Fatores determinantes da near miss materna em uma unidade de terapia intensiva obstétrica: avaliação das competências profissionais da área médica

Objective: Evaluate the determinants of morbidity and mortality in an obstetric intensive care unit and professional medical skills of students/residents at a university hospital. Methods: observational cross - sectional with 492 pregnant/pue rperal women and 261 students/residents. Patients were admitted to the obstetric intensive care unit during a year, being informed about the proposals of the study and a questionnaire was applied. The analysis was performed using Microsoft Excel 2013 and G raphPad6. Chi - square tests were used to evaluate risk factors and student t test evaluates resident/students' skills concerning the cognitive test and the Mini - Cex. Results: the main risk factors to near miss were: non - white race (OR = 2.527; RR = 2.342) ; marital status(married women) (OR = 7.968; RR = 7.113) , schooling (primary) (OR = 3.177 ; RR = 2.829) , from country town (OR = 4.643 ; RR = 4.087), low income (OR = 7014 ; RR = 5.554) , gestational hypertensive disorders (OR = 16.35 ; RR = 13.27) , re alization of pre - natal (OR = 5.023 ; RR = 4.254) and C - section before labor(OR = 39.21 ; RR = 31.25). In cognitive/Mini - cex analysis were noted significant difference in the performance of students on the subject (3.75 ± 0.93, 4.03 ± 0.94 and 4.88 ± 0.35). We still observed the best performance of residents, when compared to graduation students (p < 0.01). Conclusions: the prevalence of near miss was associated with socioeconomic/clinics factors and care issues, revealing the importance of interventions to improve these indicators. In addition, we suggest a better curriculum insertion of this subject in the medical Course disciplines due the importance to avoid the near miss through of adequacy of medical education.

Construção e avaliação de uma unidade de ensino potencialmente significativa para o conteúdo de termoquímica

Nos dias atuais, oferecer uma educação para o exercício da cidadania é função primordial das políticas públicas educacionais, conforme estabelece a constituição brasileira e a legislação de ensino. Essa função vem sendo defendida por muitos professores no Ensino Médio, atribuindo-se a disciplina de Química o papel de proporcionar um ensino crítico, participativo, reflexivo e humano. Segundo os documentos oficiais brasileiros para o Ensino de Química, o estudo do conceito de energia deve favorecer o desenvolvimento de competências para que o aluno compreenda a produção e o seu uso em diferentes fenômenos e possam interpretá-los de acordo com modelos explicativos, além de saber avaliar e julgar os benefícios e riscos da produção e do uso de diferentes formas de energia nos sistemas naturais construídos pelo homem, articulando com outras áreas de conhecimento na procura de promover a interdisciplinaridade. As unidades de ensino potencialmente significativas (UEPS), tomam como base um conjunto de teorias de aprendizagem que tem o intuito de promover um ensino com base na aprendizagem significativa e podem ajudar os estudantes nas diferentes relações que um conceito pode ter. Neste sentido, o estudo do conceito da energia a partir do trabalho com UEPS, pode ser uma importante proposta que favorece um ensino de Química na perspectiva construtivista. Assim, o objetivo deste trabalho é construir e avaliar uma proposta didática para o conteúdo de termoquímica na perspectiva das unidades de ensino potencialmente significativas de Moreira com alunos do Ensino Médio de uma escola pública do Município de Campina Grande-PB. Inicialmente a UEPS foi avaliada por 22 professores em formação inicial de duas instituições públicas de ensino superior. Em seguida, ela foi aplicada para 15 alunos do 2° ano da Escola Estadual de Ensino Médio Prof. Raul Córdula, localizada na cidade de Campina Grande-PB. A coleta dos dados para os professores em formação inicial teve como base um instrumento de validação de elaboração de unidades didáticas baseada na Engenharia Didática proposta por Artigue (1996 apud Guimarães e Giordan, 2011). Já para os alunos do ensino médio, os dados foram coletados no decorrer da UEPS e a avaliação final sobre a proposta didática ocorreu através de um questionário tomando como base a escala de Likert e o uso de mapas conceituais. Para a descrição dos dados, foram utilizados os pressupostos da análise de conteúdo de Bardin. Como produto educacional foi elaborado a Unidade de Ensino Potencialmente Significativa e um DVD contendo orientações de como trabalhar com a proposta. Os resultados deste trabalho apontam uma avaliação positiva quanto à proposta de ensino elaborada para a Educação Básica, onde se observa através do instrumento de validação aplicado, que a maioria das respostas atribuídas pelos professores, ficou entre os itens suficiente e mais que suficiente. Em relação aos momentos de aprendizagem dos alunos do Ensino Médio durante a aplicação da UEPS, foi possível observar que a proposta gerou motivação no processo de ensino e aprendizagem dos conceitos da termoquímica, como também se percebe que os mapas conceituais apresentados pelos alunos apresentaram mais proposições conceituais em uma segunda tentativa de elaboração, logo a proposta de ensino foi aprovada por mais de 90 % dos estudantes do nível médio. Portanto fica evidente que a proposta didática contribuiu no processo de ensino aprendizagem, despertando interesse e motivação nos estudantes pelo conteúdo de Termoquímica.

