Nervos: rede de discursos e práticas de cuidado na atenção básica no município de Natal/RN

The Primary Health Care and one of its main strategies, the Family Health Strategy (ESF), are framed as the gateway to the Public Health System (SUS). Thus, most of the incident and prevalent health problems in the population attended should be solved at this level of care, including psychological suffering, and the so-called complaint of nerves. Nerves and nervous denote a complexity that is not always well comprehended by health workers, in such a way that the care to this kind of problem is usually inadequate. In this line of thought, the general objective of this study is to analyze the network of discourses and the care to the psychological suffering, expressed as nerves, in SUS daily Primary Health Care. Besides and more specifically, it aims at identifying the principles and guidelines of the Primary Health Care in mental health; to investigate health workers positioning before psychological suffering and complaints of nerves, and also analyze different actions and practices of care carried out in different Health Units towards complaints like nerves. Institutional Ethnography was the theoreticalmethodological perspective adopted for the work. This approach seeks to understand and analyze the institutional relationships in a particular context considering sociostructural influences and power relations, as well as daily discourses and practices. Based on interviews with health professionals, informal conversations and observations in six Health Units with ESF teams from different sanitary districts in Natal/RN, it was possible to check that the index of complaint of nerves is high. The referral to psychologists and psychiatrists, as well as the prescription of psychotropic drugs appear as the most common intervention at this level of care. In general, the participants complain that they have poor specialized knowledge about the theme of mental health. They face the problem of bad work conditions and the lack of institutional support, which make actions of illnesses prevention and health promotion even more difficult. Besides, there are different ongoing practices such as meetings for hypertensive and aged people, walk, visit, round-table discussions and community therapy. However, not all of these actions are aimed at the care of psychological suffering. It is observed that the Matrix Support, which is a methodological strategy of supervision and follow up forcases of mental health, hasn t been totally implemented in the municipal system, although it is a tool that has been used by psychologists in some Health Units in the city. It was also verified that the health care practices to the problem of nerves strongly depend on the professional s commitment with the PSF guidelines and on mental health policies, in addition to continued support, when available, from other professional who works as matrix supporter

Os profissionais de saúde diante da violência :mapeando o processo de implantaçãoda notificação na rede básica de saúde em Natal/RN

Violence is a complex and multifarious phenomenon that has convoked the government to think about strategies to face the question. This work is about one of these strategies proposed by brazilian Health Minister: the Individual notification/investigation Card - Domestic Violence, Sexual and/or others Interpersonal Violences . This instrument is a notification protocol which is been implanted in all of the country. This process is in course in Natal/RN. This work is a report of one research realized in five units of basic health care network of Natal/RN concerning this process about the implementation of the violence notification card. The study aims to cartography all the process of card implantation, discussing the used strategies, the drawn course, difficulties and possibilities as well as how the researcher intended to map subjective process involved at health professional acting at violence case and the propose to use the card. Meetings were held at each unit and a daily fieldwork report was used as research instrument. In this investigation it was observed that notifying violence involves a complexity that is not present in other kinds of notification as consequence of the phenomenon characteristic and health workers are invited to act in different perspective that knowledge and instruments of traditional health fieldwork available does not work. It was observed that the notification card, as a possible instrument of intervention, are considered important detectors from process of work at health basic care and health policies. Depending the way the instrument is used, it may incentive different discussions and manners to offer health care or in other way it can reproduce control and vigilance logics. Consequently it is necessary to consider some factors pointed out at this experience, implanting instruments like this, thinking about these limits and possibilities

Características acústicas da oclusiva glotal associada à sequência de Pierre Robin: estudo de caso

