Diagnóstico de enfermagem risco de quedas em pacientes com angina instável

O risco de quedas pode ser reconhecido como fenômeno ou diagnóstico de enfermagem. Pesquisas relacionam diretamente isquemias miocárdicas, como a angina instável e o risco de cair. Objetivou-se analisar o diagnóstico de enfermagem Risco de quedas na ocorrência de angina instável por um estudo transversal realizado em 57 indivíduos internados em um hospitalescola, mediante exame físico e formulário. Para o tratamento estatístico foram utilizados teste qui-quadrado, teste exato de Fisher, Mann-Whitney, teste-t e Coefi ciente Phi (p<0,05). O Risco de quedas foi o diagnóstico de enfermagem mais prevalente (87,71%), sobretudo em homens, mais velhos, com menos anos de estudo e renda inferior. Presença da angina instável, hipertensão arterial, medicação anti-hipertensiva, doença vascular, difi culdades visuais e insônia apresentaram associação com o diagnóstico de enfermagem Risco de quedas. Conclui-se que é imprescindível o desenvolvimento de parâmetros claros e objetivos à mensuração mais acurada do risco de quedas no âmbito hospitalar

Análise da eficiência de contratos de serviços de elevada especificidade terceirizados pela petrobras

The definition of the boundaries of the firms is subject that has occupied the organizational theorists long ago, being the seminal work of Coase (1937) indicated as the trigger for one theoretical evolution, with emphasis on governance structures, which led to a modern theory of incomplete contracts. The Transaction Cost Economics (TCE) and Agency Theory arise within this evolution, being widely used in studies related to the theme. Empirically, data envelopment analysis (DEA) has established itself as a suitable tool for analysis of efficiency. Although TCE argues that specific assets must be internalized, recent studies outside the mainstream of theory show that, often, firms may decide, for various reasons, hire them on the market. Researches on transaction costs face with the unavailability of information and methodological difficulties in measuring their critical variables. There`s still the need for further methodological deepening. The theoretical framework includes classic works of TCE and Agency Theory, but also more recent works, outside the mainstream of TCE, which warn about the existence of strategies in use of specific assets that aren`t necessarily aligned with the classical ideas of TCE. The Brazilian oil industry is the focus of this thesis, that aimed to evaluate the efficiency of contracts involving high specificity service outsourced by Petrobras. In order to this, we made the categorization of outsourced services in terms of specificity, as well the description of services with higher specificity. Then, we verified the existence of relationship between the specificity of services and a number of variables, being found divergent results than those that are preached by the mainstream of TCE. Then, we designed a DEA model to analyze the efficiency in the use of onshore drilling rigs, identified among the services of highest specificity. The next step was the application of the model to evaluate the performance of drilling rigs contracts. Finally, we verified the existence of relationship between the efficiency of contracts and a number of variables, being found, again, results not consistent with the theory mainstream. Regarding to analyze of efficiency of drilling rigs contracts, the model developed is compatible with what is found in academic productions in efficiency of drilling rigs. The results on efficiency show a wide range of scores, with efficiencies ranging from 31.79% to 100%, being low the sample efficiency average. There is consonance between the model results and the practices adopted by Petrobras. The results strengthen the DEA as an important tool in studies of efficiency with possibility to use for analysis other types of contracts. In terms of theoretical findings, the results reinforce the arguments that there are situations in which the strategies of the organizations, in terms of use of assets and services of high specificity, do not necessarily follow what is recommended by the mainstream of TCE

Síndrome de burnout e autoeficácia: um estudo com profissionais de enfermagem de hospitais privados de Natal/rn

