Custos e benefícios de um programa de exercício aeróbios na doença pulmonar obstrutica crônica: ensaio cliníco aleatório controlado

Pulmonary Rehabilitation, especially due to aerobic exercise, positive impact in reducing morbidity/mortality of patients with COPD, however the economic impact with costs of implementing simple programs of aerobic exercise are scarce. This is a blind randomized clinical trials, which aimed to evaluate the costs and benefits of a simple program of aerobic exercise in individuals with COPD, considering the financial costs of the Public Health System and its secondary endpoints. We evaluated lung function, the distance walked during six minutes of walking, the respiratory and peripheral muscle strength, quality of life related to health (QLRH), body composition and level of activity of daily living (ADL) before and after eight weeks of an aerobic exercise program consisting of educational guidance for both groups, control and intervention and supervised walks to the intervention group. The health costs generated in both groups were calculated following table Brazilian Public Health System. The sample consisted of forty patients, two being excluded in the initial phase of desaturation during the walk test six minutes. Were randomized into control and intervention group thirty-eight patients, three were excluded from the control group and one was excluded from the intervention group. At the end, thirty-four COPD comprised the sample, 16 in the control group and 18 in the intervention group (FEV1: 50.9 ± 14% pred and FEV1: 56 ± 0.5% pred, respectively). After for intervention, the intervention group showed improvement in meters walked, the sensation of dyspnea and fatigue at work, BODE index (p <0.01) in QLRH, ADL level (p <0.001) as well as increased strength lower limbs (p <0.05). The final cost of the program for the intervention group was R $ 148.75, including: assessments, hiking supervised by a physiotherapist and reassessments. No patient had exacerbation of IG, while 2 patients in the CG exacerbated, generating an average individual cost of R $ 689.15. The aerobic exercises in the form of walking showed significant clinical benefits and economic feasibility of its implementation, due to low cost and easy accessibility for patients, allowing them to add their daily practice of aerobic exercises

Avaliação da genotoxicidade das águas do lençol freático sob a Universidade Federal do Rio Grande do Norte

The groundwater represents the most important freshwater supply of planet. Dailly, in all world a great amount of toxic and genotoxic material reaches the aquatic systems, mainly the aquifers. The Barreiras aquifer through of five water wells is responsible for the supplying of Universidade Federal do Rio Grande do Norte (UFRN). All water wells are polluted with nitrate and some heavy metals, two of them were disabled. The genotoxicity of groundwater samples from Barreiras Aquifer in UFRN was assessed using the Allium cepa test, the Ames test and the Salmonella typhymurium microsuspension test (Kado test). For the Allium cepa test the influence of the groundwater samples collected on macroscopic (root length, colour and form) and microscopic (root tip mitotic index, chromosome aberrations and micronucleus) parameters was examined. All water samples caused a significant increase of the chromosome and mitotic aberration frequency and reduction on the rooth growth compared to negative control. Bridges and chromosome stickness were the most frequent kind of aberration in dividing cells. Furthermore, breaks were also observed. No significant increase in the number of micronuclei was found in relation to the negative controls. For Ames test were used the Salmonella typhymurium strains TA98 and TA100 without metabolic activation, applying the direct method. Prior to the Kado test, organic fractions from the water samples were obtained through XAD resin concentration. The mutagenicity organic extracts were evaluated by Kado test using TA98 and TA100 strains, in the absence and presence of S9 mix (metabolic activation). The concentrations of seven heavy metal ions were measured in water samples, but only Ni, Cu and Cr levels exceeded the permissible maximum concentration for the natural reservoirs. The results obtained for mutagenic activity using the Ames test were negative in all raw water samples analyzed. Positive results in XAD4 extracts of water samples were obtained for TA98 in the presence of S9 mix for two stations. Concentrations of heavy metals and nitrate can be correlated with the toxicity and genotoxicity of water analyzed. The mutagenic effect detected with TA98 strain suggested that organic compounds (after metabolization) are involved with the mutagenicity detected in the samples analyzed. The data set obtained in this work indicated the presence of at least two classes of mutagens: organic and inorganic compounds

