Validação de protocolo de assistência para pessoas com úlcera venosa na atenção primária

People with venous ulcers constitute as an important public health problem, its treatment is onerous and require assistance provided by trained professionals, systematized through protocols, however what lies in the assistance is that the management of this group of people differs from that preconized in the scientific literature, interfering with wound healing and quality of life of affected. In this sense, the construction of a assistance protocol specific to people with venous ulcers (VU) can help professionals of the Family Health Strategy both in patient assessment as and in establishment of quality assistance. Thus, this study aimed to analyse the validity of a multiprofessional assistance protocol for people with venous ulcers in primary care by health professionals using Delphi technique. This is a quantitative study, the methodological type conducted in two steps: first step related to integrative literature review to subsidize the development of the protocol, then these aspects were organized and proposed to the judges of the study through the Delphi technique. The study was initiated after approval by the Research Ethics Committee. The first step was performed between August and September 2012, in the virtual library of health, in the page of the Coordination of Improvement of Higher Education Personnel, of Municipal Health Secretariat and international guidelines of associations and in the subsequent step carried out between September 2012 to January 2013, was performed search by Lattes platform of the National Council of Technological and Scientific Development, in order to identify health professionals in Brazil who act as judges of the instrument and then, via online, the form was submitted to them.The sample for the second step was 51 judges in the first round and 35 for the second round Delphi. The analysis was done by adopting Kappa index ≥ 0.81 and Content Validity Index (CVI)> 0.80. In the first submission for the judges, items that did not reach Kappa and CVI established were: request / realization / test results, demographic data, medical history, risk factors, verification of pain / vital signs / pulse / infection signs / lesion location/ edema and pain treatment. After removal of items which have not obtained Kappa or CVI index established, it was found achieving optimal levels of these index for the categories. In the next step was the ressubmissão of protocol to judges through the Delphi technique in it was found that, of the 15 categories of the protocol, 12 presented higher scores in Delphi 2 phase and the other three categories remained the same Kappa and IVC of the previous phase. As for the average of evaluation requirements of the protocol was found that the scores assigned by the judges were higher in the second phase in nine of the 10 items, remaining the same in only one of the items indicating validity of the instrument before the consensus of the judges. Thus, we accepted the alternative hypothesis in this study, as they were obtained in the second Delphi phase the validity index greater than or equal to the Delphi 1 phase. The formulation of this assistance protocol valid and reproducible will enable a reorganization and redesign of assistance, with standardization of actions and continuity of care for persons with venous ulcers in primary health care

Atenção à saúde mental na Estratégia Saúde da Família no Município de Parnamirim/RN: opinião dos profissionais, dos portadores de transtornos mentais e seus acompanhantes

This study aims to analyze and compare the opinion of professionals, managers and users about the mental health care in the Family Health Strategy (FHS). It is characterized as an Operations Research or Health System Research with a cross-sectional design and a descriptive quantitative nature. The study was developed from the application of the Opinion Measurement Scale allied to techniques of observation and structured interview in the city of Parnamirim / RN. The sample consists of 409 subjects, 209 professionals of the Family Health Strategy, 30 of the Oral Health Strategy, 19 of the Family Health Support Center, 24 directors of Basic Health Units, plus 68 users with mental disorders and 59 caregivers, respecting the ethical parameters of Resolution 196/96 of the National Health Council, trial registration number: CAAE 0003.0.051.000-11. Quantitative data were submitted to the Epi-info 3.5.2 for analysis. The network of mental health in Parnamirim involves the flow between the FHS, Psychosocial Care Centers, clinics and hospitals, having as main barriers the fragility of the referral and counter-referral system, of the municipal health conferences, of the FHS teams by the limitations in material and human resources as well as the population´s lack of acknowledge about the organization of the mental health network, issues that affect the integral attention. Even though the FHS professionals recognize the importance of their actions, they question their role in mental health care, experiencing difficulties in accessing psychiatric services (76.5%). Although most agree that the mentally ill is best treated in the family than in hospital (65.2%), the community health workers were the predominant category in the partial or total disagreement of this statement (40.8%), who is the professional in greater contact with the family. Nevertheless the caregivers miss the support of the FHS as the main focus of attention is on revenue control. The views of professionals, mental patients and caregivers converged in several statements, showing the main weaknesses to be focused by the mental health network of the city, as the perceptions that: (a) physical strength is needed to take care of mental patients for its tendency to aggression, requiring it to stay in the sanatorium for representing danger to society, (b) only a psychiatrist can help the person with emotional problems, (c) the user of alcohol and drugs does not necessarily develop mental illness, (d) the access barriers and doubts about the quality of psychiatric services, (e) caring of a mental health patient does not bring suffering to professionals. Therefore, the commitment to consensus building, monitoring and evaluation of the network are important mechanisms for an effective management system, reflecting in the importance of strengthening the health conferences and approximating different institutions. The results reinforce the importance of strengthening primary care through programs of continuing education focusing on the actions and functions of professionals in accordance with its competences and duties what contribute to the organization and response of mental health care, favoring user´s care and the promotion of family health

