A preceptoria na estratégia saúde da família: o olhar dos profissionais de saúde

The proposal of teaching-service integration from work experience brings a challenge to the professionals involved in health services: to combine their healthcare practice to the preparation of new professionals in accordance with the national health model. In Recife, the assistance network is known as school network, since it provides all its health equipment for Higher Education Institutions, in special for professionals who work as preceptors, making this activity an important component of the services network. The objective of the present study was to analyze preceptorship experience herein Multidisciplinary Residences in Health in the look of health professionals. This is a qualitative descriptive study, involving physicians, dentists, and nurses that have worked as preceptors for at least two years in multidisciplinary residency linked to two Higher Education Institutions. A semistructured interview was used as research instrument and data were processed by using the software Alceste 4.9. Results indicated four semantic classes which were divided into two axis. Axis 1, composed of class 4, and Axis 2, composed of classes 3, 2 and 1. Categorization considered the relation between classes. It was observed that in class 4 work overload is a dilemma for professional participation in preceptorship. This is noted by the words manage, time, patient, give, and complicated. However, it is also observed that the preceptorship involves positive learning and teaching actions, reinforced by the words say, explain, and discuss. Class 2 shows the preceptorship as an experience exchange, a positive moment that provides theoretical upgrade to the preceptor, associated to the professional practices performed by the binominal preceptor-student in health services and communities. In this perspective, everyone is benefited since preceptorship is structured according to dynamic aspects of knowledge, experienced in settings permeated by people´s health necessities. In class 3, potentialities of this practice are shown, and personal compromise is the main reason of acting as a preceptor in this network of education/attention, demonstrated in the words reason, formation, to like and professionals. Last, but not the least, class 1 suggests the importance of preceptorship and one of the strategies to create the National Politics of Humanization, from the teachingservice-community integration, observed in the words: arrives, university, fundamental, manner, partnership, service, and student. Besides, it rates perspectives and challenges for the improvement of the preceptorship in health services. Integrating teaching and service can enhance the proposals of changes concerning the healthcare model practiced in services, but this relation is still superficial. The preceptor is an actor in action, playing real life roles, and that is when he becomes essential to seek training with the profile defended in the proposed training of a professional who is capable of learning to learn

Avaliação da estrutura e processo de trabalho dos centros de atenção psicossocial

Objective: Evaluate the work structure and process in Psychos ocial Care Centers (CAPS) and the professionals profile, the satisfaction, conditions and work overload. Methods: Cross - sectional study conducted in five CAPS in Campina Grande city. The study sample consisted of five coordinators, 42 graduate professional s, 26 mid - level (technical and auxiliary nurses, and caregivers), and the medical records pertaining to 413 users followed up. Data were collected using validated questionnaires (CAPSUL - rating CAPS in southern Brazil) and adapted to the study, between July and October 2014. The questionnaires were double entered and submitted to validation in the sub - program “Validate Epi Info 3.5.4” , used along with the “SPSS 17.0” for processing the statistical analyzes. Measures of central tendency and dispersion were ap plied to the descriptive analyzes; “Fisher's” exact test to check the CAPS impact on hospital admissions and the “Bonferroni” adjusted to verify the diagnoses according to sex. 5% significance level was adopted. The study was approved by the Ethics Committ ee of the Rio Grande do Norte Federal University (UFRN), protocol 719.435, of 05.30.2014. Results: From the structure analysis were identified contextual factors that influenced the work process of CAPS professionals, such as: deficiencies with regard to h uman resources; forms of health professionals employment and qualifications; temporary contract existence. As to process dimension, it was found that the home visits performance by health professionals shows to be ineffective, given its insufficiency and i rregularity, which can be explained by the high demand, reduced staff and transportation lack. It was low coverage of items inherent to Therapeutic Individual Project, as the income generation program, insertion at work and home visit. The reference and co unter reference flow are still not satisfactorily organized. There was statistically significant difference for the diagnosis, with a predominance of mood disorders related to stress among women and those related to alcohol and other drugs among men (p <0. 05). There was an association between the degree of health professionals satisfaction and working conditions, overload and factors related to the content and working conditions, the security measures, comfort and CAPS appearance, contact between the teams and users, families treatment by the teams, temporary employment relationship. Conclusion: The data collected indicate the need for the CAPS organization through increased investments in the sector in order to enhance the infrastructure as potentiating el ement of practices with a view to changing the care model for mental health proposed by the Psychiatric Reform. It is hoped therefore that this research will contribute to better planning in CAPS unit management, with another tool to improve the dimensions involving the structure and the professional work process and improve this mental health care model.

