Avaliação da atenção humanizada ao abortamento em maternidade-escola, em Natal, Rio Grande do Norte

Unplanned pregnancy is experienced by millions of women worldwide. Such fact increases the risk of abortion-related morbimortality, which represents a serious public health problem. This study aims to evaluate the advances and challenges of the implementation of Humanized Abortion Care at the Maternity-School in Natal, state of Rio Grande do Norte. The research was evaluative, was preceded by an Evaluative Study, and resulted in a Case Study. The intentional sample totaled 102 subjects (60 users, 39 professionals and 3 managers). The collection techniques included documental analysis, semi-structured interview and observation with a field diary. The documental analysis was descriptive, while the Content Analysis by Bardin was used for semi-structured interviews and field diary. The Evaluative Study observed that Humanized Abortion Care is an evaluative program with preparation and pact of the logical model, of the matrix of indicators and evaluative questions. The Case Study showed that users were satisfied with the problem-solving capacity and access to the service; however, is also showed that they pointed out inadequacy in terms of environment, qualified hearing and reproductive planning. Professionals reported that the inefficiency of service consists of infrastructure and environment, which are considered inefficient and inadequate to humanized care, especially regarding patient accommodation, the lack of hospital beds, the reduced number of rooms in the surgical center and the lack of laboratory inside the maternity. Moreover, reproductive planning does not consist of an institutionalized practice in the service, and integrality with other services or partnership with the community is not in place. The Maternity Board emphasizes that the excessive demand of patients is one of the reasons that hinders the appropriate implementation of the technical standard. We then conclude that although satisfied regarding problem-solving capacity in terms of service and ease of access, there is room for improvement in qualified hearing systems, in the creation of a system to promote team work, implementation of ombudsman and satisfaction surveys. The right of shared choice did not prevail among users and health professionals with regard to the option of uterine evacuation procedure. Environment was the most mentioned category as that requiring more changes, seeing as a limited factor for the development of humanized and welcoming practices. Health professionals do not establish a periodic routine of planning practices, and such practices are not aligned with the Technical Standard. Incorporation of guidelines and availability of a plurality of methods and possibilities of choices for family planning are required. There is no institutionalization of reference and counter-reference, or partnerships with the community, which makes integrality of care not viable. The Standard needs to be included in the action plans of managers as one of the priorities in the construction of care strategies for women's health, in order to enable, allied to other initiatives, the real integration among safe conduct service, primary care network and social organizations. As a result, respect for human rights and adequate humanized care, as a way of attention and prevention of abortion, can be secured.

O atendimento às adolescentes autoras de atos infracionais no estado do Rio Grande do Norte

The objective of this study was to investigate the assistance for the female adolescents perpetrators of offences in the state of Rio Grande do Norte. Through the Thematic Oral History and Documentary Analysis methods, we sought to uncover historical aspects of the work provided in women’s units of the Fundação dos Direitos das Crianças e Adolescentes (FUNDAC) [Foundation for the Rights of Children and Adolescents], from the experiences of professionals who have worked in these units since the beginning of their activities. For this, we made visits to FUNDAC and the Centro Educacional Padre João Maria (CEDUC) [Educational Center Father João Maria], to identify professionals who could participate in the study, as well as institutional documents on routine of treatment. Eight professionals were found from three identified units: Granja Santana, Instituto Padre João Maria and CEDUC, who were interviewed according to a semi-structured script. The analysis of the collected material is supported in Marxian theory and feminist perspective on the sexual division of labor. The results are organized into five areas of analysis: (1) the creation of the service units; (2) the deviant “behavior”: reasons for institutionalization of female adolescents; (3) educational proposal: a female version; service strategies and; the rules and punishment: the domesticated teenage girl. The study indicates that the commission of the offense by the female adolescents in state of Rio Grande do Norte (RN) has been associated with the conduct of their families, particularly their mothers. Moreover, in general, service strategies, educational proposals, disciplinary measures were and have been developed based on the naturalization of what is female. Therefore, the assistance to adolescent girls in RN, those thirty-five years, left intact the existing hierarchy in social relations between the sexes, it reproduced the subordination of female adolescents in the juvenile justice system.

