1000 resultados para Programa Grande Carajas
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Maternal and infant mortality have become a serious public health problem in Brazil, especially in northeasternand northern regions.In RioGrande do Norte, the high rates ofdeathsofmothersandbabies haveconcerned not onlythehealthauthorities andjusticeagenciessuch as the prosecution service. In 2011, State Public Ministry (MPE) has developed a proposition which was called “Nascer com Dignidade”, focused on the monitoring ofcare givenin prenatal, childbirth andpost childbirthin the cities. The aim of thisstudy was toinvestigate how the intervention of MPE works in maternal and child care. The method adopted to survey data was the case study by analyzing the skills of the reports which were carried out in four of the eight Public Health Regional Units (URSAP).A total of 26municipalities were chosenand the results showfragilityparticularly inprenatal care which can result in complicationsin childbirthand postpartumlike:incomplete health family teams(in05cities), lack of access orinaccessibility to laboratory tests(16 cities) and lack of the pregnant woman'sattachment to thebirthing place(in26 cities). Based on this reality, MPE has adopted relevant attitudes as filing public civil suits, compliance of Conduct Adjustment Declaration in the municipal management and performing interventions in heath care centers and maternity clinics of the state. Thereforeit is known thatPublic Ministryis of paramount importanceto indicatethe necessaryadjustmentsto addressinfant and maternalmortalityin the state (mean of 65/100,000 and16/100,000respectively) and give the city hall the responsibility for the health care quality provided to their citizens. These factors demand theprinciples ofuniversality and integrality to be performed in order to reduce social inequities.
Resumo:
OBJETIVE: To evaluate the perception of Medical and Nursing students of Medicine and Nursing graduation courses at the Federal University of Rio Grande do Norte (UFRN), on obstetrics teaching and labor assistance in the context of the maternal care provided by the Maternity Hospital Januário Cicco (MEJC) and contribute to curricular updating planning of teaching obstetrics, in accordance with the principles of humanization. METHODS: It was conducted a study of cross-cutting approach and qualitative and quantitative descriptive method, with students in medicine and nursing of UFRN, who were attending or had been attended the midwifery disciplines medicine; and women's health in nursing. The data were collected through a questionnaire with objective and subjective questions, and stored in a database, spreadsheet software Excel / Office 2010 with all the variables. RESULTS: We interviewed 169 students, 118 of medical school and 51 from the nursing program, of which 46.75% were male and 53.25% female. The largest number of medical respondents is the 11th period (40.67%), and nursing, on 10, (43.15%). These students witnessed 1,073 births, and (61.8%) vaginal deliveries. The obstetricians were the most performed vaginal deliveries (40%). Nurses performed only (8.13%). The assistance provided to women during the process of labor and delivery, was configured as suitable for 87.58% of respondents and these glimpsed humane conduct. Students who performed deliveries, 76.27% were medical and 11.76% were nursing. All had guidance while doing them. A total of 19.50% medical students reported that there is a prejudice against vaginal delivery, particularly for the humanized birth, unlike all nursing students (100%) who reported that there is this prejudice. Most students (73%) showed preference for vaginal delivery, especially nursing students. On the knowledge of myths in relation to vaginal delivery, 60.35% answered that they know some. CONCLUSION: This study presents itself as a highly relevant, since the results may contribute to curricular changing and updating related to obstetrics teaching, but also serve as a resource for analysis of humanization practices that should be developed in educational institutions and which are recommended by the Ministry of Health.
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The frailty syndrome is a geriatric medical condition of vulnerability resulting in the decline of physiological reserves, characterized by high-risk consequences as falls, disability, hospitalization, institutionalization and death. Although the presence of comorbidities is not always accompanied by fragility, this presence could also indicate an increased risk of adverse health events, taking the elderly to a greater likelihood of becoming brittle due to the physical limitations that may occur with emergence of diseases, which are strongly predictive of Fragility Syndrome. This study aimed to assess the prevalence of frailty syndrome in the elderly and associated factors. The specific objectives were to identify the prevalence of frailty syndrome in the elderly and their associations with demographic, economic, health, functional and psychological; identify the reasons for the prevalence of frailty syndrome with the demographic profile, health problems, use of legal drugs and problems with sleep of older people. The study was cross-sectional and composed of 385 elderly aged 65 or more. Multivariate Poisson regression models were used to check conditions associated with fragility and determine the prevalence ratio (α = 0.05). The prevalence of fragility was 8.7% and pre-fragility of 50.4%. Fragile and pre-frail elderly presented, bigger and increasing prevalence ratio for marital status, difficulty in performing instrumental activities of daily living, old age, involuntary loss of stool, depression and negative affect. Elderly people who do not work have a higher prevalence of fragility, as well as those who reported having had a stroke / stroke / ischemia, those who suffered falls in the last 12 months and those with sleep problems. It is considered that the results, together with other available in the literature, can contribute to the understanding of the fragility epidemiology and also in the implementation of specific programs aimed at reducing the prevalence of frailty, optimizing the quality of life. It is suggested that future programs have special attention to the profiles of elderly people who have not yet developed fragility, i.e., pre-fragile. This could prevent the elderly from becoming frail.
