Serviço de atendimento móvel de urgência (SAMU) e a assistência às urgências psiquiátricas

The objective of this work which is characterized as an applied research, with a qualitative exploratory approach and has case study character has been the analysis of the conceptions and dealings of health professionals of SAMU in Natal RN about the attendance of psychiatric urgencies. The information was collected between the months of March and April of 2010, by means of semi-structured interviews, performed with 24 health professionals integrating of SAMU-Natal as well as the usage of direct observation technique, performed in the institution's medical regulation room. Both the number of professionals involved in the interviews and the bringing about of the observations, were determined by saturation methods in qualitative research's information collecting. The interviews and observations were transcribed and submitted to contents analysis technique , more specifically, to thematic analysis, which made possible to reach the deepest levels, that go beyond what has simply been manifest in the speech of the interviewed, getting to the relations among the categories and social structures of the issue of the research. Keeping this in mind, three analysis categories have been built, namely: conceptions and concepts of psychiatric urgencies shared by health professionals in SAMU-Natal; attendances to psychiatric urgencies in SAMU-Natal; and the Brazilian Psychiatric Reformation under the view of the SAMU-Natal's health professionals. Reflection about the analyzed information revealed discussions pertaining to the stigma and prejudice on mental illness, and also, pointed out to some hindrances which impair the attendance to individuals in mental suffering in SAMU-Natal. The interviewed health professionals' conceptions on the individual in psychical crisis involve concepts of unpredictability, aggressiveness and risk, stigmatizing elements and historically associated to the social hazard ideology and need for mentally sicks' segregation. The predominance of these conceptions, seen in health professionals speech, had identifiable reflexes on assistance to psychiatric demands performed by SAMU-Natal, namely: indiscriminate request for military police's presence during psychic crisis intervention, neglect about occasions that involve mental health patients, as well as repetitive assisting practice directed on physical contention, and transportation to psychiatric hospital. Associated to it, the professionals have shown distorted and reductionist understanding about Brazilian Psychiatric Reformation, and, in the majority, haven't lent credibility to present model of attention to mental health, based on psycho-social treatment, pointing their speech to a need for psychiatric patient's internment. In this sense, we notice that the hospital-centered and excluding model conceived by classical psychiatry still remains alive in these health professionals' mentality as a reference to psychiatric urgency's assistance. Therefore, the research revealed a sequence of elements, that make us think about the challenges that health sector and society must face to realize Brazilian Psychiatric Reformation's principles and guidelines

Riscos ocupacionais e acidentes de trabalho em um serviço de atendimento móvel de urgência do Rio Grande do Norte

Exploratory, descriptive and quantitative study with prospective data, performed in the Mobile Emergency Care Service in the metropolitan region of Natal/RN, in order to identify the knowledge of the multidisciplinary team about the rules of standard precautions and worker safety, to identify occupational hazards peculiar to the activities of this service; characterize work-related accidents (WRA) and know the procedures adopted after each WRA. The population consisted of 162 professionals and data were collected between the months of November and December 2010. As for personal and professional characteristics, of the 162 professional, 12,96% were physicians; 6,79%, nurses; 33,95%, nursing technicians, 46,29%, conductors; 74,70% were male; 43,21% were between 31 and 40 years old; 69,33% lived in Natal/RN, 50,00% had completed high school; 58,64% were married; 69,75% had children, 46,91% were between 1 and 4 years of training; 61,73% had improvement courses; 59,25% had 3 to 4 years of service; 54,32%, with 1-4 years experience in emergency; 44,44% received 1-2 minimum wages; 78,40% received insalubrity premium; 67,28% worked in Basic Support Unit (BSU); 83,95% had journey on SAMU Metropolitano of 31-40 hours per week; 52,47% had other employments. As for knowledge of rules of standard precautions, safety and occupational hazards, 99,38% knew what it was WRA; 62,96% gave incomplete answers; 74,07% knew the rules of prevent WRA; 46,67% acquired this knowledge in lectures; 53,09% knew Personal Protective Equipment (PPE); 71,60% gave incorrect answers about the importance of standard precautions; 45,06% never received an educational intervention on this issue; 89,51% said that educational interventions in the prevention of WRA are very important; 90,12% pointed out this as a very important issue in the workplace; 27,00% suggested guidance on the topic in the workplace; regarding the physical hazards, 34,57% considered noise as the most important; about chemical hazards, 78,40% chose the gases and smoke; for biological hazards, 48,77% reported contact with the blood; for mechanical hazards, 80,86% said that were transport accidents; about ergonomic risks, 40,12% say it is the tension/stress in the care of critically ill, psychiatric and aggressive patients; and there was an average of 4,5 to the feeling of safety in the workplace. Regarding the data on the WRAs occurred, 31,48% experienced at least one accident event; 72,55% did not notify it; 60,98% answered that there was no routine for notification; 56,86% were performing patient transportation; 49,02% were hurt in the Basic Support Unit/Rescue Unit (BSU/RH); 60,78% occurred during the day; 96,08% of professionals were in normal work schedule (24 hours on duty); 31,37% had contusion; 58.82% had damage to members/pelvic girdle; 43,14% had traffic accidents. About the evolution of the WRA, 62,75% did not have to take time away from work; 76,47% had no sequelae; 88,24% did not require rehabilitation; no professional had a change of occupation. And by means of univariate logistic regression, showed that the nurses and male sex were risk factors for the occurrence of WRA. We conclude that there were gaps in the knowledge of staff regarding WRA, emphasizing the need for continuing education in biosafety in the service.

