A PPCCIPS: a Pol��tica P��blica da Coleta Complementar Itinerante e Programada de Sangue, sob a luz da teoria do ciclo da pol��tica p��blica

This study aimed to focus on aspects of public administration concerning the implementation of the public policy of complementary blood collection by the itinerant and scheduled PPCCIPS services either trough off local unity or mobile unit blood collection operations, which are managed by the State Institute of Hematology Arthur de Siqueira Cavalcanti - HEMORIO. The case study method was used in that public health institutional field, in search for a better understanding of responsibilities and management related to collection, serology, fractionation, storage and distribution of blood supply to almost all public hospitals and clinics, summed up to agreements with the single health system of the State of Rio de Janeiro. Bibliographic references, documentary and field data obtained through interviews and systematic observation in the public servants of HEMORIO workplaces, were treated by the analysis of the content method and the results of this research revealed the complexity of those services, and needs in outstanding aspects of infrastructure, equipment, logistics and personnel, which are critical for the achievement of the increased public collection of blood in the Rio de Janeiro State, endorsing the suggestions for the implementation of PPCCIPS in HEMORIO. The main point found in this research results concern the immanent ethical commitment of that public service personnel, including staff members and low ranking members as well, perceived due to a brief philosophical overlook on that personnel��s attitudes. An important strategic aspect was revealed by the need for excellence of midia communications and education programs to implement the community involvement in the whole process. Final reflections point out that personnel posture is considered vital for the quality of the expected care of the technical activities and also for the quality of its final products release to the local public, fluminense, which is the irreplaceable human blood, and their derivatives. Despite the author��s effort in this dissertation there is much more to be studied on that crucial theme.

Participa����o popular na gest��o publica da saude: um estudo de caso

o texto mostra um estudo de caso, de car��ter qualitativo, sobre o desempenho do Conselho Municipal de Sa��de do Recife/CMS-Recife, numa perspectiva democr��tica de gest��o. Visa, prioritariamente, a identificar as condi����es sob as quais se torna poss��vel obter consensos que sejam representativos das necessidades de sa��de da popula����o por ele abrangida. A partir de um tratamento conceitual sobre a tr��ade "democracia, descentraliza����o e participa����o", descreve os processos que levam �� defini����o - na carta constitucional de 1988 - do Sistema ��nico de Sa��deSUS, e �� institui����o formal do Conselho, no munic��pio estudado. Evidencia a possibilidade e pertin��ncia da aplica����o da teoria do agir comunicativo, do fil��sofo alem��o J��rgen Habermas, no ponto em que estabelece a vincula����o entre a identifica����o das necessidades de sa��de e a defini����o de modelos de organiza����o das pr��ticas do setor, atrav��s dos conselhos municipais. Sob tal enfoque, com o recurso do m��todo hermen��utico-dial��tico, investiga o material obtido nas pesquisas bibliogr��fica e documental, nas entrevistas e pela t��cnica da observa����o aplicada em reuni��es realizadas pelo Conselho, em atividade a partir de agosto de 1993. Revela, para o momento atual, seu distanciamento em rela����o ao conceito de "situa����o de fala ideal", ao mesmo tempo em que, face os avan��os obtidos, justifica sua valoriza����o como instrumento de constru����o democr��tica e consolida����o da cidadania.

Estrutura e desafios de financiamento do programa Abrigos Solid��rios: Liga Solid��ria