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The aging process causes changes in the elderly’s sleep/awake standard impairing their cognitive abilities, particularly executive functioning, which already suffers loss by aging. The literature suggests that executive function and preserved sleep quality are key to maintaining good quality of life and independence of older people, requiring interventions to minimize the impact of losses incurred by the aging process. This study evaluated the effect of a cognitive training program and sleep hygiene techniques for executive functions and sleep quality in healthy older people. The participants were 41 healthy older adults, of both sexes, who were randomly divided into four groups: control group [GC], cognitive training group [GTC], sleep hygiene group [GHS] and training group + hygiene [GTH]. The research was developed in three stages: 1st - initial assessment of cognition and sleep; 2nd - specific intervention to each group; 3rd - post-intervention revaluation. The results showed that GTC had significant improvements in cognitive tasks flexibility, planning, verbal fluency and some aspects of episodic memory, besides gains in sleep quality and decrease on daytime hypersomnolence. The GHS improved sleep quality and daytime sleepiness as well and had significant improvements in insights capacity, planning, attention and in all evaluated aspects of episodic memory. The GTH had significant gains in cognitive flexibility, problem solving, verbal fluency, attention and episodic memory. The CG showed significant worsening in excessive daytime sleepiness in capacity planning. Thus, we conclude that cognitive training interventions and sleep hygiene strategies are useful in improving cognitive performance and quality of healthy elderly sleep.
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Reservoirs are artificial ecosystems intermediate between rivers and lakes widely used in the Brazilian semiarid region as a way to provide water supply due to the said region’s water scarcity. The use of water from these supply sources for multiple uses, along with occupation and utilization of its riparian zone without proper management, directly influences the increased nutrient flow into aquatic environments, there with contributing to the acceleration of eutrophication. The semi-arid region is characterized by peculiar weather conditions, such as severe evaporation, high temperatures with little variation throughout the year and long water residence time, making it susceptible to prolonged drought occurrence, which tends to concentrate the nutrients in reservoirs, which favors the development of eutrophic conditions. Moreover, it is common soil use and occupation by carrying out activities with potential environmental impact on natural resources such as agriculture, livestock farming and lack of sanitation. The aim of this study is both to evaluate the water quality of the Cruzeta Reservoir, located in the semiarid region of Rio Grande do Norte, during a prolonged drought period, and assess the quality of its riparian zone soil under different uses, by monitoring physical-chemical variables. Along the prolonged drought, high levels of turbidity, suspended solids, nutrients and chlorophyll a were verified as present, therefore featuring low water quality. In the riparian zone of Cruzeta Reservoir, the areas under use of agriculture and livestock farming appeared as one of the main diffuse sources of nutrients to the said reservoir, featuring the highest levels of phosphorus and nitrogen in the soil, originated from decomposition of animal excreta and from the use of fertilizers, creating a tendency to increased eutrophication of such water supply source. The indicators of water and soil quality are useful for monitoring and evaluating the conservation status of natural resources, allowing the control and mitigation of the reservoir eutrophication process. This study confirmed the hypothesis that the reduction of water level, resulting from prolonged drought event, aggravates the symptoms of eutrophication; and also that using the soil under severalways modifies the physic chemical properties of the soil, having livestock farming and agriculture as the usages with greatest potential towards yielding P and N to the aquatic environment.