Trauma em idosos atendidos pelo serviço pré-hospitalar móvel

O The aim of this study was to characterize the occurrence of trauma in the elderly population served by the mobile pre-hospital service, in Natal, Rio Grande do Norte. This is a descriptive, transversal and quantitative approach and whose population consisted of 2,080 trauma victims. The sample, of systematic random type, consisted of 400 elderly people, aged from 60 years old, assisted by the Office of Mobile Emergency in Natal / RN, between January 2011 and December 2012. Data collection began after consent and assent of the institution of a Research Ethics Committee under No. 309 505. It was proceeded to documentary retrospective analysis of records of this service through a form of self-development, validated by expert judges considered reliable (α> 0.75) and valid (CVI = 0.97) in their clarity and relevance. Data were tabulated by the Statistical Package for Social Sciences, version 20.0. The results show that older victims have an average age of 74.19 years old, with a prevalence of female involvement by chronic diseases, especially hypertension, average usage of 2.2 routine medications with vital signs within normal limits. The trauma prevailed during the daytime, in the residence of the victims, north of the city and on weekends. Among the mechanisms of trauma were falls, traffic accidents and physical aggression, whose most common type was brain-cerebral trauma and the main consequences were suture wounds and closed fractures. Basic Support Units were as more driven to pre-hospital care (87.8%) and the main destination place consisted of a referral hospital for emergency of the state (57.5%). Among the most commonly performed procedures by nursing staff immobilization with rigid board and neck collar and the peripheral venipuncture, and the main component used for volume replacement to saline were highlighted. There was a significant relationship between the deaths and the mechanism of injury, mechanism of injury and procedures, except medication administration procedures carried out, except immobilization and unit for service. It is highlighted the prevalence of trauma in the elderly, poor follow-up Pre-Hospital Trauma Life Support protocol and the paucity of records and nursing procedures performed. There is need for a protocol of care specific to elderly trauma victims and education strategies for the prevention of such events

Fatores da satisfação, fidelidade e recomendação em serviço de saúde: estudo em setor ambulatorial de hospital

This thesis deals with the factors affecting customer satisfaction, loyalty and recommendation in the health care sector. It is adapted a model proposed by Johnson et al. (2001) of quality and loyalty antecedent factors and it is conducted a survey with a sample of 109 customers of a hospital on the ambulatory in Natal city, a capital of a Northeastern State of Brazil. It is carried descriptive and multiple regression statistical analysis. The main findings related to satisfaction are that quality factors of doctor professionalism, clerical staff efficiency, consultancy room comfort, time to provide the medical consultancy but also hospital localization are the most significant factors affecting satisfaction. Regarding personal full loyalty, satisfaction with the hospital and affective commitment are the main factors yet for partial loyalty image and calculate commitment play the main role. For recommendation satisfaction, image and brand are the main factors. The overall model used fairly explains the satisfaction, loyalty and recommendation outcomes with varying factors regarding each final purpose, e.g. loyalty or recommendation

Qualidade do serviço em organização do terceiro setor: um estudo na casa de apoio à criança com câncer