A presta����o do servi��o de acolhimento institucional para crian��as e adolescentes ainda �� um grande desafio para as organiza����es que realizam este trabalho, n��o s�� pelas atuais mudan��as do perfil dos abrigados, que passa a exigir novas respostas institucionais, com pela fragilidade da estrutura de financiamento p��blico. Desse modo, o presente trabalho tem como prop��sito identificar as principais fragilidades da estrutura de financiamento p��blico desse servi��o, a partir do estudo de caso do Programa Abrigos Solid��rias da Liga Solid��ria, organiza����o social sem fins lucrativos que mant��m tr��s abrigos via conv��nio firmado com a Secretaria Municipal de Assist��ncia e Desenvolvimento Social de S��o Paulo (SMADS). Para tanto, foi realizada pesquisa qualitativa baseada em entrevistas semi estruturadas junto a gestores e t��cnicos da Liga Solid��ria, bem como uma revis��o bibliogr��fica sobre os principais marcos da Pol��tica Nacional de Assist��ncia Social, refer��ncias sobre a Reforma Gerencial do Estado e o funcionamento b��sico do Sistema ��nico de Sa��de (SUS). Com base nos dados encontrados na pesquisa, foi poss��vel realizar um diagn��stico da atual estrutura de financiamento p��blico e complementar que subsidiou a elabora����o de uma proposta integrada de aperfei��oamento da estrutura de financiamento desse servi��o respaldado por uma an��lise comparativa com o SUS e resgatando as propostas de contratualiza����o previstas na Reforma Gerencial do Estado de 1995.

Assist��ncia a mulher com c��ncer de mama em um cenro de refer��ncia no Estado da Para��ba

The assistance to women who have breast cancer is studied in a Reference Center in Paraiba and also the way this assistance is performed in a School Hospital maintained by SUS (Single Health System) is questioned. Breast cancer demands institutional organization, provision of financial, material and human resources, requiring, from the health system, effective assistance with new technologies which make it possible for the population their access to specialized medical services although it not always is able to guarantee those services nor the rights which the legislation granted them, inhibiting a proper relationship between the health professional and the patient. The theme is discussed through a transdisciplinary knowledge view and has as its theoretical referential the contribution of classical and contemporary authors from the human and social sciences and, as an empirical research strategy, the structured interview. The objectives of the research were: identify how the assistance to women with breast cancer is carried on at a Reference Center on Oncology in Campina Grande, Paraiba, identifying their difficulties and their satisfaction with the received assistance; draw up a profile of the women with breast cancer who were assisted in this Reference Center; understand their gynecological and obstetric antecedents, life styles, age group and stage of the disease when the treatment started; check their knowledge about their rights and which benefits they had received. Most women ranged between 40 and 59 years old (63%), which corresponds to the risk range of developing breast cancer. As to their occupations, 38.3% were housewives and 30.1% retired, whose family income was among those who received between less than a minimum salary and one minimum salary (58.2%). This population was mainly constituted of married women (60.2%), whose most frequent schooling was an incomplete elementary school (27.6%) and complete elementary school (24.1%), which added up to 51.6%. It was observed that the majority of the women seemed to be satisfied with the assistance received, noting that a minimum care was enough to define this satisfaction, although it is perceived that the access to the health system does not ensure the ideal attention conditions they need; it was verified that the availability of the services and the assistance itself are seen (in the local culture) as a favor and not as a right. It is also observed that only 30% of the women mentioned that they knew about their rights and the most mentioned ones were the disease assistance (13%), the medicines (13%) and the treatment (12%), which represent the most important triad to face the disease and around which the oncologic assistance most focus on. It is concluded that the condition of the users�� minimum existential of a public health unit and the condition of belonging to a lower social stratum were variables that influenced the respondents�� satisfaction in relation to the assistance received but the importance of the Reference Center for the women with breast cancer��s assistance for the whole region cannot be denied as well as the need to broaden the way the policy of the oncologic assistance in Brazil in the local realm is seen

A forma����o acad��mica do enfermeiro para o SUS na percep����o de docentes e discentes da faculdade de enfermagem/UERN

