A regula����o assistencial e a produ����o do cuidado: um arranjo potente para qualificar a aten����o

A produ����o do cuidado integral e a eq��idade s��o desafios na gest��o do SUS. Analisou-se um arranjo da gest��o municipal para a produ����o do cuidado implantado por meio da regula����o assistencial com o objetivo de enriquecer as reflex��es sobre o tema. Foi realizado estudo de caso em que os dados foram obtidos mediante observa����o, entrevistas, narrativas escritas e an��lise documental. Os sujeitos da pesquisa foram gestores e trabalhadores da Secretaria de Sa��de. Como resultado destaca-se um conceito de rede viva, produzida ativamente pela constru����o de rela����es entre os trabalhadores dos diferentes servi��os. Destacam-se as a����es de apoio ao cuidado produzido pelas equipes, com base na regula����o assistencial e na gest��o dos processos de trabalho. Os resultados foram expressivos na qualifica����o do cuidado, na redu����o das filas ��s especialidades e na satisfa����o dos profissionais. Como marca do processo, evidencia-se a necessidade de enriquecer, em ato, os saberes t��cnicos com as tecnologias leves e os saberes produzidos em movimentos ativos da gest��o para a produ����o do cuidado.

Gestores do SUS: apoio e resist��ncias �� Homeopatia

Este artigo apresenta parte dos resultados de pesquisa que investigou caracter��sticas do movimento de aproxima����o e afastamento entre homeopatas e m��dicos da Biomedicina, segundo o ponto de vista dos profissionais n��o homeopatas. Foram entrevistados 48 profissionais de sa��de (docentes, gestores e m��dicos que trabalham na rede publica). Toma-se para an��lise apenas os resultados das entrevistas com gestores. Foram usadas como refer��ncias as concep����es de: campo social e cient��fico de Bourdieu; racionalidades m��dicas de Madel Luz; arranjos tecnol��gicos do trabalho em sa��de de Mendes-Gon��alves e de identidade profissional de m��dico de Donnangelo e de Schraiber. Os resultados indicam que o apoio de gestores �� presen��a da Homeopatia no SUS relaciona-se �� percep����o da demanda social, �� defesa do direito de escolha dos usu��rios e �� constata����o de tratar-se de uma pr��tica m��dica que resgata a dimens��o humanista da medicina, contribuindo assim para a satisfa����o do usu��rio. As dificuldades e resist��ncias apontadas pelos gestores ressaltam que a falta de informa����es sobre os procedimentos homeop��ticos limita as possibilidades de utiliza����o da Homeopatia porque gera inseguran��a sobre esta medicina.

Satisfa����o no trabalho e capacidade para o trabalho entre docentes universit��rios

O objetivo principal deste estudo foi verificar a correla����o entre satisfa����o no trabalho e capacidade para o trabalho de docentes universit��rios. Este �� um estudo transversal de abordagem quantitativa. Dele fizeram parte 154 docentes, dos quais 50,6% eram homens e 49,4% eram mulheres e cuja idade m��dia era de 39,25 anos. A coleta de dados incluiu tr��s question��rios: 1. Dados sociodemogr��ficos e funcionais, 2. Escala de satisfa����o no trabalho; 3. ��ndice de capacidade para o Trabalho - ICT. A satisfa����o no trabalho e o ICT mostraram correla����o estatisticamente significativa (r=0,23, p<0,01). Conclui-se que o aumento da satisfa����o no trabalho pode melhorar a capacidade para o trabalho entre os docentes.

Acolhendo o acolhedor: o caminho mais curto para a humaniza����o da assist��ncia

INTRODU����O: o acolhimento tem se constitu��do num potente disparador de mudan��as. Este trabalho reflete a satisfa����o experimentada, resultante da atua����o num ambiente altamente sin��rgico e produtivo. OBJETIVO: implanta����o e implementa����o da assist��ncia materno-neonatal a partir do acolhimento ao cliente interno. M��TODO: realizou-se observa����o direta do cotidiano em setores distintos do Hospital Maternidade Interlagos (HMI) -SES/SP e seu Ambulat��rio. Foram realizadas entrevistas semi-estruturadas com dois profissionais da equipe multidisciplinar, as quais subsidiaram oficinas de humaniza����o no ambiente hospitalar. Os profissionais foram divididos em ��reas de exerc��cio profissional, da administrativa �� assistencial. RESULTADOS: ocorreu implanta����o do Comit�� de Acolhimento e Humaniza����o da Assist��ncia Materno-Neonatal no Hospital Maternidade Interlagos, com participa����o dos l��deres de acolhimento na ger��ncia institucional, provendo melhor desempenho individual e coletivo no exerc��cio laboral na Unidade Hospitalar

Dist��rbios ps��quicos menores e condi����es de trabalho em motoristas de caminh��o

