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

O ambulatório de Saúde Mental no contexto da Reforma Psiquiátrica em Natal/RN

The years 1990 disclose the consolidation of the Brazilian Psychiatric Reform project, assumed as official politics by the Health Department, also stirring up discussions, lines of direction and new ways of care. Substitutive services to the psychiatric hospital as CAPS, conviviality centers, therapeutical residences and ambulatory clinics are implemented. This work analyzes the relations that the Specialized Ambulatory Clinic of Ribeira establishes to the services of Mental Health of the public system in the city of Natal/RN, as well as its adjustment to the proposal of the Psychiatric Reform. Through semi-structured interviews and observation, it was possible to gather data which allowed picturing a general characterization of the service: activities, technical group, joint with other institutions, daily routine organization. Such institution develops activities that surpass the traditional character of a clinic- in other words, the psychological/medical appointments - and it mainly greets the ones proceeding from CAPS and psychiatric hospitals. It offers group activities, psychiatric appointments, therapeutical workshops, sheltering and strolls, among others. The institution is composed by a multi-professional team of psychiatrists, psychologists, occupational therapists, nurse s aide and art-educator. The joint of this service with others that make part of the Mental Health Assistance network in Natal is incipient. Due to this fact, some actions and activities that could and should be developed together are just not. Although facing difficulties, the professionals of the Ambulatory Clinic of Ribeira are able to achieve good results and establish care in Mental Health that prioritize sheltering, listening and respect to the user s individuality. The Ambulatory Clinic of Ribeira is organized according to the paradigm of the Psychiatric Reform. Therefore, it offers an attention that stimulates the re-socialization of the users and the exercise of the citizenship and autonomy of those

Gestão pública em saúde mental: um estudo em CAPS com gerência pública e privada do Rio Grande Do Norte

Currently, several models of management services from the public administration are in operation in Brazil following a global trend. Besides the traditional public management operated in SUS, there are ongoing experiments of privately management in the public health services. Accordingly, we have developed an investigation into two Psychosocial Care Centers operating between these two forms of financial resources management: the first is the CAPS II - PAR situated in the municipality of Parnamirim whose form is private and the second is the CAPS II West Christmas is that the municipal government. We seek to know the workings of services, planning forms and criteria for use of financial resources, identify differences between departments on ways to run and see how technicians and users participate in the planning and management of these resources. Documentary Research was conducted by the municipal Christmas and the financial administration of the CAPS service in Parnamirim. Were conducted an interview with manager (mental health coordinator of Natal) and another interview with an employee of planning department in the Health Department of Natal, an interview with the coordinator and financial administrator of CAPS - PAR and two groups of discussion taped conversation with semi structured script interviews with six technicians in CAPS PAR and six professionals crowded in CAPS - West.Differences were observed in the management of resources funded from four blocks of discussion and analysis of results, where the privately-run service for the direct management and bureaucracy without being discussed and planned spending on staff, as well as through meetings with users, the use of the financial resources available in box; already in service with municipal public administration there is a hierarchy, this answering the coordination of mental health and the local health department that centralizes resources and defines their spending. There are meetings with patients and families, but the demands are limited as to what can be sued because of the manager s authorization. Such differentiation would be related to differences in the articulation of public management with the different types of possible management in public services, where from the implementation of new public administration in the Brazilian s State Management Reform initiated in the second half of the 1990s, benefit management services with private regime, with autonomy and direct transfer of resources

Política de transferência de renda e desenvolvimento local: o programa Bolsa família no município de Pedra Grande/RN