Análise molecular dos éxons 8 a 11 do gene da p53 em amostras de câncer de colo de útero no Rio Grande do Norte

Mutations on TP53 gene are common in human cancer but not in cervical cancer where they are rarely found and the inactivation and degradation of p53 protein are attributed to the action of E6 viral oncogene from high risk human papillomavirus (HPV). Analysis of cervical cancer cell lines suggests that HPV negative samples shows mutation on TP53, but clinical approaches didn t confirmed this hypothesis. However, in most TP53 mutations studies on cervical cancer, only the exons 5 to 8 were analyzed. Approximately 90% of mutations described are on this region. Recent studies on several cancer suggests that mutation frequency in the other exons must be considered. The aim of this work was to verify whether mutations on coding and non-coding regions occur in cancer tissue from cervical cancer in patients from Rio Grande do Norte using Denaturing Gradient Gel Electrophoresis (DGGE) as screening tool. Exons 8 to 11 were analyzed including some introns from 80 tumor samples and 8 peripheral blood samples from healthy women. DNA were submitted to PCR using primers with GC clamp on the end of one of them. The results were observed for each region after DGGE and silver staining. It was observed no amplified fragment with different migration profile from those obtained from DNA of peripheral blood. These results agree with those from literature where TP53 mutations in cervical cancer have been described in a very low frequency

Sitios geologicos e geomorfologicos dos municipios de Acari, Carnaúba dos Dantas e Currais Novos, região saridó do Rio Grande do Norte

Geological and Geomorphological Sites of the Towns of Acari, Carnaúba dos Dantas and Currais Novos, Seridó Region of the Rio Grande do Norte, northeastern Brazil, consist s of a study about geological, geomorphological, mineralogical, palaeontological and archaeological features of the study area, aiming the identification of sites that presents scientific, historical, cultural, economic and ecological excellent importance, and that they deserve to receive special protection for its maintenance for the gifts and future generations. It was developed according with methods adopted for the Brazilian Commitee of Geological and Paleontological Sites SIGEP/UNESCO and by Initiati ve of Sofia for the Preservation of the Mineral Diversity of the Planet, objectifying the description of the main sites, the its environmental problematic and proposal of protectionistic measures. Seven sites with features and typical structures had been identified that they deserve to be aim of protection. In the Acari town, three sites had been identified: geological -geomorphologicalarchaeological site Barra of the Carnaúba; geological-geomorphological site of the Gargalheiras; and geological-geomorphological site Bico of Arara. In Carnaúba of the Dantas, the geomorphological complex river of the Bojo that possesss canyons and deep throats, with rocky-arts registers of the three great rocky-arts traditions of northeast: Northeast Seridó Sub-tradition, Wasteland and Itaquatiara. In the Currais Novos town, 3 sites had been also identified: geomorphological site Canyon of the Apertados; geomorphological-archaeological-palaeontological complex of the Totoró; e, geologicalmineralogical site Brejuí. Because to the environmental problematic that it involves each one of the identified sites, it is proposed, as a guarantee of protection to these sites, its economic exploitation with the ecogeotouristic activity, that it aims at to the integration of the community in programs of environmental education and others, besides providing to the generation of job and income for the towns. Finally, a series of measures is suggested that they aim at to the efectivation of the activity and to the protection of the sites that they can be classified as natural heritage, in accordance with the denomination of UNESCO, in its program World Natural Heritage

Gestão de estoques: uma proposta de reposição contínua para material médico hospitalar e medicamentos em um hospital universitário federal do estado do Rio Grande do Norte