This research verifies the influence of the self-efficacy level on burnout syndrome incidence in relation to nursing professionals from private hospitals located in the Municipality of Natal, State of Rio Grande do Norte. The nature of the research was descriptive, and the used data analysis method was quantitative which was developed through SPSS computational package, version 17.0. The used instrument for the investigation was Maslach-Burnout Inventory (MBI), and the General Perceived Self-efficacy Scale (GPSES) was applied to a sample formed from 230 nursing professionals. The statistic techniques to data analysis were: frequency analysis; factor analysis; Cronbach.s alpha; Kaiser-Meyer-Olkin test (KMO); Bartlett efericity test; percentual analysis; Spearman rank correlation analysis; and simple regression. The achieved factors from factor analysis of MBI were the same, taking into account the dimensions which Maslach initially suggested to the instrument (emotional exhaustion, lack of personal realization, and depersonalization). However, one highlights that the low internal consistence of the depersonalization dimension can occur from people.s difficulty (caused by cultural aspects) of assuming this attitude in their work environment. Through GSE, it was achieved a factor which confirmed the unidimensionality showed by the author of the instrument. In relation to the syndrome incidence, it was verified that about 50% of the researched sample presented burnout syndrome evidence. Referring to self-efficacy level, about 65% of the researched sample presented low level of self-efficacy, what can be explained by the work characteristics of these professionals. In relation to the self-efficacy influence on the Burnout syndrome, it was verified that self-efficacy can be one of the aspects which influences occupational stress chronification (burnout), mainly to the personal realization dimension. Therefore, the researched hospital organizations need reflect about their attitudes in respect to their professionals, since the numbers showed a dangerous tendency regarding a predisposition to burnout syndrome of their staff, what implies not only a significant amount of individuals who can present high levels of emotional exhaustion, lack of personal realization, and depersonalization, but also the fact that this group presents low level of self-efficacy

Avaliação da eficiência dos programas de pós-graduação acadêmicos em administração, contabilidade e turismo

The Triennial Evaluation of Coordination for the Improvement of Higher Education Personnel (CAPES) is made according to several indicators, divided into several issues and items, and their weights. In these it is evident the importance of scientific periodicals. This study aims to evaluate the relative efficiency of post-graduate students in Business Administration, Accounting and tourism evaluated by CAPES in Brazil. The methodology used the data envelopment analysis - DEA (Data Envelopment Analysis). The data were obtained from the site and organized by the CAPES Qualis score. The analysis was performed by the DEA variable returns to scale, product-oriented (BCC-O), with data from the three-year periods 2004-2006 and 2007-2009. Among the main results are the average increase significantly the relative efficiency of the programs in the period 2007-2009 compared to 2004-2006 period, the highest average efficiency of programs linked to public institutions in relation to private, doctoral programs with the present average efficiency sharply higher than those only with masters, and senior programs in general were more efficient. There is also moderate and significant correlation between the efficiency scores and concepts CAPES. The Malmquist index analysis showed that more than 85% of programs had increased productivity. It is noteworthy that the main effect that influences the increase of the Malmquist index is the displacement of the border (Frontier-shift)

Percepção Ambiental em Museus Paisagens de Arte Contemporânea: a legibilidade dos museus Inhotim/Brasil e em Serralves/Portugal avaliada pelo público/visitante

This thesis nalyzes the wayfinding in Landscape Museum of Contemporary Art (MPAC), based on the Institute of Contemporary Art CACI, Minas Gerais, Brazil and the Museum of Contemporary Art of the Serralves Foundation, Porto, Portugal. The study focuses on the interrelationship of the public/visitors with the landscape, architecture and contemporary art museums in these, in order to understand visual perception and apprehension of such an environment for their users. For both were confronted documentation (visual and written) and people talk. The main hypothesis put forward is that the audience/visitor MPAC appreciates the interrelationship between the natural environment (park/garden) and built environment (the works of contemporary art and the galleries), giving equal value to both. To complement this, a second hypothesis is that during the visit to MPACS, visitors define their paths spontaneously, but strongly influenced by existing visual indicators (maps, signage and striking landscape elements), which facilitate the readability of space, which also contribute to the offered services and the experiences of similar institutions. The analytical basis of the research used the concepts of legibility (LYNCH, 2009), wayfinding (GIBSON, 2009; ARTHUR, PASSINI, 2002; WEISMAN, 1982), Experiential Cotinnum (TUAN, 1985), Space Bound (CRUZ PINTO, 2007) and habitus (BOURDIEU, 1992). Methodologically was used qualitative research (DEMO 2000) by means of a case study (YIN, 2005; STAKE, 1999) and participant observation (WHYTE, 2005). In the two institutions interviews with researchers and curators, behavior observation and questionnaires from employees, trainees, monitors and the public/visitor of the two museums were performed. Although partially referende the initial hypothesis, the research showed that the public/visitor value appears more natural environments, they experience a greater intensity and in addition to the factors listed in the second case, your perception and definition of paths suffer significant influence of emotional relations established with space. Generally the audience/visitor adapts easily to different demands of contemporary art exhibition in the two museums and the built environment (park/garden and museum) interferes with your reading path during the visit, perceived by the public/visitor condition as a factor that favors the enjoyment of works on different mounts (wayfinding), though often become a factor that hinders the legibility of the building and its built environment