Visita interprofissional da cardiologia: uma estratégia de educação interprofissional na área da saúde na Universidade Federal do Rio Grande do Norte

The interprofessional education still represents a great challenge for the health education. This paper aims at implementing the Interprofessional Cardiology Visit (VIC, acronym in Portuguese) as a teaching strategy for the interprofessional education in the undergraduate and graduate courses of UFRN (Federal University of Rio Grande do Norte, acronym in Portuguese). It is a prospective and exploratory study held from March 2013 to November 2014, in the cardiology department of HUOL (Portuguese acronym for Onofre Lopes University Hospital), including health professionals from the mentioned hospital (doctor, psycologist, physiotherapist, dentist, social assistant, nutritionist, pharmacist and nurse), undergraduate and graduate students from the health courses of UFRN. The study happened in three parts: interprofessional activity planning; Implementation of the activity “Interprofessional Cardiology Visit (VIC)”; and Activity evaluation, this last one was made through focus groups. The process of planning and implementation of the VIC was described during the implementation phase: 60 meetings in which 1324 participants discussed one specific patient per meeting. After each case presentation, an interprofessional discussion was held, pointing out each professional’s specific point of view towards improving the overall care of that discussed patient. From the focus group analysis, five categories emerged: Recognition of previous participations in interprofessional activities; Conceptual vision of interprofessional activities; Impacts of the VIC to the patient’s care; Contributions of VIC to the professional training; and Challenges of VIC continuation. The making and planning of VIC process has reached its goals, despite of some health professional’s participation not being systematic due to work overload, such as the nurses’ case, as well as schedule difficulties. The VIC was praised as a successful experience and considered an initiative with positive impact for improving the care of patients with heart diseases. It is clear, from analyzing the discourses, that the VIC is a strategy which positively impacts both the care and the teaching. However, some difficulties remain, such as the lack of human resources and the challenge of making it systematic.

Violência intrafamiliar contra a criança: intervenção de enfermeiros da estratégia saúde da família

Objetivou analisar a atuação dos enfermeiros da Estratégia Saúde da Família frente à violência intrafamiliar contra a criança, visando identificar ações de prevenção do problema. Pesquisa descritiva e exploratória de cunho qualitativo, cujos dados foram analisados conforme análise de conteúdo. Participaram do estudo 14 enfermeiros da Estratégia de Saúde da Família do município de Mossoró-RN. Dados coletados utilizando-se questionário semiestruturado. As ações de promoção à saúde são atividades educativas desenvolvidas após detecção de casos. O medo de represálias do agente agressor, a sobrecarga de trabalho, a falta de apoio dos gestores e a dificuldade para a materialização da interdisciplinaridade, intersetorialidade e integralidade da atenção foram mencionadas como barreiras ao enfrentamento do problema

Violência intrafamiliar contra a criança: intervenção de enfermeiros da estratégia saúde da família

