Os nós críticos do processo de trabalho na Atenção Primária à Saúde: uma pesquisa-ação / The critical nodes of the work process in Primary Health Care: an action research

Resumo Pesquisa qualitativa com abordagem da pesquisa-ação cujo objetivo foi identificar os nós críticos inscritos no processo de trabalho da Atenção Primária à Saúde (APS). Participaram 44 profissionais/gestores da APS de um município do interior de Minas Gerais. A coleta de dados ocorreu de junho a dezembro de 2019, por meio da técnica de observação participante e, posteriormente, de oficinas. Os dados foram analisados a partir da técnica de Análise de Conteúdo de Bardin e sob a perspectiva dos referenciais teóricos de Rudimar Baldissera e Paulo Freire. Na análise, emergiram cinco categorias, que expressaram os nós críticos identificados na observação participante e validados pelos profissionais nas oficinas: ambiência, comunicação, educação permanente, planejamento e identidade profissional. Esta pesquisa sinaliza a importância do diálogo e da reflexão crítica das práticas de saúde como instrumentos de transformação do processo de trabalho em saúde.

Abstract Qualitative research with an action research approach whose objective was to identify the critical nodes enrolled in the Primary Health Care (PHC) work process. Forty-four PHC professionals / managers from a municipality in the interior of Minas Gerais participated. Data collection took place from June to December 2019, using the participant observation technique and later through workshops with the participants. The data were analyzed using Bardin's Content Analysis technique and from the perspective of the theoretical frameworks of Rudimar Baldissera and Paulo Freire. The analysis allowed the emergence of five categories, which expressed the critical nodes identified in the participant observation and validated by the professionals in the workshops: ambience, communication, continuing education, planning and professional identity. This research signals the importance of dialogue as an instrument of transformation within the health work process.

Elementos regulatorios sobre la marihuana, a consideración para la efectiva protección a la salud de la población / Regulatory elements on marijuana, for the effective population health protection

Resumen: Al hablar del abordaje de salud pública al uso de la marihuana se soslaya la complejidad de la protección a la población a través de intervenciones regulatorias rigurosas. Considerando la experiencia de gobiernos donde ya existen estas prácticas, se introduce la regulación como una función esencial de la salud pública, haciendo explícitos siete propósitos para el control de la marihuana. Se detallan luego los elementos técnicos, de capacidad institucional (incluyendo la capacidad técnica y financiera) y de gobernanza que deben cumplirse para cualquier regulación rigurosa de su uso. Se señala la dificultad de regular sustancias psicoactivas considerando que la capacidad de control de otras actualmente legales se ha traducido en su creciente consumo. Se expone también que no debe minimizarse la necesidad del fortalecimiento institucional y gobernanza de la autoridad regulatoria para la regulación efectiva de la marihuana.

Abstract: When discussing the public health approach to the use of marijuana, the complexity of rigorous regulatory interventions for population protection is omitted. Using the experience of governments where these practices already exist, regulation is introduced as an essential public health function, spelling out seven purposes for controlling marijuana. The technical elements of institutional capacity -including the technical and financial capacity- and of governance that must be covered by any rigorous regulation of its use are detailed below. The difficulty of regulating psychoactive substances is addressed when considering the capacity to control other legal substances manifested with their increased consumption. It is concluded that for an effective regulation of marijuana, the need for strengthening the institutional and governance aspects of the regulatory authority should not be minimized.

ESTIMATING THE AFFECTS OF ACCREDITATION PROCESS ON HIGHER / Шинэ санаа Шинэ нээлт

BACKGROUND Advantages of Accreditation process are assessing the institution as well as its staffs and teachers, involving them into the organization plan, determining a current level of organization, experiencing all the staffs and developing organization. This thesis was chosen to study how the voluntary audits effect development, quality and efficiency of high educational organization and the individual development. OBJECTIVE Accreditation processes to study that how influence on the institution and individual development METHOD Survey has been conducted by cross- sectional study of analytical study and collected materials through quantitative method. Totally 446 participants were provided by questionnaire sheets and 21 sheets of those were excluded due to incomplete, 407 participants involved. Data processing was implemented by interval evaluation and SWOT. RESULTS There are high prevalence of diabetes, cardiovascular diseases, cancer and mental health problem among the general populations. Majority of these conditions appear with other disability types. 66.5% of the persons with disabilities, who are living under poverty line, have chronic conditions. Number of vehicles increased in urban and rural area, high migration from rural area to urban area, high density in central area. Weak city planning, low light in the street, high number of unemployed people, and alcoholism is increased in the country. But the current collected statistics do not satisfy the basic needs of the country. CONCLUSION Comparison of interval evaluation shows that index of the influences for the institution and individual is 3.5:3.6 and it approved the accreditation influences more for the institutional development. SWOT analyzes show that there are possibilities to achieve more opportunities by using institutional and individual advantages and also strategy should be strengthening advantages by using opportunities. Accreditation process affects more for institutional development.

