Estratégias de cuidados por familiares de portadores de transtornos mentais severos residentes na zona rural do alto sertão paraibano

In the current configuration of the Brazilian Psychiatric Reform, family plays a key role in mental health care: shared responsibility and active participation in the process of rehabilitation of people with severe mental disorders. It´s considered that the family member who cares can help users in their daily tasks and articulating trajectories, networks and ways to potentiate social connections. This research was motivaded by interest in the subject and by the lack of research and studies about this reality in rural areas. This study aimed to identify ways of mental health care by relatives of severe mental disorder patients living in rural zone located at sertão of Paraiba. Methodologically was made a work with qualitative research structured in two moments. In the first one, was held a Documentary Research in CAPS II in order to identify: a) users living in rural that had a history of at least one psychiatric hospitalization, b) users who no longer use the reference service (CAPS II) for at least one year. The second stage consisted by home visits and semi-structured interviews with eleven families in rural areas. Results pointed out a profile composed by 56 users: 56 women and 26 men aged between 50 and 64 years, unmarried, without study, farmers and housewives, living six miles from CAPS II and carriers with severe mental disorders. Strategies and resources used by the families for mental health care were: religion, work, medication and help from relatives, neighbors and community. Factors related to non-use of substitute services were lack of internment in CAPS II and lack of money and transportation. The hospital, the house arrest, the police aid and religion were strategies used by family members as support to psychiatric crises. The data pointed to non-solving of care offered by psychosocial support network and the importance of redirecting practices aligned to the asylum model in favor of psychosocial strategies that aimed at rehabilitation and community participation in mental health care

A relação entre transtorno da insônia e funções executivas em adultos

The insomnia disorder is defined as a difficulty initiating or maintaining sleep or waking up earlier than expected unable to return to sleep, followed by a feeling of nonrestorative and poor quality sleep, present for at least three months, with consequences on daytime functioning. Studies have shown that insomnia affects cognitive function, especially executive functions. However, researches that sought to investigate the relationship between primary insomnia and executive functioning were quite inconsistent from a methodological point of view, especially in regard to the variability of the used methods, the heterogeneity of diagnostic criteria for insomnia and the control of sleep altering drugs. In this sense, the present study aimed to investigate the relationship between insomnia and executive functions in adults. The participants were 29 people, from both genders, aged 20-55 years old. Participants were divided into three groups, one composed of 10 people with primary insomnia who used sleep medication (GIM), nine people with primary insomnia who did not use medication (GInM) and 10 healthy people who composed the control group (CG). The research was conducted in two stages. The first one involved a diagnostic evaluation for insomnia disorder through a clinical interview and the application of the following protocols: the Athens Insomnia Scale, the Insomnia Severity Index, Sleep Journal (for 14 days), Pittsburgh Sleep Quality Index (PSQI), the Stanford Sleepiness Test, depression and anxiety Beck inventories, and Lipp’s Iventory of stress symptoms for adults. After this stage, the evaluation of executive functions was performed by applying a battery of neuropsychological tests composed by the following tests: Wisconsin, Stoop Test, Colored trails Test, the Tower of London Test, Iowa Gambling Task (IGT) and WAIS III subtest digit span, which measured selective attention, inhibitory control, cognitive flexibility, planning, problem solving, decision making and working memory, respectively. The results showed that insomniacs (GIM and GInM) showed higher sleep latency, shorter sleep duration and lower sleep efficiency compared to the CG. In regard to the performance in executive functions, no statistically significant difference between groups was observed in the evaluated modalities. However, the data show evidence that, compared to GInM and GC, the performance of GIM was lower on tasks that required quick responses and changes in attention focus. On the other hand, GInM, when compared to GIM and GC, showed a better performance on tasks involving cognitive flexibility. Furthermore, impaired sleep measures were correlated with the worst performance of insomniacs in all components evaluated. In conclusion, people with the insomnia disorder showed a performance similar to healthy people’s in components of the executive functioning. Thus, one can infer that there is a relationship between primary insomnia and executive functions in adults.