OBJETIVO: Estimar a preval��ncia de dist��rbios ps��quicos menores e identificar estressores associados entre motoristas de caminh��o. M��TODOS: Estudo transversal conduzido com 460 motoristas de caminh��o de uma transportadora de cargas das regi��es Sul e Sudeste do Brasil, em 2007. Os trabalhadores preencheram question��rio com dados sociodemogr��ficos, estilos de vida e condi����es de trabalho. As vari��veis independentes foram condi����es de trabalho, incluindo estressores ocupacionais, satisfa����o e demanda-controle no trabalho. O desfecho avaliado foi a ocorr��ncia de dist��rbios ps��quicos menores. Foram realizadas an��lises de regress��o log��stica univariada e m��ltipla. RESULTADOS: A preval��ncia de dist��rbios ps��quicos menores foi de 6,1 por cento. Os estressores mais citados foram congestionamentos, controle de rastreamento e jornada extensa de trabalho. A alta demanda no trabalho, o baixo apoio social e a jornada extensa di��ria referidos pelos motoristas estiveram associados aos dist��rbios ps��quicos menores. CONCLUS��ES: O trabalho em jornadas extensas foi associado �� ocorr��ncia de dist��rbios ps��quicos menores, tanto na an��lise das condi����es gerais de trabalho quanto como fator referido como estressor pelos motoristas. A regulamenta����o da jornada de trabalho com limita����o de horas de trabalho di��rio ��, portanto, uma medida necess��ria para a redu����o da chance de desenvolvimento de dist��rbios ps��quicos menores em motoristas

Working at night and work ability among nursing personnel: when precarious employment makes the diVerence

Purpose To test the association between night work and work ability, and verify whether the type of contractual employment has any inXuence over this association. Methods Permanent workers (N = 642) and workers with precarious jobs (temporary contract or outsourced; N = 552) were interviewed and Wlled out questionnaires concerning work hours and work ability index. They were classiWed into: never worked at night, ex-night workers, currently working up to Wve nights, and currently working at least six nights/2-week span. Results After adjusting for socio-demography and work variables, current night work was signiWcantly associated with inadequate WAI (vs. day work with no experience in night work) only for precarious workers (OR 2.00, CI 1.01- 3.95 and OR 1.85, CI 1.09-3.13 for those working up to Wve nights and those working at least six nights in 2 weeks, respectively). Conclusions Unequal opportunities at work and little experience in night work among precarious workers may explain their higher susceptibility to night work

Work and excessive sleepiness among Brazilian evening high school students: effects on days off

Previous studies have revealed that students who work and study build up sleep deficits during the wrkweek, which can trigger a sleep rebound during days off. The objective of this study was to investigate the impact of working on sleepiness during days off working / non-working on sleepiness days off among high school students. The study population, aged 14-21 years, attended evening classes in S��o Paulo, Brazil. For the study, the students completed questionaires on living conditions, health, and work; wore actigraphs; and completed the Karolinska Sleepiness Scale (KSS). To predict sleepiness, a logistic regression analysis was performed. Excessive sleepiness was observed on the first day off among working students. Results suggest that working is a significant predictor for sleepiness and that two shifts of daily systematic activities, study and work, might lead to excessive daytime sleepiness on the first day off. Further, this observed excessive sleepiness may reflect the sleep debt accumulated during the workweek

Stress at work among electric utility workers

In the last decades there was an increase in stress at work and its effects on workers' health. These issues are still little studied in the electric utility sector. This study aims to evaluate factors associated with stress at work and to verify its associations with health status among workers of an electric company in S��o Paulo State, Brazil. A cross-sectional study was conducted with 474 subjects (87.5% of the eligible workers). Data were collected using self-reported questionnaires. A descriptive analysis, a multiple linear hierarchical regression analysis and a correlation analysis were performed. The majority of participants were males (91.1%) and the mean age was 37.5 yr. The mean score of stress level was 2.3 points (scale ranging from 1.0 to 5.0). Hierarchical multiple analyses showed that: regular practice of physical activities (p=0.025) and individual monthly income (p=0.002) were inversely associated with stress level; BMI was marginally associated with the stress level (p=0.074). The demographic characteristics were not associated with stress. Stress at work was significantly associated with physical and mental health status (p<0.001). To improve health of electric utility workers, actions are suggested to decrease stress by remuneration and an appropriate practice of physical activity aiming reduction of BMI

Effects of naps at work on the sleepiness of 12-hour night shift nursing personnel

Background and objective: The purpose of the present study was to evaluate the effects of a nap at work on the sleepiness of 12-hour, night-shift (registered and assistant) nursing personnel.Methods: Twelve nurses filled out daily logs, the Karolinska Sleepiness Scale (KS), and wore wrist actigraphs for two periods of four continuous days.Results: Mean nap duration during the night shifts was 138.3 (SD+39.8) minutes. The mean sleepiness level assessed by the KS score was lower, 3.3 (SD��1.6), when the nap was taken during the first span (00:01 - 03:00h) of the night shift, compared with 6.6 (SD��1.0) when there was no nap. The mean sleepiness level assessed by the KS score was also lower, 3.6 (SD��0.9), when the nap was taken during the second span (03:01 - 06:00h) of the night shift, compared with 7.0 (SD��1.1) when there was no nap. Thus, napping either during the first or second part of the night shift reduces sleepiness of 12-hour, night-shift nursing personnel. Moreover, the mean duration of the first sleep episode after night work was longer in those who did not nap than in those who did. Conclusions: The results of this study show that napping during the 12-hour, night-shift results in less sleepiness at work and less need for recovery sleep after work