O trabalho em equipe na atenção primária à saúde: situação de Portugal e do Brasil

Introdução: Na Atenção Primária à Saúde, nos contextos internacional e nacional, o trabalho em equipe tem sido reconhecido como estratégia decisiva para a organização de processos que visam à integralidade do cuidado, além de possibilitar melhorias na satisfação dos usuários com os serviços de saúde. Neste sentido, o objetivo, deste estudo, é analisar o trabalho em equipe na Atenção Primária à Saúde. Método: Trata-se de uma pesquisa em banco de dados secundários. Realizou-se três estudos: a) O trabalho em equipe na Atenção Primária à Saúde, em Portugal, pesquisa avaliativa, de natureza qualitativa, tipo estudo de caso descritivo, que representou um recorte dos resultados derivados da pesquisa integrada ao projeto “Implantação das Unidades de Saúde Familiar em Portugal”, que teve como procedimentos entrevistas semiestruturadas, roteiro de coleta de informações (check list) e análise documental. Foi realizada a estratégia de triangulação dos dados com análise de conteúdo; b) trabalho em equipe, acesso e qualidade na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 17202 profissionais e 65391 usuários. Utilizou-se entrevista estruturada, com análise estatística realizada pelas frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. c) satisfação dos usuários com o trabalho em equipe na Atenção Primária à Saúde, no Brasil, estudo transversal, de abordagem quantitativa, realizado a partir dos dados obtidos da “Pesquisa de Avaliação Externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica”, no Brasil, em 2013. Amostra composta de 65391 usuários. Realizou-se análise estatística das frequências absolutas e relativas das variáveis através do programa Statistical Package for Social Sciences. Utilizou-se, ainda, o Teste X2 , com nível de significância de 5%; análise de regressão logística múltipla. O modelo final foi ajustado pelo teste de Hosmer/Lemeshow, o qual indicou um ajuste de 66%. Resultados: Sobre o trabalho em equipe na Atenção Primária à Saúde, em Portugal, destacou-se a formação das equipes de forma voluntária, por meio de afinidades pessoais, a existência de “carteira básica de serviços”, juntamente com x intervenções de vigilância, promoção da saúde e prevenção de doença, cuidados em situação de doença aguda, acompanhamento clínico de doença crônica e de patologia múltipla, cuidados domiciliares, interligação e colaboração em rede com outros serviços (cuidados hospitalares), sistemas informatizados nas unidades de saúde. Os dados revelaram dificuldades quanto ao atendimento domiciliar. No Brasil, foi destaque o processo de trabalho, com avanços relacionados a realização de planejamento e programação das ações e o apoio da gestão. Existência de território definido e de prontuários familiares. É destaque a agenda compartilhada e pactuada entre os profissionais. As equipes realizam acolhimento e reuniões, cujos temas, discutidos, giram em torno do processo de trabalho e planejamento. Os desafios, enfrentados, estão relacionados ao agendamento dos usuários; ao número de pessoas sob a responsabilidade das equipes; à existência de população descoberta nas áreas adscritas à Unidade de Saúde; à incipiência na ação intersetorial e ao pouco envolvimento da comunidade pelas equipes. Quanto aos fatores associados à satisfação do usuário foi marcante: a faixa etária; a escolaridade; a raça; se a falta de material prejudica o atendimento e se a equipe consegue marcar consulta para outros profissionais. Conclusões: Constatou-se o trabalho em equipe como elemento central no processo de mudança na Atenção Primária à Saúde, tanto no contexto de Portugal quanto no do Brasil, o qual ampliou o acesso e a qualidade na oferta de serviços de saúde e obteve, ainda, o reconhecimento social, mesmo que, em ambas as realidades, não tenha avançado na coordenação do cuidado e no estímulo à participação social. Os fatores, associados com a satisfação do usuário, estão relacionados diretamente ao cuidado prestado e refletem a expectativa, por parte do usuário, de resolução concreta de suas necessidades.