The model of attention to health in Single Health System (Sistema ��nico de Sa��de SUS) presupposes a human-resources policy which prepares professionals of health to guide the services and sanitary practices. The nurse, a member of health staff, takes over an important role in implementation of principles and standards of SUS, being its professional formation necessary to labor organization in this purpose. In this way this study objectifies to analyse the process of formation of the male nurse in the Politic-Pedagogical Project (Projeto Pol��tico-Pedag��gico PPP) in the perception of learning and teaching of the Faculty of nursing FAEN of the University of The Rio Grande do Norte State UERN. It treats about a descriptive-exploratory study with qualitative and quantitative approach carried out with learning and teaching of the graduation nursing course. In the field research carried out between the months of november, 2006 and february, 2007, were used like instruments the documental research below PPP��s, structured interview directed to the learning and the closed questionnaire applied to the students of eighth and ninth semesters of graduation course. The results of data about the questionnaires elaborated according to National Curricular Patters (Diretrizes Curriculares Nacionais DCN) and the Instrument of Evaluation Course of Graduation MEC were organized according to six lists about the profile of the learning and teaching that participate of the research; of the didactical-pedagogical organization and PPP��s objectives to the just-graduates person to the didactical-pedagogical curriculum organization. For considering the interviews it was adopted thematic analysis of content discribed in lexical analysis by informatical program ALCESTE which provided the organization of the material in five categories: daily problems of SUS consolidation versus nurse formation, dichotomies about FAEN��s nursing course of curriculum versus principles of integralization of graduating process, the just-graduated one from FAEN and its professional insertion united to SUS politic-pedagogical project and the concern about the overcoming of dichotomies of graduation process abilities and necessary competences to the SUS performing nurse. The analysis of informations deriving from documental performance and field research resulted on the verification that, in spite of good intentions, the implementation strategies showed themselves fragile to cope with the rendering of expressed ideal on PPP. There is still a great gap between what��s thought as innovating graduating process and what��s being really implemented

A����es dos agentes comunit��rios de sa��de diante do usu��rio da estrat��gia sa��de da fam��lia com estados depressivos no Munic��pio de Abaiara-CE-BR

Brazilian health public assistance is going through two Reforms, Sanitary and Psychiatric, and through these the assistance is guaranteed in the three levels: primary, secondary and tertiary. Thus, mental health assistance should be offered since preventive cares until the ones that demand larger technological apparatus. Programs like Health Community Agent's Program (HCAP) and Family Health Strategy (FHS), besides increasing the services coverage, have been making possible the system reorientation in the meaning of integrality, universalization and equity. Thus, united intervention of mental health team and FHS can offer several benefits to the population, providing assistance and follow-up to patients with mental disorder. It was aimed to assess health community agents facing the user of Family Health Strategy in depressive state. This quanti-qualitative study took place in the municipal district of Abaiara-CE. Semi-structured interview was applied with health community agents and Beck Depression Inventory with the users registered in Family Health Strategy. It was verified that among the 64 users interviewed, 12.5% didn't present symptoms of depression, 10.9% presented symptoms of light depression, 14.1% symptoms of moderate depression and 62.5% symptoms of serious depression. For the 22 health community agents interviewed, they all reported the existence of people with symptoms of depression in their personal micro-areas, being difficult to work with them, once the FHS team is not qualified to work with mental health problems. It was verified that the Municipal district doesn't have specialized professionals, making difficult the routing and treatment. Based on these results, it was concluded that in spite of the articulation of mental health with FHS is necessary and benefactor to the population, it still doesn't exist, worsening the situation, mainly in small Municipal districts, once they don't have mental health services. Thus, the population is exposed and without follow-up, which allows the identification of installed diseases and with gravity, like depression, because there are no prevention and control activities. It is recommended, due the extreme need, the elaboration and implantation of a mental health program in these municipal districts, articulated with FHS