Objetivou analisar a atuação dos enfermeiros da Estratégia Saúde da Família frente à violência intrafamiliar contra a criança, visando identificar ações de prevenção do problema. Pesquisa descritiva e exploratória de cunho qualitativo, cujos dados foram analisados conforme análise de conteúdo. Participaram do estudo 14 enfermeiros da Estratégia de Saúde da Família do município de Mossoró-RN. Dados coletados utilizando-se questionário semiestruturado. As ações de promoção à saúde são atividades educativas desenvolvidas após detecção de casos. O medo de represálias do agente agressor, a sobrecarga de trabalho, a falta de apoio dos gestores e a dificuldade para a materialização da interdisciplinaridade, intersetorialidade e integralidade da atenção foram mencionadas como barreiras ao enfrentamento do problema

CAREGIVING FOR A FAMILY MEMBER WITH HEAD AND NECK CANCER

Objective: To know the perception of informal caregivers regarding the care for a family member with head and neck cancer. Methods: Qualitative study conducted between March and May 2014 in the radiotherapy outpatient center of the Centro de Alta Complexidade em Oncologia – CACON (Oncology High Complexity Center) of the Hospital Universitário de Brasília – HUB (University Hospital of Brasília) using semi-structured interviews with nine caregivers about the experience of caring for family members. Data underwent Content Analysis and four units of meaning were identified: “Representation of cancer in the Family”, “The care as debt, individual reward or reconstruction of family ties”, “Repercussions of cancer on the caregiver’s personal life” and “Social support and network used by caregivers”. Results: Feelings of sadness and surprise at the moment of diagnosis were attributed to cancer, as well as the idea of punishment. The care was seen as personal satisfaction, accomplishment and opportunity for family rapprochement. Work overload and change in routine were altered functions. Religiosity, exchange of experience in the waiting room and institutional support appeared as coping strategies. Conclusion: The experience of caring for family members with head and neck cancer directly interferes in the lives of caregivers. Pointing out the institutional embracement as a strategy within the social network reinforces the importance of integrating the caregivers as a significant part of the health care plan developed by the health team.

Estou em Burnout

Dissertação de Mestrado apresentada no ISPA - Instituto Superior

Síndrome de Burnout y calidad de vida laboral en el personal asistencial de una institución de salud en Bogotá Colombia

El objetivo de este estudio fue describir el Síndrome de Burnout y la Calidad de Vida Laboral en el personal asistencial en una institución de salud de segundo nivel ubicada en Bogotá, y observar si existe relación entre estos constructos. Se aplicó el Inventario de Burnout de Maslach [MBI] y el Cuestionario de Calidad de Vida Profesional [CVP-35] a 62 participantes, pertenecientes a distintos campos del área de la salud. Los resultados indicaron que el 38,7% de los participantes presentaron severidad alta y moderada del síndrome, no obstante, con un nivel de realización personal alto, que unido a la fuerte motivación intrínseca encontrada, constituye un factor protector ante la alta carga laboral y el escaso apoyo directivo. El cansancio emocional correlacionó directamente con la carga laboral e inversamente con la motivación intrínseca. Se resalta la importancia de una eficiente gestión en las organizaciones de salud y la necesidad de una dirección más centrada en las personas a fin de garantizar su bienestar, lo que redundará en su calidad de vida y en la atención ofrecida.

Prevalencia del desorden músculo-esquelético asociado a la actividad docente en instituciones distritales de la localidad de Usme, Bogotá, D.C.

