A atenção em Saúde Mental em municípios de pequeno e médio portes: ressonâncias da reforma psiquiátrica

A partir da análise da Política Nacional de Saúde Mental formulada nos últimos anos e das experiências desenvolvidas após 1987 no país, procura-se compreender como o Sistema Único de Saúde tem contribuído ao avanço da reforma psiquiátrica nos municípios; verificar como a assistência oferecida nesses municípios está viabilizando os princípios da reforma psiquiátrica e a melhora das condições de vida dos usuários, bem como pesquisar o papel dos trabalhadores e gestores na construção de novas práticas de cuidado em Saúde Mental. A análise das práticas discursivas aponta que os vários segmentos sociais envolvidos na Saúde Mental conhecem os princípios e propostas da reforma psiquiátrica. No entanto, as gestões municipais não assumem integralmente as propostas do Ministério da Saúde para a área, sob a alegação de falta de recursos financeiros para a contrapartida exigida. Os usuários e familiares têm aos poucos assumido as novas propostas de intervenção, mas os mecanismos de participação e organização popular ainda são incipientes. Por fim, deve-se destacar que, para uma efetiva consolidação das propostas atuais da reforma psiquiátrica, é necessário um maior compromisso dos gestores com a atenção em Saúde Mental, maior investimento nas equipes multiprofissionais, o estímulo à organização e à participação dos usuários e familiares e a integralidade dos dispositivos de saúde, de assistência social e de cultura existentes nas cidades.

Regiões de saúde e escalas geográficas

O presente artigo tem como objetivo central discutir o processo de regionalização da saúde no país, considerando-se o novo cenário de direcionamento do investimento de unidades públicas de saúde, a partir da publicação da Norma Operacional de Assistência à Saúde (NOAS - SUS 01/2001). Para isso, um esforço faz-se necessário: o de superação da compreensão predominante a respeito de alguns conceitos, principalmente o de região e de escala geográfica. A proposta de divisão regional dessa NOAS baseia-se no conceito de região de planejamento que, desde a fundação do Instituto Brasileiro de Geografia e Estatística, tem subsidiado as políticas territoriais do Estado brasileiro. Contudo, a regionalização da saúde no Brasil é uma necessidade para o fortalecimento do SUS e uma mudança qualitativa da política nacional de saúde. É preciso avançar, relacionando a divisão regional do Brasil com a questão da escala. O que está em questão é se a regionalização da saúde brasileira representa ou não um aprimoramento das mediações entre as diversas escalas do SUS.

A dimensão sociocultural da reforma psiquiátrica: articulando redes para a consolidação da estratégia de atenção psicossocial

This thesis aims to discuss on articulations that have been produced on the socio-cultural field in the Psychiatric Reform process and its pertinence to the streghtening of Psychosocial Care Strategy (EAPS) in Fortaleza/CE. Such interest has been justified by the need to promote not only the production of these networks, but also interfaces to enable strategies of support and sociability from the perspective of deinstitutionalization of madness. We were inspired by the cartography perspective of Deleuze e Guattari, and determined as objectives: 1) to discuss the complexity of Psychiatric Reform process and analyze the EAPS as a model for the current Mental Health policy in the country; 2) to map socio-cultural strategies connected to the CAPS network in the city, investigating experiences that already exist or may be constituted as everyday social support networks; 3) from that mapping to start, define and discuss some aspects that converge to the accomplishment for this new mental health paradigm, drawing a cartography of the issues and movements in progress. The mapping was carried out in 2009 and consisted of semi-structured interviews with the coordinators of the 14 existent CAPS and with some people connected to the Coordination of Mental Health. Besides, during the whole development of the study, we have taken part in public events that brought us clues on the connection between mental health and culture. From the survey produced, we defined three vectors for discussion (Art, Labour and Partnership with Social Movements) which have been highlighted as effective possibilities of intervention in the socio-cultural field of Psychiatric Reform in Fortaleza and reveal important paths on the fulfillment process of a new pattern of care. For each of these axes, we chose a field of empirical research (Projeto Arte e Saúde, COOPCAPS e MSMCBJ) in which we could better understand their strengths and difficulties, starting from open interviews with some of their actors and the production of a diary of sensations in 2010. We have seen that they are articulated with the proposal of EAPS, being part of the concerns to the National Mental Health Policy and also the municipal administration. However, we have noticed to be necessary to promote those dimensions further, focusing on its complexity at the macro and micro policies, with the purpose of leading the Psychiatric Reform process