The inventory management in hospitals is of paramount importance, since the supply materials and drugs interruption can cause irreparable damage to human lives while excess inventories involves immobilization of capital. Hospitals should use techniques of inventory management to perform replenishment in shorter and shorter intervals, in order to reduce inventories and fixed assets and meet citizens requirements properly. The inventory management can be an even bigger problem for public hospitals, which have restrictions on the use of resources and decisionmaking structure more bureaucratized. Currently the University Hospital Onofre Lopes (HUOL) uses a periodic replacement policy for hospital medical supplies and medicines, which involves one moment surplus stock replenishment, the next out of stock items. This study aims to propose a system for continuous replenishment through order point for inventory of medical supplies and medicines to the hospital HUOL. Therefore, a literature review of Federal University Hospitals Management, Logistics, Inventory Management and Replenishment System in Hospitals was performed, emphasizing the demand forecast, classification or ABC curve and order point system. And also, policies of inventory management and the current proposal were described, dealing with profile of the mentioned institution, the current policy of inventory management and simulation for continuous replenishment order point. For the simulation, the sample consisted of 102 and 44 items of medical and hospital drugs, respectively, selected using the ABC classification of inventory, prioritizing items of Class A, which contains the most relevant items in added value, representing 80 % of the financial value in 2012 fiscal year. Considering that it is a public organization, subject to the laws, we performed two simulations: the first, following the signs for inventory management of Instruction No. 205 (IN 205 ), from Secretary of Public Administration of the Presidency ( SEDAP / PR ), and the second, based on the literature specializing in inventory management hospital. The results of two simulations were compared to the current policy of replenishment system. Among these results are: an indication that the system for continuous replenishment reorder point based on IN 205 provides lower levels of safety stock and maximum stock, enables a 17% reduction in the amount spent for the full replenishment of inventories, in other words, decreasing capital assets, as well as reduction in stock quantity, also the simulation made from the literature has indicated parameters that prevent the application of this technique to all items of the sample. Hence, a change in inventory management of HUOL, with the application of the continuous replenishment according to IN 205, provides a significant reduction in acquisition costs of medical and hospital medicine

Uma avaliação do serviço de atenção domiciliar/programa melhor em casa: o caso do hospital Monsenhor Walfredo Gurgel

This dissertation try to understand how management actions implemented by Monsenhor Walfredo Gurgel Hospital in the city of Natal promote effectively the benefits of Home Care Services / Programa Melhor em Casa . The research is exploratory and descriptive, qualitative approach. Data were collected through document analysis and the interviews with the managers of the Program in Health Department and Hospital beyond the questionnaires with the home care teams and technical management unit of Hospital Jobs. The information were treatment trough categories that analyzed to implemented actions and program objectives. The results show that: the practices carried out by the host teams produce the humanization of care by seeking to ensure access to health services and solving human form; networks of health care are not yet finalized hindering the referral of patients to other units, the networks allow support from other institutions to minimize the problems encountered, the management unit vacancies allows the reduction of costs, mainly by regulating beds and record of health initiatives in home care assists in the monitoring and evaluation process of the Services Home Care / Programa Melhor em Casa primarily the epidemiological profile and patients individual treatment plan. Concludes that most of the actions implemented by the Hospital contribute to the effectiveness of the goals of Programa Melhor em Casa

A intervenção do poder judiciário no acesso a medicamentos no Rio Grande do Norte: uma análise sob a ótica das políticas nacionais de medicamento e de assistência farmacêutica

The present study aimed to evaluate the inclusion of the principles of the National Medicines Policy - PNM and the Pharmaceutical assistance - PNAF in the prosecution of lawsuits involving medicines. To fulfill this necessity , data collection was performed on the website by the Tribunal Rio Grande do Norte - TJ RN ( Rio Grande do Norte Court) , in 2012 . It was obtained 115 judgments, which were analyzed in order to generate Monitoring Indicators from lawsuits and conduct content analysis proposed by Bardin (2006). The results showed that : a) 100 % of the decisions were favorable to the author , b) 76 % of decisions were requests by the trade name of the drug , c) only one drug (eculizumabe) had not granted by ANVISA , d) 36 % of drugs were present in the list of standard medicines in SUS , 16 % of primary care block and 20 % of specialized component , e) 76 % of the decisions presented the request of at least 01 non-standard medicine. With regard to decentralization of PNM and PNAF we observed a commitment to this principle at judicial decisions, to see that municipalities and states are often forced to buy medicines of responsibility from another federal entity or other tertiary units as CACONs and UNACONS. The content analysis revealed that the argument from the judges used when you utter their decisions was that the right to health is recognized by Brazilian law as a fundamental right and should be guaranteed by the State for all its citizens. So, health is more than budgetary constraints of federal entities, which are severally liable for lawsuits , regardless the medication requested belongs or not to a particular block of a pharmaceutical assistance funding. Given these data, it is observed that there are gaps in the judgment when it comes to the insertion of the words and principles of PNM and PNAF, creating then the need for greater dialogue between the executive and judicial, so that they may consider relevant the effectiveness and application of such principles to minimize the negative consequences of the phenomenon of health judicialisation. Keywords: Judicialisation, Medicines, Public Policy, Pharmaceutical Care