A educa����o permanente em sa��de na ��tica dos cirurgi��es dentistas

This study aimed to examine the perception of dentist-surgeon about the Permanent Education in Health (PEH). It is characterized as a qualitative research with focus in the field of public health policies. It refers specifically to the development of Permanent Education policy in Health in the state of Rio Grande do Norte. They were participants of this research 42 dentist surgeons and 83.3% females and 16.7% males, participants in Specialization courses approved and agreed by the Permanent Education Center in Health (PEC-RN) in the period 2005 to 2007. These professionals are part of the Family Health Strategy (FHS), and 11.9% work in management at the central level and 88.1% are directly related to oral health care in the Basic Health Units of the Family, 30 cities in the state. Data collection was through a questionnaire, with questions that guided the research development and achieve the objectives proposed. The socio-demographic data were analyzed using the descriptive statistics and subjective content was subjected to content analysis by Bardin. The emerging categories from the textual material generated by respondents were: program content, methodological approach and concepts of Permanent Education in Health. The subjects surveyed reported that the program content is more comprehensive and directs to the reflection of everyday practices, with regard to the methodological approach, concern that occurs through discussion and reflection with dynamic, participative, varied and constructive activities, questioning and putting as the main focus. As for understanding of the concepts of the PEH, there was a consensus that define as education stable strategies which contributing to transform and improve the health workers to have the upgrade, improvement of practices, being based on everyday experience and taking into account the accumulation and renewal of these experiences. Therefore, results presented showed that there is a clear understanding of the subjects on the proposals and guidelines of the PEH. It was concluded that lack continuous access to the policies proposed by Ministry of Health involving health workers, managers, communities, through social control and the teaching-service integration and that they are worked within the health system and can classify all these segments of society favor the existence of a more participatory, effective, fair and better quality health service

As diretrizes da pol��tica p��blica de sa��de bucal e suas inflex��es nos servi��os da Cl��nica Odontol��gica da UFRN

The crisis that the Brazilian State have been crossing throughout the last decades has revealed intense oscillations in the the way of life of the population reality. In the health area, specifically of buccal health, new alternatives of attending to demands for odontological services have been increasing from the 1990 decade. The research had as objective to analyze the demand of the services of the clinic-school of odontology of the UFRN to identify the socio-economic profile of the users and the inflections of the standards of the National Politics of Buccal Health. The methodology is based on a dialectic perspective and a quali-quantitative boarding. It was used as instrument of data collection forms with open and closed questions, applied to two distinguished groups of citizens: 53 users of the services and 12 pupils of 9th and 10th term of the Odontology Course. The results reaffirm that, with the aggravation of the crisis of SUS (Sistema ��nico de Sa��de- Single Health System) grow the difficulties of accessing the odontological services of the users majority. The subjects of the research make use of a regular socio-economic condition, with high school, own house, formal bond to labor and monthly medium income between 1 and 2 minimum wages. The conclusive analyses point to the selective and exculpatory character of the buccal health right, mainly, those users who find themselves in situation of extreme poverty and social vulnerability. Immediate and of lesser cost odontological assistance is what it s aimed, but the standards praised in the Public Politics of Buccal Health walk in another direction, requiring a bigger strongness of the formation bases and implementation of the programmatical actions since the academic field until the effectiveness of Politics of Buccal Health as a right while as a right to attention and care

Qualidade do servi��o prestado aos pacientes de cirurgia card��aca do Sistema ��nico de Sa��de - SUS