A criança com paralisia cerebral na educação infantil: um olhar sobre a prática docente

La inclusión de los niños con discapacidad en la educación infantil, además de ser un tema poco planteado en la comunidad científica, es un reto actual en lo que se refiere a la práctica docente. Basándose en este aspecto, nuestro objetivo en esta investigación realizada, que resultó en la elaboración de este trabajo, fue analizar cómo se procesa la práctica docente con vistas a la inclusión escolar de un niño con parálisis cerebral, en un Centro Municipal de Educación Infantil (CMEI), en la ciudad de Natal / RN. Más específicamente, buscamos: reflexionar sobre la práctica de la profesora responsable por la clase, en lo que se refiere al desarrollo del niño con parálisis cerebral; analizar las interacciones entre educador y niño con parálisis cerebral; observar la práctica docente en la perspectiva de favorecer la interacción entre el niño con parálisis cerebral y otros niños. Para ello, realizamos una pesquisa exploratoria, cualitativa, y así que optamos por el método del Estudio de Caso. Utilizamos como procedimientos metodológicos el análisis documental, la investigación bibliográfica, la entrevista semiestructurada, la observación y la filmación de escenas relacionadas a la práctica docente. Los sujetos de la investigación fueron la profesora y el niño con parálisis cerebral. Los datos construidos durante la investigación señalaron el hecho de que la práctica de la profesora no estaba encaminada a las necesidades específicas de la alumna con parálisis cerebral, todavía, se desarrollaba de una manera similar para todos los niños en la clase. La presencia de limitaciones significativas para la inclusión de la niña con parálisis cerebral en la educación infantil puede ser considerado como el resultado de la ausencia de una adecuada preparación docente, tanto en el nivel de la formación inicial, cuanto de una formación continua y también la escasez de directrices para el maestro, en proceso; directrices estas acerca de la educación de los niños con parálisis cerebral, lo que hacía imposible a la profesora contribuir de manera efectiva a su mayor desarrollo cognitivo y social.

Inclusão de estudantes com deficiência no Instituto Federal da Paraíba a partir da ação TEC NEP

The current research developed in the Federal Institute of Paraíba – IFPB, João Pessoa Câmpus, aimed at analyzing the inclusion of students with disabilities in undergraduate courses based on the TEC NEP Action. It departs from the discussion about professional and special education in an inclusive perspective, focusing on people with disabilities, in the social context of these two modalities of education, considering the world scenario and the current Brazilian educational policy. It discusses the TEC NEP Action within the national and local context through the analysis of the official documents with the objective of getting familiarized and evaluating the process of educational inclusion in the IFPB João Pessoa Câmpus. The theoretical reference used contributed to the analysis of the policy which focused on inclusion in federal undergraduate institutions for professional education. The methodology used presents a qualitative analysis, having as subject of the research students with disabilities from undergraduate courses in the IFPB João Pessoa Câmpus who are supported by NAPNE. The results based on the analyzed data show that volunteer students from this research evaluate their process of inclusion in the appointed institution as positive, in spite of challenges specially the ones related to architectural barriers. It is concluded that the foundation of the House for Supporting People with Special Education Needs – (NAPNE) through the TEC NEP Action had crucial importance in the basis for the discussion about inclusion in the institution, widening the vision towards the demands of students with disabilities in order to facilitate access, permanence and academic success of these students.

Características dos programas de residência médica em cardiologia do estado do Rio Grande do Norte

The present study had as goal to evaluate Rio Grande do Norte state’s medical residency programs (MRP) in Cardiology. It’s a descriptive study, including a documental analysis of the program’s accreditation processes (PAP) of cardiology’s medical residency in Rio Grande do Norte state in 2014 and the analysis of the resident’s perception about his professional education as a specialist in Cardiology. Beside the documental analysis of the PAPs, it was applied a semi-structured questionnaire with closed questions Likert style and open questions to all the current and former residents of the MRPs analyzed. Two MRPs in Cardiology were identified in Rio Grande do Norte state, one hosted in a public institution and the other in a private institution. The documental analysis showed a greater amount of preceptors with a good level of ownership on the public institution in comparison with the private one, as well as a bigger number of publications, participation in congresses and in book’s publications. The private institution presents a better Urgency’s infrastructure, with emergency room and cardiologic ICU. It IS clear that the residents are aware of how a good residency must work, as well as the strengths and fragilities of their own residences. Most of Onofre Lopes Universitary Hospital’s residents point out as a strength the organization, participation and quality of the preceptors, practice activities and scientific debates, great amount of patients and the visits and debates with the preceptors on the sickrooms. As the greatest fragilities, they emphasize the lack of a urgency service of their own and a specialized ICU. In Coração Hospital of Natal (HCor), it is listed as weak points the theoretic scheduling and the few ambulatory practices. As positive aspects, they report the preceptors, the agility on the execution of exams, a good number of serious patients and procedures. In both residences, it is seen a certain difficulty in accepting the important and mandatory items imposed by the rules of the Medical Residences’ National Committee, such as: biostatistics, bioethics, medical ethic, epidemiology and research methodology. Besides that, the residents recognize that both hospitals have a good infrastructure and technological support, especially in imaging methods. The evaluation of PRMCs identifies the strengths of each program and the aspects to be improved in both programs. It also allowed the observation of difficulties in accepting some regulations contained in the CNRM resolution by the resident, such as participation in activities such as biostatistics, epidemiology and research methodology as well as the improvement needs of specific technical training, such as in emergency care. Thus, our results make possible to develop strategies for continued improvement of PRMC in RN state. In addition, it enabled the preparation of the resident’s manual in cardiology, containing even a breakdown of resident evaluation system, which could serve as a model for other residency programs.

