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 ambulatório de Saúde Mental no contexto da Reforma Psiquiátrica em Natal/RN

The years 1990 disclose the consolidation of the Brazilian Psychiatric Reform project, assumed as official politics by the Health Department, also stirring up discussions, lines of direction and new ways of care. Substitutive services to the psychiatric hospital as CAPS, conviviality centers, therapeutical residences and ambulatory clinics are implemented. This work analyzes the relations that the Specialized Ambulatory Clinic of Ribeira establishes to the services of Mental Health of the public system in the city of Natal/RN, as well as its adjustment to the proposal of the Psychiatric Reform. Through semi-structured interviews and observation, it was possible to gather data which allowed picturing a general characterization of the service: activities, technical group, joint with other institutions, daily routine organization. Such institution develops activities that surpass the traditional character of a clinic- in other words, the psychological/medical appointments - and it mainly greets the ones proceeding from CAPS and psychiatric hospitals. It offers group activities, psychiatric appointments, therapeutical workshops, sheltering and strolls, among others. The institution is composed by a multi-professional team of psychiatrists, psychologists, occupational therapists, nurse s aide and art-educator. The joint of this service with others that make part of the Mental Health Assistance network in Natal is incipient. Due to this fact, some actions and activities that could and should be developed together are just not. Although facing difficulties, the professionals of the Ambulatory Clinic of Ribeira are able to achieve good results and establish care in Mental Health that prioritize sheltering, listening and respect to the user s individuality. The Ambulatory Clinic of Ribeira is organized according to the paradigm of the Psychiatric Reform. Therefore, it offers an attention that stimulates the re-socialization of the users and the exercise of the citizenship and autonomy of those

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

Em defesa da reforma psiquiátrica :por um amanhã que há de renascer sem pedir licença

Insanity was victim of several arbitrary acts perpetrated on behalf of the science. Psychiatric reform constitues an important movement which has attempted to rescue dignity and humanity in the treatment of mental disorder patients. Some countries have advanced in the implement of substutive models that work on the construction of a new social place for madness. The model of attention to mental health in Brazil has also suffered extensive modifications due to the wearing out of the psychiatric hospital model. In Santos, a town in the State of Sao Paulo, we have found a landmark in the development of an anti internment politics, through the creation of a dail care service, including psychosocial assistance. It is in this context that it has been founded in Natal, Rio Grande do Norte, the NAPS and CAPS ( Nucleus and Centres of Psychosocial Attention), municipal strategies that put into effect the law # 10.216/2001, which estabilishes the gradual extinction of psychiatric hospitals. This work has the purpose of carrying out a study about the historical process of psychiatric reform implantation in the State of Rio Grande do Norte, emphasizing the actors involved in process, their trajectory, achievements, improvements, and the movement s perspectives of achieving the ideal of reinstating mental disorder patients. In order to accomplish this purpose, it was necessary to understand the process occurred at the Municipal Secretary s Office for Health, since 1992, for it was the impelling experience towards the reflections about the psychiatric reform in the State of Rio Grande do Norte. The instruments used for this work were documentary analysis, through reports, legislation and handbooks, as well as the staments of people involved in this process. Through the statements analysis, we attempted to estabilish the social actors identity, their perception, emphasizing congruences and incongruences concerning the history of psychiatric reform in the State of Rio Grande do Norte. It is also analyzed the contribution of Psychology in this process, which has become a protagonist in the struggle for the rights of mental disorder patients

Nem tudo que reluz é ouro: oficinas terapêuticas no cenário da Reforma Psiquiátrica

The purpose of this study is to discuss the therapeutic workshops function, while questioning if they constitute a mechanism for change of the traditional asylum logic. The Psychiatric Reform was materialized with the financing and regulation of alternative services that substitute the psychiatric hospital. This change was promoted by the anti asylum debate and the deinstitutionalization besides psychosocial rehabilitation paradigms. Mental health care, therefore, acquired a new form and the Centers for Psychosocial Care (CAPS) are considered the main services of the health network presently under construction. They are services that offer a variety of therapeutics and amongst them is the workshop, considered essential for the advancement of the Reform ideas. The study was conducted in a CAPS II in Natal, RN. Systematic visits were made using the Institutional Analysis perspective, futhermore were made interviews with professionals who was related to workshops. In the end, data were then discussed according to Schizoanalysis. Results denot that workshops represents, in the same time, progress and regress of Psychiatric Reform. It was observed that workshops were oftentimes reduced to strategies for the occupation of time, and as a means for the transmission of social values considered correct. The relationship between professionals and the user of the service was hierarchical and both players was seeing the workshop as a task to be met. Although users expressed intreresting about wokshops, was reported that the work was boring. Besides, except for some cases, the therapeutic workshops wasn t helping clients to create other possibilites in theirs life and stops the job inside the mental care service

