Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2016-04-05T18:51:40Z No. of bitstreams: 2 Dissertação - Karla Alves Roldão - 2014.pdf: 2936988 bytes, checksum: 2e1347c8db0678c6585989689109ae41 (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-04-06T13:00:55Z (GMT) No. of bitstreams: 2 Dissertação - Karla Alves Roldão - 2014.pdf: 2936988 bytes, checksum: 2e1347c8db0678c6585989689109ae41 (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5) / Made available in DSpace on 2016-04-06T13:00:55Z (GMT). No. of bitstreams: 2 Dissertação - Karla Alves Roldão - 2014.pdf: 2936988 bytes, checksum: 2e1347c8db0678c6585989689109ae41 (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5) Previous issue date: 2014-12-08 / The conditions offered for work development in health setting, the professionals motivation and their interrelations have significantly impact on improving healthcare quality. Regarding this, this paper aimed at studying motivation for professional nurse workers who provide emergency fixed pre-hospital services in No Hospital Units to Emergencies in Goiania city. knowing this professional category profile, working conditions in fixed pre hospital emergency services and understand part of this particular motivational public can contribute to health municipal management in Goiania, by improving democratic management and pro-active in fixed pre-hospital emergency services and also suggests approaches to training and continuing education in these services. Thus, this research describes the working conditions in these units, on point of view of these professionals. This is an exploratory descriptive study with nurses from 11 fixed pre hospital care units of emergency in Goiânia city. It included 22 professionals, represented by two nurses from each unit. To collect the data, a structured questionnaire that had two instruments was presented to subjects’ research, Instrument 1: elaborated by the author, in order to characterize the professionals interviewed profile; Instrument 2: an instrument already validated by Porto and Tamayo (2003) and adapted by this research author. This instrument was made of two blocks: Block 1 working conditions evaluation and Block 2 work values evaluation. The results showed that most of the professional are women (95.5%) and 54.5% of respondents are married. It identified the links multiplicity among 63.6% of the nurses and the same percentage has specific qualification to perform the function. Regarding the working conditions offered by health facilities, the worst evaluation was equipment availability and supplies (62.1%), followed by the comfort offered to workers (52.3%). The best evaluation was work management and organization (28.7%). About the professionals and services provided general evaluation, 45.5% believe it is regular. The overall result on work values showed that stability is the most important factor for professionals, with higher average than all the others (4.34). The Fulfillment at Work comes next, averaging 4.19. Thus, it can be inferred, in general, that the subjects of the research nurses perform their activities with motivation, even in the face of the challenges related to working conditions. The category values safety (stability) obtained through labor, which allows the livelihoods and the satisfaction of personal needs of each. Participants also value the independence of thought and action in trabalhopor through intellectual autonomy and criativade. / As condições oferecidas para o desenvolvimento do trabalho na área da saúde, a motivação dos profissionais e suas inter-relações impactam de forma significativa a melhoria da qualidade da atenção à saúde. Considerando esse cenário, o presente estudo tem como objetivo investigar a motivação para o trabalho dos (as) profissionais enfermeiros (as) que prestam serviços de atendimento pré-hospitalar fixo de urgência nas Unidades não Hospitalares de Atenção às Urgências (UNHAU) do município de Goiânia. Conhecer o perfil dessa categoria profissional, as condições de trabalho dos serviços de atendimento pré-hospitalar fixo de urgência e interpretar parte do universo motivacional desse público específico pode contribuir com a gestão municipal de saúde de Goiânia no aprimoramento da construção de gestões democráticas e dinamizadoras nos serviços de atendimento às urgências e, ainda, sugerir abordagens para capacitações e para educação permanente nesses serviços. Dessa forma, esta pesquisa busca descrever as condições laborais nessas unidades, na perspectiva desses profissionais. Trata-se de uma pesquisa descritiva exploratória realizada com enfermeiros (as) de 11 unidades de atendimento pré-hospitalar fixo de urgência do município de Goiânia. Participaram do estudo 22 profissionais, representados por 2 enfermeiros de cada unidade. Os sujeitos da pesquisa responderam a um questionário estruturado em dois instrumentos, sendo o Instrumento 1 elaborado pela autora, com o objetivo de caracterizar o perfil dos profissionais entrevistados e o instrumento 2, que trata-se de uma escala já validada por Porto e Tamayo (2003) e adaptada pela autora desta pesquisa. Este último instrumento é composto por dois blocos: Bloco 1- Avaliação das condições de trabalho e Bloco 2- Avaliação dos valores relativos ao trabalho. Os resultados demonstraram que a maioria da categoria profissional é composta por mulheres (95,5%) e que 54,5% dos (as) entrevistados (as) são casados. Identificou-se a multiplicidade de vínculos entre 63,6% dos (as) enfermeiros (as) e o mesmo percentual possui qualificação específica para exercer a função. Em relação às condições de trabalho oferecidas pelas unidades de saúde, tem-se como a pior avaliação a