La gestión del desarrollo, las entidades de ciencia y los sistemas locales de innovación / Development Management, Science Institutions and Local Systems of Innovation

Se presenta un análisis sobre la relación necesaria a lograr entre los elementos: gestión del desarrollo-entidades de ciencia- sistemas locales de innovación, que se realiza en la provincia de Cienfuegos, Cuba (estudio de caso), con el objetivo de elaborar un programa de acción que asegure la articulación entre la gestión del desarrollo, las entidades de ciencia y los sistemas locales de innovación como un proceso de mejora continua, acompañado de un sistema de indicadores que permita evaluar el desempeño de la entidades de ciencia y elevar la efectividad, eficiencia y eficacia del mismo en función del desarrollo local. Se utilizó como método de investigación la consulta a expertos, a partir de cuyos resultados se definen los aspectos a tomar en consideración para dicho programa, en correspondencia con la aptitud que requieren expresar las entidades de ciencia para poder integrar las dimensiones ciencia, tecnología, innovación y medioambiente de forma equilibrada a través de las interfases. La evaluación del programa se realizó a nivel teórico y práctico. Como conclusión fundamental se derivó que la integración de la gestión de la ciencia, la tecnología, la innovación y el medioambiente a través de las entidades de ciencia, en función del desarrollo, articuladas por los sistemas locales de innovación, requiere de una adecuación de sus acciones para asegurar efectividad, eficiencia y eficacia en su desempeño.

An analysis on the necessary relationship among development management, science institutions and local innovation systems was conducted in the province of Cienfuegos, Cuba (Case study), in order to develop an action plan to ensure the coordination of development management, science institutions and local systems of innovation as a continuous improvement process, which is accompanied by a system of indicators to assess the performance of science institutions and to enhance its effectiveness and efficiency in terms of local development. Expert consultation was used as research method. Its results defined the aspects to consider for the plan, in line with the role that science institutions need to play to integrate science, technology, innovation and environment through interfaces in a balanced way. The major conclusion of the study is that the integration of science, technology, innovation and environment management through science institutions, which are interrelated by local innovation systems, requires an adaptation of their actions to ensure effectiveness and efficiency in performance conducive to development. Plan assessment was conducted at theoretical and practical level.

Saúde nas empresas: um modelo gráfico para identificar oportunidades de gestão / Health in enterprises: a graphical model to identify management opportunities

A gestão de saúde nas empresas encontra fatores de resistência às propostas de melhoria e se caracteriza como um problema com vícios. Novas formas de abordar estes vícios podem ser úteis como ferramentas de reflexão estratégica. O presente trabalho parte do pressuposto dedutivo em que “a causa precede a consequência” e desenvolve estrutura gráfica simples em que desenha o fluxo de formação / concentração e dissolução / desconcentração de doentes em uma empresa. Essa abordagem gráfica permite novos olhares sobre essa dinâmica e facilita a identificação de alguns dos vícios existentes. A estrutura gráfica identifica 7 pontos de inflexão, que são apresentados como oportunidades de intervenção para reverter os vícios identificados na análise estratégica.

Health management in companies is facing resistance factors to proposed improvements and is characterized as a problem, as something having defects. New ways of approaching these defects may be useful as tools for strategic thinking.This paper is based on the deductive assumption that “cause precedes consequence” developing a simple graphical structure that draws the flow of formation / concentration and dissolution / deconcentration of sick people in a company. This graphical approach allows new perspectives on this dynamic and facilitates the identification of some existing defects.The graphical structure identifies seven turning points, which are presented as opportunities for intervention to reverse the defects identified in the strategic analysis.

Democratização e reforma do Estado: o desenvolvimento institucional dos tribunais de contas no Brasil recente / Democratization and state reform: the institutional development of the courts of accounts in recent Brazil

Este artigo analisa as transformações das últimas décadas nos tribunais de contas no Brasil, à luz da discussão da temática do desenvolvimento institucional. Essa perspectiva analítica permite olhar os processos de mudanças nas arenas políticas, no longo prazo, enfatizando não só a resistência dos atores institucionais ou sociais com poder de veto e os mecanismos de path dependence, mas igualmente as conjunturas críticas que permitem levar adiante as transformações, mesmo que de forma incremental. No caso em estudo, a conjuntura crítica da democratização e da Constituição de 1988 trouxe mudanças, mas estas foram neutralizadas pela capacidade de veto da elite dirigente especialmente em alguns tribunais. Por outro lado, a nova conjuntura crítica representada pela Lei de Responsabilidade Fiscal, de 2000, alterou a dinâmica política e institucional, permitindo que, até muito recentemente, as mudanças que permaneciam bloqueadas começassem, a partir de então, a ser efetivadas diante da menor capacidade de exercício de tais vetos.

