Mortalidade infantil e condições socioeconômicas nas microrregiões do Nordeste Brasileiro

The study aims to answer the following question: what are the different profiles of infant mortality, according to demographic, socioeconomic, infrastructure and health care, for the micro-regions at the Northeast of Brazil? Thus, the main objective is to analyze the profiles or typologies associated mortality levels sociodemographic conditions of the micro-regions, in the year 2010. To this end, the databases of birth and death certificates of SIM and SINASC (DATASUS/MS), were taken from the 2010 population Census microdata and from SIDRA/IBGE. As a methodology, a weighted multiple linear regression model was used in the analysis in order to find the most significant variables in the explanation child mortality for the year 2010. Also a cluster analysis was performed, seeking evidence, initially, of homogeneous groups of micro-regions, from of the significant variables. The logit of the infant mortality rate was used as dependent variable, while variables such as demographic, socioeconomic, infrastructure and health care in the micro-regions were taken as the independent variables of the model. The Bayesian estimation technique was applied to the database of births and deaths, due to the inconvenient fact of underreporting and random fluctuations of small quantities in small areas. The techniques of Spatial Statistics were used to determine the spatial behavior of the distribution of rates from thematic maps. In conclusion, we used the method GoM (Grade of Membership), to find typologies of mortality, associated with the selected variables by micro-regions, in order to respond the main question of the study. The results points out to the formation of three profiles: Profile 1, high infant mortality and unfavorable social conditions; Profile 2, low infant mortality, with a median social conditions of life; and Profile 3, median and high infant mortality social conditions. With this classification, it was found that, out of 188 micro-regions, 20 (10%) fits the extreme profile 1, 59 (31.4%) was characterized in the extreme profile 2, 34 (18.1%) was characterized in the extreme profile 3 and only 9 (4.8%) was classified as amorphous profile. The other micro-regions framed up in the profiles mixed. Such profiles suggest the need for different interventions in terms of public policies aimed to reducing child mortality in the region

A incorporação da saúde bucal no programa saúde da família do Rio Grande do Norte: investigando a possibilidade de conversão do modelo assistencial

The Health Family Program (HFP) was founded in the 1990s with the objective of changing the health care model through a restructuring of primary care. Oral health was officially incorporated into HFP mainly through the efforts of dental professionals, and was seen as a way to break from oral health care models based on curative, technical biological and inequity methods. Despite the fast expansion of HFP oral health teams, it is essential to ask if changes are really occurring in the oral health model of municipalities. Therefore, the purpose of this study is to evaluate the incorporation of oral health teams into the Health Family Program by analyzing the factors that may interfere positively or negatively in the implementation of this strategy and consequently in the process of changing oral health care models in the National Health System in the state of Rio Grande do Norte, Brazil. This evaluation involves three dimensions: access, work organization and strategies of planning. For this purpose,19 municipalities, geographically distributed according to Regional Public Health Units (RPHU), were randomly selected. The data collection instruments used were: structured interview of supervisors and dentists, structured observation, documental research and data from national health data banks. It was possible to identify critical points that may be impeding the implementation of oral health into HFP, such as, low incomes, no legal employment contract, difficulty in referring patients for high-complexity procedures, in developing intersectoral actions and program strategies such as epidemiologic diagnosis and evaluation of the new actions. The majority of municipalities showed little or no improvement in oral health care after incorporating the new model into HFP. All of them had failures in most of the aspects mentioned above. Furthermore, these municipalities are similar in other areas, such as low educational levels in children from 7 to 14 years of age, high child mortality rates and wide social inequalities. On the other hand, the five municipalities that had improved oral health, according to the categories analyzed, offered better living conditions to the population, with higher life expectancy, low infant mortality rates, per capita income among the highest in the state as well as high Human Development Index (HDI) means. Therefore, it is possible to conclude that public policies that include aspects beyond the health sector are decisive for a real change in health care models

Saúde psíquica e condições de trabalho dos profissionais de saúde nos hospitais da Universidade Federal do Rio Grande do Norte