O Serviço Ambulatorial Móvel de Urgência (SAMU) no contexto da reforma psiquiátrica: em análise a experiência de Aracaju/SE

This research investigated professional practices from Mobile Urgency Care Service (Serviço Ambulatorial Móvel de Urgência - SAMU) at psychiatric cases of the city of Aracaju/SE, Brazil and its possible articulations to psychosocial services network. The regulation no. 2048 of 11/05/2002 from Ministry Health establishes National Urgency Policy and designates that psychiatric cases are SAMU's responsibility. Then, it is necessary to propose an analyze of psychiatric urgency service under anti-asylums social movements standpoint, mainly because this service is responsive in assisting a person in crises. Fieldwork was developed in two phases. First one was made with SAMU workers and the information were produced by recorded semi-structured interviews. Results of this first phase indicate that urgency psychiatric conception from SAMU workers is based on aggressiveness concept; delays at psychiatric cases support and low training in mental health care which means several difficulties to emergency service. Although, we noticed that SAMU use asylum procedures at psychiatric cases like ropes and odder instruments to contain people. The second step of our research was to attend meetings to build a new psychiatric urgencies protocol for SAMU to define practices to auxiliaries, vehicular conductors and medical support regulation. Therefore, open interviews were accomplished with some participators and follows-up to psychiatric case on board of SAMU's cars. Afterwards we discussed how the urgency paradigm, that influence the protocol draw and as consequence distort what we believe is the essentially function of this device, that is to give care support to persons in crises and produce articulation to psychosocial services network

Reciclagem química de Polietileno utilizando Sílica Mesoporosa tipo SBA-15 avalizada por Termogravimetriae Espectrometria de Massas

The chemical recycling of polyolefins has been the focus of increasing attention owing potential application as a fuel and as source chemicals. The use of plastic waste contributes to the solution of pollution problems.The use of catalysts can enhance the thermal degradation of synthetic polymers, which may be avaliated by Themogravimetry (TG) and mass spectrometry (MS) combined techniques. This work aims to propose alternatives to the chemistry recycling of low-density polyethylene (LDPE) on mesoporous silica type SBA-15 and AlSBA-15.The mesoporous materials type SBA-15 and AlSBA-15 were synthesized through the hydrothermal method starting from TEOS, pseudobohemite, cloridric acid HCl and water. As structure template was used Pluronic P123. The syntheses were accomplished during the period of three days. The best calcination conditions for removal of the organic template (P123) were optimized by thermal analysis (TG/DTG) and through analyses of Xray diffraction (XRD), infrared spectroscopy (FT-IR), nitrogen adsorption and scanning electron microscopy (SEM) was verified that as much the hydrothermal synthesis method as the calcination by TG were promising for the production of mesoporous materials with high degree of hexagonal ordination. The general analysis of the method of Analog Scan was performed at 10oC/min to 500 oC to avoid deterioration of capillary with very high temperatures. Thus, with the results, we observed signs mass/charge more evident and, using the MID method, was obtained curve of evolution of these signals. The addition of catalysis produced a decrease in temperature of polymer degradation proportional to the acidity of the catalyst. The results showed that the mesoporous materials contributed to the formation of compounds of lower molecular weight and higher value in the process of catalytic degradation of LDPE, representing an alternative to chemical recycling of solid waste

Ações educativas com portadores de diabetes Mellitus através da educação popular em saúde