Os rumos do fundo público no capitalismo contemporâneo: uma análise sobre o financiamento da Política de saúde no estado do Rio Grande do Norte

This work analizes the financing of Health Policies on the state of Rio Grande Do Norte, starting at the presumption that SUS is “Bombarded” by fiscal ajustments, as a neoliberal strategy to face capital crises.The trafectory of the financing of SUS demands the comprehension of two principles which are, in essence, contradictory: the “principle of universatility”, which is caracterized by the uncompromising defence of the fundaments of the Sanitary Reform, and the “principle of containment of social costs”, articulating the macroeconomic policy that has being developed in Brazil since the 1990s and which substantiantes itself on the 2000s.This last defends the reduction of the social costs, the maintanance of primary surplus and the privatization of public social services. Considering these determinations, the objective of this research constitues in bringing a critical reflection sorrounding the financing of the Health Policies on the state of Rio Grande do Norte, on the period from 2004 to 2012.Starting from a bibliografic and documentary research, it sought out to analyze the budget planning forseen on the Budget Guideline Law (LDO) and on the Multiannual Plans (PPA), investigating the reports of the Court of Auditors of the State of RN and gathering information about expenses with health, available on the System of Information About Public Budgeting in Health (SIOPS).The Analises of the data obtained, in light of the theoretic referece chosen, reveals trends in the public budget setting for health on the State of Rio Grande do Norte, which are: a tiny share of investment expenditure on health, when compared to other expenses, the amount used in daily fees and advertising; the high expense in personnel expenses, especially for hiring medical cooperatives;the strong dependence of the state on revenue transferences from the Union; the aplication of resources in actions of other nature considered as health, in exemple of the expenditures undertaken by the budgeting unit Supplying Center S/A (CEASA) on the function of health and subfunction of prophylactic and therapeutic and on the Popular Pharmacy program. Since 2006, expenses refering to Regime Security Servers (RPPA) on the area of health also have being considered as public actions and services in health for constitutional limit ends, beyond the inconsistencies on the PPAs with the actions performed efectively.

Segurança do paciente em terapia intensiva neonatal: identificação e análise de eventos adversos