A tese se propôs a avaliar a relação entre saúde psíquica e condições de trabalho em dois hospitais da Universidade Federal do Rio Grande do Norte, a saber: Hospital Universitário Onofre Lopes e Hospital Universitário Ana Bezerra. Adotou como ponto de partida epistemológico a abordagem psicossociológica, considerando que a compreensão sócio-histórica do contexto é indispensável para entender os fenômenos em análise. As condições de trabalho e a saúde psíquica foram abordadas interdisciplinarmente, fundamentando a construção de um modelo compreensivo de saúde psíquica que orientou a investigação. O caminho metodológico utilizado foi a pesquisação. Essa foi desenvolvida, utilizando técnicas como análise documental, observação participante, entrevistas não estruturadas, grupo focal e aplicação de um protocolo de pesquisa composto pelo questionário de condições de trabalho, pelo Questionário de Saúde Geral (QSG-60), pela Escala de Bem-Estar Afetivo no Trabalho (JAWS-12) e por questões sociodemográficas. A análise dos resultados mostrou que os escores sintomáticos de saúde psíquica variam por hospitais e que a saúde psíquica sofre influência das condições de trabalho, sobretudo em aspectos referentes a três dimensões: condições físicas e materiais; processos e características do trabalho e o ambiente sociogerencial. Em referência à primeira dessas dimensões, destacaram-se a exposição aos riscos psicobiológicos e de acidentes, bem como as exigências de esforço físico. Na segunda dimensão, a complexidade das atividades e a responsabilidade implicada nas mesmas. E, na última, os fatores de organização da atividade, violência e ambiente conflitivo. Como a relação do indivíduo com seu contexto é dialética, os resultados encontrados corroboraram que quanto mais as condições de trabalho são desfavoráveis, maior a afetação da saúde psíquica e dos afetos com relação ao trabalho, repercutindo novamente no ambiente de trabalho. Portanto, ações de melhoria das condições de trabalho precisam ser estabelecidas para resultar, no efeito inverso, proporcionando o aumento dos afetos positivos e a redução dos sintomas psíquicos

Perfil de mortalidade de idosos no Rio Grande do Norte: estudo comparativo entre duas faixas etárias e fatores relacionados

Measures of mortality represent one of the most important indicators of health conditions. For comprising the larger rate of deaths, the study of mortality in the elderly population is regarded as essential to understand the health situation. In this sense, the present study aims to analyze the mortality profile of the population from 60 to 69 (young elders) and older than 80 years old (oldest old) in the Rio Grande do Norte state (Brazil) in the period 2001 to 2011, and to identify the association with contextual factors and variables about the quality of the Mortality Information System (SIM). For this purpose, Mortality Proportional (MP) was calculated for the state and Specific Mortality Rate by Age (CMId) , according to chapters of ICD- 10, to the municipalities of Rio Grande do Norte , through data from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IGBE). In order to identify groups of municipalities with similar mortality profiles, Nonhierarchical Clustering K-means method was applied and the Factor Analysis by the Principal Components Analysis was resort to reduce contextual variables. The spatial distribution of these groups and the factors were visualized using the Spatial Analysis Areas technique. During the period investigated, 21,813 younger elders deaths were recorded , with a predominance of deaths from circulatory diseases (32.75%) and neoplasms (22.9 %) . Among the oldest old, 50,637 deaths were observed, which 35.26% occurred because of cardiovascular diseases and 17.27% of ill-defined causes. Clustering Analysis produced three clusters to the two age groups and Factor Analysis reduced the contextual variables into three factors, also the sum of the factor scores was considered. Among the younger elders, the groups are called misinformation profile, development profile and development paradox, which showed a statistically significant association with education and poverty and extreme poverty factors, factorial sum and the variable related to underreporting of deaths. Misinformation profile remained in the oldest old group, accompanied by the epidemiological transition profile and the epidemiological paradox, that were statistically associated with the development and health factor, as well as with the variables that indicate the SIM quality: proportion of blank fields about the schooling and underreporting. It proposed that the mortality profiles of the younger elders and oldest old differ on the importance of the basic causes and that are influenced by different contextual aspects , observing that 60 to 69 years group is more affected by such aspects. Health inequalities can be reduced by measures aimed to improve levels of education and poverty, especially in younger elders, and by optimizing the use of health services, which is more associated to the oldest old health situation. Furthermore, it is important to improve the quality of information for the two age groups