Desenvolvimento e implantação de um sistema de gestão de pedidos de informação endereçados à Universidade Federal do Rio Grande do Norte a partir do serviço de informações ao cidadão (E-SIC)

Among the numerous policy changes that the world has experienced in recent years, occupies a prominent place in the quest for greater transparency of public agencies. Transparency has been an important tool in the accountability of the State to promote greater participation of the society by providing information that was previously restricted knowledge of public agencies. Brazil, following this trend, promulgated in May 2012 the Access to Information Act that seeks to disclose the actions of the State at all levels, in all public administration agencies. On the same day of the enactment of the law is provided society with a site that is empowering citizens to make their requests for information to government agencies. The Federal University of Rio Grande do Norte, which at that time had no a tool to assist them in managing this demand. This project has the objective to describe, build and implement a solution to solve this problem using Design Science Research as methodology. As result, the solution built in this research became a new module of the institution s ERP became it capable to control the entire process, and will be helpful to others partners which use our system ERP

Maturidade em gerenciamento de projetos no contexto da gestão estratégica no setor público: análise na Secretaria de Estado da Tributação do Rio Grande do Norte

This paperwork attempts to measure the project management maturity in the State Department of Taxation in Rio Grande do Norte. Project management has shown to be a critical component to any organization success, as the projects are directly related to a set of activities resulting into organizational innovations such as products, services and processes; and its improvement is directly aligned with the strategic management. Methodologically, this paperwork uses both a quantitative and qualitative approach that will be applied to the coordinators, sub-coordinators, and directors of the Regional Offices of the State Department of Taxation. In the theoretical reference it is about the public management and analyzes the strategic management in contemporary public administration. Presents the maturity in project management is by discussing the main models: CMM, Capability Maturity Model; PMMM, Project Management Maturity Model; OPM3, Organization Project Maturity Model and the Prado-MMGP, Modelo de Maturidade em Gerenciamento de Projetos. From this analysis, considering attributes as an aid in taking strategic positioning, access to the model, possibility of benchmarking and continuous improvement, the Prado-MMGP model was the most appropriate for this research process. It has been proved that the State Department of Taxation shows a very low project management maturity level. Regarding the acceptance of the maturity dimensions by the State Department, it is still in an early developmental stage, as one of the dimensions showed a poor performance while the rest showed a regular one. In contrast with similar organizations, the maturity results have shown to be below the national average. The maturity assessment enables in the institution the implementation of a plan for institutional growth with the creation of sector strategic and project management

Avaliação de implementação da Educação Superior a Distância: o caso da Secretaria de Educação a Distância da Universidade Federal do Rio Grande do Norte SEDIS/UFRN

The considerable expansion of Distance Education registered in recent years in Brazil raises the importance of debate about how the implementation of this policy has been happening so that formulators and implementers make better informed decisions, maximizing results, identifying successes and overcoming bottlenecks. This study aims to evaluate the implementation process of Distance Education policy by Secretary of Distance Education of the Federal University of Rio Grande do Norte. For this, we sought to use an evaluation proposal consistent with this policy, and came to the one developed by Sonia Draibe (2001), which suggests an analysis called anatomy of evaluation general process. To achieve the objectives, we made a qualitative research, case study type, using documentary research and semi-structured interviews with three groups of subjects who belong to the policy: managers, technicians and beneficiaries. It was concluded that: the implementation process needs a open contact channel between the management and technicians and beneficiaries; the lack of clarity in the dissemination of information between technicians produces noises that affects the outcomes; the absence of dissemination of internal and external actions contributes to the perpetuation of prejudice in relation to Distance Education; using selection criteria based on competence and merit contributes to form a team of skilled technicians to perform their function within the policy; an institution that do not enable technicians generates gaps that possibly will turn into policy implementation failures; all subjects involved in politics need internal evaluations to contribute to improvements in the implementation process, however, a gap is opened between the subjects if there is no socialization of results; the existence of an internal structure that manipulates financial resources and balances the budget from different maintainer programs is essencial; the consortium between IES and municipalities in presential support poles are bottlenecks in the process, since beneficiaries are exposed to inconsistency and lack of commitment of these local municipalities

