Reabilitação cardíaca na insuficiência cardíaca crônica: efeitos de 12 semanas de treinamento intervalado x contínuo na função cardiopulmonar e qualidade de vida

Background: Cardiac Rehabilitation (CR) has effect on mortality in patients with heart failure (HF) chronic, and the exercise of the treatment of this patient. The most common exercise is ongoing training. Recently we have been studying the effects of interval training, but there is no consensus on the optimal dose of exercise. Objective: To evaluate the effects of interval aerobic training are superior to continuous aerobic training in patients with chronic HF. Methods: The clinical trial evaluated patients through cardiopulmonary test (CPX) and quality of life before and after the RC (3 times / 12 weeks). Patients were randomized into Group Interval Training (GTI - 85% of heart rate reserve - FCR), Continuous Training Group (GTC - 60% of HRR) and control group (CG) who received guidelines. Results: 18 patients were evaluated (mean age 44.7 ± 13.2 years and 35.2 ± 8.9% of left ventricular ejection fraction [LVEF]). Both groups were efficient to increase the peak VO2 and 15.1% (P = 0.02) in GTI and 16.1% (P = 0.01) GTC. As for the quality of life the GTI GTC showed improvement compared to the control group (P = 0.006). Hemodynamic mismatch events during the CPX were reduced after training in more GTC (patients 1 to 4) than in the GTI (5 to 3). Cardiac risk also decreased in the GTC (3 patients left the severe risk to take after training). Conclusion: Continuous training becomes more appropriate for improving fitness with little chance of developing cardiac event patients with chronic HF.

Avaliação clínica e da qualidade de vida utilizando dois protocolos para recuperação miofuncional em pacientes que se submeteram à cirurgia ortognática: resultados preliminares

The objective of this randomized, blind and prospective clinical trial was to compare the pain, the edema, the mandibular movements, the masticatory efficiency and life quality, in the first 60 days after surgery using 2 different clinical protocols for myofunctional recovery, in patients who underwent orthognathic surgery. A sample of 19 patients was used and divided into 2 groups. The control group (CG) consisted of 10 patients who had postoperative rehabilitation guided by a standard protocol, conducted by the Service of Surgery and Traumatology Oral and Maxillofacial. In other hand, the experimental group (EC) totaled 9 patients who received the speech therapy rehabilitation protocol specialized, by professionals in the area. The variables pain, edema and mandibular movements were analyzed during 48h, 96h, 7 days, 14 days, 30 and 60 days post-surgery. The masticatory efficiency and the quality of life were classified with 60 days after surgery . The data were submitted an analysis of variance, Student's t-test and Fisher's independence, at the level of 5% probability. It was identified that patients of GE have benefited in the first 14 days(p<0,001), as they have had reported less pain than those in the CG. Significant statistics differences between groups for pain parameters (after 14 days) (p=0,065), edema(p=0,063), mandibular movements(p=0,068), masticatory efficiency(p=0,630) and the impact on quality of life (p=0,813) were not observed on this study. The speech therapy protocol for myofunctional recovery (EG), although it has not obtained statistical results superiors than the CG in the general context, presents itself as a viable alternative to conventional therapy assumed by many maxillofacial surgeons, allowing the surgeon to optimize time with patients in the period postoperatively.

Aspectos da qualidade de vida de pacientes com coinfecção HIV/tuberculose

Investigar a qualidade de vida de pacientes com coinfecção HIV/ tuberculose e apreender as mudanças impostas para viver simultaneamente com estas doenças transmissíveis. Métodos: Pesquisa com abordagem qualiquantitativa, realizada em ambulatório especializado em Fortaleza, Brasil, entre 2009 e 2010, com 34 coinfectados. Para coleta de dados foi utilizada uma escala de qualidade de vida, denominada HAT-QoL que possui 42 itens e questões abertas para possibilitar perceber as mudanças em face das doenças. Resultados: A maioria dos participantes tinha tuberculose na forma pulmonar, eram homens, com pouca escolaridade. A qualidade de vida mostrou-se prejudicada nos domínios relacionados às questões econômicas, sexuais e de sigilo. Ainda, foi evidenciado, que a coinfecção impõe mudanças no cotidiano que corroboram e ampliam o comprometimento da qualidade de vida. Conclusão: Vivenciar a coinfecção, mesmo com terapêutica adequada, produz alterações na vida dos infectados, cujas repercussões podem ser amenizadas com intervenções que promovam a saúde

Contribuições da inserção musical para a qualidade de vida no trabalho em ambiente laboral fabril

