Características dos programas de residência médica em cardiologia do estado do Rio Grande do Norte

The present study had as goal to evaluate Rio Grande do Norte state’s medical residency programs (MRP) in Cardiology. It’s a descriptive study, including a documental analysis of the program’s accreditation processes (PAP) of cardiology’s medical residency in Rio Grande do Norte state in 2014 and the analysis of the resident’s perception about his professional education as a specialist in Cardiology. Beside the documental analysis of the PAPs, it was applied a semi-structured questionnaire with closed questions Likert style and open questions to all the current and former residents of the MRPs analyzed. Two MRPs in Cardiology were identified in Rio Grande do Norte state, one hosted in a public institution and the other in a private institution. The documental analysis showed a greater amount of preceptors with a good level of ownership on the public institution in comparison with the private one, as well as a bigger number of publications, participation in congresses and in book’s publications. The private institution presents a better Urgency’s infrastructure, with emergency room and cardiologic ICU. It IS clear that the residents are aware of how a good residency must work, as well as the strengths and fragilities of their own residences. Most of Onofre Lopes Universitary Hospital’s residents point out as a strength the organization, participation and quality of the preceptors, practice activities and scientific debates, great amount of patients and the visits and debates with the preceptors on the sickrooms. As the greatest fragilities, they emphasize the lack of a urgency service of their own and a specialized ICU. In Coração Hospital of Natal (HCor), it is listed as weak points the theoretic scheduling and the few ambulatory practices. As positive aspects, they report the preceptors, the agility on the execution of exams, a good number of serious patients and procedures. In both residences, it is seen a certain difficulty in accepting the important and mandatory items imposed by the rules of the Medical Residences’ National Committee, such as: biostatistics, bioethics, medical ethic, epidemiology and research methodology. Besides that, the residents recognize that both hospitals have a good infrastructure and technological support, especially in imaging methods. The evaluation of PRMCs identifies the strengths of each program and the aspects to be improved in both programs. It also allowed the observation of difficulties in accepting some regulations contained in the CNRM resolution by the resident, such as participation in activities such as biostatistics, epidemiology and research methodology as well as the improvement needs of specific technical training, such as in emergency care. Thus, our results make possible to develop strategies for continued improvement of PRMC in RN state. In addition, it enabled the preparation of the resident’s manual in cardiology, containing even a breakdown of resident evaluation system, which could serve as a model for other residency programs.

Análise da atuação do Ministério Público Estadual na assistência materno infantil do Rio Grande do Norte

Maternal and infant mortality have become a serious public health problem in Brazil, especially in northeasternand northern regions.In RioGrande do Norte, the high rates ofdeathsofmothersandbabies haveconcerned not onlythehealthauthorities andjusticeagenciessuch as the prosecution service. In 2011, State Public Ministry (MPE) has developed a proposition which was called “Nascer com Dignidade”, focused on the monitoring ofcare givenin prenatal, childbirth andpost childbirthin the cities. The aim of thisstudy was toinvestigate how the intervention of MPE works in maternal and child care. The method adopted to survey data was the case study by analyzing the skills of the reports which were carried out in four of the eight Public Health Regional Units (URSAP).A total of 26municipalities were chosenand the results showfragilityparticularly inprenatal care which can result in complicationsin childbirthand postpartumlike:incomplete health family teams(in05cities), lack of access orinaccessibility to laboratory tests(16 cities) and lack of the pregnant woman'sattachment to thebirthing place(in26 cities). Based on this reality, MPE has adopted relevant attitudes as filing public civil suits, compliance of Conduct Adjustment Declaration in the municipal management and performing interventions in heath care centers and maternity clinics of the state. Thereforeit is known thatPublic Ministryis of paramount importanceto indicatethe necessaryadjustmentsto addressinfant and maternalmortalityin the state (mean of 65/100,000 and16/100,000respectively) and give the city hall the responsibility for the health care quality provided to their citizens. These factors demand theprinciples ofuniversality and integrality to be performed in order to reduce social inequities.