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The use of energy from renewable sources is increasingly demanded by society, especially aeolian - whose raw material is wind. Investments in wind power have become significant in Brazil with emphasis on the Northeast and in particular the Rio Grande do Norte state. According to the Empresa de Pesquisa Energética (Energy Research Company) (2012 ) , investments in the state grew significantly since 2002 with a total accumulated power, by 2013, of approximately 3,400 MW . Even with the early experiences of exploitation of wind energy in 2002, it is still considered new and requires further study referring to the likely changes in the environment and society. In this case, it is of growing and urgent importance to deeply study the wind still in the survey phase of the project, ie , at the beginning of decision making on the most feasible to implement these parks site. Given the above, the question is: from a technical and environmental analysis, how to identify viable areas to install Aeolian parks, taking into account the factors of the environmental dynamics that are relevant to minimize the negative results to the environment and the society? Thus, this study conducted a study on technical and environmental feasibility, proposing a methodology of exploration of feasible wind farms in coastal areas. The study area was a fragment of the northern coast of Rio Grande do Norte and its natural landscape units were identified through the environmental characterization of the area, as well as it was elaborated the map of the land cover, restriction homes and urban areas and Permanent Preservation Areas - PPAs. The environmental fragility was subdivided in the fragility of the natural dynamic, mapped through relief, soils and geology of natural units, and the fragility of the ecosystem, originated by the land cover map. In addition to these maps, it was generated the wind resource for an area from a height of 50 and 100 meters. The intersection between the fragility maps, PPAs and Restriction of homes superimposed on maps of wind potential, provided the map of feasibility of Aeolian parks, resulting in the most favorable areas for its facilities in a technical and environmental point of view. From this study, the entrepreneur can evaluate whether or not to proceed with the studies in this area and especially decrease potential conflicts with society.
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This study evaluates the cost effectiveness of municipalities in the state of Rio Grande do Norte in the execution of spending in basic education carried out in 2011, as well as analyze the determinants of the inefficiency of the same. For this, we used two methodological approaches (i) stochastic frontier cost, and (ii) analyze data envelopment (DEA), which allows to identify the efficient frontier of the municipalities analyzed non-parametrically. Results show that municipalities under review achieved low efficiency rates in the stochastic frontier cost, while the DEA method they achieved higher rates where nineteen among them reached full efficiency. The results suggest that a significant portion of the Potiguar municipalities should review its administrative practices, especially the means of allocation of resources. In regard to determining the efficiency observed distinct results by the two methods.
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The unstable non acid milk (UNAM) is characterized by coagulation in the alcohol test and wanted acidity (14-18°D). Among Brazilian regions, the South and Southeast have the highest occurrence of LINA, which has been causing problems for both producers and for industries, due to the disposal or undervaluation of milk. In the Northeast there are few studies that indicate their occurrence and quality. The objective of this study was to identify the occurrence of unstable non-acid milk in the west and central mesoregions of Rio Grande do Norte, determine their physicochemical characteristics, test alcoholic graduations and evaluate their correlation with the quality of milk. 176 raw milk samples were analyzed in the period from September to December /2014 from 23 APASA’s cooling tanks, located in 7 cities of west and central mesoregions RN. The samples were collected in duplicate, one sample used for alcohol testing at 68, 72 and 76%, measurement of pH, acidity, electrical conductivity and boiling proof, made in LABOLEITE / UFRN; and the other sample containing Bronopol® preservative, was sent to the APCBRH (Cattle Breeders Association Paranaense Holstein) laboratory in Curitiba-PR, which were analyzed fat, protein, total solids, lactose, casein, urea nitrogen and somatic cell count. The test alcohol samples disapproved 31.82%, of which 30% proved to be non-acid, and 30% had high acidity. The samples were divided into three classes: Stable Milk, UNAM and acid milk. 3% Tukey test was used for comparison of stable milk components and UNAM and there was no significant difference between them. Both classes obtained averages within the standard required by IN 62. The average value of electric conductivity was 4.84 mS/cm for stable milk, 4.55 mS/cm for unstable and acid milk and 4.53 mS/cm for non-acid unstable milk. The electrical conductivity was positively correlated with alcohol stability of milk and negative correlation with acidity and pH. Could not observe direct relationship between the electrical conductivity and the somatic cell count.The boiling test was negative for all samples UNAM. It can be concluded that the incidence of UNAM in the studied region is low, although the predisposing factors such as heat stress, drought and nutritional deficiency. In conclusion, the UNAM has quality similar to stable milk, conform the norms required by Agriculture Ministry, and with adequate thermal stability, which proves that there is no reason to reject this milk by industry.
