Câncer de mama: vivência das usuárias dos serviços prestados pela Liga Norte Riograndense Contra o Câncer

This study is about the users' experiences of the services offered by League Against Câncer that are in treatment of breast cancer, focusing on how the health/illness process develops. It is distinguished, in this context, the National Politics of Health, approaching the sprouting, implantation and consolidation process of the Unified Health System and its shocks on the installment of health services to the low-income population as a legit right from Citizen Constitution. It has as an objective to analyze how the social-economic extract of these women intervenes with such process, the aspects who involve the cancer while a pathology, approaching the signals, symptoms, forms of prevention, diagnosis, among other aspects that configure themselves as important points to the understanding of these experiences, since the diagnosis, treatment and control phases. The research was carried out with 25 women, between the months of January and February of year of 2005. The used technique was the scriptstructured interview, whose universe was defined through intentional sample. The following distinguishes as a result of the research: The majority of the women has its origins on the interior of the state, possesses a familiar income from one to three minimum wages and didn't make any kind of prevention before diagnosis, currently make treatment, beyond other aspects. It becomes necessary posterior studies on this social problematic, with respect to the personal, professional, familiar and social daily behavior of these women. It is worth mentioning that the role of the social assistant in the developed work with these women, understanding all the impediments associated with such experiences, as well as giving information about the rights of the patients with cancer, conquered through the years

Um ambiente para especificação e execução AD-HOC de processos de negócio baseados em serviços Web

Recently the focus given to Web Services and Semantic Web technologies has provided the development of several research projects in different ways to addressing the Web services composition issue. Meanwhile, the challenge of creating an environment that provides the specification of an abstract business process and that it is automatically implemented by a composite service in a dynamic way is considered a currently open problem. WSDL and BPEL provided by industry support only manual service composition because they lack needed semantics so that Web services are discovered, selected and combined by software agents. Services ontology provided by Semantic Web enriches the syntactic descriptions of Web services to facilitate the automation of tasks, such as discovery and composition. This work presents an environment for specifying and ad-hoc executing Web services-based business processes, named WebFlowAH. The WebFlowAH employs common domain ontology to describe both Web services and business processes. It allows processes specification in terms of users goals or desires that are expressed based on the concepts of such common domain ontology. This approach allows processes to be specified in an abstract high level way, unburdening the user from the underline details needed to effectively run the process workflow

Cloud Integrator: uma plataforma para composição de serviços em ambientes de computação em nuvem

With the advance of the Cloud Computing paradigm, a single service offered by a cloud platform may not be enough to meet all the application requirements. To fulfill such requirements, it may be necessary, instead of a single service, a composition of services that aggregates services provided by different cloud platforms. In order to generate aggregated value for the user, this composition of services provided by several Cloud Computing platforms requires a solution in terms of platforms integration, which encompasses the manipulation of a wide number of noninteroperable APIs and protocols from different platform vendors. In this scenario, this work presents Cloud Integrator, a middleware platform for composing services provided by different Cloud Computing platforms. Besides providing an environment that facilitates the development and execution of applications that use such services, Cloud Integrator works as a mediator by providing mechanisms for building applications through composition and selection of semantic Web services that take into account metadata about the services, such as QoS (Quality of Service), prices, etc. Moreover, the proposed middleware platform provides an adaptation mechanism that can be triggered in case of failure or quality degradation of one or more services used by the running application in order to ensure its quality and availability. In this work, through a case study that consists of an application that use services provided by different cloud platforms, Cloud Integrator is evaluated in terms of the efficiency of the performed service composition, selection and adaptation processes, as well as the potential of using this middleware in heterogeneous computational clouds scenarios

Uma máquina de redução de grafos para serviços web

Web services are software accessible via the Internet that provide functionality to be used by applications. Today, it is natural to reuse third-party services to compose new services. This process of composition can occur in two styles, called orchestration and choreography. A choreography represents a collaboration between services which know their partners in the composition, to achieve the service s desired functionality. On the other hand, an orchestration have a central process (the orchestrator) that coordinates all application operations. Our work is placed in this latter context, by proposing an abstract model for running service orchestrations. For this purpose, a graph reduction machine will be defined for the implementation of service orchestrations specified in a variant of the PEWS composition language. Moreover, a prototype of this machine (in Java) is built as a proof of concept

Lazer e urbanização: a dinâmica do setor de serviços no litoral de Parnamirim e Nísia Floresta - RN