Avaliação do ensino da obstretícia e da assistência ao parto sob a percepção dos graduandos em medicina e enfermagem na Universidade Federal do Rio Grande do Norte

OBJETIVE: To evaluate the perception of Medical and Nursing students of Medicine and Nursing graduation courses at the Federal University of Rio Grande do Norte (UFRN), on obstetrics teaching and labor assistance in the context of the maternal care provided by the Maternity Hospital Januário Cicco (MEJC) and contribute to curricular updating planning of teaching obstetrics, in accordance with the principles of humanization. METHODS: It was conducted a study of cross-cutting approach and qualitative and quantitative descriptive method, with students in medicine and nursing of UFRN, who were attending or had been attended the midwifery disciplines medicine; and women's health in nursing. The data were collected through a questionnaire with objective and subjective questions, and stored in a database, spreadsheet software Excel / Office 2010 with all the variables. RESULTS: We interviewed 169 students, 118 of medical school and 51 from the nursing program, of which 46.75% were male and 53.25% female. The largest number of medical respondents is the 11th period (40.67%), and nursing, on 10, (43.15%). These students witnessed 1,073 births, and (61.8%) vaginal deliveries. The obstetricians were the most performed vaginal deliveries (40%). Nurses performed only (8.13%). The assistance provided to women during the process of labor and delivery, was configured as suitable for 87.58% of respondents and these glimpsed humane conduct. Students who performed deliveries, 76.27% were medical and 11.76% were nursing. All had guidance while doing them. A total of 19.50% medical students reported that there is a prejudice against vaginal delivery, particularly for the humanized birth, unlike all nursing students (100%) who reported that there is this prejudice. Most students (73%) showed preference for vaginal delivery, especially nursing students. On the knowledge of myths in relation to vaginal delivery, 60.35% answered that they know some. CONCLUSION: This study presents itself as a highly relevant, since the results may contribute to curricular changing and updating related to obstetrics teaching, but also serve as a resource for analysis of humanization practices that should be developed in educational institutions and which are recommended by the Ministry of Health.

Atuação de psicólogos em Centros de Referência de Assistência Social na região amazônica do Marajó

This study investigated the role of psychologists in Social Assistance Reference Centres in the Amazon region of Marajó, considering its specificities: extensive territory, spread population and presence of native communities. Eleven interviews were conducted in 10 out of the total 16 cities. There’s a context of fragile economies and poor housing; incomplete or disarticulated public services; bad working conditions. The activities are ad hoc or asystematic. Promising experiences bet on decentralized and intersectoral services. Experiences from other groups point to the importance of long-term work. We conclude that a powerful way of action is to strengthen the sociability that is characteristic of the native peoples, valuing their knowledge and developing their social protagonism.

Assistência em cuidados paliativos a pessoa idosa na atenção primária a saúde

This study aims to understand the significance of palliative care for the elder health care professionals working in primary health care. Descriptive study of qualitative approach. Conducted in three health units of the Family and a core of support for Health, the Felipe Camarão neighborhood, District of Natal Health West, RN. Of the 25 participants, 19 are professionals of the Family Health Strategy and six of the Center for Support to Health, the majority being women, with minimal professional work experience, a year in primary health care. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte, under CAAE no. 43895815.4.0000.5537. There were individual interviews between July and September 2015, with the use of questionnaire containing open and closed questions on the topic of study. Our results were recorded in MP4 and transcribed into written language, and analyzed using the open coding process medium in which the categories were interpreted and identified, followed by axial coding, where categories were developed and systematically related. Three categories emerged: enhancement of elder health professionals in palliative care, behavioral health professionals across care in palliative care in primary care and disjointed Meaning between palliative care and health professionals. The categories were interpreted and analyzed by the theoretical framework of social phenomenology of Alfred Schütz. Regarding the valuation of subjective perception of professionals, it is clear the issue of the complexity of multiple relationships through various aspects of his central task: focus a philosophy of the world's reality, namely a phenomenology of natural attitude; Before the professional behavior were identified: the discovery and depth of assumptions through the structure, and meaning in a common sense, and at the meaning of the disconnection between the health professionals-including that reality imminent can be represented by individuality special interest of the experience. It follows that health professionals understand there is a difficulty facing the assistance in palliative care to the elderly in primary care, and this difficulty, characterized by the complexity of social interactions across the joint teamwork. Although, I believe that the articulation between the teams, work and family, is essential for the subsequent improvement of care in palliative care favoring the health context surrounding the Elder.