disponibilidade de equipamentos e insumos (62,1%), seguida do conforto proporcionado aos trabalhadores (52,3%). A melhor avaliação relativa foi conferida ao gerenciamento e organização do trabalho (28,7%). No que se refere à avaliação geral dos profissionais quanto aos serviços prestados, 45,5% acreditam ser regular. A avaliação geral dos valores relativos ao trabalho mostrou que a estabilidade representa o fator de maior importância para os profissionais, apresentando maior média em relação aos demais (4,34). A Realização no trabalho vem em seguida, com média 4,19. Assim, pode-se inferir, de modo geral, que os enfermeiros sujeitos da pesquisa desempenham suas atividades com motivação, mesmo diante dos desafios relacionados às condições de trabalho. A categoria valoriza a segurança (estabilidade) obtida por meio do labor, o que possibilita a subsistência e a satisfação das necessidades pessoais de cada indivíduo. Os participantes também valorizam a independência de pensamento e ação no trabalho por meio da autonomia intelectual e da criativade.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22153号 / 社医博第101号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 小川 修, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

<p>The relationship between positive urgency, a personality trait reflecting rash action during extreme positive emotional states, and risk-taking has previously been experimentally examined. However, how positive urgency is related to risk-taking while under the acute influence of alcohol has not been examined. The overarching goal of this dissertation was to generate behavioral evidence concerning how the interaction between positive urgency and alcohol consumption influences risk-taking via changes in emotional arousal. In this study, 59 community-dwelling adults (mean age = 29.45 (SD = 10.96), 32.2% women, 78% White) completed mood induction procedures (positive or neutral) while consuming a beverage (alcohol or placebo) and then completed the Balloon Analogue Risk Task (BART) as a measure of risk-taking. The positive mood induction was effective in inducing high arousal positive emotions. Overall, study hypotheses were not supported; however, because of low power, effect sizes and patterns of relationship are reported. The relationship between positive urgency and risk-taking was positive and small in the positive mood condition but negative and small in the neutral mood condition. The alcohol group and the placebo group showed similar patterns of risk-taking that are positive and small. Finally, the relationship between positive urgency changes in emotional arousal was positive and small only in the positive/alcohol condition; however, there was no relationship between changes in emotional arousal and risk-taking. These findings suggest that, while changes in emotional arousal may result from a combination of positive urgency and alcohol consumption, it may not be a focal mechanism that explains the relationship between positive urgency and risk-taking. Further, positive urgency is a risk factor whether or not alcohol consumption is present. Although the small sample size limited the power to test the hypotheses, the effect size estimates obtained in this study provide preliminary data for a more properly powered future study. The pattern of findings suggests the viability of further developing the current positive mood induction to establish a lab-based paradigm for positive urgency and the use of a different experimental risk-taking task to examine positive emotion-based risk-taking.</p>

Two impulsivity-related traits, negative and positive urgency (i.e., the tendency to act rashly in the face of extreme negative and positive emotions, respectively) are important risk factors for alcohol use escalation during college and for problematic and disordered level alcohol use, in part through increasing motives for alcohol use. The majority of research to date has focused on the causal direction from trait to motives to alcohol consumption. The goal of the current study was to conduct an initial test of how continued and escalating alcohol use may drive increases and shifts in positive and negative urgency, and how such changes drive subsequent increased drinking motives over the first year of college. Data were analyzed using an archival dataset of 418 first-year college students (age 18-21) enrolled in an introduction to psychology course at a large Midwestern university. Participants were sampled at three timepoints: at the beginning of the fall semester, the end of the fall semester, and the end of the spring semester. A series of hierarchical multiple regression and mediation analyses were used to test study hypotheses. Changes in alcohol use did not predict later changes in positive and negative urgency. Results did replicate previous research showing that changes in positive and negative urgency predicted later changes in drinking motives. Finally, there was some evidence that alcohol use at baseline predicted changes in enhancement drinking motives through changes in positive urgency; but this pattern was not seen with negative urgency. This work extends existing work with urgency theory, which has primarily focused on the effects of urgency on subsequent alcohol consumption and not the inverse. The fact that alcohol use drives subsequent changes in positive urgency and drinking motives can help to better identify mechanisms contributing increased risk for transition to problematic levels of alcohol consumption, can lead to better identification of those at risk for problematic alcohol use and can set the stage to better integrate urgency theory with other well-established alcohol risk models.