The Family Scolarship Program while public politics of intersectorial form developed by Social Development Department and Famine Combat having with partner the Education Department and Health Department inaugurate in the country a new integrity way of the public politics, reinforcing a precept of 2004 Social Protection National Politics (PNAS 2004) that places the social protection while allied to the social and human development. The research INCOME TRANSFER AND LOCAL DEVELOPMENT: the family scolarship program in Pedra Grande-RN municipally had as aim to avaluate the permanent Family Scolarship Program as a possible element in local development of Pedra Grande-RN municipally understood as capacity expansion and improvement of life quality from its users. For this means we elaborate specifically the families` socio-economical profile; we avaluate the program repercussion in these families` lives; we analyse in which proportion occurred the capacity expansion and improvement of life quality of the users. The methodologic process was constituted by: literarture review about Income Transfer, Social Vulnerability, Development and Public Politics Avaluation to the criation of a theoric picture analysis. The documental research joined to the Social Development Department and Famine Combat of Pedra Grande Municipally Hall to obtain of the aims, program goals, and the profile of users. And finally, carrying out the interviews with the managers and experts of the Municipally Program and focal groups with the users to avaluate the permanent of the Program starting by the points of view of those ones. It was verified that the program expand the capacity (food, consumer goods and services, bank services access and wages) and improvement in life quality of the users. Nevertheless, there are deficiencies in coming with conditionality and from the use of resources the by families users

QualiAB: desenvolvimento e validação de uma metodologia de avaliação de serviços de atenção básica

Este artigo apresenta o desenvolvimento, validação e utilização de uma metodologia de avaliação da qualidade dos serviços de atenção primária do Sistema Único de Saúde (SUS), o Questionário de Avaliação da Qualidade de Serviços de Atenção Básica (QualiAB). Destina-se aos serviços de atenção básica, organizados segundo diferentes modelos de atenção, incluindo a Saúde da Família. Contém 50 indicadores sobre oferta e organização do trabalho assistencial e programático e 15 sobre gerenciamento, na forma de questões de múltipla escolha, autorespondidas via web pela equipe local do serviço. Confere a cada resposta valor zero, um ou dois; a média geral atribui ao serviço um grau de qualidade expresso pela distância do melhor padrão correspondente à média dois. Foi construído por processo de consenso interativo, que incluiu metodologias qualitativas, teste-piloto, aplicação em 127 serviços, validação de construto e confiabilidade. Respondido, em 2007, por 598 (92%) dos serviços de 115 municípios paulistas, mostrou bom poder para discriminar níveis de qualidade. Adotado em 2010 como parte de um programa de apoio à Atenção Básica da Secretaria de Estado da Saúde de São Paulo, foi respondido por 95% (2.735) dos serviços de 586 municípios (90,8% do Estado). Os resultados foram encaminhados aos municípios. O QualiAB fornece uma avaliação válida, simples e com a possibilidade de retorno imediato para gerentes e profissionais. Mostrou factibilidade, aceitabilidade, bom poder de discriminação e utilidade para auxiliar a gestão da rede de atenção básica do SUS em São Paulo. A experiência indica aplicabilidade nas redes de atenção básica do Brasil.

Contextualização da pesca mundial de lagostas e características de comercialização de Scyllarides spp. E Panulirus spp. na Baixada Santista, estado de São Paulo, Brasil

This study aimed to contextualize the world's lobster fishing and identify the characteristics of their trades in Santos region (SP). For this purpose, were realized surveys about the captures of 56 years referring the families traded in the world through the informations supplied by the FAO (Food and Agriculture Organization). To State of São Paulo, consults were made in the data base Propesq (Fishing Institute) about the fishing and prices. Besides interviews in fishmonger, businessmen of fishing and restaurant, we observed the trade and the economical potential compared the lobsters Scyllarides spp. and Panulirus spp. The worldwide the family Nephropidae is the one that has been presenting bigger growth in the captures from 1950 and the one that has the biggest observed captures, the Palinuridae showed a little growth of the captures up to the 80' years, and leaving from there it is oscillating without many expressive changes; Scyllarides began to stand out as fisheries only 70' in Asia, precisely where the other two Families had low catches proportional. In the State of São Paulo, two types of lobsters are sold in Baixada Santista, with conspicuous differences in prices between them. There is also a difference in the flow of trade in relation to active fishing gear. Traders notice a decrease in both abundance and size of individuals of both genders and a clear preference to sell the slippers lobsters (Scyllarides spp.) both for the quality of meat as the lowest price.