Popular Health Education in its emancipatory dimension refers to individuals and groups to exchange knowledge and experiences, allowing them to associate health to the outcomes of their living conditions. Under this view, health workers and health users are subjects of the educative process. Thus, this study aims to identify the key clinical and socio sanitary attributes and promote educational activities with patients with Diabetes Mellitus (DM) in a Family Health Care Unit of the Western Sanitary District, in the city of Natal / RN. It is an action research which uses the references of the Theory of Liberating Education, which is based on a problem-solving pedagogy and that values dialogue in the process of understanding oneself and the world. Thirty-six diabetics, who are residents of the area covered by the health care unit, and thirty health workers participated in the survey. Each group had an average of twelve participants, and the meetings took place at the Unit´s hall, using conversation wheels, group dynamics, life narratives, experiences telling, movie exhibition and discussions, music, knowledge telling, desires, limitations, beliefs and values socially constructed. Data collection took place during the second half of two thousand and thirteen through Free Word Association Technique (FWAT), recordings of conversation wheels, participative observation, group dynamics, testimonies, questionnaires, life narratives and photographs. The empirical material was organized and subjected to three analyzes: thematic content (Bardin), textual statistics analysis by software IRAMUTEQ (Ratinaud), and photographic analysis (Edmund Feldman). The data analyses originated words, expressions, categories, themes and creative situations showing that popular health education is in process of construction, but still very incipient in primary care. The National Policy on Popular Health Education shows us the necessary ways for the transformation of health practices and the build of a more shared and solidary society. The meetings could be place to reverse that normative logic that has been happening over the years in primary care, but that by itself is not enough. It is possible to conclude that the use of active practices, increasing of listening and training on Popular Health Education will enable changes in the scenario where users and health workers deal with diabetes mellitus. Thus we see the popular health education is being timidly incorporated to the educational process of the subjects involved in this study, and far away from the principles of participation, organization of political work, increase opportunities for dialogue, respect, solidarity and tolerance among different actors involved in addressing the health problems that are fundamental to the improvement in building healthy practices of primary care

A humanização da saúde no cotidiano de usuários da estrategia saúde da família

This research assumes that for changes in health practices directed to an integral care, is crucial humanization, participation and autonomy of service users. In this sense, the research had investigated the issue of humanization involving users of the Family Health Strategy (FHS) in city of Mossoró, having as objectives: to analyze the perceptions of users on humanization in the production of health care in daily of Family Health Strategy, from these perceptions, identify elements featuring humanized and non-humanized in everyday practices related to production of health care; relate perceptions of users about humanization with the notions of extended clinic and social participation present in the National Humanization Policy (NHP); identify difficulties and potentialities in the production of health care from the perspective of humanization. It was a qualitative approach to data collection and it was used the methodology of Network Analysis of Everyday Life (NAEL), which allowed the questioning of health practices through an interactive discussion involving participants subjected. The analysis of data through the technique of content thematic analysis was performed and the results were interpreted related the Extended Clinic references and the users participation, related with the Gift Theory discussed by Marcel Mauss. The results indicated senses humanization linked to affection, reciprocity and honesty, highlighting as essential to humanized practices the trust, bonding, listening, dialogue and accountability. Were also mentioned other elements related to the organization of health services such as access and good functioning of the health services. The difficulties and potentialities show structural deficiencies of the health system and changes in the labor process. The participation of users deconstructing and reconstructing concepts remainder humanization in the production of health care is a key factor for the sedimentation of what is proposed in the HNP. Using the privileged space of the FHE to create more active people and understanding their needs and demands, is possible path to build a participative management

As pessoas com deficiência no mercado de trabalho: expressão das desigualdades sociais