Proposta de modelo de gestão de riscos para uma IFES visando a realização de auditoria baseada em riscos

Organizations are susceptible to the occurrence of many events that may affect the achievement of their objectives. As a result, Brazilian Public Administration supervisory bodies have required institutions to adopt risk management policies. Given the large number of recommendations issued by Federal Audit Court (TCU) to various Federal Institutions of Higher Education (IFES) in this area, it is proposed a risk management model for Universidade Federal do Rio Grande do Norte (UFRN). This is an applied, exploratory and qualitative study. Regarding to technical procedures, it is characterized as documentary analysis, bibliographical research, case study and action research. The bibliographical research was used to support the elaboration of the Risk Management Guide for Federal Institutions of Higher Education (GERIFES). The documentary analysis, in turn, was used with the aim of knowing the organizational structure and the university´s macroprocesses. The author works in the university internal auditing department and shares the same problem. This characterizes the work as an action research. The case study supported both the elaboration of the guide and the simulation of the specific functionality for the university information system, demonstrated through the User Manual Module "Risk Management" proposed for the Integrated System of Property, Administration and Contracts (SIPAC). This manual has been prepared in order to facilitate the use of this tool if it will be incorporated into the university information system. As research results, a risk management model for UFRN was elaborated and a simulation of an informational tool, which is able to manage risks related to events that may affect the achievement of institutional objectives, was provided to the university administration.

Crianças e investigação: aspectos teórico-metodológicos e cuidados éticos nas produções dos grupos de pesquisa da UFRN

The concepts of childhood are part of a cultural construction and vary throughout history politically, economically and socially. Nouns such as "childhood" and "child" did not exist as sense of unity in periods prior to modernity, reinforcing their historical character as concepts that have been socially constructed as profess the Historical Social Psychology, theoretical perspective which will support this research. The sociology of childhood distinguishes the terms and changes the approach toward the adult researcher approach with respect to children, aiming to give voice to the child. When it comes to defining the role of children in research, the researcher must take into consideration several relevant criteria such as age, gender, time, listening to the adults close to the children, the level of language and education and which children that will be heard in a group. It is from this discussion, considering the importance of children's participation in the research that are established the purpose of this work, namely, to analyze the theoretical and methodological aspects and ethical guidelines considered in the research process with children, by researchers at the UFRN, presenting as specific objectives: analyze and discuss, from research reports, the adopted ethical procedures and methods used in research with children. Set the goal, it was made a search of the UFRN Research Groups in SIGAA in order to select those which investigate children for participating in our survey. Among the centers of UFRN, we selected the Health Sciences Centre - CCSA, the Humanities Center, Letters and Arts - CCHLA, the Biosciences Center - CB and the Health Sciences Center - CCS, a total of 64 finalized reports to be analyzed. And here it is the observation that the foolish reports were not analyzed for ethical reasons as the guiding of this dissertation is the coordinator of the research group mentioned. In this study, we chose the documentary analysis of the finalized reports from UFRN research projects teachers / researchers as procedure to set up the corpus of the research. Data analysis was performed from the qualitative analysis in the following categories were established: the concept of childhood, concept of child, age of the subjects, the research context, theoretical and methodological care adopted and ethical care. It is hoped that this study will contribute with reflections on the ethical and theoretical and methodological care on research with children. The research showed how some of the results: significant number of reports excluded by repetition, most reports did not bring any closing remarks, no different procedures for children, with rare exceptions, the ethical issue was not mentioned in 50% of reports.