A intenção e o gesto :ações gerenciais de enfermeiros em espaços hospitalares

The present study analyses the supervisory practice of the nurse in the hospital environment. It has, as its main objective identify the use of planning, supervision and evaluation, as managerial instruments in the daily nursing practice. It tries also to identify the importance given to these instruments in their supervisory actions and the difficulties encountered in their use. It deals with an exploratory and analytical investigation with a qualitative approach having as its main point of analysis the principles of strategic planning. In order for it to be done 10 nurses were interviewed, distributed in three public hospitals in the city of Natal/RN. The results show that, although the nurses recognize the importance of the managerial instruments, they do not put them into practice in an effective and systematic way. They justify it because of the existence of personal, professional and institutional difficulties. On the other hand we could conclude from what they say that there is the desire to overcome the eminently burocratic vision of the management. Thus, they express a feeling for change and point in the direction of looking for ways that will contribute to innovate this practice

Vivência do enfermeiro no cuidado humano na Unidade de Terapia Intensiva adulto

The purpose of the study was to understand the nurse s experience with human care in the Adult Intensive Care Unit (ICU). The objective was to describe the nurse s experience in caring for patients in the ICU and to analyze the nurse s perception of the care provided. The study is a descriptive inquiry of qualitative nature with a phenomenological approach. We interviewed eight nurses, 26 and 43 years of age, that provide care in the ICU of a private hospital in Natal/RN, during the manths of July and August of 2006. We analyzed the data acording to the method of Colaizzi. Four categories emerged from the data: The search for the maintenance of life, The technicalbureaucratic activities, The recognition of the patient s individuality, and the expression of the nurse s feelings.The analysis allowed us to describe the lived experience of the nurse s care the ICU and to comprehend the structural elements of this experience. The results showed that the nurse s experience presents itself as a process of the several actions and feelings that occur while the social relations between the patient and the nurse develop. Finally, we understand that although the study shows an experience based on a biological model of health, these nurses possess an initial idea on how to reach humanized care in its essence, needing, however, of an institutional policy that favors this practice, an educational formation that prepares her to recognize her field of work as a place of continuous learning and an understanding of the health model as an ally in the search of humanized care

Proposta de localização de uma unidade de tratamento de óleo e gordura residual de fritura na cidade do Natal/RN para produção de biodiesel

