Saúde da família: uma estratégia de mudança no processo de produção dos serviços de saúde

The purpose of this study is to analyze, from the point of view of nurses, changes that took place in the process of providing health services after the introduction of the Family Health Program (FHP). It is na investigation of qualitative nature that uses semi-structured interviews as a main empirical approach tool. Six nurses from the city of Caicó, Rio Grande do Norte, who were working with basic care before the introduction of the FHP, within basic care, were: adscription and ties with the community; hospitality and the humanizacion of care-giving; decrease in cases of inpatient treatment; strengthening of the prevention of injuries and health promotion; improvemente of health indicatiors, finally, actions that point towads meeting the principles of wholeness, equity and universality as a declaration of the Brazilian National Health Care System (SUS). Nevertheless, in spite of all recognizable positive aspects, the FHP has some weaknesses, such as: the difficulty posed by colletive work; the mismatch between professional education and the demands of the current health standard; a poor physical infrastructure of the Basic Health Units; a high heath staff turnover and precarious work conditions. In addition to this, some strategies that can be used to help improve the process of providing health services have been pointed out, such as, coordination between sectors, continuous education, making work conditions less precarious and improving the means whereby heathy service management is conveyed,Tthus, finally, we understand that the FHP does bring forward meaningful changes to the process of provinding health services to strengthen the Brasilian National Health Care System (SUS), in spite of the fact that it lies within a scenario of adversities that can be overcome through the collective endeavor of the several social actors

Análise do modelo de gestão implantado no Centro de Atenção Psicossocial CAPS II OESTE de 1995 a 2005, situado no distrito sanitário Oeste do município de Natal/RN, à luz da Co-gestão

This dissertation has as aim the praxis of co-management of the health service of CAPS II OESTE of Natal-RN, where health workers, family members got to materialize guidelines and principles of psychiatric Brazilian reform in real possibilities of subjectivity construction, whereas they changed social relations in daily life. The path chosen to record was from testimonials and contributions of those who meant their done. Redeeming this story from social representations of the majority of their builders was an instigating, delicate and rewarding task, emphasizing the living memory, rebuilt in a line of time which could not be found in simple documentary collections. Mainly, by knowing that service routine was intense and had as characteristic the singular mobility itself from a creation process and therefore not always its dynamic allowed adequate records. At the same time, from this occurred the field and bibliographic research which allowed the detailed information from the prior milestones and motivated to the practice here reported. The rereading of concepts in an interface with the reports of the interviewees enabled the verification that the model of mental health advocated by psychiatric reform was understood. Once noticed the presence of the beliefs and values of people in motivating energy for the progress of reform, it has gone to fetch theoretical subsidies of administrative order to understand how they saw this building and that uniqueness has been printed. The theoretical way and praxis have tracked here has allowed to analyze how occurred such a process of production and subjectivity and collectives that when organize enabled themselves for analysis and intervention, including in crisis situations. Therefore, it was revealed that ethical and multi-disciplinarity, the humanitarian sense, the coresponsibility, co-production and horizontal management were the key factors for spread from a changing protagonist. One can thus conclude that co-management from that collective has been multi-disciplinary weaving a cross

Diagnóstico sócio-produtivo-econômico da comunidade de catadores de resíduos sólidos do município de Codó-MA: um estudo de caso

