A atenção à crise e o apoio matricial: analisadores da estratégia atenção psicossocial

The National Policy on Mental Health is characterized as a territorial - political community , and it has the Psychoso cial Care Strategy (Eaps) as guideline for the proposal and the development of their actions. In its design, CAPS is idealized to be a strategic equipment within the Psychoso cial Care Network/RAPS. Matricial support and at tention to the crisis constitute strategic areas of action of CAPS in its replacement mission , and as it is g uided by the scope of deinstitutionalization, those are essential to the success of these services. We argue that sustain crises in existential territories of life is a condition for the effectiveness of psychosocial care and, ultimately, to the sustainability of its Reform. In this direction, the matricial support tool reveals a territorial supporter, intercessory and powerful in building a psychosocial care to the crisis. Recognized as one of the major challenges by the Brazilian Ministry of Health, forward these fronts materializes for workers in their mi cropolitical crafts. Our research arises as an investment toward empower them , and aimed to understand the operationalization of attention to the crisis and matricial support in a CAPS II, in the view of its workers . Besides, it aims to examine such practi ces forward the principles and purposes of Psychosocial Care Strategy. Inspired by the research - intervention and by the political and social ideas of Institutiona l Analysis, we offer a space for reflection and exchange, by implicational interviews , enablin g workers to launch them in analysis of practices in the EAPs view. We have done a documentary consulting CAPS Technical Project, and a return stage to the institution, by organizing workshop and conversation groups with CAPS workers. The results have show n that there are institutional logics in competition on that service. When operating the logic risk, some difficulties in sustaining most intense crisis situations were identified, the psychiatric hospital internment is used as a facility, particularly in view of some cases, in which the aggressiveness of the person in crises becomes aggressive, and when the brackets SAMU, the CAPS III and Comprehensive Care Beds do not respond satisfactorily to their users requests. Order weaknesses were indicated in this thesis as macropolitical and micropolitical interfering in network support. The matricial actions were identified as a powerful intercessor resource in crisis care appeared weakened, and indicates little porosity in the relationship between the Service and the territory where it takes place. Noticed by the logic of home care, without operate primarily as a knowledge exchange device, we saw capture points in the logic of assistance with ambulatoriza tion production of CAPS, welfare practices and "ext empore " . T he E APs , although it emerge s as a guiding, it is not seen to workers as effective practice. On the one hand, the results signaled that the attention to the crisis and the matricial actions are developed without tenacious connection with the purposes of EA Ps, on the other hand, successful cases were indicated with the main leads to conducting wire of intersectoral actions to the powerful bonds and to the participation of user in their care process es , indicating insurgent forces tha t intend by traditional lo gic .

Avaliação da eficácia da implementação de um pacote de medidas na prevenção de pneumonia associada à ventilação mecânica em unidade de terapia intensiva adulta

Background: Ventilator-associated pneumonia (VAP) is a health care related infection and the second leading cause of nosocomial infections linked to morbidity and mortality rates. Therefore, the implementation of care guideline protocols has become necessary for critically ill patients in ICUs in order to provide adequate treatment. Objective: To assess the impact of a package called FAST HUG in PAV ; analyze the risk factors for occurrence of VAP in adult patients at an ICU of a private hospital ; analyze the clinical characteristics of patients who were or were not submitted to the FAST HUG ; analyze the etiology of microorganisms related to EPI ; determine the cost of hospitalization in patients with pneumonia and in patients who received the FAST HUG.Methods: The study was performed in a private hospital that has an 8-bed ICU. It was divided into two phases: before implementing FAST HUG, from August 2011 to August 2012 and after the implementation of FAST HUG, from September 2012 to December 2013. An individual form for each patient in the study was filled out by using information taken electronically from the hospital medical records. The following data for each patient was obtained: age, gender, reason for hospitalization, the use of three or more types of antibiotics, length of stay, intubation time and progress. Findings: After the implementation of FAST HUG, there was an observable decrease in the occurrence of VAP (p <0.01), as well as a reduction in mortality rates (p <0.01). It also shows that the intervention performed in the study resulted in a significant reduction in ICU hospital costs (p <0.05).Conclusion: The implementation of FAST HUG reduced the cases of VAP. Thus, decreasing costs, reducing mortality rates and length of stay, which therefore resulted in an improvement to the overall quality of care.

A regionalização como instrumento de governança pública em saúde no estado do Paraná: análise dos vazios assistenciais como subsídio à ação do estado

Everyone has a right to health and the State’s duty is to provide it. SUS (unified health system) main principles are universalization, integrality and equality which are based on the decentralization, regionalization and hierarchization directives and shows the importance of a territorial perspective for planning healthcare actions. Decentralization was the strategy chosen to implant SUS, since municipalities were in charge of providing and organizing the municipal healthcare services. Nevertheless regionalization, that’s to say service, institution and practice integration, was not performed satisfactorily, thus jeopardizing the health system decision making process and causing disputes between municipalities over financial resources instead of developing an interdependent and cooperative net. This way, it is important to analyze if health regionalization has a good potential for being used as public governance tool. The present study aims at giving answers to the following research problem: What are the contributions of regionalism to the State of Paraná public governance applied to health? Besides that, it also aims at assessing the State of Parana health regionalization to identify healthcare gaps and help the State actions through public governance principles applied to healthcare. Therefore, the study used a quantitative-qualitative, exploratory and descriptive research, plus secondary data concerning bibliographic and documental research. The present study analyzed the current hospital bed distribution by compared to the ideal distribution allowing the identification of healthcare gaps in the regional healthcare centers, besides considering medical specialties in the State of Paraná. The study conclusion is that health regionalization is an important tool for reducing healthcare gaps concerning hospital beds permitting the use of seven to ten public governance principles applied to healthcare, as established in the present study, and shows health regionalization is an important pubic governance tool.