Uma cidade para pessoas: funcionalidade, racionalidade e emotividade nas relações mobiliário urbano, espaço público e cidadãos

This research investigates how functionality, rationality, and emotionality applied to urban furniture design contribute to the organization, legibility, and qualification of public spaces, according to different layouts, physical and visual qualities of the urban furniture as well as the quality of urban infrastructure that may influence the uses and appropriation of urban spaces by pedestrians, turning those spaces into socially centripetal or centrifugal places. The work consists of two parts. First refers to a bibliographical review concerning two main issues of the investigation: product design and legibility of public space, defining the conceptual and theoretical bases, linked to methodological strategies aimed at systemic planning and integrated management of urban furniture design and legibility of public spaces (sidewalks), that are necessary to define the existing relationships among the user s interface (pedestrians); product (urban artifacts); built environment (sidewalks). The second part refers to the achievement of empirical approach throughout visual analysis of public spaces and the functional and qualitative evaluation of the existing urban furniture in the central neighborhood of Cidade Alta, Natal, RN, according to the theoretical researched concepts and methodological procedures. The results expose the weaknesses and levels of intensity arising from the relations among public space, urban furniture, and users, revealing the need for theoretical and practical approaches which would help the decision-making in planning, designing and integrating innovative, sustainable, and ethical solutions in order to design attractive public spaces that could provide sociability and citizenship throughout integrated public management, city systemic thinking and urban identity. The suggested guidelines at the end of this research will provide the necessary strategies to design suitable urban furniture systems according to aesthetic and practical urban infrastructure and city context, aiming to ease visual and physical conflicts that may negatively interfere with the appropriation of public spaces by the citizens

Layout, conforto e satisfação dos usuários em escritórios: uma avaliação pós-ocupação no edifício da sede administrativa do INPE-CRN

This research aimed to identify the link between the layout of workspaces in offices and the design strategies for environmental comfort. Strategies surveyed were focused on the thermal, visual and luminic comfort. In this research, visual comfort is related to issues of visual integration within and between the interior and exterior of the building. This is a case study conducted at the administrative headquarters of Centro Regional Nordeste do Instituto de Pesquisas Espaciais (INPE-CRN), located in Natal/RN. The methodological strategy used was the Post-Occupancy Evaluation, which combined the survey data on the building (layout of workspaces, bioclimatic strategies adopted in the design, use of these strategies) with some techniques aimed at acquiring qualitative information related to users. The workspace layout is primordial to satisfaction and productivity of workers. Issues such as concentration, communication, privacy, personal identity, density and space efficiency, barriers (access, visual and even ventilation and lighting), among others, are associated with the layout. The environmental comfort is one of the essential elements to maintaining life quality in workplace. Moreover, it is an important factor in user`s perception of the space in which he or she are inserted. Both layout and environmental comfort issues should be collected and analyzed in the establishment phase of the programming step. That way, it is possible to get adequate answers to these questions in subsequent project phases. It was found that changes in the program that occurred over time, especially concerning persons (number and characteristics), resulted in changes in layout, generating high density and inflexible environments. It turns difficult to adjust the furniture to the occupants` requirement, including comfort needs. However, the presence of strategies for environmental quality provides comfort to spaces, ensuring that, even in situations not considered optimal, users perceive the environment in a positive way. It was found that the relationship between environmental comfort and layout takes the following forms: in changing the perception of comfort, depending on the layout of the arrangements; adjustments in layout, due to needs for comfort; and the elevation of user satisfaction and environmental quality due to the presence of strategies comfort even in situations of inadequate layout

Acessibilidade no ambiente escolar: reflexões com base no estudo de duas escolas municipais de Natal-RN

This work was originated through the results of the analysis of the services for the needs of people with disabilities that were permitted by the physical space of two schools of the municipality of Natal/RN. The general objective/goal was to subsidize the elaboration of alternatives for the planning of environments that could be used by any person. The study used the empirical research through the adoption of a multimethod approach including: (i) technical visits oriented by the NBR 9050, (ii) contact with users that have reduced mobility (visually impaired and wheelchair or crutch users) through escorted travels and interviews, and (iii) interview with school managers. The evidence from the research, even though with significant development of laws that guarantee people with disabilities their right to citizenship, the physical environment of our schools still present with many obstacles that prevent the mobility of people with disabilities which proves their lack of readiness to accommodate them. Therefore, the actions taken to address the accessibility has been the adoption of temporary solutions that makes the adaptation more difficult, adds obstacles and reinforces the undesirable segregation, however still very present in our society. Finally, there is the indication that in order to achieve the spatial configuration that promotes social contact and integration in between the persons with different physical status, it is necessary to completely comprehend the activities developed in each space, from the conception of the equipment to the individual learning needs, having in mind creating environments that stimulates the execution of the tasks in an independent manner without the assistance of others. The inclusion regarding attention to accessibility in the decision making process, directed to the arquitectural and urban project, would decrease the constant need to redevelop and adapt spaces, and should be definitely incorporated as an important component in the production of space