Cooperação e apoio técnico entre estado e municípios: a experiência do programa articuladores da atenção básica em São Paulo

Com os processos de regionalização no final dos anos 1990, os estados iniciam um resgate de seu papel político para enfrentamento da fragmentação do sistema público de saúde. Nesse processo, as secretarias estaduais de saúde, representadas pelo Conselho Nacional de Secretários de Saúde, passam a redefinir as funções do Estado junto à Atenção Básica. Na histórica atuação da Secretária de Estado da Saúde de São Paulo (SES-SP) na atenção primária, uma das marcas refere-se à expertise profissional nesse campo, que com o processo de municipalização migrou para os municípios, especialmente os de maior porte, ou redefiniu suas áreas de atuação no interior da própria SES-SP, em áreas como a vigilância epidemiológica e sanitária, a de avaliação e controle, entre outras. Esse capital humano foi em parte resgatado a partir de 2009, com o Programa Articuladores de Atenção Básica. O Programa representa uma política de apoio da SES-SP para os municípios, priorizando aqueles com população inferior a 100 mil habitantes, com o objetivo de auxiliar os gestores municipais na qualificação dos serviços de Atenção Básica e fortalecer esse nível de atenção no sistema público de saúde. Toma como objeto de trabalho o reconhecimento de prioridades de saúde locais e dos obstáculos para a melhoria da atenção à saúde, na construção conjunta de estratégias e alternativas de enfrentamento dos problemas identificados. Este artigo apresenta o processo de implantação desse Programa, bem como alguns resultados referentes às principais frentes de atuação desses profissionais na busca da qualificação da atenção básica no estado.

Simultaneous determination of As, Cu, Mn, Sb, and Se in drinking water by GRAS with transversely heated graphite atomizer and longitudinal Zeeman-effect background correction

A method has been developed for the direct and simultaneous determination of As, Cu, Mn, Sb, and Se in drinking water by electrothermal atomic absorption spectrometry (ETAAS) using a transversely heated graphite tube atomizer (THGA) with longitudinal Zeeman-effect back- ground correction. The thermal behavior of analytes during the pyrolysis and atomization stages was investigated in 0.028 mol L-1 HNO3, 0.14 mol L-1 HNO3 and 1 + 1 (v/v) diluted water using mixtures of Pd(NO3)(2) + Mg(NO3)(2) as the chemical modifier, With 5 mug Pd + 3 mug Mg as the modifier, the pyrolysis and atomization temperatures of the heating program of the atomizer were fixed at 1400degreesC and 2100degreesC, respectively, and 20 muL of the water sample (sample + 0.28 mol L-1 HNO3, 1 + 1, v/v), dispensed into the graphite tube, analytical curves were established ranging from 5.00 - 50.0 mug L-1 for As, Sb, Se; 10.0 - 100 mug L-1 for Cu; and 20.0 - 200 mug L-1 for Mn. The characteristic masses were around 39 pg As, 17 pg Cu, 60 pg Mn, 43 pg Sb, and 45 pg Se, and the lifetime of the tube was around 500 firings. The limits of detection (LOD) based on integrated absorbance (0.7 mug L-1 As, 0.2 mug L-1 Cu, 0.6 mug L-1 Mn, 0.3 mug L-1 Sb, 0.9 mug L-1 Se) exceeded the requirements of the Brazilian Food Regulations (decree # 310-ANVS from the Health Department), which established the maximum permissible level for As, Cu, Mn, Sb, and Se at 50 mug L-1, 1000 mug L-1, 2000 mug L-1, 5 mug L-1, and 50 mug L-1, respectively. The relative standard deviations (n = 12) were typically < 5.3% for As, < 0.5% for Cu, < 2.1% for Mn, < 11.7% for Sb, and < 9.2% for Se. The recoveries of As, Cu, Mn, Sb, and Se added to the mineral water samples varied from 102-111%, 91-107%, 92-109%, 89-97%, and 101-109%, respectively. Accuracy for the determination of As, Cu, Mu Sb and Se was checked using standard reference materials NIST SRM 1640 - Trace Elements in Natural Water, NIST SRM 1643d - Trace Elements in Water, and 10 mineral water samples. A paired t-test showed that the results were in agreement with the certified values of the standard reference materials at the 95% confidence level.