The research was carried out in the urban area in Codó-MA, a small city the east part of Maranhão, which has 4,228.000 km2 (IBGE, 2000) and population of 113,768 hab. (IBGE, 2008). The city is also inside Codó-MA micro-region. The city is located in one of the lacking area in Brazil, where the Human Development Index (IDH) is approximately 0,558. It does not present an adequate model of management when talking about solid residue collecting. All of the solid residue produced and collected in the city is stored in an open area that they call lixão , which is located in a residence area in the suburbs. Because of that, a problem that involves public health and environmental areas, we understand it is necessary to investigate the way the local government treats and manages the solid residue collecting, as well as, the social, economical and productive reality of those who are directly involved in the collecting itself, its productive chain of the material, including the handling, transportation and its final destiny. It means a social, productive, economical diagnosis, that in a such way,the local society and the organs of inspection can act in a better way to control the problems that include solid urban residue and come from a bad administration. That way, this work proposes to carry out a study that has as result a diagnosis with feasible alternatives on management, taking as basis, social and economical aspects that compound this productive chain. This work can bring great contributions to a better local reality through the introduction of an integrated and supported system of management of solid residue that includes a selective collecting and the creation of a sanitary area. Taking that into consideration, we can contribute to minimize the environmental impacts in Codó Novo, caused by the garbage

Gestão da satisfação e fidelidade do cliente : um estudo dos fatores que influenciam na satisfação e fidelidade dos clientes corporativos de telefonia celular

The competition in the telecommunications industry has grown in Brazil since the privatization, forcing companies that are active in the market to a growing commitment to quality products and services in order to survive. In this context, this work aims to understand the main factors that influence the degree of satisfaction exists in respect of a mobile operator with its corporate customers. The research covered theoretical concepts and analytical models of quality management system and models of indices related to the measurement of customer satisfaction. For the field research was carried out in a practical application of the main approaches based on this thesis by a case study in corporate segment, through a questionnaire applied to 10 consultants and 40 corporate customers of that company. Comparing the results of research with the consultants and corporate clients there is the concern of respondents to the indicators that comprise the constructs of customer satisfaction, commitment calculated, the price index and the handling of complaints, denoting the dissatisfaction of the general assessment for corporate customers with the carrier, against its current expectations. It is concluded that the mobile operator of the telecommunications industry have a big challenge, after ten years of privatization and consequently the period of rapid expansion of customer base and with the depleted, retain corporate customers as highly strategic, thus avoiding that migrate to other companies. We emphasize the need for further research and analysis of different approaches through research and using the same models to specifically evaluate and measure customer satisfaction of mobile enterprise, to adjust the model to the national market. Finally, we suggest the creation of an effective customer loyalty program with a strategy of relationship and specific to the corporate sector of mobile telephony

Proposta de um modelo de gestão da qualidade para micro e pequenas empresas integrando a estratégia seis sigma à NBR ISO 9001

This work has as its main purpose to set a model of Quality Management for micro and small companies integrating the management models: Six Sigma strategy to NBR ISO 9001:2000. An exploratory research is developed to collect technical and bibliographical information on both methods, emphasizing their integration. Then, a survey is carried out on 65 analysts/consultants of Quality Management Systems and it has detected, besides other factors, that current methodologies must be associated in order to reach better results. At last, it proposes the Sigma 9001 model, which aims to make it possible for micro and small companies to objectively and with low costs, implement a Quality Management System, able to assure competitive advantage through improvement identification in the processes, as well as an improvement in the companies management

Gestão da cadeia de fornecimento :um estudo em empresas de construção certificadas com a ISO 9000

The aim of this present research is to investigate about aplication of the supply chain management in Civil Construction, through perception of brasilian building companies directors. Research purpose includes potential benefits and main dificults analysis in supply chain management, beyond to identify decision criterions for suppliers and sales chain (commission agent and real state agency) choice and reduction, to facilility management in companies. The methodology used in this work considers the application of a questionnaire with scales of the type Likert being constituted of variables that compose the aspects of evaluation and of behaviors, beyond questions to identify the market profile of the respondents. For analysis statistics is used the descriptive, clusters and variance, ANOVA, analysis last two to verify the connections between variables. The results show more perception as for long terms contracts with suppliers for purchase of materials and services being decisive for companies nowadays (40%) than as for exclusive contracts with commission agents (30%). There is a positive appraisal about viability of hipotetic situations showed, but more caution as for disposition to apply them too. Another results aim for biggers dificults in management of chain links formed by commission agents and real state agencies, than chain links formed by anothers suppliers of materials and services. The companies for study were chosen among to those with ISO 9000 certificate until november 2001, considering that these companies have the best management systems, probably