This work was developed in the extent of the Post Graduation Program in Social Service of the Federal University of Rio Grande do Norte. It talks about the process of inclusion of the disabled people in the Job market in Mossoró-RN, bringing for the academic debate relevant thematic for the Brazilian society, for the profession of Social Service and similar areas and for the people with deficiency. It has the objective to apprehend the determiners that make possible the process of the disabled people's inclusion in the Job market in Mossoró, having as parameter the National Politics for the Integration of People Bearers of Deficiency. The critical theoretical perspective is backed in Marx's ideas for the understanding concerning the work, as well as in Pochamann, concerning the job market, regarding the exclusion/inclusion category is based in Martins, Yasbek and Sposati and on deficiency in the National Politics for the Integration of the Disabled People. The research is of qualitative nature and it took as subjects 26 (twenty-six) people, being 09 (nine) people with deficiency, inserted in the formal job and regulated market, and 17 (seventeen) managers of private companies and public institutions of the city of Mossoró-RN. For the collection of data we used techniques of nonsystemic observation, semi-structured interview and documental analysis. The results of the research mark that any modality of the human workforce used in the current context, they are functional to the capitalism and they move forward towards exploration, alienation and subordination of the work to the capital; the National Politics for the Integration of the People with Deficiency expresses and reproduces the contradictory dynamics of the class society, it reflects the neo liberal shades through the selectivity and of the articulation among the federated beings and organizations of the civil society for its operational system; there is a misproportion between the percentages of the quotas and the amount of people with deficiency inserted in the job market, just corresponding to a tiny numeric magnitude; the developed activities are of low social status and it is expressive the amount of workers that receives between one and two minimum wages. These data drive us to infer that the mentioned politics make possible, partly, the inclusion of the disabled people in the job market, though, such inclusion is executed in the selective or focused dimensions, marginal, precarious and unstable

Violência contra a mulher:uma análise do trabalho do Centro de Referência da Assistência Social-CREAS/Parnamirim-RN.

This work demonstrates the results obtained from research on violence against women: an analysis of the work from reference center of the Social Assistance-CREAS, held in the city of Parnamirim/RN from September 2008 extending through the february of 2009. Having as goal to investigate and examine in a longitudinal cut, which specifically covers the period from 2006 to 2007, find out extent the actions taken by the Reference Center Specialized Social Assistance- CREAS, contributed to the change of women who were there, by checking if there was any change in their positions ahead of the violence and if they began to realize how social subjects, able to control their living conditions and interfere in the orientation of social dynamics Have a particular emphasis on the presence of work and schooling or lack of them is also a factor to be allied to the barriers and rules imposed on women in contemporary society. In this study it was found through a qualitative research guided by dialectical and implemented through the use of documentary research, observation, semi-structured interview and an extensive theoretical background on the subject in question that the woman victim of violence is in a complex and contradictory context where there is both the construction and deconstruction of rights, a view that there are strong influences of patriarchal culture and the consequences of social issues that specifically searched for the public, focuses on social, economic , political, social and cultural. In this sense, the National Policy to Combat Violence against Women, operated by CREASE Parnamirim, is also reflected in its early stages in the life of these women are to nurture a real chance for these victims of violence, to perceive themselves as social subjects can control their lives and interfere in their own destinies. We want this study to add more knowledge to help and most appropriate intervention in this reality, but without the intention of reaching exhaustion, but to subsidize future studies on the topic of women victims of violence

Violência contra a mulher: uma análise do trabalho do centro de referência da assistência social-CREAS/Parnamirim

This work demonstrates the results obtained from research on violence against women: an analysis of the work from reference center of the Social Assistance-CREAS, held in the city of Parnamirim/RN from September 2008 extending through the february of 2009. Having as goal to investigate and examine in a longitudinal cut, which specifically covers the period from 2006 to 2007, find out extent the actions taken by the Reference Center Specialized Social Assistance-CREAS, contributed to the change of women who were there, by checking if there was any change in their positions ahead of the violence and if they began to realize how social subjects, able to control their living conditions and interfere in the orientation of social dynamics Have a particular emphasis on the presence of work and schooling or lack of them is also a factor to be allied to the barriers and rules imposed on women in contemporary society. In this study it was found through a qualitative research guided by dialectical and implemented through the use of documentary research, observation, semi-structured interview and an extensive theoretical background on the subject in question that the woman victim of violence is in a complex and contradictory context where there is both the construction and deconstruction of rights, a view that there are strong influences of patriarchal culture and the consequences of social issues that specifically searched for the public, focuses on social, economic , political, social and cultural. In this sense, the National Policy to Combat Violence against Women, operated by CREASE Parnamirim, is also reflected in its early stages in the life of these women are to nurture a real chance for these victims of violence, to perceive themselves as social subjects can control their lives and interfere in their own destinies. We want this study to add more knowledge to help and most appropriate intervention in this reality, but without the intention of reaching exhaustion, but to subsidize future studies on the topic of women victims of violence