Der Persönlichkeitsfaktor Impulsivität und eine verminderte Inhibitionsfähigkeit werden als Risikofaktoren für Suchterkrankungen diskutiert. Impulsivität ist ein multidimensionales Konstrukt und lässt sich durch Fragebögen wie die Barratt Impulsiveness Scale (BIS-11) quantifizieren. Inhibitionsfähigkeit kann mit Hilfe eines Stop-Signal Task operationalisiert werden und wird von einigen Autoren als Subdomäne von Impulsivität angesehen (Response Inhibition). Welche Domänen des Persönlichkeitsmerkmals Impulsivität die behavioralen und neuronalen Korrelate von Inhibitionsfähigkeit abbilden, ist allerdings bis jetzt nicht eindeutig geklärt. Auch Veränderungen der Belohnungswahrnehmung tragen zur Pathogenese von Suchterkrankungen bei, und belohnungsassoziierte Aktivierungen im ventralen Striatum weisen bei Gesunden eine positive Beziehung zu Impulsivität auf. Die impulsivitätsabhängigen Auswirkungen von Belohnungsverarbeitung auf die Inhibitionsfähigkeit sind jedoch unzureichend verstanden. Zur weiteren Untersuchung der Beziehung von Impulsivität und Inhibitionsfähigkeit sowie ihrer Interaktion mit Belohnungsverarbeitung selektierten wir aus einer Gruppe von 452 Probanden je 26 hoch und niedrig impulsive Probanden, deren durchschnittliche BIS-11 Werte den Kriterien für hohe bzw. niedrige Impulsivität entsprachen. Alle 52 Probanden absolvierten einen Stop-Signal Task mit integrierter Belohnungskomponente während einer simultanen funktionellen MRT Messung (fMRT). Neben einer neuropsychologischen Testung erhielten die Probanden eine umfassende Charakterisierung ihrer Persönlichkeits- und Impulsivitätsdomänen durch die Fragebögen UPPS (Urgency, Lack of Premeditation, Lack of Perseverance, Sensation Seeking), Sensation Seeking Scale und NEO-Fünf-Faktoren-Inventar. Die Auswertung der Verhaltensdaten erfolgte mit SPSS, die Analyse der fMRT-Daten nach einer Vorverarbeitung mit SPM getreu des General Linear Model. Für die Extremgruppen des BIS-11 fanden wir, entgegen unserer anfänglichen Vermutung, keinen signifikanten Gruppenunterschied, weder hinsichtlich der behavioral gemessenen Inhibitionsfähigkeit (SSRT), noch im neuronalen Aktivierungsmuster des Inhibitionsnetzwerks. Eine feinere Untersuchung unter Einbezug der Impulsivitätsubdomänen zeigte, dass die Subdimension Urgency die individuelle Inhibitionsfähigkeit der Probanden am besten vorhersagte und eine positive Korrelation mit dem Inhibitionsmaß SSRT aufwies. Interessanterweise zeigten Urgency-Werte zusätzlich auch eine negative Korrelation mit den neuronalen Aktivierungen im rechten inferior-frontalen Gyrus, einer Schlüsselregion des Inhibitionsnetzwerks. Belohnte erfolgreiche Stop-Trials wiesen gegenüber nicht erfolgreichen belohnten Stop-Trials auf neuronaler Ebene eine verstärkte Aktivierung des ventralen Striatums auf. Diese Aktivierung zeigte Ähnlichkeit mit einem Prädiktionsfehlersignal und könnte möglicherweise ein selbst generiertes Feedbacksignal darstellen. Nur Probanden mit niedrigen Urgency-Werten konnten dieses potentielle Feedbacksignal für eine verbesserte Inhibition (kürzere SSRT) nutzen, während sich dieser Zusammenhang nicht für Probanden mit höheren Urgency-Werten zeigte. Die Ergebnisse verdeutlichen, dass die Beziehung zwischen Impulsivität und behavioraler Inhibitionsfähigkeit vorsichtig und gezielt multidimensional betrachtet werden sollte. Während der Gesamtscore des BIS-11 Response Inhibition nicht ausreichend abzubilden scheint, zeigte die Subdimension Urgency sowohl behavioral als auch neuronal eine Assoziation mit einer verminderten Inhibitionsfähigkeit. Interessanterweise weist Urgency auch eine Verbindung zur Belohnungsverarbeitung im Stop-Signal Task auf und scheint mit dem Nutzen von potentiellen individuellen Feedbacksignalen verknüpft zu sein. Da Urgency-Werte sich bei verschiedenen psychischen Störungen, wie Abhängigkeitserkrankungen, erhöht zeigen, stellt Urgency möglicherweise ein Bindeglied zwischen Response Inhibition und Belohnungsverarbeitung dar. Aus diesen Gründen sollte Urgency in zukünftigen Studien zu den Entstehungsmechanismen von Suchterkrankungen als Moderator von behavioraler Handlungsadaption miteinbezogen werden.

No description available.