Entre o cartão-postal e a cidade real: um estudo sobre paisagem e produção imobiliária em Natal/RN

Recent studies concerning the landscape have investigated the most important activities that contribute for its modification and have tried to better understand the society through the marks left by its quotidian. It is understood that singular landscapes constitute the cultural patrimonies of the cities, once they are part of the daily life of the citizens and are present in their social representations. Some contemporary authors defend the preservation of the natural and urban landscape trying, specially, to keep its importance for the local population. Natal is a city where the ambient qualities are well defined and known by the beauty of the area where it is located. Situated just between a river and the sea, the city grew following its geographic characteristics. The Potengi River, the Atlantic Ocean and the vast dunes ecosystem represented natural limits to the urban expansion; at the same time they have favored the development of a landscape pattern marked by the dialectic between the natural elements and the human interventions. However, this relationship changed after the intensification of the high rising development process that took place since the 1960s. The urban legislation tried to preserve the features of the local landscape delimiting Areas for Controlling Building High , destined to protect the scenic value of some parts of the city. On the other hand, the civil construction sector has made constant pressure in sense to abolish or to modify this legal instrument, aiming profits that have increased, in the 1990s, because of the consumption and the qualification of the urban space for tourist activities. It is necessary the raising of new elements to stimulate the quarrel about the landscape preservation, the process of the urban space production and the best way for the legislation implementation. This work tries to raise elements about the subject at local level, in sense to use Natal City experience to contribute for the formulation of indicators to raise the question about the lack of measure for subjective values, for example the cultural and affective value of the landscape. The natural elements inserted in the urban profile, represent strong visual references and supply identity to the town; they are part of the collective imaginary and are detached in the social context of the city. Then, why the preservation of the landscape, that estimates the improvement in the quality of life, is not enough to justify the controlling building high already previewed as part of Natal City Legislation? These questions send us to the approach of the landscape, as a community patrimony, alerting that some of its significant esthetics attributes must be preserved as a legacy for the future generations

Criação em processo no espetáculo Ethnotron-Ghetto Experimen

Este trabalho investigou o processo criativo do espetáculo Ethnotron-Ghetto Experiment, do Coletivo paraibano Tribo Éthnos, fundado na década de 1990 e ainda em atividade. A estratégia metodológica se dá através de estudos descritivos, valendo-se da teoria e prática de diversas linguagens artísticas presentes na obra apontada: artes visuais, performance, literatura e histórias em quadrinho; em ações realizadas pelo Coletivo ao longo dos anos, objetivando descrever e analisar o processo de criação do referido espetáculo de dança, através da minuciosa coleta de dados por meio de entrevistas abertas e semiestruturadas, e da pesquisa e captação de materiais audiovisuais. A Tribo Éthnos destaca-se na cena local na cidade de João Pessoa, e estadual, na Paraíba, visto que, nesse longo percurso de existência, além da preocupação em fundir muitas formas artísticas, bem como os artistas da Paraíba, aglutina pessoas que fazem arte em outros países e faz das danças urbanas algo instigante. A Tribo ainda preocupa-se com a troca de saberes através de palestras, oficinas, cursos e intercâmbios. A dissertação investiga o processo de criação dos artistas e, especificamente, dos dançarinos, utilizando-se principalmente do conceito de work in progress, proposto por Renato Cohen, e aplicado ao espetáculo estudado. Apresentam-se descrições dos movimentos coreográficos, do espetáculo de dança paraibano Ethnotron-Ghetto Experiment, de Dança de Rua da Era Funky, especificamente, com estilos como popping, waving, animation, strobing, floatine/ slidini, tiokine, trebing, breaking, waving, sliding, entre outros, visto serem estes parte integrante do processo de criação. Tais estilos remetem ao ilusionismo ou ao mimetismo, sugerindo, em seus movimentos truques, câmeras lentas, flutuações com os pés, entre outros. Segundo Valmir Vaz, o Coletivo, através do espetáculo, busca a integração dos corpos, procura uma libertação individual e sugere uma sensação de querer voar nas coreografias/cenas. Abordam-se os aspectos do processo criativo: o espaço cênico, o trabalho corporal, a sonoplastia e a roupa/indumentária. Trabalha-se o conceito do corpo virtual de José Gil no aspecto do corpo cênico