Gestão ambiental na indústria do petróleo :um estudo sobre as práticas de gestão na perspectiva da aprendizagem organizacional

This work discusses the environmental management thematic, on the basis of ISO 14001 standard and learning organization. This study is carried through an exploratory survey in a company of fuel transport, located in Natal/RN. The objective of this research was to investigate the practices of environmental management, carried through in the context of an implemented ISO 14001 environmental management system, in the researched organization, from the perspective of the learning organization. The methodology used in this work is supported in the quantitative method, combining the exploratory and descriptive types, and uses the technique of questionnaires, having as scope of the research, the managers, employee controlling, coordinators, supervisors and - proper and contracted - of the company. To carry through the analysis of the data of this research, it was used software Excel and Statistical version 6.0. The analysis of the data is divided in two parts: descriptive analysis and analysis of groupings (clusters). The results point, on the basis of the studied theory, as well as in the results of the research, that the implemented ISO 14001 environmental system in the searched organization presents elements that promote learning organization. From the results, it can be concluded that the company uses external information in the decision taking on environmental problems; that the employees are mobilized to generate ideas and to collect n environmental information and that the company has carried through partnerships in the activities of the environmental area with other companies. All these item cited can contribute for the generation of knowledge of the organization. It can also be concluded that the company has evaluated environmental errors occurrences in the past, as well as carried through environmental benchmarking. These practical can be considered as good ways of the company to acquire knowledge. The results also show that the employees have not found difficulties in the accomplishment of the tasks when the manager of its sector is not present. This result can demonstrate that the company has a good diffusion of knowledge

Gestão de satisfação e fidelidade do cliente: um estudo dos fatores que afetam a satisfação e fidelidade dos compradores de automóveis

This Master s thesis presents a discussion on customer satisfaction models investigating the relations of antecedent variables service quality, price index, complaint handling, image, affective and calculative commitment, with satisfaction and loyalty. The scope of the research is the influence of service dimensions in the car buyer s satisfaction and loyalty. A sample of 91 customers was surveyed among new cars buyers of one brand in Natal city, Brazil, and the data was analyzed using multiple regression analysis. The literature review covers subjects such as customer satisfaction, management system, customer satisfaction measurement index models. The main findings suggest that satisfaction with the car brand is mainly influenced by customization of the service, time for accomplishing servicing, and the way the dealer handle complains. Regarding the dealer itself the main variable related to satisfaction is also time for accomplishing servicing. Considering customer loyalty, the customer satisfaction with the dealer explain strongly the loyalty with the brand/manufacturer. Also, the satisfaction, affective commitment and complains handling were found related to loyalty, as the stronger variables explaining the loyalty variance. One main conclusion is that service provided by dealers is one key factor influencing the customer satisfaction and loyalty in auto industry

Um breve estudo acerca do cotidiano do trabalho de produtores rurais: intoxicações por agrotóxicos e subnotificação

Pesquisas na área da Saúde no Trabalho têm revelado a preocupação com os agravos à saúde de trabalhadores rurais decorrentes da utilização de defensivos agrícolas. Diante disso, este estudo objetivou conhecer o cotidiano de trabalho de produtores rurais de uma cooperativa agrícola localizada no interior do estado de São Paulo, bem como avaliar a exposição deles quando da utilização de agrotóxicos no desenvolvimento de suas atividades. Esperamos, com base nos resultados, estar contribuindo com discussões sobre o tema relacionado à saúde dos trabalhadores no contexto considerado. Para coleta de dados, utilizamos entrevistas semi-estruturadas, aplicadas de formas individual e coletiva. Participaram do estudo cinqüenta produtores rurais que desenvolvem atividades nas lavouras de café, soja, trigo e milho. Os dados foram agrupados em cinco categorias e analisados qualitativamente. Os resultados expõem as características da atividade agrícola na região, a utilização dos equipamentos de proteção individual, as técnicas no uso dos agrotóxicos, o sofrimento psíquico e a produção rural e maneiras de lidar com as situações de intoxicação e alertar os órgãos competentes para o problema da subnotificação.