Travestis na atenção primária: o cuidado em saúde na cidade de Natal

Among the deviant a heteronormative ideal, transvestites are the ones that suffer abuse and discrimination. Have been found that health services often present themselves as places that maintains and reproduce such discrimination, which makes transvestites only sought medical care in the latter case. Based on the guidelines of the SUS and the National Humanization Policy as well as the inclusion and leadership of the users, we conducted a qualitative study seeking to understand the experience of transvestites in seeking health care within primary care in Natal-RN. We use as techno-methodological instruments in depth interview and workshop with use of "scenes". For interpretative analysis of the narratives we use to Hermeneutics-Dialectic. From the dialogue with the narrative we come to the following themes: 1) Understanding the meaning of being a transvestite; 2) The experience transvestite in search of health; 3) Transvestites and humanized health care. In the first point they reveal the daily struggle of transvestites between prejudice and the search for respect, as well as the meanings of being a transvestite, who appeared as: Being gay, being feminine, not transsexual and accept themselves as they are. In the second axis, expressed difficulties in access to and use of health services: the embarrassment by not using the social name; fear of going out during the day; the association of transvestites to HIV; and pain caused by discrimination from health professionals. It was also possible to identify simple demands such as illnesses from day to day, the demand for hormone therapy, which involves treatment needs as well as the vital need to have their rights XVII respected. The third axis, for the range of a humanized care identified that the respectful gaze guarantee their dignity and their right to health in a humane way, but it identified some necessary changes: Training of professionals, dialogue with the social movement, publicity campaigns and rapprochement with the transvestite. Finally, it is expected that the research will contribute to the field of knowledge know-how in health care transvestites, inside and outside of the university

O Centro de Referência da Assistência Social e a Psicanálise: efeitos de uma escuta singularizada

This paper emerged from an experience of 18 months in the CRAS – Reference Center for Social Assistance – which aroused a question about the listening of the singularity in the professional practice of Psi in the context of social assistance. The literature review revealed, on the one hand, a series of studies that aim to a discussion about of the process of professional integration of psychologists in the field of social welfare, proposing and / or analyzing practices directed towards the psychosocial assistance directed to the group and for the assurance of rights, forming citizen subjects. On the other hand, supported by a psychoanalytic perspective, we found studies that point to the importance of the singularity listening considering the subjectivity and symbolic resources of those who seek help in Basic Assistance Service. In this perspective, we aim to analyze, in a posteriori, the effects of offering a singularized listening in the context of CRAS and discuss its implications for the Psi professional practice in social institution. This is a theoretical and clinical research, based on Freudian and Lacanian psychoanalysis, in which two cases, placed as investigation boosters, are analyzed in the light of the concept of the subject. We conclude that a singularized listening allowed a significant sliding and the consequent repositioning of the subject, in each case, front to their suffering. The effects collected allowed us to affirm the importance of a singular listening in the treatment of the demands that appear within the institutional framework

Significado do trabalho para trabalhadores da construção civil

The meaning of work is a construct that has been studied more systematically from the 80s, through various approaches and in different occupational categories. This dissertation aims to describe and discuss the meanings of work for construction workers. This is an empirical study whose research supports herself in the Model Attributes Meaning of Work and its respective instrument for measuring the Meaning of Work Inventory (STI). The research involved 402 workers in the construction industry sector in the two capitals of the Brazilian Northeast, with a mean age of 35.8 years (SD = 11.4). To collect the data, besides the IST, the Working Conditions Questionnaire and sociodemographic data were also used. Data were organized and analyzed using the SPSS program. The study used data analysis techniques to Smallest Space Analisys (SSA), descriptive statistics, correlation and analysis of variance. There was evidence of validity of the STI which was structured into five types of value attributes (what work should be), and seven types of descriptive attributes (what is working). The results showed that the work has high centrality and profiling for participants after the family, the most important aspect in the lives of workers. Aspects of personal and economic growth were more emphasized in definition of what the work should be and responsibility and effort were characteristics that best described the reality of work.