Capacitação profissional em instituições de ciência e tecnologia: a experiência da FIOCRUZ / Professional training in institutions of science and technology: the experience of FIOCRUZ

O presente trabalho analisa o Programa de Capacitação Profissional para o Desenvolvimento Institucional da FIOCRUZ, aspirando a contribuir para a concepção de estratégias futuras para promover a qualificação profissional e o desenvolvimento dos recursos humanos na FIOCRUZ, no que se refere à formulação de uma política de desenvolvimento de recursos humanos em uma Instituição de Pesquisa de C&T em Saúde. Buscou-se, também, identificar as perspectivas da continuidade do Programa como ação estratégica para o desenvolvimento institucional. A metodologia aplicada para a consecução do estudo teve como propósito identificar a abrangência do Programa e suas características em termos de modalidades de curso ofertadas, áreas temáticas, estrutura, público contemplado, enfocando sua dinâmica no período de 2002 a 2007,considerando o seu alinhamento com as demais políticas internas da Instituição. A análise dos documentos institucionais identificou convergência dos princípios norteadores do Programa, - as macrodiretrizes institucionais de uma matriz de desenvolvimento voltada para a valorização do trabalhador. A pesquisa constatou diversas iniciativas da Instituição em prol da realização de um programa de capacitação para a construção de conhecimentos individuais, das equipes de trabalho e a organização, como também que, algumas das propostas de ensino implementadas para uma capacitação coletiva para o quadro institucional foram atualizadas e permanecem até os dias de hoje, visando a qualificar profissionais atuantes no âmbito da C&T e em Saúde...

This study examines the Professional Training Program for Institutional Development of the Fundação Oswaldo Cruz Foundation (FIOCRUZ), aiming to contribute to the design of future strategies for the promotion of professional training and humanresource development in science and technologies institutions. This study also tries to capture the program characteristics regarding the formulation of a policy of humanresources development in this kind of institution, and to identify the continuing aspects of the program, as a strategic action for institutional development. The methodology used to achieve the study objectives was to identify the scope of the program and their characteristics in terms of course offerings, topics, structure, audience included,focusing on their dynamics in the period 2002 to 2007, given its alignment with the other policies within the institution. The analysis of institutional documents identified convergence between of the main principles of the program format with the main institutional proposals that advocated an array of development toward the improvement of the employee. The research found various initiatives of the institution for carrying out a program of training for the construction of individual knowledge and in the work teams and organization. Some proposals for education implemented for a training conference for the institutional framework have been updated and remain until today, toqualify professionals in the field of C&T and Health...

A universidade Federal da Paraíba no contexto do SiNAES: a experiência do Curso de odontologia / The Federal University of Paraíba in the context of the National Evaluation System of Higher Education (SINAES): the dentistry course experience

Este artigo relata a experiência da Universidade Federal da Paraíba-UFPB no contexto do Sistema Na- cional de Avaliação do Ensino Superior-SINAES . Discute os principais resultados obtidos com a operacionalização da Auto-Avaliação Institucional e da Avaliação das Condições de Oferta do Curso de Graduação em Odontologia e do ENADE 2004 . Os relatórios dessas avaliações foram gerados com base na pesquisa documental e de campo realizadas pelas Comissões de Avaliação (internas e externas), e apresentam um diagnóstico das condições organizacionais e estruturais do Curso e da Instituição . Destaca a relevância desses relatórios na elaboração do Projeto Pedagógico Institucional, no Plano de Desenvolvimento Institucional e nas atividades de operacionalização e auto-avaliação do Projeto Político Pedagógico do Curso de Odontologia (AU).

This article deals with the experience of the Federal University of Paraíba-UFPB in the context of the National Evaluation System of Higher Education - SINAES . It discusses the main results obtained in applying the Institutional Self-Evaluation tool that considers the conditions offered by the Dentistry Course and the ENADE-2004 . The reports from these evaluations were based on document research and on field work performed by internal and external Commissions of Evaluation . A diagnosis is presented of both the organizational and structural status of the course and of the Institution . The data point out the relevance of these reports in drawing up the Institutional Teaching Project, in the Institutional Development Plan and in activities for implementing and developing the self-evaluation of the Political Teaching Project of the Dentistry Course (AU).

