Saúde do trabalhador no SUS: desafios e perspectivas frente à precarização do trabalho

Refletir sobre o campo saúde do(a) trabalhador(a) é o objetivo deste estudo. Busca-se sublinhar o significado das condições de trabalho para o ser humano do ponto de vista da saúde. A premissa não é quantificar, mas inferir que as condições de trabalho podem gerar danos à saúde, mas nem sempre apresentam de imediato a sua relação com o trabalho. São discutidas, a partir da abordagem qualitativa, três situações, as quais contemplam os trabalhos rural, informal e infantil e, como resultado, verifica-se a contradição da categoria trabalho, que, se por um lado é sinônimo de sociabilidade, por outro, contraditoriamente, constitui-se em mecanismo de exclusão social na medida em que é realizado sem o reconhecimento dos direitos sociais e trabalhistas. Verifica-se a expansão de formas de trabalho sem regulamentação, tais como o domiciliar e o familiar e os realizados em locais como a rua e o lixo. Encerra-se a reflexão com destaque ao papel do Sistema Único de Saúde (SUS) na assistência integral à saúde dos(as) trabalhadores(as) e ao desafio de atuar na perspectiva de prevenção e promoção da saúde do trabalhador de modo integrado e articulado aos demais órgãos públicos que atuam nesta área.

O princípio da precaução e a saúde no trabalho

O princípio da precaução (PP) é uma diretriz em saúde que vem ganhando relevo nos últimos 20 anos. Seu propósito é orientar medidas nas situações em que o conhecimento científico está ainda incompleto, denotando a incerteza. As condições de economia de mercado estimulam o uso de produtos e processos inovadores, dependentes do desenvolvimento científico e das novas descobertas em curso. Suas implicações para a saúde nem sempre estão inteiramente avaliadas, expondo a população trabalhadora às incertezas. O exame da literatura mostra que o uso do PP, embora sob consenso dos órgãos reguladores em diferentes países, ainda é objeto de intenso debate na comunidade científica. em coerência com os propósitos básicos, a proteção do meio ambiente conta com milhares de citações do seu emprego, em contraste com as poucas recomendações de uso para as exposições ocupacionais. Entre estas, o PP vem sendo entendido como pouco adequado ao âmbito dos especialistas e mais indicado à proteção de populações vulneráveis. Investigações históricas mostram que a noção de precaução foi quase sempre usada em sentido inverso, fazendo-se uso da dúvida para conter as possíveis melhorias de proteção no trabalho. Conclui-se que o uso do PP depende do pressuposto da incerteza científica, caracterizada pela noção de risco, em detrimento do determinismo da causa, condição ainda não superada nas relações de trabalho.

A doença como ponto de mutação :os processos de significação em mulheres portadores de lúpus eritematoso sistêmico

Systemic lupus erythematous (SLE) is a chronic and auto-immune disease that can affect several systems of one´s body, including the nervous system, causing several clinical evidences, which can put in risk the person´s life. Although the illness could manifest itself at any age or sex, studies indicate higher incidence among women. Its etiology points to the combination of genetic, hormonal and environmental factors. Due to the disease´s complexity, it is evident that it affects all the person´s life as a whole and not only its organic dimension. It is believed that the signification attributed to all the process of sickening influences its treatment, as well as the person´s capacity to cope with the difficulties and implicit profits involved in the process.In this study, eight women who were affected by SLE were interviewed, with the aim of examining carefully the processes of signification as well as the generation of meanings which permeate these women´s sickening processes. The analysis of their speeches evidences distinct forms of giving meaning to the process, regardless of the time of the diagnosis. The fact that the disease is incurable was shocking to all the participants, and it demanded changes in their lives, in order to detain a relative control of their condition. The majority of the participants were able to deal with these modifications, since strategies have been created to face the difficulties and thus to preserve their social life, without damaging their health. However, some of the participants did not obtain strenght to cope with the disease, eventually developing a depressive state. It is observed that not only SLE has innumerable ways of manifestation, but the experience of the illness is very subjective and dynamic. There are also several ways of expressing this experience, according to the implications in the social, cultural and economic context where the participants are inserted. This ratifies the necessity of a interdisciplinary approach to embrace SLE complexity. (310 words, 1.610 characters)