O estudo teve como objetivo analisar as percepções de enfermeiros no trabalho ao aplicar a classificação de risco em serviços de Urgência e Emergência, verificar o contexto de trabalho desses enfermeiros e avaliar indicadores de desgaste, valorização e reconhecimento. Método: Estudo quantitativo descritivo do tipo estudo de caso realizado em 4 serviços de Pronto Atendimento, participaram uma amostra de 33 enfermeiros. Coleta de dados, através observação participante (consulta a documentos, conversas informais com enfermeiros e a observação propriamente dita). Além de aplicação do instrumento EIPST (Escala de Indicadores de Prazer e Sofrimento no Trabalho) construída no Brasil por Mendes (2001) com objetivo de avaliar os fatores de Desgaste, valorização e reconhecimento. Resultados. Todos os casos conheciam o Protocolo de Classificação de Risco (PCR), porém não se verificou a padronização preconizada. O registro dos atendimentos realizados na PCR foi falho devido carência ou mau funcionamento de insumos (computadores); as instalações mostraram ser inadequadas em termos de ambiência (acolhimento dos pacientes e à realização do trabalho); os tempos de espera por atendimento médico após a PCR foram demorados (média de três horas para qualquer tipo de ficha). Dos enfermeiros destacam-se que poucos possuíam especialização em urgência e emergência, embora atuassem nos locais há um tempo considerável (média de 7,9 anos). E quanto ao trabalho executado (72,73% dos enfermeiros) relataram que rotineiramente estendem sua carga horária de trabalho. O fator valorização foi o que indicou diferenças significativas em relação ao desgaste e reconhecimento. Porém, os fatores valorização e Reconhecimento se mostraram próximos da média estipulada pela escala. O fator desgaste apresentou menor escore, embora enfermeiros possam estar em situações de desgaste em pequeno grau, pois na correlação entre o fator desgaste e esforços físico (81,25%) e mental (69,88%), houve resultados estatisticamente significantes. Além disso a maioria (87,88%) consideraram sua atividade repetitiva. Também mais da metade (60,61%) percebeu a supervisão do seu trabalho inadequada. Destaca-se o desgaste ocasionado pelo trabalho noturno, pela dupla jornada de trabalho através da correlação desgaste e carga horária estendida e ter outro vínculo empregatício. Mostraram escore de indicadores de valorização significativamente superior os enfermeiros submetidos a novas tarefas, assim como os que receberam treinamento para executar as suas tarefas e o consideraram adequado. Quanto ao reconhecimento, os que trabalhavam à tarde apresentaram escores significativamente superiores de reconhecimento em relação aos que trabalhavam à noite. Também os que perceberam a supervisão como adequada, apresentaram escores de reconhecimento significativamente superiores. Conclusão. O material coletado e analisado permitiu conhecer e compreender a realidade de uma amostra de enfermeiros de serviços de Urgência e Emergência, suas peculiaridades, deficiências ou limitações e os componentes do seu trabalho geradores de desgaste, favorecedores da valorização e reconhecimento. Melhoras devem ocorrer para a aplicação da PCR pois não há padronização na aplicação, além dos espaços e insumos para a sua realização não se mostrarem adequados para os profissionais e pacientes / The study aimed to analyze the perceptions of nurses at work when applying the classification of risk in and Emergency services, verify the work context of these nurses and evaluate indicators of wear, recovery and recognition. Methods: A quantitative descriptive study of the type of case study carried out in 4 emergency services, participated a sample of 33 nurses. Data collection through participant observation (query documents, informal conversations with nurses, and the observation itself) In addition to applying the instrument the Scale of Pleasure and Suffering at Work, built in Brazil by Mendes (2001) with the objective of evaluating the factors of Wear, valorization and recognition. Results: All cases were familiar with the Risk Classification Protocol (RCP) but the recommended standardization was not verified. The registry of the consultations realized in the PCR was flawed due to lack or poor functioning of inputs (Computers). Facilities proved to be inadequate in terms of ambience (patient care and the performance of work); the waiting