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The Psychology University Services is stablished normatively as an indispensable equipment to the recognition of the graduation courses of psychologists by the Brazilian Education Ministery. The Public Healthcare Policies (Universal Health System/SUS) constitutes itself as a input field of the professional category, but shows huge challenges in the formation of these professionals. The objective of this work is to analyse the functioning of the Psychology University Services (SEP) and the Superior Educational Institutions from Natal, understood as important formation devices to attend the actual demands of the psychologist's work on SUS. For this, it sought a) characterize the psychological practices developed in the SEP; b) relate the National Curricular Lines of Direction of the psychology courses to the skills and competences developed in the SEP to the performance on the public healthcare policies; c) mapping ways of including the SEP in the network designed by the healthcare policy. Interviews were performed with 13 academic supervisors, 8 field supervisors and technicians of superior level (TNC), along with 9 managers, being for of the Psychology University Services and 5 of the graduation programs. Questionnaires were also applied to 57 interns and 24 graduates. Besides that, two conversation circles were performed with the faculty and technician members from two of the Educational Institutions that were participating of the research, as well as a workshop with students and psychologists, promoted by the CRP 17. We observed that most part of the faculty members and managers know the DCN and comprehend that the formation is in process of change in what concerns to the extension of the formation to the performance of the psychologists in various contexts. However, most part of the TNC don't know about them. Moreover, the results point to the predominance of the assisting model based on the traditional clinic psychology, although the articulation with the public healthcare and social assistance networks can already be timidly visualized. Different modalities of practices in theses Psychology University Services were also detected, such as conversation groups, thematic workshops, organizational consultancies, team meetings with the interns and TNS in a daily basis, matriciament in mental health, therapeutic monitoring, among others. Yet, the SEP in Rio Grande do Norte are still isolated from the other courses that perform in the healthcare area and also from the services that compose the public healthcare and public policies.
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The solidary economy as the organization of production, alternative to the capitalist economy provides new forms of organization and social behavior, that, in the sight of geography, it is shown by the different territory uses. The territory assume new meanings that, influenced by the Solidary Economy movement, tries to reach for new ways of acting that differ from social order already stablished. However, the different uses show themselves in a more complex and contradictory way, given that, in solidary undertakings, different corporative agents start to act, the State being a last resource on this process. Given this reality, our goal on the present paper is to analyze the different uses of the territory from the rural economic solidary undertakings and the relationship it establishes to the different agents involved on the socio-territorial dynamics on Rio Grande do Norte. Starting from a study that contemplates the territorial organization forms and contents of the analyzed phenomena, the methodology utilized for this research is based on a bibliographic review, with authors from the geography and areas related to the Solidary Economy, besides the use of secondary data, acquired from official offices such as SIES and IBGE, from the documented research, SENAES and field interviews conducted with local solidary undertakings. The results obtained in the study reveal the complexity of the agricultural use of the territory by Solidary Economy on the RN, while a resource of intensified use, from the state actions and important economical agents, and regulating the use while shelter, that marginalize solidary workers, making them subdued to the hegemonic logic. Therefore, we can infer that the solidary economy, despite its image of new form of organization between agricultural workers, given the expressivity of the rural solidary undertakings presented on RN, it hasn’t shown a full social development as an instrument of reproduction and emancipation of the associates. Nevertheless, the undertakings articulated in nets excel, even when considering its punctual and residual form. The given contradictions show that it is necessary to fortify the building of the solidary economy as being horizontal and popular based for it to have strength to surpass the regulative actions of the capitalist state and ownership created by the Capital.