The patient safety is a major concern in health services for its global dimension, as evidenced by the fragility of care processes that predispose an occurrence of adverse events. These events in a neonatal intensive care unit are considered serious and hazardous to lives of newborns. The present study aimed to identify and analyze adverse events in a neonatal intensive care unit based in Trigger Tool. It is an epidemiological, cross-sectional , exploratory, retrospective study with quantitative, descriptive and analytical approach, performed in 2015 at a school hospital. The sample was not probabilistic, involving 116 newborns who met the eligibility criteria. Data collection was performed by retrospective review of medical records, using a specific kind of "trigger" instrument, composed of sentinel events in neonatology, adapted from the American model used by the Vermont-Oxford Network. Data were analyzed using descriptive and inferential statistics. The chi-square test for linear trend was used to assess the associations between the variables of interest. The research received a favorable agreement from Ethics Committee of the Federal University of Rio Grande do Norte, under number 1055533, and Presentation Certificate for Ethics Assessment 43894515.6.0000.5537. The results show among investigated newborns, 110 experienced at least one adverse event during their stay, with a total of 391 medical records analyzed and rate of 3.37 events per patient. Prevailed the preterm newborns with low birth weight, from mother who had hypertensive diseases during pregnancy and urinary tract infection. The average hospitalization time was 25 days, associated with hospital-acquired infections events (p = 0.01). Among the identified adverse events stood out the events related to thermoregulation disorders (39.0%), with prevalence of hypothermia (26.0%), followed by health care-related infections (16.4%) and blood glucose disorders, hypoglycemia (9.00%) and hyperglycemia (6.64%). Most of these incidents were classified in categories E and F, which represents that there was damage small proportion. Due to these damages come from the care practice with newborn, 78% were classified as avoidable. There was statistically significant association between the variable birth weight with infections (p = 0.006) as well as peri/intraventricular bleeding (p = 0.02), hypoglycemia (p = 0.021), hyperglycemia (p = 0.001), hyperthermia (p = 0.39) and death (p=0,02). Gestational age was associated with seizures (p = 0.002), hyperglycemia (p=0.017) e hyperthermia (p=0.027). The security institution culture was reported by the health workers as intermediate, even though the number of adverse events found in only one unit of service indicates that there is much to be done. Thus the high rate of adverse events identified in the neonatal intensive care unit reinforces the necessity to elaborate specific preventive strategies for this risk environment.

Segurança do paciente em terapia intensiva neonatal: identificação e análise de eventos adversos

The patient safety is a major concern in health services for its global dimension, as evidenced by the fragility of care processes that predispose an occurrence of adverse events. These events in a neonatal intensive care unit are considered serious and hazardous to lives of newborns. The present study aimed to identify and analyze adverse events in a neonatal intensive care unit based in Trigger Tool. It is an epidemiological, cross-sectional , exploratory, retrospective study with quantitative, descriptive and analytical approach, performed in 2015 at a school hospital. The sample was not probabilistic, involving 116 newborns who met the eligibility criteria. Data collection was performed by retrospective review of medical records, using a specific kind of "trigger" instrument, composed of sentinel events in neonatology, adapted from the American model used by the Vermont-Oxford Network. Data were analyzed using descriptive and inferential statistics. The chi-square test for linear trend was used to assess the associations between the variables of interest. The research received a favorable agreement from Ethics Committee of the Federal University of Rio Grande do Norte, under number 1055533, and Presentation Certificate for Ethics Assessment 43894515.6.0000.5537. The results show among investigated newborns, 110 experienced at least one adverse event during their stay, with a total of 391 medical records analyzed and rate of 3.37 events per patient. Prevailed the preterm newborns with low birth weight, from mother who had hypertensive diseases during pregnancy and urinary tract infection. The average hospitalization time was 25 days, associated with hospital-acquired infections events (p = 0.01). Among the identified adverse events stood out the events related to thermoregulation disorders (39.0%), with prevalence of hypothermia (26.0%), followed by health care-related infections (16.4%) and blood glucose disorders, hypoglycemia (9.00%) and hyperglycemia (6.64%). Most of these incidents were classified in categories E and F, which represents that there was damage small proportion. Due to these damages come from the care practice with newborn, 78% were classified as avoidable. There was statistically significant association between the variable birth weight with infections (p = 0.006) as well as peri/intraventricular bleeding (p = 0.02), hypoglycemia (p = 0.021), hyperglycemia (p = 0.001), hyperthermia (p = 0.39) and death (p=0,02). Gestational age was associated with seizures (p = 0.002), hyperglycemia (p=0.017) e hyperthermia (p=0.027). The security institution culture was reported by the health workers as intermediate, even though the number of adverse events found in only one unit of service indicates that there is much to be done. Thus the high rate of adverse events identified in the neonatal intensive care unit reinforces the necessity to elaborate specific preventive strategies for this risk environment.