O Bullying sob o olhar dos educadores: um estudo em escolas da rede privada de Natal/RN

The school bullying involves all aggressive, intentional, repetitive attitudes, occurring without apparent motivation, adopted by one or more students against another (s) causing pain and anguish, and implemented within an unequal relationship of power, making possible the intimidation of the victim. Its expressions involve defamatory rumors, discrimination, theft or damage to property, harassment, threats, beatings, isolation, exclusion of a person or group, intimidation, intolerance and disrespect. In this study, we sought to identify the design educators have about the bullying, and are known by what means are aware of the problem, is involved when identifying cases of bullying and how to give this speech. This study used for data collection a questionnaire applied to 107 educators from 14 private schools in Natal / RN, who received statistical treatment in the program SPSS and the results analyzed in the light outside of a social and historical reference. Among the results, we found that 83% of the interviewed educators has at least heard about bullying, and the information about the problem are mainly the media, like television, newspapers and magazines. The educators said that the surname and physical attacks are more frequent outbreaks of violence among students and also the most common complaints when they look for help. The necessity for intervention when it identifies a case of bullying is present in 97.03% of respondents and 73.27% of educators are also called by students or school officials to remedy the situations of bullying among students. On the forms of intervention employed, the most common is the conversation and warning the students involved. It is suggested that the intensification of studies related to the subject and the development of actions and programs antibullying involving the school community (educators, parents, students, employees), in partnership with social segments like Tutelar Council and others related to the protection of children and adolescent

O médico diante da morte na urgência e emergência:reflexões sobre o ser médico

The literature pointed that the way which people deal with death have been changing along centuries, and nowadays what is realized it is that, each time more, the human being have difficulties to deal with death. Due to the fact that the main function of the physician is to save their patients lives; responsibility that is aggravated by the necessity of to take decisions quickly, once he need to deal with the unexpected situations of the urgency and emergency, many times these professional have to face of impotency and fail situations, when he lose a patient. The main goal of this study was to understand the experience of physicians that work in the urgency and emergency, in front of death. These questioning it justified by the fact of the physicians do not have, many times, a space to express their suffering and anguish about the issues related to death in their work routine, despite lifedeath question to be often present their everyday. It is still possible to verify in the literature, an appointment of the necessity of to include in the curriculum of Medicine courses, subjects that approach such questions. The method used was based on the existential-phenomenological perspective, using as instrument the participant observation, to the intent of understand the routine in the urgency and emergency context, and semi-structured interview. It was interviewed six physicians that work in the urgency and emergency of the most important hospital of public health system of Natal-RN. The results showed that the physicians reported pleasure in work in the urgency and emergency, despite of they presented stress and the difficulties that they deal with in the public system. Despite of the fact that the death to be considered as a phenomenon that make part of the physician s routine, sometimes, deals with these one is more difficult. Many times losses generate an impotency and guilty feeling, as well as questionings about their performance during the attempts to save lives. We verified, from this study, the importance of the existence of some kind of intervention in the emergency, in order to the physicians can elaborate the questions about death and die emerged in their work. We consider yet that this study corroborates and reiterates the discussions concerning the importance of this thematic to be approached in a more effective way, during the academic formation of these professionals, as well as, the importance of a larger investment from the part of Government in the urgency and emergency sector, in order to propitiate to these professionals a work that brings less harmful for their health