Simultaneous determination of cadmium and lead in wine by electrothermal atomic absorption spectrometry

A method has been developed for the direct simultaneous determination of Cd and Pb in white and red wine by electrothermal atomic absorption spectrometry (ET-AAS) using a transversely heated graphite tube atomizer (THGA) with longitudinal Zeeman-effect background correction. The thermal behavior of both analytes during pyrolysis and atomization stages were investigated in 0.028 mol l(-1) HNO3 and in 1 + 1 v/v diluted wine using mixtures of Pd(NO3)(2) + Mg(NO3)(2) and NH4H2PO4 + Mg(NO3)(2) as chemical modifiers. With 5 mug Pd + 3 mug Mg as the modifiers and a two-step pyrolysis (10 s at 400 degreesC and 10 s at 600 degreesC), the formation of carbonaceous residues inside the atomizer was avoided. For 20 mul of sample (wine + 0.056 mol l(-1) HNO3, 1 + 1, v/v) dispensed into the graphite tube, analytical curves in the 0.10-1.0 mug l(-1) Cd and 5.0-50 mug l(-1) Pb ranges were established. The characteristic mass was approximately 0.6 pg for Cd and 33 pg for Pb, and the lifetime of the tube was approximately 400 firings. The limits of detection (LOD) based on integrated absorbance (0.03 mug l(-1) for Cd, 0.8 mug l(-1) for Pb) exceeded the requirements of Brazilian Food Regulations (decree #55871 from Health Department), which establish the maximum permissible level for Cd at 200 mug l(-1) and for Pb at 500 mug l(-1). The relative standard deviations (n = 12) were typically < 8% for Cd and < 6% for Pb. The recoveries of Cd and Pb added to wine samples varied from 88 to 107% and 93 to 103%, respectively. The accuracy of the direct determination of Cd and Ph was checked for 10 table wines by comparing the results with those obtained for digested wine using single-element ET-AAS, which were in agreement at the 95% confidence level. (C) 2001 Elsevier B.V. B.V. All rights reserved.

Simultaneous determination of As, Cu, Mn, Sb, and Se in drinking water by GFAAS with transversely heated graphite atomizer and longitudinal zeeman-effect background correction