ANTECEDENTES: Los desórdenes musculo esqueléticos DME son una de las alteraciones más frecuentes y una de las principales causas de ausentismo laboral en el continente americano, y Unión Europea, generando graves repercusiones económicas a nivel empresarial, de la salud pública, y del empleado. Esto es debido a una sobrecarga laboral causada por los trabajos repetitivos, posturas mantenidas, y requerimientos de fuerza muscular, por lo que se hace importante identificarlos a través de distintos métodos ergonómicos con el objeto de generar programas de prevención que permitan la mitigación de los mismos. OBJETIVO: Determinar los síntomas músculo-esqueléticos y su relación con las condiciones de trabajo de los docentes de instituciones educativas distritales de la localidad de Usme, Bogotá, D. C. MATERIALES Y METODOS: Estudio de corte transversal, efectuado en 192 docentes que se evaluaran con el cuestionario Nórdico estandarizado de síntomas musculo esqueléticos y preguntas sociodemográficas de la encuesta de condiciones de trabajo y salud (ECTS) para caracterizar la población estudio. Para el análisis estadístico se realizó distribución de frecuencias y medidas de tendencia central y dispersión. La evaluación de las posibles asociaciones se realizó mediante la prueba de chi-cuadrado de Pearson, con intervalos de confianza del 95%, la prevalencia fue ajustada por género con los intervalos de confianza. RESULTADOS: El 57,8% de los participantes era de sexo femenino, el 41,7% tenían edades entre los 30 y 39 años de edad, el 82,8% de los encuestados manejaban grupos de estudiantes que oscilan entre los 20 a 60 estudiantes, del total de los encuestados el 42,7% (IC95%: 35.9-49.5) presentan un DME ya diagnosticado por un médico o servicio de salud. El 77,1% respondieron afirmativamente a la presencia de esta variable con un IC95%: de 70,3-82,8. En cuanto a la localización del dolor, se observó que la región del cuello con el 51.6% (IC 44.3-58.9) y región lumbar con el 49% (IC95%: 42.2-56.3) fueron las dos regiones anatómicas valoradas con mayor presencia de dolor. Se encontró asociación entre la edad y el dolor (chi-cuadrado: 6,858), el sexo y dolor (chi-cuadrado: 0.250) y el número de estudiantes con el dolor (chi-cuadrado: 2,179) CONCLUSIONES: los resultados obtenidos en el presente estudio confirman la relación existente entre la presencia de desórdenes músculo-esqueléticos (DME) y la actividad docente, pero se hace pertinente la realización de más estudios que permitan valorar los DME con el riesgo psicosocial, jornada laboral y tipo de asignatura que imparten los docentes en sus cátedras para este tipo de población.

Los profesionales de secundaria, como factores de riesgo en el síndrome de Burnout

Recibido 21 de julio de 2010 • Aceptado 31 de agosto de 2010 • Corregido 03 de octubre de 2010   Este artículo aborda el síndrome de Bournout, entendido como un trastorno de la adaptación ante el estrés crónico laboral que logra desencadenar síntomas físicos y psicológicos, los cuales dañan significativamente la ejecución profesional de los individuos que prestan servicios, en este particular, el trabajo de los docentes de secundaria, los cuales se describen como vulnerables por atender a adolescentes, quienes requieren mayor comunicación, atención y guía por las característica propias de esa etapa. Además se describen algunos factores que pueden incidir en el docente, desde una perspectiva individual como por ejemplo estrés, rol, edad, estado civil, entre otros. Asímismo factores laborales tales como baja implicación, sobre carga, burocracia, ambiente, consecuencias sobre el individuo y sobre la institución y medidas para prevenirlo.

Metal dealing at the origin of the Chordata phylum: The metallothionein system and metal overload response in Amphioxus.