Assistência em cuidados paliativos a pessoa idosa na atenção primária a saúde

This study aims to understand the significance of palliative care for the elder health care professionals working in primary health care. Descriptive study of qualitative approach. Conducted in three health units of the Family and a core of support for Health, the Felipe Camarão neighborhood, District of Natal Health West, RN. Of the 25 participants, 19 are professionals of the Family Health Strategy and six of the Center for Support to Health, the majority being women, with minimal professional work experience, a year in primary health care. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte, under CAAE no. 43895815.4.0000.5537. There were individual interviews between July and September 2015, with the use of questionnaire containing open and closed questions on the topic of study. Our results were recorded in MP4 and transcribed into written language, and analyzed using the open coding process medium in which the categories were interpreted and identified, followed by axial coding, where categories were developed and systematically related. Three categories emerged: enhancement of elder health professionals in palliative care, behavioral health professionals across care in palliative care in primary care and disjointed Meaning between palliative care and health professionals. The categories were interpreted and analyzed by the theoretical framework of social phenomenology of Alfred Schütz. Regarding the valuation of subjective perception of professionals, it is clear the issue of the complexity of multiple relationships through various aspects of his central task: focus a philosophy of the world's reality, namely a phenomenology of natural attitude; Before the professional behavior were identified: the discovery and depth of assumptions through the structure, and meaning in a common sense, and at the meaning of the disconnection between the health professionals-including that reality imminent can be represented by individuality special interest of the experience. It follows that health professionals understand there is a difficulty facing the assistance in palliative care to the elderly in primary care, and this difficulty, characterized by the complexity of social interactions across the joint teamwork. Although, I believe that the articulation between the teams, work and family, is essential for the subsequent improvement of care in palliative care favoring the health context surrounding the Elder.

Protocolo para assistência do enfermeiro ao paciente séptico em terapia intensiva: construção e validação de conteúdo

Tratar-se-á de um estudo metodológico, com abordagem quantitativa; baseado no referencial metodológico da técnica Delphi, com objetivo de construir e validar um protocolo clínico para assistência do enfermeiro ao paciente séptico na Unidade de Terapia Intensiva. A proposta metodológica seguiu duas etapas: elaboração do instrumento por meio da revisão integrativa da literatura e validação de conteúdo do protocolo. O estudo foi aprovado pelo Comitê de Ética em Pesquisa, mediante o Parecer CAAE 41873314.5.0000.5537. O universo amostral foi composto por profissionais enfermeiros, considerados peritos, doutores ou mestres na área da saúde, com experiência em alta complexidade e/ ou estudos de validação de instrumento/protocolo, selecionados por meio da Plataforma Lattes. Referente à primeira etapa elaborou-se um instrumento composto pela caracterização profissional dos peritos; e baseado em evidência científica e nas diretrizes do Surviving Sepsis Campaign, contemplando três tópicos assistenciais ao paciente com sepse, a saber: Triagem para Sepse- Reconhecimento das Manifestações Clínicas; Pacote de Ressuscitação Inicial (Controle das Primeiras 6 Horas); Tratamento de Suporte. A segunda etapa caracterizou-se na validação de conteúdo do instrumento para elaboração final do protocolo, utilizando à técnica Delphi, em duas fases. No que concernem as variáveis referentes ao estudo, na 1ª fase de Delphi, 34 peritos avaliaram o instrumento composto por 18 itens, no período de maio a julho de 2015, e os dados foram analisados pela estatística descritiva (frequência, média, mediana e desvio padrão) e pelo Índice de Validade de Conteúdo (IVC), demonstrando um IVC extremamente satisfatório para 15 itens, com total de 0,79, obtendo assim, a reformulação e refinamento do conteúdo do instrumento. Na segunda fase de Delphi, entre julho e agosto de 2015, participaram 26 peritos, e utilizou-se o percentual de concordância acima de 75% para as variáveis consideradas pertinentes ao protocolo de cuidados ao paciente séptico em UTI, obtendo nesta fase, o percentual de concordância de 95%. O protocolo foi concluído com 15 itens, sendo respaldado e modificado, baseado em evidência científica, nas diretrizes internacionais e nas sugestões dos peritos. A utilização do protocolo proposto poderá contribuir para a prática clínica do enfermeiro ao paciente séptico na Unidade de Terapia Intensiva.

Protocolo para assistência do enfermeiro ao paciente séptico em terapia intensiva: construção e validação de conteúdo