The research aimed identify how the quality of services provided by Casa de Apoio à Criança com Câncer Durval Paiva is perceived by its users, giving an opportunity of improve their performance in social services provision pointing out the failures experienced, the institution will have the user as a important partner in fails identification, serving as a subsidy to the actions of correction and improvement to such situations demands. With this work implementation will be observed contributions that will permeate to the fields of theory and practice, enabling progress and enrichment on the subject. The theoretical contribution is observed as this work execution will provide greater advance about the models developed for the third sector. The proposed work will raise awareness issues about the full potential of the social economy, with regard to the quality of services provided by organizations, allowing a better definition of priorities on their development. The study addressed three issues: identifying the people that receive support of the Casa Durval Paiva, identifying what is the level of satisfaction of families served and evaluate the services provided by Casa Durval Paiva that demand improvements in the perception of families assisted. Found a demand for services has been found that the institution has a multidisciplinary team with a high level of professionalism, and supervised with students of various educational institutions and many volunteers to complement the actions of individual professionals. Was measured a high satisfaction of users of the services provided by Casa Durval Paiva

Determinação de Chaveamento para Recomposição do Serviço em Redes de Distribuição de Energia Elétrica em Média Tensão Através de Métodos Baseado em Parâmetros de Sensibilidade

The reconfiguration of a distribution network is a change in its topology, aiming to provide specific operation conditions of the network, by changing the status of its switches. It can be performed regardless of any system anomaly. The service restoration is a particular case of reconfiguration and should be performed whenever there is a network failure or whenever one or more sections of a feeder have been taken out of service for maintenance. In such cases, loads that are supplied through lines sections that are downstream of portions removed for maintenance may be supplied by the closing of switches to the others feeders. By classical methods of reconfiguration, several switches may be required beyond those used to perform the restoration service. This includes switching feeders in the same substation or for substations that do not have any direct connection to the faulted feeder. These operations can cause discomfort, losses and dissatisfaction among consumers, as well as a negative reputation for the energy company. The purpose of this thesis is to develop a heuristic for reconfiguration of a distribution network, upon the occurrence of a failure in this network, making the switching only for feeders directly involved in this specific failed segment, considering that the switching applied is related exclusively to the isolation of failed sections and bars, as well as to supply electricity to the islands generated by the condition, with significant reduction in the number of applications of load flows, due to the use of sensitivity parameters for determining voltages and currents estimated on bars and lines of the feeders directly involved with that failed segment. A comparison between this process and classical methods is performed for different test networks from the literature about networks reconfiguration

A relação entre as noções de eleuthería e autárkeia na filosofia de Epicuro

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Assistência odontológica diferenciada para crianças de 0 a 3 anos: avaliação de impacto no Serviço Público Municipal em Natal-RN

In Brazil, 0-5 years old children just have an oral health care system since 1990 s. Innumerable experiences of implantation of the attendance to the babies in the cities had appeared throughout the years, but it hasn´t been evaluated the comparative effect between children displayed and not displayed to the program. In this regard, the main of this research was describe the Early Childhood Oral Health Care in public health service in Natal, Rio Grande do Norte, Brazil and evaluate the impact of this specific oral health care for babies by comparison of indicators between exposed and non-exposed children. It was created an experimental group, formed by children covered by program which was paired, based on sex, age and socioeconomic status, with a control group, formed by uncovered children. After filling ethical application, the parents of children were questioned about some risk factors to dental caries and, in sequence, it was accomplish an oral examination in the child. It was verified the Visible Plaque Index (VPI), Gingival Bleeding Index (GBI), dmf-s and verification of caries activity. The sample was 40 children in each group. The results showed, for VPI, a difference of 7 percentile points for the experimental group, however this difference had no statistical significance, obtained by Student s t test (p=0.314). In relation to GBI, the control group showed a low mean (0.8%) comparing with experimental group (2.77%) and this difference was statistically significant (p=0.003). The results for dmf-s and evaluation of caries activity showed no statistical difference between groups. Among the probable reasons for absence of impact of intervention, could be included: (a) the practice model was the same in two groups, or the difference was very weak and (b) the oral health care has intrinsic limitations for to impact on oral health in low income populations

A relação trabalho e saúde no setor calçadista de Franca, São Paulo

Este texto busca evidenciar a relação trabalho e saúde em um lócus determinado: a produção calçadista em Franca, interior do estado de São Paulo. A discussão privilegia o processo sócio-histórico da referida atividade econômica em Franca, com ênfase na reestruturação produtiva que, a partir na década de 1990, disseminou parte da produção para as residências dos trabalhadores, constituindo as denominadas Bancas de Pespontos e de Corte em Calçados. Desse modo, a partir do conhecimento empírico, subsidiado pelas visitas a estes empreendimentos e de entrevistas com os trabalhadores e ainda com um relato de caso, enfatiza-se as relações sociais de trabalho que podem agredir à saúde. Todavia, diante da informalidade acabam não sendo consideradas na relação entre saúde e a atividade funcional exercida, ficando estes infortúnios distantes das negociações coletivas, fiscalizações, ou seja, de possíveis mudanças.