Non-vertebrate chordates, specifically amphioxus, are considered of the utmost interest for gaining insight into the evolutionary trends, i.e. differentiation and specialization, of gene/protein systems. In this work, MTs (metallothioneins), the most important metal binding proteins, are characterized for the first time in the cephalochordate subphylum at both gene and protein level, together with the main features defining the amphioxus response to cadmium and copper overload. Two MT genes (BfMT1 and BfMT2) have been identified in a contiguous region of the genome, as well as several ARE (antioxidant response element) and MRE (metal response element) located upstream the transcribed region. Their corresponding cDNAs exhibit identical sequence in the two lancelet species (B. floridae and B. lanceolatum), BfMT2 cDNA resulting from an alternative splicing event. BfMT1 is a polyvalent metal binding peptide that coordinates any of the studied metal ions (Zn, Cd or Cu) rendering complexes stable enough to last in physiological environments, which is fully concordant with the constitutive expression of its gene, and therefore, with a metal homeostasis housekeeping role. On the contrary, BfMT2 exhibits a clear ability to coordinate Cd(II) ions, while it is absolutely unable to fold into stable Cu (I) complexes, even as mixed species. This identifies it as an essential detoxification agent, which is consequently only induced in emergency situations. The cephalochordate MTs are not directly related to vertebrate MTs, neither by gene structure, protein similarity nor metal-binding behavior of the encoded peptides. The closest relative is the echinoderm MT, which confirm proposed phylogenetic relationships between these two groups. The current findings support the existence in most organisms of two types of MTs as for their metal binding preferences, devoted to different biological functions: multivalent MTs for housekeeping roles, and specialized MTs that evolve either as Cd-thioneins or Cu-thioneins, according to the ecophysiological needs of each kind of organisms.

Temporal analysis of PI-3kinase and MAPK signal transduction during skeletal muscle overload

Skeletal muscles can adapt to increased mechanical forces (or loading) by increasing the size and strength of the muscle. Knowledge of the molecular mechanisms by which muscle responds to increased loading may lead to the discovery of novel treatment strategies for muscle wasting and frailty. The objective of this research was to examine the temporal associations between the activation of specific signaling pathway intermediates and their potential upstream regulator(s) in response to increased muscle loading. Previous work has demonstrated that focal adhesion kinase (FAK) activity is increased in overloaded hypertrophying skeletal muscle. Thus FAK is a candidate for transducing the loading stimulus in skeletal muscle, potentially by activating phosphatidylinositol 3-kinase (PI3K) and members of the mitogen-activated protein kinase (MAPK) family. However, it was unknown if muscle overload would result in activation of PI3K or the MAPKs. Thus, this work seeks to characterized the temporal response of (1) MAPK phosphorylation (including Erk 2, p38 MAPK and JNK), (2) PI3K activity, and (3) FAK tyrosine phosphorylation in response to 24 hours of compensatory overload in the rat soleus and plantaris muscles. In both muscles, overload resulted in transient Increases in the phosphorylation state of Erk2 and JNK, which peaked within the first hour of overload and returned to baseline thereafter. In contrast, p38 MAPK phosphorylation remained elevated throughout the entire 24-hour overload period. Moreover, overload increased PI3K activity only, in the plantaris and only at 12 hours. Moreover, 24 hours of overload induced a significant increase in total protein content in the plantaris but not the soleus. Thus an increase in total muscle protein content within the 24-hour loading period was observed only in muscle exhibiting increased PI3K activity. Surprisingly, FAK tyrosine phosphorylation was not increased during the overload period in either muscle, indicating that PI3K activation and increased MAPK phosphorylation were independent of increased FAK tyrosine phosphorylation. In summary, increased PI3K activity and sustained elevation of p38 MAPK phosphorylation were associated with muscle overload, identifying these pathways as potential mediators of the early hypertrophic response to skeletal muscle overload. This suggests that stimuli or mechanisms that activate these pathways may reduce/minimize muscle wasting and frailty. ^

Next-generation sequencing of iron-metabolism related genes in Portuguese patients with iron overload: novel pathogenic genetic variants