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.

Análise estratigráfica da sequência mesodevoniana-eocarbonífera da Bacia do Parnaíba, nordeste do Brasil

The Middle Devonian-Early Carboniferous sequence of the Parnaíba Basin, lithostratigraphically defined as Canindé Group, has been reinterpreted using the basic model of sequence stratigraphy. Therefore, lithology and gamma ray well-logs and seismic lines of central portion of the basin were analyzed, producing up from there diagrams 1D, isochore maps and stratigraphic sections. As results of this study, were defined two depositional cycles of second order, referred as Depositional Sequence 1 (SEQ1) and the Depositional Sequence 2 (SEQ2). The SEQ1, with interval about 37 Ma, is limited below by Early Devonian Unconformity and is equivalent to the formations Itaim, Pimenteiras and Cabeças. The SEQ2, which follows, comprises a range of about 15 Ma and is equivalent to the Longá Formation The SEQ1 starts with the lowstand systems tract, consisting of progradational parasequence set in the basal part, predominantly pelitic, deposited on a prodelta under influence of storms and the upper part consists in sandstones of deltaic front, with the maximum regressive surface on the upper limit. The transgressive systems tract, deposited above, is characterized by retrogradacional parasequence set composed of shallow shelf mudstones, deposited under storm conditions. The maximum flooding surface, upper limit of this tract, is positioned in a shale level whose radioactivity in gammaray well-log is close to 150 API. The highstand systems tract presents progradational parasequence set, comprising mudstones and sandstones deposited in shelf, fluvial-estuarine or deltaic and periglacial environments, with the upper limit the Late Devonian Unconformity. The SEQ2 was deposited in shelf environment, starting with the lowstand systems tract, that is characterized by a progradational parasequence set, followed by the transgressive systems tract, with retrogradational character. The upper limit of the tract corresponding to the fusion between maximum flooding surface with the upper limit of this sequence, which is the Early Carboniferous Unconformity, where the overlapping section was eroded. This section, which corresponds the highstand systems tract is restricted to portions at which the erosion that generate the Early-Carboniferous Unconformity was less effective, preserving the records of this unit.

Análise estratigráfica da sequência mesodevoniana-eocarbonífera da Bacia do Parnaíba, nordeste do Brasil

The Middle Devonian-Early Carboniferous sequence of the Parnaíba Basin, lithostratigraphically defined as Canindé Group, has been reinterpreted using the basic model of sequence stratigraphy. Therefore, lithology and gamma ray well-logs and seismic lines of central portion of the basin were analyzed, producing up from there diagrams 1D, isochore maps and stratigraphic sections. As results of this study, were defined two depositional cycles of second order, referred as Depositional Sequence 1 (SEQ1) and the Depositional Sequence 2 (SEQ2). The SEQ1, with interval about 37 Ma, is limited below by Early Devonian Unconformity and is equivalent to the formations Itaim, Pimenteiras and Cabeças. The SEQ2, which follows, comprises a range of about 15 Ma and is equivalent to the Longá Formation The SEQ1 starts with the lowstand systems tract, consisting of progradational parasequence set in the basal part, predominantly pelitic, deposited on a prodelta under influence of storms and the upper part consists in sandstones of deltaic front, with the maximum regressive surface on the upper limit. The transgressive systems tract, deposited above, is characterized by retrogradacional parasequence set composed of shallow shelf mudstones, deposited under storm conditions. The maximum flooding surface, upper limit of this tract, is positioned in a shale level whose radioactivity in gammaray well-log is close to 150 API. The highstand systems tract presents progradational parasequence set, comprising mudstones and sandstones deposited in shelf, fluvial-estuarine or deltaic and periglacial environments, with the upper limit the Late Devonian Unconformity. The SEQ2 was deposited in shelf environment, starting with the lowstand systems tract, that is characterized by a progradational parasequence set, followed by the transgressive systems tract, with retrogradational character. The upper limit of the tract corresponding to the fusion between maximum flooding surface with the upper limit of this sequence, which is the Early Carboniferous Unconformity, where the overlapping section was eroded. This section, which corresponds the highstand systems tract is restricted to portions at which the erosion that generate the Early-Carboniferous Unconformity was less effective, preserving the records of this unit.