Práticas pedagógicas e inclusão escolar: o processo de ensino-aprendizagem de alunas com deficiência intelectual

This research aimed to know and analyze the pedagogical practices that have been developed in the teaching and learning of students with Intellectual Disability (DI), enrolled at common class of elementary school I. The study was conducted in a public school at Natal/RN, involving two students with DI, a multipurpose teacher, a teaching assistant, a teacher of arts and educational coordinator. As for methodological choice, we chose to develop a qualitative study, undertaking a case study. As tools for the construction of the data we use: semi-structured interviews, participant observation, field diary and document analysis. Data analysis reveals that the institution in which the research was undertaken gradually implementing changes in order to develop an inclusive practice, consistent with its assumptions. Regarding the practices developed in the teaching and learning of students with intellectual disabilities, it was possible to realize the fulfillment of certain adjustments in relation to the objectives, activities and some content, involving the use of resources and varied strategies. With regard to educational activities, we found that these had different levels of complexity, covering both basic goals as more complex objectives. From the observations, we realize that the Assistant Professor of mediations during varied activities as challenging tool in intellectual processes. We note, too, a dynamic classroom in which disabled students were under the guidance of Assistant Professor, and other students with all-round teacher who had a fairly traditional teaching methodology. It created thus an isolation situation, since there was no proposition practices to be developed with all students, and interaction among classmates, generally quite restricted. Although were highlighted developments in the social and academic learning of the surveyed students, the teachers said they did not feel prepared to work freight inclusion. The study reveals the need for teachers reviewing some actions undertaken, in order to develop more democratic pedagogical practices of education, stimulating the interactions between students, by proposing challenging activities that promote the formation and concepts. In addition, it points to the need of the education system invest and encourage the qualification of teachers with regard to education in an inclusive perspective, through actions that promote lifelong learning. It needs to be developed on the teacher a reflective attitude, resulting in a view that due diligence must be entered in practice inherent in teaching in order to use to enhance their educational experience.

Práticas pedagógicas e inclusão escolar: o processo de ensino-aprendizagem de alunas com deficiência intelectual

This research aimed to know and analyze the pedagogical practices that have been developed in the teaching and learning of students with Intellectual Disability (DI), enrolled at common class of elementary school I. The study was conducted in a public school at Natal/RN, involving two students with DI, a multipurpose teacher, a teaching assistant, a teacher of arts and educational coordinator. As for methodological choice, we chose to develop a qualitative study, undertaking a case study. As tools for the construction of the data we use: semi-structured interviews, participant observation, field diary and document analysis. Data analysis reveals that the institution in which the research was undertaken gradually implementing changes in order to develop an inclusive practice, consistent with its assumptions. Regarding the practices developed in the teaching and learning of students with intellectual disabilities, it was possible to realize the fulfillment of certain adjustments in relation to the objectives, activities and some content, involving the use of resources and varied strategies. With regard to educational activities, we found that these had different levels of complexity, covering both basic goals as more complex objectives. From the observations, we realize that the Assistant Professor of mediations during varied activities as challenging tool in intellectual processes. We note, too, a dynamic classroom in which disabled students were under the guidance of Assistant Professor, and other students with all-round teacher who had a fairly traditional teaching methodology. It created thus an isolation situation, since there was no proposition practices to be developed with all students, and interaction among classmates, generally quite restricted. Although were highlighted developments in the social and academic learning of the surveyed students, the teachers said they did not feel prepared to work freight inclusion. The study reveals the need for teachers reviewing some actions undertaken, in order to develop more democratic pedagogical practices of education, stimulating the interactions between students, by proposing challenging activities that promote the formation and concepts. In addition, it points to the need of the education system invest and encourage the qualification of teachers with regard to education in an inclusive perspective, through actions that promote lifelong learning. It needs to be developed on the teacher a reflective attitude, resulting in a view that due diligence must be entered in practice inherent in teaching in order to use to enhance their educational experience.