O processo de inserção dos psicólogos na assistência social em Natal/RN no período de 1972-2003

Since the rules of the National Social Assistance (PNAS) and the Unified Social Assistance System (SUAS) in 2004/2005 the psychologist action as an essential professional teams in the services offered in this field. Althoug, there are indications of psychologists who worked on the assistence prior this time. This insertion had not systematized in the literature, not allowing the establishment of records of this linear trajectory. The objective of this paper is investigate the entrance and a psychologist working in social care services in Natal / RN , as well as the activities undertaken by them in the period 1972-2003 . This temporal boundary is justified because Natal initiate to have a psychologist from 1972 to 2003 was immediately prior to the landmarks of the 2004/2005 year. The research was divided into two stages: documentary and oral history. The first was through the consultation of 86 monographs of the Sector Documentation Social Service Department of the Federal University of Rio Grande do Norte , its intend identify what were the services that characterized the health care field and evidence of the presence of psychologists in these spaces. In the second stage, interviews with psychologists who worked 13 trailers to social assistance in order to investigate its performance, activities undertaken, the insertion process in the area, among other things were done. The material analysis was based on themes from a historical perspective. The results point to three major areas of integration of psychologists : in child exceptionality in which psychologists were linked to Brazilian Legion Social Assistance (LBA); the field of the minor through the State Foundation for the Well Being of Minors (center), and occupying positions of management and coordination in some welfare programs.

Mobilização de competências na atividade informal do vendedor ambulante em praia de Natal (RN)

The central issue of this dissertation is to investigate the labor activity of beach hawker, in order to identify the main professional competencies mobilized in this activity, traversed by both the precariousness of the means of labor exercise, as for complex and structured routines. In the town of Natal (RN) the beaches serve as workplace for thousands of informal workers, who use various professional skills, translated into the ability to mobilize and articulate knowledge, skills and behaviors to solve problems in concrete work situations. This research therefore had as main objective to investigate the work of beach hawkers, trying to identify the core competencies mobilized for facing demands and obstacles in such a context. The beach of Ponta Negra (Natal-RN) was chosen as field of observation, in which a group of hawkers took part as voluntary subjects. Methodologically, quantitative and qualitative methods of production and analysis of data were combined in three stages. In the quantitative phase an occupational questionnaire was applied to a sample of 60 subjects, generating a set of data analyzed with quantitative univariate and multidimensional descriptive statistical tools, complemented by inferential statistical analysis. The results of this phase indicate a predominance of men sellers with salary varying in a range from one to two minimum wage Brazilian salary, age and education quite heterogeneous, extended working hours and the choice of only this activity and this beach throughout the year. Concurrently with this step of analysis, unsystematic observations of the activity of vendors were held and then driven to the technique of Instruction Impersonator with four chosen subjects. This phase had a clinicalinterpretive analysis, rooted in historical-cultural Vygotskian psychological perspective and in the french approach of skills and abilities. The main results point to several strategies for overcoming obstacles, use of technics anchored in everyday work experience and practical knowledge, building rules of conduct and collective mobilization of diverse professional skills similar to those found in formal work, such as business and time management, use of communicative tools, flexibility in problem solving, creativity and teamwork competence. We conclude that informality investigated in context can not be seen exclusively as a synonym of precariousness. It also covers skills and knowledge in a complex culture that situates informal labor in a complementary way with respect to formal work. This conclusion, therefore, contributes to overcome the notion of antinomy between formal and informal labor activity, since they both can be considered as a way to achieve job satisfaction, and even a personal representation of well done job, which is an important psychological generator of identity and social place.