A fissura de palato, em associação à Sequência de Pierre Robin, pode favorecer o desenvolvimento de produções atípicas (compensatórias), na fala da criança, como é o caso da oclusiva glotal (golpe de glote) comumente observada em substituição aos sons oclusivos (vozeados ou não). No presente estudo, foi realizada a análise dos parâmetros fonético-acústicos da oclusiva glotal produzidas em /k/ e /g/ por uma criança do gênero feminino, com 5 anos, que apresentava fissura de palato reparada, associada à Sequência de Pierre Robin. Para isso, foram selecionadas seis palavras em que a oclusiva velar encontrava-se na posição inicial da palavra e combinada com as vogais /a/, /i/ e /u/ na posição acentuada. Foi ainda realizado julgamento perceptivo-auditivo por três fonoaudiólogos, que apresentou concordância quanto à presença da oclusiva glotal de 100% para ambas as relações (intra e inter-juízes). Na inspeção dos dados via espectrograma foi observada variabilidade dos parâmetros espectrais (burst e transição formântica) e essas variações também puderam ser computadas considerando as vogais separadamente. A análise estatística revelou diferença estatisticamente significante entre as duas consoantes velares (/k/ e /g/) nos parâmetros espectral (burst), temporal (VOT e duração relativa da oclusiva na palavra) e os relativos às características acústicas das vogais adjacentes às oclusivas (período estacionário de F3). Por fim, as características acústicas da oclusiva glotal sugeriram que a criança pode ter utilizado de estratégias para marcar contrastes fônicos na língua, ainda que os mesmos não tenham magnitude suficiente para serem resgatados auditivamente pelo ouvinte.

Protozoários de vida livre em ambientes aquáticos do RN: ocorrência, caracterização e importância para a educação básica

Water is considered an essential right to life, besides being a determinant of economic development and social welfare, represented by both the quantity available, and the quality. In semi-arid Northeast, droughts occurring on a regular basis combined with human activities, aggravate the situation regarding the conservation of water resources in this area. To alleviate this condition is common to construction of artificial reservoirs, such as reservoirs and dams. As in natural aquatic environments, these reservoirs are potential sites for the proliferation, growth and development of diverse biological communities, whether of animals, plants and microorganisms. Research on the composition and ecology of these communities, especially microbial, are still restricted. One of the least studied groups in these environments are free-living protozoa, which over time have been neglected and after discoveries about its various functions in the aquatic ecosystem are beginning to receive more attention from scholars. They are, in quantitative terms, the most important consumers of microorganisms (mainly bacteria and algae) in aquatic environments, and therefore control the abundance of these. They may therefore influence the structure of the aquatic food chain in terms of species composition, abundance, biomass and biodiversity. Despite the recognition of the importance of protozoa in the final of the trophic transfer in aquatic environments, there are few data and, in general, are still precarious knowledge of them. Given the importance of protozoa in aquatic environments and the paucity of research on this group, especially in the state of Rio Grande do Norte, the present study aimed at identifying the genus and species of free-living protozoa that are present in the Armando Ribeiro Gonçalves Dam as well as to relate the occurrence and dynamics of the trophic conditions in the environment in which they are inserted, in order to support the hypothesis that species that are in these environments can serve to indicate the water quality. We observed the presence of 65 taxa of free-living protozoa, of which 29 were identified at the species level. There was a similarity space in taxonomic composition of protozoa, suggesting a possible regulation of this type of community for limnological variables other than those studied in this work (chlorophyll a, pH, temperature). Although it was aimed to analyze the conceptions of teachers and students from nearby towns Dam Armando Ribeiro Gonçalves, on issues relating to water quality and the role of protozoa. For this, we applied questionnaires with teachers and pupils of public schools of San Rafael and Itajá. It was concluded that teachers and students recognize the multi-dam Armando Ribeiro Gonçalves, although unaware of important aspects of the dynamics and ecology of this environment. Conceptions of teachers and students are matched at various times, especially with regard to waterborne diseases. In an attempt to identify possible misconceptions about the knowledge of the protozoa, assuming that these organisms have neglected their ecological role, and are seen as only, disease, a study was done with teachers and students, following a particular methodology that allowed look so clear and precise results. It was clear that knowledge about the free-living protozoa is still quite limited. The alternative conceptions that were found show a direct relation of protozoans and diseases. From the data obtained by these studies, we planned a series of science communication activities, environmental education and health education in schools close to study environments in order to promote a didactic transposition of accumulated knowledge about these organisms, favoring continuing education of teachers and the increase of information to the local community through the knowledge of biodiversity and ecology of these organisms. Moreover, the results found in this study and reflections on it that led to propose the elaboration of a book Readers with an emphasis on the group of freeliving protozoa in the populations for use in public schools in the region where it was developed the semiarid work