Currículo escolar e inclusão de estudantes com deficiência: diálogos com uma escola pública

This work of qualitative approach, has as its study object the school curriculum, resulting from the implementation of public policies for inclusion in the Brazilian educational field and of the teaching organization in State School Despertar. While we acknowledge advances in government discussions and proposals related to school inclusion in our country, it is still important to develop studies and interventions in the context of basic education focused on the curriculum. With methodological basis in collaborative-critical action research and contribution by Barbier, the survey was conducted in 2013, in a state school in the Natal - Rio Grande do Norte - school system, and aimed to analyze the curriculum of the State School Despertar, in particular issues related to the inclusion of students with disabilities in common teaching classes expressed in the school and in collective situations of continuing education with teachers and interpreter of Brazilian Sign Language (Libras). The school was previously chosen because it had already been locus of research in a study conducted by a professor at the Federal University of Rio Grande do Norte promoting the knowledge of their formative needs. The study subjects were 26 teachers in the early years and the end of elementary school and a Libras interpreter. The instruments were direct observation, semi-structured interviews, document analysis and a proposal for continuing education called Collaborative Group on School Inclusion (GCEI), established with the participating subjects and the other research collaborators. The analyzed data showed eight dialogues built with the State School Despertar, being basic the contributions of Goffman (1988) on stigma and of Forquin (1993) on school culture. As a theoretical framework, there were important contributions on School Curriculum (SACRISTÁN, 2000; 2007; APPLE, 2006; 2008), School Inclusion (BUENO, 2008), Continuing Education (NÓVOA, 2002; GATTI, 2003) and the existing studies on the dialogues between Curriculum and Special Education (MAGALHÃES, 2002; SILVA, 2008; 2010; OLIVEIRA, 2004; VIEIRA, 2012). The study highlighted the importance of extending the dialogue, the theoretical deepening of GCEI for the understanding of school curriculum and the specifics of any students, with or without disability. It will be necessary to revisit the school teaching practices that do not correspond to the students, for instance the formation of classes made in classrooms. It is also important to consider the organization of the school day and its interface with the pedagogical functions of each member of the school in building curriculum practices consistent with the diversity of modes and learning styles. Subliminal aspects of the curriculum should be reviewed, given its implications in the context of the classroom and management. However, significant changes identified in the practices of some teachers, such as the use of audio description, stimulus to the participation of students with disabilities and use of images, favored the development of other students, who benefit of more exciting and participatory classes. Based on the conducted research, we conclude on the importance of collectively discuss the conditions for / in schooling of different students and the (re)thinking of curriculum practices in the school as a whole, and therein lies a paradox because, on the one hand, it is not about minimizing the specific knowledge in dealing with the needs of students with disabilities, on the other, we are not interested in distancing these needs from those inherent in human nature, therefore peculiar to the other students. The questioning of our own practices is the challenge imposed, not to special education, or its target audience, but this is undoubtedly task of education.

Currículo escolar e inclusão de estudantes com deficiência: diálogos com uma escola pública

This work of qualitative approach, has as its study object the school curriculum, resulting from the implementation of public policies for inclusion in the Brazilian educational field and of the teaching organization in State School Despertar. While we acknowledge advances in government discussions and proposals related to school inclusion in our country, it is still important to develop studies and interventions in the context of basic education focused on the curriculum. With methodological basis in collaborative-critical action research and contribution by Barbier, the survey was conducted in 2013, in a state school in the Natal - Rio Grande do Norte - school system, and aimed to analyze the curriculum of the State School Despertar, in particular issues related to the inclusion of students with disabilities in common teaching classes expressed in the school and in collective situations of continuing education with teachers and interpreter of Brazilian Sign Language (Libras). The school was previously chosen because it had already been locus of research in a study conducted by a professor at the Federal University of Rio Grande do Norte promoting the knowledge of their formative needs. The study subjects were 26 teachers in the early years and the end of elementary school and a Libras interpreter. The instruments were direct observation, semi-structured interviews, document analysis and a proposal for continuing education called Collaborative Group on School Inclusion (GCEI), established with the participating subjects and the other research collaborators. The analyzed data showed eight dialogues built with the State School Despertar, being basic the contributions of Goffman (1988) on stigma and of Forquin (1993) on school culture. As a theoretical framework, there were important contributions on School Curriculum (SACRISTÁN, 2000; 2007; APPLE, 2006; 2008), School Inclusion (BUENO, 2008), Continuing Education (NÓVOA, 2002; GATTI, 2003) and the existing studies on the dialogues between Curriculum and Special Education (MAGALHÃES, 2002; SILVA, 2008; 2010; OLIVEIRA, 2004; VIEIRA, 2012). The study highlighted the importance of extending the dialogue, the theoretical deepening of GCEI for the understanding of school curriculum and the specifics of any students, with or without disability. It will be necessary to revisit the school teaching practices that do not correspond to the students, for instance the formation of classes made in classrooms. It is also important to consider the organization of the school day and its interface with the pedagogical functions of each member of the school in building curriculum practices consistent with the diversity of modes and learning styles. Subliminal aspects of the curriculum should be reviewed, given its implications in the context of the classroom and management. However, significant changes identified in the practices of some teachers, such as the use of audio description, stimulus to the participation of students with disabilities and use of images, favored the development of other students, who benefit of more exciting and participatory classes. Based on the conducted research, we conclude on the importance of collectively discuss the conditions for / in schooling of different students and the (re)thinking of curriculum practices in the school as a whole, and therein lies a paradox because, on the one hand, it is not about minimizing the specific knowledge in dealing with the needs of students with disabilities, on the other, we are not interested in distancing these needs from those inherent in human nature, therefore peculiar to the other students. The questioning of our own practices is the challenge imposed, not to special education, or its target audience, but this is undoubtedly task of education.