O dispositivo alta nos Centros de Atenção Psicossocial/CAPS : loucura, vida cotidiana e organização social

The present paper proposes an analysis about the Brazilian Psychiatric Reform as a public policy and deriving from a research developed with the workers of a Psychosocial Attention Centre III (CAPS III) and the managers of the Psychosocial Attention Web (REAP) in Aracaju. This analysis is developed as an investigation of the discharge at those services, understood not as a procedure, but as a dispositive from which different elements can be articulated: users, knowledge, technical procedures, police measures, juridical decisions, laws, services edifying. This, form the background of the articulation between mental alienation and the subject of right alienation, in the ways through which this articulation develops to the relations between madness,citizenship, internment and substitutive practices. Our investigation about the discharge as a dispositive was built with some narrative constructions, as a discourse analysis inspired by Michel Foucault s method, from the perspective of some of the main dispositive operators: workers and managers. The main aspect observed were: the articulations built by the discharge as a dispositive based on two discursive grate, the Reform as a new treatment substituting internship, and the Reform as juridical insertion and users rights practice; the exercise of these discursive grades based on the workers and managers perspective; the transference of limitations and contradictions of these grades to the competence of the dispositive operators, emerged in an outstanding way, as sometimes those operators are liable for the emergent limitations and difficulties, and some other times they are restrained by their institutional role, which is to maintain the domination relations articulated by the dispositive; finally, some aspects extracted which the dispositive operators - when they were expected to act in a way to maintain certain power relations - were capable to resist, managing other power relations from the dispositive, that we call, as Agamben, dispositive profanity

Carregadores de oxigênio a base de níquel suportado em materiais mesooros para aplicação na recirculação química com reforma (RQR)

Oxygen carriers are metal oxides which have the ability to oxidize and reduce easily by various cycles. Due to this property these materials are widely usedin Chemical-Looping Reforming processes to produce H2 and syngas. In this work supports based on MCM-41 and La-SiO2 were synthesized by hydrothermal method. After the synthesis step they were calcined at 550°C for 2 hours and characterized by TG, XRD, surface area using the BET method and FTIR spectroscopy. The deposition of active phase, in this case Nickel, took place in the proportions of 5, 10 and 20% by weight of metallic nickel, for use as oxygen carriers.The XRD showed that increasing in the content of Ni supported on MCM-41 resulted in a decrease in spatial structure and lattice parameter of the material. The adsorption and desorption curves of the MCM-41 samples exhibited variations with the increase of Ni deposited. Surface area, average pore diameter and wall density of silica showed significant changes , due to the increase of the active phase on the mesoporous material. By other hand, in the samples with La-SiO2 composition was not observed peaks characteristic of hexagonal structure, in the XRD diffractogram. The adsorption/desorption isotherms of nitrogen observed are type IV, characteristic of mesoporous materials. The catalytic test indicates that the supports have no influence in the process, but the nickel concentration is very important, because the results for minor concentration of nickel are not good. The ratio H2/O2 was close to 2, for all 15 cycles involving the test storage capacity of O2, indicating that the materials are effective for oxygen transport

Reforma a vapor catalítica do metano: Otimização da produção e seletividade em hidrogênio por absorção in situ do CO2 produzido