Avaliação de qualidade da unidade de diálise no Hospital Universitário Onofre Lopes - HUOL

Over the years there has been a broader definition of the term health. At the same time it was found also an evolution of the concept of health care which in turn has led to changes in the approach to delivery of health services and hence in its management. In this regard, currently the nephrology services have been searching for quality technical and social need. In view of these innovations and the quest for quality, it elaborated the general objective: to develop a quality assessment protocol for dialysis service Onofre Lopes University Hospital. It is an intervention project effected through an action research, which consisted of 4 steps. Initially was identified through a literature search in scientific literature, which quality indicators would apply to a dialysis unit being selected as follows: infection rate in hemodialysis access site, microbiological control of water used for hemodialysis and Index User satisfaction. Through critical reflection on the theme researched in the previous step, it was drawn up three data collection instruments, interview form type, applied between the months of October and November 2015. In addition to the information obtained, also made up of the use of information retrieval technique. The results were organized in graphs and tables and analyzed using qualitative and exploratory technical approach. Then a reflective analysis of the data obtained and the diagnosis of reality studied was traced and confronted with the literature was performed. The data produced in this study revealed that the Dialysis Unit of HUOL is much to be desired, considering that some weaknesses have been identified in its structure. Faced with this finding have been proposed, as a contribution and aiming to guide the development of future actions, suggestions for improvement that should be implemented and monitored to be assured overcoming these difficulties, allowing an appropriate organizational restructuring, and resulting in improved service public offered. It was concluded that for hemodialysis treatment results are achieved and positive, it is necessary to have physical structure and adequate infrastructure, multidisciplinary team specialized, trained and in sufficient quantity, well designed processes for professionals to have standards to be followed decreasing the chance to err, and a risk management system to detect and control situations that endanger patient safety.

Avaliação de qualidade da unidade de diálise no Hospital Universitário Onofre Lopes - HUOL

Over the years there has been a broader definition of the term health. At the same time it was found also an evolution of the concept of health care which in turn has led to changes in the approach to delivery of health services and hence in its management. In this regard, currently the nephrology services have been searching for quality technical and social need. In view of these innovations and the quest for quality, it elaborated the general objective: to develop a quality assessment protocol for dialysis service Onofre Lopes University Hospital. It is an intervention project effected through an action research, which consisted of 4 steps. Initially was identified through a literature search in scientific literature, which quality indicators would apply to a dialysis unit being selected as follows: infection rate in hemodialysis access site, microbiological control of water used for hemodialysis and Index User satisfaction. Through critical reflection on the theme researched in the previous step, it was drawn up three data collection instruments, interview form type, applied between the months of October and November 2015. In addition to the information obtained, also made up of the use of information retrieval technique. The results were organized in graphs and tables and analyzed using qualitative and exploratory technical approach. Then a reflective analysis of the data obtained and the diagnosis of reality studied was traced and confronted with the literature was performed. The data produced in this study revealed that the Dialysis Unit of HUOL is much to be desired, considering that some weaknesses have been identified in its structure. Faced with this finding have been proposed, as a contribution and aiming to guide the development of future actions, suggestions for improvement that should be implemented and monitored to be assured overcoming these difficulties, allowing an appropriate organizational restructuring, and resulting in improved service public offered. It was concluded that for hemodialysis treatment results are achieved and positive, it is necessary to have physical structure and adequate infrastructure, multidisciplinary team specialized, trained and in sufficient quantity, well designed processes for professionals to have standards to be followed decreasing the chance to err, and a risk management system to detect and control situations that endanger patient safety.