Fundamentos dos cuidados com crianças e adolescentes: um olhar sobre o Rio Grande do Norte entre 1964 e 1988

Childhood and adolescence care has frequently caused theoretical and methodological discussions. At national level, the way of dealing with this public has always been on the agenda, either by maintaining a paternalistic treatment, or by coercive and repressive expression with which this public is treated. Given the above, this research presents a thorough study of social policies focused on children and adolescents in Brazil, with the overall purpose of investigating how this process of implementation of public policies for poor children and adolescents in the state of Rio Grande do Norte was. In previous studies, it was identified that there are no official records regarding the policy implementation process for this population in the state of Rio Grande do Norte. A retrospective study about the care towards children and adolescents in Brazil was held. It ranged from the XXVIII century, through the period of assistance, until the historical period in which the child started to be considered from the perspective of a policy. Thus, a certain period was framed, so that, through the historical research method, this study could focus on gathering data about the attention focused on childhood and adolescence in the state of Rio Grande do Norte, between the years 1964 and 1988. Data was listed from newspaper files that circulated in the state during period mentioned above. This time framing corresponds to the regency of the National Policy of Child Welfare. In the state of Rio Grande do Norte, the implementation of institutions such as FUNBERN and then FEBEM did not differ from the national standard, since many projects and care programs for poor children and teenagers were executed in this period. The implementation of these institutions revealed the concern of the state in solving the problem of “minors” regarding to situations of abandonment or "delinquency" which they were involved with. However, the kind of protection provided by the state toward this population was based on the current ideology that supported the political system at the time: the military dictatorship. Thus, the main way to provide care to this population was through its institutionalization, through taking children to daycare centres and adolescents to “reeducational” institutes for “minors”.

O atendimento às adolescentes autoras de atos infracionais no estado do Rio Grande do Norte

The objective of this study was to investigate the assistance for the female adolescents perpetrators of offences in the state of Rio Grande do Norte. Through the Thematic Oral History and Documentary Analysis methods, we sought to uncover historical aspects of the work provided in women’s units of the Fundação dos Direitos das Crianças e Adolescentes (FUNDAC) [Foundation for the Rights of Children and Adolescents], from the experiences of professionals who have worked in these units since the beginning of their activities. For this, we made visits to FUNDAC and the Centro Educacional Padre João Maria (CEDUC) [Educational Center Father João Maria], to identify professionals who could participate in the study, as well as institutional documents on routine of treatment. Eight professionals were found from three identified units: Granja Santana, Instituto Padre João Maria and CEDUC, who were interviewed according to a semi-structured script. The analysis of the collected material is supported in Marxian theory and feminist perspective on the sexual division of labor. The results are organized into five areas of analysis: (1) the creation of the service units; (2) the deviant “behavior”: reasons for institutionalization of female adolescents; (3) educational proposal: a female version; service strategies and; the rules and punishment: the domesticated teenage girl. The study indicates that the commission of the offense by the female adolescents in state of Rio Grande do Norte (RN) has been associated with the conduct of their families, particularly their mothers. Moreover, in general, service strategies, educational proposals, disciplinary measures were and have been developed based on the naturalization of what is female. Therefore, the assistance to adolescent girls in RN, those thirty-five years, left intact the existing hierarchy in social relations between the sexes, it reproduced the subordination of female adolescents in the juvenile justice system.

Adiamento da aposentadoria e o significado do trabalho para servidores de uma universidade federal

This study investigated the intention of the older workers to continue working after state pension age/time. On this way, it explores the relation between this intention and factors related with the meanings of the work and retirement. Specifically, it was examined that factors related to work and non-work are predictors of the intention to continue working, and it was explored if meanings of retirement are linked to this decision. It is a crosssectional mixed methods study, using a survey conducted with 283 federal civil servants of a federal Northeastern University which were near retirement. It envolved an on-line questionnaire, with open-ended questions and the likert-type scale "Older Worker's Intention to Continue Working" (OWICW) of Shacklock and Brunneto (2011), which was validated to the Brazilian version. The quantitative data were analyzed using descriptive and multivariate statistics, specifically procedures for comparing means and coefficients of multiple logistic regression. The qualitative data were analyzed using the lexicographical technique Descending Hierarchical Classification. The findings indicate that most participants want to continue in paid work, and that perception of personal autonomy at work, interpersonal relationships at work, interests outside of work, and flexible working arrangements are significant predictors of intention to continue working. Furthermore, the perception of personal autonomy at work, flexible working arrangements, and the financial incentives are predictors of decision to postpone retirement and remain in the organization. The analysis revealed five patterns of meanings of retirement: "worker's right", "resting", "idle time at home", "new stage in the life course", and "enjoy the use of time”. The decision to postpone retirement is linked to idleness and lack of substitutionary activities work, and the decision to stop working linked to retirement as a life with more quality. The study provides information that can contribute with management policies before the process of retirement decision.