Tratar-se-á de um estudo metodológico, com abordagem quantitativa; baseado no referencial metodológico da técnica Delphi, com objetivo de construir e validar um protocolo clínico para assistência do enfermeiro ao paciente séptico na Unidade de Terapia Intensiva. A proposta metodológica seguiu duas etapas: elaboração do instrumento por meio da revisão integrativa da literatura e validação de conteúdo do protocolo. O estudo foi aprovado pelo Comitê de Ética em Pesquisa, mediante o Parecer CAAE 41873314.5.0000.5537. O universo amostral foi composto por profissionais enfermeiros, considerados peritos, doutores ou mestres na área da saúde, com experiência em alta complexidade e/ ou estudos de validação de instrumento/protocolo, selecionados por meio da Plataforma Lattes. Referente à primeira etapa elaborou-se um instrumento composto pela caracterização profissional dos peritos; e baseado em evidência científica e nas diretrizes do Surviving Sepsis Campaign, contemplando três tópicos assistenciais ao paciente com sepse, a saber: Triagem para Sepse- Reconhecimento das Manifestações Clínicas; Pacote de Ressuscitação Inicial (Controle das Primeiras 6 Horas); Tratamento de Suporte. A segunda etapa caracterizou-se na validação de conteúdo do instrumento para elaboração final do protocolo, utilizando à técnica Delphi, em duas fases. No que concernem as variáveis referentes ao estudo, na 1ª fase de Delphi, 34 peritos avaliaram o instrumento composto por 18 itens, no período de maio a julho de 2015, e os dados foram analisados pela estatística descritiva (frequência, média, mediana e desvio padrão) e pelo Índice de Validade de Conteúdo (IVC), demonstrando um IVC extremamente satisfatório para 15 itens, com total de 0,79, obtendo assim, a reformulação e refinamento do conteúdo do instrumento. Na segunda fase de Delphi, entre julho e agosto de 2015, participaram 26 peritos, e utilizou-se o percentual de concordância acima de 75% para as variáveis consideradas pertinentes ao protocolo de cuidados ao paciente séptico em UTI, obtendo nesta fase, o percentual de concordância de 95%. O protocolo foi concluído com 15 itens, sendo respaldado e modificado, baseado em evidência científica, nas diretrizes internacionais e nas sugestões dos peritos. A utilização do protocolo proposto poderá contribuir para a prática clínica do enfermeiro ao paciente séptico na Unidade de Terapia Intensiva.

Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.

Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.

A desigualdade espacial do Baixo Peso ao Nascer no Brasil

Low birth weight (LBW) is a risk factor for neonatal and infant morbidity and mortality. In Brazil the highest percentages of low birth weight occur in regions of higher socio-economic status. The scope of this article is to ascertain the spatial distribution of low birth weight rates and the correlation with social and service indicators. The scale is ecological taking all the Brazilian states as units of analysis. The spatial analysis technique is the methodology used together with data from SINASC, IPEA and IBGE for 2009. Higher rates of low birth weight are found in the south/southeastern states (Global Moran: 0.267, p = 0.02). Clusters of the high-high type in the Southeast and of the low-low variety in states in the Amazon region are detected. The spatial inequality of low birth weight reflects the socio-economic conditions of the states. More developed regions have higher rates of low birth weight, therefore, the presence of the service and its use decrease infant mortality and increase LBW.

Impacto do Programa Saúde da Família sobre indicadores de saúde da criança em municípios de grande porte da região Nordeste do Brasil

The present study carried out in the context of the Baseline Studies of the PROESF was aimed at evaluating the impact of the Family Health Program (PSF) on indicators for child health in cities with more than 100,000 inhabitants in the Brazilian Northeast. Four cities were investigated. In each one, twenty censual sectors were selected randomly from areas covered by the PSF and compared with twenty sectors selected from areas not covered by the PSF on the basis of socioeconomic criteria. In most cases, no significant differences were found between the areas covered and not covered by the PSF. The only difference found was a significantly lower rate of hospital admissions due to diarrhea but this was on account of the Program of Community Health Agents. The PSF exerted no additional effect on the reduction of this indicator. It was also observed that the way by which the program is implemented in each city interferes directly in the results. Thus, there is no basis for considering the PSF per se ineffective or not differing from other programs with regard to its health care patterns. An evaluation of the PSF would necessarily have to include an analysis of the way the program is implemented and conducted in each case, besides considering its general socioeconomical and political characteristics.

Assistência social ao idoso no município de Natal na proteção social básica: identificando demandas e desafios

Over the past decades, starting mainly in the 1960s, the number of elderly has grown in the country and an aging population is considered a remarkable global phenomenon. Given the speed of this process, this growth has produced different implications for the structure of the social, economic and cultural societies and, as such, constitutes new challenges for public policy, and particularly for the Brazilian social assistance policy. Considering the significant increase aging population in Natal and the challenges of social welfare policy, this research aims to identify and analyze the demands and challenges of Social Assistance Policy in the city of Natal / RN, in particular the access of the elderly to social protection basic in the Reference Centers of Social Assistance. This research uses a critical dialectical method, and the methodological procedures that guided the study: the bibliographical research, documentary and field as well as systematic observation. Some initial questions were important to guide this work: What are the demands that come to CRAS the elderly population? What are the answers to these demands by the Basic Social Protection? How this CRAS has implemented social protection responses to these demands as rights guarantee the elderly population? The services offered by CRAS meets user needs? To get the results of this research, bibliographic sources were used, documentary and observation for four (4) CRAS of different district areas of the city of Natal. The results of this research show that basic social protection is quite fragile, leaving part of the population at risk and social vulnerability still without attention due to several factors, including the reduced technical team and the impossibility of service to all neighborhoods referenced by CRAS in the respective zones, and 50% of elderly assisted arising from spontaneous demands.