Terceiro setor em HIV/AIDS: mapeando o ativismo social na contemporaneidade

The struggle against AIDS is a kind of action in favor of life and the organized Brazilian civil society incorporated it in a meaningful dimension. This struggle matured the creation of non-governmental organizations (NGOs) and advanced with the discoveries about the disease. Since the very early 90 s, the consolidation of the partnership involving the movement anti-aids with State came up with a dilemma for the entities of civil society: are they just executors of governmental policies or do they take up the role of effective demands concerning public policies? Since then, activism against aids started to stand for execution of projects and one considers that the institutional way of anti-aids work has problems because it constructs a basic strategy to take off the political aspect of the third sector. The NGOs/aids consolidate the reconfiguration of capital and get far from street activities. This is important to be studied because the relationship between society and aids, contemporarily, can prevent them from accomplishing their agenda referring to political mobilization and collective resistance. This research started to be carried after some visits, previously arranged, to an institutional life support group called Grupo de Apoio à Vida-GAV, in Campina Grande. A semi-structured interview was applied to 31 users and to 6 technicians of the entity mentioned. One aimed at investigating the activist anti-aids practice, identifying the conceptions of activism and knowing how social actors assess those practices. Preliminary results indicate that one of the conceptions on activism among the interviewees refers to the execution of projects through partnership of NGOs and supporting institutions, governmental or non-governmental. Although this new conception on activism consolidates a non-political aspect, there are other ways of executing projects and participating actively, according to some users, such as: meetings, lectures and other sorts of events promoted by the group, which are also legitimate actions representing anti-aids activism at the present context

Avaliação do comportamento de argila ativada na presença de água destilada, soluções salinas e inibidores de hidratação catiônicos

The clay swelling is today one of the major problems during the well drilling. Nearly 50% of clays that constitute shale expand easily in the presence of water molecules. During the drilling of a geological formation containing swelling clays, when is feasible the use of water base fluids, it is necessary to apply clay inhibitors. This avoids the incorporation of the cutting to the drilling fluid which is responsible for the wall swelling and crumbling. The aim of this work was to evaluate the synergistic behavior that occurs when swelling clay inhibitors are associated to NaCl and KCl salts. Three swelling clay inhibitors samples, INIB A, INIB B and INIB C, were analyzed. Each inhibitor was characterized by the amount of chlorides and active matter content. For the water-clay interaction evaluation in the presence of various fluids, it was used the Capillary Suction Timer (CST, Fann) and Linear Swell Meter (LSM 2000, Fann). For better interpretation of results, a Design of Experiments (DOE, Umetrics MODDE 7.0 TM) through Result Surface Methodology (RSM) was employed, taking into account the type, the swelling inhibitors concentration and the contact time with the clay. The results showed different efficiencies among the inhibitors employed, and the salt-inhibitors mixtures were more efficient than those products alone. However, for field operation, other parameters should be taking into account, as operational cost, environmental requests and time of application for each product

Estudo da descelularização tecidual na produção de arcabouços biológicos para enxertos

The regeneration of bone defects with loss of substance remains as a therapeutic challenge in the medical field. There are basically four types of grafts: autologous, allogenic, xenogenic and isogenic. It is a consensus that autologous bone is the most suitable material for this purpose, but there are limitations to its use, especially the insufficient amount in the donor. Surveys show that the components of the extracellular matrix (ECM) are generally conserved between different species and are well tolerated even in xenogenic recipient. Thus, several studies have been conducted in the search for a replacement for autogenous bone scaffold using the technique of decellularization. To obtain these scaffolds, tissue must undergo a process of cell removal that causes minimal adverse effects on the composition, biological activity and mechanical integrity of the remaining extracellular matrix. There is not, however, a conformity among researchers about the best protocol for decellularization, since each of these treatments interfere differently in biochemical composition, ultrastructure and mechanical properties of the extracellular matrix, affecting the type of immune response to the material. Further down the arsenal of research involving decellularization bone tissue represents another obstacle to the arrival of a consensus protocol. The present study aimed to evaluate the influence of decellularization methods in the production of biological scaffolds from skeletal organs of mice, for their use for grafting. This was a laboratory study, sequenced in two distinct stages. In the first phase 12 mice hemi-calvariae were evaluated, divided into three groups (n = 4) and submitted to three different decellularization protocols (SDS [group I], trypsin [Group II], Triton X-100 [Group III]). We tried to identify the one that promotes most efficient cell removal, simultaneously to the best structural preservation of the bone extracellular matrix. Therefore, we performed quantitative analysis of the number of remaining cells and descriptive analysis of the scaffolds, made possible by microscopy. In the second stage, a study was conducted to evaluate the in vitro adhesion of mice bone marrow mesenchymal cells, cultured on these scaffolds, previously decellularized. Through manual counting of cells on scaffolds there was a complete cell removal in Group II, Group I showed a practically complete cell removal, and Group III displayed cell remains. The findings allowed us to observe a significant difference only between Groups II and III (p = 0.042). Better maintenance of the collagen structure was obtained with Triton X-100, whereas the decellularization with Trypsin was responsible for the major structural changes in the scaffolds. After culture, the adhesion of mesenchymal cells was only observed in specimens deccelularized with Trypsin. Due to the potential for total removal of cells and the ability to allow adherence of these, the protocol based on the use of Trypsin (Group II) was considered the most suitable for use in future experiments involving bone grafting decellularized scaffolds