This work addresses biodiesel by transesterification from the use of waste frying oil as a possible technological alternative for both reducing greenhouse gas emissions and by presenting themselves as an environmental call to designate a rational use of oil when no longer played in the environment to become renewable energy. It has proposed location of a residual oil and fat treatment plant to produce biodiesel, using models of Location and Routing for the improvement of routes. To achieve the goal, questionnaires were administered in establishments that use oil or vegetable fat in their productive activities in order to quantify the residue, to analyze actions and environmental perception of people who work directly with the residue on the destination you are being given to oil and fat used. It has indicated using of two single setup location, the method of Center of Gravity and the model of Ardalan, a geographical point that minimizes the costs of transporting waste to the treatment plant. Actions have been proposed for the improvement of collection routes this residue using the Routing Method of Scanning, as an illustration. The results demonstrated the lack of knowledge of the people who deal directly with large amounts of waste, on the environmental impacts caused by their incorrect disposal. The models used were uniform since point out to neighborhoods in similar regions. The neighborhoods of Lagoa Nova / Morro Branco (Ardalan) and Nova Descoberta (Center of Gravity) as ideal for the installation of treatment plant. However, it is suggested to be tested other models that take into account new variables than those used (supply of waste and the distance between points). The routing through the method of scanning has shown that it is possible, in a simple way to optimize routes in order to reduce distances and therefore the logistics costs in the collection of such waste. Introducing a route as a test to gather the twenty largest oil suppliers used in sample frying, using as a main factor time 8 hour of working shift every day

Abordagem da ergonomia para análise da acessibilidade a hóspedes com deficiência visual em hotéis: soluções de inclusão de pessoas cegas e com baixa visão

This study evaluates the level of accessibility for people with visual impairment (blindness and low vision) hotels in the city of Natal-RN, Brazil, and provides principles, guidelines and means of projective make hotels accessible, to promote comfort, autonomy and security of these people. We used a qualitative research methodology and quantitative trait descriptive, analytical and interpretive. Was taken as a base for field studies Ergonomic Analysis of Work, beginning with a study of the demands of accessibility of hotels and analyzing the modeling activity in these establishments through the application of interactional and observational techniques, such as film, photographic records, conversational actions and observation protocols. A protocol was developed and applied to evaluate the compliance of accessibility of hotels in the face of Brazilian technical standard NBR 9050 (2004). We used methods of Cognitive Task Analysis (CTA) associated with simulated activities to identify the processes of decision making and analyzing the observables of the activities performed by people with visual impairment (POS). Interviews were conducted with people who are blind and low vision in various cities in order to meet accessibility difficulties they faced in hotels and recommendations for improvement that they indicate. The mapping results showed that of 16 hotels 4 and 5 star studied in Natal-RN, reached only 7% of the 50 items of the protocol, while none of them reached 70% of the items. About the results obtained in simulated activities and analyzed from the ATC, we saw that the hotel where it was performed this step shows a need to adequately address the guests with visual impairments

Aprendizado por Reforço com Valores deInfluência em Sistemas Multi-Agente

We propose a new paradigm for collective learning in multi-agent systems (MAS) as a solution to the problem in which several agents acting over the same environment must learn how to perform tasks, simultaneously, based on feedbacks given by each one of the other agents. We introduce the proposed paradigm in the form of a reinforcement learning algorithm, nominating it as reinforcement learning with influence values. While learning by rewards, each agent evaluates the relation between the current state and/or action executed at this state (actual believe) together with the reward obtained after all agents that are interacting perform their actions. The reward is a result of the interference of others. The agent considers the opinions of all its colleagues in order to attempt to change the values of its states and/or actions. The idea is that the system, as a whole, must reach an equilibrium, where all agents get satisfied with the obtained results. This means that the values of the state/actions pairs match the reward obtained by each agent. This dynamical way of setting the values for states and/or actions makes this new reinforcement learning paradigm the first to include, naturally, the fact that the presence of other agents in the environment turns it a dynamical model. As a direct result, we implicitly include the internal state, the actions and the rewards obtained by all the other agents in the internal state of each agent. This makes our proposal the first complete solution to the conceptual problem that rises when applying reinforcement learning in multi-agent systems, which is caused by the difference existent between the environment and agent models. With basis on the proposed model, we create the IVQ-learning algorithm that is exhaustive tested in repetitive games with two, three and four agents and in stochastic games that need cooperation and in games that need collaboration. This algorithm shows to be a good option for obtaining solutions that guarantee convergence to the Nash optimum equilibrium in cooperative problems. Experiments performed clear shows that the proposed paradigm is theoretical and experimentally superior to the traditional approaches. Yet, with the creation of this new paradigm the set of reinforcement learning applications in MAS grows up. That is, besides the possibility of applying the algorithm in traditional learning problems in MAS, as for example coordination of tasks in multi-robot systems, it is possible to apply reinforcement learning in problems that are essentially collaborative