Topics of research related to energy and environment have significantly grown in recent years, with the need of its own energy as hydrogen. More particularly, numerous researches have been focused on hydrogen as energy vector. The main portion of hydrogen is presently obtained by reforming of methane or light hydrocarbons (steam, oxy, dry or auto reforming). During the methane steam reforming process the formation of CO2 undesirable (the main contributor to the greenhouse effect) is observed. Thus, an oxide material (sorbent) can be used to capture the CO2 generated during the process and simultaneously shifting the equilibrium of water gas shift towards thermodynamically more favorable production of pure hydrogen. The aim of this study is to develop a material with dual function (catalyst/sorbent) in the reaction of steam reforming of methane. CaO is well known as CO2 sorbent due to its high efficiency in reactions of carbonation and easy regeneration through calcination. However the kinetic of carbonation decreases quickly with time and carbonation/calcination cycles. A calcium aluminate (Ca12Al14O33) should be used to avoid sintering and increase the stability of CaO sorbents for several cycles. Nickel, the industrial catalyst choice for steam reforming has been added to the support from different manners. These bi-functional materials (sorbent/catalyst) in different molar ratios CaO.Ca12Al14O33 (48:52, 65:35, 75:25, 90:10) were prepared by different synthesis methodologies, among them, especially the method of microwave assisted self-combustion. Synthesis, structure and catalytic performances of Ni- CaO.Ca12Al14O33 synthesized by the novel method (microwave assisted selfcombustion) proposed in this work has not being reported yet in literature. The results indicate that CO2 capture time depends both on the CaO excess and on operating conditions (eg., temperature and H2O/CH4 ratio). To be efficient for CO2 sorption, temperature of steam reforming needs to be lower than 700 °C. An optimized percentage corresponding to 75% of CaO and a ratio H2O/CH4 = 1 provides the most promising results since a smaller amount of water avoids competition between water and CO2 to form carbonate and hydroxide. If this competition is most effective (H2O/CH4 = 3) and would have a smaller amount of CaO available for absorption possibly due to the formation of Ca(OH)2. Therefore, the capture time was higher (16h) for the ratio H2O/CH4 = 1 than H2O/CH4 = 3 (7h) using as catalyst one prepared by impregnating the support obtained by microwave assisted self-combustion. Therefore, it was demonstrated that, with these catalysts, the CO2 sorption on CaO modifies the balance of the water gas-shift reaction. Consequently, steam reforming of CH4 is optimized, producing pure H2, complete conversion of methane and negligible concentration of CO2 and CO during the time of capture even at low temperature (650 °C). This validates the concept of the sorption of CO2 together with methane steam reforming

Serviço Social Audit Saúde no SUS/RN: projeto ético político profissional e de reforma sanitária

Health policies in Brazil, the decentralization of SUS management responsibilities for the three spheres of government has driven the creation and regulation of the audits of health services in the National Audit Office, this is a trend of neoliberal policies imposed by international bodies like the World Bank and IMF to peripheral countries characterized by productive restructuring and reforming the state focuses on the presence of two competing projects in the area of health: Health Sector Reform Project which is based on the democratic rule of law with the assumption of health as social right and duty of the State in defending the extension of the conquest of rights and democratization of access to health care guaranteed through the public financing strategies and the effective decentralization of decisions pervaded by social control and privatized Health Project which is based on the state minimum, with a reduction in social spending or in partnerships and privatization, stronger nonprofit sector, subject to capitalist interests, is made effective through strategies targeting health policy and refilantropização actions. In this context, the present study is an analysis on the work of social audits of public health in infants from a qualitative and quantitative approach, embodied by the critical method of dialectical Marxist social theory that enabled us to unveil the characterization, the demands, challenges and outline the profile of Social Work in teams inserted audits of SUS in RN, but also provided evidence to demonstrate the prospects and possibilities of this area of activity of social workers. It was also found that through the audit work that the state fulfill its role as bureaucratic and regulator of health services with efficiency, effectiveness and economy. Yet, paradoxically, the audits of SUS may provide a vehicle for enforcing rights and ensuring the fundamental principles contained in the project of health reform, because it can be configured in a space of political struggle as representing a new field of knowledge production that needs to be appropriate for a theoretical critic able to redirect the social interests in favor of the user. From this perspective, it is concluded that the work of social audits of public health in infants despite the social relevance that prints, as they constitute an activity study of reality and its transformation proposition requires a transformative political action guided the discussion Marxist theory holds that the ethical project professional politician of Social Work

Desnudando as condições para materialização da reforma psquiátrica em Natal/RN: para além da implantação dos serviços substitutivos em saúde mental

Esta pesquisa objetivou analisar a concretização da reforma psiquiátrica em natal, partindo de um dos serviços substitutivos que compõe a rede psicossocial deste município. A política de saúde mental tem passado por mudanças paradigmáticas, definindo como objetivo maior o processo de desistitucionalização. Redirecionando sua ação para os serviços substitutivos e não, mas o hospital psiquiátrico tradicional. Nesse cenário os Centros de Atenção Psicossocial (CAPS) se mostram estratégicos para materialização dos objetivos pretendidos pela reforma psiquiátrica. O estudo transcorre dentro da perspectiva materialista dialética. A presente pesquisa teve como lócus de investigação empírica o primeiro Centros de Atenção Psicossocial implantado em Natal/RN. A escolha por um serviço extra-hospitalar vai ao encontro de uma postura defendida pelo movimento de Reforma Psiquiátrica. Considerando o CAPS um serviço substitutivo estratégico em saúde mental para a efetivação da Reforma Psiquiátrica, neste sentido objetivamos apreender as contradições que marcam o processo de concretização da Reforma Psiquiátrica através da vivência dos usuários e de suas famílias, no interior de uma unidade integrante do novo modelo de atenção em saúde mental. Partimos do pressuposto de que os usuários e seus familiares são sujeitoschave no processo de reforma psiquiátrica, por vivenciarem em seu cotidiano as mudanças concretas realizadas, que acenam para um processo de re-inserção social, mas também, contraditoriamente, os limites e entraves desse processo