The research here undertaken analyzes the process of urbanization on the coast of Panamirim - RN and Nísia Floresta - RN, arising from leisure, the main leisure expression was considered the second residence and coastal tourism. The leisure promoted the growth of businesses and public and private services to meet consumer demand in that area, which initially occurred with users of second home, and which also gradually begin to occupy the coastline of these municipalities in 1980 and more recently with the development of tourism in the 1990s until now. To undertake such an analysis, we did the georeferencing about the trade and also public and private services of that coast, characterizing them; evaluated the extent to which services deployed in this area meets the demands of tourists and users of second residence; it was also identified how the centrality of Natal interferes in the expansion of services in these locations. The spatial area of research includes the coastal municipalities of Parnamirim and Nísia Floresta, considering the limits of the census of the Instituto Brasileiro de Geografia e Estatística- IBGE, and about the time frame, it was considered the 1990s to the present day. The methodology consists of: 1. survey and reading of the literature related to the researched topic, serving as the theoretical analysis in the construction of the object studied; 2. collection and organization of secondary data by the IBGE and tourism sectors of the State of Rio Grande do Norte, Natal and main municipalities of the research; 3. Questionnaires and / or interviews with the traders, service providers, tourists, users of second homes, local residents, and government. The analysis of such data collected allowed the preparation of graphs, maps and tables that illustrate the results obtained in the research field, basing so the study. The relevance of the study is shown by the extensive survey data involving agents of the research, including tourists, users of second homes and, above all, the data for the service sector that did not exist in the analyzed area. The study results identified in the area analyzed the emergence of three new centers, arising from the urbanization process from leisure, one of them located in the municipality of Nísia Foresta Beach in Barra de Tabatinga, and two in Parnamirim, more specifically in locality Pium and Beach Pirangi do Norte. It was further observed that, being located in tourist areas, the main feature of these new centers is seasonality

Análise da percepção da qualidade ambiental e de serviços turísticos em João Pessoa/PB

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

A saúde ambiental e os resíduos de serviços de saúde nos três níveis de complexidade do Sistema Único de Saúde - SUS

The environmental management in the health establishments is a reality still little explored in the health sector in Brazil, especially concerning its wastes. The management of wastes of health services is established in the valid legislation through the National Council of Environment and Sanitary Vigilance Agency (358/2005 and 304/2004 respectively). The present work is about a descriptive work about the environmental health in the health services. The used criterion was to diagnose the environmental management in twelve establishments of health inserted in the three levels of complexity of the Unique Health System (Sistema Ùnico de Saúde SUS). Among the sub criteria used the waste management is the one of bigger concern. The one referring to the water quality is considered good. The analysis of data reveals that 66% of the establishments got a poor environmental ranking, 17% critical and 17% appropriate, showing that the health establishments in the three levels of complexity of the SUS need urgent structural, environmental and educational interventions

A redefinição do espaço urbano de Natal/RN a partir da influência dos serviços: uma análise das avenidas Bernardo Vieira e Engenheiro Roberto Freire

This paper analyzes the influence of trade and services in the reconfiguration of urban space in Natal, with the Avenues Bernardo Vieira end Roberto Freire Engineer as privileged analysis. Initially, we discussed the concepts of production and reproduction of urban space, urban centralities, decentralized, services and public policies, especially transport and tourism. Then, we show the construction of urban space from Natal, highlighting the historical formation of the districts of Ribeira, Cidade Alta and Alecrim, pioneers in the service sector, noting that currently there is an ongoing process of decentralization in the city of such activities, to other areas of the urban fabric of Natal. Later, we studied the Avenues Bernardo Vieira to Roberto Freire Engineer, noting, in both the distribution of commercial activities and services, and issues related to transportation, traffic, tourism and socio-economic problems, identified them. Finally, testify that Natal, from the 1980s, underwent a process of decentralization of services, both to the south, and north of the city on the ball. In this process of decentralization we ascertain the role of public policies on transport and tourism, complementing the action of private enterprise, through the real estate market, on Avenue Roberto Freire Engineer.