Concordâncias e discordâncias de Dewey com Freud

Este artigo expõe ideias de Sigmund Freud sobre temas que são fundamentais para compreender o homem contemporâneo: a constituição do psiquismo; a formação e a resolução das patologias mentais; a cultura em sentido amplo e a educação como elemento mediador entre o indivíduo e a sociedade. O objetivo é apresentar e comparar as análises feitas por John Dewey sobre esses mesmos temas, tomando por base o livro Human nature and conduct. As comparações entre os discursos freudiano e deweyano são feitas por meio da metodologia proposta por Chaïm Perelman no livro Tratado da argumentação (elaborado em coautoria com Olbrechts-Tyteca), que busca esclarecer as estratégias argumentativas usadas por um autor para obter ou aumentar a adesão às teses propostas e, com isso, despertar ações concretas. As conclusões sugerem que, embora Dewey discorde de Freud, existem pontos de concordância entre ambos, especialmente no que diz respeito ao significado dos impulsos e da sublimação e à concepção de que o conhecimento é mutável e impreciso, o que rejeita a crença em certezas absolutas e insere as decisões e ações humanas no âmbito da probabilidade.

Trajetória do ifrn em inclusão escolar

Discussions over the topic of inclusion of handicapped people at school are considered recent, but they have become more and more frequent within the national and international scenario. Such discussion has also being inserted in the speeches and actions of the school institution and with the formation of educators. This investigation is made necessary as a way to collect elements to reconsider the actions for the inclusion of the special education need youth. In special the visually handicapped ones, at Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Norte (IFRN). The creation of a support unit functions as main vehicle for the actions of the institution. It is intended to know what young people with limitations have to say regarding their experiences as a way to signal paths to be and not to be followed by the support unit. Therefore, the experience which these young boys and girls have is of crucial importance. In order to accomplish the task, it was decided to use methodological elements based upon elements supported by the life reports of two deficient students here called Borges and Stéfano. Their reports are from childhood to their arrival at IFRN. From their reports, categories appeared: childhood and the role of family; school life and, finally, related to the actions of the support unit of IFRN, being divided in inclusive actions and obstacles. The first one takes a second look at the actions of the family within the learning-teaching process of these students. The second category presents the moment in which students started to receive formal education per se. The last category constitutes the cornerstone of the investigation, for it analyses the process of inclusion in the institution, according to the perception of the students with visual limitations. The results signaled the need for shared intervention between students with Special Education Needs and school professionals in the elaboration of the Educational Planning, which guarantees the defense of the rights to an efficient teaching practice and effective in the process of inclusion of these students

Dificuldades na construção de gráficos de funções

This study describes about graduation s students difficulties of to draw functions graph. Specifically, we intend to observe their abilities evolution, as well as their difficulties during Calculus I subject in engineering course. For that, we show them publications about the elaboration of graphs and its difficulties in obstacle terms and some researches witch contain this subject and that it was done during postgraduate studies in mathematical education. It shows by research methodology aspects related to French didatic s mathematic and some theories of cognitive psychology considering the high value between theoretical-methodological relation that was evidenced in both theoretical conceptions about ways to understand and teach mathematic. This methodology is based on didactic engineering purpose, that consist in preliminaries analysis, conception and didactic sequence analysis prior, trials by application followed analysis up and conclusion. We had also used pedagogicals actions and analysis of results achieved, to classify types of errors made by the 2005 s students during second semester, from conceptions related to the episthemologic and didactics obstacles

A inferência causal na filosofia moral de Hume.