Dependência química em mulheres :um estudo sobre o consumo de medicamentos ansiolíticos no serviço público de saúde de Natal/RN

This work was concerned to investigate the meaning attributed to anxiolytic drugs by women, in public health service. It proposes a joint analysis through a link between three dimensions: the woman, the drug, and public health service itself, in an hegemonic medical assistance model. It is observed that the relation between these elements has a great influence over the use and construction of a particular meaning, by the user. The medication is analysed as a consumption merchandise and as an health symbol. In this way, it reflects a biologized vision, which believes the drug as a solution for all health problems. It tries to analyse the generalized medical prescription for anxiolythics and it s consequences. It focalizes also the production and utilization of public health services by patients, mainly women. The question related to the use of anxiolytics and the meaning construted by women is analysed focusing the way that relations of masculine/feminine gender are organized in our society. At this point of view, it tries to understand the dimension that these questions have in subjectivity production, and how it acts in the health/disease process. Finally, this work tries to understand, in a broad sense, the use of anxiolytics looking at the problem not only as a biological question, but also as a cultural matter. The research was done over seventeen women, all of them anxiolytic users. It was used, as research instrument, semi-structured interview associated with methodological analysis of user s speeches

A relação juventude-trabalho no projovem integrado do município de Natal/RN

The National Program for Youth Inclusion (ProJovem) has been created in 2005 in order to break the reproductive cycle of social inequality, through the improvement of the basic education and the professional qualification. Therefore, our objective is to discuss how the categories youth-work are inserted and implemented on ProJovem Integrado , which could be translated as Integrated , in Natal/RN. In 2008, ProJovem is has started to be executed based in four modalities: (1) Teenagers Socio-Educational Service, (2) Urban, (3) Worker and (4) Countryside Land Knowledge, aiming to serve a population from 15 to 29 years old who were seldom helped by specifics policies so far. In order to implement this research, three semi-structured interviews have been made, as well as observations at the program units and analysis of the official documents. In Natal, the operating modalities are: ProJovem Urban, which three units, divided in two districts of the city; the ProJovem Teenagers , which has ten units on Natal s four administrative regions; and ProJovem Worker , which were still structuring its courses until the beginning of the data collection. The data has been qualitatively analyzed through the Marxian Theory, tied to the Constant Comparative Method. The referred approach, based on the Grounded Theory, enables the understanding of the phenomenon s meanings through the perspective of the participants. The neighborhoods in which ProJovem s units are inserted has been characterized as well the Program s target. The results have been presented in three blocks: a) the modality s structure, which includes the implementation, functioning and operationalization of the activities; b) management of the modality s management, concerned to the main difficulties, expectations and functions; and c) the relation youth-work at the modalities. About the objectives and qualification and insertion goals, there is incongruence at the offer of occupational arches. We have observed that offered occupations are historically subservient and precarious. Hence they do not promote significant changes on the students career paths by usually inserting them into informal jobs or underemployments. Besides that, the professional qualification is very incipient. For that reason, it does not go with the necessary requirements to enable the youngster to enter the work world. It is considered that other researches are necessary to for better understanding of the remaining aspects of the relation youth-work

O Serviço Social nas operadoras de planos privados de assistência à saúde: demandas, atribuições e respostas profissionais

The present study deals with the exercise of professional social workers in private health care plans registered with the Regional Council of Medicine/RN, in the city of Natal/RN, with regards to the demands/tasks, work conditions, and the professional response, given the climate of restructuring the capital. The set of socio-historical transformations, as a results of the dynamic capitalist, is a process of new configurations in relation to state and society that interfere directly in relation to working conditions, social rights historically won by workers. In this context, the operator of health plans arises as a possibilities to provide services in health, through the logic of the market, in which the subjects of law, become consumers contributing to the displacement of the responsibilities of the State. Obligating workers to lessen the burden with the reproduction of their workforce. This involves changing societal context for social service, since it is one of the professions that are active in terms of the immediate social issue, and come as part of the collective worker. From qualitative research based on a theoretical and methodological perspective and critical dialectics, it was possible to unveil some features and trends of the exercise of(a) social operators in private health care plans. The survey results indicated that : a) the demands and duties for certain social service, are associated with the redevelopment of the capital, whose requirements and responsibilities professionals have with their needs, particularly the guarantee of profit, services rendered; b) in the conditions of work there is a trend of insecurity uncertainty and dismantling of professionals; c) the answers professionals suffer the limits and contradictions present in the daily training, mainly depending one the characteristics of management and operation of the operators, which has professional relative autonomy