OBJETIVO: Avaliar qualidade do servi��o prestado aos pacientes de cirurgia card��aca no per��odo hospitalar, em servi��o do SUS, identificando as expectativas e percep����es dos pacientes. Relacionar qualidade de servi��o com g��nero, faixa et��ria e circula����o extracorp��rea. M��TODOS: Estudaram-se 82 pacientes (52,4% do sexo feminino e 47,6% do masculino) submetidos a cirurgia card��aca eletiva, operados por toracotomia m��dio-esternal, idade: 31 a 83 anos (m��dia 60,4 �� 13,2 anos), per��odo: mar��o a setembro de 2006. Avaliou-se a qualidade do servi��o em dois momentos: expectativas no pr��-operat��rio e percep����es do atendimento recebido no 6�� dia de p��s-operat��rio; mediante aplica����o da escala SERVQUAL modificada (SERVQUAL-Card). O resultado foi obtido pela diferen��a da somat��ria das notas das percep����es e expectativas por meio de an��lise estat��stica. RESULTADOS: A escala SERVQUAL-Card foi validada estatisticamente, apresentando adequado ��ndice de consist��ncia interna. Encontrou-se maior frequ��ncia de revasculariza����o do mioc��rdio 55 (67,0%); primeira cirurgia card��aca 72 (87,8%) e utiliza����o de CEC 69 (84,1%). Verificaram-se altos valores para expectativas e percep����es, com resultados significantes (P<0,05). Observou-se rela����o significante entre qualidade de servi��o com g��nero, na empatia (P=0,04) e faixa et��ria, na confiabilidade (P=0,02). N��o se observou signific��ncia entre CEC e qualidade de servi��o. CONCLUS��O: A qualidade dos servi��os foi satisfat��ria. O paciente demonstrou expectativa alta ao servi��o m��dicohospitalar. Mulheres apresentaram maior percep����o da qualidade na empatia, jovens na confiabilidade. A utiliza����o de CEC n��o est�� relacionada com qualidade do servi��o nesta amostra. Os dados obtidos sugerem que a qualidade deste servi��o de sa��de pode ser monitorada pelo emprego peri��dico da escala SERQUAL.

Percep����o do egresso de enfermagem sobre a contribui����o do curso para o exerc��cio do cuidado

O estudo avaliou a forma����o em enfermagem ancorada na problematiza����o e na aprendizagem baseada em problemas a partir da percep����o dos egressos. Trata-se de estudo transversal de natureza ex-post-facto. Os resultados foram analisados na triangula����o das abordagens quantitativa e qualitativa e na perspectiva hermen��utica dial��tica. Na abordagem quantitativa 180 egressos responderam um question��rio. Na qualitativa, 14 participaram das entrevistas, que buscaram sentidos relacionados ao cuidado ideal, para constru����o dos indicadores que revelassem a l��gica da avalia����o. Esses indicadores nortearam a escolha das quest��es para triangula����o. Os resultados apontaram que 85,1% dos egressos est��o inseridos no mercado de trabalho, 92,1% cursaram p��s-gradua����o e 99,1% acreditam apresentar forma����o necess��ria ao cuidado ��tico, humanizado e fundamentado. A an��lise dos dados aponta para forma����o comprometida com a constru����o da autonomia e do conhecimento, bem como articulada aos princ��pios do Sistema ��nico de Sa��de e do mundo do trabalho em enfermagem.

Childbirth care: contributing to the debate on human development

Com a finalidade de subsidiar gestores da ��rea de sa��de da mulher, na formula����o de pol��ticas p��blicas, voltadas ao desenvolvimento humano, realizou-se esta investiga����o, cujo objetivo foi avaliar a estrutura e o processo da aten����o ao parto e ao neonato desenvolvido em regi��o do interior paulista. Estudo epidemiol��gico, voltado para avalia����o dos servi��os de sa��de, baseou-se na observa����o da assist��ncia prestada pelo Sistema ��nico de Sa��de em 12 maternidades e 134 partos, adotando-se padr��es estabelecidos pelo Minist��rio da Sa��de ou Organiza����o Mundial de Sa��de para compara����o. Os resultados apontam problemas relacionados �� estrutura em algumas maternidades, mostrando que pr��ticas ��teis ao parto normal ainda s��o pouco utilizadas, enquanto que outras prejudiciais ou ineficazes ainda s��o utilizadas rotineiramente. Reverter esse quadro ser�� essencial para oferecer atendimento de qualidade ��s mulheres, com conseq��ente redu����o nas taxas de mortalidade materna e neonatal, para que a regi��o atinja as metas estabelecidas para amplia����o do desenvolvimento humano no mil��nio.