Caracterização tectono-estratigráfica da sequência transicional na sub-bacia de Sergipe

This thesis deals with the tectonic-stratigraphic evolution of the Transitional Sequence in the Sergipe Sub-basin (the southern segment of the Sergipe-Alagoas Basin, Northeast Brazil), deposited in the time interval of the upper Alagoas/Aptian stage. Sequence boundaries and higher order internal sequences were identified, as well as the structures that affect or control its deposition. This integrated approach aimed to characterize the geodynamic setting and processes active during deposition of the Transitional Sequence, and its relations with the evolutionary tectonic stages recognized in the East Brazilian Margin basins. This subject addresses more general questions discussed in the literature, regarding the evolution from the Rift to the Drift stages, the expression and significance of the breakup unconformity, the relationships between sedimentation and tectonics at extensional settings, as well as the control on subsidence processes during this time interval. The tectonic-stratigraphic analysis of the Transitional Sequence was based on seismic sections and well logs, distributed along the Sergipe Sub-basin (SBSE). Geoseismic sections and seismic facies analysis, stratigraphic profiles and sections, were compiled through the main structural blocks of this sub-basin. These products support the depositional and tectonic-stratigraphic evolutionary models built for this sequence. The structural analysis highlighted similarities in deformation styles and kinematics during deposition of the Rift and Transitional sequences, pointing to continuing lithospheric extensional processes along a NW trend (X strain axis) until the end of deposition of the latter sequence was finished by the end of late Aptian. The late stage of extension/rifting was marked by (i) continuous (or as pulses) fault activity along the basin, controling subsidence and creation of depositional space, thereby characterizing upper crustal thinning and (ii) sagstyle deposition of the Transitional Sequence at a larger scale, reflecting the ductile stretching and thinnning of lower and sub crustal layers combined with an increasing importance of the thermal subsidence regime. Besides the late increments of rift tectonics, the Transitional Sequence is also affected by reactivation of the border faults of SBSE, during and after deposition of the Riachuelo Formation (lower section of the Transgressive Marine Sequence, of Albian age). It is possible that this reactivation reflects (through stress propagation along the newlycreated continental margin) the rifting processes still active further north, between the Alagoas Sub-basin and the Pernambuco-Paraíba Basin. The evaporitic beds of the Transitional Sequence contributed to the development of post-rift structures related to halokinesis and the continental margin collapse, affecting strata of the overlying marine sequences during the Middle Albian to the Maastrichtian, or even the Paleogene time interval. The stratigraphic analysis evidenced 5 depositional sequences of higher order, whose vertical succession indicates an upward increase of the base level, marked by deposition of continental siliciclastic systems overlain by lagunar-evaporitic and restricted marine systems, indicating that the Transitional Sequence was deposited during relative increase of the eustatic sea level. At a 2nd order cycle, the Transitional Sequence may represent the initial deposition of a Transgressive Systems Tract, whose passage to a Marine Transgressive Sequence would also be marked by the drowning of the depositional systems. At a 3rd order cycle, the sequence boundary corresponds to a local unconformity that laterally grades to a widespread correlative conformity. This boundary surface corresponds to a breakup unconformity , being equivalent to the Pre-Albian Unconformity at the SBSE and contrasting with the outstanding Pre-upper Alagoas Unconformity at the base of the Transitional Sequence; the latter is alternatively referred, in the literature, as the breakup unconformity. This Thesis supports the Pre-Albian Unconformity as marker of a major change in the (Rift-Drift) depositional and tectonic setting at SBSE, with equivalent but also diachronous boundary surfaces in other basins of the Atlantic margin. The Pre-upper Alagoas Unconformity developed due to astenosphere uplift (heating under high lithospheric extension rates) and post-dates the last major fault pulse and subsequent extensive block erosion. Later on, the number and net slip of active faults significantly decrease. At deep to ultra deep water basin segments, seaward-dipping reflectors (SDRs) are unconformably overlain by the seismic horizons correlated to the Transitional Sequence. The SDRs volcanic rocks overly (at least in part) continental crust and are tentatively ascribed to melting by adiabatic decompression of the rising astenospheric mantle. Even though being a major feature of SBSE (and possibly of other basins), the Pre-upper Alagoas Unconformity do not correspond to the end of lithospheric extension processes and beginning of seafloor spreading, as shown by the crustal-scale extensional structures that post-date the Transitional Sequence. Based on this whole context, deposition of the Transitional Sequence is better placed at a late interval of the Rift Stage, with the advance of an epicontinental sea over a crustal segment still undergoing extension. Along this segment, sedimentation was controled by a combination of thermal and mechanical subsidence. In continuation, the creation of oceanic lithosphere led to a decline in the mechanical subsidence component, extension was transferred to the mesoceanic ridge and the newly-formed continental margin (and the corresponding Marine Sequence) began to be controlled exclusively by the thermal subsidence component. Classical concepts, multidisciplinary data and new architectural and evolutionary crustal models can be reconciled and better understood under these lines

