The starting point of the present work consisted of investigating the development of biotechnology in the Northeast region of Brazil from the perspective of a Regional Innovation System (RIS). The theoretical framework adopted relied on the approaches and concepts presented by the Neo-Schumpeterian perspective. This framework was chosen because, by means of the Innovation System concept, this literature allows us to analyze the relationships and configurations of actors, as well as the role of the state and of social, science and technology, and economic policies in the studied region. The analysis considered four selected dimensions: physical infrastructure, human capital, scientific production, and funding. These variables were chosen because they allow us to verify the possibilities and limitations of developing a biotechnology RIS in the Northeast of Brazil, and these elements would help in answering the question behind this dissertation. The location of the physical infrastructure was determined by means of bibliographic and documental research and interviews with heads of institutions that do biotechnology research. Regarding human capital, the analysis focused on resource training in biotechnology, highlighting graduate courses and research groups in the area. To measure knowledge production, we delimited scientific collaboration among researchers in the field of biotechnology as the focus of this category. For the funding dimension, information was gathered from reports available at the websites of national and state funding agencies. The data was analyzed through method triangulation, involving quantitative and qualitative research stages. To back the analyses, we revisited the integration policies in the area of Science, Technology and Innovation. Our analysis has shown that these policies play a crucial role in the development of biotechnology in the region being studied. The data revealed that the physical infrastructure is concentrated in only three states (Bahia, Ceará, and Pernambuco). In this regard, the Northeast Biotechnology Network (Renorbio) stands out as a strategic actor, enabling states with poor infrastructure to develop research through partnerships with institutions located in another state. We have also verified that the practices involving human resource training and knowledge production are factors that enable the emergence of a regional system for biotechnology in the studied region. As limitations, we have verified the low immersion level of regional actors, the heterogeneity of socioeconomic indicators, the lack of financial resources, and a low innovation culture in the business sector. Overall, we have concluded that the development of a Regional Innovation System in Biotechnology, based on the current regional dynamics, depends on an effective change in the behavior of the social agents involved, both in the national and regional dimensions as well as in the public and private spheres