Características psicológicas do paciente obeso grave e suas implicações pós-operatórias na cirurgia bariátrica

Obesity is a chronic disease that has multi-factorial aetiology, characterized by high degree of body fat; the degree of obesity will vary according to the Body Mass Index (BMI=m2 /kg). The severe degree of obesity is characterized by BMI>40 and it is regularly associated to endocrine-metabolic or mechanic clinical alterations, and to psychological disorders. Binge Eating (BE) results were overly high for this population. The Bariatric Surgery has been the treatment chosen by those diagnosed with severe obesity as this intervention provides prompt outcomes for loss of weight and clinical improvement conditions. However, recent research has acquiesced that after two years between 20% and 30% of people subject to this intervention gained weight. The main objective of this research is to assess the psychological and behavioral characteristics of those diagnosed with severe obesity that have been subject to Gastric Bypass Surgery in the past 24 months. Specific aspects were investigated: (1) characteristics of different personalities and diagnose of clinic and personality disorders; (2) BE and its relation with loss of weight; (2) the difference between the groups regarding post-surgery care, e.g. physical activity, psychological and dietician input. Method: 40 adults (women and men) aged 23 and 60 year-old who went through a bariatric surgery in the past 24 months, in the city of Natal-RN (Brazil); they were assembled in two groups n=20, Gain group displaying loss of < 50% of their initial surplus of weight, and the Loss group displaying loss of >50%. The research protocol is made of a socio-demographic questionnaire and 3 psychometric instruments: Rorschach – Comprehensive System; Millon Personality Inventory (MCMI-III); and the Binge Eating Scale (Escala de Compulsão Alimentar Periódica (ECAP). Through Rorschach significant differences between these groups were verified according to the kind of personality (EB) - more EB Extratensivo in Gain group and Intratensivo in Loss group – and the lack of control to express affect, increasing the answer for Color Pure at Group I. Concerning the people standardization, the sample as a whole tends to show psychic pain, denigrated selfperception, high levels of self-criticism, distorted perceptions, vulnerability to develop mood disorders and high scores regarding Suicide. MCMI-III results showed more clinic and personality disorders in Group I: Depressive Disorder and Schizotypal, Anxiety, Dysthymia, Major Depressive Disorder; Thought Disorder, Bipolar- Manic and Posttraumatic Stress Disorder. In relation to ECAP, the results indicated significant differences, showing increased BE results in Gain group. There were found significant differences between BE severity and the presence of clinic and personality disorders. Concerning the post-surgery care, the observed differences are statistically significant regarding physical activities with median-increased differences in Loss group. There is a difference between the initial weight and the time post-surgery, indicating that the higher the initial weight and the time after the surgery the higher the re-gain of weight post-surgery. Finally, the results show that the participants with more than 3 years of surgery will have Clinic and Major Depressive Disorders; Somatoform Disorder; Dysthymia. These results confirm prior studies related to BE post-surgery and re-gain of weight as well as the proneness of clinic disorders in severe obesity people. That means the results reinforce that the surgery process is a facet of the severe obesity treatment. The post-surgery process needs to be the main focus of attention and have a long-term input to sustain the care of the surgery results and the quality of life of the patients.