A docência na educação infantil: representações sociais dos professores cursistas do proinfantil do Estado do Rio Grande do Norte sobre o trabalho docente

The overall objective of this research is to identify and analyze social representations of (the) teachers(the) Ranciere the Initial Training Program for Teachers in Office in Early Childhood Education - PROINFANTIL - UFRN/MEC on the teaching work, seeking to identify their constituent elements and understand the dynamics of your organization. We assume that these teachers work fundamentally, in the institutions of Early Childhood Education, with knowledge of common sense and related cultural inherent to be/do professor in the design of education guardian/giving handouts to ensure the physical integrity of children, causing a rift between the caring and educating. From this general objective, we elected as specific objectives: identify the social, economic and cultural backgrounds of these (the) teachers (sa); identify what is teaching work for them (the) as well as identify which the psychosocial implications driven by RS on teaching work that point to tensions between the training and the exercise teacher as activity profissional.Como theoretical foundation we opted for Social Representations Theory of Moscovici (2003), Jodelet (2001); Specificities of the teaching Work in Early Childhood Education: Kramer (2002; 2006); OliveiraFormosinho (2007); Zilma de Oliveira (2007), Teacher Training: Ramalho, Nunez and Galthier (2003) and Tardif and Lessard (2008), content Analysis: Bardin (2004). As methodological procedure, we chose the Central Nucleus theory, developed by Jean Claude Abric (2000). Contributed to the scope of this objective the 171 teachers (the) that concluded the Proinfantil NBs to participate of TALP with justifications. The corpus arising from evocations around the words suggested by Carlos Chagas Foundation: give classrooms, teacher, pupil and added the word Child Education, were subjected to a treatment with the aid of the EVOC software (2000), identifying the central nucleus. The results indicate the words more evoked and significant: Planning, child care, educating, and play. Indicating that for these (the) teachers (the) the teaching work in Early Childhood Education must have a systematic pedagogical to educate children. These words correspond to the specificity of being/doing teaching in Early Childhood Education. However, the data shows that it is a job with different characteristics of the teaching work in other stages of education

Análise da atuação do Ministério Público Estadual na assistência materno infantil do Rio Grande do Norte

Maternal and infant mortality have become a serious public health problem in Brazil, especially in northeasternand northern regions.In RioGrande do Norte, the high rates ofdeathsofmothersandbabies haveconcerned not onlythehealthauthorities andjusticeagenciessuch as the prosecution service. In 2011, State Public Ministry (MPE) has developed a proposition which was called “Nascer com Dignidade”, focused on the monitoring ofcare givenin prenatal, childbirth andpost childbirthin the cities. The aim of thisstudy was toinvestigate how the intervention of MPE works in maternal and child care. The method adopted to survey data was the case study by analyzing the skills of the reports which were carried out in four of the eight Public Health Regional Units (URSAP).A total of 26municipalities were chosenand the results showfragilityparticularly inprenatal care which can result in complicationsin childbirthand postpartumlike:incomplete health family teams(in05cities), lack of access orinaccessibility to laboratory tests(16 cities) and lack of the pregnant woman'sattachment to thebirthing place(in26 cities). Based on this reality, MPE has adopted relevant attitudes as filing public civil suits, compliance of Conduct Adjustment Declaration in the municipal management and performing interventions in heath care centers and maternity clinics of the state. Thereforeit is known thatPublic Ministryis of paramount importanceto indicatethe necessaryadjustmentsto addressinfant and maternalmortalityin the state (mean of 65/100,000 and16/100,000respectively) and give the city hall the responsibility for the health care quality provided to their citizens. These factors demand theprinciples ofuniversality and integrality to be performed in order to reduce social inequities.

Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.

Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil

The scope of this study was to identify socioeconomic contextual and health care factors in primary care associated with maternal near misses and their marker conditions. This is an ecological study that used aggregated data of 63 clusters formed by the municipalities of State of Rio Grande do Norte, Brazil, using the Skater method of area regionalization, as the unit of analysis. The ratio of maternal near misses and their marker conditions were obtained from the Hospital Information System of the Brazilian Unified Health System. In multiple linear regression analysis, there was a significant association between maternal near misses and variables of poverty and poor primary health care. Hypertensive disorders were also associated with poverty and poor primary care and the occurrence of hemorrhaging was associated with infant mortality. It was observed that the occurrence of maternal near misses is linked to unfavorable socioeconomic conditions and poor quality health care that are a reflection of public policies that accentuate health inequalities.

Avaliação das condições de trabalho em Hospitais de Natal, Rio Grande do Norte, Brasil

Buscou-se identificar como os profissionais de saúde avaliam as condições de trabalho em hospitais de diferentes naturezas, e verificar como estas condições interferem na satisfação laboral. A amostra foi composta por 213 profissionais de diferentes categorias. A análise dos resultados evidenciou um perfil distinto entre os hospitais no tocante as condições de trabalho. De forma geral, apontou as menores médias no hospital estadual, enquanto as maiores foram observadas no hospital filantrópico; resultado que corrobora o atual cenário da saúde pública do País. Ressalta-se ainda, uma associação significativa entre satisfação no trabalho e as variáveis renda familiar e hospital em que o profissional atua. Acredita-se que os conflitos nesse cenário são inevitáveis, frente à precária estrutura de algumas instituições públicas, contudo, são previsíveis e passíveis de solução se o hospital dispuser de um canal de expressão livre e acessível a todos os agentes.

Determinantes socioeconômicos e ambientais do declínio das hospitalizações por diarréias em lactentes no Rio Grande do Norte - 1992 a 2001

There was a significant decline in hospitalizations for acute diarrhea in children younger than 1 year of age in Brazil between 1992 to 2001. The less economically developed state of Rio Grande do Norte is a case example of the national trend. In this work, we show a significant association between improvements in socioeconomic variables as well as increased access to sanitation and the decreased rate of hospitalization. Additionally, we observed a positive, seasonal correlation between rainfall and hospitalizations. Most notably, however, we show that improvements in income and inflation were positively correlated with a decline in hospitalizations. Improvements in public health infrastructure, socioeconomic variables like education and literacy, and increased investment in health services were important in reducing severe early childhood diarrheas. However, the data suggests that increased buying power and reductions in poverty played an equally crucial role in reducing hospitalizations for acute diarrhea in infants in Brazil. The work includes elements of the demography of the period for the age groups involved, children under one year, women in fertile age and fertility rate

Desfechos clínicos e mortalidade de sujeitos submetidos à cirurgia bariátrica no Rio Grande do Norte

Introduction: Actually the obesity is a public health problem throughout the world. Bariatric surgery has been an efficient method of weight reduction body in severe obesity, reducing its associated effects and presenting low levels of immediate and late postoperative complications. In Brazil, bariatric surgery asa recent therapeutic that has been growing recently. Being Brazil a country with continental dimensions and with a huge diversity socioeconomic and cultural, it is essential to understand the reality of patients undergoing bariatric surgery in less economically privileged regions of Brazil. Objectives: To evaluate the epidemiological, clinical outcomes and mortality of patients undergoing videolaparoscopic bariatric surgery through the public health system in the Brazilian state of Rio Grande do Norte- Brazil. Methods: Observational descriptive study of a prospective, carried out from February 2009 to February 2011, the Clinic Obesity and Bariatric Surgery at Universitary Hospital Onofre Lopes - Federal University of Rio Grande do Norte (HUOL-UFRN). Anthropometric measures, comorbidity and deaths register were made in the postoperative period. Results: Seventy patients (54 women) with low income aged 22 to 63 years completed the study. We recorded the death of three patients during the study period. The results show significant decrease anthropometric parameters, especially in relation to body weight, waist circumference and hipin both sexes. Only Waist / Hip ratio showed no difference after intervention in male patients It had a resolution of comorbidities. No significant differences in reports of daily sleepiness and the snoring male patients. Conclusion: Our findings attest laparoscopic bariatric surgery as an effective method reducing weight and comorbidities in morbidly obese patients