Percepção ambiental como ferramenta diagnóstica para o processo de integração entre uma unidade de conservação e a comunidade do entorno

It is remarkable the current planet’s situation of degradation and modification of natural assets and the considerable loss of the recovery power inherent to the ecosystems. Concomitant with this, all communities and species are suffering the consequences of these changes without planning. The creation of conservation units (UCs) through the National System of Conservation Units (SNUC) was a concrete action on the deliberateness of halting these processes, which, on the other hand, generated socio-environmental, geo-economical and cultural-political conflict of interests between traditional communities in the vicinity of these units, institutions, governmental entities and society in general. The country’s National Program of Environmental Education (ProNEA) provides the integration of the communities and UCs’ managers in a co-participative administration to solve these conflicts. The principles of Environmental Education (EA) leads the methodology found to change the socio-educational paradigms of traditional teaching, still existing in our society and intrinsically related to environmental problems, which are contrary to the dialogic pedagogy from Paulo Freire, that valorize popular knowledge, pro-active citizenship, as well as contrary to Ecopedagogy, that re-integrate human being on its natural environment, the Earth. One of the tools for starting environmental sensitization is the diagnosis by environmental perception of individuals. In this context, the objective of our work was to identify the environmental perception of Tenda do Moreno community located nearby Pau Furado State Park (PEPF) in Uberlândia – MG. To reach this objective, the research sought, in a first moment, to evaluate the environmental perception of residents of this community through semi-structured interviews applied in their homes and, in a second moment, we evaluated the environmental perception of community’ school students and made Environmental Education intervention activities with the intention to make children aware of the importance of conservation and function of PEPF. Using the Content analysis methodology, we found in nearly 60% of the 118 residents a systemic perception of nature, while approximately 32% expressed an anthropocentric perception. Mixed perceptions were found in 21%. A considerable part of the residents (47 individuals) indicated not knowing the park, although many of them recognize its importance. Among the 46 interviewed students, half expressed an anthropocentric perception of nature, while almost 36% had a systemic view. Seventeen children said they did not know the park and almost half of the students recognize some aspect of the importance of its existence. During the intervention activities, we had huge participation and dedication of students, beyond the massive expression of their personal views and daily experiences. In relation to the ten students that subjected the second evaluation about their environmental perception after the intervention, 80% showed systemic perception and emphasized the importance of conservation and of park. We believe that the continuity of the intervention activities could generate positive perspectives of socio-environmental effective changes in the daily school. Activities lead by Ecopedagogy and that encourage the citizen leadership in the young students are fundamental, while in the community, closer ties and dialog by UC’s managers would be important elements to generate effective change.

Desenho e Análise de Processo de Candidatura ao P.2020: estudo de caso via CTC/GP, do IPL

Melhorar o desempenho organizacional, através do (re)desenho dos processos de negócios, é uma premente e desafiadora questão para promover a eficiência e eficácia organizacional. O presente trabalho aborda a Gestão de Processos de Negócio e conceitos que lhe estão subjacente, enquanto ferramenta ao dispor da gestão para planear, modelar, executar, analisar, controlar e melhorar o operacional do processo. Para tal, recorreu-se a um estudo de caso, realizado no Centro de Transferência e Valorização de Conhecimento e Gabinete de Projetos (CTC/GP), do Instituto Politécnico de Leiria (IPL), referente ao processo de candidatura de projetos em co-promoção, no novo quadro comunitário. A escolha deste estudo de caso prendeu-se com o facto de o CTC/GP ser uma unidade orgânica do IPL que, entre outras atividades, articula a academia com o tecido empresarial da região de Leiria, contribuindo para a criação de uma economia de valor acrescentado, suportada por produtos exportáveis e competitivos ao nível da qualidade. Por outro lado, o processo de candidatura de projetos em co-promoção é um processo de grande rendibilidade para o instituto. A grande contribuição deste trabalho foi, por um lado, munir a equipa de um fluxograma do supra citado processo, numa ferramenta de fácil utilização e premiável às mudanças de paradigma e, por outro, apresentar várias questões de partida para investigações futuras.