A percepção da fiscalização dos contratos de mão de obra terceirizada pelos agentes envolvidos nesse processo no âmbito da Universidade Federal do Rio Grande do Norte: uma análise sob o modelo do principal-agente

Outsourcing has emerged as one of the new ways of guiding the work. For its advantages and be consistent with the paradigms of managerial reform, outsourcing also started to be used in the Public Administration. However, taking into account the particularities of the latter, some issues are relevant when outsourcing concluded with the State. Gains notoriety, for example, the step of monitoring these contracts, to the extent that, from this activity, we can avoid the negative effects of outsourcing like the fact that the state will pay for labor and wage liens that are obligation of the company providing the services. This study aims to understand the perception that this process is under the Federal University of Rio Grande do Norte, from the point of view of different stakeholders, also explaining the motivations that these agents have to perform the supervisory process. As a theoretical basis was used the Agency Theory, which reinforces the supervisory activities as a necessary means to minimize moral hazard and adverse selection, seeking to understand not only the different motivations tax contracts to properly perform their duties, but also analyze other phenomena arising from this contractual relationship. To achieve the proposed objectives, were taken a literature review and a presentation of how to organize the management and oversight of contracts in UFRN. The methodological procedures included questionnaires and interviews with those involved in the process. After analyzing the results obtained in the survey instruments , and also based on the laws, regulations and instructions governing the procurement process within the UFRN, it was concluded that the process of overseeing the outsourcing of labor contracts in UFRN is not fully institutionalized, some points should be strengthened in order to have the consolidation of this process, highlighting the need for training of UFRN servers that act as tax, the knowledge that the contractual penalties are applied effectively, the need that there is a supervisor of tax of contractors and also the realization of the rotation system of outsourced employees

A institucionalização do programa nacional de Educação Fiscal nos estados brasileiros e Distrito Federal

The research seeks to comprehend the development of the promoting and structuring Fiscal Education actions in the states and in the federal district, attending to the guideline and the administrative requirements established by the Escola de Administração Fazendária (ESAF) to implement the Programa Nacional de Educação Fiscal (PNEF). The study has an exploratory content with a qualitative approach. The informations were collect with a questionnaire applied through the Google-docs by the managers of the program in any federated unit. Were founded several results, as the fragility of the program in the budgeting and financial area, the low frequency of the Grupo de Educação Estadual (GEFE) in regular meetings, the absence to monitor undertaken actions and the absence of interlocution between the GEFE and the forums of national discussions, especially the Conselho Nacional de Política Fazendária (CONFAZ). Despite the fragilities, the work shows the occurrence of some actions to disseminate Fiscal Education in schools and universities, the establishment of partnerships and the participation of the GEFE‟s in the national meetings. With the study, it was possible to conclude that in spite of the weaknesses found in its structure, the PNEF s institutionalized in the states and in the federal district, observing the differences between the federal units in relation to the ripening of the program. Despite the difficulties evidenced, it appears that they are capable of resolution, as far as it recognizes the importance of the Program for the promotion of a culture of active citizenship in the society and it will gives better conditions of implementation

Cargos comissionados da administração pública direta do Rio Grande do Norte: análise comparativa entre o perfil profissional dos cargos comissionados com vínculo funcional e sem vínculo funcional