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

Desenvolvimento de bloco de vedação com barita na composição de partida para blindagem de radiação X

This work main objective is to study the use of bricks in barium X-rays rooms in order to contribute to the optimization of shielding rooms diagnosis. The work was based on experimental measurements of X-ray attenuation (40 to 150 kV), using ceramic seal bearing the incorporation of barium sulfat (BaSO4). Different formulations were studied in three different firing temperatures and evaluated for incorporation in the ceramic body. The composition of 20% of barite processed at a temperature of 950 ° C showed better physical and mechanical properties, is considered the most suitable for the purpose of this work. Were produced bricks sealing composition formulated based on that presented the best technological features. These blocks were tested physically as a building material and wall protective barrier. Properties such as visual, deviation from the square, face flatness, water absorption and compressive strength were evaluated for all the blocks produced. The behavior of this material as attenuator for X-rays was investigated by experimental results which take into account mortar manufacturers barium through the different strains and compared with the reference material (Pb). The simulation results indicated that the ceramic block barium shows excellent properties of attenuation equivalence lead taking into account the energy used in diagnostic X-ray

Uma metodologia para a análise do desempenho sustentável dos postos de revenda de combustível na cidade de Natal/RN, com o uso de data envelopment analysis-DEA

The increasing use of fossil fuels in line with cities demographic explosion carries out to huge environmental impact in society. For mitigate these social impacts, regulatory requirements have positively influenced the environmental consciousness of society, as well as, the strategic behavior of businesses. Along with this environmental awareness, the regulatory organs have conquered and formulated new laws to control potentially polluting activities, mostly in the gas stations sector. Seeking for increasing market competitiveness, this sector needs to quickly respond to internal and external pressures, adapting to the new standards required in a strategic way to get the Green Badge . Gas stations have incorporated new strategies to attract and retain new customers whom present increasingly social demand. In the social dimension, these projects help the local economy by generating jobs and income distribution. In this survey, the present research aims to align the social, economic and environmental dimensions to set the sustainable performance indicators at Gas Stations sector in the city of Natal/RN. The Sustainable Balanced Scorecard (SBSC) framework was create with a set of indicators for mapping the production process of gas stations. This mapping aimed at identifying operational inefficiencies through multidimensional indicators. To carry out this research, was developed a system for evaluating the sustainability performance with application of Data Envelopment Analysis (DEA) through a quantitative method approach to detect system s efficiency level. In order to understand the systemic complexity, sub organizational processes were analyzed by the technique Network Data Envelopment Analysis (NDEA) figuring their micro activities to identify and diagnose the real causes of overall inefficiency. The sample size comprised 33 Gas stations and the conceptual model included 15 indicators distributed in the three dimensions of sustainability: social, environmental and economic. These three dimensions were measured by means of classical models DEA-CCR input oriented. To unify performance score of individual dimensions, was designed a unique grouping index based upon two means: arithmetic and weighted. After this, another analysis was performed to measure the four perspectives of SBSC: learning and growth, internal processes, customers, and financial, unifying, by averaging the performance scores. NDEA results showed that no company was assessed with excellence in sustainability performance. Some NDEA higher efficiency Gas Stations proved to be inefficient under certain perspectives of SBSC. In the sequence, a comparative sustainable performance and assessment analyzes among the gas station was done, enabling entrepreneurs evaluate their performance in the market competitors. Diagnoses were also obtained to support the decision making of entrepreneurs in improving the management of organizational resources and promote guidelines the regulators. Finally, the average index of sustainable performance was 69.42%, representing the efforts of the environmental suitability of the Gas station. This results point out a significant awareness of this segment, but it still needs further action to enhance sustainability in the long term

A saúde psíquica de quem faz saúde: uma análise crítica sobre a humanização direcionada ao profissional de saúde