Work start time and chronotype of indoor and outdoor daytime workers

Introdu����o e objetivo: A exposi����o �� luz natural tem efeitos relevantes no sistema de temporiza����o biol��gica. Pode-se supor que essa exposi����o poderia promover um ajuste melhor entre os ritmos biol��gicos e os hor��rios de in��cio de trabalho entre trabalhadores diurnos de ambientes externos. O objetivo deste estudo foi comparar a matutinidade/vespertinidade e a rela����o entre o hor��rio de trabalho real e o ideal em trabalhadores diurnos expostos a condi����es de ilumina����o distintas. M��todos: O estudo foi conduzido com dois grupos de trabalhadores (n=49) que residiam em uma ��rea rural e tinham condi����es sociais similares. Um grupo trabalhava em ambiente interno (n=20, idade m��dia 30,8 anos (21-50); desvio padr��o=9,8) e o outro grupo trabalhava em ambiente externo (n=29, idade m��dia 30,8 anos (17- 50); desvio padr��o=10,0). Os trabalhadores preencheram um question��rio de matutinidade/vespertinidade (MEQ). Foi realizada uma ANOVA de um fator com o intuito de comparar os escores do MEQ entre os dois grupos de trabalhadores. Resultados: Como esperado, o Grupo do Ambiente Externo (GAE) apresentou m��dia de escores mais elevada que o Grupo do Ambiente Interno (GAI), o que significa uma tend��ncia �� matutinidade (GAE: 58,4��7,9; GAI; 47,4��6,4), com signific��ncia estat��stica (F=26,22; p<0,001). De acordo com os dados relatados em rela����o aos hor��rios de trabalho, o GAE gostaria de atrasar seu hor��rio de trabalho em 31 minutos, em m��dia, enquanto que o GAI gostaria de atrasar em 96 minutos seu hor��rio de trabalho (F=7,71; p<0,01). Conclus��es: Os resultados desse estudo sugerem que a exposi����o �� luz natural pode promover um ajuste melhor aos hor��rios de in��cio de trabalho matutinos

Women's satisfaction with childbirth's experience in different models of care: a descriptive study

Com o objetivo de comparar a satisfa����o das mulheres com a experi��ncia do parto em tr��s modelos assistenciais, foi realizada pesquisa descritiva, com abordagem quantitativa, em dois hospitais p��blicos de S��o Paulo, um promovendo o modelo "T��pico" e o outro com um centro de parto intra-hospitalar (modelo "CPNIH") e um peri-hospitalar (modelo "CPNPH"). A amostra foi constitu��da por 90 pu��rperas, 30 de cada modelo. A compara����o entre os resultados referentes �� satisfa����o das mulheres com o atendimento prestado pelos profissionais de sa��de, com a qualidade da assist��ncia e os motivos de satisfa����o e insatisfa����o, com a indica����o ou recomenda����o dos servi��os recebidos, com a sensa����o de seguran��a no processo e com as sugest��es de melhorias, mostrou que o modelo CPHPH foi o melhor avaliado, vindo em seguida o CPNIH e por ��ltimo o T��pico. Conclui-se que o modelo peri-hospitalar de assist��ncia ao parto deveria receber maior apoio do SUS, por se constituir em servi��o em que as mulheres se mostram satisfeitas com a aten����o recebida

Decision theory applied to image quality control in radiology

Background: The present work aims at the application of the decision theory to radiological image quality control ( QC) in diagnostic routine. The main problem addressed in the framework of decision theory is to accept or reject a film lot of a radiology service. The probability of each decision of a determined set of variables was obtained from the selected films. Methods: Based on a radiology service routine a decision probability function was determined for each considered group of combination characteristics. These characteristics were related to the film quality control. These parameters were also framed in a set of 8 possibilities, resulting in 256 possible decision rules. In order to determine a general utility application function to access the decision risk, we have used a simple unique parameter called r. The payoffs chosen were: diagnostic's result (correct/incorrect), cost (high/low), and patient satisfaction (yes/no) resulting in eight possible combinations. Results: Depending on the value of r, more or less risk will occur related to the decision-making. The utility function was evaluated in order to determine the probability of a decision. The decision was made with patients or administrators' opinions from a radiology service center. Conclusion: The model is a formal quantitative approach to make a decision related to the medical imaging quality, providing an instrument to discriminate what is really necessary to accept or reject a film or a film lot. The method presented herein can help to access the risk level of an incorrect radiological diagnosis decision.

Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA Study

Introduction: Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries. Methods: The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses. Results: At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score. Conclusions: Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.