A prescrição de medicamentos por enfermeiros na atenção primária à saúde no Brasil: caracterização, normatização, formação e lições aprendidas.

O papel do enfermeiro como prescritor vem se ampliando em muitos países nos últimos anos, em diferentes situações e amplitudes de ação, se configurando como prática avançada na enfermagem. No Brasil, a prescrição de medicamentos por enfermeiros está prevista na Lei do Exercício Profissional desde 1986, e permite a esse profissional, a prescrição de medicamentos estabelecidos em programas de saúde pública. Esse estudo tem como objetivo geral analisar as determinações e perspectivas da prescrição de medicamentos por enfermeiros nos protocolos da Estratégia Saúde da Família. Os objetivos específicos são: apreender a atual situação internacional da prescrição de medicamentos por enfermeiros em comparação a essa prática no Brasil identificando semelhanças e diferenças; identificar os contornos legais e normativos da prescrição de medicamentos por enfermeiros no Brasil apontando sua história, tendências e desafios; caracterizar o modelo de prescrição de medicamentos por enfermeiros nos protocolos de Atenção Primária à Saúde no Brasil; investigar possíveis lacunas entre formação, capacitação, autoavaliação e prática da prescrição de medicamentos na Atenção Primária à Saúde na perspectiva do enfermeiro. Trata-se de Estudo de Caso Exemplar com abordagem qualitativa através de Revisão Bibliográfica, Análise Documental e Grupo Focal com enfermeiros. A análise dos dados deu-se por meio da Análise de Conteúdo e Análise Qualitativa de Conteúdo. Os resultados revelam que a categoria da enfermagem contribuiu para a legalização da prescrição, porém não para a sua legitimação; na Atenção Primária à Saúde, essa atribuição está consolidada por meio de protocolos e legislação, embora sem estratégia clara de acompanhamento pelo Ministério da Saúde; observa-se resistência em algumas normatizações dentro do setor saúde. Quanto aos protocolos, observou-se não há exigência de pré-requisitos na maioria deles; há possibilidade de diagnóstico pelo enfermeiro na gravidez, nutrição infantil e doenças sexualmente transmissíveis; observou-se variados graus de autonomia; amplo grupo de medicamentos prescritos por enfermeiros. Dos 37 participantes do Grupo Focal, 97,3% eram do sexo feminino; 54% formados há menos de 10 anos, 27% entre 10 e 20 anos, 16,2% há mais de 20 anos; 83,8% com especialização em Saúde Pública. Todos os enfermeiros relataram insuficiência da disciplina de farmacologia para instrumentalizar a prática prescritiva. Destacou-se a necessidade de pós-graduação; a importância da experiência clínica; falta de discussões e capacitação. Apenas alguns se autoavaliaram como competentes para prescrever, outros revelam medo de reação adversa a medicamentos. Conclui-se que há tendência da prescrição de medicamento por enfermeiros permanecer apenas na legalidade e o principal desafio é alcançar a legitimidade. Confirma-se uma prática prescritiva sem requisitos, diversidade de orientações induzindo a multiplicidade de ações que pode afetar a qualidade da prescrição. Há lacunas entre formação, capacitações e exigências cotidianas da prescrição de medicamentos por enfermeiros na Atenção Primária à Saúde. No Brasil se faz premente pesquisa para avaliar o impacto, a qualidade e a segurança da prescrição de medicamentos por enfermeiros. A experiência internacional sugere também que essa prescrição deve ser apoiada pelo coletivo de enfermeiros, com robusto plano de capacitação nacional, além de governança e apoio local.