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This study aims to investigate the process of implementation of Programa Nacional Biblioteca da Escola, PNBE, and the reader's training on Childhood Education level in Natal. The promotion of literary reading is the opportunity of inclusion in a world that is connected to citizenship, to human rights and social justice, because the reading is the way which gives meaning to the life and, therefore, it is a right for everybody. The study is characterized as a qualitative research with evaluative approach. The methodological procedure that constitutes this corpus took place in three stages: the first one was about the analysis of laws and documents of national public policies for the reading promotion; questionnaires were applied by Managing Committee - Natal/RN to CMEIs and the available websites from MEC that provide distribution of the acquis; in the second stage, we adopted the semi-structured interview as a methodological procedure elaborated with open questions that focus on the program management and to the acquis of PNBE; and in the third step we visited the 21 centers of childhood education in Natal for interviewing and to do the exploratory observation in places of reading. The Informant actors in this research are: the advisors of SME - Natal and FNDE, managers and teachers in Municipal Childhood Education Centers who totalize 30 informants. This theoretical and methodological framework follows the studies of Amarilha (1993; 1994; 2002; 2006; 2010; 2012), Bardin (2001), Bogdan; Biklen (1994), Castro (2007; 2008; 2012), Demo (2000; 2006; 2008), Fischer (2006), Moreira; Caleffe (2008), Paiva (2008; 2012), Secchi (2010; 2012), Soares (2003; 2008) and Zilberman (2001; 2003; 2008). The analysis indicates that decentralization strategy which is adopted in public management model will transfer responsibilities and assumption of the PNBE, exempting the actors to planning actions ensuring the efficiency and efficacy implementation on reading policy to national and municipal levels. The qualified acquis that is distributed by MEC reaches every Childhood Education center and does not depend on teacher's desire or it action, only a few of them know about it and they do not have information about the PNBE, neither receive specific training in order to articulate it to the practice of reading with children from Childhood Education. The reading project implemented by private education system in Natal overlaps the PNBE, making it invisible. The reading places that are available for that schooling stage are summarized to the reading corners. In some CMEI, books remain stored in boxes or they are locked in the closet, out of use to the teachers and students. Thus, care for the acquisition, selecting acquis, and a preoccupation to the supply of the reading and books for this education level are lost into volumes of closed boxes, teachers are jettisoned to this process and children do not have any enchantment to the reading or books. In this context, this paper draws attention to how much we should still investigate in order to understanding the perspectives, stresses and challenges from public policies for the reading promotion in our country. We hope that the research will help to improve the management model of the PNBE, ensuring the reading democratization and therefore the reader's training in early Childhood Education.
Resumo:
This study aims to investigate the process of implementation of Programa Nacional Biblioteca da Escola, PNBE, and the reader's training on Childhood Education level in Natal. The promotion of literary reading is the opportunity of inclusion in a world that is connected to citizenship, to human rights and social justice, because the reading is the way which gives meaning to the life and, therefore, it is a right for everybody. The study is characterized as a qualitative research with evaluative approach. The methodological procedure that constitutes this corpus took place in three stages: the first one was about the analysis of laws and documents of national public policies for the reading promotion; questionnaires were applied by Managing Committee - Natal/RN to CMEIs and the available websites from MEC that provide distribution of the acquis; in the second stage, we adopted the semi-structured interview as a methodological procedure elaborated with open questions that focus on the program management and to the acquis of PNBE; and in the third step we visited the 21 centers of childhood education in Natal for interviewing and to do the exploratory observation in places of reading. The Informant actors in this research are: the advisors of SME - Natal and FNDE, managers and teachers in Municipal Childhood Education Centers who totalize 30 informants. This theoretical and methodological framework follows the studies of Amarilha (1993; 1994; 2002; 2006; 2010; 2012), Bardin (2001), Bogdan; Biklen (1994), Castro (2007; 2008; 2012), Demo (2000; 2006; 2008), Fischer (2006), Moreira; Caleffe (2008), Paiva (2008; 2012), Secchi (2010; 2012), Soares (2003; 2008) and Zilberman (2001; 2003; 2008). The analysis indicates that decentralization strategy which is adopted in public management model will transfer responsibilities and assumption of the PNBE, exempting the actors to planning actions ensuring the efficiency and efficacy implementation on reading policy to national and municipal levels. The qualified acquis that is distributed by MEC reaches every Childhood Education center and does not depend on teacher's desire or it action, only a few of them know about it and they do not have information about the PNBE, neither receive specific training in order to articulate it to the practice of reading with children from Childhood Education. The reading project implemented by private education system in Natal overlaps the PNBE, making it invisible. The reading places that are available for that schooling stage are summarized to the reading corners. In some CMEI, books remain stored in boxes or they are locked in the closet, out of use to the teachers and students. Thus, care for the acquisition, selecting acquis, and a preoccupation to the supply of the reading and books for this education level are lost into volumes of closed boxes, teachers are jettisoned to this process and children do not have any enchantment to the reading or books. In this context, this paper draws attention to how much we should still investigate in order to understanding the perspectives, stresses and challenges from public policies for the reading promotion in our country. We hope that the research will help to improve the management model of the PNBE, ensuring the reading democratization and therefore the reader's training in early Childhood Education.