Coeficientes de incidência do dengue e sua relação com os diferenciais intra-urbanos segundo condições de vida no município do Natal, Rio Grande do Norte

This study sprang from the hypothesis that spatial variations in the morbidity rate for dengue fever within the municipality of Natal are related to intra-city socioeconomic and environmental variations. The objective of the project was to classify the different suburbs of Natal according to their living conditions and establish if there was any correlation between this classification and the incidence rate for dengue fever, with the aim of enabling public health planners to better control this disease. Data on population density, access to safe drinking water, rubbish collection, sewage disposal facilities, income level, education and the incidence of dengue fever during the years 2001 and 2003 was drawn from the Brazilian Demographic Census 2000 and from the Reportable Disease Notification System -SINAN. The study is presented here in the form of two papers, corresponding to the types of analysis performed: a classification of the urban districts into quartiles according to the living conditions which exist there, in the first article; and the incidence of dengue fever in each of these quartiles, in the second. By applying factorial analysis to the chosen socioeconomic and environmental indicators for the year 2000, a compound index of living condition (ICV) was obtained. On the basis of this index, it was possible to classify the urban districts into quartiles. On undertaking this grouping (paper 1), a heterogeneous distribution of living conditions was found across the city. As to the incidence rate for dengue fever (paper 2), it was discovered that the quartile identified as having the best living conditions presented incidence rates of 15.62 and 15.24 per 1000 inhabitants respectively in the years 2001 and 2003; whereas the quartile representing worst living conditions showed incidence rates of 25.10 and 10.32 for the comparable periods. The results suggest that dengue fever occurs in all social classes, and that its incidence is not related in any evident way to the chosen formula for living conditions

Dimensão educativa do trabalho: estudo de caso da associação de bordadeiras do Seridó ABS- Caicó/ Rio Grande do Norte

This current work s contains issues about the educative dimension of work and its organization s process and managing for it own professionals. It aims to understand how the skills and pedagogic process, in a educative praxis perspective. Are based in a new culture of work of education process an work managing by workers in Handcraft Association of Serido/ Caicó/ RN. It uses as a methodologic-theoric reference cases s study approach, selecting the procedures of part extructure interview. It was done with six embroidereses from the Handcraft Association. The research shows that the educative process of learning and knowledges construction, in the work and by the work. Those processes develop in exchange experiences net in a friendly economic environment and raise elements of a work culture personal that work there. The embroidereses learn how to embroid doing the job and this learning, a lot of times, is influenced by the life conditions, residence local and infantile work in the country area and the living to the urban area, particularly to Caicó. The knowledge relation between them is the matter fact in the embroider learning process that means a social relation based on the knowledge differences between their position in its structure involving the work division, that each handcraft maker knows every part of the embroider, type of work or machine type, step by step until the work is done. It involves decision, execution and machine movements repetition, the focus are the categories that fit in current flexible financial issue. They schedule the work at home so they have time to do other stuff. Most part of the production currently is done to obey de a certain request that aims as production target, being a homework. Another important issue is the embroider work time: time and experience that is within in the professional life and its knowledge representation of job/profession. This time is got as a acquisition process of certain a work dominion and self knowing; time added to changes that were being there practicing from the new characteristics in the furniture, clothes and towels that are in the introduction communicative and its effect. In this way this work include articulations process among skills, educative process and handcraft work organization that allowed the interpretation and finish, that are related to the case study and its developments: handcraft embroidered considered as a profession, money source not conventional where is not work available and a temporary activity while studyng, homework and flexible work