The present thesis aimed at understanding how the insertion of music in the work environment contributes to achieving Quality of Work Life. - QWL, under the perspective of biopsychosocial and organizational well-being. As to music insertion we considered the theoretical-empirical perception about how music is inserted at work and its functions on such place. The context where the study was taken was the manufacturing area of a major textile company, located in Natal, state of Rio Grande do Norte, Brazil, in which music is used during labor activities. The only study case was the research strategy adopted, with exploratory and descriptive purposes. The primary data were collected through the focus group technique, applied to the collaborator in the manufacturing sector. The semi-structured interview was done as a complementary tool, directed to the supervisor in that sector. Respecting the theoretical saturation criterion, we formed four focus groups, each one composed of eight members randomly selected, among the seventy-six collaborators in the sector. The data were analyzed qualitatively, through the content analysis technique, more specifically the category analysis. We identified twenty-eight QWL attributes. Six of them were found present in the four focus groups and in the interview. Among these ones, the attribute of Interpersonal Relationship at Work, contemplating the Psychological and Organizational dimensions, was the only one anticipated in four out of fifteen theoretical models here listed. The attribute Music at Work Environment could be inserted in the four QWL dimensions, highlighting the power and relevance of this attribute for the research participants. The way music has been inserted in the labor environment contributes to promoting well-being at work, which goes against theoretical conceptions, especially when it comes to musical genre. We identified nine functions of music at work, among which, Improving Work Conditions, Improving Interpersonal Relationship at Work and Favoring Motivation for Work had to be emphasized for being associated to three QWL attributes. In the total, we highlighted seven associations. The most affected QWL dimension through the insertion of music at work was the Psychological one, followed by the Organizational one. We conclude that music insertion provides biological, social and, above all, psychological and organizational well-being to the contributors, thus contributing to obtaining QWL at the labor environment researched. However, we should consider the context and proceed to periodical plans and adjustments in the way of music insertion so as to avoid health and well-being problems to those people at work

Qualidade de vida no trabalho da Emater-RN: validação de um instrumento síntese de pesquisa e diagnóstico

The theoretical recital of the present study it is initiated of the evidence that the work occupies an important space in the man s life in way that the majority of the people works and passes great part of its time inside organizati ons. However, it is verified that the relation between man and work is becoming increasingly disagreement a time that the employees had started to complain work s routines, stress, not use all their potential and inadequate work s conditions. It can be observed by the way of Dejours (1994) studies. Thus, as contribution for the quality of work life s (QWL) studies the research developed here objectified to characterize the public employees quality of work life at EMATER -RN taking as reference an instrumen t of research synthesized from the typical academic literature of the subject. The synthesis of an ampler instrument is a necessity not taken care to the literature that treats on the subject but already perceived by some studies like Moraes et al (1990); Rodrigues (1989); Siqueira & Coleta (1989); Moraes et al (1992); Carvalho & Souza (2003); El -Aouar & Souza (2003) and Mourão, Kilimnick & Fernandes (2005); Adorno, Marques & Borges (2005) amongst others. These studies point out weak points of the existing models in the QWL s literature, as well as they recommend the elaboration of a model more flexible, that contemplates Brazilian cultural characteristics, and that contemplates the entire variable studied in the main existing models. For reach this objectiv e the adopted methodology was characterized as a case study with collected data in qualitative and quantitative way. Questionnaires and comments had been used as sources of evidences. These evidences had been tabulated through of statistical package SPSS ( Statistical Package for Social Science), in which the main technique of multivariate analysis used were the factorial analysis. As for the gotten results, it was verified the grouping of the quality of work life s indicators in 11 factors which are: Work s execution, Individual accomplishment, Work s equity, Relation individual and organization, Work s organization, Adequacy of the remuneration, Relation between head and subordinate, Effectiveness of the communication and the learning, Relation between work and personal life, Participation and Effectiveness of the work processes. Whatever to the characterization of the EMATER -RN s quality of work life it was clearly that to the measure that the satisfaction s evaluation with the QWL in the organization walks to intrinsic factors for extrinsic factors this level of satisfaction goes diminishing what points to the importance to improve these extrinsic factors in the institution. In summary it is possible to conclude that the organization studied has offered a significant set of referring variable to the quality of work life of the individual

Qualidade de vida no trabalho: o caso de enfermeiros dos Hospitais Públicos Walfredo Gurgel e Santa Catarina