Desafios e limites da prática do sindicalismo rural :um estudo de caso em São Paulo do Potengi/RN

The dissertation analyzes how the syndical practice of the workers rural Brazilians works your aspects of mobilization and claim in front of the execution of attendance services and providences, instituted in the marks of the military dictatorship, in the decade of 1970. We try to apprehend how these services have been interfering in the development of base works. Considering base works, as an enduring political formation of the rural workers, formation of new syndical leaderships and an effect participation of the workers in the political spaces. We trace the path of the rural workers' organization, starting from the previous period to the military stroke of 1964, while protagonists inserted in the national political conjuncture, organizing fight fronts and conquering rights. The research reveals that the rural workers' syndical movement, when it develops the activities coming from Funrural, established in 1971, they confront a dilemma that go through the political nature of your practice, which such activities can reduce the syndical rural workers, to a antity of assistance, and so interfere in the accomplishment of base works with the rural working class. The rural workers' syndical movement, inserted in the several conjunctures, since of your emersion in ante-64, when they have passed by growth and retrocession, they built along this period a structure to the national level, which makes possible the recognition of the rural workers' organization, as a class, and human being politicians of your own structure. It is in this context that the syndical practice is analyzed, emphasizing your limits and your possibilities while policy strenght nationally constituted

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

Hábito alimentar e percepção ambiental : um estudo de caso com estudantes do Ensino Médio em Natal-RN

This study has as objective to examine the level of perception of high school students from two private schools in Natal-RN about the existence of a direct link between alimentary habit and its effects on environmental. The research was lead with 433 students, who had their school alimentary habits investigated according to the 24-hour recall method and presents the results of data collection from their opinions on participating in the generation of industrialized solid residues and their yearnings about the improvements of the standard of the food offered in the school. The students show a high rate of grading age for level at school, traditional family structure, riding, predominantly, by car or by bus in the house-school-house way, have generally all three important meals at home, feed frequently at their school, getting it from their won school, which included, mainly, soft drinks and fried or grilled appetizers; show a good knowledge about selective collectors, however with a high variation in their correct use. They show significant approval in the existence of a connection between their alimentary habits and debased effects about environmental and consider their food compounds at school could improve the offering of health/natural food, slowing industrialized foods, which are highly used, sometimes. The study on the students knowledge and concern level with regard to the interface alimentary habit-environmental impact allowed delimitating some of the mainly involved components in the alimentary choices of the same students in the school environment, what might help to develop a set of proposals that stimulates the formation of a responsible consumption standard among teenagers and the need of a consideration about the consequences of their choices

Políticas públicas de educação ambiental: a gestão do programa municipal de educação ambiental de Mossoró/RN

Study about environment education public policies, emphasizing the directress since the 1970 . It analyses the environment education administration of Mossoró city, indentifying its articulation with the international directresses and the Environment Education National Policy (PNEA), established according the law number 9.795/99. The text takes as empiric reference the Environment Education National Policy (PNEA) of Mossoró city, realized since 2006. In order to make the research, we employed as methodologic proceedings a bibliographical and documental revision from wich we developed a contextualization of the propolsals toward a environment Education policy and administration, the institution of the environment Education in Brazil, in the neoliberal context on the State reform ambit. We also employed a semi-structured interview, having as individuals two Environment Education Municipal Program Administration of Mossoró city / RN state administrators and nine Municipal Education System educators. The analysis was done from the historic and dialetic perspective, trying to understand the facts in its totallity. The results revealed that the environment Education has become to be emphasize as an environment crises superation strategy since the 1970 s. In this context, the environment Education administration directress, in the United Nations (UN) initiative ambit, emphasizes the participation and the partnership as a way to share responsabilities between the State and society. In the neoliberalism affirmation context, in the 1990 s, these directresses were fortified, once, since the State reform, their functions were redimensioned and the State turns into a stronger planner an controller, inducing the society to act as a public polcies executor. Therewith, a deconcentration action process is consolidated, rather than an administrative and pedagocgic decentralization, historically revendicated on Education by the progressist sectors. Even though the administrators interviewed have revealed the wish that the schools become autonomous on the PMEA execution, through the NEAs, we notice that the methods employed do not contribute to that, because of the decisions concentration on the associated managership ambit and the few human and financial resources. In spite of the difficulties, the research showed that the Mossoró municipality innovated on the environment Education field, by the institution of the NEAs, even though they demonstrate fragilities regarding their performance, revealed on the educators and adiminstration talk on the interviews. We verify that the main difficulties come from the politc culture installed on the municipality, ruled by a technocracy and power concentration wich brings difficulties to the implementation of a democratic and participative administration, even though it would not be totally impossible, even on the circumstances described