times for medical care after the RCP were delayed (average of three hours for any type of card); Of the nurses, it should be noted that few had specialization in emergency and emergency, although they have acted locally for a considerable time (average of 7.9 years) Regarding the work performed (72.73% of the nurses). reported that they routinely extend their workload. The valorization factor indicated significant differences in wear and recognition. However, the valuation and recognition factors were close to the mean stipulated by the scale. Wear factor presented lower score, although nurses may be in low-grade wear situations, because in the correlation between the wear factor and physical (81.25%) and mental (69.88%) efforts, there were statistically significant results. In addition, the majority (87.88%) considered their activity repetitive. Also, more than half (60.61%) perceived the supervision of their work inadequate. Emphasis is given to wear and tear caused by night work, by double working hours through the correlation of wear and extended working hours and having another employment relationship. They showed a significantly higher score for nurses who underwent new tasks, as well as those trained to perform their tasks and considered it appropriate. As for recognition, those who worked in the afternoon presented significantly higher scores of recognition than those who worked at night. Also those who perceived supervision as adequate presented significantly higher recognition scores, Conclusion: The material collected and analyzed allowed to know and understand the reality of a sample of emergency and emergency services nurses, their peculiarities, deficiencies or limitations and the components of their work that generate wear, favoring the recovery and recognition. Improvements must occur for the application of RCP since there is no standardization in the application beyond the spaces and inputs for its realization not to be adequate for professionals and patients.

In modern business environment, time becomes more and more valuable resource fororganizations. The way managers will organize their time for completing managerialtasks, will influence not only job performance but inner feelings and job satisfaction,and, eventually, organizational performance. Research uses the term t emporaldispositions for analyzing how people are seeing the time. Temporal disposition hasdifferent elements and each of them are considering a different viewpoint of howpeople perceive the time. We found out that the connection between two basicelements of temporal disposition, time urgency and pacing styles, are not researchedproperly which leads into a misunderstanding about these concepts.  The purpose of this study is to d iscover the correlation between two different elementsof temporal dispositions (time urgency and pacing styles) through measuring the timeurgency and pacing styles of middle- and low-level managers. Further, this studyaims to enhance our understanding about Swedish managers’ time urgency andpacing styles. Finally, the thesis attempts to expand the academic field of temporaldisposition through e xplaining how the way managers are feeling about time (timeurgency) affects how they are distributing their time for completing managerial tasks(pacing styles). The quantitative research has been used in this study. A questionnaire with 10 itemshas been developed for this study, and 122 managers have been participated in thesurvey. The following correlation between time urgency and pacing styles has been found:time urgency is positively correlated with U-shaped pacing style and negativelycorrelated with steady-action style. We have not found any significant correlationbetween time urgency and deadline-action pacing style. Further, this study foundthat time patience (the opposite of time urgency) is positively correlated withsteady-action pacing style and negatively correlated with deadline-action pacingstyle. Similarly, results have shown that U-shaped pacing style is used both by timeurgent and time patient managers. Finally, we found that middle-level managers aremostly time urgent and using U-shaped pacing style when completing managerialtasks while low-level managers are mostly time patient and using steady-actionpacing style.