The theoretical foundation of this study addresses the construct Quality of Worklife involving pro-active reading organizations in face to social developments of the working class, which is a challenge to the people s management. In this sense, as a contribution to the studies of quality of worklife (QOWL), this study addresses the quality of lifework of nurses at Walfredo Gurgel and Santa Catarina public hospitals. The goal is to make a diagnosis about the quality of lifework of these employees taking as a basis dimensions and performance indicators shown in the model by Fernandes (1996). The research is characterized by field, in a descriptive way. This survey comprised 75 nurses, with 49 by Walfredo Gurgel hospital and 26 by Santa Catarina one. The data collection was carried out through structured questionnaire. The questions were processed in the software Statistic 6.0, with factor analysis and multiple regressions, after the systematization of data. As a result, the most nurses in hospitals are dissatisfied with the quality of lifework, with the highest incidence in Santa Catarina hospital. The variable occupational health assessment was more negative in the hospital Santa Catarina one, whereas in Walfredo Gurgel, was family assistance. The variable guarantee of employment was more positive assessment in two hospitals without, though, implying in high importance on QOWL of nurses. The factor structure and decision showed greater sensitivity to explain the QOWL of nurses, joining 17 variables from 40 of the model. The factor working conditions, joining 6 variables, showed the second highest sensitivity. The compensation factor, gathering 5 variables, showed the third highest sensitivity while image and health factors showed minor importance

O idoso e as ações sociais em prol desse grupo etário: um estudo sobre a qualidade de vida na Terceira Idade e o Projeto Saúde e Cidadania na Melhor Idade

The present study regards an applied qualitative social research (descriptive) which approaches the matter between old age and Brazilian social actions performed in social projects, aiming a qualified life and citizenship for this group of age. The objective of the study is to evaluate the contribution of Project Health and Citizenship in Old Age regarding social actions from the government directed to old age individual treatment for life quality improvement. The theoretical fundamentals of this work is, in a first moment, about old age and certain existing theories about aging process, as well as the differences and perspectives that come up throughout this process. In a second moment, some reflections are developed about the relation between life quality and leisure regarding old age, with the conception and historical rescue about these questions, as well as the evidence of leisure as an instrument of well-being feasibility and a better life quality in old age. Then the study contextualizes Brazilian government treatment to old age individuals, cutting off the Constitution of Republic from 1988 and some social attitudes taken by the government in a try to reach this specific group. Finally, the study presents the Project Health and Citizenship in Old Age , as a social program which belongs to extension activities from Federal Center of Technological Education of Rio Grande do Norte (CEFET-RN), which aims old age treatment and their citizenship and life quality. After the application of a semi-structured interview using the technique of Analysis of content for the Analysis and Discussion of Results, it is possible to conclude that the Project Health and Citizenship in Old Age fulfils its objective regarding contribution, through offered leisure activities, for old age well-being and life quality improvement. Hence, on this regard, it is possible to observe the importance and value of government actions, social projects and programs assisting old age individuals, for they are able to provide this group the opportunity to live out activities that allow their citizenship and socialization, regarding well-being and life quality improvement.

Análise da influência da qualidade em um ciclo de serviços na satisfação do cliente: estudo de caso em uma instituição de ensino.

With the increasing offer of education services in Brazil, it is necessary to evaluate the quality of service in education, especially in those institutions for vocational education which have a greater interaction with the labor market, in order to form qualified professionals and meet the growing demand that the country has today[A1] . In Brazil, the evaluation of the quality of library services has influenced the assessment of educational institutions and in this context, there needs to be a process to monitor the quality of services provided by libraries. However, the service is not done in a single moment and thus to a more detailed assessment it needs to be measured and evaluated each different time the customer uses it. Therefore, the aim of this work consists in measuring the quality in every moment of truth of a cycle of library services to assess which are the most relevant moments in the client's perspective at the library of the Federal Institute of Education, Science and Technology of Rio Grande do Norte (IFRN) Campus João Câmara in building the overall quality of service. In the literature review, internal secondary sources were used, from the database of the institution studied, and also external sources, through literature in books, articles, dissertations, theses and journals on compost quality, service quality, cycle services, measuring quality, satisfaction, teaching activities, and on library services specifically. We applied a questionnaire to students in the library based on models of quality measurement SERVPERF and SERVQUAL and its variations such as SERVQUAL pondered and SERVPERF pondered . Through analysis based on concepts of reliability and validity of measuring instruments, it was found that the SERVPERF model is the instrument that most closely matches the dimensions of quality assessed in the library with customer satisfaction measured by the questionnaire. From there, the search results as measured by statistical techniques of analysis, indicated that the initial and final moments of truth of the cycle of service quality had the greatest influence on overall customer satisfaction with the library service

Humanização hospitalar, ambiente físico e relações assistenciais :a percepção de arquitetos especialistas