Assistência social ao idoso no município de Natal na proteção social básica: identificando demandas e desafios

Over the past decades, starting mainly in the 1960s, the number of elderly has grown in the country and an aging population is considered a remarkable global phenomenon. Given the speed of this process, this growth has produced different implications for the structure of the social, economic and cultural societies and, as such, constitutes new challenges for public policy, and particularly for the Brazilian social assistance policy. Considering the significant increase aging population in Natal and the challenges of social welfare policy, this research aims to identify and analyze the demands and challenges of Social Assistance Policy in the city of Natal / RN, in particular the access of the elderly to social protection basic in the Reference Centers of Social Assistance. This research uses a critical dialectical method, and the methodological procedures that guided the study: the bibliographical research, documentary and field as well as systematic observation. Some initial questions were important to guide this work: What are the demands that come to CRAS the elderly population? What are the answers to these demands by the Basic Social Protection? How this CRAS has implemented social protection responses to these demands as rights guarantee the elderly population? The services offered by CRAS meets user needs? To get the results of this research, bibliographic sources were used, documentary and observation for four (4) CRAS of different district areas of the city of Natal. The results of this research show that basic social protection is quite fragile, leaving part of the population at risk and social vulnerability still without attention due to several factors, including the reduced technical team and the impossibility of service to all neighborhoods referenced by CRAS in the respective zones, and 50% of elderly assisted arising from spontaneous demands.

O direito penal do inimigo na atualidade: Mutual Legal Assistance Treaty – MLAT, em matéria penal, celebrado entre a República Federativa do Brasil e os Estados Unidos da América bem como seus reflexos na jurisdição brasileira

In view of the climate of instability and deep social inequalities, it has been evident in the Brazilian reality, a new way to punish systematic already developed and consolidated in other countries, in which, among other things, the criminality is anticipated only by danger that the individual sports. It appears, therefore, that the theory developed by Günter Jakobs, nominated Criminal Law of the Enemy, became subtly inserted in the Brazilian reality as well as in international relations signed. In this sense, the Brazilian State, in order to carry out the international legal cooperation in the criminal field, signed a mutual assistance agreement with the government of the United States of America. Forward the conclusion of Mutual legal Assistance Treaty (MLAT), the signatory countries voiced a desire to cooperate in order to facilitate the implementation of tasks of the authorities responsible for law enforcement in both countries, comprising research, investigation, prosecution and prevention of crime, said internalized adjustment in the Brazilian legal system by means of Decree No. 3810 of 02 May 2001. Alongside these considerations, the present study aims to analyze the Criminal law of the Enemy today, seeking to find evidence of that theory in the MLAT, international legal cooperation instrument signed between the government of the Federative Republic of Brazil and the government of the United States of America. Moreover, it has the objective to describe its effects on the Brazilian jurisdiction, especially as concerns the relativity and the suppression of human rights. Once done the introit, analysis will be carried out in the first chapter, on the definition and main features of the theory of Criminal Enemy of the law, it is imperative to approach the humanistic aspect that preceded the theory as well as the dealings given to some controversial issues surrounding it, such as the anticipation of the enemy's punishment and the disproportionality of the penalties imposed. In the second chapter will present the conceptual assumptions, historical evolution and the positives aspects, as well as the barriers and the pursuit of effectiveness of international legal cooperation. In the chapter, bedroom effective analysis of specific modality of cooperation will be held, the Mutual legal Assistance Treaty - MLAT in criminal matters, signed between the Federative Republic of Brazil and the United States of America, in which the general aspects will be addressed and the MLAT reflections on the Brazilian jurisdiction, which includes analysis about the relativity or suppression of human rights, future trends and creating stricter laws, followed by the presentation of the seized conclusion on the subject, in which, among other approaches, will be voiced understanding about the unconstitutionality certain service requests that, from these, there is the bad use of the agreed instrument.