Instrumentalidade do serviço social: dimensões teórico-metodológica, ético-política e técnico-operativa e exercício profissional

The dissertation proposes a discussion about the instrumentality of the Social Work, in the attempt of visualizing her, as well as the profession, in a totality perspective to the light of the rationality critical-dialetical. Understood as the capacity that the professional subjects acquire of giving answers to the demands that are placed to the profession, itself built partner-historically, in a teleologys conflicts and causalitys. So, it is proposed the discussion of the instrumentality while a group of you know specific, composed essentially by the development of three practical-formative dimensions. The theoretical-methodological refers to the capacity of apprehension of the method and of the theories and, consequently, of the relationship that does with the practice. The dimension ethical-politics concerns the development of the capacity of analyzing the society and the own profession as field of contradictory forces, being considered the character eminently political of the professional exercise, as well as the professional's conscience concerning the social direction that prints in your intervention. And the technician-operative dimension refers more strictly to the technical elements and you score for the development of the intervention. It was looked for to evidence as those dimensions they attend in the professional exercise, starting from the experience lived by the social workers of the Social Attendance Reference Centers, in Natal/RN

Adolescência e violência: um estudo da medida socioeducativa de prestação de serviço a comunidade no município do Natal

This Project was built to reflect about juvenile violence and the socio-educational´s range of community services provision. It is known that the juvenile violence is a phenomenon inserted on the capitalism system, backed on neo liberal project. Though, it is essential a historical analysis, showing the economical, political, social and cultural mechanisms which determine the juvenile violence personality. On this way, it is seek understand the elements that leads on work world changes, on the State and public politics sphere, that deepens social dissimilarities. On this propose, it is known that there is a relation among the violence, while one of many manifestations of social question on society and the macroestructuals´determinant that lead the teenager to a social rick situation. This research focused on a inquiry quail-quantitative, using the theoric-metodological procedures of observation, interview and documental quest techniques. The universe had been defined by the intentional sample of 22 interviewed on total, during August and October 2008, covering adolescents and their relatives, technical and the coordinator, which subsidized the Socio educational program of community services provision from Natal analysis of limits and their range. The results of this investigation indicate the necessity of development, with the teenagers authors of infringement acts, a care system that is grounded on a professional formation, respect on human rights and citizenship conquest, regarding that children and teenagers are designed as people on development, that have theirs rights and integral protection, being the State, society and family responsibility assure the integral development of them

Movimento estudantil e serviço social no capitalismo contemporâneo: tendências e particularidades

This dissertation aims to analyze the social direction in which the Student Movement in Social Work in Brazil (ENESSO) has gone through. This is done considering how the functioning of the National Executive, the Brazilian Social Work Student union has operated. The research analyzed their political position regarding the university as well as professional education in the period of 2003 to 2008. The study s theoretical and methodological object was obtained according to its structural, juncture, and time determinants. All of the mentioned elements considered the contemporary capital crisis and its implications towards the State and Society emphasizing specifically the changes that occurred in the University regarding professional education. For the purpose of data collection and production, a documental and field research was realized. Thus, interviews were done considering one manager of each management period of the ENESSO group in the time span of 2003 to 2008. Some subjects that represented the Brazilian Social Work Teaching and Research Association (ABEPSS) as well as were also interviewed. These subjects have had a relevant role in partnership with these entities and represented students in the contemporary scene. Results suggest that ENESSO has developed work that defends a project of a public, free and laic quality university. This entity also defends a project that considers the 1996 Curricular Guidelines. Currently, there is internal dispute in the social direction of the MESS, this is seen amongst political groups that diverge in opinions related to the analysis done by the Lula government regarding the political role that the National Student Union-UNE has taken in the counter-reform of higher education. This current juncture is seen as extremely individualist and it results as in unfavorable for the collective organization of the working class, especially regarding student movement. MESS has been going through a moment of profound instability and this dimension is being expressed by the absence of national coordinator for the 2008/2009 management period at ENESSO. Even though there are difficulties, it is possible to point out partnership of the entities that represent the national Social Work in Brazil. These partnerships are all related to a struggle and search for the development of a professional project that leads towards the sociability awareness that goes beyond capital.