Resiliência e apoio social em gestantes tardias

The gestation process, in general, is a very important event on a woman’s life and it brings phisical, phisiological and emotional changes, which by itself is an experience full of intense feelings. By late-aged pregnancy we mean those which occurs at the age of 35 or further. The occurance of this type of pregnancy is rising in Brasil and throughout the world, factors such as, better access to birth control resources and the search for financial stability explains the pregnancy delay. Important processes like resilience and social support can help late-aged pregnant women, in a benefical way, to adapt to the gestation process. Resilience is the capacity that a certain individual or group of individuals have to go through an adverse situation, be able to overcome it and become streghtened, transforming it in motivation for its biopsichosocial development. Social support is a complex and dinamic process that involves transactions between individuals and their social networks, meeting the social needs, promoting and complementing the personal resources that they have to face new demands. This research has the intention of raising information about the issues of late-aged pregnant women in the County of Natal- RN, the main objective was to evaluate the resilience indicators and the social support on late-aged pregnant women in the Natal-RN County. A transversal cut, correlational and descriptive research that was done with 150 lateaged pregnant women. The tools that were used were: A form with sociodemographic and gestation info, the scale of resilience and social support. An eletronic spreadsheet sofware (Excel e SPSS 21.0) was used to analize data which helped on the statistics according to its variables and the objective of this work. For the nominal variables, relative frequencies were used and for continuous the Pearson correlation and determination coefficient were used, regarding that; the sample had a normal distribution. The project fulfilled the ethnic aspects prescribed by Resolution 466/12 of the National Health Council, with a favorable decision (356.436/ 2013) of the UFRN Ethics on Research Committee. Most of the pregnant women had a low money income and education level, born in the state of Rio Grande do Norte they had an average age of 37,49 (±2,577), catholic, married, house wives, they had more than one child and were on their third trimester of pregnancy; they also had a low past abortion rate, not having planned their pregnancy, with an average of 4,22 (±2,506) pre-natal appointments, residing with an average of 3,673 (±1,397) people, having used any sort of birth control device and having high indicators of resilience and social support. The correlations kept between resilience, social support and some of the social demographics and gestation variables were considered low. Such data points out the fact that most of these women were in a stable relationship; they hadn’t had a past of abortion, they were involved with some kind of religion, they were not first pregnancy mothers, had an age on which they are not considered inexperienced mothers and even had scored high on the social support scale, these may all possibly be the most contributing factors on development and resilience building on these 35 years or more mothers. We expect that the data and information from this research may add up knowledge, actions and improvements regarding late-aged pregnant women and the pregnancy phenomena in general.

A inserção da família no processo socioeducativo de adolescentes em privação de liberdade

This master thesis has the main goal investigate how families are inserted in the socioeducational process of teenagers who are undergoing social measures of liberty deprivation. The specific objectives are: to characterize the family´s living together of adolescents deprived of their freedom and their families, from the actions and routines of the socio-educational system; to assess the professional working links in the context of socio-education, in order to care and strengthening families of the adolescents; to investigate how families evaluate the operation of socio-educational process in which adolescents are met. Method: to achieve the proposed objectives, data collection occurred in complementary steps: the first phase took place from visits to socioeducational units of liberty deprivation of RN, and dialogues with professionals working in socio-education. Subsequently, action research stage was carried out, from the insertion of the researcher in the extension project Family and the struggle for the effectiveness of the National Socio Service System, that aimed to strengthen monitoring the adolescents socio-education by their families, and had as methodology the conversation circles and thematic workshops. Lastly, were performed reading and analysis of the references to the family in the Individual Care Plans (PIAs) for adolescents. The information gathered was recorded in field diaries and subjected to thematic content analysis. This research was guided by the Marxist theoretical framework, structured on the understanding of the involvement of adolescents with illegal acts as a development and expression of the social question. From this theoretical framework, the prevailing view in the capitalist society of adolescents in conflict with the law as individuals who are treated by means of repression and segregation and the weakness of social policies is questioned, both in the execution of their own socioeducational measures as the articulation of network services for adolescent protection and strengthening your family. Results: in relation to the operation of the socioeducational system in RN in general, it was observed a state of unhealthy physical spaces and institutional practices that violate human rights, idleness and lack of access to social rights, and criminalization and institutionalization of poor young people and their families. With regard to family´s living together, it was noticed great distance between principles and guidelines recommended by the SINASE, about acquaintanceship and family strengthening, and every day practices of socio-education in RN: serious violations were observed that undermine the family´s living together, as the distance between the socio-educational units of deprivation of liberty and the cities where families live; absence, irregularity and poor conditions in carrying out the family visits; lack of conjugal visits; restricted and unarticulated actions for the care and strengthening of the families of adolescents, most of whom live in poverty or extreme poverty. Finally, it was found a number of blamefully and punishments to the family, including practices such as inward inspection (visual inspection while naked and squant), plus a series of violence and omissions care that sick family members and weaken the links between adolescents and their families.