Saúde mental na estratégia saúde da família: notas cartográficas sobre processos de trabalho em saúde

This study aims to map the working process in the health area starting from the meeting between the family and health teams and mental trouble carriers./MTC. The area of research was the Family Health Unit of Ozeas Sampaio, which is located in the county of Teresina-PI. As regard to the methodology procedure, we used a semi-structured interview timetable, aimed to detail the care practices, admittance and diagnostics that those teams realize with their users. Three teams of eleven workers each were interviewed. There was a doctor, a nurse and two health community agents in each team. The other tools we used were a camp logbook, in which we wrote down some informal dialogs, daily observations and feelings of the unit, and also the accompaniment of the staffs in house calls as well as the weekly meetings in the unit. Those meetings allowed us the construction of two analytic axes: 1) description of the establishment (Family Health Unit) of the organization, (municipal foundation of health and the service network), and the institutions and practice of health. 2) Analysis of the meetings between the worker and the user of Mental Trouble Carriers. In the first axis, we verified the repetition of the working logic focused on jobs in the hospital with the maintenance of the hierarchical relations between worker and the work processes which dissociate management and watchfulness in health care. We identified the lack of physical structure, the lack of self-confidence of the worker in the attention of the mental health care. At the second axis, we assess that the meetings, at the Family Health Unit (FHU) or at the dwelling of the users cause nuisance, discomfort and anxiety to the workers because they deal with issues that go beyond what is named as being the health order such as life stories, family conflicts, unemployment, hunger, sexual and psychological violence. As a matter of fact, they involve difficulties for having new relationships, reception and responsibility for this request

Um enfoque psicológico da educação ambiental no contexto da gestão: uma experiência de Fernando de Noronha

Currently, many companies pay attention to the necessities of change of attitude in relation to the use of the natural resources and the environment quality of its products, mainly to keep a positive and competitive image in the market. This new concept of management associates the productive activities to the care with environment using the education of environment as a tool of programs of qualification directed toward the promotion of pro-environment behaviors. For effectiveness of this management it is essential the attachment of the employees and the major understanding of the importance of the preservation of the environment. This was the objective of the qualification process carried out in a lodge in Fernando de Noronha island. The purpose of this study, therefore, was to verify the power of this management system which fulfills the objectives of the environmental education. It was applied questionnaires to employees of three Inns and carried out a interview, in one Inn, with the participants of the program of qualification. The analysis of the data showed that the actions as care with the environment are strongly associates to the management system, which includes garbage control, as well water economy. It was observed that the environment accomplishment (EcoAntro) of the employees with environment decreases in proportion to their qualification. In the same way, as higher the instruction level, of the speaker and/or of the father, less is the apathy for environmental questions. It was also noticed that the knowledge about the development sustainability was very poorly used by the interviewed. The pro-environment behavior mentioned before, is not necessarily related to a local autonomy posture that could express a behavior related to job but not to environment it self. Therefore, a complete understanding about the reverberation of environment information an all the placed factors in a life stile facing a construction of sustainability remains as a question to be studied in future researches

As condições de trabalho na área de saúde e o processo de adoecimento da (o) assistente social