Caracterização das intervenções em grupo na rede básica de saúde em Natal-RN

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Qualidade de vida no trabalho do enfermeiro da Atenção Básica à Saúde

OBJETIVOS: Apreender as concepções e experiências de enfermeiros sobre qualidade de vida e qualidade de vida no trabalho na Atenção Básica à Saúde. MÉTODOS: Estudo descritivo de abordagem qualitativa, realizado no interior paulista, Brasil, com oito enfermeiros cujos depoimentos foram submetidos à análise de conteúdo, na vertente temática. RESULTADOS: Os enfermeiros apresentaram concepções ampliadas sobre qualidade de vida e qualidade de vida no trabalho, em geral, apresentando-se satisfeitos quanto às mesmas. Entretanto, foram apontados entraves comprometedores da qualidade de vida dos profissionais no contexto estudado determinados, principalmente, pela falta/inadequação de recursos materiais, humanos e ambientais, bem como pelo processo de trabalho estabelecido. CONCLUSÃO: Embora haja o reconhecimento da satisfação em trabalhar na Atenção Básica à Saúde, os problemas apontados revelam a importância de se mobilizar maior atenção dos profissionais e gestores para o tema.

Perfil dos beneficiários do Programa de Suplementação Alimentar de uma unidade básica de saúde de Botucatu, São Paulo

OBJETIVO: Este estudo objetivou apreender algumas características sócio-sanitárias do grupo de beneficiários do Programa de Suplementação Alimentar de unidade básica de saúde de um município de médio porte do interior paulista. Especificamente, buscou-se delinear o perfil deste grupo quanto aos fatores de risco para a desnutrição infantil a que estava exposto e dimensionar a utilização dos critérios de inclusão neste programa. MÉTODOS: A pesquisa é de cunho descritivo e se baseou em documentos oficiais vigentes para a definição dos fatores de risco a serem analisados. Foram avaliadas 290 crianças cujas mães ou responsáveis foram entrevistados, segundo um protocolo previamente estabelecido. RESULTADOS: O grupo de beneficiários caracterizou-se por ser heterogêneo quanto à freqüência e ao grau da exposição a fatores de risco para a desnutrição, denotando que há diferenças nos problemas socioeconômicos e sanitários apresentados, como também na combinação entre eles, em cada família. CONCLUSÃO: Para a otimização do programa, ainda vigente no município, sugere-se a padronização loco-regional de critérios de inclusão, conforme a proposta oficial central, com o registro claro dos mesmos e, também, a aplicação de métodos avaliativos periódicos, adequada capacitação da equipe de saúde e maior envolvimento da população usuária.