Análise das Dimensões do Comprometimento no Setor Público da Educação: um estudo de caso com os gestores dos Campi do IFCE Limoeiro do Norte e Fortaleza - CE/Brasil

O presente trabalho tem como objetivo definir, analisar e identificar por meio de um estudo de caso, as dimensões de comprometimento organizacional: afetivas, instrumental e normativa dos gestores do campus do Limoeiro do Norte, que estão em fase de estágio probatório e dos gestores do campus Fortaleza que já passaram desse estágio, traçar um comparativo e relacionar ambos os casos. Norteado por um modelo teórico de comprometimento organizacional abordado por Meyer e Allen (1991; 1997). Comprometimento no setor público neste estudo tem-se como unidade de análise duas instituições federais de educação, ciência e tecnologia. Como os gestores são, na maioria das vezes, responsáveis pelo desenvolvimento de uma força de trabalho capaz e comprometida, sua atuação torna-se de fundamental importância no âmbito da educação, aliado a competência técnica e a vontade polí­tica de ações planejadas. De acordo com a pesquisa descritiva e quantitativa, foram aplicados questionários já testados e validados, contendo aspectos semi-estruturados, onde foi dividido em duas partes: a primeira, com seis itens, abordando as caracterí­sticas pessoais e funcionais dos gestores do IFCE de cada campus estudado, e segunda, que possui dezoito itens divididos nas três dimensões do comprometimento organizacional: afetivo, instrumental e normativo, tudo baseado na escala de mensuração do comprometimento de Meyer e Allen (1997) modelo internacionalmente aceito e validado. Os resultados obtidos na pesquisa apontaram que dos 35 gestores do campus Limoeiro do Norte o comprometimento organizacional que obteve maior média foi o afetivo. Os gestores estáveis do campus Fortaleza, também apontaram a dimensão afetiva com a maior média de comprometimento. Com isso os estudos balizam que não há uma possível relação com o fator tempo na instituição, uma vez que a maioria dos gestores do campus Fortaleza possui mais de uma década de atuação, enquanto os do campus Limoeiro do Norte, possuem menos de três anos na instituição. A maior parte dos pesquisados nos campi defendem uma forte relação na instituição, já se sentem de casa, o vínculo se estabelece pela presença de sentimentos, afeição e identificação, até mesmo pelo fato dos gestores permanecerem mais tempo no trabalho que na sua prápria casa, ele faz da organização um esteio do seu próprio lar. Conclui-se que os resultados não permitem afirmar que as dimensões do comprometimento estão relacionadas ao tempo de atuação dos gestores na instituição. / This paper aims to define, analyze and identify through a case study, the dimensions of organizational commitment: affective, continuance and normative managers campus of Castle Hayne, who are in their probationary period and the managers of Fortaleza campus who have passed this stage, draw a comparison and to relate both cases. Guided by a theoretical model of organizational commitment by Meyer and Allen (1991; 1997) approached. Commitment in the public sector in this study has as unit of analysis two federal institutions of science and technology education. As managers are, in most cases, responsible for developing a workforce capable and committed, its performance becomes very important in education, combined with technical competence and political will of planned actions. According to the descriptive and quantitative research, questionnaires were applied, tested and validated, containing aspects of semi-structured, which was divided into two parts: the first, with six items, addressing the personal and functional characteristics of the managers of each campus IFCE studied, and second, which has eighteen items divided into the three dimensions of organizational commitment: affective, continuance and normative, all based on a scale to measure the commitment of Meyer and Allen (1997) model is internationally accepted and validated. The results obtained in this research showed that the 35 managers of the Castle Hayne campus organizational commitment that was obtained more affective. Managers stable campus Fortaleza, also pointed to the affective dimension with the highest average commitment. With this guiding studies that there is a possible relationship with the time factor in the institution, since most managers campus Fortaleza has over a decade of operation, while the Castle Hayne campus, have less than three years in institution. Most of the campuses surveyed favor a strong relationship with the institution, already feel at home, the link is established by the presence of feelings, affection and identification, even by the fact that managers stay longer at work than at home, he is a mainstay of the organization of your own home. We conclude that the results do not allow us to state that the dimensions of commitment are related to time of performance of managers in the institution.