O financiamento da política de assistência social no contexto do SUAS: tendências e particularidades do município do Natal-RN

This dissertation analyzes the configuration of the financing of Social assistance in the municipality of Natal-RN in the context of their particular expressions of the problematizando municipal budget against neoliberal adjustment macroeconomic policy. The current trends of "disclaimer" and "desfinanciamento" of social protection by the State, in the context of contemporary capitalism, bring strong implications for Social Security, especially through the redirection of public resources to the international capital, which highlights the overlapping economic interests on social needs. Whereas the changes and innovations occurring in connection with the financing of Social assistance policy, the goal of this documentary research is to identify the characteristics and trends of funding this policy in Natal-RN, from the secondary data analysis from the City of Natal, the Ministry of Social development and hunger and Portal of transparency. In the light of the theoretical, research now presented, shows trends of investment in Social assistance in the municipality of Natal-RN, in the period 2005 to 2009, which are: the tiny role membership (08) Social assistance in the municipal budget; the dispersion and fragmentation of the resources of Social assistance in other organs and/or secretariats of municipal administration; the participation of just 47.5% in expenditure from own organ Manager; the low percentage of implementation of resources foreseen in the Annual Budget Laws; the low allocation of resources in Municipal Social Assistance Fund (FUMAS), which contradicts the national policy for Social Assistance-PNAS/2004; and the predominance of government transfers in the composition of the resources of Social assistance in the municipality. The results of this research suggest that the process of financing of Social assistance in Natal is distant from the principles and guidelines pointed by PNAS/2004. In addition to the effort to understand the complexity of the financing of Social assistance in Natal, this work seeks to contribute to a political analysis in the direction of strengthening social control and the struggle for the expansion of investment in social spending

O sistema de garantia dos direitos da criança e do adolescente: análise da trajetória e do processo de resolubilidade dos casos de violência doméstica sexual em Recife PE (2007-2011)

This work discourses about the child and adolescent s Guaranty System of Rights (GSR), on the intervention in cases of juvenile domestic sexual violence, in Recife. The course (trajectory) is analyzed, where circulate cases of sexual violence, until its resolution, in (GSR). Actually, the violence represents a serious problem of public health. Was thought about the difficulties and the limits that make GSR become a full field of contradictions and challenges for the effectiveness of the children and adolescents rights. Therefore, it was verified the treatments that are developed by GSR, how this system is structured and articulated and how occurs the resolution of the sexual violence cases against children and adolescents. Proceedings of the quantitative and qualitative research were used, was done observation, directed interview and analysis of documents. Thus, the field research was the visits in these institutions: Restauração Hospital, Police Management of the Child and Adolescent (PMCA) three Guardianship Councils, Dom Helder Camara Center of Studies and Social Action (CENDHEC) and the Tribunal of Childhood and Adolescence. The research subjects were seven professionals of GSR. The theoretical discussion is guided in reflections about the children and youth rights, in the violence theme and in the construction and institutionalization process of GSR. In this experiment, was noticed there are many difficulties for working together the GSR, because many obstacles are found when we call the responsible institutions, besides some violence cases happen again. This system is not totally institutionalized and articulated, faces structural problems, material, poorly qualified professionals, underinvestment, low transfer of public resources, among other difficulties, causing many losses in the implementation of public policies that enforce secured rights by legislation