Sistema de auditoria no SUS: an��lise dos dados de produ����o e glosas no servi��o odontol��gico na rede p��blica

P��s-gradua����o em Odontologia Preventiva e Social - FOA

As ouvidorias de sa��de p��blica no Estado do Par��: uma rela����o dial��gica entre governo, medicina e sociedade?

Esta Disserta����o tematiza sobre as ouvidorias de sa��de p��blica como um espa��o de participa����o cidad�� na gest��o administrativa, indagando se acontece uma rela����o dial��gica entre governo, medicina e sociedade, na perspectiva de aproxima����o da gest��o e servi��os prestados pela sa��de p��blica, de acordo com a Pol��tica de Humaniza����o do SUS. A hip��tese norteadora do estudo �� a de que com a participa����o popular, atrav��s das ouvidorias, s��o produzidas transforma����es nas pr��ticas desempenhadas pelos diferentes atores na configura����o das pr��ticas no cuidado em sa��de, em aproxima����o com os princ��pios e estrat��gias de Humaniza����o do Sistema ��nico de Sa��de, com capacidade de tensionar os pap��is constitu��dos no contexto biom��dico que se constituiu como predominante, a partir dos fins do s��culo XVII. Objetiva identificar as contribui����es efetivas da atua����o das ouvidorias de sa��de p��blica, na constru����o e execu����o de novas pr��ticas da sa��de, de acordo com a PNH. Foi desenvolvida em quatro cap��tulos, que tratam da participa����o social e da hist��ria das ouvidorias de sa��de p��blica, no Brasil, do SUS e da Pol��tica de Humaniza����o na Sa��de,da pesquisa propriamente dita e as considera����es finais. A investiga����o, com desenho qualitativo e explorat��rio, visa a conhecer, descrever e compreender a realidade da pol��tica de humaniza����o nas institui����es de sa��de p��blica no estado do Par��, por interm��dio das demandas das ouvidorias em um processo de amplia����o de mecanismos democr��ticos de controle social das pol��ticas p��blicas de sa��de. Entre os resultados alcan��ados nesta pesquisa, cita-se que as Ouvidorias de Sa��de P��blica t��m o claro compromisso de se tornarem institui����es de excel��ncia e cumprirem o seu papel na promo����o do di��logo entre o estado, a medicina e a sociedade. Quanto a esse processo colaborar na constru����o de novas pr��ticas em sa��de, n��o se identificam grandes efetividades, por��m, serve como valor simb��lico de representatividade de acessibilidade de comunica����o e di��logo sem burocracia entre sociedade e gest��o p��blica �� significativa. Observa-se a necessidade da gest��o da sa��de p��blica, no sentido de se organizar em suas v��rias inst��ncias.

A import��ncia da integra����o universidade e servi��os de sa��de

Brazilian Curricular Directrix demand changes on teaching dental surgeon, proposing new scenes of learning and study other than the classroom. So, pedagogic projects should search for integral and adequate education by relating teaching, research and extension/assistance. This paper discusses the importance of university extension activities on teaching Odontology students and relates the experience of Ara��atuba Dental School of S��o Paulo State University. This school develops some university extension activities since the 60s by Dental Service Beyond School (SEMO, in portuguese). Among the activities included by SEMO there are several projects, such as: ���Program of Dental Attention for Pregnant Women���, ���Program of Dental Attention to Juvenile Foundation at Ara��atuba���, ���Always Smiling ��� Health Promotion for Institutionalized Elderlies���, ���Santa Clara de Assis Nursery School Program of Dental Attention���, and "Promotion of oral health in Ara��atuba public kindergarten schools���. These programs give the student knowledge of structure dimensions of public health services; chance to participate on attendance for the population, comprehension of oral health politics, and the role of dental surgeon in social context, where these students will work in the future. The positive impact obtained with these services is perceived by students return. Most of them feel satisfied about the experience lived there.