The requirements in the world of work in the contemporary impact on quality of life, health workers in their relations with users and other professionals of the healthcare team. Given this reality, this study discusses the working conditions in health and disease process of (a) having social goals as analyze the implications of working conditions in the disease (the) social workers in state hospitals Metropolitan Region Christmas (NMR); identify the main diseases affecting social workers in hospitals in the SESAP NMR and reveal the relationship between the disease processes of social and working conditions in hospitals in the state NMR. The research was guiding questions to reveal how to configure the work, conditions of work and of the disease process (the) social worker. To grasp the socioeconomic profile of (the) social workers, the characterization of the work, duties and responsibilities in the sociooccupational, factors that interfere with the disease process of (the) social workers of RMN, and actions and investments Policy on Occupational Health RN correlating to illness today is that we set for the unveiling of the movement of the object of study through the methodological approach with documentary research aimed at literature review; extensive direct observation correlated to real life observation and application of 66 (sixty-six) questionnaires. The data from the closed questions were treated using the Statistical Package for the Social Sciences (SPSS). The open questions were transcribed and then analyzed the light of theoretical work on the subject. The research reveals that social workers are subject to conditions and labor relations precarious illness causing health problems because some of these professionals, among them are: stress, allergies and skin conditions or, Read / WMSD among other diseases. Thus, we understand the need for debates about the relationship work (the) social worker and worker health before the contradictions of capital also present in public health services

Avaliação de impacto ambiental e gestão dos recursos natuarias no estuário Apodi Mossoró, nordeste do Brasil

The aim of this study is to investigate the eco-environmental vulnerability, its changes, and its causes to develop a management system for application of eco-environmental vulnerability and risk assessment in the Apodi-Mossory estuary, Northeast Brazil. This analysis is focused on the interference of the landscape conditions, and its changes, due to the following factors: the oil and natural gas industry, tropical fruits industry, shrimp farms, marine salt industry, occupation of the sensitive areas; demand for land, vegetation degradation, siltation in rivers, severe flooding, sea level rise (SLR), coastal dynamics, low and flat topography, high ecological value and tourism in the region and the rapid growth of urbanization. Conventional and remote sensing data were analyzed using modeling techniques based on ArcGIS, ER-Mapper, ERDAS Imagine and ENVI software. Digital images were initially processed by Principal Component Analysis and transformation of the maximum fraction of noise, and then all bands were normalized to reduce errors caused by bands of different sizes. They were integrated in a Geographic Information System analysis to detect changes, to generate digital elevation models, geomorphic indices and other variables of the study area. A three band color combination of multispectral bands was used to monitor changes of land and vegetation cover from 1986 to 2009. This task also included the analysis of various secondary data, such as field data, socioeconomic data, environmental data and prospects growth. The main objective of this study was to improve our understanding of eco-environmental vulnerability and risk assessment; it´s causes basically show the intensity, its distribution and human-environment effect on the ecosystem, and identify the high and low sensitive areas and area of inundation due to future SLR, and the loss of land due to coastal erosion in the Apodi-Mossoró estuary in order to establish a strategy for sustainable land use. The developed model includes some basic factors such as geology, geomorphology, soils, land use / land cover, vegetation cover, slope, topography and hydrology. The numerical results indicate that 9.86% of total study area was under very high vulnerability, 29.12% high vulnerability, 52.90% moderate vulnerability and 2.23% were in the category of very low vulnerability. The analysis indicates that 216.1 km² and 362.8 km² area flooded on 1m and 10m in sea levels respectively. The sectors most affected were residential, industrial and recreational areas, agricultural land, and ecosystems of high environmental sensitivity. The results showed that changes in eco-environmental vulnerability have a significant impact on the sustainable development of the RN state, since the indicator is a function of sensitivity, exposure and status in relation to a level of damage. The model were presented as a tool to assist in indexing vulnerability in order to optimize actions and assess the implications of decisions makers and policies regarding the management of coastal and estuarine areas. In this context aspects such as population growth, degradation of vegetation, land use / land cover, amount and type of industrialization, SLR and government policies for environmental protection were considered the main factors that affect the eco-environmental changes over the last three decades in the Apodi-Mossoró estuary.