A política do argumento de inclusão regional no âmbito da Universidade Federal do Rio Grande do Norte

O acesso ao ensino superior gratuito no Brasil continua sendo um grande desafio para significativa parcela da população. Várias políticas de ações afirmativas têm sido estimuladas no sentido de promover um acesso mais homogêneo às universidades públicas brasileiras. Essa dificuldade no acesso acaba refletindo-se no mercado de trabalho, gerando um desequilíbrio em várias áreas de atuação. Na área de saúde, temos observado que um intenso debate sobre a oferta, a concentração e a fixação de médicos vem acontecendo no Brasil. Embora o número de médicos tenha aumentado nos últimos anos, chama a atenção a desigualdade da distribuição dos mesmos, que prioriza os grandes centros urbanos e as capitais em detrimento dos municípios do interior. A abertura de novos cursos de medicina é uma das estratégias na tentativa de conseguir uma melhor distribuição de médicos nas diversas regiões do Brasil. O presente trabalho teve como objetivo estudar o Argumento de Inclusão Regional da Universidade Federal do Rio Grande do Norte, enquanto política que objetiva priorizar a seleção de estudantes do interior do Estado com vistas a promover maior fixação futura de profissionais nas regiões com maior carência destes, especialmente médicos. Trata-se de estudo exploratório, descritivo, em que a coleta de dados constou de revisão bibliográfica e análise documental. O estudo se desenvolveu em etapas, transformadas em capítulos descritivos que deram forma ao trabalho final. É importante destacar a necessidade de esclarecimento sobre esse instrumento, que pode ser utilizado por todos os novos cursos de Medicina do país como um dos meios para um melhorar o acesso de estudantes das regiões onde os cursos estão inseridos e, com isso, tentar promover, ao final do curso, uma maior fixação de médicos nos municípios do interior do Brasil.

A gestão educacional das secretarias municipais de educação de municípios maranhenses a partir do plano de ações articuladas 2007-2011

The main purpose of this thesis was to analyze educational management of Municipal Departments of Education (SEMED’s) of cities in Maranhão inserted in the Plan of Articulated Actions (2007- 2011). We evidence the role of Union in that public policy. The leading argument is that Brazilian federal government is not demos constraining in relation to its national sub-governments, what makes the central government to enforce, primarily, educational politics like PAR. This kind of politics interferes in the educational management by national sub-governments, turning them into mere executors. By turning them into mere executors, PAR limits their autonomy and over imposes the results-based management as a parameter to improve the education quality. In order to develop the hypothesis, we adopted Political Science as theoretical basis, represented by Federalism Theory as pact which premise is the cooperative pattern of federalism as being the best form of government because it allows a joint decision-making process from the idea of no centralization of power. The methodology was historical materialism, which assumes the totality and contradiction as a form to understand the phenomenon that does not express in direct way its existence, but can be analyzed from such categories that made possible to interpret the reality. So, we used as tools the semistructured interview and documental analyses with triangulation of data. The empirical basis of the research is 04 (four) cities in Maranhão that obey the following criteria: 1. The municipality has to be assigned on the FNDE Resolution nº 29/2007; 2. To present the lowest educational management indexes from the diagnosis made in loco by PAR; 3. To present the lowest financial management indexes based on the diagnosis in loco by PAR. The results suggest that PAR does not effect a resultbased management which are proposed in its legal rules neither the SEMEDs can propose their conception of educational management. That situation creates a hybridism that sometimes turns to managerialism and performativity, sometimes to bureaucracy, sometimes to a total uncoordinated and unarticulated action. In relation to SEMEDs management, this thesis shows that these institutions have no own conception about educational management and end up acting in an uncoordinated and unarticulated way. The thesis concludes that PAR is an over imposition by federal government towards national sub-governments that conflicts with management patterns of those institutions that are used to a less managerial logic. This over imposition makes the Central government to be the center of Brazilian federalism, which is in reality an incomplete pact.