O SAMU brasileiro utiliza o modelo francês e opera com uma Central Única de Regulação Médica regionalizada, hierarquizada e descentralizada na composição das equipes de socorro e unidades móveis como USBs (Unidade de Suporte Básico) e USAs (Unidade de Suporte Avançado) que variam de acordo com o tipo de gravidade do caso. Na cidade de Ribeirão Preto, o serviço do SAMU, implantado em 1996, era municipal até 2012, porém seguindo as resoluções e portarias do Ministério da Saúde houve a necessidade da transição do SAMU Municipal para o SAMU Regional, com um único número (192) para os 26 municípios do Departamento Regional de Saúde de Ribeirão Preto (DRS XIII) sendo composto/constituído por 38 (trinta e oito) USBs sendo 01 USB para cada base descentralizada, 13 USB para Ribeirão Preto, 01 (uma) equipe de motolância e mais 03 (três) USAs (unidades de suporte avançado de vida) para cada base nos municípios polos microrregionais (Ribeirão Preto, Sertãozinho e Batatais). Com base nessas informações, este estudo visou caracterizar a estrutura e funcionamento do SAMU Municipal e sua Central de Regulação de Urgência e a transição para a regionalização nos seus aspectos estruturais, recursos humanos, tecnológicos e principalmente a viabilidade financeira, considerando o repasse tripartite (estado - união e município) insuficientes. Para a viabilidade financeira foi instituído o Consórcio CIS-AVH (consórcio intermunicipal de saúde - Aquífero guarani, Vale das cachoeiras e Horizonte verde). Os Consórcios Intermunicipais de Saúde (CISs) são importantíssimos instrumentos de cooperação e gestão entre municípios integrados, com 9interesses comuns definidos através do Plano Anual de Trabalho descritos pelos gestores municipais, conselhos e entidades públicas que estabelecem as prioridades e necessidades de determinado local e região. O objetivo foi criar soluções para problemas comuns, racionalizando a ação governamental a partir da realização conjunta de atividades de promoção, proteção e recuperação da saúde. Observa-se o fortalecimento da co-gestão compartilhada em saúde, em especial para os municípios de menor porte, cujas capacidades de investimento no setor são reduzidas em razão do limitado orçamentos disponível, as crescentes necessidades dos cidadãos, o avanço do aparato tecnológico e seus custos e principalmente o ganho por meio de editais de aquisição, compras ou contratação em escala seja de serviços, exames ou insumos. / The Brazilian SAMU uses the French model and operates with a regionalized, hierarchical and decentralized Single Regulated Medical Regulation Center in the composition of rescue teams and mobile units such as USBs (Basic Support Unit) and USAs (Advanced Support Unit) that vary according to with the type of severity of the event. In the city of Ribeirão Preto, the SAMU service, implemented in 1996, was municipal until 2012, but following the resolutions and ordinances of the Ministry of Health, there was a need to transition from SAMU Municipal to SAMU Regional, with a single number (192) for the 26 municipalities of the Regional Health Department of Ribeirão Preto (DRS XIII) consisting of 38 (thirty-eight) USBs, with 1 USB for each decentralized base, 13 USB for Ribeirão Preto, 01 (one) motolance team and more 03 (three) USAs (advanced life support units) for each base in the microregional poles municipalities (Ribeirão Preto, Sertãozinho and Batatais). Based on this information, this study aimed to characterize the structure and functioning of the Municipal SAMU and its Central Emergency Regulation and the transition to regionalization in its structural aspects, human resources, technological and mainly financial viability, considering the tripartite pass-through insufficient. (2013 to 2016). For the financial viability, the CIS-AVH Consortium (inter-municipal health consortium - Aquifer, Guaraní, Vale das cachoeiras and Horizonte verde) was instituted. The Intermunicipal Health Consortiums (CISs) are very important instruments of cooperation and 11management among integrated municipalities, with common interests defined through the Annual Work Plan described by municipal managers, councils and public entities that establish the priorities and needs of a given place and region. With the objective of creating a solution to common problems, rationalizing government action through joint activities to promote, protect and recover health. The strengthening of shared co-management in health is observed, especially for smaller municipalities, whose investment capacities in the sector are reduced due to the limited budgets available, the growing needs of the citizens, the advancement of the technological apparatus and its costs, and especially the gain through purchase, purchase or scale calls for services, examinations or inputs.