The creation of the Humanization Program of Hospital Care and the increasing number of academic works and journal articles that discuss more humane practices in the health care services express the emphasis given to the theme in Brazil. In these discussions, however, it is not usual to find reference to architecture as a relevant factor in the humanization of hospitals, even though it is known that the physical structure of the building may help the recovering of the patients; elements such as gardens, the use of colors and open spaces may soften the impact caused by the hospital routine on patients. Considering the contribution the architectural project may bring to the humanization of hospitals, the aim of this study was to verify how the architects perceive the hospital humanization process. Besides having searched for subsides in informal interviews with health professionals, in visits to hospitals and in related seminars, the study was based on semi-structured interviews with architects of Natal, Rio Grande do Norte, who are specialists in this kind of projects. The content analysis of the interviews showed that physical space and attendance are essential to the humanization process. Those professionals see two humanization tendencies: while private hospitals have the structural physical appearance considered as humanized, public hospitals emphasize the humanization in attendance, fact that illustrates the contradictions in Brazilian health system. The interviewees consider the post-occupancy evaluation of the building as a learning exercise that contributes to new projects, but surprisingly they do not mention the patients opinion as part of it. Two annoying facts have emerged from the interviews, as also seen in preliminary stages of the study: rare are the works that focus on the person-environment relationship, and the definition of humanized hospital environments is still broad and inaccurate. This suggests the need of new studies in order to better understand how the two factors shown in this study attendance and physical space interact towards a true hospital humanization

Avaliação da qualidade da assistência prestada pelo serviço de atendimento móvel de urgência do Rio Grande do Norte

O objetivo dessa investigação foi avaliar a qualidade da assistência prestada pelo Serviço de Atendimento Móvel de Urgência do estado do Rio Grande do Norte (SAMU 192 RN), na visão dos profissionais de saúde. Trata-se de estudo descritivo, avaliativo com delineamento longitudinal e abordagem quantitativa, desenvolvido em quatro etapas: construção de perfil dos atendimentos do SAMU 192 RN; revisão integrativa para levantamento dos indicadores de avaliação da qualidade da assistência em serviços pré-hospitalares móveis de urgência; construção e validação de conteúdo do instrumento e definição dos indicadores de estrutura e processo; e aplicação do instrumento aos profissionais de saúde para avaliação da qualidade da assistência. A populaçãoe amostra foram compostas por todos os profissionais do SAMU 192 RN, atuantes no período do estudo. A coleta de dados foi realizada entre janeiro e dezembro/2012. Participaram do estudo: 11 enfermeiros, 24 médicos, 56 técnicos de enfermagem e 88 condutores, totalizando 179 profissionais. O estudo foi aprovado (Parecer nº 437/2010 e CAAE: 0025.0.294.051-10) pelo Comitê de Ética em Pesquisa do Hospital Universitário Onofre Lopes da Universidade Federal do Rio Grande do Norte. Os dados foram analisados por meio de estatística descritiva e inferencial, nesta foram utilizados os programas Microsoft-Excel XP e SPSS 20.0, com uso do índice Kappa (K) e Índice de Validade de Conteúdo (IVC), considerando K ≥0,61 e IVC>0,80. Além disso, foi considerando nível de significância estatística de ρ-valor < 0,05. Entre os 179 profissionais, 100,0% tinham menos de 5 anos de tempo de serviço, 55,9% tinham menos de 5 anos de experiência na área de urgência, 88,3% referiram trabalhar na instituição porque gosta, 55,3% possuiam outro vínculo de trabalho, 54,3% com jornada semanal de 30 a 40 horas, 98,9% participaram de treinamento, 83,2% valorizam o treinamento em serviço, 87,2% têm boa frequência de participação no treinamento e 96,6% sentem necessidade de realizar mais treinamentos. Com relação à categorização dos itens em indicadores de estrutura ou de processo, os juízes determinaram para estrutura: estado de conservação das ambulâncias; estrutura física geral do serviço; conforto dentro da ambulância; disponibilidade de recursos materiais; segurança para o usuário dentro da ambulância; segurança para o profissional; educação permanente; segurança demonstrada pela equipe profissional; remuneração do profissional e a satisfação profissional. E para processo: acesso ao serviço; acolhimento; humanização; atendimento realizado; tempo resposta; privacidade ao usuário; orientações sobre o atendimento; relacionamento entre o profissional e usuário; oportunidade do usuário realizar reclamações e articulação multiprofissional. O instrumento quando submetido à validação de conteúdo constatou-se que as contribuições dos juízes permitiram melhorar/otimizar o instrumento de avaliação da qualidade da assistência pré-hospitalar móvel de urgência, uma vez que os índices Kappa e IVC foram considerados bons e ótimos e o conteúdo foi validado. Na avaliação da qualidade da assistência, constatou-se que a qualidade da assistência prestada pelo SAMU 192 RN está prejudicada nas dimensões estrutura, com relação à estrutura física, segurança dos pontos de apoio descentralizados, o conforto e o estado de conservação das ambulâncias. Já com relação aos indicadores de processo, os profissionais avaliaram todos positivamente. A avaliação da qualidade da assistência contribui para a busca de soluções dos problemas detectados, permite novas perspectivas e colabora para a consolidação do serviço.