Breves consideraciones sobre la mistanasia y el caso del Hospital Universitario Evangélico de Curitiba, estado de Paraná, Brasil

Con frecuencia, los profesionales de la salud se encuentran limitados a continuar con el tratamiento de sus pacientes, debido a las condiciones estructurales de los hospitales públicos, como la cantidad de camas, la calidad del material hospitalario, la calificación de los propios profesionales públicos, entre otras. En este sentido el artículo tiene como objetivo presentar la negligencia con los derechos de la personalidad y principios fundamentales en el sistema de salud público brasileño, señalando la necesidad de políticas públicas para la mejora del Sistema Único de Salud (SUS, Sistema Único de Saúde en portugués), precisamente en las fallas de su sistema, tomando como ejemplo la banalización de la vida por un médico del Hospital Evangélico de Curitiba, Estado de Paraná. Con este ejemplo se buscó presentar también el verdadero sentido de la eutanasia, y su evolución en la historia de la humanidad, distinguiendo la práctica que se llevó acabo en el Hospital Evangélico de Curitiba, que fue presentado por los medios de comunicación de todo el mundo como el caso de la eutanasia en Brasil. El enfoque del tema es de suma importancia para la bioética, porque tiene como objeto permitir una mejor reflexión sobre el problema y sus posibles soluciones.

Delimitação da Reserva Ecológica Nacional para 9 municípios do Alto Alentejo – Execução Técnica dos Trabalhos / Coordenação Científica - Relatório Final

O relatório que se apresenta descreve as tarefas efetuadas no âmbito do cumprimento do contrato celebrado relativo à aquisição de serviços para “Delimitação da Reserva Ecológica Nacional para 9 municípios do Alto Alentejo – Execução Técnica dos Trabalhos”, levadas a cabo pela empresa Mobnetics, Sistemas de Informação Lda., bem como dá cumprimento ao contrato relativo à aquisição de serviços para “Delimitação da Reserva Ecológica Nacional para 9 municípios do Alto Alentejo – Coordenação Científica”, da Responsabilidade da equipa da Universidade de Évora. O presente relatório contém a descrição metodológica, os resultados obtidos e uma ilustração de um conjunto de elementos cartográficos (cujas bases informativas digitais constituem anexo a este documento), dos “Elementos Fundamentais” elaborados à escala 1:25.000:  Carta de bacias hidrográficas com área superior a 3,5 km2;  Carta de lagoas e lagos e respetivos leitos, margens e faixas de proteção;  Carta de albufeiras e respetiva faixa de proteção, no mínimo de 100m de largura;  Carta de áreas estratégicas de proteção e recarga de aquíferos;  Carta de zonas ameaçadas pelas cheias;  Carta de áreas de elevado risco de erosão hídrica do solo;  Carta de áreas de instabilidade de vertentes. Os elementos cartográficos foram produzidos de acordo com o estabelecido na Resolução do Conselho de Ministros n.º 81/2012, de 3 de outubro, e Declaração de Retificação n.º 71/2012, de 30 de novembro, e em conformidade com os termos técnicos da proposta adjudicada.

Dinâmica da regeneração natural do mogno (Swietenia macrophylla King), em área manejada na Amazônia sul ocidental.

Este trabalho teve como objetivo geral analisar a dinâmica de regeneração natural do mogno (Swietenia macrophylla King) em uma área explorada seletivamente na Floresta Estadual do Antimary-Acre. Foram estudados cincos ambientes floresta não perturbada, trilhas de arraste, pátios de estocagem, bordas e leitos de estradas. Foram selecionadas 20 matrizes para o estudo, em torno delas foram instalados 4 transectos de 40 x 5 m partindo da base de cada uma nos quadrantes Norte, Sul; Leste e Oeste. Foram identificadas e estudadas as trilhas, pátios e estradas próximas das matrizes. Em todos os ambientes, foram plaqueteadas e medidas todas as plântulas encontradas. Foram calculadas as taxas de ingresso, mortalidade e crescimento. As variáveis morfométricas área de projeção da copa e altura foram obtidas a partir do modelo de altura do dossel gerado a partir de dados LIDAR. Em todos os ambientes foram realizadas análises químicas do solo. Os principais resultados foram: i. O maior número de plântulas foi encontrado na floresta não perturbada (86,9%); ii. As distâncias de 0-15 m da matriz concentraram o maior número de plântulas; iii. O número de plântulas aumentou conforme acréscimo na áreas da copa das matrizes e altura; iv. As variáveis distância e DAP também tiveram efeito no total de plântulas por ambiente; v. Embora não tenha sido encontrada diferença estatística, a direção influenciou a densidade de plântulas que foi maior no quadrante Oeste (36,1%); vi. A mortalidade foi maior nas trilhas (67,3%) e a sobrevivência nos pátios (75%) e leitos de estradas (80%); viii. Na floresta houve maior percentual de ingressos (20,2%). ix. As médias de pH H2O, K, P, M.O e C.O foram menores na floresta; ix. O crescimento das plântulas foi melhor nas faixas mais distantes da matriz. Entre as principais conclusões: houve efeito de ambiente no total de plântulas, sem efeito observado da direção, nos leitos e pátios as plântulas tiverem melhor estabelecimento, a ausência de luz foi um fator determinante para alta mortalidade, o crescimento em altura no ambiente de floresta não perturbada foi lento.