Lugar, saúde e informação: os círculos de informação da atenção básica do SUS no contexto na disputa pelo conceito de saúde

Through the analysis of the informational activity at the primary care of SUS at the scale of places, this dissertation has as central objective to observe the dispute for the concepts of health and sickness, in the ambit of Brazilian Health Movement, featuring, on one hand, the clinic, biomedical or flexnerian line hegemonic, scientifically restrict and the primary frame of references for the Brazilian health politics and on the other hand a multiplicity of new proposals and critic thoughts to the current model, which have , as common characteristic, the worry with a territorial way of thinking the health context, therefore beyond the biological processes. On the first chapter we jut out with details these scientific and ideological movements, on a wider way, but also on the specificities of the public health s information politics. On the second chapter we analyze the downward health information circle at the basic care, observing the operational processes of the information s technical systems SIAB and e-SUS. On the third and last chapter, we give references to think about an upward health information circle, centered on the places, ruled by the notions of autonomy, organic solidarity and communicational density. It would possess, as method s primary horizon, the local organization of production and managing of information through the work of the Health Community Agent, privileging therefore the urgency of the most contingent needs of the people in theirs every day s life

O ensino de pediatria na atenção básica em saúde entre as fronteiras do modelo biomédico e a perspectiva da integralidade do cuidado: a visão dos médicos supervisores

Trata-se de estudo sobre educação médica, focalizado no ensino de pediatria na atenção básica, com o objetivo de analisar a contribuição da disciplina de Pediatria Social e Comunitária no 4º ano de graduação em medicina da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista.Utilizou-se metodologia qualitativa de pesquisa, tendo como estratégia o estudo de caso. A análise foi fundamentada na abordagem sócio-histórica, subsidiada pelos estudos de Vigotski. Identificou-se o que os supervisores consideraram como aprendizados relevantes a sua contribuição no processo de mediação para que os estudantes aprendam sobre o processo de trabalho na atenção básica, o que não poderiam alcançar sozinhos. As entrevistas transcritas revelaram núcleos de significação comuns: importância da diversificação de cenários de ensino, aprendizado dos principais problemas de saúde, integralidade no atendimento da criança, com ênfase no vínculo e oportunidade do estudante aprender sobre promoção da saúde.

Desinstitucionalização dos cuidados a pessoas com transtornos mentais na atenção básica: aportes para a implementação de ações

Parte-se do interesse dispensado contemporaneamente às articulações entre saúde mental e atenção básica. Após uma breve síntese histórica e conceitual neste campo, discutem-se aspectos operativos da desinstitucionalização dos cuidados a pessoas com transtornos mentais na atenção básica. Com a análise de alguns estudos e experiências são destacados, a seguir, componentes fundamentais para avançar neste sentido: (1) desenvolver processos de comunicação que visem ampliar a legibilidade profissional, (2) superar a centralização em ações restritas aos enquadres tradicionais, (3) manter questionamento permanente com relação ao risco de psiquiatrização do cuidado em saúde mental, (4) superar concepções culpabilizantes do grupo familiar, e (5) investir na formação das equipes de atenção básica para as múltiplas dimensões do cuidado em saúde mental. Apontam-se, desta forma, alguns caminhos e direções possíveis para o desenho de ações de saúde mental na atenção básica que tenham, no horizonte, a perspectiva antimanicomial.

Validade das informações ocupação e causa básica em declarações de óbito de Botucatu, São Paulo

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Saúde do trabalhador na atenção básica: análise a partir de uma experiência municipal

Este texto apresenta um relato da experiência de implantação de ações de saúde do trabalhador nos serviços de atenção básica no município de Amparo, no estado de São Paulo, ocorrida durante a gestão do período 2001 a 2008, visando contribuir na premente necessidade do SUS de implantação das ações de saúde do trabalhador. A análise realizada pelas autoras, protagonistas na gestão do processo, ressalta alguns dos elementos-chave para a efetiva implantação de ações de saúde do trabalhador na rede de atenção básica. Dentre eles, a Estratégia Saúde da Família (ESF), ao lado de outros elementos - como o modelo de matriciamento com ação pedagógica contínua e participação nos colegiados de gestão, a educação permanente e o protagonismo dos trabalhadores da saúde -, mostrou-se um facilitador do processo. Como elementos estruturantes da construção efetivada, apontam-se o modelo de gestão colegiada adotado pela secretaria e a forma de implantação do Centro de Referência de Saúde do Trabalhador no município. Todo esse arranjo promoveu uma interlocução permanente entre as equipes de saúde, da atenção básica e da referência especializada que foi indispensável para a experiência ocorrida.