Infecção hospitalar em pacientes cirúrgicos de hospital universitário

Analisar fatores intercorrentes e a incidência da infecção em pacientes operados no Hospital Universitário da UFRN. Métodos: Foram estudados, através de protocolo previamente estabelecido, 3.120 pacientes internados que se submeteram a procedimentos cirúrgicos no período de janeiro de 1999 a outubro de 2002. Resultados: O índice de infecção hospitalar foi de 5,9%, e a topografia de maior incidência foi a ferida operatória (3,7%). Infecção respiratória ocorreu em 1,2%, urinária em 0,6% e bacteremia em 0,1%. O índice de infecção comunitária foi de 9,2%, predominando infecção urinária (5%) e respiratória (2,1%). Quanto ao grau de contaminação das feridas operatórias, as feridas limpas (1479) apresentaram infecção em 2,9%, as feridas limpascontaminadas (1277) em 6,0% dos casos, as feridas contaminadas (270) em 15,1%, e as ferida infectadas (94) resultaram em infecção em 30,75% dos casos. Conclusão: Concluiu-se que a incidência de infecção cirúrgica foi compatível com os índices na literatura mundial. A partir desses dados, ratifica-se a importância de medidas de controle de infecção hospitalar de forma sistemática, como vem sendo realizado no hospital onde o estudo foi realizado

Infecção hospitalar em pacientes cirúrgicos de hospital universitário

Objetivo: Analisar fatores intercorrentes e a incidência da infecção em pacientes operados no Hospital Universitário da UFRN. Métodos: Foram estudados, através de protocolo previamente estabelecido, 3.120 pacientes internados que se submeteram a procedimentos cirúrgicos no período de janeiro de 1999 a outubro de 2002. Resultados: O índice de infecção hospitalar foi de 5,9%, e a topografia de maior incidência foi a ferida operatória (3,7%). Infecção respiratória ocorreu em 1,2%, urinária em 0,6% e bacteremia em 0,1%. O índice de infecção comunitária foi de 9,2%, predominando infecção urinária (5%) e respiratória (2,1%). Quanto ao grau de contaminação das feridas operatórias, as feridas limpas (1479) apresentaram infecção em 2,9%, as feridas limpascontaminadas (1277) em 6,0% dos casos, as feridas contaminadas (270) em 15,1%, e as ferida infectadas (94) resultaram em infecção em 30,75% dos casos. Conclusão: Concluiu-se que a incidência de infecção cirúrgica foi compatível com os índices na literatura mundial. A partir desses dados, ratifica-se a importância de medidas de controle de infecção hospitalar de forma sistemática, como vem sendo realizado no hospital onde o estudo foi realizado

Motivação no trabalho voluntário: expectativas e motivos na Pastoral da Criança

The present study has proposed a structural model to identify the reasons why individuals become voluntary, keep and exit this type of work. The empirical space was the Pastoral da Criança - social action agency of the National Conference of Bishops of Brazil (CNBB) - community-based institution that has its work based on solidarity and the sharing of knowledge. The theoretical framework has the context in which are volunteering studies in Brazilian and world level. Then discuss the various concepts of volunteering and presented the theoretical models of volunteer motivation. Studies of Mostyn (1983) and studies conducted by the BEPEGE-Base for Studies and Research in Management Policies and Strategies - in their line of research GERQUAL - Human Resource Management and Organizational Quality - of the Federal University of Rio Grande do Norte as Carvalho e Souza(2006), Souza, Medeiros e Fernandes (2006), Souza et al (2009, 2010), Cavalcante et al (2011a, 2011b, 2011c, 2011d) were the main theoretical references for the construction of the model that was tested. Data collection was done through a survey with 71 indicators, in 2 visits to cities from the Diocese of Pesqueira, Pernambuco. The first data collection occurred in the period between May 30 and June 3, 2011, in Buique/PE and the second collection happened in Pesqueira/PE, in St. Joseph Seminary, in the period between July 6-8, 2011. 720 questionnaires were collected. The sample was divided into two parts. Exploratory Factor Analysis was applied in first part and Confirmatory Factor Analysis - structural equation modeling - in the second half. The examination of the results achieved by the expectations, reasons for entry, reasons for staying and exit reasons showed that all hypotheses were accepted. So the motivation of voluntary Pastoral da Criança can be explained by a set of interactions between these five constructs: Altruistic, Affectionate, Amiable, Adjusted and Astute

