Indicators for Occupational Health Reference Centers: proposal of a system for monitoring health services

This research proposes a framework of indicators to monitor the activities of the Occupational Health Reference Centers (CEREST). CEREST are structural elements of the National Network of Comprehensive Attention to Workers' Health (RENAST) and are coordinated by the General Coordination of Occupational Health of the Ministry of Health (CGSAT). In order to build this framework, we first elaborated a list of indicators based on the norms that govern CEREST's responsibilities. As a strategy to build a participative approach, a Likert scale questionnaire was sent to 173 CEREST coordinators, who were asked to evaluate this preliminary list of indicators. After the return of the questionnaires (48,6%), the answers were analyzed, considering the CEREST scope (State or Regional), date of accreditation and location. Indicators with approval rate higher than 75% were included in the proposed framework. This instrument consisted in 12 indicators for State CEREST and 13 indicators for Regional CEREST. It is expected that the procedures proposed in this research and the framework itself might encourage the government to create a monitoring system for RENAST as well as for health services in general.Os Centros de Referência em Saúde do Trabalhador (CEREST) são eixos estruturantes da Rede Nacional de Atenção Integral à Saúde do Trabalhador (RENAST), coordenados pela Coordenação Geral de Saúde do Trabalhador (CGSAT) do Ministério da Saúde. O instrumento apresentado no artigo visa contribuir para o acompanhamento e a futura avaliação da implantação e implementação da RENAST. Com o objetivo de construir um sistema de indicadores para monitoramento dos CEREST, elaborou-se uma primeira listagem de indicadores com base nas determinações previstas pela Portaria GM/MS nº 2.437/2005. A listagem foi enviada a 173 coordenadores dos CEREST para avaliação, com base em uma escala do tipo Likert. Retornaram 48,6% das avaliações, cuja análise foi realizada globalmente e segundo a abrangência, a data de habilitação e a localização dos CEREST. Consideraram-se aprovados os indicadores com 75% ou mais de aceitação, resultando um instrumento final com 12 indicadores para os CEREST estaduais e 13 indicadores para os CEREST regionais. A descrição dos procedimentos para a construção do instrumento e sua formatação final poderá ser útil no estímulo à construção de indicadores de monitoramento/avaliação de serviços de saúde em geral

Proposition of an instrument with national indicators for monitoring CEREST

Made available in DSpace on 2011-05-04T12:36:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2009Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Os Centros de Referência em Saúde do Trabalhador (CEREST) são eixos estruturantes da Rede Nacional de Atenção Integral à Saúde do Trabalhador (RENAST), coordenados pela CGSAT (Coordenação Geral de Saúde do Trabalhador) do Ministério da Saúde. Com o objetivo de construir indicadores nacionais para monitoramento dos CEREST, elaborou-se uma primeira listagem de indicadores com base nas determinações previstas pela Portaria GM/MS nº 2.437/2005. A listagem foi enviada aos 173 coordenadores dos CEREST, habilitados até dezembro de 2008, para avaliação em uma escala do tipo Likert, a partir de critérios estabelecidos, conformando um modelo participativo de pesquisa. Retornaram 84 (48,55 por cento) avaliações cuja análise foi realizada globalmente e segundo a abrangência, data de habilitação e localização dos CEREST. Consideraram-se aprovados os indicadores com 75 por cento ou mais de aceitação, resultando em um instrumento final com 12 indicadores para os CEREST estaduais e 13 indicadores para os CEREST regionais, já que houve diferença significativa (p=0,003) entre os percentuais de avaliação considerando a abrangência dos Centros. O instrumento resultante visa contribuir para o acompanhamento e futura avaliação da implantação e implementação da RENAST, estratégia fundamental da Política Nacional de Saúde do Trabalhador do Ministério da Saúde.This research proposes a framework of indicators to monitor the activities of the Workers‟ Health Reference Centers (CEREST). CEREST are structural elements of the National Network of Integral Attention to Workers‟ Health (RENAST) and are coordinated by the General Coordination on Works‟ Health of the Ministry of Health (CGSAT). In order to build this framework, we first elaborated a list of indicators based on the regulation that defines the CEREST‟s responsibilities. As a strategy to build a participative approach, a Likert scale questionnaire was sent to 173 CEREST coordinators, who were asked to evaluate the preliminary list of indicators. After the return of the questionnaires (48,55%), the answers were analysed, considering the CEREST scope (State and Regional), date of accreditation and locality. Indicators with approval rate higher than 75% were included in the proposed framework. This instrument consisted in 12 indicators for State CEREST and 13 indicators for Regional CEREST, since there was a significant difference (p=0,003) between these two group. It is expected that the final framework might contribute to the monitoring and further evaluation of RENAST as well as the National Policies for Worker‟s Health