Ecossocialismo: a gênese de uma ecologia social em assentamentos de reforma agrária a partir dos movimentos sociais do campo

The world`s ecology crisis has in the capitalism way of production one of the possible causes. The unstopped search for the profits, into unlimited exploration of limited resources, made a huge transformation in human relationships with the nature, causing environment devastation, shortage of resources and species disappearance. Arises the necessity of question the society model that we are and which brings this crisis state, while we are impelled to search an alternative way. The ecosociallist praxis blows marxist principles with ecological matters, bringing important contributions regarding alternatives to capital/exploratory modus, advocating for a social fair society and environmentally sustainable. This way, by bibliographic review, we will research about this theory which have been growing in academic middles. In the same way, we will analyze the rural social movements paper in the construct of this reality. Throut the half estruture interviwes, bibliografic research and visities in the space of settlement called Moacir Lucena, that is today a exemple of rural resignification

Reforma agrária de mercado e territorialização: um estudo a partir do Programa Cédula da Terra em Canindé-CE

The research Reforma Agrária de Mercado e Territorialização: um estudo a partir do Programa Cédula da Terra em Canindé-Ce , has an objective to discuss until whas time denominated agrarium refom has capacity of territory the of families in Five from the seven settlements cmated by resourles from the prgramme cell of earth em Canindé-Ce. In this context, the present work analysis the relation sitip between power and kind of identity, in special in those settlements, trying to learn the dialetic relationship. That passes by the process and appropriation in these spaces by these families gave the beginning of buying the land. The procedure methologic used by us gave privilege to realize the interview included in this process, wita the leaders of rural associations (STR); commission clero of earth (CPT); rural workers movement without land (MST); wita agricolas tecnics, and so the local coordinators of cell of earth in Fortaleza. The analysis of agrarium reform in Canindé, infects that the families giving entrance in buying the land, they could creatieg a hope in quality of life for getting the land. Nevertheless, it did not happen, in the rost of the parts of the areas in study. The territories present in general focus, the worse process of poomest besides the amount of debiths of these families, putting in risk the territorialization of themselves

Uma leitura geográfica da reforma agrária potiguar

It understands a study made concerning the main aspects of the Agrarian Reform and the Agricultural Nestings of the Rio Grande do Norte. For in such a way an inquiry became necessary initially on the origin of the Brazilian agrarian concentration passing for the donation of Sesmarias, Land Law, Statute of Land and Ith National Plan of the Agrarian Reformation, as well as of the Social Movements of fight for the land appeared since century XIX: Canudos, Contestado, Cangaço, Ligas Camponesas and MST. Drawing the fight for the land in the Rio Grande do Norte, we rescue the component elements of the first indications of the Agrarian Reform and formation of Agricultural Nestings in the State. In the attempt to unmask the current situation of the Settlements, we investigate some concerning aspects to the conditions of life of the seated ones, that it is marked by innumerable problems that go since the lack of water until the a precariousness of the infrastructure and presence of services, over all with relation to the education and health. For in such a way we work initially on the basis of diverse bibliographical readings, together data-collecting the official agencies and some directly involved entities with the Agrarian Reform in the RN. We utilized also the research of field in 27 Settlements of different Microregions of the State that consisted of the application of interviews together to the leaderships of these Settlements and application of forms with the seated families who resulted in a bigger knowledge concerning the reality of these areas that integrate the Politics of the Agrarian Reform

Orientações nacionais para a reforma do ensino médio: dogma e liturgia

O estudo analisa criticamente os fundamentos das atuais diretrizes nacionais para o ensino médio brasileiro, dando especial enfoque à sua coerência com tendências mundiais e seus nexos com recomendações de agências internacionais para reformas educativas nos países emergentes. Discute, outrossim, as vicissitudes e peculiaridades do processo de formulação das referidas diretrizes e sugere o aprofundamento da discussão, indicando aspectos polêmicos que merecem maior reflexão.