A method has been developed for the direct and simultaneous determination of As, Cu, Mn, Sb, and Se in drinking water by electrothermal atomic absorption spectrometry (ETAAS) using a transversely heated graphite tube atomizer (THGA) with longitudinal Zeeman-effect background correction. The thermal behavior of analytes during the pyrolysis and atomization stages was investigated in 0.028 mol L-1 HNO3, 0.14 mol L-1 HNO3 and 1 + 1 (v/v) diluted water using mixtures of Pd(NO3)2 + Mg(NO3)2 as the chemical modifier. With 5 μg Pd + 3 μg Mg as the modifier, the pyrolysis and atomization temperatures of the heating program of the atomizer were fixed at 1400°C and 2100°C, respectively, and 20 μL of the water sample (sample + 0.28 mol L-1 HNO3, 1 + 1, v/v), dispensed into the graphite tube, analytical curves were established ranging from 5.00 -50.0 μg L-1 for As, Sb, Se; 10.0 - 100 μg L-1 for Cu; and 20.0 - 200 μg L-1 for Mn. The characteristic masses were around 39 pg As, 17 pg Cu, 60 pg Mn, 43 pg Sb, and 45 pg Se, and the lifetime of the tube was around 500 firings. The limits of detection (LOD) based on integrated absorbance (0.7 μg L-1 As, 0.2 μg L-1 Cu, 0.6 μg L-1 Mn, 0.3 μg L-1 Sb, 0.9 μg L-1 Se) exceeded the requirements of the Brazilian Food Regulations (decree # 310-ANVS from the Health Department), which established the maximum permissible level for As, Cu, Mn, Sb, and Se at 50 μg L-1, 1000 μg L-1, 2000 μg L-1, 5 μg L-1, and 50 μg L-1, respectively. The relative standard deviations (n = 12) were typically < 5.3% for As, < 0.5% for Cu, < 2.1% for Mn, < 11.7% for Sb, and < 9.2% for Se. The recoveries of As, Cu, Mn, Sb, and Se added to the mineral water samples varied from 102-111%, 91-107%, 92-109%, 89-97%, and 101-109%, respectively. Accuracy for the determination of As, Cu, Mn, Sb, and Se was checked using standard reference materials NIST SRM 1640 - Trace Elements in Natural Water, NIST SRM 1643d - Trace Elements in Water, and 10 mineral water samples. A paired t-test showed that the results were in agreement with the certified values of the standard reference materials at the 95% confidence level.

Associação entre o achado de cárdia incompetente à endoscopia digestiva alta e presença de esofagite de refluxo

Incompetent cardia (IC) or loose cardia is not uncommon at endoscopic examination but its meaning is not clear. Such incompetence could facilitate gastroesophageal reflux and the appearance of esophagitis as a consequence. The aim of this study is to investigate if there is an association between IC and reflux esophagitis (RE). A review was made of 395 consecutive endoscopic reports of adult males and females performed at the Botucatu Clinics Hospital, of the Unesp - University of the State of São Paulo. Diagnosis of IC is defined by the endoscopic image in which the cardia is partially opened and/or involves the endoscope in a loose manner. Esophagitis characterization was based in the Los Angeles classification. The statistical analysis showed a significant association between CI and RE (p < 0.0001). Although there is not a clear explanation for this association, some hypotheses could be suggested involving hypotonic LES, diaphragmatic crura ineffectiveness and TLESR disorders as conditions able not only to keep the cardia relaxed but also to the reflux followed by esophagitis.

Avaliação da assistência pré-natal e puerperal desenvolvidas em região do interior do Estado de São Paulo em 2005

Objectives: to evaluate the structure and process of the prenatal and puerperal care given by Direção Regional de Saúde (DIR) XI, at the city of Botucatu, State of São Paulo, Brazil. Methods: an evaluation of resources and activities developed during prenatal and puerperal care in twenty municipalities comprising DIR XI which had adhered the Prenatal and Birth Humanization Program until 2003. Interviews with city managers and analysis of 385 sampled patient charts taking into account recommendations by the Health Department. Results: structure analysis showed that caregiving was centered on medical work; basic equipment and instruments were available; 85.2% of patients began prenatal care with up to 120 days of pregnancy, and 75.9% had at least six prenatal consultations. The active search for absentees and strategies for early prenatal care initiation were observed in 30% and 50% of the municipalities, respectively. Process indicators showed that 3.6% of women had six prenatal consultations, one puerperal consultation, all basic exams and tetanus immunization. Recording of gestational age, arterial blood pressure and weight was of approximately 90%; 58.7% of the women underwent childbirth review and 31.5% were vaccinated. Conclusions: the performance of the set of activities is a challenge to prenatal care at DIR XI.

Programa de empleo juvenil: Encuentro de Mejores Prácticas con Jóvenes del Cono Sur

Incluye Bibliografía