Cytological and genome size data analyzed in a phylogenetic frame : evolutionary implications concerning Sisyrinchium taxa (Iridaceae: Iridoideae)

Sisyrinchium is the largest genus of Iridaceae in the Americas and has the greatest amount of cytological data available. This study aimed at investigating how genomes evolved in this genus. Chromosome number, genome size and altitude from species of sect. Viperella were analyzed in a phylogenetic context. Meiotic and pollen analyses were performed to assess reproductive success of natural populations, especially from those polyploid taxa. Character optimizations revealed that the common ancestor of sect. Viperella was probably diploid (2n = 2x =18) with two subsequent polyplodization events. Total DNA content (2C) varied considerably across the phylogeny with larger genomes detected mainly in polyploid species. Altitude also varied across the phylogeny, however no significant relationship was found between DNA content changes and altitude in our data set. All taxa presented regular meiosis and pollen viability (> 87%), except for S. sp. nov. aff. alatum (22.70%), suggesting a recent hybrid origin. Chromosome number is mostly constant within this section and polyploidy is the only source of modification. Although 2C varied considerably among the 20 taxa investigated, the diversity observed cannot be attributed only to polyploidy events because large variations of DNA content were also observed among diploids

Cytological and genome size data analyzed in a phylogenetic frame : evolutionary implications concerning Sisyrinchium taxa (Iridaceae: Iridoideae)

Sisyrinchium is the largest genus of Iridaceae in the Americas and has the greatest amount of cytological data available. This study aimed at investigating how genomes evolved in this genus. Chromosome number, genome size and altitude from species of sect. Viperella were analyzed in a phylogenetic context. Meiotic and pollen analyses were performed to assess reproductive success of natural populations, especially from those polyploid taxa. Character optimizations revealed that the common ancestor of sect. Viperella was probably diploid (2n = 2x =18) with two subsequent polyplodization events. Total DNA content (2C) varied considerably across the phylogeny with larger genomes detected mainly in polyploid species. Altitude also varied across the phylogeny, however no significant relationship was found between DNA content changes and altitude in our data set. All taxa presented regular meiosis and pollen viability (> 87%), except for S. sp. nov. aff. alatum (22.70%), suggesting a recent hybrid origin. Chromosome number is mostly constant within this section and polyploidy is the only source of modification. Although 2C varied considerably among the 20 taxa investigated, the diversity observed cannot be attributed only to polyploidy events because large variations of DNA content were also observed among diploids

Cytological and genome size data analyzed in a phylogenetic frame: Evolutionary implications concerning Sisyrinchium taxa (Iridaceae: Iridoideae)

<div><p>Abstract Sisyrinchium is the largest genus of Iridaceae in the Americas and has the greatest amount of cytological data available. This study aimed at investigating how genomes evolved in this genus. Chromosome number, genome size and altitude from species of sect. Viperella were analyzed in a phylogenetic context. Meiotic and pollen analyses were performed to assess reproductive success of natural populations, especially from those polyploid taxa. Character optimizations revealed that the common ancestor of sect. Viperella was probably diploid (2n = 2x =18) with two subsequent polyplodization events. Total DNA content (2C) varied considerably across the phylogeny with larger genomes detected mainly in polyploid species. Altitude also varied across the phylogeny, however no significant relationship was found between DNA content changes and altitude in our data set. All taxa presented regular meiosis and pollen viability (> 87%), except for S. sp. nov. aff. alatum (22.70%), suggesting a recent hybrid origin. Chromosome number is mostly constant within this section and polyploidy is the only source of modification. Although 2C varied considerably among the 20 taxa investigated, the diversity observed cannot be attributed only to polyploidy events because large variations of DNA content were also observed among diploids.</p></div