Objective: In Southern European countries up to one-third of the patients with hereditary hemochromatosis (HH) do not present the common HFE risk genotype. In order to investigate the molecular basis of these cases we have designed a gene panel for rapid and simultaneous analysis of 6 HH-related genes (HFE, TFR2, HJV, HAMP, SLC40A1 and FTL) by next-generation sequencing (NGS). Materials and Methods: Eighty-eight iron overload Portuguese patients, negative for the common HFE mutations, were analysed. A TruSeq Custom Amplicon kit (TSCA, by Illumina) was designed in order to generate 97 amplicons covering exons, intron/exon junctions and UTRs of the mentioned genes with a cumulative target sequence of 12115bp. Amplicons were sequenced in the MiSeq instrument (IIlumina) using 250bp paired-end reads. Sequences were aligned against human genome reference hg19 using alignment and variant caller algorithms in the MiSeq reporter software. Novel variants were validated by Sanger sequencing and their pathogenic significance were assessed by in silico studies. Results: We found a total of 55 different genetic variants. These include novel pathogenic missense and splicing variants (in HFE and TFR2), a very rare variant in IRE of FTL, a variant that originates a novel translation initiation codon in the HAMP gene, among others. Conclusion: The merging of TSCA methodology and NGS technology appears to be an appropriate tool for simultaneous and fast analysis of HH-related genes in a large number of samples. However, establishing the clinical relevance of NGS-detected variants for HH development remains a hard-working task, requiring further functional studies.

Construction Of A Manual Of Work Processes And Techniques From Centro De Dispensação De Medicamentos De Alto Custo (cedmac), Hospital De Clínicas, Unicamp.

The Centers for High Cost Medication (Centros de Medicação de Alto Custo, CEDMAC), Health Department, São Paulo were instituted by project in partnership with the Clinical Hospital of the Faculty of Medicine, USP, sponsored by the Foundation for Research Support of the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo, FAPESP) aimed at the formation of a statewide network for comprehensive care of patients referred for use of immunobiological agents in rheumatological diseases. The CEDMAC of Hospital de Clínicas, Universidade Estadual de Campinas (HC-Unicamp), implemented by the Division of Rheumatology, Faculty of Medical Sciences, identified the need for standardization of the multidisciplinary team conducts, in face of the specificity of care conducts, verifying the importance of describing, in manual format, their operational and technical processes. The aim of this study is to present the methodology applied to the elaboration of the CEDMAC/HC-Unicamp Manual as an institutional tool, with the aim of offering the best assistance and administrative quality. In the methodology for preparing the manuals at HC-Unicamp since 2008, the premise was to obtain a document that is participatory, multidisciplinary, focused on work processes integrated with institutional rules, with objective and didactic descriptions, in a standardized format and with electronic dissemination. The CEDMAC/HC-Unicamp Manual was elaborated in 10 months, with involvement of the entire multidisciplinary team, with 19 chapters on work processes and techniques, in addition to those concerning the organizational structure and its annexes. Published in the electronic portal of HC Manuals in July 2012 as an e-Book (ISBN 978-85-63274-17-5), the manual has been a valuable instrument in guiding professionals in healthcare, teaching and research activities.

Obesity Versus Osteoarthritis: Beyond The Mechanical Overload.

Obesity is currently considered a major public health problem in the world, already reaching epidemic characteristics, according to the World Health Organization. Excess weight is the major risk factor associated with various diseases, such as type 2 diabetes mellitus, hypertension, dyslipidemia and osteometabolic diseases, including osteoporosis and osteoarthritis. Osteoarthritis is the most prevalent rheumatic disease and the leading cause of physical disability and reduced quality of life of the population over 65 years. It mainly involves the joints that bear weight - knees and hips. However, along with the cases of obesity, its prevalence is increasing, and even in other joints, such as hands. Thus, it is assumed that the influence of obesity on the development of OA is beyond mechanical overload. The purpose of this review was to correlate the possible mechanisms underlying the genesis and development of these two diseases. Increased fat mass is directly proportional to excessive consumption of saturated fatty acids, responsible for systemic low-grade inflammation condition and insulin and leptin resistance. At high levels, leptin assumes inflammatory characteristics and acts in the articular cartilage, triggering the inflammatory process and changing homeostasis this tissue with consequent degeneration. We conclude that obesity is a risk factor for osteoarthritis and that physical activity and changes in diet composition can reverse the inflammatory and leptin resistance, reducing progression or preventing the onset of osteoarthritis.