Comparação da cifose torácica e capacidade funcional de mulheres idosas com e sem osteoporose

A diminuição da densidade mineral óssea das vértebras, própria do processo de envelhecimento e que pode ser agravada pela osteoporose, determina uma diminuição da região anterior dos corpos vertebrais, resultando em compressão e colapso dessas vértebras, com maior estreitamento dos discos e espaços intervertebrais. Essas novas condições interferem no funcionamento normal de órgãos e sistemas do organismo. O objetivo foi avaliar o grau de cifose torácica e a capacidade funcional de mulheres idosas com e sem osteoporose. Foram avaliadas 30 idosas ativas fisicamente, sendo 20 sem osteoporose ( GSO: 65,1± 4,67 anos) e 10 idosas com osteoporose (GCO: 68,6± 6,46anos). Foram avaliados a medida da cifose torácica, teste de caminhada de seis minutos (TC6'), Timed Up and go (TUG) e força dos músculos respiratórios (PImáx e PEmáx). Os dados obtidos foram analisados utilizando o teste t de Student. O nível de significância utilizado foi de 5% (α£ 0,05). Houve diferença significativa entre os grupos sem (GSO) e com osteoporose (GCO) somente no TC6'(GSO: 426,63±46,36 m; GCO: 392,64±36,68 m , α =0,02). As outras variáveis analisadas não apresentaram diferença significativa (Cifose torácica: α = 0,17; TUG: α =0,49; PImax: α =0,45; PEmax: α =0,19). A osteoporose não influenciou o grau de cifose torácica, a força dos músculos respiratórios e mobilidade das idosas. Entretanto, o desempenho no TC6' foi influenciado negativamente pela osteoporose.

Anestesia para separação de gêmeos isquiópagos no período neonatal: relato de caso

JUSTIFICATIVA E OBJETIVOS: A separação de gêmeos unidos causa grande interesse devido à complexidade da anestesia e cirurgia, à raridade da patologia e às poucas chances de sobrevida. O objetivo desta descrição é o de contribuir para a literatura existente, relatando os desafios encontrados por nossa equipe no atendimento à cirurgia-anestesia de separação de gêmeos isquiópagos. RELATO do CASO: Pacientes gêmeos, nascidos a termo, de parto cesariano, pesando juntos 5.100 g, classificados como isquiópagus tetrapus. Duas equipes anestésico-cirúrgicas estavam presentes, sendo o procedimento anestésico esquematizado com aparelho de anestesia, cardioscópio, capnógrafo, oxímetro de pulso, termômetro elétrico, estetoscópio esofágico, todos em dobro. Realizou-se indução anestésica com halotano e fentanil, com os gêmeos em posição lateral e com rotação da cabeça em 45º para facilitar a intubação traqueal. Os recém-nascidos foram mantidos em ventilação controlada manualmente, utilizando o sistema de Rees-Baraka. A anestesia foi mantida com halotano, oxigênio e fentanil. Durante o per-operatório, foram encontrados órgãos abdominais duplos, com exceção do cólon, que era único. As bexigas e os ísquios estavam ligados. Ao final da cirurgia as duas crianças apresentavam-se com sinais vitais estáveis. Os gêmeos permaneceram na Unidade de Terapia Intensiva (UTI) Neonatal por quatro semanas e receberam alta em bom estado geral. CONCLUSÕES: Ressalta-se a importância do entrosamento da equipe, do estudo retrospectivo multidisciplinar, da monitorização adequada e acurada observação clínica; todos esses fatores contribuíram para a boa evolução e alta dos gêmeos.