Mapa dos programas sociais: transferência de renda e dinâmicas sociais no Rio Grande do Norte (2000-2007)

The question of evaluating the fight against poverty in a given society is very complex task, considering the range of factors that permeate, such as education, culture and economy itself. Come hence the relevance of the theme and its constant presence in discussions on the fruits of public policies, institutional structure and economic development which are the guiding elements of this work, and noted that seeks to highlight the social demographics and most important, the most significant trends and issues pertaining to her. The assessment was initially made in all the municipalities of Rio Grande do Norte doing a verticalilzação to the municipalities Caicó, Pau dos Ferros, Ipueira and Taboleiro Grande. Highlighting the role of a social policy through government programs, such as the Bolsa Familia Program (PBF), which creates the possibility of changes in the socio demographic profile given the importance that the action of this public policy has in shaping the regional economic reality As well as social programs and actions of the government here reported that generate mobility of people and new social demands, such as rural retirements, the benefit of continuing provision (BPC), the Program for the Eradication of Child Labor (PETI) that put on the market of population living on the margins of various forms of consumption. Accordingly, the socio economic profile of the state shows a significant improvement in their social indicators, vital education and redistribution of income, due to the significant improvement in life expectancy in the fall of school drop-out rate and the drop in indicators of Proportion Poor and destitute of the state. Where the fall in the proportion of poor and indigent is strongly associated with an increase in income, from social programs. With this transfer and redistribution of income can be gauged that occurs a strengthening of local economies and an engagement of families with the conditionalities of social programs and PETI Bolsa Familia. Our research concludes that simply raising the rents caused by transfers, presents relevant impacts on the education of young people in beneficiary families. There is no doubt that the programs of transfer income, no facing the social field, representing a mechanism to decrease the most perverse ills of poverty, social and economic inequality that is hungry. For a significant portion of the Brazilian population living below the poverty line, programs for the transfer of income are expressed directly in improving the material conditions of life and indirectly in improving self-esteem of women and all family members receiving encouraging yet the integration family. Experiments have shown that improvements in health and nutrition can be obtained through the implementation of adequate social policies like the programs of transfer income, while social inclusion and economic does not become full

Atenção à criança no período neonatal: chamada neonatal, Rio Grande do Norte, 2010

The neonatal period, which includes the first 27 da ys postpartum, is a vulnerability phase in child health, making it necessary for a greater mon itoring by health professional through actions that add value to the binomial mother/child and comprehensive care to the newborn. To this end, this study aimed to evaluate the care actions the neonato from the strategies recommended by the Ministry of Health. This is a cr oss-sectional study carried out from the database of the national survey of population base entitled "Call Neonatal: evaluation of prenatal care and to children younger than one year old in the North and Northeast regions". It used as the sample unit the mothers and children yo unger than 1-year-old, costal residents of Rio Grande do Norte, Natal, Brazil, who attended th e vaccination campaign on June 12, 2010 in nine municipality’s priority for the Pact to Red uce Infant and Neonatal Mortality. To compose the study variables were selected issues/ac tions regarding the neonatal period and socio-demographic factors, followed by a descriptiv e and inferential analysis. A sample of 837 mother/child pairs was obtained, being 57.6% in capital and 42.4% in the whole from the interiors, which was weighted to represent the muni cipalities of the State. It was predominated by mothers aged between 20-29 years, complete high school, not entitled to income transfer program and male children (51.2%). The frequency of the actions of the hospital ranged from 35% to 96% and those performed at the Basic Health Unit (BHU) from 57% to 91.2%. Most actions had an association with hospitals and publi c nature of the state capital (p<0.05). The results for most of the actions are recommended in the care programs and policies for children, and reveal the regional inequities in hea lth and the need for the involvement of services and professionals in search of comprehensi ve care for enabling better care through humanized practices during this increased vulnerabi lity period.