Made available in DSpace on 2016-04-28T20:37:36Z (GMT). No. of bitstreams: 1 Claudia Sofia Ferrao Baroni.pdf: 682807 bytes, checksum: e2057c2dd88dd76c909828461572a926 (MD5) Previous issue date: 2011-05-06 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / This work intends to reflect on the possibilities of a Lacanian psychoanalysis treatment facing terminality at a Psychological Urgency Attendance. The proposed work was a theoretical study drawn from 15 years of Lacanian clinical practice with cancer terminally ill patients. It aims to identify the main Lacanian operators such as unconscious, desire and structure of the subject, which help in the analytical hearing of the story of people living a somatic finitude so they can rebuild the signifying chains that constitute them as a unique subject. To illustrate the possibility of expansion of Lacanian concepts it was used the "vignettes" of clinical cases, resulted from the Lacanian practice of the author. To support this work, at first, it was chosen, along with Freud and Jacques Lacan and their original works, authors that are reference for Lacanian psychoanalysis formation and Lacanian psychoanalysis and others who have the practice in caring for people with cancer and hospitalization. Then it was chosen some authors who are national and international reference in the study of death and terminality, making a description of the phenomenon of death. It arises as critical, the listening to the reason that each subject gives to the illness, since this explanation will assign a subjective sense, allowing the construction of a meaning. The unconscious is timeless and in front of the Real time is replaced by a new dimension for the individual, with the precipitation of the unconscious subject. Narrowing of time can give rise to a demand for giving a meaning to the life lived. What enables the analysis to occur is the handling of transference, in the grounds of ethical and technical procedures and the analyst's desire and for this to occur it is not necessary a perfect setting. The urgency can be seen as an opportunity for a new position of the subject towards his own questions, enabling him to build new outlets for his subjective troubles. We conclude that it up to the psychoanalyst who falls within the emergency clinic to be sustained by concepts of the demands of the attendance that will need to be presented in words, because it refers to a bet on the subject, seeking to modify the emergency situation where the subject is devoid of words, by entering him again in the signifying chain / O presente trabalho pretende refletir a respeito das possibilidades do atendimento da psicanálise lacaniana diante da terminalidade na clínica de urgência. A proposta de trabalho foi realizar um estudo teórico, a partir de uma prática clínica lacaniana de 15 anos junto a pessoas vivendo o estado terminal do tratamento oncológico. Objetiva-se apontar os principais operadores lacanianos como inconsciente, desejo e estruturação do sujeito, que auxiliam na escuta analítica da história de pessoas vivendo a finitude somática de forma que elas possam reconstruir as cadeias Dignificantes que as constituem como sujeitos singulares. Para ilustrar esta possibilidade de ampliação dos conceitos lacanianos utilizou-se "vinhetas" de casos clínicos, fruto da prática lacaniana da autora. Para fundamentar este trabalho, em um primeiro momento foram escolhidos, além de Freud e Jaques Lacan com suas obras originais, autores que são referência na formação da psicanálise lacaniana e outros que são psicanalistas lacanianos com prática no atendimento a pessoas com câncer e atendimento hospitalar. Depois foram escolhidos alguns autores que são referência nacional e internacional no estudo sobre a morte e terminalidade, fazendo uma descrição do fenômeno da morte. Coloca-se como fundamental escutar o porquê que cada sujeito confere ao seu adoecimento, pois esta explicação lhe atribuirá um sentido subjetivo, possibilitando a construção de uma Dignificação. O inconsciente é atemporal e frente ao aparecimento do Real o tempo passa a ter uma nova dimensão para o sujeito, havendo a precipitação do sujeito do inconsciente O estreitamento do tempo, pode fazer surgir a demanda por dar um significado à vida que se viveu. O que possibilita que a análise ocorra é o manejo da transferência, nos fundamentos éticos dos procedimentos técnicos e no desejo do analista e para que isto ocorra não é necessário um setting ideal. A urgência pode ser vista como uma oportunidade para um novo posicionamento do sujeito diante de suas questões, fazendo com que construa novas saídas para seus impasses subjetivos. Conclui-se que cabe ao psicanalista que se insere na clínica da urgência estar sustentado pelos conceitos da clínica da demanda que precisará ser apresentada em palavras, pois se refere a uma aposta no sujeito, buscando modificar a situação de urgência onde o sujeito está desprovido de palavras, inserindo-o novamente na cadeia significante