Starting from the idea that the result of the Humean analysis of causal inferences must be applied coherently to the remaining part of his work, including its moral theory, the present master thesis aims at investigating whether Hume´s moral philosophy is essentially based on feeling, or whether this would not be rather essentially a consequence of our causal inferences in human actions and deliberations. The main idea consists in showing that our moral inferences, to the extent that they are for Hume empirical , depend on our belief in a connexion between something which has been previously observed and something which is not being observed ( but that it is expected to occur or to be observed in the future). Thus, this very belief must base our moral inferences concerning the actions and deliberations of the individuals. Therefore, must e o ipso induce us to associate actions and behaviors, as well as character and moral claims of men to certain moral feelings. Accordingly, the thesis is unfolded in three chapters. In the first chapter Hume´s theory of the perception is reported as essential part of the explanation or the principles that bind ideas in our mind and constitute our inferences. In the second chapter, the Humean analysis of causal inferences is presented and the way they contribute in the formation of our moral inferences is explained. In the third and last chapter, the formation of our moral inferences and the real contribution of the doctrine of freedom and necessity for the examination or our actions are analysed and discussed.

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

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

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

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

O desejo, o relato e a prática da cidade: de como são produzidos territórios marginais na cidade do príncipe (1880 - 1900)

The theme of this work is the study of marginal territories of the Cidade do Príncipe, sketch in time than today is constituted as the city of Caicó/RN, with the time frame the years 1880 to 1900. Our goal is to investigate the construction of these territories from multiple speech subjects practitioners of the city. Thus, we propose to discover the mapping of the deviation in the city in question, as they were drawn, those who experienced and through which practices. Investigate the construction of these spaces from the speeches, and fill a historiographical gap, allows to find stories sharp, silenced or ignored, abortions and madness in prison, repressed passions and avenged. To meet these spaces the sources are diverse, such as the newspaper O Povo, the Codes of posture, the Reports of Presidents and Heads of Provincial Police and process-crime. Regarding the methodological aspects of research, we decided by discourse analysis, discourse here conceived not only as what is said about someone or something, but as a set of statements circulating at any given time in society, articulating speech, intentions, actions and thought. The city is then considered from their territories, imagined as a space configured in/by the relations power that the dispute, but also as a space for experiences multiple, different feelings, place and non-place, the discipline and mockery, of power and resistance.

A incorporação da saúde bucal no programa saúde da família do Rio Grande do Norte: investigando a possibilidade de conversão do modelo assistencial

The Health Family Program (HFP) was founded in the 1990s with the objective of changing the health care model through a restructuring of primary care. Oral health was officially incorporated into HFP mainly through the efforts of dental professionals, and was seen as a way to break from oral health care models based on curative, technical biological and inequity methods. Despite the fast expansion of HFP oral health teams, it is essential to ask if changes are really occurring in the oral health model of municipalities. Therefore, the purpose of this study is to evaluate the incorporation of oral health teams into the Health Family Program by analyzing the factors that may interfere positively or negatively in the implementation of this strategy and consequently in the process of changing oral health care models in the National Health System in the state of Rio Grande do Norte, Brazil. This evaluation involves three dimensions: access, work organization and strategies of planning. For this purpose,19 municipalities, geographically distributed according to Regional Public Health Units (RPHU), were randomly selected. The data collection instruments used were: structured interview of supervisors and dentists, structured observation, documental research and data from national health data banks. It was possible to identify critical points that may be impeding the implementation of oral health into HFP, such as, low incomes, no legal employment contract, difficulty in referring patients for high-complexity procedures, in developing intersectoral actions and program strategies such as epidemiologic diagnosis and evaluation of the new actions. The majority of municipalities showed little or no improvement in oral health care after incorporating the new model into HFP. All of them had failures in most of the aspects mentioned above. Furthermore, these municipalities are similar in other areas, such as low educational levels in children from 7 to 14 years of age, high child mortality rates and wide social inequalities. On the other hand, the five municipalities that had improved oral health, according to the categories analyzed, offered better living conditions to the population, with higher life expectancy, low infant mortality rates, per capita income among the highest in the state as well as high Human Development Index (HDI) means. Therefore, it is possible to conclude that public policies that include aspects beyond the health sector are decisive for a real change in health care models