Resumo:
The new management models have led to the reorganization of institutions today. Much is made in improving the delivery of public services entities, and they have sought to adopt these new initiatives in order to improve the quality of the product or service offered to users. The modernization of the management model at the Federal University of Rio Grande do Norte (UFRN) strengthened by the accession of the institution to GesPública Program, which focuses on the management modernization leading institutions to seek ways to fit to meet the demands proposed the Program. Therefore, the Department of Personnel Administration (DAP) has structured its processes and procedures using the mapping tool processes. This research starts from the question: what were the results obtained with the implementation of the management and process mapping of PAD? It is proposed as a general objective to analyze the management and the mapping of that Board processes, identifying the possible benefits in improving the quality of the services provided to users. The specific objectives to achieve results, are pointed out: describe how you carried out the implementation of the management and process mapping in DAP and how it is working at the moment; examine the line in the relationship between the actions developed by the DAP and modern theories of this theme; identify the evolution of the sector with the measures adopted and the results obtained with the implementation of the mapping tool. In the theoretical framework, it was approached a brief history of the evolution of public administration in Brazil, GesPública program and its importance for process management in public institutions as well as the Management and Process Mapping. The context of the study was the DAP, and participants were managers of the institution in the survey. Data collection was done through the study of the institution's documents, bibliography analysis available on the topic, questionnaires and semi-structured interviews with professionals of the institution involved with the object of study, since its inception until July 2015, when it was finished the search. As a result, were listed: the motivation, importance, benefits and innovations that management and the mapping of processes brought to the institution, point out what has been improved in the service users and the tools used. We also analyze the main problems identified during the implementation of the mapping. As a suggestion, it was analyzed how these procedures can, if possible, be extended to other sectors of UFRN.
Resumo:
The new management models have led to the reorganization of institutions today. Much is made in improving the delivery of public services entities, and they have sought to adopt these new initiatives in order to improve the quality of the product or service offered to users. The modernization of the management model at the Federal University of Rio Grande do Norte (UFRN) strengthened by the accession of the institution to GesPública Program, which focuses on the management modernization leading institutions to seek ways to fit to meet the demands proposed the Program. Therefore, the Department of Personnel Administration (DAP) has structured its processes and procedures using the mapping tool processes. This research starts from the question: what were the results obtained with the implementation of the management and process mapping of PAD? It is proposed as a general objective to analyze the management and the mapping of that Board processes, identifying the possible benefits in improving the quality of the services provided to users. The specific objectives to achieve results, are pointed out: describe how you carried out the implementation of the management and process mapping in DAP and how it is working at the moment; examine the line in the relationship between the actions developed by the DAP and modern theories of this theme; identify the evolution of the sector with the measures adopted and the results obtained with the implementation of the mapping tool. In the theoretical framework, it was approached a brief history of the evolution of public administration in Brazil, GesPública program and its importance for process management in public institutions as well as the Management and Process Mapping. The context of the study was the DAP, and participants were managers of the institution in the survey. Data collection was done through the study of the institution's documents, bibliography analysis available on the topic, questionnaires and semi-structured interviews with professionals of the institution involved with the object of study, since its inception until July 2015, when it was finished the search. As a result, were listed: the motivation, importance, benefits and innovations that management and the mapping of processes brought to the institution, point out what has been improved in the service users and the tools used. We also analyze the main problems identified during the implementation of the mapping. As a suggestion, it was analyzed how these procedures can, if possible, be extended to other sectors of UFRN.
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O objetivo deste estudo foi avaliar a incorporação da saúde bucal no Programa Saúde da Família no Rio Grande do Norte, com base na análise de fatores capazes de interferir no processo de mudança dos modelos assistenciais em saúde bucal. Esta avaliação tomou como referência três dimensões: o acesso, a organização do trabalho e as estratégias de programação. Foram sorteados 19 municípios no estado. Os instrumentos de coleta foram a entrevista estruturada aplicada a gestores e dentistas, a observação estruturada e a pesquisa documental. Foi possível identificar precariedade nas relações de trabalho e dificuldades no referenciamento para média e alta complexidade, na intersetorialidade, no diagnóstico epidemiológico e na avaliação das ações. A maioria dos municípios apresentou pouco ou nenhum avanço no modelo assistencial em saúde bucal. Os municípios que demonstraram avanços apresentaram alta expectativa de vida ao nascer, baixas taxas de mortalidade infantil, valores per capita entre os mais altos do Estado e altos valores de IDH-M. Concluiu-se que políticas públicas que contemplam aspectos além dos pertinentes ao setor saúde são decisivas para uma real mudança nos modelos assistenciais.