A representação social do papel de gestores em organizações não governamentais

The discussions concerning the absence of a management model appropriate to the peculiarities of third sector organizations have not been impeditive to their emphasized expansion in the last decades. In the attempt of understanding this phenomenon from the perspective of those who manage social organizations, this work based on the theory of social representations to understand the notion that organization managers of the third sector - based in Fortaleza CE - have of the part that they play and how this notion influences the direction of their activities. Social representations of managers of four different categories of non-governmental organizations have been investigated, each category composed of two unities. The categories researched were: social integration through art and education, prevention and treatment of alcohol and drug abuse, children s health assistance and community action. By using Doise s Societal Approach, the role of social managers translated in intraindividual, interindividual and situational processes of their actions, has been analysed within the social representations, focusing on beliefs, values, symbols and stories that give meaning to the existence of non-governmental organizations. Analysis and discussion of data displayed the existence of diversity in the understanding of managers within their practice, in other words, the management profile is also its own manager s. The branch where an organization acts is also preponderant in the shaping of a management style. It could be deduced, from to the organizations researched, that professional formation and the manager s social insertion mainly, are determinative factors in the outlining of a management model of its own. It was concluded that, due to heterogeneity of interests and action segments, there is no systematic process for social management among organizations. Management styles are supported by their director s own perception of achievement, who model organizations according to their contingencies

Avaliação do desenvolvimento neuropsicomotor em crianças na rede básica de saúde utilizando o teste de Denver II: identificação de fatores de risco materno

Alterations in the neuropsychomotor development of children are not rare and can manifest themselves with varying intensity at different stages of their development. In this context, maternal risk factors may contribute to the appearance of these alterations. A number of studies have reported that neuropsychomotor development diagnosis is not an easy task, especially in the basic public health network. Diagnosis requires effective, low-cost, and easy - to-apply procedures. The Denver Developmental Screening Test, first published in 1967, is currently used in several countries. It has been revised and renamed as the Denver II Test and meets the aforementioned criteria. Accordingly, the aim of this study was to apply the Denver II Test in order to verify the prevalence of suspected neuropsychomotor development delay in children between the ages of 0 and 12 months and correlate it with the following maternal risk factors: family income, schooling, age at pregnancy, drug use during pregnancy, gestational age, gestational problems, type of delivery and the desire to have children. For data collection, performed during the first 6 months of 2004, a clinical assessment was made of 398 children selected by pediatricians and the nursing team of each public health unit. Later, the parents or guardians were asked to complete a structured questionnaire to determine possible risk indicators of neuropsychomotor development delay. Finally the Denver II Developmental Screening Test (DDST) was applied. The data were analyzed together, using Statistical Package for Social Science (SPSS) software, version 6.1. The confidence interval was set at 95%. The Denver II Test yielded normal and questionable results. This suggests compromised neuropsychomotor development in the children examined and deserves further investigation. The correlation of the results with preestablished maternal risk variables (family income, mother s schooling, age at pregnancy, drug use during the pregnancy and gestational age) was strongly significant. The other maternal risk variables (gestational problems, type of delivery and desire to have children) were not significant. Using an adjusted logistic regression model, we obtained the estimate of the greater likelihood of a child having suspected neuropsychomotor development delay: a mother with _75 4 years of schooling, chronological age less than 20 years and a drug user during pregnancy. This study produced two manuscripts, one published in Acta Cirúrgica Brasileira , in which an analysis was performed of children with suspected neuropsychomotor development delay in the city of Natal, Brazil. The other paper (to be published) analyzed the magnitude of the independent variable maternal schooling associated to neuropsychomotor development delay, every 3 months during the first twelve months of life of the children selected.. The results of the present study reinforce the multifactorial characteristic of development and the cumulative effect of maternal risk factors, and show the need for a regional policy that promotes low-cost programs for the community, involving children at risk of neuropsychomotor development delay. Moreover, they suggest the need for better qualified health professionals in terms of monitoring child development. This was an inter- and multidisciplinary study with the integrated participation of doctors, nurses, nursing assistants and professionals from other areas, such as statisticians and information technology professionals, who met all the requirements of the Postgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte

Investigação farmacoepidemiológica do uso do clonazepam no distrito sanitário leste em Natal-RN

Prescription errors are the most serious type of medication errors found in the health system. The main purpose of this study was to evaluate the quality of clonazepam prescriptions. A descriptive and observational study with retrospective data collection was conducted at 30 community pharmacies in Natal/RN, Brazil, after informed consent was obtained from the pharmacists. A sample of 313 prescription notifications was randomly collected in October 2009. They were analyzed for legible handwriting and completeness. During the study, one researcher, two pharmacists, and one pharmacy undergraduate student evaluated patient and purchaser identification, pharmaceutical form, dosing regimen, administration route, and prescription by generic name. This research was approved by the institutional Ethics Committee. Among the 313 collected notifications, only 44.1% were legible. A total of 55.91% (175/313) had at least one illegible item, 100% contained incomplete information, and 97.12% (304/313) contained one or more abbreviations. The proportion of illegible handwriting related to the patient s identification (p=0.0001) was statistically significantly greater than that related to the drug purchaser s identification (p=0.0004). Contrary to legal requirements, prescriptions with the generic name accounted for 13.42% (42/313) of the total. All the examined notifications were handwritten. Prescription errors, which potentially can have serious consequences, have been evaluated worldwide, although little is known about this subject as it relates to community pharmacies. This study showed high percentages of prescribing problems, which justifies the development of future research about medication errors in community pharmacies and education activities for prescribers

Ensaio clínico randomizado sobre a prática da atenção farmacêutica nas farmácias comunitárias

Introdução: A criação de programas de equipe multiprofissional de saúde desponta como uma alternativa eficiente para controlar a evolução dos pacientes portadores de diabetes, e a inserção do farmacêutico em tais programas tem contribuído para melhorar o acompanhamento desses pacientes. Objetivo: Avaliar o impacto da intervenção do farmacêutico no acompanhamento dos pacientes diabéticos tipo 2, em farmácias comunitárias. Métodos: Ensaio clínico randomizado, uni-cego envolvendo 100 pacientes diabéticos tipo 2 de ambos os gêneros, usuários de farmácia comunitária, com idade igual ou superior a 30 anos, em uso de hipoglicemiantes orais com adição ou não de insulina e foram acompanhados por 6 meses. Os pacientes do grupo controle receberam o tratamento habitual existente em qualquer farmácia, e os de intervenção receberam o acompanhamento do farmacêutico incluindo intervenções aos problemas relacionados aos medicamentos. Os desfechos primários avaliados foram os valores da hemoglobina glicada (HbA1c), glicose basal e um questionário de qualidade de vida validado denominado de Diabetes Quality of Life Measure (DQOL) - Brasil; e como desfechos secundários as dosagens dos triglicérides, colesterol total, (HDL) colesterol, (LDL) colesterol, tensão arterial e a satisfação do usuário com o serviço prestado. Essa pesquisa contou com a colaboração de vários profissionais das diferentes áreas do conhecimento a seguir nominados: médico, farmacêutico bioquímico, enfermeiro, nutricionista e estatístico. Resultados: Finalizaram o estudo 89 pacientes. Durante o acompanhamento 95,7% (45/47) dos pacientes no grupo intervenção apresentaram problemas relacionados aos medicamentos (PRM), perfazendo um total de 141, com uma média de 3 eventos por paciente, ocorrendo uma resolutividade de 61,7% (87/141). A categoria que mais apresentou PRM foi a de efetividade com 34,1% (48/141) e a classe farmacológica mais utilizada foi a dos hipoglicemiantes orais com 35% (49/141). As variáveis de desfechos primários como hemoglobina glicada (HbA1c) e a glicose basal não apresentaram valores estatisticamente significantes quando comparadas o final com o inicial do acompanhamento nos grupos intervenção e controle considerando um p<0,05, mas o questionário de qualidade de vida DQOL Brasil apresentou resultados estatisticamente significante com um p=0,000. Os desfechos secundários, com exceção da satisfação do usuário, não apresentaram valores xi estatisticamente significantes quando comparados o final com o início do acompanhamento nos grupos de intervenção e controle. Conclusão: Os resultados indicam que as modificações das variáveis clínicas não apresentaram valores significativos no controle da enfermidade e comorbidades, enquanto que na avaliação da qualidade de vida os pacientes afirmaram que melhoraram; portanto, pode-se postular que a intervenção farmacêutica é uma atividade necessária, mas que a prática do Pharmaceutical Care trará benefícios com sustentabilidade para os pacientes se houver uma efetiva integração do farmacêutico numa equipe multiprofissional de saúde, o que está indisponível nas Farmácias Comunitárias