It is noticeable that pressure, tension and overwork are frequent in health professionals routine. The work related to the ward area demands deep attention and surveillance. Because of that, it is essential to have a specific look at the humanization directed at health professionals, considering that taking care of other human beings is the essence of their job. This study has analyzed the psychic health levels, as well as the stress health professionals are submitted to, providing a debate about the humanization in 06 public hospitals (03 of them awarded by actions of humanization, and 03 not awarded) in Rio Grande do Norte state, Brazil. A study with 126 active health professionals (doctors, nurses, psychologists, nutritionists and social workers) in ward areas in their respective institutions was carried out. The thesis presented, with multi-disciplinary characteristic, counted on the support of statisticians (to calculate samples and data analysis), psychologists, social workers and administrators (linked to the human resources sector in each hospital). A cross-sectional study was performed, taking into consideration both quantitative and qualitative factors. The tools used for that were a semistructured questionnaire with socio-demographic characteristics, work and humanization; Lipp's Stress Symptoms Inventory for Adults (ISSL), and the Goldberg s General Health Questionnaire (QSG). The workers are predominantly women (84,9%), married (54,8%), between 46 and 55 years old (40,5%), working in the same institution for more than 20 years (22,2%), and between 16 and 20 years (20,6%), respectively. They work 40 hours a week (71,4%) and have multiple jobs (61,9%). Although most of these individuals global psychic health is in a good level, there are a significant number of people that is gradually getting worse concerning psychic stress (F1) showed by QSG (54,7%), and stress showed by ISSL(42,1%). Observing the categories, nurses (41,5%). Nutritionists (20,8%), doctors and social workers (18,9%), were among the most affected. About general health (F6), 63% of the awarded hospitals and 70% of the not awarded ones, presented good health levels (ranging from 5 to 50%). It was also noticed that, in the groups mentioned above, 25 and 20% respectively, were inserted in scores between 55 to 90%, what means that they are in worsening phase. The fact that the hospital is awarded or well recognized doesn t interfere in health professionals stress level and in their psychic health. Through what was heard from these individuals, it was possible to verify that they know little about humanization, once few of them identify or know that the service they offer is in an adoption process by Ministerial Policies. It was also detected the necessity of developing actions aimed at worker s health. Such results showed the importance of have more investments in programs that are directed to workers well-being, because they deal with other people s health and it is known that it is difficult for them to offer high-quality assistance if there are not suitable physical, psychological and material conditions to help them develop their jobs. As a warning, it is fair to say that investments in actions that provide humanized care to health professionals, mainly concerning preventive care for their health and life quality in their work

Associação entre fatores nutricionais e a resposta frente à infecção por Leishmania chagasi

Leishmania chagasi infection presents a wide spectrum of clinical outcomes, ranging from asymptomatic self resolving infection to disease, visceral leishmaniasis (VL). The exact mechanisms that lead the evolution of infection to disease are not understood. It is believed that malnutrition is a risk factor associated with VL development, although there are few human studies in the area. We aimed to assess the nutritional factors associated with the response to L. chagasi infection in Rio Grande do Norte. The study was conducted from December 2006 to January 2008. 149 children were assessed: 20 active VL cases, 33 children with VL history, 40 DTH+ asymptomatic children and 56 DTH-. Nutritional status was assessed using z scores for Weight/Age, Weight/Height, Height/Age, Body Mass Index (BMI), and mid-upper arm circumference/height (MUAC/height). Vitamin A status was determined by serum retinol concentrations and the modified-relative-dose-esponse test (MRDR). Breastfeeding time and birth weight were also evaluated. VL children presented compromised nutritional status when compared to the other groups using BMI and MUAC/age, with means -1,53 ± 1,10 and -1,48 ± 1,28 z scores, respectively (ANOVA, p < 0,05). VL children also showed lower vitamin A levels: 43% presented serum retinol < 20 µg/dL and 15% MRDR > 0,060. Birth weight was inverserly associated with the risk to belong the VL group (β = -0,00; OR = 0,84; 95% CI 0,73 - 0,99; p = 0,047), whereas more breastfeeding time was directly associated with the risk to belong to the DTH+ group (β = 0,02; OD = 1,16; 95% CI 1,01 - 1,33; p = 0,036). The nutritional variables evaluated were associated with the response to the L. chagasi infection, with malnutrition and compromised vitamin A status as markers of children who present with VL. Higher birth weight was associated with protection to disease, and higher breastfeeding time was associated with increased likelihood of an asymptomatic infection. The results show that modifiable nutritional aspects in the study population are associated with the response to the L. chagasi infection