The professional profile of public administrators in Brazil is changing very rapidly in recent years, seeking to meet the principle of efficiency by public agencies at all levels. The admission of the permanent government employee under the Public Administration is by competition, however, commissioned positions are free appointment of managers, which allows effective participation of external experts according to their respective standards and norms. In this context, this dissertation seeks to understand the main characteristics of the profile of the occupants of commissioned positions in Direct Public Administration of the State of Rio Grande do Norte, noting the differences between those with functional link with the have nots. For this study, by data collection and content analysis, a mapping of the administrative structure of the Government of the State of Rio Grande do Norte was done, i.e., the organization of the Executive Branch, which is regulated by the Complementary Law no. 163/1999 and its amendments, which consists of 53 (fifty three) entities, these 29 (twenty nine) are agencies of the direct administration and the remaining 24 (twenty four) comprises the indirect administration. With the collected data, analysis on the number of commissioned positions of each organ of the State of Rio Grande do Norte and information on education, age, length of service, gender and functional link with the direct administration was carried out. Data were available from SEARH in June/2013, when they totaled 58,733 (fifty-eight thousand seven hundred thirty-three) servers, these 2.15% (two point fifteen percent) occupy commissioned positions, corresponding to 1,262 commissioned positions under the Direct Administration, below the national average of 4% (four percent). Of total commissioned positions 64.7% (sixty-four point seven percent) have no functional link with the direct administration, while only 35.3% (thirty -five point three percent) have functional link. It was noticed that there are no clear and specific criteria for the appointments of commissioned positions in the State. They occur freely, as provided in the State Constitution. Another conclusion is the importance of Public Administration define and improve their capacity, competence and efficiency in the delivery of public services. For that it is necessary to invest in their workforce composed of permanent employees and commissioned positions to define the appropriate professional profile

A percepção dos docentes da UFRN sobre o programa de apoio a planos de reestruturação e ampliação das universidades federais - REUNI

In recent decades higher education in Brazil has gone through several changes. The Programa de Reestruturação e Expansão das Universidades Federais REUNI has been the greatest overhaul performed by the government in public universities in the last years. REUNI is presented as the biggest reform in tertiary education in contemporary times, having as the main goal a gradual increase in the average rate of conclusion in live learning graduation courses up to 90%, as well as a rate expansion of graduating students in face to face classes per professor. This research aims at studying the perception of professors from UFRN concerning the REUNI program in execution from 2008 until 2012. The study seeks to understand how professors evaluate the program and what the dimensions that most influence in this evaluation are. The study made use of a research tool (survey) which was sent through the internal system of the university, SIGAdmin, to all professors of superior teaching from UFRN. The answers generated by the survey were processed using SPSS statistical software (Statistical Package for Social Science). Factorial Analysis and Multiple Linear Regression were used as an analysis technique. 180 answers were obtained, reaching all UFRN Centers and some academic units, as well as some campuses in the countryside of the state. Through the research was possible to analyze how professors from UFRN perceive the REUNI program implemented in the institution. The results point to the program approval by the professors. Statistical tests showed that the average values obtained in the Centers and academic units are basically the same. It was demonstrated that the extent that most influenced in the answers is linked to practical outcomes of the program, whereas the knowledge of REUNI goals was the least that impacted on the marks given to the program. Another dimension which influenced the perception of professors relates to the influence of REUNI in their activities. It was observed that professors from UFRN don t see REUNI as an impediment to them

Avaliação e monitoramento de políticas públicas: criação de um modelo sistêmico aplicado ao Instituto de Assistência Técnica e Extensão Rural do Rio Grande do Norte (EMATER-RN)

The nature of this thesis is interventionist and aims to create an alternative on how to control and evaluate the public policies implementation developed at the Institute for Technical Assistance and Rural Extension of Rio Grande do Norte State. The cenarium takes place in a public institution , classified as a municipality that belongs to the Rio Grande do Norte government and adopts the design science research methodology , where it generates a set of artifacts that guide the development of a computerized information system . To ensure the decisions, the literature was reviewed aiming to bring and highlight concepts that will be used as base to build the intervention. The use of an effective methodology called Iconix systems analysis , provides a software development process in a short time . As a result of many artifacts created by the methodology there is a software computer able of running on the Internet environment with G2C behavior, it is suggested as a management tool for monitoring artifacts generated by the various methods. Moreover, it reveals barriers faced in the public companies environment such as lack of infrastructure , the strength of the workforce and the executives behavior