Da Barra do Rio aos parrachos: duas realidades sociorganizacionais no litoral Norteriograndense

Observing that social capital is considered crucial for the consolidation of an association, this paper analyzes how different groups associative absorb the concept of membership and how to manage routing in their actions to the social interest. The research aimed to evaluate two central forms of association, based on the concept of Pierre Bourdieu (1980) on social capital, stressing that its distribution and perception are uneven and depends on the ability of ownership of different social groups. Accordingly, took up two organizations community based one in - Barra do Rio and another in Maracajaú - whose main activity is the exploitation in the coastal tourist norteriograndense. Once processed the data, it became clear that, despite the purpose for the association has been motivated by exploration in both organizations, each differently appropriates its capital. While one maintains a feelings of togetherness, trust and satisfaction of group work, the other one, feelings are stifled by individualism, mistrust among their members that although they see the association as something important for the growth and strengthening of the group, working individually

O canto das senhoras :Análise do discurso do sujeito coletivo (DSC) de velhas mulheres da Ponta do Tubarão, no Rio Grande do Norte

The participation of women of more than 60 years of age in the social ritual of the creation of the Reserva de Desenvolvimento Sustentável Estadual ( Sustainable Development State Reserve ) at Ponta do Tubarão, in the state of Rio Grande do Norte, is the central object of this research. This work is an attempt to analyze the oral discourse of these women, to understand the historical participation in this ritual, pointing out the actions for dehistoricization that, in the Western world, take women out of the community scene making their roles less important or invisible as agents of social construction. The reflections that take place in this research, using as a starting point, the example of a traditional fishing community on the Brazilian coast, and denounce the mechanisms of male domination that try to silence their hábitus, such as: the discourse of power (that is responsible for the permanent division of sexual structures) and of the correspondent social and cultural division. The present research respects the oral discourse of the Elderly Women as a significant practice of community life in Diogo Lopes in Macau, Rio Grande do Norte. The creation of the community of RDSE in Ponta do Tubarão as an instrument for political and social management is also accepted here as a process conducted by various social actors that react to developmental threats that have interfered with and are still trying to interfere with the equilibrium of the regional ecosystem. The methodology used in the research is supported in the oral discourse of these women as social representations of a focus group, on which the method of the Análise do Discurso do Sujeito Coletivo (DSC) ( Collective Subject Discourse Analysis ) is applied