Anestesia na Pré-Eclâmpsia

JUSTIFICATIVA E OBJETIVOS: Embora a pré-eclâmpsia acometa pequena porcentagem da população obstétrica, ela é responsável por considerável morbidade e mortalidade maternas. Assim sendo, o controle anestésico adequado deste grupo de pacientes ainda hoje é um desafio para os anestesiologistas. Este artigo tem a finalidade de apresentar a fisiopatologia, o tratamento farmacológico e as opções anestésicas para o parto normal ou cirúrgico, em pacientes com pré-eclâmpsia. CONTEÚDO: Estão descritos a classificação e terminologia da hipertensão arterial induzida pela gestação, a fisiopatologia, as alterações nos diversos órgãos e sistemas, os princípios gerais no controle das pacientes e as opções anestésicas para o parto normal e cirúrgico. CONCLUSÕES: O conhecimento, pelo anestesiologista, da fisiopatologia, das formas de tratamento e das características farmacológicas das drogas utilizadas para o controle da hipertensão arterial e a profilaxia das convulsões, assim como sua interação com as drogas e técnicas anestésicas, possibilita a redução das complicações peri-operatórias e da mortalidade materna e fetal.

Pós-graduação stricto sensu em anestesiologia: experiência de dez anos na UNESP

JUSTIFICATIVA E OBJETIVOS: O número de Programas de Pós-Graduação em Anestesiologia stricto sensu existente no país ainda é muito pequeno. Com a finalidade de incentivar a pós-graduação em Anestesiologia no Brasil, é apresentada a experiência acumulada em dez anos de atividades do programa da Universidade Estadual Paulista (UNESP). CONTEÚDO: O Programa de Pós-Graduação em Anestesiologia stricto sensu da UNESP foi credenciado pela CAPES, desde a sua criação em 1994, nos Cursos de Mestrado e Doutorado. O Programa é desenvolvido em três Áreas de Concentração: Risco e Proteção de Órgãos e Sistemas em Anestesia e Cirurgia; Qualidade e Segurança em Anestesiologia; e Modelos Clínicos e Experimentais em Terapia Antálgica, com as suas respectivas linhas de pesquisa, em número de 14. O número de alunos regulares do Programa é compatível com o número de orientadores (12), com proporção média de três alunos por orientador. Desde o seu início até setembro de 2004, ocorreram 45 Dissertações de Mestrado e 24 de Doutorado, perfazendo 69 defesas, a maioria com bolsas e financiamentos de Órgãos de Fomento à Pesquisa. Após a conclusão do doutorado, 65% dos alunos têm atividade de docência e pesquisa em instituições públicas e privadas do ensino universitário do país. A maioria das publicações do programa tem sido realizada em revistas nacionais com Qualis A, com menor número de publicações em revistas internacionais Qualis A ou B. O programa recebeu da CAPES o conceito 4,0 numa escala de 1 a 7, em suas três últimas avaliações. CONCLUSÕES: O programa tem se desenvolvido muito bem nos 10 anos de sua existência, alcançando os principais objetivos, como a formação de professores e pesquisadores na área de Anestesiologia para as instituições universitárias do país.

Os leucócitos e a resposta inflamatória na lesão de isquemia-reperfusão

Os eventos de isquemia-reperfusão desencadeiam uma resposta inflamatória sistêmica que pode levar a lesões celulares e até falência de órgãos. Tais repercussões são notadas no pós-operatório de cirurgias, em especial, com o uso de circulação extracorpórea. Sabe-se, atualmente, que os leucócitos exercem importante papel neste processo. Assim, este estudo aborda o papel dos leucócitos na fisiopatologia das lesões de isquemia-reperfusão e a ativação das cascatas inflamatórias por esse processo e procura auxiliar na compreensão destes mecanismos assim como trazer contribuições acerca das abordagens terapêuticas que possam atenuá-los. Esta revisão bibliográfica retrospectiva foi realizada a partir de documentos científicos publicados nos últimos dez anos, em português e inglês, indexados em bases de dados internacionais Medline e SciELO e de textos clássicos relacionados. Os descritores pesquisados foram: isquemia-reperfusão, leucócitos, resposta inflamatória, circulação extracorpórea, efeitos adversos e apoptose.