O Serviço Social na Unidade de Transplantação Hepática Pediátrica e a Criação da Associação de Crianças e Jovens Transplantados ou com Doenças Hepáticas – HEPATURIX pelo Direito à Saúde

Com a crise financeira que se tem vindo a agudizar, com o agravamento da pobreza e exclusão social, associados a problemas de saúde e à emergência de problemas sociais (como o desemprego e a pobreza) tem assomado uma vaga de iniciativas de movimentos da sociedade civil. São novas formas de organização e resposta a situações específicas de grupos de indivíduos na luta por políticas públicas e direitos sociais tais como o da saúde, da habitação, da educação, do trabalho, entre outras. Nos finais da década de 70, em Portugal, a criação do Serviço Nacional de Saúde intenta o acesso à saúde garantido a todos os cidadãos. Nos anos 80 o Estado limita este direito baseado no princípio da justiça social protegendo os grupos mais desfavorecidos. Institui as taxas moderadoras e define as isenções para alguns doentes crónicos. Perante a desigualdade de direitos que daí advém, no Hospital Pediátrico de Coimbra, a partir dos anos 90, surgem movimentos associativos em prol dos direitos de saúde, criados e dinamizados por Assistentes Sociais, nomeadamente as Associações Acreditar em 1993, a Coração Feliz em 1994, a Associação Nacional de Fibrose Quística em 1996 e já no século XXI a Diabéticos Todo o Terreno em 2004 e a Hepaturix em 2006. A Hepaturix – Associação de Crianças e Jovens Transplantados ou com Doenças Hepáticas – fundada já no século XXI e cuja actividade será descrita neste trabalho, tem vindo a lutar pelos direitos sociais desta população, com a colaboração da Assistente Social que, no Hospital Pediátrico de Coimbra, apoia a Unidade de Transplantação Hepática Pediátrica. Entre outros, a isenção das taxas moderadoras para os doentes transplantados e para os dadores vivos assim como o direito aos transportes nas deslocações para o hospital após o transplante, são direitos sociais alcançados pela Hepaturix através da sensibilização do poder político. A Assistente Social tem sido um pilar neste percurso, sendo mediadora entre a instituição e a associação, em prol do direito destas crianças e jovens. / With the financial crisis that has been worsening, with increased poverty and social exclusion associated with health problems and the emergency of social problems (such as unemployment and poverty) there has been a loomed wave of initiatives for movements from the civil society. These are new ways of organization and response to specific situations of groups of individuals in the strike for public policies and social rights such as health, habitation, education, work, among others. In the late 70s, in Portugal, the creation of the National Health Service intents the access to health care guaranteed to all citizens. In the 80s the government limits this right based on the principle of social justice, protecting the most disadvantaged groups. Establishes user fees and defines the exemptions for some chronically ill. Before the inequality of rights resulted from this, there has been a rising of associative movements for health rights, created and dynamized by Social Workers at the Pediatric Hospital of Coimbra, from the 90s on: "Acreditar" in 1993, "Coração Feliz" in 1994, Associação Nacional da Fibrose Quistica" in 1996 and now, in the XXI century: "Diabéticos Todo o Terreno"in 2004 and "Hepaturix" in 2006. The “Hepaturix” - Association of Transplanted Children and Youth or with Hepatic Diseases - founded in the twenty-first century, whose will be discussed in this work, has been fighting for social rights of this population, with the cooperation of the Social Work who, at the Children’s Hospital of Coimbra, supports the Pediatric Hepatic Transplantation Unit. Among others, the exemption of user fees for transplanted patients and living donors as well as the right to transport at dislocations to the hospital after transplant, are social rights accomplished by Hepaturix, through the awareness of political power. The Social Worker has been a pillar in this journey, being a mediator between the institution and the association on behalf of the rights of these children and youth.