Maracatus Solar e Reis de Paus: tradição e modernidade no carnaval de rua em Fortaleza

This is an ethnographic and comparative study of the Maracatus Solar (2006) and Reis de Paus (1960), whose aim was to verify what is ancient and traditional in the new maracatu practiced by the guild Solar and conversely, what is new or modern in the old maracatu ritualized by guild Reis de Paus. It is worth noting that through this case study it is also intended to ethnographically observe and better understand the processes of ruptures and continuities between modernization and tradition, and the relationship between the global and the local. The communication system, the dancing, the music, the costumes and the loas (letters) were analyzed using the technique of participant observation as well as secondary materials such as newspapers, blogs and magazines. The interviews were open, non-directive, but recorded to facilitate understanding the speech of revelers. The research has shown that all the symbolic elements of aesthetic expression of the maracatu are permeated by clashes of historical contexts and of political representation, which, in another instance, also enunciates a fight of micro-community resistance regarding the renewal process and the social development that plague modern megalopolis. It is In this interim, between modernity and tradition that today it can be spoken about the existence of hybrid identity in the maracatu regarding a context mediated by the overall above mentioned values and customs specific of the new generations. However, one can not deny that the forms of negotiations with modernity also require the establishment of a link with the specific singularity of a popular culture that is not excluded, but also should not get invaded by the idea of authenticity. Therefore, performing this study was above all an opportunity to understand also the community life in the city outskirts, understanding society, culture and everyday social relations maintained between humans that produce and make it all happen. The Solar and Reis de Paus do not join in opposition between themselves nor by their similarity. What is most striking among them is the renewal of a tradition that reinvents itself in the form of popular representation across the street parade

Avaliação do programa saúde da família no Rio Grande do Norte

The Family Health Program implemented in Brazilian municipalities from 1994 represents today the most promising proposal to promote important changes in municipality`s health systems, to allow universal access to health care, comprehensiveness, equity and to promote social control, achievements provided by the health reform process and incorporated to the Unified Health System principles. However, many are the challenges imposed to the Family Health Program so that it can cause these advances. In this study, we aimed to answer the following research question: what are the results of the Family Health Program in relation to beneficiaries at small, medium and large municipalities? The hypothesis that guided this work was that the variation in levels of achievement/results (strict, impacts and effects) of the Family Health Program is related to the size of the municipalities. Therefore, our general aim was to evaluate the results of the Family Health Program in municipalities at Rio Grande do Norte, Brazil. And as specific objectives, to measure strict results, effects and impacts of the Program, from the criteria of efficiency and effectiveness on the beneficiated population, and to measure the Program`s impact on the organization of municipality`s health system. This is an impact assessment research, developed from multiple case studies with quanti-qualitative approach. The study included small municipalities (Acari and Taipu), midsize (Canguaretama and Santa Cruz) and large (Natal and Mossoró). The individuals chosen to the research were users/beneficiaries of the Program and health professionals. Data analysis was performed using descriptive statistics and content analysis compared from the Program`s logical /theoretical model. The results obtained in relation to the principles evaluated (universality, comprehensiveness and community participation) presented that municipalities show different results, although not directly related to the size, but related with characteristics of the Program`s implementation form in each municipality and the arrangements made for its operationalization. The positive effect that generated significant change in people`s lives has been linked to the increase of access and to the decrease of geographic barriers. However, to the municipal health system, regarding the changes desired by the Program, it was not observed a positive impact, but a negative impact related to the increase of barriers for the user to access other levels of the health system

Trajetória dos assentamentos rurais financiados pelo crédito fundiário no estado do Rio Grande do Norte: uma análise da experiência do assentamento da fazenda Paz no município de Maxaranguape/RN