Conhecimento sobre ergonomia no âmbito acadêmico: um estudo com alunos e professores de odontologia

OBJETIVO: As doenças osteomusculares são as afecções ocupacionais mais prevalentes em cirurgiões-dentistas. Nosso propósito: 1) investigar os conhecimentos, aplicabilidades clínicas dos princípios ergonômicos em discentes e docentes em atividades clínicas de uma universidade pública 2) pesquisar a incidência de sintomatologias dolorosas no pescoço, ombros, parte superior e inferior das costas, cotovelos, quadris, coxas, joelhos, tornozelos e pés no universo de alunos em estágios clínicos. 3) incitar discussões de normas e diretrizes ergonômicas na universidade. MÉTODOS: Esse estudo investigou o universo de alunos matriculados em disciplinas clínicas (148) e respectivos professores (30) do curso de odontologia da Universidade Federal do Rio Grande do Norte, Natal-RN a respeito dos princípios ergonômicos utilizados na rotina clínica. Paralelamente foi pesquisada a incidência de sintomatologia dolorosa nos alunos por intermédio do questionário nórdico e a partir dos resultados foi mensurado o índice de severidade dos sintomas em alunos. The Nordic Musculoskeletal Questionnaire (NMQ) é um instrumento de diagnóstico, proposto para padronizar a mensuração de relatos de sintomas osteomusculares. A análise dos dados foi através do programa SPSS-Statistical Package for the Social Sciences, versão 17.0 realizada analítica e descritivamente, com determinação das médias (x), desvio-padrão para variáveis quantitativas, freqüências simples e relativas para as variáveis categóricas, além da estatística de associação entre grupos (teste t) e a análise de associação do quiquadrado com nível de significância 5% entre as variáveis (Person). As respostas das questões abertas foram codificadas e transformadas em freqüências, descritas posteriormente. RESULTADOS: A aplicabilidade de medidas ergonômicas nas clínicas universitárias não foi evidenciada pelo universo de discentes e docentes. Quanto ao relato de sintomas osteomusculares o sexo feminino foi o mais acometido qualquer que seja o nível acadêmico cursado. As regiões anatômicas de maior grau de severidade de relatos dos sintomas foram: pescoço, parte inferior das costas, punhos, mãos e ombros, com significância etatística p<0,001. CONCLUSÃO: Em função dos achados os autores apresentam um protocolo de intervenção clínica baseado nos determinantes ergonômicos da Associação internacional de ergonomia (EAI) como medida de prevenção da saúde ocupacional dos futuros cirurgiões-dentistas ainda em processo de formação nas clínicas odontológicas das universidades.

A mineração artesanal e de pequena escala em pegmatitos e cerâmica no município de Parelhas, região do Seridó/Rio Grande do Norte

The working conditions, occupational health, occupational illness and workers quality of life, usually referring to the artisanal activities and the workers with a poor professional support. Because this reality is still present in locals without good infrastructure of social and economic attention, there is a need for a broad knowledge of problems related to the productive processes that include features of unsanitary and unhealthy. Despite the intense process of industrialization promoted by globalization and the growth of developing nations like Brazil, the activities of artisanal and small-scale mining are still suffering from the marginalization of their production processes and their workers. This dissertation deals with the description of mineral-based activities (MBA), especially the activities related to production processes of extraction and processing of red pottery and minerals in pegmatites in Parelhas city, Seridó, Rio Grande do Norte, which are conducted by small mining companies or artisanal miners. The study of the work process was based on direct observation, photographic documentation, ergonomics, health and occupational safety analysis, interviews and structured questionnaire with workers of the two activities. The results indicate the need for improvement in both workplaces (red pottery and pegmatites), adaptation of workers to safety standards specific to the workplace, more attention and care related to ergonomics and occupational safety, greater importance to economic and social relations among performed activities, workers and firms of mineral branch and better and greater integration of social policies, supported by different sectors of society with the intention of transforming the current social, cultural, labor and education situation