Pobreza e desigualdades socioterritorias: uma problematização acerca da perspectiva territorial nas politicas públicas sociais no município de Pau dos Ferros/RN

El presente trabajo se constituye en un estudio sobre la pobreza y las desigualdades socio territoriales en el Brasil, problematizando la perspectiva territorial de las políticas públicas sociales observando la distribución espacial del Índice de Desarrollo de las familias (IDF) en el municipio de Pau dos Ferros/RN, así como las principales políticas sociales, a ejemplo del Programa Bolsa Familia. En este sentido, el objetivo principal de esa disertación se dió en la tentativa de comprender la importancia de la lectura previa del territorio para la reflexión sobre la pobreza en su aspecto multidimensional y para la territorialización de las políticas Públicas sociales construidas en el intento de minimizar la problemática de la desigualdad social, observando la distribución espacial do IDF en el municipio de Pau dos Ferros/RN. A partir del objetivo general trazado, hicimos una revisión teórica sobre los temas, pobreza, desigualdades sociales y políticas públicas, en el primero caso atentando para el aspecto multidimensional de esta, abogando la importancia de analizarnos la pobreza no apenas por el nivel de rienda, pero considerando otras dimensiones que corroboran para la constitución del ser pobre, como habitaciones precarias, falta de saneamiento básico e infraestructura, el no acceso a la salud, la educación y los otros servicios que posibilitan el individuo vivir con el mejor dignidad. Comprendiendo la importancia del conocimiento previo del territorio para que ocurra las debidas reflexiones e intervenciones en la realidad territorial buscamos reflexionar acerca de ese concepto en sus nexos con la construcción e implementación de las políticas públicas sociales teniendo la Política Nacional de Asistencia Social (PNAS) como política esencial y también el el Programa Bolsa Familia (PBF), una vez que buscamos compreender su importancia a partir de la visión del sujeto, o sea las beneficiadas del PBF en el Municipio de Pau dos Ferros. Para tanto, hicimos entrevistas orales con las beneficiadas del PBF que fueron elegidas aislada a partir de los equipos del CRAS, además de la aplicación de cuestionarios semiesctructurados y abiertos con gestores y asistentes sociales del muninicipio.Buscamos además trabajar con algunos datos del CadÚnico para el município en estudio proponiendo analisar las condiciones sociales y económicas de las famílias cadastradas. Algunos resultados fueron posibles, a saber, es necesario interpretarse la pobreza a partir de varias dimensiones para no tener el riesgo de quedarnos solamente en la perspectiva financiera, o sea de la rienda, que mismo sirva para lo emergencial no es suficiente para transformar las condiciones de vida de las famílias; PNAS puede ser considerada como un avanzo de la política social en el Brasil una vez que posuye importancia fundamental en la familia. Sin embargo, es preciso avanzar en la interpretación del territorio que en la política y en el habla de los agentes sociales , es interpretación apenas como un recorte donde deberán ocurrir las acciones para minimizar la pobreza ; al fin, o PBF es un programa de urgencia moral una vez que combate lo mas emergencial que es el directo de sobrevivir , pero aun no conseguió transformar de una manera significativa la pobreza en el país