Las contribuciones del doctor Ramón de la Fuente en el campo de las adicciones

resumen está disponible en el texto completo

Summary This paper reviews the publications of doctor Ramón de la Fuente in the field of addictions, the infrastructure he created for the study and treatment of these problems and his contributions to human resource training. Doctor Ramón de la Fuente's contributions in the field of addictions are both wide-ranging and outstanding, as they were in all issues in which he took interest. They include the development of infrastructure, research and the training of human resources. He thought that advances in knowledge could only be achieved through the integration of neuroscience and clinical and social research. His critical thought led him to question the scientific basis of many of the programs and recommendations made in the field of addictions. In his view, there was a tendency to ignore the biological basis of the disease and its link with the environment. He also suggested that social processes affected genetics and the functioning of the brain, leaving to science the challenge of determining how these processes occur. His advanced conception of the problem led him to establish an institution where multidisciplinary research would be carried out in neurosciences, clinical and social areas, this being the reason he created and promoted these three departments in the institute he created 27 years ago. Their integration was his challenge and the enormous responsibility he left to those of us who were fortunate enough to collaborate with him in the development of his institutional project. Doctor de la Fuente thought that any public policy in this field would have to be based on knowledge of the problem and its trends, and thus he proposed the development of epidemiology; a group emerged that studied addictions from a social perspective. One of the first epidemiological studies of students was conducted by doctor de la Fuente. This study, published in the early 1970s, was the forerunner of several studies that would be undertaken in this field. Doctor de la Fuente was also one of the first to describe the mental disorders induced by hallucinogenic drugs. During his time as director of the psychiatric unit in the Spanish Hospital in Mexico, patients with this dual disorder were treated in an integral fashion. Together with other well-known personalities of the time, founded one of the first self-help groups that existed in the country, at the Spanish Hospital. Later on, under the coordination of the National Institute of Psychiatry, he promoted the creation of a Treatment Center for Alcoholics and their Relatives (CAAF). The Center is also designed to help the family. The concept of treatment evolved from regarding the family as a fundamental part in the treatment of the patient to understanding that the family was also sick and required help, regardless of whether the patient wanted or not to be rehabilitated. The center's therapeutic orientation was integral, including general medicine, psychiatry, psychology and social work. From the outset, the center incorporated Alcoholics Anonymous in a perfect example of collaboration between professionals and civil society. From 1972 to 1979 and again from 1982 to 1986, doctor Ramón de la Fuente was a member of the International Narcotics Control Board (INCB). He always defended the position, now internationally acknowledged, that demand also stimulated supply and that the solution would have to come from global perspectives. The National Institute on Psychiatry is a Collaborative Center of the World Health Organization in Addictions and Mental Health. Doctor de la Fuente was its director during the period from 1977-1998. In 1988, he was appointed member of the advisory board for the Diploma Course in Addictive Behavior of the Institute of Psychiatry in London. From 1973 to 1982 and then from 1991 to 2000, he was a member of Experts' Committee of the World Health Organization, and agreed with this organization's views on the need to conceptualize the problem of addiction from a broad public health perspective. From 1980 to 1982, he collaborated in the area of the diagnosis and classification of problems related to mental disorders, alcoholism and drug dependence. His collaboration in this last issue was extremely significant since it occurred during a period of transition in regard to the way in which the problem was defined and therefore, in how it could be affected. Responsibility for the problem was no longer attributed to a small sector of chronic drinkers, and instead, drinking was regarded as the result of the consumption patterns of the general population. This new conception in turn opened up the possibility of influencing the problem on the basis of public policies capable of affecting the way alcohol is made available to the population and the consumption behavior. Part of the research that triggered this change of conception was carried out at the National Institute of Psychiatry in its capacity as Collaborative Center of the World Health Organization. The time when doctor de la Fuente directed the WHO Collaborative Center was crucial to the development of research infrastructure in its early years and to the proposal of new ways of understanding the problem from different socio-cultural perspectives other than those of developed countries where most of the research on this issue had been carried out. Given the characteristics of the phenomenon that prevailed in Mexico, doctor de la Fuente placed particular emphasis on the study of inhalants, not included in international conventions. The first studies conducted in Mexico, designed to evaluate brief interventions with problem drinkers, were carried out at the Institute. Researchers measured the impact of a brief advice for the modification of drinking patterns given by a doctor in hospital settings, lasting 5 or 10 minutes including the application of screening tests. During his mandate, collaboration agreements were established with several institutions with complementary interests, being the most outstanding those with the Public Education Secretariat, with which the Institute has conducted school surveys since 1978. He supported the creation of master's and doctoral degree programs in Medical Sciences in Psychiatry and in Health Sciences in Public Mental Health, in collaboration with UNAM, in order to include training in the field of Public Health for doctors, psychiatrists, and other professionals in the health social sciences. Given doctor de la Fuente's vast knowledge of the issue and the importance of the research he has undertaken, it is hardly surprising that doctor Guillermo Soberón, then Health Secretary, should have requested his collaboration in the formulation of National Addiction Programs. The Institute designed the projects for programs to combat alcohol abuse and alcoholism, addictions and tobacco, which were submitted for consideration by over 100 institutions in the public, social and private sectors. Doctor de la Fuente's work has had an impact on several generations of university students and nowadays on a large number of people with scientific training work in this area.