A CRONIFICAÇÃO NOS SERVIÇOS SUBSTITUTIVOS NA REDE DE SAÚDE MENTAL DE NATAL/RN

Brazilian Psychiatry Reform, through Psychosocial Care Strategy, has intended to build insane people care practices from community care services which contemplates the subjects complete lives. However, to change the traditional care ways demands the facing of a series of epistemological, political and cultural obstacles. One of the current challenges deals with patients aggravation processes, with management ways, with devices and with professionals, as well as with the assistance network. The purpose of this thesis was to investigate how these aggravation processes has been constituted in Natal mental healthcare network, understanding its effects in the work teams and patients. Theoretical and methodological perspective used was Institutional analysis was, subsidizing the usage of concept-tools as the implication analysis, selfmanagement and self-analysis, and restitution. The research was carried out at the Natal East Sanitary District Mental Healthcare Clinic, with the participation of technicians and patients. The research procedures were: literature and document research on the attendance and the analyzed theme; attendance registers analysis; participating observation of the institutional routine for three months and field log entries; talking groups, one with the team and one with the patients. Two main discussion points are shown: 1. The mental healthcare clinic organization logic and the intersector politics; 2. The work and management processes developed at the mental healthcare clinic. The analysis show diversity in the attended demands in the service, which has favored the patients aggravation, this device and the substitute network processes. The work processes are apart from the political sphere and from the managements processes. In this sense, we show the need to reevaluate the clinic device as well as the management models adopted in the Brazilian Psychiatry Reform context

O cuidado em saúde no ciclo gravídico-puerperal sob a perspectiva de usuárias de serviços públicos

O objetivo do trabalho foi apreender as representações sociais de puérperas sobre o cuidado em saúde no período pré-natal, no parto e no puerpério, em um contexto regional de serviços públicos de saúde do interior paulista. Seguindo a abordagem de pesquisa qualitativa, os dados foram colhidos por meio de entrevistas semi-estruturadas, realizadas em 2004, e organizados segundo o método do Discurso do Sujeito Coletivo, tendo o Programa de Humanização do Pré-natal e Nascimento (PHPN) como referencial teórico para discussão dos resultados. A perspectiva das puérperas sobre o cuidado em saúde no ciclo gravídico-puerperal evidenciou a importância das relações interpessoais, a essencialidade da qualidade técnica do atendimento e a propriedade da percepção de que o sujeito da atenção é a mulher e, como tal, dela deve participar efetivamente. Conclui-se que as diretrizes do PHPN devem ser incorporadas de forma mais ampla nas práticas de saúde voltadas à mulher, recomendando-se a adoção de indicadores específicos para avaliação das dimensões do cuidado evidenciadas por este estudo.

O uso do território pelos serviços privados de saúde em Natal/RN

Nowadays we can observe in Natal city, the development of the structure and the health s private service. However, the spatial distribution of these services will be marked by an uneven distribution on the places, what will be in according with the conditions offered by the same in each historical period. Accordingly, the objective of this job is analyze the use of the territory by the health s private service and the dynamics that promotes in Natal city in the technical scientific information period. Thus, seeking to search this goal, realized literature, documentary, empirical, considering the process of development and the spatial distribution of the health s private service in the city. From a topology we can observe that prevails in the city a service s concentration at all levels of complexity in only a few neighborhoods, being Tirol and Petrópolis, which are neighborhoods that have high densities of engineer system, bigger fluidity, and the best level salaries of the city, which present a greater number of these establishments. However, equal this concentration has occurred a dispersion of these services to other neighborhoods, as for example Lagoa Nova which is presenting the same attractiveness in the view of attributes territorial, begins to protect services presenting the same profile like the firsts. However, the city has a significant demand to this kind of service found in these neighborhoods, some events provided the emergency of another type of market of health s private service, that are those created to attend guests with a lower purchasing power, which will have their establishments in the same way selectively distributed in some areas of the city, which will not be the same pursued by the other, showing how selective is the installation of an enterprise guide by the logic of capitalism reproduction. So, the imperative of spatial selectivity presented by the health s private sector exposes an use of the differential territory for these services