The market-assisted land reform (RAAM) has been constituted as an alternative of agrarian reform funded by the Programa Nacional do Crédito Fundiário (PNCF). It is a policy of acquisition, distribution and use of Earth ideologically disseminated and funded by the World Bank in the context of productive insertion of landless workers. Accordingly, this study seeks to analyze the trajectory of rural settlements financed by this policy, seeking to understand what factors promote or limit the process of rural development of those settlements. To do so, take as a reference case study of the Assentamento da Fazenda Paz, in the municipality of Maxaranguape in the State of Rio Grande do Norte. From the methodological point of view, bibliographical and documentary research were used, in addition to visits to the settlement and semi-structured interviews with the settlers, trade union leaders, consultants and technicians linked to the project. Assuming the reports of respondents, initially constructs the hypothesis that informal and formal institutions present in the Assentamento da Fazenda Paz were unable to effectively coordinate the actions of the agents. The results obtained showed the existence of a very complex undertaking, with a total area of 607 hectares and 80 families settled, endowed with good quality water and irrigation infrastructure, with assets of approximately R$ 5 million reais. Experience experienced by the settlers understood the development of complex systems of production and marketing of fruits and vegetables, with an emphasis on the cultivation of papaya in an area of 45 hectares based on modern irrigation system and extensive use of technology. Collective management of production, marketing, revenue and costs stood out as a major challenge for the settlers and their representative organisations, i.e. the Community Association and the cooperative. From this observation it was possible to identify two moments on the trajectory of the project: the first, between 2007-2011, considered by respondents as successful, in which the integration of public policies and abundant input of revenue from the commercialization of the fruits da Paz, mainly through the sale of papaya and pineapple in national and international markets, allowed an average remuneration of R$ 800.00 reais to R$ 1,000 reais seated/monthIn addition to the production of vegetables and other types of products for sale and consumption; the second, from 2012, characterized as a failure, due to the discontinuity of the cultivation, production and marketing of fruits based on the collective bargaining model deployed. Important factors explain the discontinuity of the project, including the model of agriculture implemented, difficulties related to the management of production, marketing and finance the venture, in addition to the breach of trust between the Board of the cooperative and the associates and the distancing of the governmental organizations more directly responsible for the project. It is therefore concluded that we must to rethink rural development as a multidimensional phenomenon, requiring a broad engagement between State and society under the foundations of a territorial development contract

Programa alfabetização solidária: um estudo sobre a experiência no município de Lagoa de Pedras/RN (1997 - 2003)

The educational reform of the 90 s was tainted by the objectives of the fiscal adjustments, resulting in the redefinition of the state s role in the financing and offering of teaching services, and bringing about a shuffling of the responsibility between the public and private sectors to promote education to young people and adults. The 90 s also highlighted the proliferation of providers and the multiplication of Educational Programs for Youths and Adults (EJA), implemented through partnerships between governmental and nongovernmental agencies. During this period of time, the agenda of educational responsibilities concerning analphabetism was organized in a process of decentralized of the state, with the following political, social, and economic objectives: to reduce the public deficit, increasing public savings and the financial capacity of the state to concentrate resources in areas considered indispensable to direct intervention; to increase the efficiency of the social services moffered or funded by the state, giving citizens more at a lower cost, and spreading services to more remote areas, expanding access to reach those most in need; to increase the participation of citizens in public management, stimulating communitarian acts as well as developing efforts towards the effective coordination of public figures in the implementation of associated social services. Thus, Assistance Programs co-financed by the government try to deal with the problem of analphabetism. Within the sphere of the 90 s educational policy decentralization, we come to see how the agenda dedicated to the reduction of analphabetism was formed by the Solidarity Alphabetization Program (PAS). Between 1997 and 2003, the latter agenda s decentralizing proposal was integrated in the management partnership for the operationalization of tasks and resources faced with the execution of the formal objectives. In this study, we identify the dimensions of the implantation and progress of the tasks carried out by PAS, in the municipality of Lagoa de Pedras/RN. However, we consider these Programs to assist in the process without guaranteeing the reduction of the causes or substituting the responsibility of the system once the monetary resources for program maintenance provided by the partners is exhausted