Avaliação do desenvolvimento infantil e a influência dos fatores biopsicossociais em crianças com cardiopatia congênita

Child development is the result of the interaction of biological, psychological and social factors. Hostile environment, income, offered stimuli, as well as the presence of a chronic illness are issues that may interfere significantly. Considering the chronic diseases, we can identify congenital heart disease (CHD) is characterized by anatomical heart defects and functional and currently has presented an incidence of up to 1% of the population of live births. This research aimed to evaluate child development and verify an association with the commitment by biopsychosocial factors of children with and without CHD. Study participants were children from zero to six years, divided into three groups: Group1- 29 children pre-surgical congenital heart disease, Group2- 43 children post-surgical cardiac patients and Group3- 56 healthy children. The instruments used were a biopsychosocial questionnaire and the Screening Test Denver II. Of the total of 128 children evaluated, 66 (51.56%) are girls, and ages ranged from two months to six years (median 24.5 months). In G1 and G2 predominated acyanotic heart disease (55.2% and 58.1%). Regarding the Denver II reviews, children with heart disease had more development ratings "suspicious" and "suspect/abnormal", and 41.9% of children who have gone through surgery had characterized its development as "suspect/abnormal" . In the group of healthy children 53.6% were classified as developmental profile "normal" (p = ˂0,0001). On the areas of Denver II, among children with heart disease was greatest change in motor areas (p = 0.016, p = ˂0,001). The biopsychosocial variables that were related to a possible developmental delay were gender (p = 0.042), child's age (p = 0.0001) and income per capita (p = 0.019). There were no associations between the variables related to the treatment of disease, information, understanding of the disease and the way parents treat their children. In the group of healthy children showed that children who underwent hospitalization rates were more changes in development (p = 0.025) and the higher the number of admissions over these changes have intensified (p = 0.023). The results suggest that children with congenital heart disease have likely delayed development. It was also observed that there is a significant difference between the children who have gone through surgery, those who are still waiting for surgery only doing clinical follow-up. Changes in the development are more connected motor areas can be explained by the characteristic features of the disease and treatment, such as dyspnea, fatigue, care and limitations in daily activities. The gender and age appear to be decisive in the development as well as healthy children go through hospitalization experience. Already in children with heart disease, it was realized that social variables involved in the disease and the treatment did not affect the development. This question can be understood by means of protective factors and resiliency, as this population receives family and social support.

O saber na perspectiva psicanalítica de orientação freudo-lacaniana: um estudo teórico

This work came from a research question, namely authorizing a child to learn, lifted from the care of a child of 09 years in the school service of a private university located in Natal, whose complaint referred to a learning disorder more specifically, not the formalization of reading and writing. To undertake a survey of the Lacanian psychoanalytic - Freudian literature on learning, we find the concept of knowledge as fundamental to the analysis of this issue which led us to investigate the history of its co nstruction in Freud and Lacan, with a view to shed light on their relationship to learn. This is a theoretical type of research with the proposal to revisit the concept of knowledge in the work of Freud and Lacan's teaching, in which case only served as th e trigger point of this work. We found that in both these authors, the concept of knowledge is associated to the unconscious exclusively and can be hinged to learn the way of the desire to know. It concludes that learning is a process that involves the unconscious knowledge. Consequently, learning disorders may be linked to the impossible into play in the know about the desire to find himself alienated the significant of what operates as forbidden to know when not referred only or also of teaching and / or educational aspects. This shows us that the complaints that come to the clinic can illustrate dilemmas experienced by the speaking, related to subjective questions. Deviations from the possibility of learning may indicate in these cases, a manifestation of what is singular and very impossibility of generalization when it comes to subjects. With this, also attest that the relations of the subject with knowledge effect in learning processes.