Detecção do risco de suicídio nos serviços de emergência psiquiátrica

OBJETIVO: Auxiliar o profissional de saúde na identificação dos fatores de risco e de proteção, e no manejo de pacientes com risco de suicídio, por meio de entrevista clinica, no contexto de emergência médica. MÉTODO: Revisão seletiva da literatura para identificar achados clínicos relevantes e ilustrativos. RESULTADO: A entrevista clinica é o melhor método para avaliar o risco suicida e tem dois objetivos: 1) apoio emocional e de estabelecimento de vínculo; 2) coleta de informações. Existe um número considerável de informações a serem coletadas durante a entrevista: fatores de risco e proteção (predisponentes e precipitantes), dados epidemiológicos, caracterização do ato, aspectos psicodinâmicos, antecedentes pessoais e familiares, modelos de identificação, dados sobre saúde física e rede de apoio social. Dificuldades ao longo da entrevista serão encontradas, mas com conhecimento e treinamento adequado, o profissional poderá abordar e ajudar adequadamente o paciente. Embora várias escalas tenham sido propostas, nenhuma delas demonstrou eficiência para a detecção de risco de suicídio. CONCLUSÃO: Não há como prever quem cometerá suicídio, mas é possível avaliar o risco individual que cada paciente apresenta, tendo em vista a investigação detalhada e empática da entrevista clinica. Impedir que o paciente venha a se matar é regra preliminar e fundamental.

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.

Avaliação de serviços de assistência ambulatorial em aids, Brasil: estudo comparativo 2001/2007

OBJETIVO: Avaliar os serviços do Sistema Único de Saúde brasileiro de assistência ambulatorial a adultos vivendo com aids em 2007 e comparar com a avaliação de 2001. MÉTODOS: Os 636 serviços cadastrados no Ministério da Saúde em 2007 foram convidados a responder a um questionário previamente validado (Questionário Qualiaids) com 107 questões de múltipla escolha sobre a organização da assistência prestada. Analisaram-se as frequências das respostas de 2007 comparando-as com as obtidas em 2001 na forma de variação percentual (VP). RESULTADOS: Responderam o questionário 504 (79,2%) serviços. Cerca de 100,0% dos respondentes relataram ter pelo menos um médico, suprimento sem falhas de antirretrovirais e de exames CD4 e carga viral. Vários aspectos mostraram melhor desempenho em 2007 comparados a 2001: registro de número de faltas à consulta médica (de 18,3 para 27,0%, VP: 47,5%), agendamento de consulta em menos de 15 dias no início da terapia antirretroviral (de 55,3 para 66,2%, VP: 19,7%) e participação organizada do usuário (de 5,9 para 16,7%, VP: 183,1%). Houve manutenção de dificuldades: pequena variação na disponibilidade de exames especializados em até 15 dias, como endoscopia (31,9 para 34,5%, VP: 8,1%), e a piora de indicadores como tempo ideal de acesso a consultas especializadas (55,9 para 34,5% em cardiologia, VP negativa de 38,3%). O tempo médio despendido nas consultas médicas de seguimento manteve-se baixo: 15 minutos ou menos (52,5 para 49,5%, VP negativa de 5,8%). CONCLUSÕES: A avaliação de 2007 mostrou que os serviços contam com os recursos essenciais para a assistência ambulatorial. Houve melhoras em muitos aspectos em relação a 2001, mas persistem desafios. Pouco tempo dedicado à consulta médica pode estar vinculado ao número insuficiente de médicos e/ou à baixa capacidade de escuta e diálogo. A acessibilidade prejudicada a consultas especializadas mostra a dificuldade das infraestruturas locais do Sistema Único de Saúde.

Absenteísmo por motivos odontológico e médico nos serviços público e privado

O absenteísmo é um assunto de interesse crescente devido ao atual contexto econômico de competitividade, que faz com que as empresas procurem meios para diminuir sua ocorrência, aumentando a rentabilidade e com isso crescendo de forma sustentada. Procurou-se estudar o absenteísmo por razões odontológicas e médicas, nos serviços público e privado, analisando se a idade, o sexo e a função do trabalhador, além do regime empregatício, interferem na sua ocorrência. Desenvolveu-se o estudo na prefeitura do município de Araçatuba, São Paulo, Brasil, e em uma indústria acrílica. Para a coleta dos dados, analisaram-se todos os atestados odontológicos e médicos, que deram entrada nas empresas no período de janeiro a junho de 2002 e as listagens dos trabalhadores. Verificou-se que a falta por motivos odontológicos tiveram pouco peso sobre o total de faltas por motivo de doença, além de provocarem o afastamento do trabalhador por um período menor. As variáveis idade, sexo, função e regime empregatício influenciaram na ocorrência do absenteísmo ao trabalho. A disponibilidade dessas informações deverá ser muito importante, pois, visto as inúmeras variáveis envolvidas, facilitarão a tomada de decisões das distintas estratégias para sua prevenção.